The Lower

Extremities
Lectured by Bien Eli Nillos, MD
1. Thigh muscle (Rectus femoris)
2. Thighbone (Femur)
3. Quadriceps tendon
4. Knee cap (Patella)
5. Knee cap tendon (Patellar tendon)
6. Knee cap tendon insertion (Tuberositas tibiae)
7. Shinbone (Tibia)
8. Splintbone (Fibula)
1. Thighbone (Femur)
2. Inner meniscus (medial meniscus)
3. Anterior cruciate ligament (ACL)
4. Shinbone (Tibia)
5. Outer meniscus (lateral meniscus)
 Surface Anatomy

► The skin of the thigh,

especially in the hollow
of the groin and on the
medial side, is thin,
smooth and elastic,
and contains few hairs
except on the
neighborhood of the
pubis.
 Surface Anatomy

► Laterally it is thicker
and the hairs are more
numerous.
► The skin over the
buttock is fairly thick
and is characterized by
its low sensibility and
slight vascularity
► An almost transverse fold—the gluteal fold—crosses
the lower part of the buttock
► practically bisects the lower margin of the Glutæus
maximus and is most evident during extension of the
hip-joint.
 Surface Anatomy

► The skin over the front

of the knee is covered
by thickened epidermis;
it is loose and thrown
into transverse wrinkles
when the leg is
extended.
 Surface Anatomy

► The skin of the leg is

thin, especially on the
medial side, and is
covered with numerous
large hairs.
► On the dorsum of the
foot the skin is thin,
loosely connected to
subjacent parts, and
contains few hairs
 Surface Anatomy

► The hip bones are largely

covered with muscles, so that
only at a few points do they
approach the surface.
► In front the anterior superior
iliac spine is easily recognized,
and in thin subjects stands out
as a prominence at the lateral
end of the fold of the groin
 Surface Anatomy

► Proceeding upward
and backward from
this process the
sinuously curved iliac
crest can be traced to
the posterior superior
iliac spine, the site of
which is indicated by a
slight depression
 Surface Anatomy

► Another part of the bony

pelvis which is accessible
to touch is the ischial
tuberosity, situated
beneath the Glutæus
maximus, and, when the
hip is flexed, easily felt,
as it is then uncovered by
muscle.
 Surface Anatomy

► Another part of the bony

pelvis which is accessible
to touch is the ischial
tuberosity, situated
beneath the Glutæus
maximus, and, when the
hip is flexed, easily felt,
as it is then uncovered by
muscle.
 Surface Anatomy

► The femur is enveloped

by muscles, so that in
fairly muscular subjects
the only accessible parts
are the lateral surface of
the greater trochanter
and the lower expanded
end of the bone.
 Surface Anatomy

► When the thigh is

flexed, and especially
if it be crossed over
the opposite one, the
trochanter produces
a blunt eminence on
the surface
 Surface Anatomy

► Theanterior surface of the

patella is subcutaneous.
When the knee is extended
the medial border of the
bone is a little more
prominent than the lateral,
and if the Quadriceps
femoris be relaxed the bone
can be moved from side to
side.
►  Aconsiderable portion of
the tibia is subcutaneous.
At the upper end the
condyles can be felt just
below the knee; the medial
condyle is broad and
smooth, and merges into the
subcutaneous surface of the
body below
►   Theonly
subcutaneous parts of
the fibula are the
head, the lower part of
the body, and the
lateral malleolus.
►   Theonly
subcutaneous parts of
the fibula are the
head, the lower part of
the body, and the
lateral malleolus.
► the longest and
largest bone
► responsible for
bearing the largest
percentage of body
weight during
normal weight-
bearing activities
► Femoral neck fractures
occur most commonly
after falls. Factors that
increase the risk of
injuries are related to
conditions that increase
the probability of falls
and those that decrease
the intrinsic ability of
the person to withstand
the trauma
Anterior Femoral Compartment
Muscles
► Superficial Fascia.—The superficial
fascia forms a continuous layer over
the whole of the thigh; it consists of
areolar tissue containing in its meshes
much fat, and may be separated into
two or more layers, between which are
found the superficial vessels and
nerves
► The superficial layer is continuous
above with the superficial fascia of the
abdomen.
► It is intimately adherent to the fascia
lata a little below the inguinal
ligament.
► It covers the fossa ovalis (saphenous
opening)
► Deep Fascia.—The deep fascia of the
thigh is named, from its great extent,
the fascia lata; it constitutes an
investment for the whole of this region
of the limb, but varies in thickness in
different parts.
► The fascia lata is attached, above and
behind, to the back of the sacrum and
coccyx; laterally, to the iliac crest; in front,
to the inguinal ligament, and to the
superior ramus of the pubis; and medially,
to the inferior ramus of the pubis, to the
inferior ramus and tuberosity of the
ischium, and to the lower border of the
sacrotuberous ligament.
► Laterally,the fascia lata receives the
greater part of the tendon of insertion
of the Glutæus maximus, and
becomes proportionately thickened.
The portion of the fascia lata attached
to the front part of the iliac crest, and
corresponding to the origin of the
Tensor fasciæ latæ, extends down the
lateral side of the thigh as two layers
► Thisband is
continued
downward, under
the name of the
iliotibial band
(tractus iliotibialis)
and is attached to
the lateral condyle
of the tibia.
 The Fossa Ovalis
► A large oval-shaped aperture in the
fascia lata at the upper and medial
part of the thigh, a little below the
medial end of the inguinal ligament
► It transmits the great saphenous vein,
and other, smaller vessels
► The superficial
portion of the
fascia lata is
the part on the
lateral side of
the fossa
ovalis
► The Sartorius - longest muscle in the body, is
narrow and ribbon-like; it arises by tendinous
fibers from the anterior superior iliac spine and
the upper half of the notch below it.
► It passes obliquely across the upper and anterior
part of the thigh, from the lateral to the medial
side of the limb, then descends vertically, as far
as the medial side of the knee, passing behind
the medial condyle of the femur to end in a
tendon.
► This curves obliquely forward
and expands into a broad
aponeurosis, which is inserted,
in front of the Gracilis and
Semitendinous, into the upper
part of the medial surface of
the body of the tibia, nearly as
far forward as the anterior
crest
► The Quadriceps femoris - Rectus femoris, Vastus
lateralis, Vastus medialis, Vastus intermedius
► Rectus femoris is situated in the middle of the
front of the thigh; it is fusiform in shape, inserted
into the base of the patella.
► Vastus lateralis (Vastus externus) is the
largest part of the Quadriceps femoris
► Vastus medialis (Vastus internus) arises from
the lower half of the intertrochanteric line, the
medial lip of the linea aspera, the upper part of
the medial supracondylar line, the tendons of
the Adductor longus and the Adductor magnus
and the medial intermuscular septum.
► Vastus intermedius (Crureus) arises from the
front and lateral surfaces of the body of the
femur in its upper two-thirds and from the lower
part of the lateral intermuscular septum
► The muscles of the ANTERIOR
COMPARTMENT are supplied by the
second, third, and fourth lumbar
nerves, through the femoral nerve.
► Sartorius flexes the leg upon the thigh
► Quadriceps femoris extends the leg
upon the thigh
 The Medial Femoral Muscles

► Gracilis - most superficial muscle on the medial side

of the thigh
► thin and flattened, broad above, narrow and tapering
below
► Pectineus- flat, quadrangular muscle,
situated at the anterior part of the
upper and medial aspect of the thigh
► Adductorlongus - most superficial of the three
Adductores, is a triangular muscle, lying in the
same plane as the Pectineus.
► Adductorbrevis - situated immediately
behind the two preceding muscles,
somewhat triangular in form.
► Adductor magnus - a large triangular muscle,
situated on the medial side of the thigh, arises
from a small part of the inferior ramus of the pubis,
from the inferior ramus of the ischium, and from
the outer margin of the inferior part of the
tuberosity of the ischium
► The three Adductores and the Gracilis
are supplied by the third and fourth
lumbar nerves through the obturator
nerve; the Adductor magnus receiving
an additional branch from the sacral
plexus through the sciatic. The
Pectineus is supplied by the second,
third, and fourth lumbar nerves
through the femoral nerve
► Pectineus and three Adductores
adduct the thigh powerfully
► They rotate the thigh outward,
assisting the external Rotators, and
when the limb has been abducted,
they draw it medialward, carrying the
thigh across that of the opposite side
The Gluteal Region
► Gluteus maximus.
► Gluteus medius.
► Gluteus minimus.
► Obturator internus.
► Gemellus superior.
► Gemellus inferior.
► Tensor fasciæ latæ.
► Quadratus femoris.
► Piriformis.
► Obturator externus
A. Bursa trochanterica
m. glutei maximi
B. M. gluteus maximus
C. M. biceps femoris
(caput longum)
D. M. semitendinosus
E. M.
semimembranosus
F. M. adductor magnus
G. M. gracilis
H. M. quadratus femoris
I. Bursa ischiadica m.
glutei maximi
► The Glutæus maximus is supplied by the fifth
lumbar and first and second sacra nerves
through the inferior gluteal nerve; the Glutæi
medius and minimus and the Tensor fasciæ
latæ by the fourth and fifth lumbar and first
sacral nerves through the superior gluteal; the
Piriformis is supplied by the first and second
sacral nerves; the Gemellus inferior and
Quadratus femoris by the last lumbar and first
sacral nerves; the Gemellus superior and
Obturator internus by the first, second, and
third sacral nerves, and the Obturator
externus by the third and fourth lumbar
nerves through the obturator.
Posterior Femoral Muscles
(Hamstring Muscles)
► Biceps femoris
(Biceps) is
situated on the
posterior and
lateral aspect of
the thigh
► It has two heads
of origin
Posterior Femoral Muscles
(Hamstring Muscles)
► Semitendinosus,
remarkable for
the great length
of its tendon of
insertion, is
situated at the
posterior and
medial aspect of
the thigh
Posterior Femoral Muscles
(Hamstring Muscles)
► Semimembranosu
s, so called from
its membranous
tendon of origin, is
situated at the
back and medial
side of the thigh
► The muscle
overlaps the
upper part of the
popliteal vessels.
► The muscles of this region are supplied
by the fourth and fifth lumbar and the
first, second, and third sacral nerves;
the nerve to the short head of the
Biceps femoris is derived from the
common peroneal, the other muscles
are supplied through the tibial nerve.
► Thigh: innervation by compartment

►"MAP OF Sciatic":
► Medial compartment: Obturator
► Anterior compartment: Femoral
► Posterior compartment: Sciatic
KNEE JOINT
► formerly
described as
a ginglymus
or hinge-joint
► consisting of
three
articulations
in one
 Articulations
► Two condyloid joints, one between each
condyle of the femur and the corresponding
meniscus and condyle of the tibia; and a
third between the patella and the femur
► The bones are connected together by the
following ligaments:
 The Articular Capsule.
 The Anterior Cruciate.
 The Ligamentum Patellæ.
 The Posterior Cruciate.
 The Oblique Popliteal.
 The Medial and Lateral Menisci.
 The Tibial Collateral.
 The Transverse.
 The Fibular Collateral.
 The Coronary.
► Bursæ.—The bursæ near the knee-joint are the
following: In front there are four bursæ: a large
one is interposed between the patella and the
skin, a small one between the upper part of the
tibia and the ligamentum patellæ, a third
between the lower part of the tuberosity of the
tibia and the skin, and a fourth between the
anterior surface of the lower part of the femur
and the deep surface of the Quadriceps
femoris, usually communicating with the knee-
joint.
► Laterally there are
four bursæ.
► Medially, there are
five bursæ
 Muscles of the
Anterior
Compartnment of the
Leg
► Tibialis anterior
(Tibialis anticus)
is situated on the
lateral side of the
tibia; it is thick
and fleshy
above, tendinous
below
► Thesemuscles are supplied by the fourth and fifth
lumbar and first sacral nerves through the deep
peroneal nerve.
► anterior muscles of leg
► "Tom's Hairy ANd Dirty Penis":
► T: Tibialis anterior
► H: extensor Hollicis longus
► AN: Anterior tibial Artery & deep fibular Nerve
► D: extensor Digitorum longus
► P: Peronius tertius
 Posterior Crural Muscles

► Gastrocnemius is the most superficial muscle, and

forms the greater part of the calf. It arises by two
heads, which are connected to the condyles of the
femur by strong, flat tendons.
► Soleus is a broad
flat muscle situated
immediately in front
of the
Gastrocnemius. It
arises by tendinous
fibers from the back
of the head of the
fibula, and from the
upper third of the
posterior surface of
the body of the
bone
► Plantarisis placed
between the
Gastrocnemius and
Soleus. It arises from
the lower part of the
lateral prolongation of
the linea aspera, and
from the oblique
popliteal ligament of
the knee-joint.
►"Stand on your Soles. Explosive
gas"
► Soleus vs. gastrocnemius muscle function

► You stand on soles of your shoes, so Soleus

is for posture.
► Gasoline is explosive, so Gastrocnemius is
for explosive movement.
► Popliteal fossa: muscles arrangement
► The two Semi's go together, Semimembranosus
and Semitendonosus.
► The Membranosus is Medial and since the two
semis go together, Semitendonosus is also medial.
► Therefore, Biceps Femoris has to be lateral.
► Of the semi's, to remember which one is
superficial: the Tendonosus is on Top.
Tarsal
► Tarsal bones are
seven in number,
viz., the
calcaneus, talus,
cuboid, navicular,
and the first,
second, and third
cuneiforms.
► “Tall
Californian Navy Medical Interns
Lay Cuties”
 Talus
 Calcaneus
 Navicular
 Medial cuneiform
 Intermediate cuneiform
 Lateral cuneifrom
 Cuboid
► “HerC#nt's Too Tight So Lubricate The
Penis” (Anticlockwise)
 Hamate
 Capate
 Trapezoid
 Trapezium
 Scaphoid
 Lunate
 Triquetral
 Pisiform
END
 Lab Exercise No. 3
► Trace the Branches of the Common Iliac
Artery (entire blood supply of the lower
extremities). You may present your answer in
a diagram properly labeling the branches
► What is a Femoral hernia? What causes it?
► What are the boundaries of the Femoral
Triangle? What are the contents of the
Femoral triangle?