Divisions of the lower extremity
Gluteal region, thigh (hip to knee), popliteal fossa (posterior aspect of knee), leg (knee to ankle), foot (dorsal and plantar aspects)
What are the 7 tarsals?
Talus, calcaneus, navicular, cuboid, medial, intermediate, and lateral cuneiforms
How many metatarsals?
5
How many phalanges?
14 (proximal, middle, distal); the hallux only has a proximal and distal
Parts of the femur
Head, neck, shaft with linea aspera, medial and lateral femoral condyles
Parts of the tibia
Medial and lateral tibial condyles, shaft, medial malleolus
Parts of the fibula
Head, shaft, lateral malleolus
Acetabulum
Part of the hip bone that articulates with the femoral head
What type of joint is the hip joint?
Ball and socket synovial joint
Flexion of the hip joint
Reduces the angle between the thigh and trunk anteriorly
Muscles that cross the hip joint anteriorly will be capable of what?
Hip flexion
Hip extension
Increases the angle between the thigh and trunk anteriorly
Muscles that cross the hip joint posteriorly will be capable of what?
Hip extension
Hip abduction
Draws the thigh away from the midline of the body
Muscles that cross the hip joint laterally will be capable of what?
Hip abduction
Hip adduction
Draws the thigh towards the midline of the body
Muscles that cross the hip joint medially will be capable of what?
Hip adduction
Medial rotation of the hip
Rotates the femur medially along its longitudinal axis
Muscles that cross anterior to the longitudinal axis of the femur will be capable of what?
Medial rotation of the hip
Lateral rotation of the hip
Rotates the femur laterally along its longitudinal axis
Muscles that cross posterior to the longitudinal axis of the femur will be capable of what?
Lateral rotation of the hip
What do the femoral condyles articulate with?
Tibial condyles
What type of joint is the knee joint?
Hinge synovial joint
What type of joint is the ankle/talocrural joint?
Hinge synovial joint
With what does the talus articulate to form the ankle joint?
Distal tibia and lateral malleolus of the fibula
What forms the subtalar joint?
The talus and calcaneus
Inversion of the foot
Causes the sole of the foot to face medially
Eversion of the foot
Causes the sole of the foot to face laterally
Muscles that cross the subtalar joint medially will be capable of what?
Inversion
Muscles that cross the subtalar joint laterally will be capable of what?
Eversion
Is there a greater range of inversion or eversion at the subtalar joint?
Inversion. The lateral malleolus restricts eversion
Metatarsophalangeal (MTP) joints
Synovial joints between the metatarsals and proximal phalanges
Flexion of the MTP joints
Draws toes toward the ground
Extension of the MTP joints
Draws toes away from ground
Abduction of the MTP joints
Draws the toes away from the second digit axis
Adduction of the MTP joints
Draws the toes towards the second digit axis
Interphalangeal (IP) joints
Synovial hinge joints between the phalanges
Proximal interphalangeal joints (PIPs)
Located between the proximal and middle phalanges
Distal interphalangeal joints (DIPs)
Located between the middle and distal phalanges
Does the hallux have a PIP or DIP?
No. Only a single IP joint
Superficial fascia of the lower extremity
Contains fat, cutaneous nerves, superficial veins, lymphatic vessels and lymph nodes
Deep fascia
Dense connective tissue, helps prevent muscles from bulging during contraction, aiding in pumping blood back to the heart
Fascia lata
Deep fascia of the thigh
What is the oval window in the fascia lata called?
Saphenous opening
Where is the saphenous opening?
Just inferior to the inguinal ligament
What passes through the saphenous opening?
Great saphenous vein and lymphatic vessels
Iliotibial tract (or band)
Lateral thickening of the fascia lata
What divides the thigh into the 3 compartments - anterior, posterior, medial?
3 intermuscular septa
Crural fascia
Deep fascia of the leg
Synovial tendon sheaths
Facilitate sliding of tendons as they pass under a retinaculum. Can become infected or inflamed
Compartment syndrome
Swelling within a compartment that can compromise blood flow and/or innervation to tissues in that space
How do you treat compartment syndrome
Fasciotomy
Perforating veins
Connect the superficial and deep veins. Contain valves that allow blood to flow from superficial to deep veins
Superficial veins of the lower extremity
Great and small saphenous veins
Great saphenous vein location
Anterior to medial malleolus. Ascends along medial aspect of leg and thigh. Enters saphenous opening and drains into the femoral vein
Saphenous cut down procedure
Procedure to access the great saphenous vein to administer fluids, meds, etc
What vein is sometimes used as a graft for coronary bypass surgery?
Great saphenous vein
Location of small saphenous vein
Arises from lateral side of foot. Passes posterior to lateral malleolus of ankle, enters popliteal fossa and drains into popliteal vein
Musculovenous pump
Contraction of muscles help pump blood in the veins towards the heart
Varicose veins
Occur when valves in perforating veins become incompetent, causing blood to pool in the superficial veins
Where does lymph from superficial tissues of the gluteal region drain?
Superficial inguinal nodes to the external iliac lymph nodes
Where does lymph from deep tissues of the gluteal region drain?
Superior and inferior gluteal lymph nodes to the internal iliac lymph nodes
Where do superficial lymphatic vessels accompanying the great saphenous vein drain to?
The superficial inguinal lymph nodes
Where do superficial lymphatic vessels accompanying the small saphenous vein drain to?
The popliteal lymph nodes to the deep inguinal lymph nodes
Where do deep lymphatic vessels accompanying the deep veins of the thigh, leg and foot drain to?
Deep inguinal lymph nodes
Where do the superficial and deep inguinal lymph nodes drain to?
External iliac lymph nodes
What nerves make up the lumbar plexus?
Ventral rami L1-L4. Iliohypogastric, ilioinguinal, genitofemoral, lateral cutaneous nerve of the thigh, obturator, and femoral nerves
Ventral ramus origin of the iliohypogastric nerve
L1
Somatic motor muscles of the iliohypogastric nerve
Abdominal muscles
Somatic sensory and sympathetics of the iliohypogastric nerve
Skin of inguinal region and superolateral gluteal region
Ventral ramus origin of the ilioinguinal nerve
L1
Somatic motor of the ilioinguinal nerve
Abdominal muscles
Somatic sensory and sympathetics of the ilioinguinal nerve
Skin of inguinal region, scrotum and labia majora and superomedial thigh
Ventral ramus origin of the genitofemoral nerve
L1-L2
Somatic motor of the genital branch of the genitofemoral nerve
Cremaster muscle
Somatic sensory and sympathetics of the genital branch of the genitofemoral nerve
Skin of the scrotum and labia majora
Somatic sensory and sympathetics of the femoral branch of the genitofemoral nerve
Skin of superomedial thigh
Ventral ramus origin of the lateral cutaneous nerve of the thigh
L2-L3
Somatic sensory and sympathetics of the lateral cutaneous nerve of the thigh
Skin of lateral thigh
Ventral ramus origin of the obturator nerve
L2-L4
Location of the obturator nerve
Medial to psoas major, lateral wall of pelvis, exits the pelvis via the obturator canal
Somatic motor of the obturator nerve
Medial compartment of the thigh
Somatic sensory and sympathetics of the obturator nerve
Skin of medial thigh
Ventral ramus origin of the femoral nerve
L2-L4
Location of the femoral nerve
Lateral to psoas major, passes deep to inguinal ligament
Somatic motor of the femoral nerve
Anterior compartment of the thigh
Somatic sensory and sympathetics of the femoral nerve
Skin of anteromedial thigh, leg, and foot
What nerves make up the sacral plexus?
Ventral rami L4-S4. Lumbosacral trunk, superior gluteal, inferior gluteal, sciatic, and pudendal nerves
Lumbosacral trunk
Ventral rami of L4-L5. Joins ventral rami S1-S4 as they emerge from the anterior sacral foramina (and through piriformis)
Ventral ramus origin of the superior gluteal nerve
L4-S1
Location of the superior gluteal nerve
Exits pelvis via greater sciatic foramen superior to piriformis
Somatic motor of the superior gluteal nerve
Gluteus medius, gluteus minimus, tensor fascia latae
Ventral ramus origin of inferior gluteal nerve
L5-S2
Location of inferior gluteal nerve
Exits pelvis via greater sciatic foramen inferior to piriformis
Somatic motor of inferior gluteal nerve
Gluteus maximus
Ventral ramus origin of the sciatic nerve
L4-S3. Largest nerve in the body
Location of the sciatic nerve
Exits pelvis via greater sciatic foramen inferior to the piriformis
Somatic motor of sciatic nerve
Posterior compartment of thigh, all compartments of leg and foot
Somatic sensory and sympathetics of the sciatic nerve
Skin of foot and most of leg
Ventral ramus origin of pudendal nerve
S2-S4
Location of pudendal nerve
Exits pelvis via greater sciatic foramen inferior to piriformis, courses around ischial spine, enters perineum via lesser sciatic foramen
Somatic motor of pudendal nerve
Muscles of the UG and anal triangles
Somatic sensory and sympathetics of the pudendal nerve
Skin of the UG and anal triangles