1. 1 ANATOMY OF LOWER LIMB DR. SIDRA HASAN

2. Introduction Lower limb is designed to support the body, its weight & it is mainly responsible for gait Organization of the Lower Limb Lower limb has four parts i)Hip (gluteal region) ii)Thigh iii)Knee iv)Leg v)Ankle vi)Foot 2

3. Superficial fascia of the lower Limb Fatty & Membranous layers Superficial nerves, superficial vessel, & superficial inguinal lymph nodes are present b/w these two layers. Nerves: Lat. Cut. N of thigh Med. Cut. N of thigh Intermed. Cut. N of thigh Femoral br. of Genitofemoral n Ilioinguinal n Branch from obturator n Patellar plexus Veins: Great Saphenous Vein Small Saphenous Vein 3

4. Superficial Inguinal Lymph Nodes Horizontal Group Vertical Group 4

5. Deep fascia of the lower limb Fascia Lata (deep fascia of the thigh) Crural Fascia (deep fascia of the leg) Iliotibial Tract Saphenous Opening 5

6. An opening or a gap in the deep fascia in the front of the thigh 4cm inferolateral to the pubic tubercle. The saphenous opening is covered by loose CT called CRIBRIFORM fascia. 6

7. Fascial Compartments of the Thigh Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur. Making Anterior posterior & Medial compartments. Having muscles, nerves & arteries. 7

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9. Muscles of the Anterior Fascial Compartments of the Thigh 9

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11. Muscles of the Anterior Fascial Compartments of the Thigh 11

12. Muscles of the Anterior Fascial Compartments of the Thigh Quadriceps Femoris 12

13. Muscles of the Anterior Fascial Compartments of the Thigh Quadriceps Femoris

14. Femoral Triangle A triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligament 14

15. BUNDARIES OF FEMORAL TRIANGLE Medially by adductor longus Laterally by medial Border of sartorius Base by inguinal ligament Apex : by meeting of medial & lateral border Roof: 1)Skin, 2)Superfacial fasia ( containing sup.inginal lymph nodes, femoral branch of genitofemoral N.,Ilioinguinal N. Branches, superficial branches of femoral arteries n veins &upper part of great saphanous vein 3) Deep fascia with saphanous opening and cribriform fascia Floor : medially by adductor longus and pectineus and laterally by psoas major and iliacus 15

16. CONTENTS OF TRIANGLE FEMORAL ARTERY &Its branches ( 6 branches) FEMORAL VEIN & its tributraies FEMORAL SHEATH encloses upper 4cm of femoral vessels. NERVES 1) FEMORAL Nerve 2) Nerve to pectineus 3) Femoral branch of genitofemoral nerve 4) Lateral cutaneous nerve of thigh 5) Deep inguinal lymph nodes 16

18. Blood Supply of the Anterior Fascial Compartments of the Thigh Femoral Artery main artery of lower limb Origin Continuation of Ext. Iliac artery below the inguinal ligament. Enters the thigh midway between the ant. Sup. Iliac spine & pubic Symphysis Termination Ends at the opening in the adductor magnus muscle by entering the popliteal fossa as popliteal artery Branches Superficial: Sup. Ext. Pudendal Sup. Epigastric Sup circumflex iliac Deep: Profunda femoris Deep Ext. pudendal Descending genicular Lat. Cir femoral Med. Cir. Femoral 4 perforating a 18

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20. Femoral Nerve Largest branch of lumbar plexus 20

21. Femoral Sheath Inferior prolongation of transversalis & iliopsoas fascia 21

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24. The femoral sheath does not enclose the femoral nerve 24

25. The adductor (subsartorial) canal An intermuscular cleft situated on the medial aspect of the middle 3 rd of the thigh Contents of adductor canal Femoral artery & vein Deep lymph vessels Saphenous nerve Nerve to vastus med Obturator nerve 25

26. Boundaries of adductor canal ANTERIOR WALL : Vastus medialis POSTERIOR WALL or floor : Adductor longus above &adductor magnus below MEDIAL WALL OR roof :strong fibrous membrane joining ant. &post. Walls.. Its overlapped by sartorious. >SUBSARTORIAL PLEXUS: LIES ON FIBROUS ROOF Formed by branches from med. Cut.nerve of thigh,the saphanous nerve and ant. Div. of obturator nerve. It supplies the overlying fascia lata &the neibouring skin. 26

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31. POPLITEAL FOSSA POPLITEAL FOSSA is a diamond shaped depression lying behind the knee joint.. The lower part of femur & upper part of tibia. BOUNDARIES OF FOSSA SUPEROLATERAL : BICEPS FEMORIS SUPEROMEDIAL : SEMITENDINOSIS supplemented by the gracilis,the sartorious, the adductor magnus INFEROLATERAL :LAT. Head of gastrocnemius INFEROMEDIAL : MED. Head of gastrocnemius 31

32. ROOF : Formed by deep fascia (popliteal fascia) The superfascial fascia over roof contains 1) Short saohanous vein 2)Three cutaneous nerves. Terminal part of post. Cutaneous nerve of thigh.peroneal (sural) communicating nerve FLOOR: 1) POPLITEAL Surface of femur 2)capsule of knee joint &oblique popliteal ligament 3)strong popliteal fascia covering popliteus muscle 32

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34. Contents Popliteal artery n its branches Popliteal vein & its tributries TIBIAL nerve n its branches Common peroneal n branches Post. Cutaneous n of thigh Genicular branch of obturator nerve Popliteal lymph nodes fat 34

35. Femoral artery & vein Catherization Varicose veins Veinous cut down Saphenous vein in coronary bypass surgery Femoral hernia Clinical Notes 35

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37. Interosseous membrane Binds tibia & fibula together &provide attachments for neighbouring muscles. SUPERIOR EXTENSOR RETINACULUM ATTACHMENTS: MEDIALLY: Lower part of ant. Border of tibia LATERALLY:Lower part of ant. Border of fibula 37

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