2. Dr. Banafshe Esmaeilzade, M.S., Ph.D.
lowerlimb
Dr. Banafshe Esmaeilzade, M.S., Ph.D.
Deptartment of Anatomy
Bushehr Univ. of Medical Sciences

3. Organization of the Lower Limb

4. Limb Development

5. Limb Rotation

6. Regional anatomy of the lower limb

7. Parts and regions of the lower limb
Gluteal region:between iliac crest superiorly and gluteal fold inferiorly
Thigh:between hip and knee
Knee:joint between leg and thigh
Leg:between knee and foot
Ankle
Foot

8. Anterior Region of Thigh
Superficial structures:

9. Cutaneous nerves: Femoral branch of jenitofemoral n. ilioinguinal n.
Lateral cutaneous n. of thigh
Anterior cutaneous n. of thigh
medial cutaneous n. of thigh

10. Key dermatomes* of the Lower Limb
umbilicus - T10
hip crease - L1
great toe - L4
5th toe - S1
*area of skin supplied by a dorsal nerve root

11. Cutaneous Nerve Innervation of the Lower Limb

12. Superficial arteries:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.

15. Superficial veins Superficial epigastric v.
Superficial circumflex iliac v.
Superficial External
pudendal v.
Superficial lateral femoral v.
Great saphenous v.

16. Superficial inguinal lymph nodes:
Horizontal group
Vertical group

17. Superior group: Inferior group: Superficial inguinal lymph nodes
Lies just distal to the inguinal ligament
Receive lymph from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs
Inferior group:
Lies vertical along the terminal great saphenous v.
Receives all superficial lymphatics of lower limb, except for those from the posterolateral part of calf
Efferent vessels drain into the deep inguinal ln. or external iliac ln.

18. Fascia of the Lower Limb
Gluteal Fascia Fascia Lata Crural Fascia

19. Fascial Compartments of the Thigh
anterior compartment
Fascia Lata
medial compartment
posterior compartment
Anterior compartment
Medial (adductor) compartment
Posterior compartment

20. Deep fascia – fascia lata
Iliotibial tract
Saphenous hiatus
falciform margin
cribriform fascia

21. Muscles of Hip and Thigh
Gluteals (posterior pelvis)
Extend thigh
Rotate thigh
Abducts thigh
Anterior Compartment Thigh
Flexes thigh at hip
Extends leg at knee
Medial/Adductor Compartment
Adducts thigh
Medially rotates thigh
Posterior Compartment Thigh
Extends thigh
Flexes leg

22. Anterior Compartment muscles of Thigh
Tensor fascia lata
O: iliac crest, A.S.I.S.
I: iliotibial tract
A: Flex thigh, abduct thigh, medial rotation of thigh
N. : Superior Gluteal n.

23. Sartorius
-O – ASIS
-I – superior part of medial surface of tibia
-A – flexes, abducts, and external rotates thigh
-N. Femoral n.

24. Iliopsoas
-O – sides of T12-L5 vertebrae, iliac crest & fossa
-I – lesser trochanter of femur, pectineal line
-A – flexing the thigh
-N- Femoral n.

25. Quadriceps Femoris
1) Vastus lateralis
2) Vastus medialis
3) Vastus intermedias
4) Rectus femoris
O: femur,
I: patellar ligament
A: Knee extension
_ N: Femoral n.
pg 299

26. Rectus femoris
O: A.I.I.S., margin acetabulum
I: patellar ligament
A: Knee extension, flexes thigh

27. Vastus lateralis
-O – greater trochanter and lateral lip of linea aspera of femur
Vastus medialis
-O – intertrochanteric line and medial lip of linea aspera of femur
Vastus intermedius
-O – anterior and lateral surfaces of body of femur
*Same for all 3
-I – base of patella
A – helps flex thigh

28. Femoral triangle
This triangle is bounded by: superiorly; the inguinal ligament (base)
laterally; the medial border of sartorius
Medially; the medial border of adductor longus
Inferiorly; the apex of the triangle is continuous with adductor canal.
The anterior wall is fascia lata
The posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to lateral side.

29. Contents of the femoral triangle
1. The femoral artery and its branches,the profunda femoris artery,The lateral and medial circumflex arteries,The deep external pudendal.
2. The femoral vein and its tributaries.
3. Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein.
4. The femoral nerve.
5. The femoral canal.

30. Adductor canal
Extends from apex of femoral triangle to adductor hiatus
Bounded by : laterally;vastus medialis
posteriorly; adductors longus and magmus,
anteriorly ;adductor lamina and sartorius
Contents – saphenous nerve, femoral a., femoral v., lymphatic vessels, and loose connective tissue

31. The adductor hiatus is a gap in the distal attachment of adductor magnus to the femur, which permits the femoral vessels to pass from the adductor canal downward into the popliteal space.

32. Femoral sheath
The femoral sheath is a funnel- shaped sheath , derived from transversalis fascia anteriorly and iliac fascia posteriorly. It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.

33. The femoral sheath is divided into three compartments by two fibrous septa. The femoral artery occupies the lateral compartment of the sheath. The femoral vein lies the middle compartment. The medial compartment is small, called the femoral canal.

34. The femoral canal
It is about 1.3cm long , and its upper opening is called the femoral ring .
The boundaries of the femoral ring are:, anteriorly; the inguinal ligamentthe
medially; lacunar ligament;
, posteriorly; the pecten of pubis laterally; the femoral vein, superiorly; covered by femoral septum.
The canal contains a little loose fatty tissue, a small lymph node, and some lymph vessels.

35. Femoral hernia
A femoral hernia is common in women than in men (possibly due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh.

36. Lacuna musculorum
Bounded by: anteriorly; lateral portion of inguinal ligament,
posterolaterally; ilium
Medially; iliopectinal arch
Contents: iliopsoas m, femoral n. and lateral femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Femoral n.
Iliopectinal arch

37. Lacuna vasorum
Bounded by: anteriorly,medial portion of inguinal ligament posteromedially, pectineal ligament medially,lacunar ligament ,
Posterolaterally,
iliopectinal arch Contents:
femoral sheath, femoral a. and v., genital branch of genitofemoral n. and lymphatic vessels, femoral ring
Femoral a.
Femoral v.
Femoral ring

38. Arteries of lower limb Femoral a.
This is the main artery of the lower limb and is directly continuous with the external iliac artery of the abdomen behind the inguinal ligament at the mid- inguinal point. It becomes the popliteal artery by passing through the adductor tendinous opening.

39. 2. Descending genicular a. 3. Deep external pudendal a.
Femoral a.
Principal branch: Deep femeral a.: arises from the posterolateral surface of the femoral artery about 4 cm below the inguinal ligament.
2. Descending genicular a.
3. Deep external pudendal a.
4. Superficial branches:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.

40. Profunda femoris Four perforating arteries Lateral circumflex artery
It arises from the profunda near its origin and runs laterally among the branches of the femoral nerve and then deep to rectus femoris. Here it divides into ascending, transverse, and descending branches.
Medial circumflex artery
arises either from the profunda near its origin or occasionally direct from
the femoral artery.
Four perforating arteries

41. Medial circumflex a.
Profunda femoral a.
Latral circumflex a.
Saphenous n.

42. Femoral nerve
It arises from the lumbar plexus in the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2cm below the inguinal ligament.
Muscular branche to: pectineus, sartorius, quadriceps femoris

43. Cutaneous nerve branches:
(1) Anterior cutaneous nerves of the thigh (medial and lateral).
(2) Saphenous nerve is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.

44. Femoral vein
This is the direct continuation of the popliteal vein. It begins at the adductor tendinous opening and accompanies the femoral artery to the inguinal ligament behind which it becomes the external iliac vein.
The femoral vein contains several valves.

45. Med. compartment
of the thigh

46. Cutaneous

47. Medial compartment

48. Medial compartment muscles
Adductor longus
Adductor brevis
Adductor magnus
Pectineus
Gracilis
pg 299

49. Pectineus
-O - Superior ramus of pubis
-I - Pectineal line of femur
-A – adducts and flexes thigh
N: Femoral, obturator

50. Innervation: Obturator nerve
Adductor Brevis
O - Inferior Pubic Ramus
I - Pectineal Line and Linea Aspera
A - adducts, flexes, and medially rotates femur
Gracillis
O - pubic Symphysis and inferior pubic ramus
I - medial surface of the tibia
A - adducts thigh, flexes medially and medially rotates thigh, flexes leg
Innervation: Obturator nerve

51. Adductor Longus O - med portion of the superior pubic ramus
I - linea aspera of femur
A - adducts, flexes, and medially rotates the femur
Innervation: Obturator nerve

52. Adductor Magnus
O - ischiopubic ramus and ischial tuberosity
I - linea aspera of the femur; the ischiocondylar part inserts on the adductor tubercle of the femur
A - adducts, flexes, and medially rotates the femur; extends the femur
Innervation: post div of Obturator nerve and tibial n.

53. Nerve and artery Obturator n. Accessory obturator n. Obturator a.
Medial circumflex a.
arises either from the profunda near its origin or occasionally direct from the femoral artery.

54. Nerve of Medial Fascial Compartment of the Thigh
Obturator Nerve
Nerve of Medial Fascial Compartment of the Thigh
The posterior division pierces the obturator externus and passes downward behind the adductor brevis and in front of the adductor magnus
The anterior division passes downward in front of the obturator externus.

55. Lumbar
plexus

56. Lumbar Plexus Femoral nerve Obturator nerve Lateral femoral cutaneous
Cutaneous branches
Thigh, leg, foot (e.g. saphenous nerve)
Motor branches
Anterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas)
Obturator nerve
Sensory
Skin medial thigh; hip, knee joints
Motor
Adductor muscles
Lateral femoral cutaneous
Skin lateral thigh
Genitofemoral
Skin scrotum, labia major, anterior thigh
Cremaster muscle