1. WINDSOR UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF ANATOMY
Lower limb
Dr. SREEKANTH THOTA

2. Muscle compartments in the thigh
In the thigh, there are medial (adductor), anterior (extensor), and posterior (flexor) compartments.

3. Anterior Compartment of the Thigh
Muscles: Sartorius, iliacus, psoas, pectineus, and quadriceps femoris
Blood supply: Femoral artery
Nerve supply: Femoral nerve

4. Anterior Thigh Muscles
Anterior thigh muscles are the flexors of the hip and extensors of the knee.

6. SARTORIUS shaft of tibia N. supply: Femoral nerve
Origin : A.S.I.S.
Insertion : Upper medial surface of
shaft of tibia
N. supply: Femoral nerve
Action :1.Flexion, abduction and
Lateral rotation of thigh at hip joint.
2. Flexion leg at knee joint

7. ILIACUS lesser trochanter of femur N. supply: Femoral nerve
Origin : Iliac fossa of hip bone
Insertion : Along with psoas into
lesser trochanter of femur
N. supply: Femoral nerve
Action :Flexes thigh on trunk
Eg.: Sitting up from lying down

8. PSOAS I.V.D.’S of T12 & L 1-L5 vertebrae trochanter of femur
Origin : Transverse process, bodies &
I.V.D.’S of T12 & L 1-L5 vertebrae
Insertion : Along with Iliacus into lesser
trochanter of femur
N. supply: Lumbar plexus
Action : Flexes thigh on trunk
Eg.: Sitting up from lying down
T12
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9. PECTINEUS Upper end of linea aspera of shaft of femur
Origin : Superior ramus of Pubis
Insertion :
Upper end of linea aspera of
shaft of femur
N. supply: Femoral nerve
Action :Flexion, adduction of thigh
at hip joint

10. QUADRICEPS FEMORIS RECTUS FEMORIS : Quadriceps tendon in to patella
Origin : Straight Head:
A.I.I.S
Reflected Head:
Ilium (Above Acetabulum)
Insertion :
Quadriceps tendon in to patella
Via lig.patellae in to tibial tubercle
N. supply: Femoral nerve
Action : Flexion of thigh at hip joint
Extension of Leg at Knee joint

11. Patellar ligament
The patellar ligament  is the central portion of the common tendon of the Quadriceps femoris, which is continued from the patella to the tuberosity of the tibia.

12. VASTUS LATERALIS patella via Lig.patellae in to tubercle of tibia
Origin : Upper end & shaft of femur
Insertion : Quadriceps tendon in to
patella via Lig.patellae in to
tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint

13. VASTUS MEDIALIS patella Via Lig.patellae in to tubercle of tibia
Origin : Upper end & shaft of femur
Insertion : Quadriceps tendon in to
patella Via Lig.patellae in to
tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee &
Stabilizes Patella

14. VASTUS INTERMEDIUS of shaft of femur patella Via Lig.patellae
Origin : Anterior & lateral surface
of shaft of femur
Insertion : Quadriceps tendon in to
patella Via Lig.patellae
in to tubercle of tibia
N. supply: Femoral nerve
Action : Extension of Leg at Knee joint

15. Summary of Ant compt of thigh Muscle Movements
Anterior compartment
Flexors of hip
Sartorius (also abducts and laterally rotates hip and flexes and medially rotates knee)
Iliopsoas
Pectineus (also adducts hip)
Extensor of knee
Quadriceps femoris
Rectus femoris (also flexes hip)
Vastus lateralis
Vastus intermedius
Vastus medialis (also stabilizes patella)

16. Patellar tendon reflex
Tapping the patellar ligament with a hammer elicits the patellar tendon reflex (knee jerk)
Tests the L2-L4 nerves
Diminution or absence—result from interruption of innervation of quadriceps .

17. Medial compartment of thigh
Muscles: Gracilis, adductor longus, adductor brevis, adductor magnus, and obturator externus.
Blood supply: Profunda femoris artery and obturator artery.
Nerve supply: Obturator nerve

19. GRACILIS ramus of Ischium part of shaft of tibia
Origin : Inferior ramus of Pubis &
ramus of Ischium
Insertion :Medial aspect of upper
part of shaft of tibia
N. supply: Obturator nerve
Action : Adduction of thigh at hip joint
Flexion of Leg at Knee joint

20. ADDUCTOR LONGUS to pubic tubercle shaft of femur
Origin : Body of Pubis, medial
to pubic tubercle
Insertion : Posterior surface of
shaft of femur
N. supply: Obturator nerve
Action : Adduction of thigh at
hip joint
Assists Lateral rotation

21. ADDUCTOR BREVIS shaft of femur N. supply: Obturator nerve hip joint
Origin : Inferior ramus of pubis
Insertion : Posterior surface of
shaft of femur
N. supply: Obturator nerve
Action : Adduction of thigh at
hip joint
Assists Lateral rotation

22. ADDUCTOR MAGNUS Ramus of ischium Ischial tuberosity shaft of femur
Origin : Inferior ramus of pubis
Ramus of ischium
Ischial tuberosity
(HAMSTRING PORTION)
Insertion :Posterior surface of
shaft of femur
Adductor tubercle of femur
N. supply: Obturator + Sciatic
nerves
Action : Adduction of thigh at hip
Assists Lateral rotation &
Extension of thigh at hip joint

23. Adductor Hiatus
The adductor hiatus is an opening or gap between the aponeurotic distal attachment of the adductor part of the adductor magnus and the tendinous distal attachment of the hamstring part.
The adductor hiatus transmits the femoral artery and vein from the adductor canal in the thigh to the popliteal fossa posterior to the knee.

24. OBTURATOR EXTERNUS Obturator membrane Pubic & Ischial rami
Origin : Outer surface of
Obturator membrane
Pubic & Ischial rami
Insertion :Medial surface of
greater trochanter
N. supply: Obturator nerve
Action : Lateral rotation of thigh at
hip joint

25. Obturator nerve
As the obturator nerve enters the thigh, it divides into two branches, an anterior branch and a posterior branch, which are separated by the adductor brevis muscle:
Anterior branch: adductor longus, gracilis, and adductor brevis muscles, and often contributes to the supply of the pectineus muscle, and cutaneous branches innervate the skin on the medial side of the thigh.
Posterior branch: obturator externus and adductor brevis muscles and the part of adductor magnus that attaches to the linea aspera

26. Obturator nerve

27. Obturator nerve

28. Deep artery of thigh (Profunda femoris artery)
Branches :lateral and medial circumflex femoral branches and four perforating branches.
Lateral circumflex femoral artery: 3 branches
1. Ascending branch
2. Descending branch
3. Transverse branch
Medial femoral circumflex artery: It takes part in the formation of the cruciate anastomosis.

30. Obturator Artery
The obturator artery is a branch of the internal iliac artery.
It gives off muscular branches and an articular branch to the hip joint.

31. Gluteal Region
The gluteal region lies posterolateral to the bony pelvis and proximal end of the femur.
Muscles in the region mainly abduct, extend, and laterally rotate the femur relative to the pelvic bone.

32. Ligaments of the Gluteal Region
Sacrotuberous Ligament: sacrotuberous ligament connects the back of the sacrum to the ischial tuberosity
Sacrospinous Ligament: sacrospinous ligament connects the back of the sacrum to the spine of the ischium.

34. Foramina of the Gluteal Region
Greater Sciatic Foramen:The greater sciatic foramen is formed by the greater sciatic notch of the hip bone and the sacrotuberous and sacrospinous ligaments.
It provides an exit from the pelvis into the gluteal region.

35. Lesser Sciatic Foramen:
Formed by the lesser sciatic notch of the hip bone and the sacrotuberous and sacrospinous ligaments.
It provides an entrance into the perineum from the gluteal region.

36. Nerves of the Gluteal Region
Sacral Plexus:
The sacral plexus lies on the posterior pelvic wall in front of the piriformis muscle .
It is formed from the anterior rami of the lumbar nerves and the anterior rami of the sacral nerves.

37. Posterior wall of the pelvis

38. Branches
Branches to the lower limb that leave the pelvis through the greater sciatic foramen .
1. Sciatic (L4, L5, S1, S2, S3): Articular branches to hip joint and muscular branches.
It is the largest nerve in the body and consists of the tibial and common peroneal nerves bound together with fascia.
Innervates all muscles in the posterior compartment of the thigh that flex the knee and all muscles that work the ankle and foot. llmusclein leg and foot

40. 2. Superior gluteal (L4, L5, S1) : Gluteus medius and gluteus minimus muscles
3. Inferior gluteal (L5, S1, S2): Gluteus maximus

41. 4. Nerve to obturator internus ( L5, S1, S2) : Obturator internus and superior gemellus muscles
5. Nerve to quadratus femoris (L4, L5, S1) : Quadratus femoris and inferior gemellus muscles
6. Posterior cutaneous nerve of the thigh(S2, S3) : Cutaneous branches to buttock and uppermost medial and posterior surfaces of thigh.

42. Branches to the pelvic muscles, pelvic viscera, and perineum:
1. Pudendal (S2, S3, S4) : Structures in perineum: sensory to genitalia; muscular branches to perineal muscles, external urethral sphincter, and external anal sphincter
2. Nerve to piriformis (S1, S2) : Piriformis muscle

44. Muscles of the Gluteal Region
Muscles of the gluteal region are mainly in two groups:
Superficial group of larger muscles:
Gluteus minimus, gluteus medius, and gluteus maximus-and tensor fasciae latae.
2. Deep group of small muscles:
Piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris.

45. Muscles of Gluteal Region (Superficial group)
Extensor of hip
Gluteus maximus (also helps in lateral rotation)
Abductors of hip (help in Medial rotation)
Gluteus medius
Gluteus minimus
Tensor Fascia lata (also stabilizes knee in extension)
Function of all 3
Contract to prevent sagging of unsupported side of hip during locomotion, enabling opposite foot to swing through (e.g., Trendelenburg test)

47. Gluteus maximus
Origin : Outer surface of ilium, sacrum, coccyx, sacrotuberous ligament
Insertion :Iliotibial tract and gluteal tuberosity of femur
N. supply:Inferior gluteal nerve
Action :Extends and laterally rotates hip joint

48. Gluteus medius Origin : Outer surface of ilium
Insertion :Lateral surface of greater trochanter of femur
N. supply: Superior gluteal nerve
Action :Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground

49. Gluteus minimus Origin : Outer surface of ilium
Insertion :Anterior surface of greater trochanter of femur
N. supply: Superior gluteal nerve
Action :Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground

50. Positive Trendelenburg's sign
If right gluteus medius and minimus muscles are paralyzed, the unsupported left side of the pelvis falls (sags) instead of rising; normally, the pelvis rises.

51. Tensor fasciae latae Origin : Iliac crest Insertion :Iliotibial tract
N. supply: Superior gluteal nerve
Action :Assists gluteus maximus in extending the knee joint

52. Deep group of small muscles
Lateral Rotators of the Hip.
Small Muscles
Mostly attach near or on greater trochanter
All but one innervated by named nerves specific to one or two of them
The exception is the obturator externus – innervated by posterior branch of obturator n.

53. PYRIFORMIS N. supply: 1st & 2nd Sacral nerves
Origin :
Anterior surface of sacrum; sacrotuberous ligament
Insertion : Upper border of
Greater trochanter of femur
N. supply: 1st & 2nd Sacral nerves
Action : Lateral rotation of thigh at
hip joint

54. OBTURATOR INTERNUS Obturator membrane Greater trochanter of femur
Origin : Inner surface of
Obturator membrane
Insertion : Upper border of
Greater trochanter of femur
N. supply: Nerve to obturator internus
Action : Lateral rotation of thigh
at hip joint

55. SUPERIOR GEMELLUS N. supply: Nerve to obturator internus
Origin : Spine of ischium
Insertion : Upper border of Greater trochanter of femur
N. supply: Nerve to obturator internus
Action : Lateral rotation of thigh at hip joint

57. INFERIOR GEMELLUS Greater trochanter of femur
Origin : Ischial tuberosity
Insertion : Upper border of
Greater trochanter of femur
N. supply: Nerve to quadratus femoris (L5, S1)
Action :
Lateral rotation of thigh at hip joint

58. QUADRATUS FEMORIS ischial tuberosity femur
Origin : Lateral border of
ischial tuberosity
Insertion : Quadrate tubercle of
femur
N. supply: Nerve to quadratus femoris (L5, S1)
Action :
Lateral rotation of thigh at hip joint

59. Nerves of the Gluteal Region
1. Sciatic Nerve: L4 to S3
2. Posterior Cutaneous Nerve of the Thigh
3. Superior Gluteal Nerve: L4 to S1
4. Inferior Gluteal Nerve: L5 to S2
5. Nerve to the Quadratus Femoris
6. Pudendal Nerve:S2 to S4
7. Nerve to Obturator Internus

61. Intramuscular injections
The safest place to inject is the upper outer quadrant of either gluteal region.

63. Arteries of the Gluteal Region
1. Superior Gluteal Artery
2. Inferior Gluteal Artery

65. Posterior compartment of thigh
Muscles:
Biceps femoris, semitendinosus, semimembranosus, and a small part of the adductor magnus (hamstring muscles)
Blood supply: Branches of the profunda femoris artery
Nerve supply: Sciatic Nerve

67. Biceps femoris
Origin : Long head: Ischial tuberosity
Short head: linea aspera, lateral supracondylar ridge of shaft of femur
Insertion : Head of fibula
N. supply: Long head: tibial portion of sciatic nerve
Short head: common peroneal portion of sciatic nerve
Action : Flexes and laterally rotates leg at knee joint; long head also extends thigh at hip joint

68. Semitendinosus N. supply: Tibial portion of sciatic nerve
Origin : Ischial tuberosity
Insertion : Upper part of medial surface of shaft of tibia
N. supply: Tibial portion of sciatic nerve
Action : Flexes and medially rotates leg at knee joint; extends thigh at hip joint

69. Semimembranosus N. supply: Tibial portion of sciatic nerve
Origin : Ischial tuberosity
Insertion : Medial condyle of tibia
N. supply: Tibial portion of sciatic nerve
Action : Flexes and medially rotates leg at knee joint; extends thigh at hip joint

70. Adductor magnus (hamstring portion)
Origin : Ischial tuberosity
Insertion : Adductor tubercle of femur
N. supply: Tibial portion of sciatic nerve
Action : Extends thigh at hip joint

71. Posterior compartment
Hamstrings
Together extend hip (except short head of biceps femoris) and flex knee (except add mag)
Biceps femoris- (laterally rotates knee)
Semitendinosus- (medially rotates knee)
Semimembranosus- (medially rotates knee)

72. Blood Supply of the Posterior Compartment of the Thigh
The four perforating branches of the profunda femoris artery provide a rich blood supply to this compartment