1. Lower Limb Anatomy

2. Learning Objectives Clinical Anatomy and Imaging Major bony features
Major muscles/muscle groups
Landmark tendons
Major neurovascular structures at key locations
Borders and major contents of the axilla, cubital fossa, anatomical snuffbox, carpal tunnel, femoral triangle, popliteal fossa, tarsal tunnel

6. Indecent Ian Gets Laid On Fridays Luckily
Ilio-inguinal, ilio-hypogastric, genito-femoral, lateral cut., obturator, femoral, lumbosacral trunk

8. Muscles – Gluteus maximus, medius, minimus, Piriformis, gemellus superior and inferior, quadratus femoris, obturator internus
Superior gluteal artery – glutes
Inferior gluteal artery – the rest
Superior gluteal nerve (L4,5,S1) – glute med and min
Inferior gluteal nerve (L5,S1,S2) – glute max
Nerve to quad fem (L5,S1) – quad fem, gem inf
Nerve to obturator internus (L5, S1) – obturator internus, gem sup
Piriformis gets branches from L5,S1,S2

10. Injections 2 options Upper outer to avoid sciatic
Vertical line from peak of iliac crest
2 options
Line from PSIS to greater trochanter
Horizontal line midway from iliac crest to ischial tuberosity
Upper outer to avoid sciatic

11. Hip Joint Type - Ball and Socket
Articular surfaces – femoral head, acetabulum
Ligaments – iliofemoral, pubofemoral, ischiofemoral, transverse acetabulum, ligamentum teres
Bursa – iliopsoas, trochanteric, gluteus medius, ischiogluteal
Vascular – capsular retinacula vessels (medial and lateral circumflex), artery of ligamentum teres, nutrient artery
Nerve – obturator, femoral, sciatic
Movements – flexion, extension, abduction,
adduction, rotation (medial, lateral)

12. Hip problems Elderly lady, shortened and externally rotated leg
Fractured NOF
Avascular necrosis
Poor blood supply
Sub-capital, intracapsular
Head on collision in a car, loss of sensation in foot
Posterior dislocation compressing sciatic nerve

13. Femoral Triangle
Borders – Inguinal ligament, medial margin of Sartorius, medial margin of adductor longus.
Floor – pectinues, adductor longus, iliopsoas
Contents
Nerve
Artery (within 1.5cm of mid-inguinal)
Vein
Y-fronts
Mid-inguinal point – ASIS to pubic tubercle

14. Anterior compartment of the Thigh
Muscles – Iliacus, Psoas, Sartorius, Rectus femoris, Vastus lateralis, intermedius and medialis (rectus and vasti = quadriceps femoris)
Femoral nerve L2-4 (Iliopsoas L1-3)
Knee extension, hip flexion
Femoral artery and vein

15. Medial Compartment of Thigh
Muscles – Obturator externus, Pectineus, Gracilis, Adductor magnus, brevis, longus
Nerves – Obturator nerve L2-4
Blood supply
Adduction
Adductors medially rotate at hip
Obturator laterally rotates at hip
Gracilis and pectineus flex

16. Posterior compartment of thigh
Muscles – SemiMembranosus (medial), semiTendinosus (on top), biceps femoris
Sciatic nerve (L5-S2)
Blood supply
Flex at knee, extend at hip, rotation

17. Knee Joint Type – Synovial hinge joint
Articulation – femur, tibia, patella
Ligaments
Intracapsular - Cruciates, meniscofemoral
Extra – patella, collaterals, oblique, arcuate, popliteal
Movements – flexion, extension
Blood – genicular anastomosis
Nerves – femoral, obturator, sciatic
Extras – Menisci, bursae (pre-, infra-, suprapatellar)

18. Knee Locking mechanism Unhappy Triad from lateral blow
Inferior aspect of femoral condyles are large and flat  increased surface area + therefore stability
Femur medially rotates in extension which tightens ligaments
Centre of gravity anterior to knee, keeping joint locked
Popliteus laterally rotates the femur, unlocking the joint
Unhappy Triad from lateral blow
ACL, MCL, medial meniscus
ACL – prevents anterior movement of tibia on femur
PCL – prevents posterior movement of tibia on femur

19. Popliteal Fossa Borders Contents Semimembranosus Biceps femoris
Medial and lateral head of gastrocnemius
Contents
Medial to lateral – Popliteal artery, popliteal vein, tibial nerve, common fibular nerve

20. Posterior compartment of the leg
Gastrocnemius, Soleus
Popliteus, Tibialis posterior, flexor digitorum longus, flexor hallucis longus,
Posterior tibial artery
Tibial nerve
Plantar flexion of foot and toes

21. Anterior Compartment of the Leg
Muscles – Tibialis anterior, extensor digitorum longus, extensor halluces longus, fibularis tertius
Deep fibular nerve (L4, L5, S1)
Anterior tibial artery (runs between tibial tuberosity and fibular head)
Dorsiflexion of foot and toes, tibialis inverts

22. Lateral compartment of the leg
Muscles – Fibularis longus, fibularis brevis
Superficial fibular nerve (L5, S1, S2)
Fibular artery
Eversion of the foot, longus helps plantarflex
Injury to lateral leg
What nerve will be injured and what will be the presentation?
Common fibular nerve, foot drop

23. Tarsal Tunnel – Tom, Dick And Very Nervous Harry
Roof - Flexor retinaculum; Floor - medial surfaces of talus and calcaneus

24. Foot Tiger Cubs Need MILC Talus Calcaneus Navicular Medial cuneiform
Intermediate cuneiform
Lateral cuneiform
Cuboid

25. Venous drainage Great Saphenous vein Small Saphenous vein
Medial foot from dorsal venous arch
Small Saphenous vein
Lateral foot from dorsal venous arch, superficial posterior leg, joins popliteal vein in fossa
Popliteal vein becomes femoral vein
Femoral triangle
External Iliac veins
Great Saphenous vein
Medial foot from dorsal venous arch
Small Saphenous vein
Lateral foot from dorsal venous arch, superficial posterior leg, joins popliteal vein in fossa
Popliteal vein becomes femoral vein
Femoral triangle
External Iliac veins

26. Pulses Femoral pulse Popliteal pulse Posterior tibial pulse
Mid-inguinal point
Popliteal pulse
Popliteal fossa, medial side, artery deepest structure in fossa so push hard
Posterior tibial pulse
Located posterior and inferior to medial malleolus
Dorsalis pedis pulse
Dorsum of foot, between tendons of extensor hallucis longus and extensor digitorum longus to second toe
Dorsalis pedis artery from anterior tibial artery

27. Reflexes 1,2 Buckle my shoe 3,4 Kneel on the floor 5, 6 Pick up sticks
S1, 2 Achilles tendon
3,4 Kneel on the floor
L3, 4 Patella tendon
5, 6 Pick up sticks
C5, 6 Biceps tendon
7, 8 I’m great
C7, 8 Triceps tendon

28. Compartment Syndrome
Increase in pressure within a fascial compartment due to increase in fluid
Signs – 6P’s
Pallor
Pulselessness
Paraesthesia
Paralysis
Pain
Perishingly cold