1. Windsor University School of Medicine
Gluteal region, thigh & leg The future belongs to those who believe in the beauty of their dreams. Eleanor Roosevelt
Lecture Idara C. Eshiet

2. OBJECTIVES Be able to describe the bones of lower limb.
Be able to describe the muscles of the gluteal region, & thigh.
Be able to describe the femoral triangle & popliteal fossa.
Be able to describe the muscles of the leg.

3. Bones of lower limb Hip bone ( Ilium, Ischium and pubis) Femur Tibia
Fibula

4. Areas of transition/Bones & joints of the lower limb.

5. COXAL BONE /Acetabulum

6. Shaft /Proximal end of the femur

7. Femur vs. Tibia & Fibula

8. Proximal ends of tibia & fibula

9. Tibia & Fibula/ posteromedial view of distal ends.

10. Thigh
Fascia
Compartments : anterior, medial, posterior
muscles

11. Fascia of the thigh
Superficial is the continuity of the superficial fascia of anterior abdominal wall
Deep fascia thickened laterally to form the illiotibial tact
Has a gap called saphenous opening
Divided into 3 compartments by 3 intermuscular septa

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

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

14. Iliacus
Action: Chief flexor of the hip joint. Nerve Supply: Femoral nerve

15. Psoas Major
Action: Flexes thigh on trunk Nerve Supply: femoral nerve

16. Pectineus
Action: Flexion & adduction of hip joint Nerve supply: Femoral nerve

17. Sartorius Nerve Supply: Femoral nerve Action :
1.Flexion, abduction and Lateral rotation of thigh at hip joint.
2. Flexion leg at knee joint
Nerve Supply: Femoral nerve

18.  Tailor's muscle
This combination of lateral rotation and flexion of the hip and flexion of the knee gave tailors particularly enlarged sartorius muscles.
Looking at the bottom of one's foot, as if checking to see if one had stepped in gum, demonstrates all four actions of sartorius.

19. Quadriceps femoris Four muscles make up this group. They are:
rectus femoris,
vastus lateralis,
vastus medialis,
vastus intermedialis
Action: extension of knee
Rectus femoris also flexes the hip joint as well.
Nerve Supply: Femoral nerve

20. Quadriceps

21. Medial Compartment of Thigh
1. Gracilis
Adduction of hip joint & flexion of knee joints
2. Adductor longus
Adduction of hip joint.
3. Adductor brevis
Adduction of hip
4. Adductor magnus has 2 parts.
Ant. Part is an adductor
Post. Part is an extensor of hip
5. Obturator externus
Lateral rotation of hip joint
Obturator nerve but the post. part of adductor magnus is supplied by tibial nerve 3 2 1 4

22. Adductor magnus & Obturator externus
Is innervated by the posterior branch of obturator nerve
2. Adductor magnus
The adductor part is innervated by the obturator nerve
& the hamstring part is innervated by the tibial division of the sciatic nerve 1 2

23. Pectineus, Adductors longus & brevis
Is innervated by the femoral nerve
2. Adductor longus
Is innervated by the anterior division of the obturator nerve
3. Adductor brevis
Is innervated by the obturator nerve 1 3 2

24. Posterior Compartment of the Thigh (Hamstring)
1. Biceps femoris
Extension of hip joint & flexion & lateral rotation of knee joint.
2. Semitendinosus
Extension of hip joint & flexion & medial rotation of knee joint.
3. Semimembranosus
Tibial nerve but the short head of biceps femoris is supplied by the common fibular nerve 2 1 3

25. Movements of Hip joint Flexion Extension Abduction Adduction
Circumduction
Medial rotation
Lateral rotation

26. Movements of Hip joints

27. Muscles responsible for movements of Hip joints.
Flexion : iliopsoas, rectus femoris
Extension: Hamstrings, gluteus maximus
Abductor: Gluteus medius & minimus
Adduction: Gracilis &
3 Adductors

30. Muscles responsible for movements of Hip joints Cont’d.
Medial rotation: gluteus medius & minimus
Lateral rotation:
obturator internus & externus,
piriformis,
superior & inferior gemelli,
quadratus femoris

31. Muscles responsible for movements of Knee Joints.
Flexion: Hamstrings
Extension: Quadriceps
Medial rotation: Semitendinosus & Semimembranosus.
Lateral rotation : Biceps femoris.

33. Muscles of the gluteal region

34. Muscles of the gluteal region
1. Gluteus maximus
Extension of the hip joint, lateral rotation, steadies the thigh, assists in rising from a sitting position
Inferior gluteal nerve
2. Tensor fasciae latae
Tensing fascia lata & illiotibial tract
Abducts and medially rotates the thigh
Superior gluteal nerve
3. Gluteus medius & minimus
Abduction and medial rotation of the thigh 3 1

36. Muscles of the gluteal region Cont’d.
4. Piriformis m.
Lateral rotation of an extended thigh
Abduction of a flexed thigh
S1 & S2 nerves
Important landmark of the gluteal region.
5. Obturator Internus
Same function as piriformis
(L5-S1) nerves to obturator internus 3 4 5

37. Muscles of the gluteal region Cont’d.
6. Superior Gemellus
Lateral rotation of an extended thigh
Abduction fo a flexed thigh
(L5-S1) nerves to obturator internus
7. Inferior Gemellus
Same function as superior gamellus
Nerve to quadratus femoris ( L5, S1) 6 7

38. Muscles of the gluteal region Cont’d.
8. Quadratus Femoris
Lateral rotation of the thigh
(L5-S1) nerves to quadratus femoris 8

39. Femoral triangle & Popliteal fossa
Femoral triangle boundaries, floor, & contents
Popliteal fossa boundaries, floor, & contents

40. Femoral Triangle Boundaries: Superior: inguinal ligament
Lateral: Sartorius
Medial : Adductor longus.
Floor: (lat. to med.)
Iliopsoas
Pectineus
Contents : (lat. to med.)
Femoral nerve
Femoral artery
Femoral vein

42. Boundaries of Popliteal fossa
Superiolateral : biceps femoris
Superiomedial: semimembranosus & semitendinosus
Inferolateral: lateral head of gastrocnemius
Inferomedial: medial head of gastrocnemius 2 1 2 3

43. Contents of Popliteal fossa
Floor is formed by popliteal surface of distal femur, capsule of knee joint & popliteus muscle.
Contents: from superficial to deep
Tibial nerve
Popliteal vein
Popliteal artery
Also contains common fibular nerve & lymph nodes.

44. LEG Fascia Muscles of anterior compartment
Muscles of lateral compartment
Muscles of posterior compartment (superficial & deep layers)
Main muscles responsible for ankle joint movements

45. Fascia of the Leg Deep fascia (crural fascia) .
Leg divided into 3 fascia compartments (anterior, posterior, lateral) by 3 intermuscular septa.
In the region of the ankle the fascia forms retinacula :
Superior & inferior extensor retinacula
Flexor retinaculum
Fibular retinaculum

46. Cross-section through the left leg (post. View)
Muscles of the anterior compartment of leg dorsiflex the ankles, extend the toes, & invert the foot.
(deep fibular nerve).
Muscles in the posterior compartment plantarflex the ankle, flex the toe, & invert the foot.
(tibial nerve).
Muscles in the lateral compartment evert the foot.
(superficial fibular nerve).

47. Muscles of anterior compartment
1. Tibialis anterior
Dorsiflexion & inversion of the foot at the ankle.
2. Extensor digitorum longus
Extension of lateral 4 digits & dorsiflexion of the ankle
3. Extensor hallucis longus
Extension of big toe & dorsiflexion of the ankle
Deep fibular nerve from common fibular nerve 1 2 3

49. Muscles of lateral compartment
1. Fibularis longus
Eversion & plantar flexion of foot.
2. Fibularis brevis
Superficial fibular nerve from common fibular nerve 1 2

50. Muscles of posterior compartment (superficial layer)
1. Triceps surae muscle has
2 heads of gastroecnemius muscle
Plantaflexion of foot & flexion of knee joint.
1 head of soleus muscle
Plantarflexion of foot

51. Muscles of posterior compartment (deep layer)
2. Popliteus
Flexion of knee joint
3. Flexor digitorum longus
Flexion of DIP of lateral 4 digits
4. Flexor hallucis longus
Flexion of big toe
5. Tibialis posterior
Plantarflexion & inversion of foot
Tibial nerve 2 5 3 4

52. Muscles responsible for ankle joint movements (fig.B)
Dorsiflexion :
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Plantarflexion :
Triceps surae
Tibialis posterior
Flexor digitorium longus
Flexor hallucis longus

53. Movements of knee & ankle

54. Surface Anatomy1.

55. Surface Anatomy2.

56. Surface Anatomy3.

57. POWER REVIEW1.
1. What are the 4 regions of the lower limb, and which bones are found in each region?
Hip: ilium, Ischium, & pubis
Thigh: Femur & patella
Leg: Tibia & fibula
Foot: Tarsal bones, metatarsal bones, & phalanges.
2. Name the 7 tarsal bones
Talus, Calcaneus, Cuboid bone, Navicular bone, Cuneiform bones (3)

58. POWER REVIEW2. 3. what is the largest and most posterior tarsal bone?
The calcaneus
4. what structure inserts into the posterior surface of the calcaneus?
The tendon calcaneus (Achilles tendon)
5.the calcaneus articulates with which 2 tarsal bones?
The talus & the cuboid bone

59. POWER REVIEW3. 6. The talus articulates with which 2 tarsal bones?
The calcaneus & the navicular bone
7. The navicular bone articulates with which 5 tarsal bones?
The talus, the cuboid bone, and the 3 cuneiform bones.
8. which movements occur around the intertarsal joints?
Inversion & eversion of the hindfoot

60. POWER REVIEW4. 9. which muscle is the major flexor at the hip joint?
Iliopsoas.
10. name the external rotators of the hip
Piriformis, Gemellus superior, Obturator internus
Gemellus inferior, Obturator externus, Quadratus femoris
11. Name the 5 ligaments that are associated with the hip joint.
Iliofemoral ligament, ischiofemoral ligament, pubofemoral ligament
Transverse acetabular ligament, ligament capitis femoris

61. POWER REVIEW5.
12. list the 4 muscles of the posterior thigh compartment.
Semimembranous m., semitendinous m.,
biceps femoris m. (long & short head), adductor magnus m. (hamstring part)
13.what are the “hamstring” muscles?
The semimembranous m., the tendinosus m.,
the long head of the biceps femoris m., and the adductor magnus m. (hamstring part)

62. POWER REVIEW 6.
14. which of the medial thigh muscles contributes to the action of the hamstrings?
The adductor magnus muscle has 2 portions with separate insertions & innervations, 1 of which contributes to the action of the hamstrings (flex the leg).
15. list the 6 muscles of the medial thigh compartment.
Pectineus m., adductor longus m.,
Adductor magnus m., (adductor part), Adductor brevis m., Gracilis m., Obturator externus m.

63. POWER REVIEW 7.
16. list the 3 muscles of the anterior compartment of the thigh.
Iliopsoas m., Sartorius m., Quadriceps femoris m.
17. which 4 muscles contribute to the quadriceps femoris muscles?
Rectus femoris m., Vastus lateralis m.,
Vastus medialis m., Vastus intermedius m.,

64. Review Questions.1
1. Which of the following muscles is located in the posterior aspect of the thigh?
2. All of the following muscles are lateral rotators of the thigh EXCEPT
3. The deep fascia of the thigh is known as which of the following?
4. The medial and lateral malleoli articulate with which of the following bones?
5. Which of the following muscles is the strongest flexor of the hip joint?

65. Review Questions.2
6. The strongest dorsiflexor of the foot is which of the following muscles?
7. All of the following muscles are lateral rotators of the hip joint EXCEPT
8. Which of the following groups of muscles produce dorsiflexion of the ankle?
9. Which of the following muscles is a flexor of the knee joint?
10. All of the following muscles are located in the deep muscle group of the posterior compartment EXCEPT

66. Review Questions.3
11. Which of the following muscles is the strongest dorsiflexor and invertor of the foot?
12. Muscles that evert the foot include which of the following muscles?
13. Which of the following muscles dorsiflex the ankle?
14. All of the following statements concerning the popliteal fossa are correct EXCEPT
15. Which of the following muscles is located in the posterior aspect of the thigh?

67. Review Questions.4
16. All of the following muscles are lateral rotators of the thigh EXCEPT
17. All of the following statements concerning the gluteus medius and minimus are correct EXCEPT
18. All of the following statements concerning the gluteus maximus are correct EXCEPT
19. All of the following statements concerning the femoral triangle are correct EXCEPT
20. All of the following statements concerning the adductor magnus are correct EXCEPT
21. Which of the following statements concerning the gracilis muscle is correct?

68. T. S. Eliot
No one can become really educated without having pursued some study in which he took no interest--for it is a part of education to learn to interest ourselves in subjects for which we have no aptitude.
………………..references………………………….
Dr. Bolgova PPt.
Gray’s Anatomy for students, 2nd edition