1. GNK 483 MUSCULOSKELETAL CONDITIONS BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012

2. Arterial Supply Superior gluteal – Runs through greater sciatic foramen Inferior gluteal – Runs through gluteal region Obturator – Runs through obturator foramen to adductor compartment of thigh & hum head Femoral Popliteal

3. Femoral Artery Main artery Origin = external iliac artery Course = femoral sheath – Lateral to femoral vein – Anterior to femoral head – Runs superficially in femoral triangle – Passes through adductor canal – Changes name to popliteal artery at add hiatus

4. Femoral Artery Branches Branches inferior to inguinal ligament – Superficial circumflex iliac artery – Superficial epigastric artery – Superficial external pudendal artery Branches in femoral triangle – Deep external pudendal artery – Deep femoral artery – Descending genicular artery

5. Deep Femoral Artery Main artery of thigh Arises lateral side of femoral artery Leaves femoral triangle betw pectineus & add longus in the floor of the triangle In adductor compartment it runs betw add longus and add magnus Supplies adductors & flexor compartment Branches – Medial circumflex femoral a : clinical importance Supplies largest quantity of blood to fem head and neck – Lateral circumflex femoral a Supplies lat side of thigh & fem head

6. Deep Femoral Artery Anastomosis at height of lesser trochanter on posterior side of thigh – Medial circumflex femoral – Lateral circumflex femoral – Inferior gluteal – 1 st perforator of deep femoral

7. Popliteal Artery Branches Cutaneous – Posterior surface of leg Muscular – Lower part of thigh muscles – Calf muscles : sural artery Articular – Medial & lateral superior genicular – Middle genicular – Medial & lateral inferior genicular Terminal – Anterior tibial Called dorsalis pedis on dorsum of foot – Posterior tibial Divides into medial & lateral plantar aa Latter forms plantar arch & anastomosis with dorsalis pedis a

8. Venous Drainage Deep veins Superficial veins Perforators

9. Deep Veins 2 venae comitantes accompany each artery of the leg of which popliteal and femoral vv are examples Blood flows proximally in these veins with the aid of: – Valves – Muscular contraction – Pulsation of aa adj to venae comitans – Pressure changes in thorax

10. Superficial Veins On dorsum of foot Small saphenous – Post to lateral malleolus – Middle of calf it runs superficial to calcaneal tendon & gastroc – Ascends in relation sural n – Ends in popliteal vein Great saphenous – Medial side of dorsal arch – Ant to medial malleolus – Ascends in relation to saphenous n – Drains into femoral vein

11. Before terminating, great saphenous receives: – Superficial epigastric – External pudendal – Superficial circumflex iliac – Anterolateral branch – Posteromedial branch Perforators – At saphenous opening – Lower part of thigh Hunters perforating v – Below knee : Boyd’s perforating v – Medial aspect of leg

12. Innervation

13. Lumbar Plexus Femoral n : L2,3,4 (posterior) – Muscular to ant compartment, pectineus – Articular to hip & knee – Cutaneous Intermediate ant cutaneous Medial ant cutaneous saphenous

14. Lumbar Plexus Obturator n : L2,3,4 (anterior) – Muscular to adductor, gracilis – Articular to hip & knee – Cutaneous to medial part of thigh Lateral cutaneous nerve to thigh : L2,3

15. Sacral Plexus Sciatic n : L4,5,S1,2,3 – Muscular to hamstrings, add magnus – Articular to hip & knee Tibial n – Common fibular Superficial fibular – Muscular to peroneus longus & brevis – Cutaneous to distal 1/3 of leg & dorsum of foot except 1 st web space Deep fibular – Muscular to 4 muscles of ant compartment – Cutaneous to 1 st web space

16. LYMPHATIC SYSTEM LOWER LIMB