Lower limb (LL) skeleton, joints, muscles, arterial blood supply, venous and lymphatic drainage, innervation, regional anatomy

Transcription

1 Silvia Rybárová, Prof., DVM, PhD. Lower limb (LL) skeleton, joints, muscles, arterial blood supply, venous and lymphatic drainage, innervation, regional anatomy Skeleton of LL Pelvic girdle: Free LL: hip bone (2x) dorsally sacrum and coccyx on thigh femur, patella on leg tibia, fibula on foot: 1/ tarsal bones: talus, calcaneus, navicular bone, cuboid bone, cuneiforme bones (medial, intermediate and lateral) 2/ metatarsal bones 3/ phalanges Joints of LL Immobile: Syndesmosis Synchondrosis Mobile: 1/ pelvic girdle obturator membrane, sacrotuberal lig., sacrospinal lig., iliolumbar lig. pubic symphysis (anterior connection of pubic bones) 2/ free extremity interosseous membrane of the leg, tibiofibular syndesmosis 1/ pelvic girdle sacroiliac joint immobile joint (amphiarthrosis) 2/ free extremity hip joint knee joint tibiofibular joint 1/ talocrurual joint (ankle joint) 2/transverse tarsal joint (Chopart s joint) 3/ tarsometatarsal joints (Lisfranc s joint) 4/ metatarsophalangeal joints 5/ interphalangeal joints Diameters of the pelvis: external internal Muscles (mm.) of LL Hip muscles: Mm. of the thigh: 1/ anterior hip mm.: psoas major, (psoas minor), iliacus 2/ posterior hip mm.: superficial: gluteus maximus, medius, minimus, tensor fasciae latae deep: piriformis, gemelli (superior et inferior), obturatorius internus, quadratus femoris 1/ anterior group: extensors sartorius (flexor), quadriceps femoris

2 2/ medial group: adductors pectineus, adductor longus, brevis et magnus, gracilis, obturator externus 3/posterior group: flexors biceps femoris, semitendinosus, semimembranosus Mm. of the leg: Mm. of the foot: 1/ anterior group: extensors - tibialis anterior, extensor digitorum longus, extensor hallucis longus 2/ lateral group: pronators peroneus (fibularis) longus, peroneus (fibularis) brevis 3/ posterior group: flexors triceps surae (gastrocnemius + soleus), plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus 1/ dorsal (posterior) group: extensors extensor digitorum brevis, extensor hallucis brevis, dorsal interossei (4) 2/ plantar group: a/ middle group: flexor digitorum brevis, quadratus plantae, lumbricales, plantar interossei (3) b/ mm. of big toe: abductor hallucis, adductor hallucis, flexor hallucis brevis c/ mm. of little toe: m. abductor digiti minimi, m. flexor digiti minimi, opponens digiti minimi Arterial blood supply of LL Femoral a.: it is a continuation of external iliac artery, it ends in the popliteal fossa Branches: superficial: superficial epigastric a., superficial circumflex iliac a., external pudendal aa. deep: deep femoral a., descending genicular a. Region of supply: part of the abdominal wall, thigh, hip joint, knee joint Popliteal a.: it is a continuation of femoral a. and is situated in the popliteal fossa Branches: articular and muscular Division of popliteal a.: 1/ anterior tibial a. 2/ posterior tibial a. Region of supply: knee joint, mm. of the leg (part) Rete articulare of 1/ femoral a. 2/ popliteal a. the knee is formed 3/ anterior tibial a. 4/ posterior tibial a. by branches of: Anterior tibial a.: runs above the interosseus membrane, between the muscles of the leg (anterior group), continues on the dorsum of the foot as dorsalis pedis a. (dorsal a. of the foot).

3 Region of supply: leg, knee joint, ankle joint, dorsum of the foot Posterior tibial a.: is situated deep between the muscles of the leg (posterior group or calf mm.), on the medial side, at the end divides into two branches Branches: peroneal (fibular) a. Division of posterior tibial a.: 1/ medial plantar a. 2/ lateral plantar a. Region of supply: calf, knee joint, ankle joint Medial and lateral 1/ medial plantar a. - tinner plantar aa.: 2/ lateral plantar a. - thicker, it connects with medial plantar a. and form plantar arch (deep) Region of supply: sole of the foot and digits Internal iliac a. gives off branches for the LL: 1/superior gluteal a. 2/ inferior gluteal a. 3/ obturator a. pubic branch (from obturator a.) + obturator branch (from inferior epigastric a.) form anastomoses - Corona mortis Region of supply: gluteal region, hip joint, medial group of thigh mm. Venous drainage of LL Superficial veins: Deep veins: 1/ great saphenous vein (v). - drains to femoral vein 2/ small saphenous v. - drains to popliteal vein they accompany equal deep arteries Lymphatic drainage of LL The lymph of LL runs through superficial and deep lymph vessels and nodes. superficial lymph nodes: superficial inguinal lymph nodes deep lymph nodes: deep inguinal lymph nodes Cloquetti (Rosenmülleri) node popliteal lymph nodes Innervation of LL 1/ lumbar plexus 1/ iliohypogastric nerve (n.) Th12 L4 2/ ilioinguinal n. 3/ lateral femoral cutaneous n. 4/ genitofemoral n. 5/ femoral n.

4 6/ obturator n. Region of innervation: lesser part of the abdominal wall (skin and muscles), lesser part of LL 2/ sacral plexus It gives off short direct muscular branches for deep gluteal mm., first L4 -L5, S1-S5, Co Main branches: 1/ superior gluteal n. 2/ inferior gluteal n. 3/ posterior femoral cutaneous n. 4/ sciatic n. 5/ pudendal n. 6/ coccygeal n. Region of innervation: greater part of LL, external genital organs, region of the anus,perineum and pelvic floor Regional anatomy of LL Borders of LL against the trunk: Regions of LL: Subinguinal hiatus: Important spaces: inguinal sulcus, iliac crest, genitofemoral sulcus anterior femoral, anterior genicular, anterior crural, dorsalis pedis, gluteal, posterior femoral, posterior genicular, posterior crural, planta pedis Anterior femoral region inguinal lig., lacuna vasorum (vascular compartment), lacuna musculorum (muscular compartment) femoral trigon (triangle), adductor canal above the fascia lata great saphenous vein + tributaries superficial (spf.) branches of femoral a. (spf. epigastric a., spf. circumflex iliac a., external pudendal aa.) sensory branches of femoral n., lateral femoral cutaneous n. spf. inguinal lymph nodes below the fascia lata medio-lateral order: deep inguinal lymph nodes, femoral v., femoral a., femoral n. deep branches of femoral a.,v. (deep femoral a.,v. + branches) Anterior genicular region rete articulare of the knee

5 Anterior crural region great saphenous vein saphenous nerve branches of spf. peroneal nerve anterior tibial a. + vein deep peroneal nerve (laterally to vessels) Dorsalis pedis region dorsal venous plexus (arch) sensory nerves for the skin dorsalis pedis a. + its branches + veins deep peroneal nerve Gluteal region sensory nerves (superior, middle, inferior cluneal nn.) Suprapiriform foramen: superior gluteal a.+ v., superior gluteal n. Infrapiriform foramen: sciatic nerve posterior femoral cutaneous nerve inferior gluteal a. + v. pudendal nerve internal pudendal a.+ v. Posterior femoral region skin branches of posterior femoral cutaneous nerve lateral femoral cutaneous nerve sciatic nerve (division) branches of deep femoral a. Posterior genicular region - popliteal fossa small saphenous v. posterior femoral cutaneous nerve popliteal a., popliteal v., tibial n. + common peroneal n. (laterally) popliteal lymph nodes Posterior crural region small saphenous v. sural n. (sensory) branches of sural n. (sensory) post. tibial a. + veins + tibial n. peroneal a.

6 Planta pedis (sole of the foot) Vessels and nerves: medial plantar a. + vv., medial plantar n. (+ their branches) lateral plantar a. + vv., lateral plantar n. (+ their branches)