Bone



Bone

Anterior View:

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Posterior View:

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Lesser Sciatic Foramen

Boundaries

Front: tuberosity of ischium

Above: spine of ischium and sacrospinous ligmanet

Behind: sacrotuberous ligament

Contents

Tendon of obturator internus

Int pudendal artery and vein

Pudendal nerve

The Hip Joint

Type: multiaxial ball and socket; synovial

Articulating Surfaces: head of femur (2/3 of sphere), acetabulum (accommodates >1/2 femoral surface in lunate surface)

Acetabular Labrum: increases depth of acetabulum

Capsule: strong; attaches to edge of acetabulum and transverse acetabular ligament; anteriorly attached to intertrochanteric line and root of greater trochanter, posteriorly attached to neck proximal to greater trochanter; some reflects back as retinaculum that carries blood vessels to head and neck

Ligaments:

1) Iliofemoral – strong, anterior, AIIS and acetabular rim ( intertrochanteric line; prevents over-extension

2) Pubofemoral – iliopubic eminence and pubic part of acetabular rim ( iliofemoral ligament; strengthen inf and ant joint; prevents overabduction

3) Ischiofemoral – posterior; ischial acetabular rim ( neck of femur; prevents hyperextension

4) Ligament of head of femur – intracapsular; of little importance; acetabular notch ( fovea; contains branch of obturator artery

Anterior aspect strengthen by ligaments, posterior by muscles

Pelvic Ligaments

Sacrotuberous: sacrum and ischial tuberosity

Sacrospinous: sacrum and ischial spine

Inguinal: ASIS and pubic tubercle

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Knee Joint

Type: synovial, hinge

Movements: flexion and extension, rotation; knee locks 2Y to MED ROTATION OF FEMUR on tibia; popliteus unlocks knee by laterally rotating femur

Articulations: 1) Femorotibial (lateral and medial) – femoral and tibial condyles

2) Femoropatellar

Fibular IS NOT involved

Strength: from muscles (esp. vastus medalis) > ligaments

Capsule: attaches to femur (just above condyles), tibial plateau;

has an opening just post to lat tibial condyle for popliteus to pass through where

it is prolonged inflate over popliteus to head of fibula (arcuate popliteal lig); ant

part is formed by quads tendon

Synovial membrane: posteriorly it reflects into intercondylar region covering

cruciates

Continuous with: suprapatellar, popliteus, anserine and gastrocnemius bursae

Artery: genicular anastomosis (from femoral, popliteal, ant and post recurrent

branches of ant tibial recurrent and circumflex fibular arteries). Intra-articular

components supplied by middle genicular branch of popliteal.

Nerve: femoral, tibial, common fibular, obturator, saphenous

Menisci: wider externally; attached to intercondylar tibia; coronary ligaments extend from menisci to tibial condyles

1) Medial – C-shaped; broader posteriorly; adheres to surface of TCL therefore less mobile

2) Lateral – nearly circular; smaller; more moveable

Ligaments:

EXTRACAPSULAR

1. Patellar – distal part of quads tendon; from apex of patella to tibial tuberosity; receives medial and lateral patellar retinacula from vastus medialis and lateralis

2. Fibular collateral – cord like; 5cm; extracapsular; strong; lat epicondyle of femur to lat fibular head; tendon of popliteus passes deep to it, separating it from lat meniscus

3. Tibial collateral – weaker flat band; intracapsular; med epicondyle of femur to med condyle of tibia; fibres firmly attached to medial meniscus

INTRA-ARTICULAR

Cruciates WIND on in rotation, and UNWIND on ex rotation; maintain contact of femur with tibia during flexion

Factoid: inf fibres of vastus medialis stabilize patella when knee extended; PCL stabilizes knee when knee flexed

Suprapatellar bursa ascends 5cm+ above patella

There is no active rotation of extended knee

Synovial membrane does not cover back of PCA

Ankle Joint

Medial:

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Lateral:

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Type: hinge, synovial

Articulating Surfaces: tibia, fibula, trochlea of talus

Capsule: synovial membrane can extends superiorly to IO ligament

Ligaments:

1) Lateral ligament of the ankle:

a. Anterior talofibular ligament: flat, weak band; lat malleolus ( neck of talus

b. Posterior talofibular ligament: thick, strong; malleolar fossa ( lat tubercle of talus

c. Calcaneofibular ligament: round cord; lat malleolus ( lat calcaneus

2) Deltoid ligament: medial malleolus ( talus, calcaneus, navicular; stabilizes during eversion

Artery: malleolar branch of fibular, ant and post tibial arteries

Nerve: tibial and deep fibular

Factoid: most stable during dorsiflexion

SubTalar (Talocalcanean) Joint

Type: synovial

Articulating Surfaces: body of talus (concave), sup calcaneus (convex)

clinical subtalar jt also contains talocalcaneal part of talocalcaneonavicular jt

Capsule: weak

Ligaments: med, lat ad post talocalcanean ligament

interosseous talcocalcanean ligament (anterior) – strong, within tarsal sinus

Movement: inversion and eversion

Talocalcaneonavicular Joint

Type: synovial, ball and socket

Articulating Surfaces: head of talus, post navicular, sup surface of plantar calcaneonavicular (spring) lig, sustentaculum tali, calcaneus

Capsule: blends with interosseous talocalcanean ligament posteriorly

Ligaments: dorsal talonavicular ligament

spring ligament (sustentaculum tali (talar shelf) ( postinf navicular bone) – supports talus,

maintains longitudinal arch

Talus

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Calcaneus

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Calcaneal Tendon

15cm long; continuation of aponeurosis formed halfway down calf; inserts on calcaneal tuberosity; fibres spiral 90deg (gastrocnemius fibres attach laterally, soleal medially)

Subcutaneous calcaneal bursa

Arches of Foot

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Areas

Saphenous Opening

Opening in fascia lata inf to med inguinal ligament; suplatinf margin formed by falciform ligament (attaches to inguinal ligament); gt saphenous vein passes through suplaterally to enter femoral vein. Post wall lies ant to pectineus.

Femoral Triangle

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Femoral sheath: formed by transversalis and iliopsoas fascia; 3 compartments

1) Lateral - artery

2) Intermediate - vein

3) Medial = femoral canal; allows femoral vein to expand; femoral ring = base; can contain lymph node of Cloquet

Factoid - femoral branch of genitofemoral nerve lies within femoral sheath but pierces it anteriorly to

supply skin overlying femoral triangle

- mid-inguinal point is half way between ASIS and pubic symphysis

- femoral pulse is 2-3cm inf to midpoint of inguinal ligament

- femoral nerve is midway between ASIS and pubic tubercle

- long saphenous vein joins femoral vein within triangle

Adductor Canal

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Popliteal Fossa

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Posterior to Medial Malleolus

Tom Dick And Very Nervous Harry

Tibialis posterior tendon

Flexor Digitorum Longus tendon

Posterior tibial Artery

Posterior tibial Vein

Tibial Nerve

Flexor Hallicus longus tendon

Muscles

Muscles Inserting Onto Greater Trochanter

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Gluteal Region

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Gluteus Maximus

Course: post gluteal line, post sacrum and coccyx, sacrotuberous ligament ( iliotibial tract, gluteal tuberosity of femur

Action: extends and laterally rotates thigh

Nerve: inf gluteal

Artery: sup and inf gluteal

Gluteus Medius

Course: ext ilium between post and ant gluteal lines ( greater trochanter of femur

Action: abduct and medially rotates thigh

Nerve: sup gluteal

Artery: sup gluteal

Gluteus Minimus

Course: ext ilium between ant and inf gluteal lines ( greater trochanter of femur

Action: abducts and medially rotates thigh

Nerve: sup gluteal

Artery: sup gluteal

Piriformis

Course: ant sacrum ( upper greater trochanter of femur

Action: laterally rotates and abducts thigh

Nerve: S1 – 2

Artery:

Factoid: passes through greater sciatic foramen

Superior Gemellus

Course: ischial spine ( obturator internus tendon

Action: laterally rotates femur

Nerve: nerve to obturator internus

Artery: inferior gluteal

Inferior Gemellus

Course: ischial tuberosity ( obturator internus tendon

Action: laterally rotates femur

Nerve: nerve to quadratus femoris

Artery: inferior gluteal

Obturator Internus

Course: internal obturator membrane and margin of obturator foramen (med greater trochanter above trochanteric fossa

Action: laterally rotates and abducts thigh

Nerve: nerve to obturator internus

Artery: obturator

Obturator Externus

Course: external obturator membrane and sup and inf pubic rami ( trochanteric fossa of femur

Action: laterally rotates thigh

Nerve: obturator

Artery: obturator

Quadratus Femoris

Course: lat ischial tuberosity ( quadrate line of femur below intertrochanteric crest

Action: laterally rotates thigh

Nerve: nerve to quadratus femoris

Artery: inf gluteal

Posterior Thigh

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Semimembranosus

Course: upper lateral ischial tuberosity ( med condyle of tibia

Action: Extends thigh, flexes knee

Nerve: tibial

Artery: deep femoral

Semitendinosus

Course: lower, med ischial tuberosity (common tendon with biceps femoris) ( med tibia (via pes anserinus)

Action: extends thigh, flexes knee

Nerve: tibial

Artery: deep femoral

Factoid: pes anserinus is common insertion for gracilis, sartorius and semitendinosus

Bicep femoris

Long head: ischial tuberosity ( head of fibula and lat condyle of tibia

Short head: lat lip of linea aspera ( head of fibula and lat condyle of tibia

Action: extends thigh, flexes knee

Nerve: long head – tibial nerve

short head – common fibular nerve

Artery: deep femoral

Medial Thigh

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Adductor Magnus

Course: ischiopubic ramus and ischial tuberosity ( linea aspera and adductor tubercle of femur

Action: adducts, flexes and medially rotates thigh

ischiocondylar part: extends thigh

Nerve: post division of obturator nerve

ischiocondylar part: tibial nerve

Artery: obturator, deep femoral, medial femoral circumflex

Gracilis

Course: pubic symphysis and inf pubic ramus ( med tibia (via pes anserinus)

Action: adducts, flexes and medially rotates thigh, flexes knee

Nerve: ant division of obturator nerve

Artery: obturator

Adductor Brevis

Course: inf pubic ramus ( pectineal line and linea aspera

Action: adducts, flexes and medially rotates thigh

Nerve: ant division of obturator nerve

Artery: obturator, deep femoral

Adductor Longus

Course: med sup pubic ramus ( lower 2/3 linea aspera of femur

Action: adducts, flexes and medially rotates thigh

Nerve: ant division of obturator nerve

Artery: obturator, deep femoral

Anterior Compartment of Thigh

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Iliacus

Course: iliac fossa and crest, ala of sacrum ( lesser trochanter of femur

Action: flexes thigh

Nerve: femoral

Artery: iliolumbar

Factoid: inserts with psoas major via iliopsoas tendon

Iliopsoas

Course: iliac fossa, bodies and transverse processes of lumbar vertebrae ( lesser trochanter of femur

Action: flexes thigh, flexes lumbar

Nerve: L2-4, femoral

Artery: iliolumbar

Pectineus

Course: pectin of pubis ( pectineal line of femur

Action: adducts, flexes, and medially rotates thigh

Nerve: femoral and ant division of obturator – DUAL NERVE SUPPLY

Artery: med femoral circumflex

Sartorius

Course: ant sup iliac spine ( med tibia (pes anserinus)

Action: flexes, abducts and laterally rotates thigh, flexes knee

Nerve: femoral

Artery: lat femoral circumflex, saphenous

Quadriceps Femoris

1) Rectus Femoris

a. Straight head: ant inf iliac spine ( patellar ligament (patella and tibial tuberosity)

b. Reflected head: sup rim of acetabulum ( patellar ligament

2) Vastus Intermedius: ant lat femur ( patella

3) Vastus Lateralis: lat IM septum, lat linea aspera and gluteal tuberosity ( patella and med patellar retinaculum

4) Vastus Medialis: med IM septum, med linea aspera ( patella and med patellar retinaculum

Action: extends knee (all), flexes thigh (rectus femoris)

Nerve: femoral

Artery: lat circumflex femoral (all), perforating branches of deep femoral (vastus medialis)

Anterior Compartment Leg

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Tibialis Anterior

Course: lat tibial condyle and upper lat tibia ( med medial cuneiform and 1st MT

Action: dorsiflexes and inverts foot

Nerve: deep fibular

Artery: ant tibial

Factoid: ant tibial artery lies lateral to this

Extensor Digitorum Longus

Course: lat condyle of tibia, ant fibula, lat IO membrane ( extensor expansions lat 4 toes

Action: extends MTP, PIP and DIPJ lat 4 toes

Nerve: deep fibular

Artery: ant tibial

Factoid: ant tibial artery lies medial to this

Extensor Hallicus Longus

Course: med ½ ant fibula and IO membrane ( base DP GT

Action: extends MTP and IPJ GT

Nerve: deep fibular

Artery: ant tibial

Fibularis Tertius

Course: distal ant fibula ( dorsum shaft 5th MT

Action: everts foot

Nerve: deep fibular

Artery: ant tibial

Lateral Compartment Leg

Boundaries:

Lat surface fibula

Ant and post IM septa

Deep fascia leg

Superior fibular retinaculum

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Posterior Compartment Leg

SUPERFICIAL

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DEEP

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Muscles of the Foot

1ST LAYER

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2ND LAYER

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3RD LAYER

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4TH LAYER

Dorsal Interosseous (4)

Course: shafts MT ( base PP

Action: abduct 2-4; flex MTPJ and extend IPJ

Nerve: lat plantar (deep branch)

Artery: dorsal metatarsal

Plantar Interossei (3)

Course: bases and med sides MT ( med bases of P

Action: adducts digits, flex MTPJ

Nerve: lat plantar

MUSCLE ATTACHMENTS

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ARTERIES

Blood Supply to Hip

Trochanteric anastomosis (gter trochanter): descending sup gluteal

inf gluteal

ascending branches of med and lat circumflex femoral

Cruciate anastomosis (lesser trochanter): descending branch of inf gluteal

ascending branch of 1st perforating artery

transverse branches of med and lat circumflex femoral

Femoral Artery

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Profunda Femoris

Arises from lat side of fem art within fem triangle, 4cm inf to inguinal ligament ( runs lat to fem art ( passes posterior leaving fem triangle between pectineus and adductor longus ( descends post to adductor longus

Branches: perforating branches – perforate adductor magnus to post and lat compartments of thigh

circumflex femoral – med branch – passes between iliopsoas and pectineus; supplies blood to head

and neck of femur

lat branch – passes deep to sartorius and rectus femoris

Popliteal Artery

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VEINS

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NERVES

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Clunial Nerve

Superior, middle and inferior clunial nerve – supply skin over iliac crest

Superior Gluteal Nerve

Course: runs between gluteus medius and minimus with deep branch of sup gluteal artery

Supplies: gluteus medius and tensor of fascia lata

Lesion: loss of abduction at hip

Inferior Gluteal Nerve

Course: runs through greater sciatic foramen (inf to Piriformis, deep to gluteus maximus and sup to sciatic nerve) with inf gluteal vessels

Supplies: gluteus maximus

Lesion: loss of extension of hip

Sciatic Nerve

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Pudendal Nerve

Most medial structure to exit greater sciatic foramen inf to Piriformis ( enters perineum through lesser sciatic foramen

Femoral Nerve

Course: descends through psoas major ( down between psoas major and iliacus ( deep to inguinal ligament midpoint ( splits into ant and post divisions ( through femoral triangle where separated from femoral artery by portion of psoas major

Anterior division: anterior cutaneous branch (intermediate and medial cutaneous)

muscular branches – to pectineus and sartorius

Posterior division: saphenous – accompanies femoral artery and vein in adductor canal ( becomes

superficial by passing between sartorius and gracilis ( skin and fascia on

antmed knee, leg and foot

muscular branches – to quads

articular branches – to knee and hip

Factoid: largest branch of lumbar plexus)

comes from POSTERIOR divisions of anterior rami

Obturator Nerve

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1. Abductor Hallicus

Course: med tuberosity of calcaneus, flexor retinaculum, plantar aponeurosis ( med base PP gt toe

Action: abducts GT, flexes MTPJ

Nerve: medial plantar

Artery: med plantar

2. Flexor Digitorum Brevis

Course: med tuberosity of calcaneus, plantar aponeurosis, IM septum ( base MP 2-5

Action: flexes MTP and PIPJ 2-5

Nerve: med plantar

Artery: med and lat plantar

Factoid: splits to allow passage of flexor digitorum longus

3. Abductor digiti minimi

Course: med and lat tuberosity of calcaneus, plantar aponeurosis, IM septum ( lat base PP 5th digit

Action: abducts LT, flexes MTPJ

Nerve: lat plantar nerve

Artery: lat plantar

1. Flexor Hallicus Brevis

Course: cuboid, lat cuneiform, med 1st MT ( med PP GT, lat PP GT

Action: flexes MTPJ GT

Nerve: med plantar

Artery: med plantar

Factoid: tendons of insertion contain sesamoid bone

2. Adductor Hallicus

Oblique head: bases of MT 2-4 ( lat side base PP GT

Transverse head: heads of MT 3-5 ( lat side base PP GT

Action: adducts GT

Nerve: lat plantar (deep branch)

Artery: plantar arterial arch

Factoid: plantar arterial arch passes sup to oblique head of adductor hallucis

3. Flexor Digiti Minimi Brevis

Course: base 5th MT ( lat base PP LT

Action: flexes MTPJ LT

Nerve: lat plantar

Artery: lat plantar

1. Quadratus Plantae

Course: med plantar surface of calcaneus ( postlat tendon of flexor digitorum longus

Action: flexes lat 4 digits

Nerve: lat plantar

2. Lumbricals

Course: tendons of FDL ( med expansion

Action: flex PIP, extend MIP and DIP

Nerve: med plantar (med 1), lat plantar (lat 3)

3. Flexor Digitorum Longus

Course: mid ½ post tibia ( bases DP digits

Action: flexes MTP, PIP and DIPJ, plantar flexes foot

Nerve: tibial

Artery: tibial

4. Flexor Hallicus Longus

Course: lower 2/3 post fibula ( base DP GT

Action: flexes MTP and PIPJ GT, plantar flexes foot

Nerve: tibial

Artery: fibular, tibial

Factoid: important in ‘push off’

Extensor Digitorum Brevis

Course: suplat calcaneus ( extensor expansion toes 1-4

Action: extends toes 1-4

Nerve: deep fibular

Artery: dorsalis pedis

Extensor Hallicus Brevis

Course: suplat calcaneus ( dorsum of base PP GT

Action: extends GT

Nerve: deep fibular

Artery: dorsalis pedis

Fibularis Brevis

Course: lower 1/3 lat fibula ( tuberosity base 5th MT

Action: plantar flexes and everts foot

Nerve: sup fibular

Artery: fibular

Fibularis Longus

Course: upper 2/3 lat surface fibula ( past groove on ant-inf aspect of cuboid ( deep to intrinsic muscles of foot ( med cuneiform and base 1st MT

Action: plantar flexes and everts foot

Nerve: superficial fibular

Artery: fibular

Tendons are posterior to lat malleous, through sup fibular retinaculum (from lat malleolus to calcaneus)

Transverse

Bones: cuboid, cuneiforms, bases of MT’s

Support: tibialis anterior and fibularis longus

Longitudinal

Medial part: higher; calcaneus, talus (keystone), navicular, 3 cuneiforms, 3 MT’s

Lateral part: flatter; calcaneus, cuboid, lat 2 MT’s

Support: tibialis anterior, fibularis longus, flexor hallicus longus, spring and plantar ligament, plantar aponeurosis

Gastrocnemius

Medial head: above medial femoral condyle ( dorsum of calcaneus via calcaneal tendon

Lateral head: above lateral femoral condyle ( dorsum of calcaneus via calcaneal tendon

Action: flexes knee, plantar flexes foot

Nerve: tibial

Artery: sural, post tibial

Soleus

Course: post head and upper shaft fibula, soleal line tibia ( calcaneus via Achille’s tendon

Action: plantar flexion

Nerve: tibial

Artery: post tibial

Plantaris

Course: above lat femoral condyle ( calcaneus medial to calcaneal tendon

Action: flex knee, plantar flexion

Nerve: tibial

Artery: popliteal

Flexor Hallicus Longus

Course: lower 2/3 post fibula ( base DP GT

Action: flexes MTP and PIPJ GT, plantar flexes foot

Nerve: tibial

Artery: fibular, tibial

Factoid: important in ‘push off’

Flexor Digitorum Longus

Course: mid ½ post tibia ( bases DP digits

Action: flexes MTP, PIP and DIPJ, plantar flexes foot

Nerve: tibial

Artery: tibial

Tibialis Posterior

Course: IO membrane, postmed fibula, postlat tibia ( tuberosity of navicular and med cuneiform, MT’s

Action: plantar flexes and inverts foot

Nerve: tibial

Artery: fibular, tibial

Popliteus

Course: lat condyle femur ( post tibia above soleal line

Action: flexes knee, med rotate femur

Nerve: tibial

Artery: popliteal

Factoid: unlocks knee to initiate flexion of knee; lies immediately deep to popliteal art; may attach to lat meniscus

Boundaries

Upper: semimembranosus

biceps femoris

Lower: gastrocnemius

plantaris

Floor: popliteus (inf), capsule (mid), femur (sup)

Roof: skin and Popliteal fascia

Deeply, sup boundary by med and lat supracondylar lines

Contents

Small saphenous vein entering popliteal vein

Popliteal artery and vein

Tibial and common fibular nerve

- tibial is largest, most superficial

Post cut nerve of thigh

Lymph nodes and vessels

Factoids

Popliteal artery is deep to popliteal vein which is deep to nerves

Skin overlying popliteal fossa supplied by post cut nerve of thigh

Popliteal

Begins when femoral artery passes through adductor hiatus of adductor magnus (Passes inferolaterally through fossa ( Divides at inf border of popliteus ( ant and post tibial arteries

Starts medial to tibial nerve, ends lateral to it. Popliteal vein lies between the two

Gives off sural arteries to supply gastrocnemius

Branches form genicular anastomosis

1) Inf lat genicular

2) Inf med genicular

3) Sup lat genicular

4) Sup med genicular

5) Mid genicular

Also contribute to anastomosis:

Descending genicular branch of femoral art

Descending branch of lat femoral circumflex art

Ant tibial recurrent branch of ant tibial art

Boundaries

Superior: inguinal ligament (inf margin of ex oblique aponeurosis)

Medial: med border of adductor longus

Lateral: med border of sartorius

Floor: iliopsoas (lateral), pectineus (medial), adductor longus

Roof: fascia lata and cribiform fascia, sub cut tissue, skin

Contents

Femoral nerve

Femoral sheath: femoral artery, vein and inguinal lymph

Lat cutaneous nerve, femoral branch of genitofemoral nerve

Ileopectineal arch splits area post to inguinal ligament into 2

Continuation of ex iliac beginning at femoral triangle ( descends on iliopsoas, pectineus and adductor longus ( enters adductor canal (vein lies post to artery, saphenous nerve ant to artery) ( pass through adductor hiatus ( becomes popliteal artery

Factoid: bisects femoral triangle

Course: From apex of femoral triangle to adductor hiatus

Contents: femoral artery and vein, saphenous nerve, nerve to vastus medialis

NOT FEMORAL NERVE

Boundaries:

ant and lat – vastus medialis

floor – adductor longus and magnus

medial – adductor longus and magnus, sartorius

roof – fascia, sartorius

1-Anterior cruciate – weaker; from ANT INTERCONDYLAR TIBIA ( sup, post, lat ( POST LAT CONDYLE OF FEMUR; limits POST MOVEMENT OF FEMUR ON TIBIA

Tightens on knee extension

2-Posterior cruciate – stronger; from POST INTERCONYLAR TIBIA ( sup, ant, med ( ANT MED CONYLE OF FEMUR; limits ANT MOVEMENT OF FEMUR ON TIBIA

3-Popliteal tendon

a)oblique: expansion of tendon of semimembranosus; from med tibial condyle to lat femoral condyle, blending with joint capsule b)arcuate: from post fibular head to post knee joint

Course: formed at inf border of Piriformis; most lateral structure coming through greater sciatic foramen ( runs inflat under gluteus maximus midway between greater trochanter and ischial tuberosity ( rests on ischium ( passes post to obturator internus, quadratus femoris and adductor magnus ( travels in thigh deep to biceps femoris

Accompanied by post femoral cutaneous nerve and inf gluteal artery

Branches: tibial and common fibular nerve

Supplies: post thigh muscles, all muscles of leg and foot, most skin of leg and foot

Lesion: loss of all motor except adduction and flexion of thigh and extension of knee

loss of sensation lower leg and foot

Surface marking: midpoint between ischial tuberosity and gter trochanter ( apex of popliteal fossa

Great Saphenous Vein

Formed by union of dorsal vein of gt toe and dorsal venous arch ( ascends ANTERIOR TO MEDIAL MALLEOLUS ( POST TO MEDIAL CONDYLE OF FEMUR ( passes through saphenous opening in fascia lata ( enters femoral vein in femoral triangle

Accompanied by saphenous nerve

Small Saphenous Vein

Formed by union of dorsal vein of lt toe and dorsal venous arch (ascends POST TO LAT MALLEOLUS ( along lateral border of calcaneal tendon ( penetrates deep fascia ( between 2 heads of gastrocnemius ascends ( enters popliteal vein

Accompanied by sural nerve

Femoral Vein

Ascends through adductor canal, passing from postlat to fem art to posterior ( femoral canal ( becomes ex iliac vein. Receives greater saphenous vein in femoral triangle

Popliteal Vein

Begins at distal border of popliteus as post tibial and ant tibial veins meet ( peroneal vein drains into it

Lies in sheath with popliteal artery, passing from med to lat side of artery

Becomes femoral vein as passes through adductor hiatus

Small saphenous vein drains in in popliteal fossa

Med and lat plantar veins form post tibial and fibular veins POST TO MED AND LAT MALLEOLI

Gluteus medius and minimus (maximus goes to iliotibial tract)

Gemellus superior and inferior

Obturator internus and externus

Piriformis

Quadratus femoris

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Anterior Tibial Artery

Begins at inf border of popliteus ( passes anteriorly through IO membrane ( descends on ant surface of IO membrane between EHL and TA with deep fibular nerve ( changes name to dorsalis pedis

Give off ant and post tibial recurrent arteries at knee; malleolar arteries over med and lat malleoli

Accompanied by ant tibial vein

Posterior Tibial Artery

Begins at distal border of popliteus as popliteal artery passes deep to tendinous arch of soleus and gives off fibular artery ( accompanied by tibial nerve ( runs post to medial malleolus ( runs between tendons of FHL and FDL ( divides into med and lat plantar arteries

Gives off tibial nutrient artery

Accompanied by deep tibial vein

Fibular Artery

Arises from post tibial artery inf to distal border of popliteus and tendinous arch of soleus ( descends to med side of fibula within FHL

Branches: nutrient artery of fibula

perforating branch – pierves IO membrane

lat calcaneal branch ( heel

lat malleolar branch

Dorsalis Pedis Artery

Continuation of ant tibial artery. Travels deep to extensor hallicus longus in ankle ( lies lat to tendon of EHL ( ends when divides to form 1st dorsal metatarsal and deep plantar artery

Joins lat plantar artery to form plantar arch

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From ventral divisions of L2-4 ( descends through psoas major ( pierces psoas fascia, crosses sacroiliac joint, passes lat to in iliac vessels and ureter ( leaves pelvis through obturator foramen ( divides into ant and post branches which are separated by obturator externus then adductor brevis

Supplies: obturator externus, pectineus, adductor longus, adductor brevis, gracilis, adductor magnus, and med thigh

Tibial Nerve

Formed at bifurcation of sciatic nerve at top of popliteal fossa where it lies medial to vessels ( passes between 2 heads of gastrocnemius deep to tendinous arch of soleus with post tibial vessels ( descends in post compartment of leg deep to soleus on tibialis posterior ( lies between tendons of FHL and FDL POSTERIOR TO MEDIAL MALLEOLUS ( terminates as med and lat plantar nerves

Gives branches in fossa – gastrocnemius, soleus, plantaris, popliteus. Also supplies tibialis posterior, FDL, FHL

Med plantar – supplies AbH, FDB, 1st lumbrical, medial sole of foot and med 3.5 toes

Lat plantar – supplies quadratus plantae, FDM, AdH, IO, AbDM and 3 lumbricals, lat sole and lat 1.5 toes

Med sural cutaneous (joined by sural communicating branch from fibular ( sural nerve) ( skin of inf leg and lat foot

Lesion: loss of flexion of toes and inversion of foot; loss of sensation sole of foot

Common Fibular Nerve

From dorsal branches L4+5, S1+2 ( begins at top of popliteal fossa ( Follows med border of biceps femoris in lat popliteal fossa ( Passes superficial to lat head of gastrocnemius ( passes between soleus and fibularis longus ( Winds around post neck of fibula (runs deep to fibularis longus ( Divides into superficial and deep fibular nerve

Lesion: loss of extension toes and foot; loss of sensation lat lower leg and upper foot

Before division: articular branch to knee

lat sural cutaneous – postlat calf

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Splits into superficial (R) and deep (L) groups

Sup: 2 muscular, 2 cutaneous

Deep: 2 muscular, 2 cutaneous

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Superficial Fibular Nerve

Begins between fibularis longus and fibula ( runs between fibular muscles and EDL ( pierces deep fascia to become superficial at lower 1/3 leg ( divides into medial and intermediate dorsal cutaneous nerve

Supplies: fibularis longus and brevis; skin of distal ant leg and dorsum of foot

Action: everts foot

Deep Fibular Nerve

Arises between fibularis longus and neck of fibula ( accompanies ant tibial artery between tibialis anterior and EDL ( pierces ant crural intermuscular septum and EDL ( runs deep to EDL ( descends ant to IO membrane with ant tibial artery between TA and EHL ( divides into lateral and medial terminal branch at ankle

Supplies: skin of 1st webspace, tibialis anterior, EDL, fibularis tertius, EHL, ankle

Action: dorsiflexion, extension toes

Sural Nerve

Formed by medial sural cutaneous and peroneal anastomotic branches ( passes down with small saphenous vein, near lat margin of tendocalcaneus, behind lat malleolus. Becomes lat dorsal cutaneous nerve

Greater Sciatic Foramen

Boundaries

Antlat: greater sciatic notch of ilium

Postmed: sacrotuberous ligament

Inf: sacrospinous ligament and ischial spine

Sup: ant sacroiliac ligament

Contents

Above Piriformis: sup gluteal vessels

sup gluteal nerve

Below Piriformis: inf gluteal and int pudendal vessels

inf gluteal, pudendal, sciatic, post femoral cutaneous nerves; nerves to obturator internus and quadratus femoris

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