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LO: Topographical and Surface Anatomy of Muscles and Nerves of the Lower Limb

Basic Anatomical Structures and Principles (syllabus)

Understand the concepts and associated principles, functional and clinical applications of the topographical anatomy of the muscles and nerves of the lower limbs.

Surface and Functional Anatomy (syllabus)

Understand and explain the relevant surface and functional anatomy of the muscles and nerves of the lower limb.

Muscles

Anterior and Medial Thigh Muscles

|Anterior Compartment of the Thigh |Medial Compartment of the Thigh |

|Sartorius |Garcilis |

|Rectus femoris, vastus lateralis, medialis and intermedius |Adductor longis |

|(‘quadriceps femosis’) |Adductor brevis |

|Pectineus |Adductor magnus |

| |Obturator externus |

Gluteal Muscles

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|Muscles of the Gluteal Region |

|Tensor fascia lata |Obturator internus |

|Gluteus maximus |Superior gemellus |

|Gluteus medius |Inferior gemellus |

|Gluteus minimus |Quadratus femoris |

|Piriformis | |

Posterior Thigh Muscles

|Muscles of the Posterior Thigh |

|Semitendinosus |

|Semimembranosus |

|Biceps femoris |

Muscles of the Anterior and Lateral Leg

|Muscles of the Anterior Leg |

|Tibialis anterior |

|Extensor hallucis longus |

|Extensor digitorum longus |

|Peroneus tertius |

|Muscles of the Lateral Leg |

|Peroneus longus |

|Peroneus brevis |

Muscles of the Posterior Leg

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|Muscles of the Posterior Leg |

|Superficial layer |Gastrocnemius |

| |Plantaris |

|Intermediate layer |Soleus |

|Deep layer |Popliteus |

| |Flexor digitorum longus |

| |Flexor hallucis longus |

|Very Deep Layer |Tibialis posterior |

Muscles of the Dorsum of the Foot

Muscles of the Dorsum of the foot:

• extensor digitorum brevis

• tendons of the extensor digitorum longus

• extensor hallucis brevis

• dorsal interosseous muscles

Muscles of the Sole of the Foot

|Muscles of the Sole of the Foot |

|1st layer |Abductor hallucis |

| |Flexor digitorum brevis |

| |Abductor digiti minimi |

|2nd layer |Flexor accessorius (quadratus plantae) |

| |4 lumbricals |

|3rd layer |Flexor hallucis brevis |

| |Flexor digiti minimi brevis |

|4th layer |3 Plantar interossei |

| |4 Dorsal interossei |

Nerves

(Sorry – I can’t find any good pictures for the nerves, so you will need to refer to the lecture nots)

Nerves of the Anterior and Medial Thigh:

• lateral femoral cutaneous nerve

• femoral nerve

• anterior branch of obturator nerve

• posterior branch of obturator nerve

• cutaneous branch of obturator nerve

• cutaneous branches of femoral nerve

• saphenous nerve

• nerve to vastus medialis

Nerves and Arteries of the Posterior Thigh:

• Superior gluteal nerve

• sciatic nerve

• nerve to obturator internus

• inferior gluteal nerve

• posterior femoral cutaneous nerve

• nerve to quadrates femoris

Nerves of Anterior Leg:

• Common peroneal nerve (also called the common fibular nerve)

• Deep peroneal nerve

• Saphenous nerve

• Superficial peroneal nerve

Nerves of the Posterior Leg:

• Tibial nerve

• Common peroneal nerve

• Medial cutaneous nerve

• Lateral cutaneous nerve

• Sural nerve

• Lateral sural nerve

• Medial sural nerve

Nerves of the Foot:

• Medial calcaneal branch (tibial nerve)

• Tibial nerve

• Lateral calcaneal branch (sural nerve)

• Lateral plantar nerve

• Medial plantar nerve

• Common plantar digital nerves

• Proper plantar digital nerves

Functional Anatomy of the Muscles and Nerves of the Lower Limb

|Muscles that move the thigh |

|Group and Muscle |Action |Innervation |

|GLUTEAL GROUP |

|Gluteaus Maximus |Extension and Lateral rotation at hip |Inferior gluteal nerve (L5 – S2) |

|Gluteus Medius |Abduction and medial rotation at hip |Superior Gluteal Nerve (L4 – S1) |

|Gluteaus Minimus |As above |As above |

|Tensor Fascia Latae |Flexion and medial rotation at hip; tneses |As above |

| |fascia lata, which laterally supports the | |

| |knee | |

|LATERAL ROTATOR GROUP |

|Obturators (externus and internus) |Lateral rotation at hip |Obturator Nerve (externus – L3 – L4) and |

| | |special nerve from sacral plexus (L5 – S2) |

|Piriformis |Lateral Rotation and Abduction at hip |Branches of Sacral Nerves (S1 – S2) |

|Gemelli (sup and inf) |Lateral rotation at hip |Nerves to obturator internus and quadrates |

| | |femoris |

|Quadratus femoris |As above |Special nerve from Sacral Plexus (L4 – S1) |

|ADDUCTOR GROUP |

|Adductor brevis |Adduction, flexion and medial rotation at |Obturator nerve (L3 – L4) |

| |hip | |

|Adductor longus |As above |As above |

|Adductor magnus |Adduction at hip; superior part produces |Obturator and sciatic nerves |

| |flexion and medial rotation; inferior part | |

| |produces extension and lateral rotation | |

|Pectineus |Flexion, medial rotation and adduction at |Femoral Nerve (L2 – L4) |

| |hip | |

|Gracilis |Flexion at knee, adduction and medial |Obturator nerve (L3 – L4) |

| |rotation at hip | |

|ILIOPSOAS GROUP |

|Iliacus |Flexion at hip |Femoral Nerve (L2 – L3) |

|Psoas Major |Flexion at hip or lumbar intervertebral |Branches of the lumbar plexus (L2 – L3) |

| |joints | |

|Muscles that move the Leg |

|FLEXORS OF THE KNEE |

|Biceps Femoris |Flexion at knee, extension and lateral |Sciatic nerve, tibial portion (S1 – S3; to |

| |rotation at hip |long head) and common fibular branch (L5 – |

| | |S2; to short head) |

|Semimembranosus |Flexion at knee, extansion and medial |Sciatic nerve (tibial portion, L5 – S2) |

| |rotation at hip | |

|Semitendinosus |As above |As above |

|Sartorius |Flexion at knee, fklexion and lateral |Femoral nerve (L2 – L3) |

| |rotation at hip | |

|Popliteus |Medial rotation of tibia (or lateral |Tibial nerve (L4 – S1) |

| |rotation of femur), flexion at knee | |

|EXTENSORS OF THE KNEE |

|Rectus femoris |Extension at knee, flexion at hip |Femoral nerve (L2 – L4) |

|Vastus intermedius |Extension at knee |As above |

|Vastus lateralis |As above |As above |

|Vastus medialis |As above |As above |

|Extrinsic Muscles that move the Foot and Toes |

|ACTION AT THE ANKLE |

|Flexors |Tibialis anterior |Dorsiflexion at ankle, inversion of foot |Deep fibular nerve (L4 – S1) |

|(Dorsiflexors) | | | |

|Extensors (Plantar |Gastrocnemius |Plantar flexion at ankle, inversion of foot,|Tibial nerve (S1 – S2) |

|flexors) | |flexion at knee | |

| |Fibularis brevis |Eversion of foot and plantar flexion at |Superficial fibular nerve (L4 – S1) |

| | |ankle | |

| |Fibularis longus |Eversion of foot and plantar flexion at |As above |

| | |ankle; supports longitudinal arch | |

| |Plantaris |Plantar flexion at ankle; flexion at knee |Tibial nerve (L4 – S1) |

| |Soleus |Plantar flexion at ankle |Sciatic nerve, tibial branch (S1 – S2) |

| |Tibialis posterior |Adduction and inversion of foot; extension |As above |

| | |(plantar flexion) at ankle | |

|ACTION AT THE TOES |

|Digital flexors |Flexor digitorum longus|Flexion at joints of toes 2 - 5 |Sciatic nerve, tibial branch (L5 – S1) |

| |Flexor hallucis longus |Flexion at joints of great toe |As above |

|Digital extensors |Extensor digitorum |Extension at joints of toes 2 - 5 |Deep fibular nerve (L4 – S1) |

| |longus | | |

| |Extensor hallucis |Extension at joints of great toe |As above |

| |longus | | |

|Intrinsic muscles of the foot |

|Extensor digitorum brevis |Extension at metatarso-phalangeal joints of |Deep fibular nerve (L5 – S1) |

| |toes 1 - 4 | |

|Abductor hallucis |Abduction at metatarso-phalangeal joint of |Medial plantar nerve (L4 – L5) |

| |great toe | |

|Flexor digitorum brevis |Flexion at proximal interphalangeal joints |As above |

| |of toes 2 - 5 | |

|Abductor digiti minimi |Abduction at metatarso-phalangeal joint of |Lateral plantar nerve (L4 – L5) |

| |toe 5 | |

|Quadratus plantae |Flexion at joints of toes 2 - 5 |As above |

|Lumbrical (4) |Flexion at metatarso-phalangeal joints; |Medial plantar nerve (1), lateral plantar |

| |extension at proximal interphalangeal joints|nerve (2 – 4) |

| |of toes 2 - 5 | |

|Flexor hallucis brevis |Flexion at metatarso-phalangeal joint of |Medial plantar nerve (L4 – L5) |

| |great toe | |

|Adductor hallucis |Adduction at metatarso-phalangeal joint of |Ateral plantar nerve (S1 - S2) |

| |toe 5 | |

|Flexor digiti minimi brevis |Flexion at metatarso-phalangeal joint of toe|As above |

| |5 | |

|Dorsal interosseus (4) |Abduction at metatarso-phalangeal joints of |As above |

| |toes 3 and 4 | |

|Plantar interosseus (3) |Abduction at metatarso-phalangeal joints of |As above |

| |toes 3 - 5 | |

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