muscles, nerve and blood supply of lower limb

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intrinsic back muscles vs. extrinsic back muscles

extrinsic: one attachement to the back and one attachment outside of back
intrinsic: both attachments are with in the back, act on vertebral column

actions of intrinsic back muscles on vertebral column

1. extension
2. rotation
3. lateral bending

erector spinae

keep vertebral column erect
bilarterally paired, aranged parallel to the vertebral column not oblique.

erector spinae runs up and down the full length of the vertebral column

runs up and down the vertebral column but no one muscle fiber runs the full length, fibres "leap frog" along the path of the vertebral column from sacrum to cervical vertebrae

actions with bilateral contractions

so both left and right side contracted will extend the vertebral column

unilateral contraction of erector spinae cause wat action

lateral bending

intrinsic back muscle- transversospinalis

run from transverse process of one vertebrae to spinus process of next vertebrae

with bilateral contraction of transversospinalis, see what?

extension

unilateral contraction of transversospinalis

rotation of vertebral column

intrinsic back muscle - quadratus lumborum

in the lower back, not behind nor in front of vertebral column, actually in line of vertebrae

bilateral contraction of quadratus lumborum

stabalize the vertebral column

unilateral contraction of QL

lateral bending

hip joint allows what movements

1/ ab/ad
2. flex/extend
3. medial lateral rotation of femur

muscular action of hip joint

muscle vertically infront of hip joint will flex hip, muscle vertically at back of hip joint will extend hip, abduction (muscle on the side of hip joint), adduction (muscle pulling femur towards pubis),
medial rotation (some component of the other muscles), lateral rotation (muscle across back of joint and pull)

gluteus maximus and actions

large muscle in the bumb
very powerful muscle, muscle fibers runs not perpenticular or parallel to the leg but is somewhere in between so it's able to do both actions of extension and lateral rotation

iliotibial tract

gluteus maximus inserts into IT band and extend to the lateral side of knee and helps to stablize the extended knee
action of gluteus maximus also exerts on the knee joint to help stablize it

gluteus medius

over top of the hip joint (abduction)

gluteus maximus, medius, minimus

with maximus on the most outer layer, then it's medius, then it's minimus

medius and minimus both

run over top of hip joint and both gonna abduct and stablize the pelvis

gluteus medius and minimus

stablizes the pelvis and contracts to keep pelvis in level

6 lateral rotators

across the back of hip and originate in/on pelvis and extend to region of greater trochanter, horizontally across posterior aspect of hip joint and are all lateral rotator of hip

flexor of hip

illiopsoas= iliacus + psoas (dual origin, combined insertion)
deep to inguinal ligament!

adductor of hip

bundle of muscle on medial aspect of high and extend from pubis to humerus inferior to hip joint

thigh in cross section

skin, subq adipose, fascia lata (deep fascia just like the brachial fasica in the arm=deep ct sleeve enclosing thigh, ct septa extend to femur subdividing muscles of thigh into 3 compartments)

what is a thickening of fascia lata

lateral thickening of fascia lata forms IT tract

3 compartments of thigh

1. medial(hip adductor)
2. anterior (inc quadricep, cross anterior aspect of knee- extensor of knee)
3. posterior (hamstrings-- cross back of hip and back of knee-- extension of hip and flexion of knee)

anterior comparment of high

quadricep femoris

quadricep femoris

has 4 separate pts of origin, largely on anterior aspect of femur
1. one head of the 4 originates from ilium therefore crosses anterior to hip therefore it will flex the hip-- just from this one head

common insertion via quadricps tendon, patella, patellar ligament to the tibial tuberosity

2. crosses anterior aspect of knee--exte$nd the knee (kick ball)

3. stablize the kneebecause tendon runs anterior aspect and medial and lateral aspect of knee
(so strong quadricep leads to less knee injury)

hamstrings where is it located

posterior compartment of thigh,
attach ischial tuberosity to priximal tibia/ can be felt medial and lateral to the knee

***so it causes hip extension and knee flexion

lumbosacral plexus

innervate hip and lower limb
so muscles of abdomen, pelvis, lower limb

lumbosacral plexus 2 divisions

lumbar and sacral plexus

lumbar plexus

anterior primary rami L1-L5
femoral, obturator Nerves, lumbosacral trunk

femoral nerve

pass deep to inguinal ligament into ant comparment of thigh

accompanied by femoral artery and vein

inguinal ligament

ligament extending from pubic bone to anterior superior iliac spine, forming lower border of abdomen

obturator N

pass thru obturator canal enters medial compartment of thigh, accompanied by obturator artery and vein

femoral and obturator arise from different spinal levels

no they come from same spinal levels (L2,3,4)

lumbosacral trunk

formed from contribition of L4 and L5, it passes into the true pelvis and provides contribution from L4,5 to sacral plexus

sacral plexus location

located on post wall of true pelvis, contributed from primary rami of L4-S4

-superior and inferior gluteal nerves
-sciatic nerves

superior and inferior gluteal nerve

pass thru greater sciatic foramen, accompanied by sup and inf gluteal As and Vs, innervate the gluteal muscles (maximus, medius, minimus)

sciatic nerve

largest nerve in the body
passes thru sciateic foramen and consist of tibial and common fibular divisions
innervates the hamstring -- posterior compartment of thigh

anterior compartment

quadricep, femoral nerve

medial compartment of thigh

adductor of hip, obturator nerve

posterior compartment of thigh

hamstrings, sciatic nerve

branches of sacral plexus

1. gluteus muscles
2. sacrotuberus ligament (define lesser sciatic foramen)
3. lateral rotators
4. superior and inferior gluteal N&A

gluteus medius and minimus are innervated by inferior gluteal nerve

NO! they're higher up and are innervated by superior gluteal nerve
inferior gluteal nerve innervates maximus

superior and inferior gluteal artery

...

sciatic nerve

runs straight down leg and into posterior compartment of leg innervating the hamstrings

blood supply of hip and thigh

abdominal aorta--> R and L common iliac arteries-->internal iliac artery and external iliac artery -->external iliac artery continue as femoral artery

internal iliac artery includes

superior gluteal artery, inferior gluteal artery (these 2 go thru greater sciatic foramen), obturator artery going thru obturator canal in medial compartment of thigh

external iliac artery

under iguinal ligament and into the thigh continuing as femoral artery (a name change)

femoral artery

thru anterior comp of thigh and thru into popliteal fossa into the space behind the knee and now it's called the popliteal artery (name change, not a branch)

femoral artery

supply some blood to the thigh and its' primary concern is to the knee

deep femoral artery

supply most of the structures of the anterior compartment of thigh and supply to the hip joint (medial and lateral circumflex branch to run up to supply to the hip joint)
perforating branches to post compartment of thigh

anterior and medial and posterior artery

obturator in medial
superior and inferior gluteal artery to anterior
no sciatic artery, so we have perforate branches (perforate thru CT septa to posterior comp)

deep veins

mirror the arterial supply

superficial veins of lower limb resp for

no companion artery, located subQ below skin, anastomase to reg temp regulation

superficial veins of lower limb

begin in foot as dorsal venous arch

great saphenous vein

runs up on medial aspect of leg/thigh, drains lower limb, empty into femoral vein in femoral triangle to meet the deep circulation

short saphenous vein

on lateral aspect of leg and only drains leg and foot doesn't go beyond the knee, at knee it will go thru deep fascia of leg and empty into popliteal vein in popliteal fossa

mvt of ankle, foot and toes

1. tendon may pass posterior to the ankle- plantarflexion
2. tendon pass anterior to ankle- dorsiflexion
3 across superior aspect of toes: extension of toes
4.tendon pass behind lateral malleolus into foot: eversion
5. tendon pass behind medial malleolus into foot: inversion
6. tendon across inferior aspect of toes: flexion

deep fascia

brachial fascia
antebrachial fascia
fascia lata= of thigh
crural fascia= deep fascia of leg

compartments of leg

4 compartments:
1) anterior compartment
2) lateral compartment
3) posterior superficial compartment
4) posterior deep compartment

what separates the legs in to compartments

tibia, fibula, interosseus membrane, septa of crural fascia

shin splints

pain that develops with lots of exercising and running, accumulation of tissue fluid, ***ischemic pain******, blood supply to skeletal muscle is reduced, increased pressure within the osteofibrous compartment decreasing blood flow

carpal tunnel

accumulation of tissue fluid in a space incapable of expanding so we have a build up of pressure

posterior superficial compartment of leg

insert via tendo calcaneus into calcaneal tuberosity, muscles that cross behind talocrural joint causes plantarflexion

medial and lateral heads of gastrocnemius

crosses back of knee so can help with knee flexion in addition to plantarflexion

soleus

flat muscle and broad, sticks behind from gastrocnemius, causes plantarflexion

posterior deep compartment of leg

3 muscles: tendon pass behind medial malleolus and
1) attach to medial side of foot: inversion
2) passes to inferior of great toe: flex the great toe
3) passes via 4 tendons to inferior of 4 lateral toes: flexion of 4 toes

lateral compartment of leg

2 muscles: orginate on lateral surface of fibula, tendon pass behind lateral malleolus into foot, action: eversion

anterior compartment of leg

tendon cross front of ankle, action: dorsiflexion
1. one muscle passes to medial aspect of foot:inversion (another muscle from posterior compartment causes inversion too)
2. one muscle passes to great toe, action: extension
3. one muscle passes via 4 tendons to lateral 4 toes, action: extension of toe

innervation of leg

sciatic nerve is not only a function of thigh but also else where like in teh leg
sciatic nerve bifurcates in the posterior compartment of the thigh forming:
tibial nerve
common fibular nerve (

tibial nerve runs where

between posterior superficial and posterior deep compartments of the leg, so 1. innervates all teh muscles of both the posterior superficial and posterior deep compartments of the leg
2.tibial nerve continues passes behind medial malleolus into the sole of the foot

common fibular nerve

runs laterally, around head of fibula.
this is a very superficial nerve, just below the skin so we can cut off nerve if we sit cross leged
common fibular nerve splits into superficial fibular nerve and deep fibular nerve

superficial fibular nerve

in lateral compartment of leg, innervates all muscles of lateral compartment of leg

deep fibular muscle

in anterior compartment and innverate all muscles of the anterior compartment of leg

put muscles and nerve supply together and their actions

...

blood supply of the leg

femoral artery passes from anterior comp of thigh into the popliteal fossa where it becomes the popliteal artery which is responsible for blood supply distal to the knee

blood supply of the leg

around knee it gives genicular branches (anastomoses around knee)
distal to knee, popliteal artery bifurcates into
1) anterior tibial artery: passes thru interosseous membranes into anterior comp of leg
2) posterior tibial artery continues distally between posterior superficial and deep comp of leg ----- tibial nerve
posterior artery gives a fibular branch
posterior tibial artery pass behind medial malleolus into foot

no major bv in lateral compartemnt

well there's anastomese from other compartments blood supply

blood supply of the leg

anterior tibial artery is a branch of popliteal artery, it enters anterior comp of leg by passing interosseus membrane
superficial=side of leg
nerve that innervate muscles of anterior comp of leg (deep nerves)
can take femoral and popliteal pulse

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