81 terms

muscles, nerve and blood supply of lower limb

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?
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
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