GLUTEAL REGION,THIGH & LEGTHE FUTURE BELONGS TO THOSE WHO BELIEVE IN THE BEAUTY OF THEIR DREAMS.ELEANOR ROOSEVELT

Lecture 10 Idara C. Eshiet

WINDSOR UNIVERSITY SCHOOL OF MEDICINE

OBJECTIVES

Be able to describe the bones of lower limb.

Be able to describe the muscles of the gluteal region, & thigh.

Be able to describe the femoral triangle & popliteal fossa.

Be able to describe the muscles of the leg.

Hip bone ( Ilium, Ischium and pubis) FemurTibiaFibula

Bones of lower limb

Areas of transition/Bones & joints of the lower limb.

COXAL BONE /Acetabulum

Shaft /Proximal end of the femur

Femur vs. Tibia & Fibula

Proximal ends of tibia & fibula

Tibia & Fibula/ posteromedial view of distal ends.

FasciaCompartments : anterior, medial, posteriormuscles

Thigh

Fascia of the thigh

Superficial is the continuity of the superficial fascia of anterior abdominal wall

Deep fascia thickened laterally to form the illiotibial tact

1. Has a gap called saphenous opening

2. Divided into 3 compartments by 3 intermuscular septa

Muscle compartments in the thigh

In the thigh, there are medial (adductor), anterior (extensor), and posterior (flexor) compartments.

Anterior Thigh Muscles

Anterior thigh muscles are the flexors of the hip and extensors of the knee.

Iliacus

Action: Chief flexor of the hip joint.

Nerve Supply: Femoral nerve

Psoas Major

Action: Flexes thigh on trunkNerve Supply: femoral nerve

Pectineus

Action: Flexion & adduction of hip joint

Nerve supply: Femoral nerve

Sartorius

Action :

1.Flexion, abduction and Lateral rotation of thigh at hip joint.

2. Flexion leg at knee jointNerve Supply: Femoral nerve

This combination of lateral rotation and flexion of the hip and flexion of the knee gave tailors particularly enlarged sartorius muscles.

Looking at the bottom of one's foot, as if checking to see if one had stepped in gum, demonstrates all four actions of sartorius.

 Tailor's muscle

Quadriceps femoris

Four muscles make up this group. They are:

rectus femoris, vastus lateralis, vastus medialis, vastus intermedialis Action: extension of knee Rectus femoris also flexes the hip joint as

well.Nerve Supply: Femoral nerve

Quadriceps

Medial Compartment of Thigh

1. Gracilis Adduction of hip joint & flexion

of knee joints 2. Adductor longus Adduction of hip joint. 3. Adductor brevis Adduction of hip 4. Adductor magnus has 2

parts. Ant. Part is an adductor Post. Part is an extensor of hip 5. Obturator externus Lateral rotation of hip joint

Obturator nerve but the post. part of adductor magnus is supplied by tibial nerve

12

3

4

Adductor magnus & Obturator externus

1. Obturator externus Is innervated by the

posterior branch of obturator nerve

2. Adductor magnus The adductor part is

innervated by the obturator nerve

& the hamstring part is innervated by the tibial division of the sciatic nerve

1

2

Pectineus, Adductors longus & brevis

1. Pectineus Is innervated by

the femoral nerve 2. Adductor longus

Is innervated by the anterior division of the obturator nerve

3. Adductor brevis Is innervated by

the obturator nerve

1

2

3

Posterior Compartment of the Thigh (Hamstring)

1. Biceps femoris Extension of hip joint &

flexion & lateral rotation of knee joint.

2. Semitendinosus Extension of hip joint &

flexion & medial rotation of knee joint.

3. Semimembranosus Extension of hip joint &

flexion & medial rotation of knee joint.

Tibial nerve but the short head of biceps femoris is supplied by the common fibular nerve

2

31

FlexionExtensionAbductionAdductionCircumductionMedial rotationLateral rotation

Movements of Hip joint

Movements of Hip joints

Muscles responsible for movements of Hip joints.

Flexion : iliopsoas, rectus femoris

Extension: Hamstrings, gluteus maximus

Abductor: Gluteus medius & minimus

Adduction: Gracilis &

3 Adductors

Muscles responsible for movements of Hip joints Cont’d.

Medial rotation: gluteus medius & minimus

Lateral rotation: 1. obturator internus

& externus,2. piriformis, 3. superior & inferior

gemelli, 4. quadratus femoris

Muscles responsible for movements of Knee Joints.

Flexion: Hamstrings

Extension: Quadriceps

Medial rotation: Semitendinosus & Semimembranosus.

Lateral rotation : Biceps femoris.

8 muscles.

Muscles of the gluteal region

Muscles of the gluteal region

1. Gluteus maximus Extension of the hip joint, lateral

rotation, steadies the thigh, assists in rising from a sitting position

Inferior gluteal nerve 2. Tensor fasciae latae Tensing fascia lata & illiotibial tract Abducts and medially rotates the

thigh Superior gluteal nerve 3. Gluteus medius & minimus Abduction and medial rotation of

the thigh Superior gluteal nerve

1

3

Muscles of the gluteal region Cont’d.

4. Piriformis m. Lateral rotation of an

extended thigh Abduction of a flexed

thigh S1 & S2 nerves Important landmark of

the gluteal region. 5. Obturator Internus Same function as

piriformis (L5-S1) nerves to

obturator internus

3

4

5

Muscles of the gluteal region Cont’d.

6. Superior Gemellus Lateral rotation of an

extended thigh Abduction fo a flexed

thigh (L5-S1) nerves to

obturator internus 7. Inferior Gemellus Same function as

superior gamellus Nerve to quadratus

femoris ( L5, S1)

6

7

Muscles of the gluteal region Cont’d.

8. Quadratus Femoris

Lateral rotation of the thigh

(L5-S1) nerves to quadratus femoris

8

Femoral triangle boundaries, floor, & contentsPopliteal fossa boundaries, floor, & contents

Femoral triangle & Popliteal fossa

Femoral Triangle

Boundaries:1. Superior: inguinal

ligament2. Lateral: Sartorius3. Medial : Adductor

longus. Floor: (lat. to med.)1. Iliopsoas2. Pectineus Contents : (lat. to

med.)1. Femoral nerve2. Femoral artery3. Femoral vein

Boundaries of Popliteal fossa

Boundaries : Superiolateral :

biceps femoris Superiomedial:

semimembranosus & semitendinosus

Inferolateral: lateral head of gastrocnemius

Inferomedial: medial head of gastrocnemius

1

2

2

3

Contents of Popliteal fossa

Floor is formed by popliteal surface of distal femur, capsule of knee joint & popliteus muscle.

Contents: from superficial to deep

Tibial nerve Popliteal vein Popliteal artery Also contains

common fibular nerve & lymph nodes.

FasciaMuscles of anterior compartmentMuscles of lateral compartmentMuscles of posterior compartment (superficial & deep layers)Main muscles responsible for ankle joint movements

LEG

Fascia of the Leg

Deep fascia (crural fascia) .

Leg divided into 3 fascia compartments (anterior, posterior, lateral) by 3 intermuscular septa.

In the region of the ankle the fascia forms retinacula :

Superior & inferior extensor retinacula

Flexor retinaculum Fibular retinaculum

Cross-section through the left leg (post. View)

Muscles of the anterior compartment of leg dorsiflex the ankles, extend the toes, & invert the foot.

(deep fibular nerve).

Muscles in the posterior compartment plantarflex the ankle, flex the toe, & invert the foot.

(tibial nerve).

Muscles in the lateral compartment evert the foot.

(superficial fibular nerve).

Muscles of anterior compartment

1. Tibialis anterior Dorsiflexion & inversion of

the foot at the ankle. 2. Extensor digitorum

longus Extension of lateral 4 digits

& dorsiflexion of the ankle 3. Extensor hallucis

longus Extension of big toe &

dorsiflexion of the ankle Deep fibular nerve from

common fibular nerve

1

2

3

Muscles of lateral compartment

1. Fibularis longus Eversion & plantar

flexion of foot. 2. Fibularis brevis Eversion & plantar

flexion of foot.

Superficial fibular nerve from common fibular nerve

1

2

Muscles of posterior compartment (superficial layer)

1. Triceps surae muscle has

• 2 heads of gastroecnemius muscle

Plantaflexion of foot & flexion of knee joint.• 1 head of soleus

muscle Plantarflexion of

foot

Muscles of posterior compartment (deep layer)

2. Popliteus Flexion of knee joint 3. Flexor digitorum

longus Flexion of DIP of lateral 4

digits 4. Flexor hallucis longus Flexion of big toe 5. Tibialis posterior Plantarflexion & inversion

of foot

Tibial nerve

2

3

4

5

Muscles responsible for ankle joint movements (fig.B)

Dorsiflexion : 1. Tibialis anterior2. Extensor digitorum

longus3. Extensor hallucis longus

Plantarflexion :1. Triceps surae2. Tibialis posterior3. Flexor digitorium longus4. Flexor hallucis longus

Movements of knee & ankle

Surface Anatomy1.

Surface Anatomy2.

Surface Anatomy3.

POWER REVIEW1.

1. What are the 4 regions of the lower limb, and which bones are found in each region? Hip: ilium, Ischium, & pubis Thigh: Femur & patella Leg: Tibia & fibula Foot: Tarsal bones, metatarsal bones, &

phalanges. 2. Name the 7 tarsal bones

Talus, Calcaneus, Cuboid bone, Navicular bone, Cuneiform bones (3)

POWER REVIEW2.

3. what is the largest and most posterior tarsal bone? The calcaneus

4. what structure inserts into the posterior surface of the calcaneus? The tendon calcaneus (Achilles tendon)

5.the calcaneus articulates with which 2 tarsal bones? The talus & the cuboid bone

POWER REVIEW3.

6. The talus articulates with which 2 tarsal bones? The calcaneus & the navicular bone

7. The navicular bone articulates with which 5 tarsal bones? The talus, the cuboid bone, and the 3

cuneiform bones. 8. which movements occur around the

intertarsal joints? Inversion & eversion of the hindfoot

POWER REVIEW4.

9. which muscle is the major flexor at the hip joint?

Iliopsoas. 10. name the external rotators of the hip

Piriformis, Gemellus superior, Obturator internusGemellus inferior, Obturator externus, Quadratus femoris

11. Name the 5 ligaments that are associated with the hip joint.

Iliofemoral ligament, ischiofemoral ligament, pubofemoral ligament

Transverse acetabular ligament, ligament capitis femoris

POWER REVIEW5.

12. list the 4 muscles of the posterior thigh compartment.

Semimembranous m., semitendinous m., biceps femoris m. (long & short head), adductor

magnus m. (hamstring part) 13.what are the “hamstring” muscles?

The semimembranous m., the tendinosus m., the long head of the biceps femoris m., and

the adductor magnus m. (hamstring part)

POWER REVIEW 6.

14. which of the medial thigh muscles contributes to the action of the hamstrings?

The adductor magnus muscle has 2 portions with separate insertions & innervations, 1 of which contributes to the action of the hamstrings (flex the leg).

15. list the 6 muscles of the medial thigh compartment.

Pectineus m., adductor longus m., Adductor magnus m., (adductor part), Adductor

brevis m., Gracilis m., Obturator externus m.

POWER REVIEW 7.

16. list the 3 muscles of the anterior compartment of the thigh. Iliopsoas m., Sartorius m., Quadriceps

femoris m.

17. which 4 muscles contribute to the quadriceps femoris muscles? Rectus femoris m., Vastus lateralis m., Vastus medialis m., Vastus intermedius m.,

Review Questions.1

1. Which of the following muscles is located in the posterior aspect of the thigh?

2. All of the following muscles are lateral rotators of the thigh EXCEPT

3. The deep fascia of the thigh is known as which of the following?

4. The medial and lateral malleoli articulate with which of the following bones?

5. Which of the following muscles is the strongest flexor of the hip joint?

Review Questions.2

6. The strongest dorsiflexor of the foot is which of the following muscles?

7. All of the following muscles are lateral rotators of the hip joint EXCEPT

8. Which of the following groups of muscles produce dorsiflexion of the ankle?

9. Which of the following muscles is a flexor of the knee joint?

10. All of the following muscles are located in the deep muscle group of the posterior compartment EXCEPT

Review Questions.3

11. Which of the following muscles is the strongest dorsiflexor and invertor of the foot?

12. Muscles that evert the foot include which of the following muscles?

13. Which of the following muscles dorsiflex the ankle?

14. All of the following statements concerning the popliteal fossa are correct EXCEPT

15. Which of the following muscles is located in the posterior aspect of the thigh?

Review Questions.4

16. All of the following muscles are lateral rotators of the thigh EXCEPT

17. All of the following statements concerning the gluteus medius and minimus are correct EXCEPT

18. All of the following statements concerning the gluteus maximus are correct EXCEPT

19. All of the following statements concerning the femoral triangle are correct EXCEPT

20. All of the following statements concerning the adductor magnus are correct EXCEPT

21. Which of the following statements concerning the gracilis muscle is correct?

No one can become really educated without having pursued some study in which he took no interest--for it is a part of education to learn to interest ourselves in subjects for which we have no aptitude.………………..references………………………….Dr. Bolgova PPt.Gray’s Anatomy for students, 2nd edition

T. S. Eliot