THIGH dr. borhan.ppt

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    LOWER LIMB

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    INTRODUCTION

    The primary function of the lower limb is to

    - support the weight of the body

    - provide a stable foundation in standing,

    walking, running (locomotion)

    Similar in structure to the upper limbs but

    have less freedom of movement

    Connected by the pelvic girdle to the trunk

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    ORGANIZATION

    Gluteal region

    Thigh

    Leg

    Foot

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    BONES OF THE LOWER LIMB

    Pelvic girdle (left & right hip bones)

    Femur

    Patella

    Tibia

    Fibula

    Tarsal bones

    Metatarsal

    Phalanges

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    HIP BONE

    L. os coxae

    Innominate bone

    Large irregular bone

    Formed by the fusion of 3 bones:

    - ilium- pubis

    - ischium

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    United at the acetabulum.

    Pubis and ischium are separated by

    obturator foramen. The 2 hip bones articulated anteriorly at the

    pubic symphysis

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    ILIUM

    Largest part of the hip bone

    Upper expanded plate like part

    Contributes the superior part of acetabulum

    Posterolateral surfacegluteal surface

    Long curved superior border

    iliac crest

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    ISCHIUM

    Posteroinferior part of the hip bone

    Forming posteroinferior aspect of acetabulum

    Upper, thicker partbody

    Lower, thinner partramus

    Ischial spine Ischial tuberosity

    Lesser sciatic notch

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    PUBIS

    Anteromedial part of the hip bone

    Anterior part of acetabulum

    Divided into body & 2 rami

    Articulates with the contralateral pubis at

    the symphysis pubis

    Pubic crest

    Pubic tubercle

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    OBTURATOR FORAMEN

    Large oval or triangular aperture

    Bounded by the pubis & ischium

    Closed by obturator foramen

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    ACETABULUM

    Large, cup-shaped cavity or socket on the

    lateral aspect of the hip bone.

    Articulates with the head of femur to formthe hip joint

    Acetabular notch

    Acetabular fossa

    Lunate surface

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    ANATOMICAL POSITION

    Anterior superior iliac spine &

    anterosuperior aspect of the pubis lie in the

    same vertical plane

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    HIP INJURIES

    Hip fractures are common in serious

    vehicular accidents

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    FEMUR

    Longest & heaviest bone in the body

    Transmits body weight from the hip bone to

    the tibia

    Long bone

    Consists of a body (shaft) & 2 ends

    Superior end consists of head, neck, 2

    trochanters

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    Head of femur projects superomedially &

    slightly anteriorly

    Attached to the body by the neck

    Neck-body angle126

    Less in females

    Neckallows for greater mobility

    But imposes considerable strain

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    Greater & lesser trochanterslarge

    eminences situated at the junction of the

    neck & shaft Intertrochanteric line

    Intertrochanteric crest

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    Body of femur slightly bowed anteriorly

    Smoothly rounded

    Posteriorlylinea aspera

    Has medial & lateral lips

    Lateral lips gluteal tuberosity

    Medial lip spiral line

    Medial & lateral supracondylar lines

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    Condyleslateral & medial condyles

    Separated posteriorly by intercondylar

    notch

    Above the condyles, epicondyles

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    Angle of inclination varies

    Angle - coxa vara (# neck of femur)

    - abduction limited Angle - coxa valga (congenital dislocation of

    hip joint)

    - adduction limited

    Fracture neck of femur

    - elderly

    - osteoporosis (trivial trauma)

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    BLOOD SUPPLY OF FEMUR

    Medial femoral circumflex artery

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    THIGH

    SKIN

    Cutaneous nerves

    1. Lateral cutaneous nerve of the thigh2. Femoral branch of genitofemoral nerve

    3. Ilioinguinal nerve

    4. Medial cutaneous nerve of the thigh5. Intermediate cutaneous nerve of the thigh

    6. Obturator nerve (anterior division)

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    Superficial veins

    1. Great saphenous vein

    2. Small saphenous vein

    3. Perforating veins

    Venous pump

    Varicose veins

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    Lymphatic drainage

    Inguinal lymph nodes

    - superficial inguinal lymph nodes

    - deep inguinal lymph nodes

    Superficial inguinal lymph nodes

    - horizontal group

    - vertical group Deep inguinal lymph nodes

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    DEEP FASCIA

    Fascia lata

    Attached to the iliac crest & inguinal

    ligament

    Laterallythickened to form iliotibial tract

    Saphenous openinggap in the deep fascia,

    just below the inguinal ligament

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    FASCIAL COMPARTMENTS

    3 intermuscular septa

    - lateral intermuscular septum

    - medial intermuscular septum- posterior intermuscular septum

    Compartments of the thigh

    - anterior- medial

    - posterior

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    ANTERIOR COMPARTMENT

    Muscles

    - sartorius

    - quadriceps femoris- iliacus

    - psoas

    - pectineus Blood supplyfemoral artery

    Nerve supplyfemoral nerve

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    SARTORIUS

    Tailors muscle

    Origin: ASIS (anterior superior iliac spine)

    Insertion: upper part of medial surface oftibia

    Nerve supply: femoral nerve

    Action: flexes, abducts, laterally rotates thethigh at the hip joint; flexes & mediallyrotates the leg at the knee joint

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    ILIACUS

    Origin: iliac fossa

    Insertion: join the tendon of psoas to form

    iliopsoas

    Nerve supply: femoral

    Action: flexes the thigh/flexes the trunk

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    PSOAS MAJOR

    Long fusiform muscle that arises in the

    abdomen & descends into the thigh

    Origin: lumbar vertebrae

    Insertion: lesser trochanter of the femur

    Nerve supply: branches from lumbar plexus

    Action: flexes the thigh on the trunk/flexes

    the trunk on the thigh

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    PECTINEUS

    Origin: superior ramus of pubis

    Insertion: upper end of linea aspera just

    below the lesser trochanter Nerve supply: femoral nerve (+ obturator

    nerve)

    Action: flexes & adducts thigh at the hipjoint

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