THIGH dr. borhan.ppt

7/27/2019 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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QUADRICEPS FEMORIS

4 parts:

- rectus femoris

- vastus lateralis

- vastus intermedius

- vastus medialis


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Action

- inserted into the patella & via theligamentum patellae into the tibial

tuberosity.

- powerful extensor of the knee joint- lowest fibers of v. medialis are horizontal

& prevent lateral displacement of patella

- the tone of quadriceps greatly strengthensthe knee joint


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FEMORAL ARTERY

Enters the thigh behind the inguinalligament

Continuation of external iliac artery Midway between the anterior superior iliac

spine & symphysis pubis

Main arterial supply of the lower limb

Ends at the adductor hiatus

Continues as popliteal artery


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Branches

- superficial circumflex iliac artery

- superficial epigastric artery

- superficial external pudendal artery

- deep external pudendal artery

- profunda femoris artery


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FEMORAL VEIN

Tributaries

- great saphenous vein

FEMORAL VEIN


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FEMORAL VEIN

CATHETERIZATION

Rapid access to a large vein


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FEMORAL NERVE

Largest branch of the lumbar plexus

L2, 3, 4

Lateral to the femoral artery

Supplies all muscles of the anterior

compartment


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MEDIAL COMPARTMENT

Muscles:

- gracilis

- adductor longus

- adductor brevis

- adductor magnus

- obturator externus

Blood supply: profunda femoris & obturator arteries

Nerve supply: obturator nerve


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GRACILIS

Origin: outer surface inferior ramus of pubis

Insertion: upper part of the medial side of

tibia Nerve supply: obturator

Action: adducts the thigh, flexes the leg


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ADDUCTOR LONGUS

Origin: body of pubis

Insertion: linea aspera


Action: adducts the thigh & assists in lateral

rotation


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ADDUCTOR BREVIS

Origin: inferior ramus of pubis

Insertion: linea aspera



rotation


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ADDUCTOR MAGNUS

Adductor & hamstring portions

Origin: inferior ramus of pubis, ramus of

ischium, ischial tuberosity Insertion: linea aspera, adductor tubercle



rotation; extends the thigh


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OBTURATOR EXTERNUS

Origin: outer surface of obturator membrane

& pubic & ischial rami

Insertion: medial surface of greatertrochanter


Action: laterally rotates the thigh


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POSTERIOR COMPARTMENT


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POSTERIOR COMPARTMENT

Contents

Muscles:

- biceps femoris

- semitendinosus

- semimembranosus

- adductor magnus (hamstring part) Blood supply: profunda femoris artery

Nerve supply: sciatic nerve


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BICEPS FEMORIS

Origin: long headischial tuberosity

short headlinea aspera

Insertion: head of fibula

Nerve supply: tibial n. & common peronael n.

Action: flexes & laterally rotates the leg;

extends the hip joint


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SEMITENDINOSUS

Origin: ischial tuberosity

Insertion: upper part of the medial surface

of the tibia Nerve supply: tibial part of sciatic

Action: flexes & medially rotates the leg;



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SEMIMEMBRANOSUS

Origin: ischial tuberosity

Insertion: posteromedial surface of the

medial condyle of tibia Nerve supply: tibial part of sciatic nerve

Action: flexes & medially rotates the leg;



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THIGH dr. borhan.ppt