Prezentace aplikace PowerPoint

Charles University in Prague - 1st Faculty of Medicine
Muscles, osteofascial compartments,
vessels, and nerves of the lower limb
Institute of Anatomy, First Faculty of Medicine
Author: David Sedmera
Subject: Anatomy 1
Date: 5.11.2012

Overview of muscle groups
• Muscles of the hip joint (3 groups)
• Thigh muscles (3 groups)
• Muscles of the leg (3 groups)
• Muscles of the foot (2 groups)

Muscles of the hip joint
(musculi coxae)
• Anterior group (flexors)
• Posterior group:
- gluteal (superficial)
- pelvitrochanteric (deep)

Muscles of the hip joint
(musculi coxae)
• Anterior group muscles:
-iliacus
-psoas major
-(psoas minor)
• Function: flexors
• Innervation: lumbal plexus (Th12 - L4)

Muscles of the hip joint
(musculi coxae)
• Posterior group muscles - gluteal
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fasciae latae
• Function: abductors, extensors, rotators
• Innervation: sacral plexus (L4 - S2), directly
or via gluteal nerves

Muscles of the hip joint
(musculi coxae)
• Posterior group muscles - deep (aka.
pelvitrochanteric) muscles
- piriformis
- mm. gemelli (superior and inferior)
- obturatorius internus (tendon - landmark)
- quadratus femoris
• Function: mainly outer rotators
• Innervation: sacral plexus (L4 - S2)

Thigh muscles (musculi femoris)
• Ventral (anterior) group (quadriceps,
sartorius - knee extensors)
• Medial group (adductors)
• Posterior (dorsal) group (knee flexors)

Thigh muscles (musculi femoris)
• Ventral (anterior) group
- m. sartorius - tailor’s muscle
- quadriceps femoris (4 heads):
rectus femoris
vastus medialis,
intermedius,
lateralis
• Innervation: femoral nerve (L2 - L4)

Thigh muscles (musculi femoris)
• Medial group muscles (inner thigh):
- pectineus
- gracilis
- adductor longus, brevis, magnus
- obturatorius externus
• Innervation: obturator nerve (L2 - L4);
pectineus and add. magnus bineural

Thigh muscles (musculi femoris)
• Posterior group muscles (hamstring):
- biceps femoris
- semitendinosus
- semimembranosus
• Innervation: sciatic nerve (n.
ischiadicus, L4 - S2)

Leg muscles (musculi cruris)
• Anterior group (digit and foot extensors
and foot supinators)
• Lateral group (supplemental foot flexors
and pronators)
• Dorsal (calf) group (foot and digit
flexors)
• Tough fascial compartments -
compartment syndrome!

Leg muscles (musculi cruris)
• Anterior group
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
• Innervation: deep peroneal nerve (n.
peronaeus profundus, L4 - S1)

Leg muscles (musculi cruris)
• Lateral group
- peronaeus longus
- peronaeus brevis
• Inervation: n. peronaeus superficialis
(L5 - S1)

Leg muscles (musculi cruris)
• Posterior group
- superficial layer:
- triceps surae,
- plantaris - deep layer:
- popliteus
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus
• Innervation: n. tibialis (L4 - S2)

Foot muscles (musculi pedis)
• Plantar muscles:
- muscles of the big toe (medial compartment)
- muscles of the little toe (lateral compartment)
- central compartment
- mm. interossei
Inervation: n. plantaris medialis et lateralis via n.
tibialis (S1-S2)
• Muscles of the dorsum of the foot (extensors)
- ext. digitorum brevis and ext. hallucis brevis
Inervation: n. peronaeus profundus (L4-S1)

Foot muscles (musculi pedis)
- medial (big toe) compartment -
• M. abductor hallucis
• M. flexor hallucis brevis
• M. adductor hallucis

Foot muscles (musculi pedis)
- lateral (little toe) compartment -
• M. abductor digiti minimi
• M. flexor digiti minimi brevis
• M. opponens digiti minimi

Foot muscles (musculi pedis)
- central compartment -
• M. flexor digitorum brevis
• Mm. lumbricales
• M. quadratus plantae

Foot muscles (musculi pedis)
- musculi interossei -
• Mm. interossei plantares (3 ; 3., 4., 5. toe)
• Mm. interossei dorsales (4; axis = 2. toe)
• M. quadratus plantae

Muscles supporting the foot arch
• Foot arch is supported by ligaments
• Longitudinal muscles (“bow string”):
- tibialis posterior
- flexor digitorum longus
- flexor hallucis longus
- abductor and flexor hallucis brevis
• Tibialis anterior and peroneus longus -
tendinous support of the transverse arch

Muscle groups and their
nerves
• Dorsal group - extensors:
-dorsal hip joint group (glutei mm. and nn.)
-anterior group of the thigh (femoral n.)
-anterior and lateral group of the leg (peroneal n.)
-dorsum of the foot (deep peroneal n.)
• Ventral group - flexors:
-posterior group of the thigh (hamstrings, sciatic n.)
-medial group of thigh (adductors, obturator n.)
-calf muscles (tibial nerve)
-muscles of the sole of the foot (branches of tibial n.)

Coming up next time:
Vessels and nerves of the lower
limb

Lower limb vessels
• Arteries - femoral artery and its branches
• Veins:
- deep system (accompanies arteries)
- superficial system - great and small
saphenous vv. - varices, by-pass grafts
• Lymphatic vessels

Femoral artery
• Circumflexa ilium
superficialis
• Epigastrica
superficialis
• Pudenda externa
• Profunda femoris +
rami perforantes I-III
• Circumflexa femoris
medialis et lateralis
• Rami musculares

• A. genus descendens
- rr. articulares
- r. saphenus
• Anastomoses around the
knee joint
• Rete articulare et patellae
• A. poplitea

Femoral angiography
• Profunda femoris +
rami perforantes I-III
• Circumflexa femoris
medialis et lateralis

Blood supply to the
posterior thigh
muscles
• Profunda femoris +
rami perforantes I-III
• A. poplitea and
anastomoses around
the knee joint
• Topography in the
popliteal fossa:
AVeN!
(from deep to
superficial)

Blood supply to
the leg
• A. poplitea and
anastomoses around
the knee
• A. tibialis anterior
• A. tibialis posterior
et a. fibularis
PLEASE learn to feel
the pulsations around
the ankles and on the
dorsum of the foot!

• A. poplitea and
anastomoses around
the knee
• A. tibialis anterior
• A. tibialis posterior
et a. fibularis

Arteries of the foot -
dorsal view
• A. dorsalis pedis
- palpable between
the tendons of m.
extensor hallucis
longus and extensor
digitorum longus

Arteries of the foot -
plantar view
• posterior tibial artery
passes behind the
medial malleolus
• arterial arch
analogous to palmar
• individual variations
• lower limb ischemia
in diabetes:
gangrene =>amputation

Veins of the lower limb
- deep system (follows the arteries)
- superficial network - great and small
saphenous vein - varices (in valvar
insufficiency); potentially redundant =>
material for by-pass (of clogged coronary
arteries)
- deep venous thrombosis => lung embolism

Femoral vein and
its tributaries
Great saphenous vein
Relationship of structures
in trigonum femorale
under the inguinal
ligament:
(Clo)VAN
significance:
catheterization of femoral
artery and vein

Lymphatic drainage of the lower
limb
• Follows the course of veins
• Regional lymph node groups:
- nodi lymphatici poplitei
- nodi lymphatici inguinales
• Knowledge of this is necessary to
understand tumor spreading and
searching for infectious foci.

Lymphatic vessels of the lower
limb

Nerves of the lower limb
• Thigh:
- anterior group - n. femoralis (L2-L4)
- adductors - n. obturatorius (L2-L4)
- posterior group - n. ischiadicus (L4-S2)

Nerves of the thigh

Nerves of the lower limb
• Leg:
- anterior group - n. peronaeus
profundus
- lateral group - n. peronaeus
superficialis
- posterior group - n. tibialis

Nerves of the leg

Nerves of the lower limb
• foot:
- plantar muscles -
n. plantaris
medialis et
lateralis (via n.
tibialis)
- extensors - n.
peronaeus
profundus

Embryology of lower limb
• Skeleton (cingulum, stylopodium,
zeugopodium, autopodium)
• Muscles (dorsal group - extensors, ventral
group - flexors)
• Parallel to fin of the fish - myoblast migration
• Vessels: sciatic artery (central, axial -
replaced by ventrally located femoral artery in
its proximal segment)
• Reasons for the nervous plexus: safety,
phylogeny

References
• Cihák: Anatomie 1, 3
• Netter: Anatomical atlas (CD version)
• Sobotta: Atlas of anatomy
• Grim M, Druga R et al.: Základy anatomie 5.
Anatomie krajin těla
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