lower limb
TRANSCRIPT
The Lower LimbThe Lower Limb
Popliteal Fossaa diamond shaped intermuscular space situated at the back of the knee
the fossa is most prominent when the knee joint is flexed.
Contains:
Popliteal vessels
small saphenous veins
common peroneal and tibial nerves
posterior cutaneous nerve of the thigh
genicular branch of the obturator nerve
connective tissue and lymph nodes
Popliteal Fossa
BOUNDARIES
Laterally: biceps femoris and lateral head of gastrocnemius and plantaris
Medially: semimembranosus and semitendinosus above and medial head of gastrocnemius below
Anterior wall or floor: popliteal surface of femur, posterior ligament of knee joint and politeus muscle
roof: skin, superficial fascia and deep fascia of thigh
Popliteus MuscleORIGIN
Lateral surface of the lateral condyle of femur
INSERTIONAttached to posterior surface of tibia, above the soleal line
NERVE SUPPLY Tibial nerve
ACTION
• medial rotation of tibia on femur• lateral rotation of femur on tibia (if foot is on the ground)• flexion of the knee
Popliteal Arterydeeply placed and enters the popliteal fossa through the opening of adductor magnus as a continuation of adductor magnus
it ends at the level of the lower border of popliteus muscle by dividing into anteror and posterior tibial arteries
Anteriorly: popliteal surface of femur, knee joint and popliteus muscle
Posteriorly: popliteal vein, tibial nerve, fascia and skin
Branches
muscular branches and
articular branches of knee
Popliteal Vein
formed by the junction of the venae comitantes of the anterior and posteror tibial arteries at the lower border of politeus muscle on the medial side of politeal artery
As it ascends through the fossa, it crosses behind the politeal artery so that it comes to lie on its lateral side.
it passes through the opening in the adductor magnus to become femoral vein
Popliteal Vein
TRIBUTARIES
Veins that correspond to branches given off by the popliteal artery
Small Saphenous vein
Arterial anastomosis around the knee joint
To compensate for the narrowing of the popliteal artery, which occurs during extreme flexion of knee, around the knee joint is a profuse anastomosis of small branches of femoral artery with muscular and articular branches of popliteal artery and with branches of anterior and posterior tibial arteries
Popliteal Lymph Nodes
about six lymph nodes are embedded in the fatty connective tissue of popliteal fossa
receive superficial lymph vessels from the lateral side of foot and leg
accompany small saphenous vein into the popliteal fossa
receive lymph from knee joint and from deep lymph vessels accompanying the anterior and posterior tibial arteries
Tibial Nerve
larger terminal branch of sciatic nerve that enters the popliteal fossa
arises in the lower third of thigh
runs downward through the popliteal fossa, lying first on the lateral side of popliteal artery, then posterior and finally medial to it.
Tibial Nerve
BRANCHES
Cutaneous: sural nerve
Muscular branches supply both heads of gastrocnemius, plantaris, soleus and popliteus
Articular branches supply the knee joint
Common Peroneal Nervesmaller terminal branch of sciatic
nerve
arises in the lower third of thigh
runs downward through the popliteal fossa following the medial border of biceps muscle
leaves the fossa by crossing superficially the lateral head of gastrocnemius muscle
passes behind the head of fibula winds laterally around the neck bone, pierces the peroneus longus muscle and divides into two terminal branches:
superficial peroneal nerve
deep peroneal nerve
Common Peroneal Nerve
Branches:
Cutaneous: sural communicating branch runs downward and joins sural nerve and lateral cutaneous nerve of calf that supplies skin on the lateral side of the back of the leg
Muscular branch to the short head of biceps femoris muscle, which arises high up in the popliteal fossa
Articular branches to the knee joint
Posterior Cutaneous of the thigh
A branch of sacral plexus
terminates by supplying the skin over the popliteal fossa
Obturator Nerve
leaves the subsartorial canal with the femoral artery by passing through the opening in the adductor magnus
terminates by supplying knee joint
Facial compartments of Leg
the deep fascia surrounds the leg and is continous above with the deep fascia of thigh
it is attached to the anterior and medial borders of tibia
two intermuscular septa pass from its deep aspect to be attached to fibula
these, together divide the leg into three compartments
anterior, lateral and posterior each having its own muscles, blood supply and nerve supply
Facial compartments of Leg
INTEROSSEROUS MEMBRANE
binds the tibia and fibula together and provides attachment for neighboring muscles
Facial compartments of Leg
RETINACULA OF ANKLE
thickenings of deep fascia that keep the long tendons around the ankle joint in position and act as pulleys
Inferior Peroneal Retinaculum
binds the tendons of the peroneus longus and brevis muscles to lateral side of calacaneum
Facial compartments of Leg
RETINACULA OF ANKLE
Superior Extensor Reticulum
attached to the distal ends of anterior borders of fibula and tibia
Inferior Extensor Reticulum
Y shaped band loacated in front of ankle joint
Facial compartments of Leg
RETINACULA OF ANKLE
Flexor Retinaculum
extends from medial malleolus downward and backward to be attached to the medial surface of calcaneum
binds the tendons of the deep muscles of the back of leg to the back of medial malleolus as they pass forward to enter the sole
Facial compartments of Leg
RETINACULA OF ANKLE
Superior Peroneal Retinaculum
connects the lateral malleolus to the lateral surface of calcaneum
binds the tendons of peroneal longus and brevis to the back of lateral malleolus
Inferior Peroneal Retinaculum
binds the tendons of peroneal longus and brevis muscles to lateral side of calcaneum
Facial Compartments of Leg
Skin
Cutaneous Nerves
Lateral cutaneous of calf - branch of common peroneal nerve, supplies skin on the upper part of lateral surface of leg
Superficial peroneal nerve - branch ofbranch of common peroneal nerve, supplies the skin of the lower part of anterolateral surface of leg
Saphenous nerve - branch of femoral nerve, supplies the skin on anteromedial surface of leg
Facial Compartments of Leg
Skin
Superficial Veins
numerous small veins curve around the medial aspect of leg and ultimately drain into the great saphenous vein
Facial Compartments of Leg
Skin
Lymh Vessels
the greater part of lymph from skin and superficial fascia on the front of the leg drains upward and medially in vessels that follow the great saphenous vein, to end in the vertical group of superficial inguinal lymph nodes.
a small amount of lymph from the upper lateral part of the front of the leg may pass via vessels that accompany the small saphenous vein and drain into the popliteal nodes
Contents of the anterior Fascial Compartment of the
Leg
Muscles: tibialis anterior, extensor digitorum longus, peroneus tertius and extensor extensor hallucis longus
Blood Supply: Anterior tibial artery
Nerve Supply: Deep peroneal nerve
Contents of the anterior Fascial Compartment of the Leg
Muscles of the anterior Fascial compartment of LegMuscles of the anterior Fascial compartment of Leg
muscle origin insertion Nerve Supply nerve root Action
Tibialis anterior
lateral surface of shaft of tibia and
interosserous membrane
Medial cuneiform and base of 1st metatarsal
bone
Deep peroneal
nerveL4, 5
extends foot at ankle joint, inverts
foot at subtalar and transverse
trasal joints; holds up medial
longitudinal arch of foot
Extensor digitorum longus
Anterior surface of shaft of tibula
extensor expansion of lateral four toes
deep peroneal
nerveL5, S1
Extends toes; extends foot at
ankle joint
Peroneus tertiusAnterior surface of
shaft of tibulabase of 5th metatarsal
bone
Deep peroneal
nerveL5, S1
extends foot at ankle joint; everts
foot at subtalar and transverse
tarsal joints
Extensor hallucis longus
anterior surface of shaft of tibula
base of distal phalanx of great toe
Deep peroneal
nerveL5, S1
Extends big toe and foot at ankle joint; inverts foot at subtalar and
transverse tarsal joint
extensor digitorum brevis
Calcaneum
by four tendons into the proximal phalanx of big toe and long extensor
tendons to 2nd, 3rd and 4th toes
deep peroneal
nerveL5, S1 Extends toes
Contents of the anterior Fascial Compartment of the Leg