All joints & Nerves of lower limb

All joints & Nerves of lower limb

This presentation describes in full detail All joints & Nerves of lower limb

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Dr.Sherif Fahmy

August 03, 2019
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Transcript

  1. Knee Joint (Page 167)

  2. Type , Variety Articular Surfaces Type: Synovial. Variety: Modified hinge

    or bicondylar. Articular surfaces: - Lower end of femur (femoral condyles). - Upper surface of tibial condyles. - Back of patella. Dr. Sherif Fahmy
  3. Articular Surfaces

  4. Patella Femoral condyles Tibial condyles Dr. Sherif Fahmy

  5. Lateral epicondyle Groove for popliteus Groove for semimembranosus Dr. Sherif

    Fahmy Grooves related to lateral to lateral femoral condyle & medial tibial condyle
  6. Capsule & Synovial Membrane

  7. Capsule The capsule is absent anteriorly and replaced by tendon

    of quadriceps, patella and ligamentum patellae. Side attachments: -Above to sides of femoral condyles below epicondyles and above groove of popliteus. -Below to the sides of tibial condyle. Posterior attachment: -Above is attached to back of lower end of femur above femoral condyles. -Below is attached to back of tibial condyles and above the groove for semimembranosus. -The capsule is perforated posterolaterally for exit of popliteus m. Dr. Sherif Fahmy
  8. Quadriceps tendon Patella Ligamentum patellae Capsule Ligamentum patellae Dr. Sherif

    Fahmy
  9. Back of capsule of knee joint

  10. Synovial Membrane -It lines the capsule and covers intracapsular structures

    except the articular surfaces. -It forms a sheath around tendon of popliteus during its exit from the capsule. -It forms supra-patellar bursa (between tendon of quadriceps and lower end of femur). -Infra-patellar synovial fold (between back of ligamentum patellae and intercondylar notch) where it covers front and sides of cruciate ligaments. Dr. Sherif Fahmy
  11. Suprapatellar bursa Infrapatellar fold Dr. Sherif Fahmy

  12. Ligaments of Knee Joint A- Extracapsular: 1- Ligamentum patellae. 2-

    Oblique poplitel lig. 3- Fibular collateral lig. 4- Tibial collateral lig. B- Intracapsular: 1- Anterior & posterior cruciate ligaments. 2- Transverse ligament of knee. Dr. Sherif Fahmy
  13. A- Extra-capsular Ligaments

  14. Collateral ligaments and Ligamentum Patellae Ligamentum patellae Ligamentum patellae Tibial

    collateral ligament Fibular collateral ligament Tendon of popliteus Lateral meniscus Medial meniscus Head of fibula Lateral epicondyle Medial epicondyle Medial tibial condyle Dr. Sherif Fahmy
  15. Oblique popliteal ligament Tendon of semimembranosus Dr. Sherif Fahmy

  16. Intra-capsular Ligaments 1- Cruciate ligaments. 2- Transverse ligament of the

    knee.
  17. Cruciate Ligaments (Page 173)

  18. Anterior horn of medial meniscus Anterior cruciate lig. Anterior horn

    of lateral meniscus Posterior horn of lateral meniscus Posterior horn of medial meniscus Posterior cruciate lig. Lateral intercondylar tubercle Dr. Sherif Fahmy
  19. Anterior cruciate lig. Posterior cruciate lig. Cruciate ligament Dr. Sherif

    Fahmy Medial Lateral
  20. Tibial tuberosity Anterior cruciate lig.

  21. Tibial tuberosity Posterior cruciate lig.

  22. Anterior Cruciate Ligament Posterior Cruciate Ligament Lower attachment Course Upper

    attachment Becomes tense Functions Anterior part of intercondylar eminence between anterior horns of 2 menisci Posterior part of intercondylar eminence behind posterior horns of 2 menisci Upwards, backwards and laterally. Upwards, forewords and medially. Posterior part of medial surface of lateral femoral condyle. Anterior part of lateral surface of medial femoral condyle. In terminal stage of extension (during last 15 degrees of extension) In terminal stage of flexion. 1- Prevents hyperextension of knee. 2- Prevents anterior displacement of tibia during extension. 1- Prevents posterior displacement of tibia during flexion, because it becomes tense at complete flexion.
  23. Transverse Ligament of Knee

  24. Lateral meniscus Medial meniscus Transverse ligament of knee Dr. Sherif

    Fahmy
  25. Lateral & Medial Menisci (Page 171)

  26. Medial meniscus Lateral meniscus Dr. Sherif Fahmy Horns (ends) of

    Medial meniscus Horns (ends) of Lateral meniscus Lateral tubercle of intercondylar eminence Tibial tuberosity
  27. Medial meniscus Lateral meniscus Transverse ligament of knee Dr. Sherif

    Fahmy Anterior horns (ends) Posterior horns
  28. Functions of the menisci 1- Shock absorbent between femur and

    tibia. 2- Increase the concavity of the tibial condyles to give more stability to the knee joint.
  29. Intracapsular Structures (Page 171)

  30. Intra-capsular Structures Synovial Membrane: 1- Supra-patellar bursa. 2- Infra-patellar fold.

    Ligaments: 1- Anterior & posterior cruciate ligaments. 2- Transverse ligament of knee. Cartilages: 1- Lateral & medial menisci. Tendon: 1- Tendon of popliteus and its synovial sheath. Fat: -Infra-patellar pad of fat. Dr. Sherif Fahmy
  31. Movements of Knee Joint 1- Flexion & Extension 2- Medial

    & lateral rotations. ➢ Active (voluntary) (only with semiflexed knee). ➢ Passive (involuntary) (During locking & unlocking). Dr. Sherif Fahmy
  32. Locking & Unlocking (Page 174)

  33. A- Locking

  34. Mechanism of locking: -At the beginning of extension the 2

    femoral condyles glide equally over the tibial condyles. -During the last 15 degrees, the anterior cruciate ligament becomes tense. -This will lead to stop of lateral condyle gliding while the medial condyle continues gliding leading to medial rotation of femur over tibia. -This lead to stretch of collateral and oblique popliteal ligament in addition to anterior cruciate lig. and locking of knee. Dr. Sherif Fahmy
  35. B- Unlocking

  36. Mechanism of unlocking: -Unlocking occurs by either: -Medial rotation of

    tibia, if tibia is free from ground. -Lateral rotation of femur, if tibia is on the ground. -Both movements produced by the action of popliteus helped by hamstrings Dr. Sherif Fahmy
  37. Nerve Supply of Knee 1- Genicular branches from medial popliteal

    nerve. 2- Genicular branches from common peroneal nerve. 3- Femoral n. through branch to vasti of quadriceps femoris m. 4- Obturator n. from its posterior division. Dr. Sherif Fahmy
  38. Arterial Supply -Anastomosis around the knee

  39. Bursae Around the Knee (Page 178)

  40. None
  41. Anterior to Knee: 1- Supra-patellar. 2- Subcutaneous pre-patellar. 3- Subcutaneous

    infra-patellar. 4- Deep infra-patellar. Dr. Sherif Fahmy
  42. Bursae on Medial & Lateral Sides of Knee joint Bursae

    on medial side Bursae on lateral side 1- Between medial head of gastrocnemius and capsule of knee j. 1- Between lateral head of gastrocnemius and capsule of knee j. 2- Between SGS tendons and capsule of knee j. 2- Between tendon of biceps and fibular collateral ligament. 3- Between semimembranosus and medial tibial condyle. 3- Between tendon of popliteus and lateral condyle of tibia.
  43. Applied Anatomy of knee joint 1- Genu valgum (knock knee).

    Due to tear of tibial collateral ligament after trauma on the lateral aspect of knee joint. The joint becomes opened medially. May be associated with injury of medial meniscus and anterior cruciate ligament, Dr. Sherif Fahmy
  44. None
  45. None
  46. Tibio-Fibular Joints

  47. None
  48. None
  49. None
  50. Ankle Joint (Page 197)

  51. None
  52. None
  53. Neck of talus Navicular bone Spring ligament Deltoid ligament Sustentaculum

    tali Body of talus Medial malleolus
  54. Anterior talo-fibular lig. Posterior talo- fibular ligament Calcaneo- fibular lig.

  55. Relations of Ankle Joint

  56. None
  57. None
  58. None
  59. Anastomosis Around Knee (Page 201)

  60. None
  61. None
  62. Anastomosis Around Ankle (page 202)

  63. None
  64. None
  65. Retinacula (Page 203)

  66. Extensor Retinacula

  67. None
  68. None
  69. Peroneal Retinacula

  70. None
  71. None
  72. Flexor Retinacula

  73. None
  74. Intertarsal Joints (Page 206)

  75. Subtalar Joint

  76. None
  77. None
  78. Ligaments of subtalar joint: 1- Lateral talo-calcanean. 2- Medial talo-calcanean.

    3- Interosseous talo-calcanean.
  79. None
  80. Talo-calcaneo- navicular joint

  81. None
  82. None
  83. Ligaments of talo-calcaneo- navicular joint: 1- Spring (plantar calcaneo-navicular) 2-

    Calcaneo-navicular. 3- Talo-navicular.
  84. (Spring lig.)

  85. Calcaneo-navicular lig.

  86. Calcaneo-cuboid Joint

  87. None
  88. Ligaments of calcaneo-cuboid joint: 1- Bifurcate ligament. 2- Short plantar.

    3- Long plantar.
  89. Calcaneo-navicular lig.

  90. Short plantar lig. Tendon of peroneus longus m. Long plantar

    lig. Spring lig.
  91. Ligaments of Foot (Page 209) •1- Spring Ligament. •2- Bifurcate

    ligament. •3- Long plantar ligament. •4- Short plantar ligament.
  92. None
  93. None
  94. Short plantar lig. Tendon of peroneus longus m. Long plantar

    lig. Spring lig.
  95. Inversion & Eversion (Page 211)

  96. None
  97. Inversion: Elevation of inner border of foot with sole directed

    medially. Eversion: Elevation of outer border of foot with sole is directed laterally. Joints: 1- Subtalar joint. 2- Talo-calcaneo-navicular joint. Mechanisms: -Calcaneus and navicular swing around relatively fixed talus. -Muscles: Innvertors & Evertors
  98. Cutaneous Nerve Supply of Lower Limb

  99. None
  100. None
  101. Dermatomal Cutaneous Supply

  102. None
  103. Superficial Veins of Lower Limb

  104. None
  105. Lymph Drainage of Lower Limb

  106. None
  107. None
  108. Body Weight Transmission (Page 223)

  109. None
  110. None
  111. Mechanism of Walking (Page 224) • Stance phase: when foot

    on the ground. • Swing phase: when foot is off the ground.
  112. None
  113. Stance phase

  114. None
  115. Swing phase

  116. Arches of Foot

  117. None
  118. None
  119. None
  120. None
  121. None
  122. None
  123. Foot

  124. Dorsum of Foot (Page 160)

  125. Structures in the Dorsum of Foot 1- Dorsi-flexors tendons. 2-

    Extensor digitorum brevis. 3- Dorsalis pedis artery. 4- Divisions of anterior tibial nerve.
  126. Calcaneus Talus Navicular Cunieform bones Cuboid Bony Skeleton of Dorsum

  127. Muscles, Vessels & Nerves of Anterior Compartment of Leg

  128. Tibialis anterior m. Extensor digitorum longus Extensor halluces longus m.

    Peroneus tertius m. Superior extensor retinaculum Inferior extensor retinaculum Anterior tibial vessels & nerve
  129. Extensor Digitorum Brevis

  130. Attachments of Ext.Digit.Brevis Origin of extensor digitorum brevis Extensor expansions

    of middle 3 toes Extensor halluces brevis
  131. Extensor Digitorum brevis

  132. Divisions of Anterior Tibial Nerve

  133. Medial division Anterior tibial nerve Lateral division

  134. Dorsalis Pedis Artery (Page 160)

  135. Course

  136. Dorsalis pedis artery Anterior tibial artery

  137. Anterior tibial artery Dorsalis pedis art Navicular bone Intermediate cunieform

    Proximal part of 1st intermetatarsal space Course of dorsalis pedis artery
  138. Relations of Dorsalis Pedis Artery

  139. Superficial Relations Inferior extensor retinaculum Extensor hallucis brevis

  140. Medial and lateral relations Tendon of tibialis anterior muscle Tendon

    of extensor hallucis longus Dorsalis pedis artery Medial division of anterior tibial nerve Tendon of extensor digitorum longus
  141. Talus Navicular bone Intermediate cunieform Deep relations

  142. Branches of Dorsalis Pedis artery 1- Medial tarsal artery. 2-

    Lateral tarsal artery. 3- Arcuate artery which gives 2nd, 3rd, 4th dorsal metatarsal arteries. 4- First dorsal metatarsal artery.
  143. 1-Medial tarsal artery 2-Lateral tarsal artery. 3-Arcuate artery 2nd, 3rd

    and 4th dorsal metatarsal arteries 4- First dorsal metatarsal artery Proximal perforating Distal perforating
  144. Surface Anatomy A line extending from midway between 2 malleoli

    to proximal part of 1st intermetatarsal space.
  145. None
  146. Anastomosis of dorsalis pedis artery 1- Around ankle. 2- With

    plantar arch and plantar metatarsal arteries through perforating arteries.
  147. Applied Anatomy Causes of failure to feel its pulsation: 1-

    in 15% it is absent it could be replaced by perforating br. from peroneal artery. 2- Thrombus in femoral, popliteal or anterior tibial arteries.
  148. Sole of Foot Dr. Sherif Fahmy

  149. Skeleton of Lower surface of foot Calcaneus Medial tubercle Lateral

    tubercle Sustentaculum tali Cuboid bone Navicular bone Navicular tuberosity 1st metatarsal bone 5th netatarsal Base Head Proximal phalynx Metatarso-phalangeal joints Dr. Sherif Fahmy
  150. Plantar Aponeurosis.

  151. Plantar aponeurosis Medial tubercle of calcaneus Thin medial part Thin

    lateral part 5 slips of plantar aponeurosis Dr. Sherif Fahmy
  152. Muscles of Sole of Foot

  153. First Layer 1- Abductor Hallucis. 2- Flexor digitorum brevis. 3-

    Abductor digiti minimi.
  154. Abductor hallucis Abductor digiti minimi Flexor digitorum brevis Dr. Sherif

    Fahmy
  155. Second Layer 1- Tendon of flexor hallucis longus. 2- Tendon

    of flexor digitorum longus. 3- Lumbericals muscles. 4- Flexor Digitorum accessorius.
  156. Tendon of flexor digitorum longus Flexor digitorum accessorius Tendon of

    flexor hallucis longus Lumbricals Dr. Sherif Fahmy
  157. Third layer 1- Flexor hallucis brevis. 2- Adductor Hallucis. 3-

    Flexor digiti minimi brevis.
  158. Flexor digiti minimi brevis Flexor hallucis brevis Adductor hallucis Cuboid

    bone Aponeurosis Dr. Sherif Fahmy
  159. Fourth Layer 1- Dorsal interossii muscles. 2- Plantar interossii muscles.

    3- Tendon of peroneus longus muscle. 4- Tendon of tibialis posterior muscle.
  160. Dorsal interossie Tendon of peroneus longus Tibialis posterior tendon Dr.

    Sherif Fahmy
  161. Plantar interossei Dr. Sherif Fahmy

  162. Nerves & Vessels of The sole

  163. Flexor retinaculum Medial malleolus Heel Posterior tibial vs & n

    Dr. Sherif Fahmy
  164. Plantar Nerves

  165. Medial plantar nerve Lateral plantar nerve Dr. Sherif Fahmy

  166. 1- Medial Plantar Nerve

  167. Abductor hallucis m. Flexor digitorum brevis Medial plantar nerve Dr.

    Sherif Fahmy
  168. 2- Lateral Plantar Nerve

  169. Abductor hallucis m. Flexor digitorum brevis Lateral plantar nerve Dr.

    Sherif Fahmy
  170. Flexor digitorum accessorius Lateral plantar nerve Superficial branch Base of

    5th metatarsal bone Deep branch Plantar arch Dr. Sherif Fahmy
  171. Plantar Arteries

  172. 1- Medial Plantar Artery

  173. Abductor hallucis m. Flexor digitorum brevis Medial plantar artery Dr.

    Sherif Fahmy
  174. 2- Lateral Plantar Artery

  175. Abductor hallucis m. Flexor digitorum brevis Lateral plantar artery Dr.

    Sherif Fahmy
  176. Flexor digitorum accessorius Lateral plantar artery Base of 5th metatarsal

    bone Deep branch of lateral plantar art. Plantar arch Dr. Sherif Fahmy
  177. Deep branch of lateral plantar nerve Plantar arch Termination of

    dorsalis pedis artery 2nd, 3rd and 4th plantar metatarsal arteries 1st plantar metatarsal artery Dr. Sherif Fahmy
  178. Nerves of the Lower Limb

  179. Nerves of the Lower Limb Lumbar Plexus Muscular: -Anterior compartment

    of thigh. -Medial compartment of thigh. Cutaneous: -Lateral, front & medial aspects of thigh. -Medial sides of leg & foot till the root of big toe. Articular: -Hip & knee. Sacral Plexus Muscular: -Gluteal region. -Back of thigh. -muscles of leg & foot. Cutaneous: Rest of lower limb. Articular: All joints of lower limb.
  180. Lumbar Plexus (Page 76)

  181. L1 L2 L3 L4 Ilio- hypogastric n. Ilio-inguinal n. Genito-

    femoral n. Lateral cutaneous nerve of thigh Femoral n. Accessory obturator n. Obturator n. Lumbo-sacral trunk L5 Dr. Sherif Fahmy
  182. Ilio- hypogastric n. Ilio-inguinal n. Lateral cutaneous nerve Femoral n.

    Genito-femoral n. Obturator n. Lumbo- sacral trunk Psoas major m. Iliacus Dr. Sherif Fahmy
  183. Ilio-hypogastric n. Ilio-inguinal n. Lateral cutaneous n. Femoral n. Genitofemoral

    n. Lumbosacral trunk Obturator n. Dr. Sherif Fahmy Psoas major m.
  184. Femoral Nerve (Page 79)

  185. Course of Femoral Nerve

  186. L1 L2 L3 L4 Femoral n. L5 Dr. Sherif Fahmy

  187. Femoral n. Dr. Sherif Fahmy Psoas major m.

  188. Femoral nerve Psoas major Iliacus m. Inguinal lig. Femoral vessels

    inside femoral sheath
  189. It ends 2 cm below inguinal ligament giving multiple branches

    Femoral nerve Dr. Sherif Fahmy
  190. Branches of Femoral Nerve Muscular: -To iliacus, pectineus, Sartorius and

    quadriceps muscles. Cutaneous: -Medial & intermediate cutaneous nerves of thigh. -Saphenous nerve. Articular: -Hip and knee joints.
  191. Saphenous nerve Muscular branches to: -Sartorius m. -Pectineus m. -Quadriceps

    m. muscular branch to iliacus Dr. Sherif Fahmy
  192. Medial cut.n. of thigh Saphenous nerve Femoral n. Dr. Sherif

    Fahmy
  193. Nerve Injury of Femoral Nerve

  194. Nerve Injury of Any Nerve Muscle (motor) loss: name the

    paralyzed muscles. Sensory loss: describe the area of loss of sensation. Disability: describe the lost actions. Deformity: Fixed deformed position of the paralyzed part. Late wasting changes: Decrease the size of paralyzed part.
  195. Nerve Injury of Femoral Nerve Motor loss: paralysis of iliacus,

    pectineus, sartorius and quadriceps muscles. Sensory loss: loss of sensation at medial side & front of thigh, medial side of leg & foot till the root of big toe. Disability: Inability to extends the knee against resistance (Extension by ilio-tibial tract could be done) and weak flexion of hip. Deformity: Flexed knee and extended hip. Late wasting changes: decrease the size of the front of thigh. Dr. Sherif Fahmy
  196. Obturator Nerve (Page 90)

  197. L1 L2 L3 L4 Accessory obturator n. Obturator n. L5

    Dr. Sherif Fahmy
  198. Obturator nerve Dr. Sherif Fahmy

  199. Lumbar plexus Obturator n. Obturator n. in obturator canal Dr.

    Sherif Fahmy
  200. Obturator nerve Obturator externus Adductor brevis Adductor longus m. Anterior

    division Posterior division Gracilis Lateral pelvic wall Adductor longus Obturator canal Dr. Sherif Fahmy
  201. Pectineus (cut) Obturator externus Anterior division of obturator nerve Adductor

    brevis Posterior division of obturator n. Gracilis Adductor longus (cut) Adductor magnus Dr. Sherif Fahmy Dr. Sherif Fahmy
  202. Nerve Injury Causes: Very rare injury. Results: Motor loss: -Paralysis

    of adductor muscles except pectineus. Sensory loss: -Loss of sensation on middle part of medial aspect of thigh. Dr. Sherif Fahmy
  203. Disability: -Loss of adduction of thigh and weak medial rotation.

    Deformity: -The thigh is abducted and laterally rotated. Late wasting changes: -Decrease size of medial side of thigh. Dr. Sherif Fahmy
  204. Sacral Plexus

  205. Sacral plexus

  206. Ala of sacrum Lumbo- sacral trunk S1 Ventral primary rami

    of S1-4 leaving anterior sacral foramena Hip bone Sacrum Sciatic nerve Pudendal nerve
  207. L4 L5 S1 S2 S3 S4 Superior gluteal n. Inferior

    gluteal n. N. to piriformis Common peroneal part of sciatic n, Tibial part of sciatic nerve N. To obturator internus N.To quadratus femoris Perforating cutaneous n. Pudendal n. Posterior cut. N. of thigh Perineal br.of S4 Anterior division Posterior division Lumbo-sacral trunk Ventral primary rami Dr. Sherif Fahmy
  208. Roots Ventral Divisions Dorsal Divisions` Grey rami Pelvic splanchnic nerve

    (S2,3,4) N.To obturator internus (L5,S1,2) N. To quadratus femoris (L4,5,S1) Pudendal nerve (S1,2,3) Perineal br.of S4 Tibial part of sciatic nerve (L4,5,S1,2,3) N.to levator ani and coccygeus (S2,3) Superior gluteal nerve (L4,5,S1) Inferior gluteal nerve (L5,S1,2) N.to piriformis (S1,2) Perforating cutaneous (S2,3) Common peroneal part of sciatic (L4,5S1,2) Posterior cutaneous nerve of thigh (S1,2,3) Dr. Sherif Fahmy
  209. Divisions of superior gluteal nerve Posterior cutaneous nerve of thigh

    Sciatic nerve Inferior gluteal nerve N.To obturator internus Pudendal nerve Piriformis Dr. Sherif Fahmy
  210. Sciatic Nerve (Page 114)

  211. Sciatic nerve Gluteal Region Back of the thigh Dr. Sherif

    Fahmy Dr. Sherif Fahmy
  212. Course of Sciatic Nerve

  213. L4 L5 S1 S2 S3 S4 Common peroneal part of

    sciatic n, Tibial part of sciatic nerve Dr. Sherif Fahmy
  214. Piriformis Greater sciatic foramen Back of ischium Posterior superior iliac

    spine Ischeal tuberosity Tip of greater trochanter Capsule of hip joint Sciatic nerve Dr. Sherif Fahmy Dr. Sherif Fahmy
  215. Greater sciatic foramen Common peroneal nerve. Tibial nerve Sciatic Nerve

    Dr. Sherif Fahmy
  216. Relations of Sciatic Nerve 1- Superficial. 2- Deep.

  217. Superficial Relations

  218. Dr. Sherif Fahmy Long head of biceps femoris Posterior cutaneous

    n. of thigh Sciatic nerve
  219. Deep Relations

  220. Sciatic nerve Nerve to quadratus femoris Dr. Sherif Fahmy

  221. Back of ischium Superior gemellus Tendon of obturator internus Inferior

    gemellus Quadratus femoris Adductor magnus Dr. Sherif Fahmy
  222. High Division of Sciatic Nerve

  223. Tibial part Common peroneal part Piriformis Dr. Sherif Fahmy

  224. Branches of Sciatic Nerve Tibial division: to semimembranosus, long head

    of biceps femoris, semitendinosus and ischeal part of adductor magnus. Common peroneal division: To short head of biceps femoris. Articular branch: to hip joint. Terminal: Gives Tibial (medial popliteal) and common peroneal (Lateral popliteal).
  225. Surface Anatomy of Sciatic Nerve

  226. Posterior superior iliac spine Ischeal tuberosity Tip of greater trochanter

    Below middle of the back of the thigh Dr. Sherif Fahmy
  227. Injury of Sciatic Nerve

  228. Causes: 1- Posterior dislocation of hip j. 2- Wrong IM

    injection. 3- Stab wound or gun shot. Results: Motor loss: Paralysis of hamstring muscles and all muscles of leg and foot.
  229. Sensory loss: Loss of sensation of skin of leg and

    foot except the medial side till the metatarso- phalangeal joint of big toe and upper part of back of leg. Disability and deformity: Weak flexion of the knee. Loss of all movements of leg & foot. Foot drop and high stepping gait. Late wasting changes: Decrease the size of back of thigh, leg and foot. Dr. Sherif Fahmy
  230. Popliteal Nerves 1- Tibial (Medial popliteal) nerve (L4,5 & S1,2,3).

    2- Common peroneal (Lateral popliteal) nerve (L4,5 & S1,2). Dr. Sherif Fahmy
  231. Tibial (medial popliteal nerve)

  232. Course

  233. Sciatic nerve Dr. Sherif Fahmy Tibial (Medial popliteal nerve

  234. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial

    Superior angle Dr. Sherif Fahmy
  235. Medial popliteal nerve (Tibial) Popliteus Posterior tibial nerve Dr. Sherif

    Fahmy
  236. Lateral popliteal (common peroneal )n.

  237. Sciatic nerve Dr. Sherif Fahmy Common peroneal nerve

  238. Lateral popliteal (common peroneal) n. Lateral Medial Biceps femoris Plantaris

    Lateral head of gastrocnemius Superior angle Lateral angel Dr. Sherif Fahmy
  239. Lateral popliteal nerve (common peroneal nerve) Head of fibula Neck

    of fibula Dr. Sherif Fahmy
  240. Branches of Popliteal Nerves Medial popliteal 1- Genicular (upper medial,

    lower medial and middle). 2- Cutaneous (sural). 3- Muscular (to gastrocnemius, soleus, popliteus and plantaris). Lateral popliteal 1- Genicular (upper lateral, lower lateral and recurrent). 2- Cutaneous (sural communicating, lateral cutaneous n. of calf)
  241. Tibial nerve Common peroneal n. Sural nerve Sural communicati ng

    Dr. Sherif Fahmy
  242. Nerves of the Leg A- Divisions of Common peroneal n.:

    1- Superficial peroneal (Musculocutaneous) n. in the loateral compartment of leg. 2- Deep peroneal (Anterior tibial) n. in the anterior compartment of leg. B- Posterior tibial n.: In the posterior compartment of leg.
  243. Common Peroneal Nerve It ends over the lateral surface of

    neck of fibula by dividing into: - Musculo-cutaneous (superficial peroneal nerve). - Anterior tibial (Deep peroneal) nerve.
  244. Musculo-cutaneous Nerve

  245. Common peroneal nerve Anterior tibial nerve Musculo- cutaneous n. Peroneus

    longus Extensor retinaculum Neck of fibula Dr. Sherif Fahmy
  246. Anterior tibial nerve Musculo- cutaneous nerve Extensor retinacula Dr. Sherif

    Fahmy
  247. Branches of Musculo-cutaneous Nerve Muscular: to peroneus longus and brevis.

    Sensory: To skin of the middle 1/3 of lateral aspect of leg and front of lower 1/3 of leg.
  248. Area supplied by musculo- cutaneous nerve Area supplied by medial

    division of anterior tibial nerve Dr. Sherif Fahmy
  249. Anterior Tibial Nerve (Deep Peroneal) (Page 136)

  250. Course

  251. Anterior tibial nerve Peroneus longus Tibialis anterior n. Extensor halluces

    longus Extensor retinacula Anterior tibial artery Dr. Sherif Fahmy
  252. Medial division Anterior tibial nerve Lateral division Dr. Sherif Fahmy

  253. Injury of Common Peroneal Nerve Causes: -Fracture of neck of

    fibula. Results: Motor loss: - Paralysis of muscles of anterior (Dorsiflexors) and lateral (Evertors) compartments. - Paralysis of extensor digitorum brevis. Dr. Sherif Fahmy
  254. Sensory: - Loss of sensation on lateral part of middle

    1/3 and front of lower 1/3 and dorsum of foot except borders. Disability: - Loss of dorsi flexion and eversion. - Weak inversion. Deformity: The foot is plantar flexion (foot drop) and inverted (Equinovarus). Late wasting changes: Decrease the size of anterolateral aspect of leg. Dr. Sherif Fahmy
  255. Posterior Tibial Nerve(Tibial Nerve in back of leg) (Page 154)

  256. Course & Relations

  257. Lower border of popliteus Medial popliteal nerve Tendinous arch Soleus

    Posterior tibial nerve Flexor digitorum longus Tibialis posterior Flexor hallucis longus Back of lower end of tibia Flexor retinaculum Lateral Medial Dr. Sherif Fahmy
  258. Posterior tibial nerve Posterior tibial artery Flexor halluces longus Flexor

    retinaculum Dr. Sherif Fahmy
  259. Posterior tibial nerve Medial plantar nerve Lateral plantar nerve Dr.

    Sherif Fahmy
  260. Injury of Tibial Nerve Causes: - Cut wound or gun

    shot. Results: Motor loss: -Paralysis of muscles of back of leg and sole of foot. Sensory loss: -Loss of sensation on sole of foot. Dr. Sherif Fahmy
  261. Disability: -Weak plantar flexion accompanied with eversion. -Weak inversion. Deformity:

    -The foot is dorsi-flexed and everted. Late wasting changes: -Decrease the size of back of leg and sole of foot. Dr. Sherif Fahmy
  262. Plantar Nerves

  263. Posterior tibial nerve Posterior tibial artery Flexor halluces longus Flexor

    retinaculum Dr. Sherif Fahmy
  264. Medial plantar nerve Lateral plantar nerve Dr. Sherif Fahmy

  265. Medial Plantar Nerve

  266. Abductor hallucis m. Flexor digitorum brevis Medial plantar nerve Dr.

    Sherif Fahmy
  267. Lateral Plantar Nerve

  268. Abductor hallucis m. Flexor digitorum brevis Lateral plantar nerve Dr.

    Sherif Fahmy
  269. Flexor digitorum accessorius Lateral plantar nerve Superficial branch Base of

    5th metatarsal bone Deep branch Plantar arch Dr. Sherif Fahmy
  270. Cutaneous Nerve Supply

  271. None
  272. Dermatomal (Segmental) Nerve Supply of Lower Limb

  273. None