Lower Limb from Back of Thigh to Femoral Artery

This presentation explains Lower Limb from Back of Thigh to Femoral Artery

Transcript

1. Back pf Thigh & Knee
2. Back of Thigh & Knee 1- Hamstring muscles. 2- Sciatic nerve. 3- Popliteal fossa. 4- Popliteal vessels. 5- Popliteal nerves.
3. Sciatic nerve Gluteal Region Back of the thigh Biceps femoris Semitendinosus Semimembranosus Popliteal artery Popliteal vein Popliteal nerves Popliteal fossa Medial Lateral Dr. Sherif Fahmy
4. Muscles of the Back of Thigh
5. Hamstring Muscles 1- Semimembranosus. 2- Semitendinosus. 3- Biceps femoris.
6. Orientation of Hamstring Muscles
7. Biceps femoris Semitendinosus Popliteal fossa Gluteus maximus Gastrocnemius Dr. Sherif Fahmy
8. Ischeal tuberosity Biceps femoris Semitendinosus Semimembranosus Popliteal fossa Adductor magnus Dr. Sherif Fahmy
9. Biceps femoris Semimembranosus Dr. Sherif Fahmy
10. Short head of biceps Long head of biceps (cut) Sciatic nerve Dr. Sherif Fahmy
11. Attachments of Hamstring Muscles
12. Origin of Hamstring Muscles
13. Upper quadrangular part of ischeal tuberosity Dr. Sherif Fahmy
14. Upper & lateral area (for semi- memranosus) Lower medial area (for semi- tendinosus & biceps femoris) Upper quadrangular part Dr. Sherif Fahmy
15. Short head of biceps femoris
16. Insertion of Hamstring Muscles
17. Sartorius Gracilis Semitendinosus biceps femoris Anterior view of knee region Dr. Sherif Fahmy
18. Groove for semimembranosus Insertion of biceps femoris Posterior view of knee region Soleal line Dr. Sherif Fahmy
19. Semimembranosus Muscle
20. Upper lateral area of upper quadrangular part of ischeal tuberosity Semimembranosus Muscle Groove for semimembranosus Oblique popliteal ligament Fascia covering popliteus m. Soleal line Dr. Sherif Fahmy
21. Semitendinosus Muscle
22. Lower medial area of upper quadrangular part of ischeal tuberosity Upper medial side of tibia behind gracilis Semitendinosus Dr. Sherif Fahmy
23. Biceps Femoris Muscle
24. Lower medial area of upper quadrangular part Long head Short head of biceps Linea aspera and lateral supracondylar line Head of fibula Dr. Sherif Fahmy
25. Action of Hamstring Muscles 1- All hamstring muscles flex the knee. 2- All hamstring muscles extend the hip except short head of biceps. 3- Semi-membranosus and semi-tendinosus medially rotate the knee. 4- Biceps femoris laterally rotates the knee. 5- Semitendinosus (one of the guy ropes) stabilizes pelvis over femur. Dr. Sherif Fahmy
26. Nerve Supply of Hamstring Muscles -All hamstring muscles are supplied from tibial part of sciatic -Except short head is supplied by common peroneal part of sciatic nerve. Dr. Sherif Fahmy
27. Sciatic Nerve (Page 114)
28. Sciatic nerve Gluteal Region Back of the thigh Dr. Sherif Fahmy
29. Course of Sciatic Nerve
31. 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
32. Greater sciatic foramen Common peroneal nerve. Tibial nerve Sciatic Nerve Dr. Sherif Fahmy
33. Relations of Sciatic Nerve 1- Superficial. 2- Deep.
34. Superficial Relations
35. Dr. Sherif Fahmy Long head of biceps femoris Posterior cutaneous n. of thigh Sciatic nerve
36. Deep Relations
37. Sciatic nerve Nerve to quadratus femoris Dr. Sherif Fahmy
38. Back of ischium Superior gemellus Tendon of obturator internus Inferior gemellus Quadratus femoris Adductor magnus Dr. Sherif Fahmy
39. 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).
40. High Division of Sciatic Nerve
41. Tibial part Common peroneal part Piriformis Dr. Sherif Fahmy
42. Surface Anatomy of Sciatic Nerve
43. Posterior superior iliac spine Ischeal tuberosity Tip of greater trochanter Below middle of the back of the thigh Dr. Sherif Fahmy
44. Applied Anatomy Causes: 1- Posterior dislocation of hip j. 2- Wrong IM injection. 3- Stab wound or gun shot. Results: 1- Loss of sensation of foot and leg except medial side and upper part of the back of leg. 2- Paralysis of hamstring muscles and all muscles of leg and foot leading to foot drop. N.B. Sciatica: Pain in the back of lower part body, thigh and leg due to pressure on roots of sciatic nerve by tumor or inflammation
45. Site of Intra-muscular Injection Dr. Sherif Fahmy
46. Popliteal Fossa (Page 121)
47. Site, Shape & Boundaries
48. Dr. Sherif Fahmy
49. Popliteal fossa Dr. Sherif Fahmy
50. Biceps femoris Plantaris Semi- memranosus muscle Semi- tendinosus muscle Medial head of gastrocnemius muscle Lateral head of gastrocnemius muscle Lateral Medial Superior angle Inferior angle Lateral angle Medial angle Dr. Sherif Fahmy
51. Roof
52. Skin and deep fascia of roof of popliteal fossa Posterior cutaneous nerve of thigh Short saphenous vein Dr. Sherif Fahmy
53. Floor
54. Popliteal surface of femur Capsule of knee joint Oblique popliteal ligament Popliteal muscle and covering fascia Lateral Medial Dr. Sherif Fahmy
55. Contents of Popliteal Fossa 1- Popliteal artery and branches. 2- Popliteal vein and tributaries. 3- Popliteal nerves (lateral & medial). 4- Termination of posterior cutaneous of thigh. 5- Termination of small saphenous vein. 6- popliteal lymph nodes and fat.
56. Lateral popliteal (common peroneal) n. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial Dr. Sherif Fahmy
57. Popliteal Artery (Page 123)
58. Course
59. Adductor hiatus Popliteal artery Lower border of popliteus m. Posterior tibial art Anterior tibial art It begins It ends Lateral Medial Dr. Sherif Fahmy
60. Relations of Popliteal Artery 1- Superficial (Posterior). 2- Deep (Anterior). 3- Lateral. 4- Medial.
61. Superficial Relations
62. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial Sem-imembranosus Gastrocnemius
63. Deep Relations
64. Popliteal artery Popliteal surface of femur Capsule of knee joint Oblique popliteal lig. Popliteus muscle and covering fascia
65. Lateral & Medial Relations
66. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial Sem- imembranosus Lateral head of gastrocnemius Biceps femoris Popliteal nerves Plantaris Medial head of gastrocnemius Popliteal vein
67. Branches of Popliteal Artery
68. Upper lateral genicular a. Upper medial genicular a. Lower medial genicular a Posterior tibial a. Anterior tibial a. Lower lateral genicular a. Middle genicular a.
69. Nerves in the Popliteal Fossa
70. Nerves in the Popliteal Fossa 1- Tibial (medial popliteal) n. 2- Common peroneal (lateral popliteal) n. 3- Termination of posterior cutaneous n. of thigh.
71. 1- Tibial (medial popliteal nerve)
72. Medial popliteal nerve (Tibial) Lateral popliteal nerve (common peroneal nerve) Head of fibula Neck of fibula Popliteus Posterior tibial nerve
73. Lateral popliteal (common peroneal) n. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial
74. 2-Lateral popliteal (common peroneal )n.
75. Lateral popliteal nerve (common peroneal nerve) Head of fibula Neck of fibula
76. Lateral popliteal (common peroneal) n. Lateral Medial Biceps femoris Plantaris Lateral head of gastrocnemius
77. 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)
78. Tibial nerve Common peroneal n. Sural nerve Sural communicati ng
79. Popliteal Vein
80. Medial popliteal (tibial) n. Popliteal vein Popliteal artery Lateral Medial
81. Femoral Triangle
82. Femoral Triangle (Page 61) It is intermuscular space in front of upper 1/3 of the thigh. Shape: Inverted triangle.
83. Femoral Triangle Lateral Medial
84. Boundaries
85. Medial border of Sartorius muscle Medial border of adductor longus muscle Inguinal ligament Lateral Medial
86. Roof
87. Ilio-inguinal nerve Femoral branches of genito-femoral nerve Great saphenous vein Fascia lata Superficial inguinal veins
88. Superficial inguinal lymph nodse
89. Floor
90. Iliopsoas muscle Pectineus m. Adductor longus m.
91. Contents
92. Sartorius (cut) Femoral art. Femoral vein Femoral nerve Femoral branch of genito-femoral nerve Lat. Cut. N. of thigh Medial cut. N. of thigh Saphenous nerve Dr. Sherif Fahmy
93. Deep inguinal lymph nodes
94. Fascia transversalis Fascia iliaca Femoral artery in the lateral compartment Femoral vein in the middle compartment Femoral canal Lymph node of Cloquet Femoral sheath
95. Femoral Canal (Page 65) It is the medial compartment of femoral sheath. Shape: Conical (has apex and base): Apex: Lower closed end (fused anterior & posterior walls of the femoral sheath). Base: Femoral ring which is closed by femoral septum (extraperitoneal fat) Length: 1.5 cm Contents: -Lymph node of Cloquet, Lymph vessels, Fat. Clinical importance: -Allows dead space for distension of femoral vein. -Gives passage of lymph vessels from lower limb to abdomen. -May give a passage for intestine (femoral hernia). Dr. Sherif Fahmy
96. Femoral vein Femoral canal (medial compartment of femoral sheath) Lateral Medial Dr. Sherif Fahmy 1.5 cm
97. Pectineal lig Femoral ring Femoral vein Dr. Sherif Fahmy Lacunar lig. Inguinal lig. Femoral septum (Extraperitoneal fat) Aponeurosis of external abdominal oblique m. (cut)
98. Hernia (Page 66)
99. Fundus Hernia is the protrusion of intestine or omentum (peritoneum attached to stomach) through a defect in abdominal wall. Causes: 1- Increased intraabdominal pressure for example in case of chronic cough or constipation. 2- Weakness of the abdominal wall.
100. Femoral Hernia (Page 66)
101. Femoral hernia: Protrusion of intestine inside femoral canal. Frequency: it is more common in females due to wider femoral ring secondary to wider pelvis. Structure (formation): It is formed of loop of intestine covered with peritoneum. It has neck, body and fundus.
102. Direction of descent of the hernia: It takes a U-shaped course. It descends downwards through femoral ring and canal. Then, it passes forewards through saphenous opening. Then, it passes upwards and laterally. Direction of reduction: Reverse to the course of descent. Coverings (from inside to outside): Extraperitoneal fat (femoral septum), fascia transversalis, cribriform fascia, superficial fatty layer and skin.
103. Dr. Sherif Fahmy Femoral hernia
104. Pubic tubercle Femoral hernia Site of protrusion of femoral and inguinal hernia
105. Adductor Canal (Subsartorial or Hunter’s) (Page 68)
106. Shape & boundaries of the Canal Sartorius Adductor magnus Vastus medialis Med. Lat Fibrous roof
107. Position, Boundaries and Contents
108. Sartorius m. Vastus medialis m. Adductor longus m. Adductor magnus m.
109. Sartorius m. (cut) Adductor longus m. Adductor magnus m. Vastus medialis m. Femoral artery Femoral vein Saphenous nerve Nerve to vastus medialis Adductor hiatus
110. Anastomoses of Lower Limb
111. Around Anterior Superior Iliac Spine
114. Cruciate
116. Femoral Artery (page 75)
117. Orientation of Muscles of Anterior and Medial Compartment of Thigh Dr. Sherif Fahmy
118. Inguinal lig. ASIS Pubic tubercle Sartorius m. Rectus femoris m. V.Lateralis V.Medialis Adductor longus m. Pectinus m. Ilio-psoas m. Adductor magnus m. Gracilis m. Muscles of front & medial side of thigh Medial Lateral Dr. Sherif Fahmy
119. Rectus Femoris Sartorius (cut) iliopsoas Pectineus Adductor longus Adductor magnus Adductor hiatus Vastus lateralis Vastus medialis Gracilis Lat. Med. Dr. Sherif Fahmy
120. Sartorius (cut) Rectus femoris Vastus lateralis Vastus medialis Ilio- psoas Pectineus (cut) Obturator externus Adductor longus (cut) Adductor brevis Adductor magnus Adductor hiatus Gracilis L. M. Dr. Sherif Fahmy
121. Sartorius (cut) Ext iliac art. Femoral art. Adductor hiatus Inguinal ligament Femoral vein Femoral nerve Femoral branch of genito-femoral nerve Lat. Cut. N. of thigh Medial cut. N. of thigh Saphenous nerve Nerve to vastus medialis Dr. Sherif Fahmy Medial Lateral Mid-inguinal point
122. Femoral Artery (page 75)
123. Course of Femoral Artery It begins ……………………….. It passes ……………………….. It ends ……………………………
124. External iliac art. Femoral art. Inguinal ligament Dr. Sherif Fahmy At mid-inguinal point
125. Sartorius (cut) Ext iliac art. Femoral art. Course of femoral artery Begins at mid-inguinal point Subsartorial (adductor) canal Adductor hiatus Ends Inguinal ligament Femoral triangle Dr. Sherif Fahmy Medial Lateral
126. Femoral sheath Femoral artery Femoral vein Femoral nerve Dr. Sherif Fahmy
127. Relations 1- Superficial (anterior). 2- Deep (posterior). 3- Medial. 4- Lateral.
128. Anterior (Superficial) Relations
129. Sartorius (cut) Femoral art. Femoral branch of genito-femoral nerve Medial cut.n. of thigh Saphenous nerve Anterior (superficial Relations) Dr. Sherif Fahmy Medial Lateral Femoral sheath
130. Deep (posterior) Relations
131. Psoas part of ilio-poas m. Pectineus m. Adductor longus m. Femoral vein Adductor magnus m. Deep (posterior) relations Dr. Sherif Fahmy Medial Lateral
132. Femoral a. Adductor longus Adductor magnus Cont. deep relations Psoas part of ilio-psoas m. Pectineus m. Dr. Sherif Fahmy Medial Lateral
133. Medial Relations
134. Femoral vein Medial relations Saphenous nerve Dr. Sherif Fahmy Medial Lateral
135. Lateral Relations
136. Femoral branch of genito-femoral nerve V. Medialis N. To v.medialis Femoral n. Saphenous nerve Lateral relations Dr. Sherif Fahmy Medial Lateral
137. Branches of Femoral Artery Superficial branches: -Superficial epigastric. -Superficial external pudendal. -Superficial circumflex iliac. Deep branches: -Deep external pudendal. -Descending genicular. -Profunda femoris.
138. 1-Superficial circumflex iliac a 2-Superficial epigastric 3-Superficial external pudendal 4-Deep external pudendal Femoral a. 5-Descending genicular a. Dr. Sherif Fahmy Medial Lateral
139. Surface Anatomy of Femoral Artery (Page 77)
140. Mid-inguinal point Adductor tubercle Upper 2/3 of a line between midinguinal point and adductor tubercle. Dr. Sherif Fahmy Surface Anatomy of Femoral Artery
141. Clinical points related to femoral artery:(Page 78) ➢To stop sever bleeding in the lower limb, press the artery against superior pubic ramus at mid-inguinal point. ➢On ligation of femoral artery above origin of profunda femoris artery, blood passes to lower limb through cruciate anastomosis. ➢Catheterization of femoral artery for left heart and kidney angiography.
142. Profunda Femoris Artery (Page 78)
143. Course of Profunda Femoris Artery
144. Femoral a. Pectineus Adductor longus Adductor magnus Dr. Sherif Fahmy 4 cm Medial Lateral
145. Profunda femoris artery Femoral artery Femoral vein Pectineus Adductor longus (Cut) Adductor brevis Adductor magnus Dr. Sherif Fahmy 4th perforating Medial Lateral
146. Branches of Profunda Femoris Artery Two Circumflex Arteries: 1- Lateral circumflex femoral artery. 2- Medial circumflex femoral artery. Four Perforating arteries: 1- First perforating. 2- Second perforating. 3- Third perforating. 4- Fourth perforating. Dr. Sherif Fahmy
147. Circumflex Arteries
148. Lateral circumflex femoral artery Medial circumflex femoral artery Dr. Sherif Fahmy Ascending br. Transverse br. Descending branch Medial Lateral
149. Medial circumflex femoral artery Transverse branch Ascending branch Branch to anastomosis around greater trochanter Transverse branch of lateral circumflex femoral a. Ascending branch of 1st perforating artery Descending branch of inferior gluteal artery Quadratus femoris m. Adductor magnus m. Dr. Sherif Fahmy Medial Lateral
150. Perforating Arteries
151. 4 perforating arteries Dr. Sherif Fahmy Medial Lateral
152. 1st perforating artery 2nd perforating artery 3rd perforating artery 4th perforating artery Dr. Sherif Fahmy Medial Lateral Back of Adductor Magnus
153. Applied anatomy of femoral artery: -To stop sever bleeding in the lower limb, we should press over the artery against superior pubic ramus at the beginning of the artery. -Catheterization of femoral artery is needed to examine renal angiogram and left side of the heart. -If femoral artery is ligated, blood reaches the lower limb through cruciate anastomosis. Dr. Sherif Fahmy
154. Anastomoses of Femoral Artery
155. Anastomosis of the Femoral Artery It shares in the following anastomosis: 1- Cruciate anastomosis. 2- Around anterior superior iliac spine. 3- Around Greater trochanter. 4- Around knee. Dr. Sherif Fahmy
156. Cruciate Anastomosis It is composed of: Transverse limb: 1- Transverse branch of lateral circumflex femoral a. and transverse branch of medial circumflex femoral a. Vertical limb: 1- Ascending branch of 1st perforating a. (lower part) 2- Ascending branch of medial circumflex femoral a. 3- Descending branch of inferior gluteal a. N.B. 2,3 forms the upper part of vertical limb.Dr. Sherif Fahmy
157. Back of Thigh & Gluteal Region Transverse br. of lateral circumflex femoral a. Transverse br. of medial circumflex femoral a. Ascending br. of 1st perforating a. Ascending branch of medial circumflex femoral a. Descending branch of inferior gluteal a. Cruciate anastomosis Dr. Sherif Fahmy Medial
158. Anastomosis Around Anterior Superior Iliac Spine It is composed of the following arteries 1- Superficial circumflex iliac artery (from femoral artery). 2- Deep circumflex iliac artery (from external iliac artery). 3- Ascending branch of lateral circumflex iliac artery. 4- Superior gluteal artery. Dr. Sherif Fahmy
159. External iliac artery 1-Deep circumflex iliac artery Femoral artery 2-Superficial circumflex iliac artery 3-Ascending branch of lateral circumflex femoral artery 4-Superior gluteal artery Dr. Sherif Fahmy
160. Anastomosis Around Greater trochanter 1- Superior gluteal artery. 2- Inferior gluteal artery. 3- Ascending branch of medial circumflex femoral artery.
161. Superior gluteal a. Dr. Sherif Fahmy Inferior gluteal a. Ascending branch of medial circumflex femoral a. Anastomosis around greater trochanter
162. Anastomosis of the Femoral Artery It shares in the following anastomosis: 1- Cruciate anastomosis. 2- Around anterior superior iliac spine. 3- Around Greater trochanter. 4- Around knee.
164. Descending branch Medial circumflex femoral artery Descending
165. Transverse branch of lateral circumflex femoral Transverse branch of medial circumflex femoral art Ascending branch of first perforating art.
166. 1-Superficial circumflex iliac a 2-Superficial epigastric 3-Superficial external pudendal 4-Deep external pudendal Femoral a. 5-Descending genicular a. Dr. Sherif Fahmy