Lower Limb from Gluteal region to Anterior part of Leg

This presentation shows Lower Limb from Gluteal region to Anterior part of Leg

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1. Gluteal Region (Page 87)
2. Gluteal Region 1- Skeleton. 2- Ligaments and sciatic foramina. 3- Muscles: A- Gluteus (maximus, medius and minimus) muscles. B- Lateral rotator muscles. 4- Nerves of gluteal region. 5- Vessels of gluteal region.
3. iliac crest Gluteal fold
4. Skeleton of Gluteal Region
5. Sacrum Ischeal spine ischial tuberosity Gluteal surface of ilium Coccyx Dr. Sherif Fahmy Bursa on greater trochanter Bursa on ischial tuberosity Greater trochanter
6. Posterior gluteal line Anterior gluteal line Inferior gluteal line
7. Gluteal ligaments and Sciatic Foramina
8. Sacrospinous ligament Sacrotuberous ligament Greater sciatic foramen Lesser sciatic foramen Dr. Sherif Fahmy
9. Tensor fasciae Latae m. Dr. Sherif Fahmy Gluteus maximus
10. Gluteus maximus Deep ¼ inserted into gluteal tuberosity Superficial ¾ inserted into ilio-tibial tract Dr. Sherif Fahmy Muscles of the back of the thigh (Hamstring)
11. Gluteus medius (cut) Gluteus minimus muscle Dr. Sherif Fahmy
12. Piriformis muscle Superior gemellus muscle Obturator internus muscle Inferior gemellus muscle Quadratus femoris muscle
13. Vessels & Nerves of the Gluteal Region
14. Dr. Sherif Fahmy
15. Arteries of Gluteal Region (Page 92)
16. Superior gluteal artery Superificial division Deep division Inferior gluteal artery Internal pudendal artery Cruciate anastomosis
17. Nerves of the Gluteal Region (Page 93)
18. Superior gluteal nerve Sciatic nerve with nerve to quadratus femoris deep to it Posterior cutaneous nerve of the thigh Inferior gluteal nerve Nerve to obturator internus Pudendal nerve Piriformis muscle
19. Sacral Plexus (Page 97) Dr. Sherif Fahmy
20. Site, Relations & Formation of Sacral Plexus
21. Sacral plexus Dr. Sherif Fahmy Lumbar plexus Site
22. Ala of sacrum Ventral primary rami of S1-4 leaving anterior sacral foramena Hip bone Sacrum Sciatic nerve Pudendal nerve Lumbo-sacral trunk (L4,5) Dr. Sherif Fahmy Piriformis m 5th lumbar vertebra
23. L4 L5 S1 S2 S3 S4 Dr. Sherif Fahmy Formation of Sacral Plexus Anterior division Posterior division Roots Sciatic nerve Divide Converge
24. Branches of Sacral Plexus From roots: -N. to piriformis (S1,2) -Pelvic splanchnic nerve (S2,3,4). From posterior surface (posterior divisions): -Superior gluteal n. (L4,5,S1) -Inferior gluteal n. (L5,S1,2)
25. From anterior surface of the plexus: - N. to obturator internus (L5, S1,2). - N. to quadratus femoris (L4,5,S1). Cutaneous branches: - Posterior cutaneous nerve of thigh (S1,2,3). - Perforating cutaneous nerve (S2,3) Terminal branches: - Sciatic (L4,5, S1,2,3). - Pudendal (S2,3,4).
26. Superior gluteal nerve Sciatic nerve with nerve to quadratus femoris deep to it Posterior cutaneous nerve of the thigh Inferior gluteal nerve Nerve to obturator internus Pudendal nerve Piriformis muscle
27. Ligaments and Foramina of Gluteal Region
28. Ligaments of Gluteal Region ➢Sacrospinous ligament. ➢Sacrotuberous ligament.
29. Sacrospinous ligament Sacrotuberous ligament Dr. Sherif Fahmy
30. Functions of gluteal ligaments ➢Prevent foreword tilt of sacrum at sacroiliac joint, under the effect of the weight of vertebral column. ➢They convert sciatic
31. Foramina of Gluteal Region 1- Greater sciatic foramen. 2- Lesser sciatic foramen.
32. Sacrospinous ligament Sacrotuberous ligament Greater sciatic foramen Lesser sciatic foramen Dr. Sherif Fahmy
33. Contents of Sciatic Foramina
34. Superior gluteal vessels Posterior cutaneous nerve of thigh Sciatic nerve with nerve to quadratus femoris (deep to its upper part) Inferior gluteal vessels N.To obturator internus Pudendal nerve Piriformis m. Dr. Sherif Fahmy Internal pudendal a. Tendon of obturator internus m. Inferior gluteal nerve Superior gluteal nerve
35. Safe Area for Intramuscular Injection
36. Area of intramuscular injection Dr. Sherif Fahmy
38. Anterior (Extensor) & Lateral (Peroneal) Compartments of Leg (Page 123) Dr. Sherif Fahmy
39. Lateral compartment of leg Anterior intermuscular septum Posterior intermuscular septum Lateral surface of fibula Dr. Sherif Fahmy Lateral surface of tibia Anterior surface of fibula Interosseous membrane Anterior compartment
40. Anterior Compartment It contains: 1- Dorsiflexor (extensor) muscles. 2- Anterior tibial artery. 3- Anterior tibial (deep peroneal) nerve. Dr. Sherif Fahmy
41. Dorsi-flexor (Extensor) muscles 1- Tibialis anterior muscle. 2- Extensor digitorum longus muscle. 3- Extensor hallucis longus muscle. 4- Peroneus tertieus muscle (if present). Dr. Sherif Fahmy
42. Tibialis anterior muscle Extensor digitorum longus muscle Extensor hallucis longus muscle Peroneus tertius muscle Extensor retinaculae Medial Lateral Dr. Sherif Fahmy
43. Attachments of Dorsiflexor (Extensor) Muscles Dr. Sherif Fahmy
44. Lateral surface of tibia Anterior surface of fibula Interosseous membrane Dr. Sherif Fahmy
45. Tibialis anterior m. (from upper 2/3 of lateral surface of tibia) Extensor hallucis longus m. (from middle 2/4 of anterior surface of fibula) Extensor digitorum longus m. (from upper ¾ of anterior surface of fibula) Peroneus tertius m. (from lower ¼ of anterior surface of fibula) Origin of dorsiflexor (extensor) muscles Interosseous membrane Dr. Sherif Fahmy
46. Insertion of tibialis anterior m. (Medial aspects of medial cuneiform bone and base of 1st metatarsal bone) Insertion of Extensor halluces longus (Dorsal aspect of base pharynx of big toe) Insertion of peroneus tertius m. (Dorsal aspect of base of 5th metatarsal bone) Insertion of extensor digitorum longus (extensor expansion to dorsum of all phalanges of lateral 4 toes) Insertion of Dorsiflexor (extensor) muscles Dr. Sherif Fahmy
47. Actions of the Muscles of Leg Dorsi flexion of the foot is done by any muscle that reaches the foot infront the ankle between 2 malleoli. Planter flexion is done by any muscle that reaches the foot behind the ankle and the 2 malleoli. Any muscle named tibialis will produce inversion of foot and support the medial longitudinal arch. Any muscle named peroneus will produce eversion of foot and support the lateral longitudinal arch. Dr. Sherif Fahmy
48. Tibialis Anterior Muscle Dr. Sherif Fahmy
49. Tibialis anterior m. Origin: Upper 2/3 of lateral surface of tibia and interosseous membrane Insertion: into medial aspects of medial cuneiform and base of 1st metatarsal bone Dr. Sherif Fahmy
50. Action & nerve supply Action: 1- Dorsiflex (extends) the foot at ankle j. 2- Inversion of foot at subtalar and talo- calcaneonavicular joints. 3- Supports medial longitudinal arch. Nerve supply: - Anterior tibial (deep peroneal) nerve from common peroneal nerve. Dr. Sherif Fahmy
51. Extensor Digitorum Longus Dr. Sherif Fahmy
52. Insertion: Extensor expansion of lateral 4 toes Dr. Sherif Fahmy Extensor digitorum longus muscle Origin: Upper ¾ of anterior surface of fibula & interosseous membrane
53. Action & Nerve Supply Action: 1- Extends all joints of lateral 4 toes. 2- Dorsiflex foot at ankle joint. Nerve supply: - Anterior tibial (deep peroneal) nerve from common peroneal nerve. Dr. Sherif Fahmy
54. Extensor Hallucis Longus M. Dr. Sherif Fahmy
55. Extensor hallucis longus muscle Origin: From middle 2/4 of anterior surface of fibula & interosseous membrane Insertion: Into dorsum of base of terminal phalanx of big toe Dr. Sherif Fahmy
56. Action & Nerve Supply Action: 1- Extends all joints of big toe. 2- Dorsi-flexes foot at ankle joint. Nerve supply: - Anterior tibial (deep peroneal) nerve from common peroneal nerve. Dr. Sherif Fahmy
57. Peroneus Tertius Muscle Dr. Sherif Fahmy
58. Peroneus tertius Origin: From lower ¼ of anterior surface of fibula & interosseous membrane Insertion: Into dorsum of base of 5th metatarsal Dr. Sherif Fahmy
59. Action & Nerve Supply Action: 1- Dorsi-flexes foot at ankle joint. 2- Eversion of foot at subtalar joint. 3- Supports lateral longitudinal arch. Nerve supply: - Anterior tibial (deep peroneal) nerve from common peroneal nerve. Dr. Sherif Fahmy
60. Lateral (Peroneal) Compartment of the Leg (Page 132) Dr. Sherif Fahmy
61. Lateral compartment of leg Anterior intermuscular septum Posterior intermuscular septum Lateral surface of fibula Dr. Sherif Fahmy
62. Contents of Lateral Compartment Muscles: -Peroneus longus muscle. -Peroneus brevis muscle. Nerve: -Superficial peroneal Dr. Sherif Fahmy
63. Attachments of Muscles of Lateral compartment of Leg Dr. Sherif Fahmy
64. Origin of peroneus longus m. from upper 2/3 of lateral surface of fibula & intermuscular septa Origin of peroneus brevis m. from lower 2/3 of lateral surface of fibula & intermuscular septa Insertion of peroneus brevis to tuberosity of base of 5th metatarsal bone Insertion of peroneus longus muscle Groove on lower surface of cuboid Peroneal trochlea Cuboid Lateral malleolus Lateral surface of Calcaneus Dr. Sherif Fahmy
65. Peroneus longus muscle Peroneus brevis Lateral malleolus Calcaneus Dr. Sherif Fahmy
66. Peroneus Longus Muscle Dr. Sherif Fahmy
67. Peroneus longus m. Cuboid bone Tendon of peroneus longus in sole of foot Lateral aspect of base of 1st metatarsal bone Lateral aspect of medial cuneiform bone Long plantar ligament Dr. Sherif Fahmy
68. Action & Nerve Supply of Peroneus Longus Muscle Action: 1- Planter flexion of foot at ankle. 2- Eversion of foot at subtalar joint. 3- Supports lateral and transverse arches. Nerve supply: - Superficial peroneal (musculo-cutaneous) nerve. Dr. Sherif Fahmy
69. Peroneus Brevis Muscle Dr. Sherif Fahmy
70. Peroneus brevis m. Lateral malleolus Dr. Sherif Fahmy
71. Action & nerve supply Action: 1- Planter flexion of foot at ankle. 2- Eversion of foot at subtalar joint. 3- Supports lateral arch. Nerve supply: - Superficial peroneal (musculo-cutaneous) nerve. Dr. Sherif Fahmy
72. Anterior Tibial (Deep peroneal) Nerve (Page 126) Dr. Sherif Fahmy
73. Common peroneal nerve Lateral angle Dr. Sherif Fahmy
74. Lateral popliteal nerve (common peroneal nerve) Head of fibula Neck of fibula Dr. Sherif Fahmy
75. Common peroneal nerve Deep peroneal nerve Superficial peroneal nerve Peroneus longus Extensor digitorum longus Tibialis anterior m. Dr. Sherif Fahmy
76. Tibialis anterior m. Anterior tibial a. Extensor digitorum longus m. Anterior tibial nerve Extensor hallucis m. Superior extensor retinaculum Inferior extensor retinaculum Medial division Lateral division Dr. Sherif Fahmy
77. Branches of Anterior Tibial Nerve 1- Muscular to muscles of anterior compartment of the leg. 2- Articular to ankle joint. 3- Terminal branches: - Medial to skin between big and second toes. - Lateral to extensor digitorum brevis and intertarsal joints of foot. Dr. Sherif Fahmy
78. Injury of Anterior Tibial Nerve Cause: Fracture neck of fibula. Motor loss: Paralysis of dorsiflexor muscles and extensor digitorum brevis muscle. Sensory loss: Loss of sensation between big and 2nd toes. Disability & deformity: -Loss of dorsiflexion of foot (foot drop). -Loss of extension of all toes. -Week inversion. Late wasting changes: Decrease of the size of anterior compartment. Dr. Sherif Fahmy
79. Anterior Tibial Artery (Page 129)
80. Course of Anterior Tibial artery
81. Anterior tibial a. Popliteal artery Interosseous membrane Begins Popliteus muscle
82. Tibialis anterior m. Anterior tibial a. Extensor digitorum longus m. Anterior tibial nerve Extensor hallucis m. Superior extensor retinaculum Inferior extensor retinaculum Dorsalis pedis artery It ends
83. Branches of Anterior Tibial Artery 1- Posterior tibial recurrent. 2- Anterior tibial recurrent. 3- Muscular. 4- Anterior medial malleolar. 5- Anterior lateral malleolar. Anastomosis around Knee Anastomosis around ankle
84. Anterior tibial recurrent Muscular branches Anterior medial malleolar Anterior lateral malleolar
85. Surface Anatomy
86. Midway between head of fibula and tibial tuberosity Midway between 2 malleoli
87. Superficial Peroneal (Musculo-cutaneous ) Nerve (Page 135) Dr. Sherif Fahmy
88. Common peroneal nerve Superficial peroneal (musculocutaneous) Dr. Sherif Fahmy
89. Superficial peroneal nerve Dr. Sherif Fahmy
90. Injury of Superficial peroneal Nerve Dr. Sherif Fahmy
91. Cause: Fracture neck of fibula. Motor loss: Paralysis of peroneal muscles. Sensory loss: Loss of sensation in anterior surface of lower 1/3 of leg and dorsum of foot except ????. Disability & deformity: -Loss of eversion. -Weak plantar flexion. -The foot is inverted and dorsiflexed. Late wasting changes: Decrease of the size of lateral compartment. Dr. Sherif Fahmy
92. Injury of Common Peroneal Nerve Cause: Fracture neck of fibula. Motor loss: Paralysis of dorsiflexor muscles, peroneal and extensor digitorum brevis muscle. Sensory loss: Loss of sensation infront of lower 1/3 of leg and dorsum of foot except lateral margin (sural) and medial margin till metatarsophalangeal j. of big toe (saphenous). Disability & deformity: -Loss of dorsiflexion and eversion of foot -Loss of extension of all toes. -Foot drop and inverted foot. Late wasting changes: Decrease of the size of anterior and lateral compartments. Dr. Sherif Fahmy