Transcript Gluteal region, thigh & leg

WINDSOR UNIVERSITY
SCHOOL OF MEDICINE
GLUTEAL REGION,
THIGH & LEG
THE FUTURE BELONGS TO THOSE WHO BELIEVE IN THE BEAUTY OF THEIR DREAMS.
ELEANOR ROOSEVELT
Lecture 10
Idara C. Eshiet
OBJECTIVES




Be able to describe the bones of lower limb.
Be able to describe the muscles of the gluteal
region, & thigh.
Be able to describe the femoral triangle &
popliteal fossa.
Be able to describe the muscles of the leg.
Bones of lower limb
Hip bone ( Ilium, Ischium and pubis)
Femur
Tibia
Fibula

Areas of transition/Bones & joints of
the lower limb.
COXAL BONE /Acetabulum
Shaft /Proximal end of the femur
Femur vs. Tibia & Fibula
Proximal ends of tibia & fibula
Tibia & Fibula/ posteromedial view
of distal ends.
Thigh
Fascia
Compartments : anterior, medial, posterior
muscles

Fascia of the thigh


1.
2.
Superficial is the
continuity of the
superficial fascia of
anterior abdominal wall
Deep fascia thickened
laterally to form the
illiotibial tact
Has a gap called
saphenous opening
Divided into 3
compartments by 3
intermuscular septa
Muscle compartments in the thigh

In the thigh, there are medial (adductor),
anterior (extensor), and posterior (flexor)
compartments.
Anterior Thigh Muscles

Anterior thigh muscles are the flexors of the hip and
extensors of the knee.
Iliacus
Action: Chief flexor of the hip joint.
Nerve Supply: Femoral nerve
Psoas Major
Action: Flexes thigh on trunk ( hip flexion)
Nerve Supply: femoral nerve
Pectineus
Action: Flexion & adduction of
hip joint. Also assists with
medial rotation of the thigh
Nerve supply: Femoral nerve
Sartorius
Action :
1.Flexion, abduction and Lateral rotation of
thigh at hip joint.
2. Flexion leg at knee joint
Nerve Supply: Femoral nerve
Tailor's muscle

This combination of
lateral rotation and
flexion of the hip and
flexion of the knee
gave tailors particularly
enlarged sartorius
muscles.

Looking at the bottom of
one's foot, as if checking
to see if one had
stepped in gum,
demonstrates all four
actions of sartorius.
Quadriceps femoris
Four muscles make up this group. They are:
 rectus femoris,
 vastus lateralis,
 vastus medialis,
 vastus intermedius
Action: extension of knee
Rectus femoris also flexes the hip joint as well.
Nerve Supply: Femoral nerve
Quadriceps
Rectus
femoris
Vastus
lateralis
Vastus
medialis
Vastus
intermedius
Medial Compartment of Thigh
1. Gracilis
 Adduction of the
thigh @ the hip
joint & flexion of
knee joints
 2. Adductor longus
 Adduction of the
thigh @ the hip joint.

3
1
2








3. Adductor brevis
Adduction of the thigh @ the hip joint.
4. Adductor magnus has 2 parts.
Ant. Part is an adductor
Post. Part is an extensor of the thigh @ the hip joint
5. Obturator externus
Lateral rotation of hip joint
Obturator nerve but the post. part of adductor magnus
is supplied by tibial nerve which is a branch of the
sciatic nerve.
Adductor magnus & Obturator externus

1. Obturator externus

1
2

Is innervated by the
obturator nerve
2. Adductor magnus
The adductor part is
innervated by the
obturator nerve
 & the hamstring part is
innervated by the tibial
division of the sciatic
nerve

Pectineus, Adductors longus & brevis

1. Pectineus
 Is
innervated by the
femoral nerve
1
3

2. Adductor longus
 Is
innervated by the
obturator nerve
2

3. Adductor brevis
 Is
innervated by the
obturator nerve
Obturator nerve
3. Semimembranosus
 Extension of hip joint & flexion & medial rotation of
knee joint.
Nerve Supply: Tibial portion of sciatic nerve
Posterior Compartment of the Thigh
1. Biceps femoris
 Extension of the thigh @ the hip joint & flexion &
lateral rotation of the knee joint.
Nerve supply:
 Long head: tibial portion of sciatic nerve
Short head: common peroneal portion of sciatic nerve

2. Semitendinosus/ Semimembranosus
 Extension of the thigh @ the hip joint & flexion &
medial rotation of the knee joint.
Nerve supply: Tibial portion of sciatic nerve

Movements of Hip joint
Flexion
Extension
Abduction
Adduction
Circumduction
Medial rotation
Lateral rotation

Movements of Hip joints
Muscles responsible for movements
of Hip joints.
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Flexion : iliopsoas,
rectus femoris
Extension: Hamstrings,
gluteus maximus
Abductor: Gluteus
medius & minimus
Adduction: Gracilis &
3 Adductors
Muscles responsible for movements
of Hip joints Cont’d.


Medial rotation: gluteus
medius & minimus
Lateral rotation:
1.
2.
3.
4.
obturator internus &
externus,
piriformis,
superior & inferior
gemelli,
quadratus femoris
Muscles responsible for movements
of Knee Joints.

Flexion: Hamstrings

Extension: Quadriceps

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Medial rotation:
Semitendinosus &
Semimembranosus.
Lateral rotation :
Biceps femoris.
Muscles of the gluteal region

8 muscles.
Muscles of the gluteal region
3
1
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

1. Gluteus maximus
Extension of the thigh @ the
hip joint, lateral rotation,
steadies the thigh, assists in
rising from a sitting position
Inferior gluteal nerve
Tensor fasciae latae
Assists Iliopsoas ad rectus femoris in flexing the
thigh
 Assists gluteus maximus in extending the knee joint
 Also assists the gluteus medius and minimus in
abduction and medial rotation of the thigh
Nerve Supply: Superior gluteal nerve

3. Gluteus medius & minimus
 Abduction and medial rotation of the thigh; tilts
pelvis when walking to permit opp. Leg to clear the
ground.
 Superior gluteal nerve
Positive Trendelenburg's sign

If right gluteus
medius and minimus
muscles are
paralyzed, the
unsupported left
side of the pelvis
falls (sags) instead
of rising; normally,
the pelvis rises.
4. Piriformis m.
Lateral rotation of the thigh@ hip joint
nerve Supply: S1 & S2 nerves
Important landmark of the gluteal region.
 5. Obturator Internus
Same function as piriformis
Nerve supply: (L5-S1) nerves to obturator internus

Muscles of the gluteal region Cont’d.


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

6. Superior Gemellus
Lateral rotation of the thigh @ the hip joint
(L5-S1) nerves to obturator internus
7. Inferior Gemellus
Same function as superior gamellus
Nerve to quadratus femoris ( L5, S1)


8

8. Quadratus Femoris
Lateral rotation of the
thigh @ the hip joint
(L5-S1) nerves to
quadratus femoris
Femoral triangle & Popliteal fossa
Femoral triangle boundaries, floor, & contents
Popliteal fossa boundaries, floor, & contents

The femoral triangle is bounded
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Superiorly :Inguinal ligament that forms the base of the
femoral triangle.
Medially :Adductor longus.
Laterally :Sartorius.
Apex is where the lateral border of the sartorius crosses
the medial border of the adductor longus.
Roof :Fascia lata, subcutaneous tissue, and skin.
Floor :Iliopsoas laterally and the pectineus medially.
Femoral Triangle
Inguinal ligament
Iliopsoas
Pectineus
Adductor longus
Adductor
longus
Femoral Triangle
Contents : (lat. to med.)
1.
Femoral nerve
2.
Femoral artery and its
branches
3.
Femoral vein and its
proximal tributaries
( great saphenous and
deep femoral veins)
4.
Deep inguinal lymph
nodes
Adductor Canal, subsartorial canal; Hunter
canal
Approximately 15 cm.
It extends from the apex of the femoral triangle, where
the sartorius crosses over the adductor longus, to the
adductor hiatus in the tendon of the adductor magnus.
Contents: Femoral artery and vein, the saphenous nerve,
and the nerve to vastus medialis.
Adductor Hiatus

The adductor hiatus is
an opening or gap
between the
aponeurotic distal
attachment of the
adductor part of the
adductor magnus and
the tendinous distal
attachment of the
hamstring part.

The adductor hiatus
transmits the femoral
artery and vein from the
adductor canal in the thigh
to the popliteal fossa
posterior to the knee.
Boundaries of Popliteal fossa
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Superolateral : biceps femoris
Superomedial: semimembranosus &
semitendinosus
Inferolateral: lateral head of gastrocnemius
Inferomedial: medial head of gastrocnemius
Contents of the popliteal fossa
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1. Termination of the small saphenous vein.
2. Popliteal arteries and veins.
3. Tibial and common fibular nerves.
4. Posterior cutaneous nerve of thigh
5. Popliteal lymph nodes and lymphatic vessels
Floor
This is formed by:
1. popliteal surface of the femur,
2. capsule of knee joint &
3.
popliteus muscle covered by the politeal
fascia
LEG
Fascia
Muscles of anterior compartment
Muscles of lateral compartment
Muscles of posterior compartment (superficial &
deep layers)
Main muscles responsible for ankle joint movements

Fascia of the Leg


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


Deep fascia (crural fascia) .
Leg divided into 3 fascia
compartments (anterior,
posterior, lateral) by 3
intermuscular septa.
In the region of the ankle the
fascia forms retinacula :
Superior & inferior extensor
retinacula
Flexor retinaculum
Fibular retinaculum
Cross-section through the left leg (post. View)
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
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
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
Muscles of the anterior
compartment of leg dorsiflex the
ankles, extend the toes, & invert
the foot.
(deep fibular nerve).
Muscles in the posterior
compartment plantarflex the ankle,
flex the toe, & invert the foot.
(tibial nerve).
Muscles in the lateral compartment
evert the foot.
(superficial fibular nerve).
Muscles of anterior compartment
1
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
2


1. Tibialis anterior
Dorsiflexion & inversion of
the foot at the ankle.
2. Extensor digitorum
longus
Extension of lateral 4
digits & dorsiflexion of
the ankle


3. Extensor hallucis longus
Action: Extension of big toe & dorsiflexion of the
ankle
4. Fibularis Tertius
 Action :Dorsiflexion and eversion of foot
Deep fibular nerve from common fibular nerve
supplies all the muscles in this compartment

Muscles of lateral compartment


1


1. Fibularis longus
Eversion & plantar flexion
of foot.
2. Fibularis brevis
Eversion & plantar flexion
of foot.
2

Superficial fibular nerve
from common fibular
nerve
Injury to common fibular nerve

Footdrop and loss of
eversion
May cause sensory loss over
lateral leg and dorsum of
foot

Causes


Direct trauma as nerve
passes superficially
around neck of fibula
Foot drop
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
Foot drop, sometimes
called drop foot, is a
general term for
difficulty lifting the
front part of the foot.
The loss of dorsiflexion
of the ankle causes
footdrop.
Posterior compartment of leg


Muscles in the posterior
(flexor) compartment of
leg are organized into
two groups; superficial
and deep.
Nerve supply: Tibial
nerve
Muscles of the Posterior Compartment
of the Leg
Superficial group of muscles
 1.Gastrocnemius
 2.Soleus
 3.Plantaris
Deep group of muscles
 1.Popliteus
 2.Tibialis posterior
 3.Flexor digitorum longus
 4.Flexor hallucis longus
Muscles
mainly
plantarflex,
invert the
foot and flex
the toes.
Superficial Group
1. Gastrocnemius
Action: Plantar flexion of the foot (@ the ankle), knee
flexion
Nerve Supply: Tibial nerve
2. Soleus
Action: Plantarflexion of the foot, knee flexion
Nerve Supply: Tibial nerve
3. Plantaris:
 Action: plantarflexion of the foot
 Nerve Supply: Tibial nerve
Gastrocnemius has two heads; a medial and a
lateral head.
The two heads of the Gastrocnemius muscle
and the Soleus muscle are together called the
Triceps Surae.
Gastrocnemius and plantaris cross knee joint
and thus also flex knee .
All three contribute to calcaneal tendon
Muscles of posterior compartment
(deep layer)
2

5
3


4


2. Popliteus
Flexion of knee joint
3. Flexor digitorum
longus
Flexion of DIP of lateral
4 digits
Tibial nerve

4. Flexor hallucis longus
Flexion of big toe
 5. Tibialis posterior
 Plantarflexion & inversion of foot
 Nerve Supply: tibial nerve

Muscles responsible for ankle joint
movements (fig.B)

Dorsiflexion :
1.
2.
3.
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Plantarflexion :

1.
2.
3.
4.
Triceps surae
Tibialis posterior
Flexor digitorium longus
Flexor hallucis longus
Movements of knee & ankle
Surface Anatomy1.
Surface Anatomy2.
Surface Anatomy3.
POWER REVIEW1.

1. What are the 4 regions of the lower limb, and
which bones are found in each region?
 Hip:
ilium, Ischium, & pubis
 Thigh: Femur & patella
 Leg: Tibia & fibula
 Foot: Tarsal bones, metatarsal bones, & phalanges.

2. Name the 7 tarsal bones
 Talus,
Calcaneus, Cuboid bone, Navicular bone,
Cuneiform bones (3)
POWER REVIEW2.

3. what is the largest and most posterior tarsal
bone?
 The

4. what structure inserts into the posterior surface of
the calcaneus?
 The

calcaneus
tendon calcaneus (Achilles tendon)
5.the calcaneus articulates with which 2 tarsal
bones?
 The
talus & the cuboid bone
POWER REVIEW3.

6. The talus articulates with which 2 tarsal bones?
 The

7. The navicular bone articulates with which 5 tarsal
bones?
 The

calcaneus & the navicular bone
talus, the cuboid bone, and the 3 cuneiform bones.
8. which movements occur around the intertarsal
joints?
 Inversion
& eversion of the hindfoot
POWER REVIEW4.

9. which muscle is the major flexor at the hip joint?
 Iliopsoas.

10. name the external rotators of the hip
 Piriformis,
Gemellus superior, Obturator internus
 Gemellus inferior, Obturator externus, Quadratus femoris

11. Name the 5 ligaments that are associated with
the hip joint.
 Iliofemoral
ligament, ischiofemoral ligament, pubofemoral
ligament
 Transverse acetabular ligament, ligament capitis femoris
POWER REVIEW5.

12. list the 4 muscles of the posterior thigh
compartment.
 Semimembranous
m., semitendinous m.,
 biceps femoris m. (long & short head), adductor magnus m.
(hamstring part)

13.what are the “hamstring” muscles?
 The
semimembranous m., the tendinosus m.,
 the long head of the biceps femoris m., and the adductor
magnus m. (hamstring part)
POWER REVIEW 6.

14. which of the medial thigh muscles contributes to
the action of the hamstrings?
 The
adductor magnus muscle has 2 portions with separate
insertions & innervations, 1 of which contributes to the action
of the hamstrings (flex the leg).

15. list the 6 muscles of the medial thigh
compartment.
 Pectineus
m., adductor longus m.,
 Adductor magnus m., (adductor part), Adductor brevis m.,
Gracilis m., Obturator externus m.
POWER REVIEW 7.

16. list the 3 muscles of the anterior compartment of
the thigh.
 Iliopsoas

m., Sartorius m., Quadriceps femoris m.
17. which 4 muscles contribute to the quadriceps
femoris muscles?
 Rectus
femoris m., Vastus lateralis m.,
 Vastus medialis m., Vastus intermedius m.,
Review Questions.1
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1. Which of the following muscles is located in the
posterior aspect of the thigh?
2. All of the following muscles are lateral rotators
of the thigh EXCEPT
3. The deep fascia of the thigh is known as which of
the following?
4. The medial and lateral malleoli articulate with
which of the following bones?
5. Which of the following muscles is the strongest
flexor of the hip joint?
Review Questions.2
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6. The strongest dorsiflexor of the foot is which of the
following muscles?
7. All of the following muscles are lateral rotators of
the hip joint EXCEPT
8. Which of the following groups of muscles produce
dorsiflexion of the ankle?
9. Which of the following muscles is a flexor of the knee
joint?
10. All of the following muscles are located in the deep
muscle group of the posterior compartment EXCEPT
Review Questions.3



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
11. Which of the following muscles is the strongest
dorsiflexor and invertor of the foot?
12. Muscles that evert the foot include which of the
following muscles?
13. Which of the following muscles dorsiflex the
ankle?
14. All of the following statements concerning the
popliteal fossa are correct EXCEPT
15. Which of the following muscles is located in the
posterior aspect of the thigh?
Review Questions.4
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16. All of the following muscles are lateral rotators of
the thigh EXCEPT
17. All of the following statements concerning the
gluteus medius and minimus are correct EXCEPT
18. All of the following statements concerning the
gluteus maximus are correct EXCEPT
19. All of the following statements concerning the
femoral triangle are correct EXCEPT
20. All of the following statements concerning the
adductor magnus are correct EXCEPT
21. Which of the following statements concerning the
gracilis muscle is correct?
T. S. Eliot
No one can become really educated without having
pursued some study in which he took no interest--for
it is a part of education to learn to interest ourselves
in subjects for which we have no aptitude.
………………..references………………………….
Dr. Bolgova PPt.
Gray’s Anatomy for students, 2nd edition