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Lower Extremity I Trans

Lower Extremity I Trans

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Published by fielvirata
gluteal region, posterior leg and thigh, sole feet and hip joint

trans by: nica, fiel and abby (PLM)
gluteal region, posterior leg and thigh, sole feet and hip joint

trans by: nica, fiel and abby (PLM)

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Published by: fielvirata on Aug 24, 2009
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11/05/2010

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 1of 8
GROSS ANATOMY: LOWER EXTREMITY 1Dr. DamascoAugust 12, 2009trans by Nica, Fiel, & Abby
I. GLUTEAL REGION
 –
buttocks
A. BOUNDARIES
Superior: Iliac crestInferior: Inferior gluteal folds (kuyukot)Lateral: sides of thighMedial: Intergluteal canal (between two cheeks)* Each cheek is divided into four quadrantsUpper lateral, Upper medial, lower lateral, lower medial
B. CUTANEOUS NERVES
>The upper medial quadrant is supplied by the
posterior rami of the upper three lumbar nerves
andthe
upper three sacral plexus
.>The upper lateral quadrant is supplied by the
lateralbranches of the iliohypogastric (L1)
and
12
th
thoracicnerves (anterior rami)
 >The lower lateral quadrant is supplied by branchesfrom the
lateral cutaneous nerve of the thigh (L2 and3, anterior rami)
 >The lower medial quadrant is supplied by branchesfrom the
posterior cutaneous nerve of the thigh (S1,2, and3, anterior rami)C. MUSCLESMUSCLES OF THE GLUTEAL REGIONMUSCLE ORIGIN INSERTION NERVESUPPLY ;NERVE ROOTACTION1. Gluteusmaximus^
Outer surface of ilium,sacrum, coccyx,sacrotuberous ligamentIliotibial tract andgluteal tuberosity offemurInferior glutealnerve;L5, S1, 2Extends and laterally rotateship joint; through iliotibial tract,it extends knee joint
2. Gluteusmedius^
Outer surface of ilium Lateral surface ofgreater trochanter offemurSuperior glutealnerve;L5, S1Abducts thigh at hip joint; tiltspelvis when walking to permitopposite leg to clear ground
3. Gluteusminimus^
Outer surface of ilium Anterior surface ofgreater trochanter offemurSuperior glutealnerve;L5, S1Abducts thigh at hip joint; tiltspelvis when walking to permitopposite leg to clear ground
4. Tensorfascia latae^
Iliac crest Iliotibial tract Superior glutealnerve;L4, 5Assists gluteus maximus inextending the knee joint
5. Piriformis*
Anterior surface of sacrum Upper border ofgreater trochanter offemur1
st
and 2
n
 sacral nerves;L5, S1, 2Lateral rotator of thigh at hip joint
6. Obturatorinternus*
Inner surface of obturatormembraneUpper border ofgreater trochanter offemurSacral plexus;L5, S1Lateral rotator of thigh at hip joint
7. Gemellussuperior*
Spine of ischium Upper border ofgreater trochanter offemurSacral plexus;L5, S1Lateral rotator of thigh at hip joint
8. Gemellusinferior*
Ischial tuberosity Upper border ofgreater trochanter offemurSacral plexus;L5, S1Lateral rotator of thigh at hip joint
9. Quadratusfemoris*
Lateral border of ischialtuberosityQuadrate tubercle offemurSacral plexus;L5, S1Lateral rotator of thigh at hip jointTable Legend: (above)^ - gluteal muscles* - small lateral rotators of the hip joint
*Gluteus maximus
: largest muscle in the body
*Iliotibial tract:
thickening of the fascia on the lateralside
*Gluteus maximus and Tensor fascia latae
: maintainsextension of knee joint
 
 2of 8
GROSS ANATOMY: LOWER EXTREMITY 1Dr. DamascoAugust 12, 2009trans by Nica, Fiel, & Abby
D. LIGAMENTS OF THE GLUTEAL REGION
Fxn: stabilize the sacrum and prevent its rotation at thesacroiliac joint by the weight of the vertebral column
1. Sacrotuberous Ligament
: connects the back of thesacrum to the ischial tuberosity
2. Sacrospinous Ligament
: connects the back of thesacrum to the spine of the ischium
E. FORAMINA OF THE GLUTEAL REGION1. Greater Sciatic Foramen
: formed by the greater sciatic notch of the hip bone andthe sacrotuberous and sacrospinous ligaments:provides an exit from the pelvis into the gluteal region
Structures that exit the foramen
:- Piriformis- sciatic nerve- posterior cutaneous nerve of the thigh- superior and inferior gluteal nerves- nerves to the obturator internus and quadratusfemoris- pudendal nerve- superior and inferior gluteal arteries and veins- internal pudendal artery and vein
2. Lesser Sciatic Foramen
: formed by the lesser sciatic notch of the hip bone andthe sacrotuberous and sacrospinous ligaments:provides an entrance into the perineum from the glutealregion
Structures that pass through the foramen
:- tendon of obturator internus muscle- nerve to obturator internus- pudendal nerve- internal pudendal artery and veinNote:Intramuscular injection in the gluteal region should bedone in the upper lateral quadrant to avoid hitting thesciatic nerve.
F. NERVES TO THE GLUTEAL REGION
 
1. Sciatic nerve
(L4, L5, S1, S2, S3): largest nerve in the body and branches into
tibial andcommon peroneal nerves
 
*Sciatica (fat wallet syndrome)
 
 –
occurs in rich people;pain in the posterior aspect of the thigh, the posteriorand lateral sides of the leg, and the lateral part of thefoot
2. Posterior Cutaneous Nerve of the Thigh
:passes downward on the posterior surface of the sciaticnerve; runs down the back of the thigh beneath the deepfascia.Branches:
a. Gluteal branches
to the skin over the lower medialquadrant of the buttock
b. Perineal branch
to the skin of the back of thescrotum or labium majus
c. Cutaneous branches
to the back of the thigh andthe upper part of the leg
3. Superior Gluteal Nerve
: leaves the pelvis through the upper part of the greatersciatic foramen above the piriformis:
supplies both gluteus medius and minimus andends by supplying tensor fascia latae4. Inferior Gluteal Nerve
:leaves the pelvis through the lower part of the greatersciatic foramen below the piriformis:
supplies gluteus maxmius
 
5. Nerve to Quadratus Femoris
:leaves the pelvis through the lower part of the greatersciatic foramen:ends by
supplying quadratus femoris and theinferior gemellus6. Pudendal nerve and Nerve to Obturator Internus
:leaves the pelvis through the lower part of the greatersciatic foramen, below the piriformis:
pudendal nerve supplies structures in the perineum: nerve to obturator internus supplies the obturatorinternus muscle on its pelvic surfaceG. ARTERIES OF THE GLUTEAL REGION1. Superior gluteal artery
: largest branch from the internal iliac artery and entersthe gluteal region through the upper part of the gratersciatic foramen above the piriformis:
supplies gluteus maximus (superficial) and gluteusmedius and minimus (deep)2. Inferior gluteal artery
: branch from the internal iliac artery and enters thegluteal region through the lower part of the grater sciaticforamen below the piriformis:
supplies hamstring muscle, hip joint
 
3. Trochanteric anastomoses
:main blood supply to the head of the femur:arteries that take part include superior gluteal artery,inferior gluteal artery, medial femoral circumflex arteryand lateral femoral circumflex artery.
 
 3of 8
GROSS ANATOMY: LOWER EXTREMITY 1Dr. DamascoAugust 12, 2009trans by Nica, Fiel, & Abby
4. Cruciate Anastomosis
: at the level of the lesser trochanter of the femur and,together with the trochanteric anastomosis, provides aconnection between the internal iliac and the femoralarteries: arteries that take part include inferior gluteal artery,medial femoral circumflex artery, lateral femoralcircumflex artery and the first perforating artery (branchof the profunda artery)
II. POSTERIOR THIGH
: refers to the posterior compartment of the thigh (Thighis divided into compartments by the
intermuscularseptum
 
MUSCLES OF THE POSTERIOR THIGH (HAMSTRINGS)MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTIONA. MEDIAL HAMSTRINGS
 
1. Semitendinosus
IschialtuberosityUpper part of the medialsurface of the shaft oftibiaSciatic nerve (tibialpart) (L5,S1, S2)Flexion and medialrotation of the leg
2. Semimebranosus
IschialtuberosityMedial condyle of the tibia Sciatic neve (tibialpart) (L5, S1, S2)Flexion and medialrotation of the leg
B. LATERAL HAMSTRINGS
 
3. Bicepsfemoris
LongHeadIschialtuberosityHead of fibula Sciatic neve (tibialpart) (L5, S1, S2)Flexion and lateralrotation of the leg; thighextensionShortHeadLineaasperaCommon peroneal(fibular) nerve (L5,S1, S2)Flexion and lateralrotation of the legC. HAMSTRINGS OF THE ANTERIOR THIGH
4. Adductor magnus
(hamsting part)IschialtuberosityAdductor tubercle offemurSciatic neve (tibialpart) (L3, L4))Thigh extesion: The muscle fibers of the semimembranosus expands tosupport the capsule on the back of the knee joint. Thisfibrous expansion is called the
oblique poplitealligament
.:Cutaneous Innervation:
posterior cutaneous nerve ofthe thigh
 
Nerve Supply of the Posterior Thigh 
 
Sciatic Nerve
: branch of the sacral plexus: divides at the lower third of the thigh into:1.
tibial nerve
(medial)2.
common peroneal nerve
(lateral)
III. POPLITEAL FOSSA
: diamond-shaped intermuscular space at the back of theknee joint: most prominent in knee flexion: counterpart of the cubital fossa
A. Boundaries
1. Medially: semitendinosus and semimembranosus(above): medial had of gastrocnemius (below)
 
2. Laterally: biceps femoris (above): lateral head of gastrocnemius and plantaris (below)3. Floor: popliteal surface of femur: posterior ligament of knee joint: popliteus4. Roof: deep fascia of thigh: superficial fascia: skin
B. Contents1. Popliteal vesselsa. Popliteal Artery
(medial)Level Popliteal fossa(entrance throughopening in adductormagnusPopliteus(lower border)Femoralartery
Popliteal artery
Anterior tibialarteryPosterior tibialartery
*Guide to understanding the table (and all similar tables):The femoral artery,
upon entering the popliteal fossa through the opening in the adductor magnus, becomes the popliteal arterr. At the level of the lower border of the popliteus, the popliteal artery divides into the anterior and posterior tibial arteries.

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