GNK 483 MUSCULOSKELETAL CONDITIONS

1. GNK 483 MUSCULOSKELETAL CONDITIONS BLOOD AND NERVE SUPPLY TO THE LOWER LIMB 2012

2. Arterial Supply • Superior gluteal • Runs through greater sciatic foramen • Inferior gluteal • Runs through gluteal region • Obturator • Runs through obturator foramen to adductor compartment of thigh & hum head • Femoral • Popliteal

3. Femoral Artery • Main artery • Origin = external iliac artery • Course = femoral sheath • Lateral to femoral vein • Anterior to femoral head • Runs superficially in femoral triangle • Passes through adductor canal • Changes name to popliteal artery at add hiatus

4. Femoral Artery Branches • Branches inferior to inguinal ligament • Superficial circumflex iliac artery • Superficial epigastric artery • Superficial external pudendal artery • Branches in femoral triangle • Deep external pudendal artery • Deep femoral artery • Descending genicular artery

5. Deep Femoral Artery • Main artery of thigh • Arises lateral side of femoral artery • Leaves femoral triangle betw pectineus & add longus in the floor of the triangle • In adductor compartment it runs betw add longus and add magnus • Supplies adductors & flexor compartment • Branches • Medial circumflex femoral a : clinical importance • Supplies largest quantity of blood to fem head and neck • Lateral circumflex femoral a • Supplies lat side of thigh & fem head

6. Deep Femoral Artery • Anastomosis at height of lesser trochanter on posterior side of thigh • Medial circumflex femoral • Lateral circumflex femoral • Inferior gluteal • 1st perforator of deep femoral

7. Popliteal Artery Branches • Cutaneous • Posterior surface of leg • Muscular • Lower part of thigh muscles • Calf muscles : sural artery • Articular • Medial & lateral superior genicular • Middle genicular • Medial & lateral inferior genicular • Terminal • Anterior tibial • Called dorsalis pedis on dorsum of foot • Posterior tibial • Divides into medial & lateral plantar aa • Latter forms plantar arch & anastomosis with dorsalis pedis a

8. Venous Drainage • Deep veins • Superficial veins • Perforators

9. Deep Veins • 2 venae comitantes accompany each artery of the leg of which popliteal and femoral vv are examples • Blood flows proximally in these veins with the aid of: • Valves • Muscular contraction • Pulsation of aa adj to venae comitans • Pressure changes in thorax

10. Superficial VeinsOn dorsum of foot • Small saphenous • Post to lateral malleolus • Middle of calf it runs superficial to calcaneal tendon & gastroc • Ascends in relation sural n • Ends in popliteal vein • Great saphenous • Medial side of dorsal arch • Ant to medial malleolus • Ascends in relation to saphenous n • Drains into femoral vein

11. Before terminating, great saphenous receives: • Superficial epigastric • External pudendal • Superficial circumflex iliac • Anterolateral branch • Posteromedial branch • Perforators • At saphenous opening • Lower part of thigh Hunters perforating v • Below knee : Boyd’s perforating v • Medial aspect of leg

12. Innervation

13. Lumbar Plexus • Femoral n : L2,3,4 (posterior) • Muscular to ant compartment, pectineus • Articular to hip & knee • Cutaneous • Intermediate ant cutaneous • Medial ant cutaneous • saphenous

14. Lumbar Plexus • Obturator n : L2,3,4 (anterior) • Muscular to adductor, gracilis • Articular to hip & knee • Cutaneous to medial part of thigh • Lateral cutaneous nerve to thigh : L2,3

15. Sacral Plexus • Sciatic n : L4,5,S1,2,3 • Muscular to hamstrings, add magnus • Articular to hip & knee • Tibial n • Common fibular • Superficial fibular • Muscular to peroneus longus & brevis • Cutaneous to distal 1/3 of leg & dorsum of foot except 1st web space • Deep fibular • Muscular to 4 muscles of ant compartment • Cutaneous to 1st web space

16. LYMPHATIC SYSTEM LOWER LIMB