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Lower Limb
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Lower Limb

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  1. Lower Limb • What is a limb? • Skeleton • Joints • Pelvis or limb girdle • Hip/Hip Muscles • Lumber and sacral plexus—getting spinal nerves out onto limb • Muscles—anterior and posterior compartments • Surface anatomy • Skeleton (homologous with upper limb) • Muscles--anterior, posterior compartments • Nerves--sciatic, femoral • Surface anatomy

  2. What is a limb? • Ventral somatic outgrowth of outer tube • Bones (made of bony tissue, cartilage, and other tissues) • Joints • Muscles • Nerves (with motor neurons to muscles, sensory neurons to skin, proprioceptors) • No viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)

  3. Upper Limb Lower Limb • Scapula • Humerus • Radius, ulna • Carpals • Digits • Metacarpals • Phalanges • Pelvis • Femur • Tibia, fibula • Tarsals • Digits • Metatarsals • Phalanges

  4. Upper Limb • Scapula • Humerus • Radius, ulna • Carpals • Digits • Metacarpals • Phalanges

  5. Tibia/fibula • Tibia--big toe side • Fibula--little toe side (no pronation/supination)

  6. Ankle • Talus--forms ankle joint • Calcaneus--forms heel

  7. Foot • Function: • Support weight • Act as lever when walking • Tarsals • Talus = ankle • Between tibia + fibula • Articulates w/both • Calcaneus = heel • Attachment for Calcaneal tendon • Carries talus • Metatarsals • Homologous to metacarpals • Phalanges • Smaller, less nimble

  8. Joints of Lower Limb • Hip (femur + acetabulum) • Ball + socket • Multiaxial • Synovial • Knee (femur + patella) • Plane • Gliding of patella • Synovial • Knee (femur + tibia) • Hinge • Biaxial • Synovial

  9. Joints of Lower Limb • Proximal Tibia + Fibula • Plane • Gliding • Synovial • Distal Tibia + Fibula • Slight “give” • Fibrous • Ankle (Tibia/Fibula + Talus) • Hinge • Uniaxial • Synovial pg 218

  10. Hip Flexion/extension Abduction/adduction Lateral/medial rotation Knee Flexion/extension Ankle Dorsiflexion/plantarflexion Inversion/eversion Toes Flexion/extension Bending on posterior side is flexion (except hip) Bending on anterior sided is extension (except hip) Lower Limb Movements

  11. Pelvic tilt and a reverse lumbar curve (or how we got to be upright) • Bowl concept • pelvis spills forward • Hernia • “beer belly” • In human minor pelvis is behind (posterior) to guts and abdominal cavity • Compare human pelvic position with quadruped (cat for instance)

  12. Human pelvis still has quadruped orientation

  13. Bony structure of the pelvis MAIN STRUCTURES • Hip bone (innominate, os coxae)--fusion of • Ilium (“hips”) • Ischium (“rear”) • Pubis (anterior midline) • Sacrum and coccyx • Acetabulum • Femur--head, neck, greater trochanter HOLES • False and true pelvis (major, minor pelvis) • Pelvic inlet, pelvic outlet • Sacrotuberous ligament • Sacrospinous ligament • Greater, lesser sciatic foramen • Obturator foramen

  14. Female Male • Cavity is broad, shallow • Pelvic inlet oval + outlet round • Bones are lighter, thinner • Pubic angle larger • Coccyx more flexible, straighter • Ischial tuberosities shorter, more everted • Cavity is narrow, deep • Smaller inlet + outlet • Bones heavier, thicker • Pubic angle more acute • Coccyx less flexible, more curved • Ischial tuberosities longer, face more medially

  15. Posterior and lateral hip • Gluts (gluteal nn.) • Maximus—extensor of thigh • Medius--pelvic tilt (relative to insertion with foot planted) • Lateral rotators (spinal nn.) • Piriformis syndrome

  16. Anterior Hip • Iliopsoas • iliacus • psoas • Quadratus lumborum

  17. Lumbar and sacral plexus • Mr. Bill is happy—so easy • Lumbar plexus forms femoral n.—anterior • Sacral plexus forms sciatic n.--posterior Femoral n. Sciatic n.

  18. Lumbar plexus (femoral nerve) Sacral plexus (sciatic nerve) With leg out to side like quadruped, lumbar-anterior, sacral-posterior makes sense

  19. Dermatomes show twisting of leg during development Dorsal becomes anterior: thus “dorsiflexion” and extension in anterior compartment (unlike upper limb) Ventral becomes posterior: thus flexion is in posterior compartment (unlike upper limb)

  20. Anterior/Posterior compartments

  21. Thigh movements by compartment

  22. Anterior thigh (femoral n.) • Sartorius (Tailor’s muscle) • Quads (four) • Rectus femoris (crosses hip) • 3 vastus mm. (vast--big)

  23. Posterior thigh (sciatic n.) • Hamstrings • Biceps femoris • Semimembranous • Semitendinous

  24. Medial thigh (obturator n.) • Adductor muscles • Gracilis • Adductor • Magnus • Longus • brevis

  25. Leg movements by compartment (in leg all nn are branches of sciatic)

  26. Anterior Leg (deep fibular n.) • Extensors (dorsiflexors) • Fibularis (peroneus) longus • Extensor digitorum longus • Extensor hallicus longus • Tibialis anteriorus

  27. Lateral Leg (superficial fibular n.) • Fibularis brevis/longus

  28. Posterior Leg (tibial n.) • Flexors (plantarflexors) • Gastrocs and soleus • Flexor digitorum longus • Flexor hallucus longus

  29. Human gait • Humans only large mammal marathoners, ultra-runners • Prehistoric cultures hunted by exhausting large prey • Bipedalism very efficient energetically • Gastroc-Achilles spring • One other large mammal more efficient—also bipedal

  30. Intrinsics of foot

  31. pg 792 Surface Anatomy: Anterior Thigh + Leg • Palpate • Patella • Condyles of femur • Femoral Triangle • Sartorius (lateral) • Adductor longus (medial) • Inguinal ligament (superior) • Femoral a + v, lymph nodes pg 785

  32. Surface Anatomy: Posterior Leg • Popliteal fossa • Diamond-shape fossa behind knee • Boundaries • Biceps femoris (sup-lat) • Semitendinosis + semimembranosis (sup-med) • Gastrocnemius heads (inf) • Contents • Popliteal a + v • Calcaneal (Achilles) tendon pg 793

  33. Blood supply to lower limb • Internal Iliac • Cranial + Caudal Gluteals= gluteals • Internal Pudendal = perineum, external genitalia • Obturator = adductor muscles • External Iliac • Femoral = lower limb • Deep femoral = adductors, hamstrings, quadriceps • Popliteal (continuation of femoral) • Geniculars = knee • Anterior Tibial = ant. leg muscles, further branches to feet • Posterior Tibial = flexor muscles, plantar arch, branches to toes