thigh=

Leg=

Foot=

thigh=Femur

Leg=Tibia and Fibia

Foot= Tarsals, Metatarsals and phalanges

1-function of the femur

2-direction of the femur

1-directs the body weight down to the leg

2-not straight up and down, run in a medial direction

-Stable joint, head is locked in deap to acatabulum

fovea capitis

1-location

2-accommodates what ligament

1-depression in the center of the head of Femur

2-accommodate prominent ligament

1-What artery supplies the head of the femur

2-what does it run inside of

1- The acetabular branch of the obturator artery supplies the head of femur

2-the acetabular artery runs inside of the Ligament of the head of femur

*if this artery gets cut off we could have necrosis of the head of the femur, remember bones need a blood supply (they are just dense connective tissue)

Anterior-pubofemoral ligament- comes from pubic bone, limits the abduction of the hip cant completely abduct like upper extremity

Iliofemoral ligament- arises from the ilium, spirals around the hip joint anteriorly- prevents hyperextension

Ischiofemoral ligament-arises from the ischium, limits hyperextension

Deep Fascia of lower extremity

1-deep fascia of thigh

2-deep fascia of leg

1- Fascia Lata

2-Crural fascia

Crural=think leg

Great Saphenous vein

1-where does it run

1-superficial to fascia and it runs medially from dorsum of foot up to the groin region then goes deep to meet the femoral vein.

* veind in legs have alot of valves

Iliotibial tract

1- location

2-what muscle is this fascia assoc. w/

1-thickening of the lateral side of the facia lata (only over lateral thiegh) crosses the the lateral part of the knee joint and (supplys some stability to knee joint) and attaches to tibia.

2-The tensor of fascia lata of the hip and

Muscles of the Glutial area and there location and relationship to each other

4

1-tensor of fascia-lateral

2-Gluteus maximus- most superficial posterior muscle, it is directed downward and laterally,

3-Gluteus medius-deep to G. maximus and a more lateral origin from the Ilium

4-Gluteus Minimus-deep to G. medius

Muscles of the Glutial area

origin

insertion

innervation

action

tensor of fascia lata

origin-from ASIS and

inserts- to iliotibial tract 

innervation-superior gluteal nerve

Gluteus maximus

origin- from the coccyx, sacrum and part of ilium and insets- partly onto the iliotibial tract and party onto the shaft of the femur

innervation- inferior gluteal nerve

Action-major hip extendor and lateral rotation of hip joint,

Gluteus medius

 origin- from the Ilium

inserts- onto the greater trochanter of the femur

innervation- by the superior gluteal nerve

Action-abductor and medial rotator of the hip joint (kindof crosses the hip joint anteriorly allows for medial rotation)

Gluteus Minimus

origin-ilium

inserts-onto the greater trochanter of the femur

innervation-superior gluteal nerve 

Action-abductor and medial rotator of the hip joint (kindof  crosses the hip joint anteriorly)

1.Sacrotuberous ligament

2. Sacrospinous ligament

1and2=what bones do they attach

3-these ligament create borders for which foramens

1-coming from sacrum and going to ishial tuberosity

2-from sacrum to ischeal spine

3- the greater and lesser sciatic foramen

Greater sciatic foramen

1-allows comunication between what two areas

2-what travels through it

 1-the true pelvic and the gluteal region

2-Piriformis muscle

-sciatic nerve

Piriformis muscle

-location

-course and insertion

-relationship

- deep to the glut. maximus

-passes through the greater sciatic foramen and inserts onto the greater trochanter

-superior to the sciatic nerve

sciatic nerve

-route

-2 branches

-innervation

-comes from the sacral plexus=(which is located within the true pelvis) and tavels inferior to the piriformis muscle through the greater sciatic foramen

-tibial nerve and common fibular nerve

-innervates the posterior compartment of the leg= which is your hamstrings and everything inferior to the knee= leg and foot

Triceps coxae

1-made up of 3 muscles

2-inserion

3-action

4-relationships

1-superior gemellus-inserts onto the greater trochanter of femur

2-Obturator internus-covers the obturator foreamen on the inner side  of the pelvis, has a tendon that exits the lessor sciatic foramen and inserts onto the greater trochanter of femur

3-Inferior gemellus-inserts onto the greater trochanter of femur

2-(Triceps coxae-inserts onto the greater trochanter of femur)

3-lateral rotaters, (add stability to the hip joint)

4- inferior to piriformis muscle

Quadratus Femoris

-action

-location

Lateral rotator, that stabalizes the hip joint

-inf to Triceps coxae

Superior gluteal neurovascular bundle

-loaction/relationship

-includes what and branch from where

-innervates

-superior to the piriformis, through the greater sciatic foramen

-superior gluteal artery branches from the internal iliac

-superior gluteal nerve branches from the sacral plexus

-innervates the gluteus minimus, gluteus medius and the tensor fasa lata

inferior gluteal neurovascular bundle

-loaction/relationship

-includes what and branch from where

-innervates and suppies blood

-inferior to piriformis, medial to the sciatic nerve, through the greater sciatic foramen

-inferior gluteal nerve-branches from the sacral plexus

inferior gluteal artery-branches from the internal iliac

-innervates and supplies blood to the Gluteus Maximus

Internal pudendal artery and Pudendal nerve (NVbundle)

-loacation/course/relationships

-branch from

-enters gluteal region through the greater sciatic foramen, medial to the inferior gluteal NV bundle, (short course in the gluteal region) wraps around the sacrospinus ligament then exits the gluteal region through the lessor sciatic foramen to the perineum

Internal pudendal artery-branch of the internal iliac

 Pudendal nerve-branch of the sacral plexus

-upper right quadrant of gluteal area

-place the tip of your index finger on ASIS and tip of ur middle finger on the tubercle of iliac crest then shoot between the V ur fingers make

Begin thigh and knee slide set

compartments of the thigh

Anterior Compartment- Quadriceps

Medial Compartment-groin muscles

Posterior Compartment- hamstrings

Quadriceps

-name the 4 heads and their origins and insertions, locations, actions and tendon

(located in the anterior compartment of thigh)

1-Anterior Compartment- Quadriceps-4 heads

 Rectus Femoris-anterior to femur, only head that takes origin from the hip (ASIS)-flexion of hip joint

Vastus Lateralis-lateral to femur originates from the femur

Vastus intermedius-originates from the femur

Vastus medialis-medial to femur, originates from the femur

 2-all four heads extend the knee joint, only the rectus femoris flexes the hip

3-The four heads merge together to form a commontendon, the quadriceps tendon, that encloses the patella-(a sesmoid bone bc it is surrounded by ligament), then inferior to the patella this ligament is called the pateller ligament-which inserts onto the anterior tibia.

1-Lateral intermuscular septum

2-Medial intermuscular septum

tendon is superior to patella and ligament is inferior to patella,

ligament-this is the one u hit for reflex

Iliopsoas muscle

-formed by what 2 muscles

-action

-origin and insertion/ location/route

-located in what compartment of thigh

-formed by the psoas major and Iliacus muscles

-most powerful flexor the hip joint, (psoas major also act on the Lspine- not important now)

-takes origin from the abdominopelvic cavity (ilium and L spine) and runs deep to the inguinal ligament then insert onto the lesser trochanter of the femur

-located in the anterior compartment of the thigh

Sartorius muscle

-origin/insertion/route

-action

-located in which compartment

Takes origin from the ASIS and runs from lateral to medial and crosses the hip and knee joint medially then inserts onto the medial superior aspect of the tibia

-flexes both the knee and hip joint and lateral rotation of hip (tailer's muscle)

-anterior compartment

Pectineus

-which compartment

-origin/insertion

-action

-can be a part of the anterior compartment and the medial compartment

-arises from the hip and inserts onto the superior portion of the femur.

-flexion of hip joint and adduct the hip joint, bring femur to midline

Anterior compartment

-muscles inside are innervated by what nerve which is a branch of what and location/route/relationship?

-name muscles inside this compartment

-innervated by the femoral nerve, which is a branch of the lumbar plexus, femoral nerve-runs deep to the inguinal canal and enters the anterior thigh (psoas major also gets some innervation frofrom other branches of the lumbar plexus)

-Quadriceps (Rectus Femoris,Vastus Lateralis, Vastus intermedius, Vastus medialis)

-Iliopsoas-(psoas major and Iliacus)

-Sartorius

-Pectineus(also in medial comppartment)

Medial compartment

-muscles

-action

-innervation

-pectineus

-adductor brevis

-adductor longus

-adductor magnus

-gracilis

-all adductors, bring thigh to midline

-obturator nerve, branch of the lumbar plexus, enters the anterior medial thigh

adductor magnus

-name 2 parts

-deepest and largest muscle in the medial compartment

-1-hamstring portion-it originates from the ischial tuberosity(hamstrings arise from the ischial tuberosity)

2-adductor part-arises from the shart of the femur along the linea aspera

-the tendon for this muscle inserts onto the inferior medial part of the femur on the adductor tuberosity (Adductor tendon)

Takes origin from  pelvis and crosses knee joint medially; inserts on medial aspect of tibia

Long slender muscle that is involved in ADDUCTION

Femoral triangle

boundaries

Superior: Inguinal ligament

Lateral: Sartorius muscle

Medial Boundary: adductor longus

Floor: Pectinius muscle and iliopsoas-(

iliopsoas is more lateral)

Femoral Sheath

-contains

-located w/in the femoral triangle

-contains the femoral artery, femoral vein, lymphatics (deep inguinal lymph node) and femoral canal

(*does not enclose the femoral nerve, the femoral nerve is lateral to the femoral sheath)

Lateral to medial=nerve artery vein lymph (NAV)

Name change of vessels occurs once they pass deep to inguinal ligament (iliac to femoral)

  loop of bowel travels in femoral canal; assumes position in ant/medial thigh; herniated tissue is medial to NV bundle and within sheath

more prevelent in female

Great saphenous vein (superficial vein on medial aspect of thigh) will enter femoral vein within the confines of femoral triangle

Femoral nerve from lumbar plexus (traveling deep to inguinal ligaement)

adductor canal

1-purpose

2-where does it start and stop

canal within adductor muscles that allow vessels to pass from ant side to posterior aspect of  knee

vessels enter the canal at the apex of triangle (Apex-crossing of Sartorius and adductor longus muscle)

 Canal extends From apex of the femoral triangle to adductor hiatus: allows vessels to get to post aspect of extremity

adductor canal

boundries

contents

 Sartorius-roof or medial boundry

Vastus medialis-anterior boundry

adductor longus-lateral posterior boundry

contents-femoral artery and vein and saphenous nerve-(cutaneous nerve from femoral)

Hamstrings

-Three Muscles: names and locations

-what compartment

-

1-Semitendinosis-Medial Side and Crosses knee joint medially (narrow, cord-like tendon)

2-Semimembranosus- Medial Side and Crosses knee joint medially (broad flat tendon) 

3-Biceps femoris- Lateral side of knee and has two heads-short and long head

-posterior compartment

True Hamstrings

-muscles included

-origin

-cross knee anf hip joint where

-action

-innervation

True hamstrings=-semimembranosus, -semitendinosis, -long head of biceps femoris

true hamstrings=Cross hip joint post and cross knee joint post to central axis of knee; 

 EXTENSION AT THE HIP JOINT and FLEXION OF KNEE (anatogonist action to quadriceps)

Innervated by Bracnhes from tibial nerve

Sciatic nerve is still inact but branches are from tibial portion of the sciatic nerve

Short head of the bicep

-origin/route

-action

-innervation

 arises from shaft of femur; does NOT cross hip joint; only crosses knee joint

-only flexes the knee

Innervation: Common fibular nerve of the sciatic

-distal end of femur

-proximal end of tibia

-patella

*fibula is not a part of the knee joint-it does articulate w/ the tibia

1-Lateral condyle of femur articulates w/

2-Medial condyle of femur articulates w/

1-Lateral condyle of Tibia articulates w/

2-Medial condyle of Tibia articulates w/

Patella

-articulates with

-type of bone

-enclosed by

-articulates with pateller fossa on femur

-Sesmoid bone

-Quadriceps tendon encloses patella then the patellar ligament will attach to tibial tuberocity (*imp for stability of joint, stabilizing quadriceps tendon, offers strength to joint.

Tibial plateu

-location

-attachments

-Sup surface of tibia

Will be articulatar surfaces for medial and lateral condyles and will accommodate articular surfaces of femur

-Medial and Lateral Meniscus attach here

-Cruciate Ligaments attach here (ACL, PCL)

Cruciate ligaments

(they cross, cruciate=cross)

Ant and posterior

Named by their attachments to tibia

Cross within joint

Posterior: courses superiorly, anteriorly will also go medially

Anterior: as it courses sup, will go posterior and lateral

* Ref point is the tibia=they are coursing from tibia

Lateral (Fibular) Collateral ligament vs medial (tibial) collateral ligament

LCL, MCL

Fibular Lateral Collateral Ligament: Attachment from femur to the fibula

 Tibial (Medial) Collateral Ligament: physically attached to the medial meniscus  and femur and tibia

Popliteus muscle

-location

-attachments

actions

-crosses knee joint posteriorly

-attached to the femur laterally and tibia inferiorly and medially

-Flexion of Knee

-locks the knee

Rotates Femur Slightly Laterally when it contracts; allows flexion to occur at knee

Pes Anserius

-3 muscles

-attachments

-action

-point about innervation

Attachment for three muscles that will insert onto the medial aspect of the proximal part of the tibia

 Muscles:

Gracilus: obterator nerve

Semitendonosis: tibial nerve

Sartorius: femoral nerve

 Support medial aspect of knee joint

Each muscle coming from different muscular compartment of thigh and therefore being innervated by dif nerve

Fixed foot (ex. Cletes) lateral blow, causes twisting to occur

3 thigns can get torn:(ACL, MCL, Miniscus)

ACL (ant crucial ligament)

Medial miniscus and tibial (medial) collateral ligament are attached to each other

*can put stress on these two as well

See if Ant or Post crucial ligament is torn

ANT DRAWER SIGN (push out): If torn, tibia will be able to move ant/femur will be able to move more post

POST DRAWER SIGN (push in): Femur will go more ant/ tibia more post

new slides-popliteal fossa, leg and foot

Bones of legs

Tibia and fibula

Tibia- medial bone- larger- weight bearing bone of leg/

“shin bone”- ant/medial surface is subcutaneous

Tibia- involved in knee joint; will have proximal and distal articulation with fibula

Interosseous membrane btw two bones- will compartmentalize leg

Distal part of tibia and fibula and one of the tarsal bones (TALUS)  (Tibia, fibula and TALUS)

Medial malleolas- distal tibia

Lateral malleolas-distal fibula

Tibia involved with knee and ankle

Fibula only involved with ankle; non-weight bearing bone

Metatarsals and phalanges (same arrangement in hand)

5 metatarsals

5 proximal phalanges

4 distal phalanges

great toe (#1) doesn't have DP so it only has one IP joint (PIP)

Tarsal bones

7 bones not oriented in two rows

Tall Centers Never take shots from corners=Talus, Calcaneus, Navicular, Third Cuneiform, Second Cuniform, First Cuniform Cuboid

TALUS- sup view; articular surface for  tibia and fibula=ankle joint

Calcaneus-Largest tarsal- heal bone

articulate w/ metatarsals=(Lateralto medial): cuboid (4+5MT), third(lateral) Cuniform, second (intermediat) Cuniform, first(medial)Cuniform.

Navicular-medial in foot, i think it articulates with all the tarsals

Popliteal fossa

-location

-borders

-region posterior to the knee joint

Diamond-shaped area

Superior boundary:

1. hamstrings: semimembranosus (medial)

2. biceps long head (lateral )

Inferior boundary: Gastrocnemius muscle (medial and lateral head)

Popliteal vein and artery (emerged from adductor hiatus)

Sciatic nerve already divided; tibial nerve goes with vasc bundle; laterally-common fibular nerve or peroneal nerve

 Tibial nerve in midline- coursing laterally

Genu-vessels assoc with collateral circulation of the knee will have name genu or genucular/genucucular arteries. System of arteries coming off vessel that is in the popliteal fossa

Ex. Femoral artery leads into popliteal artery

Popliteal vein- becomes femoral vein when it exits fossa

same vessels but NAME CHANGE

3 compartments of the leg

1-Anterior

2-Lateral

3-posterior

Anterior compartment of leg

-innervation

-blood supply

-action

-muscles

-deep branch of the fibular nerve(deep fib nerve)

-Anterior Tibial artery

-dorsiflexion or extension of ankle

Muscles

TA-tibialis anterior

EHL-Extensor hallucis longus

EDL-Extensor digitorum longus

Lateral Compartment of Leg

-Muscles

-action

-innervation

-blood supply

-muscles-Fibularis Longus and Fibularis Brevis they both cross the ankle joint laterally and they both evert the foot.

-eversion compartment

(antagonistic to the ant and post tibialis muscles)

-innervated by the superficial branch of the fibular nerve

-Fibular artery

Posterior Compartment of Leg

-action of compartment

-2 compartments w/in and there muscles

-innervation

-blood supply

-flexor compartment

Superficial compartment-1-Gastrocnemius 2-Plantaris 3-Soleus

Deep compartment-1-Flexor hallucis Longus 2-Flexor digitorum Longus 3-Tibialis posterior

innervation-tibial nerve

artery-posterior tibial artery

Leg fascia etc.

-these fascia are all very ridgid, so  pressure build up (edema etc.) could occlude nerves and vessels and cause necrosis.

sural fasia-fascia of entire leg

Interosseous membrane-connects to the tibia and fibula and seperates the ant and post compartments

anterior (AC)and posterior(PC) intermuscular septum-connect to the sural fascia and the fibula

ant.-eperates the ant and lat compartments

post-seperates the lateral and post compartments

muscles of the superficial compartment of the posterior compartment of leg

-names

-relationships

-attachments

-actions

Gastrocnemius-muscle(calf)-has a medial and lateral head that arise from the distal femur and cross the knee joint (can flex the knee joint) then they come down and form the Calcaneal (achilles) tendon that crosses the ankle joint and then connects to the calcaneus (plantar flexion)

Plantaris-deep to Gastroc, crosses the knee (thin looks like a nerve)and the tendonblends in with the calcaneal or achilles tendon.

Soleus-bilateral, arise from tibia and fibula acts on ankle only-plantor flexion, its tendon  joins the achilles also crosses the ankle joint and then connects to the calcaneus

Deep compartment

-muscles

-actions

1-Flexor hallucis Longus-flexes the great toe

2-Flexor digitorum Longus-flexes digits 2-5 on feet

3-Tibialis posterior-inversion of the ankle or foot

these 3 rap around to the medial malleolus

tome dick and harry

muscles that invert the foot

Tibialis anterior

and

Tibialis posterior

-The sciatic nerve branches where and into what

- continues inferiorly to innervate the muscles of the soles of the feet

The sciatic nerve branches posterior to the knee around the pop fossa and branches into the common fibular nerve and the tibial nerve 

-tibial nerve continues down then innervates the muscles of the soles of feet

Common fibular nerve

-anatomic relationship with?

-this nerve branches into? and they innervate what compartments?

clinical correlation?

-proximal  head of fibula

branches

superficial fibular nerve- lateral compartment

deep fibular nerve-to ant compartment, dorsiflexors- if those muscles are knocked out from (eg fracture proximal head of fibula)- plantar flexors are unopposed- will get “Foot drop” syndrome; extensors are impaired; more exaggerated plantar flexion- could trip

1- popliteal artery 

2-genicular arterys

3-anterior tibial artery

4-posterior tibial arteris

Fibular artery

-is a branch of

-supplies what compartment

Plantar aponeurosis; can get aggravated; could develop spurs or calcium deposits

-hurts to walk

anterior tibial artery travels through the ____1_______ and comes out on the anterior side and supplys the anterior compartment, then this artery continues onto the _______2_____ and is called the ______3______

posterior tibial arteris supplies the the

1-interosseus membrane

2-dorsum of the foot

3-Dorsalis Pedis artery

posterior tibial arteris supplies the the posterior compartment