Muscles of the Lower Limb

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Muscles of the Lower Limb

• Dr. Emad I Shaqoura
• IUG Faculty of Medicine

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Thigh anterior medial aspects

• Cutaneous Nerves The lateral cutaneous nerve of
  the thigh, a branch of the lumbar plexus (L2 and
  3), enters the thigh behind the lateral end of
  the inguinal ligament
• Femoral branch of the genitofemoral nerve
• Ilioinguinal nerve
• Medial cutaneous nerve of the thigh
• Intermediate cutaneous nerve of the thigh

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Superficial Veins

• The great saphenous vein ascends in the medial
  side in company with the saphenous nerve and
  passes behind the knee and curves forward around
  the medial side of the thigh. It passes through
  the lower part of the saphenous opening in the
  deep fascia and joins the femoral vein about 1.5
  in. (4 cm) below and lateral to the pubic
  tubercle
• It receives three tributaries the superficial
  circumflex iliac vein, the superficial epigastric
  vein, and the superficial external pudendal vein

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Superficial Veins

• Small saphenous vein arises from the lateral
  part of the dorsal venous arch of the foot (Fig.
  10-19). It ascends behind the lateral malleolus
  in company with the sural nerve. It runs up the
  middle of the back of the leg. The vein pierces
  the deep fascia and passes between the two heads
  of the gastrocnemius muscle in the lower part of
  the popliteal fossa. It ends in the popliteal
  vein.

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Inguinal Lymph Nodes

• Superficial Inguinal Lymph Nodes
• The superficial nodes lie in the superficial
  fascia below the inguinal ligament and can be
  divided into a horizontal and a vertical group
• Deep Inguinal Lymph Nodes The deep nodes are
  located beneath the deep fascia and lie along the
  medial side of the femoral vein

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Superficial Deep Fascia of the Thigh

• Superficial Fascia of the Thigh fatty layer of
  the superficial fascia.
• Deep Fascia of the Thigh (Fascia Lata) encloses
  the thigh like a trouser leg and at its upper end
  is attached to the pelvis and the inguinal
  ligament. On its lateral aspect, it is thickened
  to form the iliotibial tract , which is attached
  above to the iliac tubercle and below to the
  lateral condyle of the tibia.
• saphenous opening is a gap in the deep fascia in
  the front of the thigh just below the inguinal
  ligament. It transmits the great saphenous vein,
  some small branches of the femoral artery, and
  lymph vessels. saphenous opening is a gap in the
  deep fascia in the front of the thigh just below
  the inguinal ligament. It transmits the great
  saphenous vein, some small branches of the
  femoral artery, and lymph vessels

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Fascial Compartments of the Thigh

• Three fascial septa pass from the inner aspect of
  the deep fascial sheath of the thigh to the linea
  aspera of the femur The compartments are
  anterior, medial, and posterior in position.
• Contents of the Anterior Fascial Compartment of
  the Thigh
• Muscles Sartorius, iliacus, psoas, pectineus,
  and quadriceps femoris
• Blood supply Femoral artery
• Nerve supply Femoral nerve

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Femoral Triangle

• It is a triangular depressed area situated in the
  upper part of the medial aspect of the thigh just
  below the inguinal ligament. Its boundaries are
  as follows
• Superiorly The inguinal ligament.
• Laterally The sartorius muscle.
• Medially The adductor longus muscle.
• Its floor is gutter shaped and formed from
  lateral to medial by the iliopsoas, the
  pectineus, and the adductor longus. Its roof is
  formed by the skin and fasciae of the thigh.
• The femoral triangle contains the terminal part
  of the femoral nerve and its branches, the
  femoral sheath, the femoral artery and its
  branches, the femoral vein and its tributaries,
  and the deep inguinal lymph nodes.

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Adductor (sub-sartorial) Canal

• It is an intermuscular cleft situated on the
  medial aspect of the middle third of the thigh
  beneath the sartorius muscle. It commences above
  at the apex of the femoral triangle and ends
  below at the opening in the adductor magnus.
• The antero-medial wall is formed by the sartorius
  muscle and fascia.
• The posterior wall is formed by the adductor
  longus and magnus.
• The lateral wall is formed by the vastus
  medialis.
• The adductor canal contains the terminal part of
  the femoral artery, the femoral vein, the deep
  lymph vessels, the saphenous nerve, the nerve to
  the vastus medialis, and the terminal part of the
  obturator nerve.

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Muscles of the Gluteal Region
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Foramina of the Gluteal Region

• Greater Sciatic Foramen is formed by the greater
  sciatic notch of the hip bone and the
  sacrotuberous and sacrospinous ligaments. It
  provides an exit from the pelvis into the gluteal
  region.
• The following structures exit the foramen
  Piriformis, Sciatic nerve, Posterior cutaneous
  nerve of the thigh, Superior and inferior gluteal
  nerves, Nerves to the obturator internus and
  quadratus femoris, Pudendal nerve, Superior and
  inferior gluteal arteries and veins, Internal
  pudendal artery and vein.
• Lesser Sciatic Foramen is formed by the lesser
  sciatic notch of the hip bone and the
  sacrotuberous and sacrospinous ligaments. It
  provides an entrance into the perineum from the
  gluteal region. Its presence enables nerves and
  blood vessels that have left the pelvis through
  the greater sciatic foramen above the pelvic
  floor to enter the perineum below the pelvic
  floor.
• The following structures pass through the
  foramen Tendon of obturator internus
  muscle,Nerve to obturator internus,Pudendal
  nerve,Internal pudendal artery and vein

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Popliteal Fossa

• The popliteal fossa is a diamond-shaped
  intermuscular space situated at the back of the
  knee. It contains the popliteal vessels, the
  small saphenous vein, the common peroneal and
  tibial nerves, the posterior cutaneous nerve of
  the thigh, the genicular branch of the obturator
  nerve, connective tissue, and lymph nodes.
• Boundaries
• Laterally The biceps femoris above and the
  lateral head of the gastrocnemius and plantaris
  below.
• Medially The semimembranosus and semitendinosus
  above and the medial head of the gastrocnemius
  below.
• The anterior wall or floor is formed by the
  popliteal surface of the femur, the posterior
  ligament of the knee joint, and the popliteus
  muscle.
• The roof is formed by skin, superficial fascia,
  and the deep fascia of the thigh.

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Lateral Compartment of the leg
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Posterior compartment of leg

• Muscles in the posterior (flexor) compartment of
  leg are organized into two groups, superficial
  and deep, separated by a layer of deep fascia.
  Generally, the muscles mainly plantarflex and
  invert the foot and flex the toes. All are
  innervated by the tibial nerve.
• The superficial group comprises three
  muscles-gastrocnemius, plantaris, and soleus -all
  of which insert onto the heel (calcaneus) of the
  foot and plantarflex the foot at the ankle joint.
  They propel the body forward off the planted foot
  during walking and can elevate the body upwards
  onto the toes when standing.
• Two of the muscles (gastrocnemius and plantaris)
  originate on the distal end of the femur so can
  also flex the knee.
• The gastrocnemius muscle is the most superficial
  of the muscles in the posterior compartment and
  is one of the largest muscles in the leg. It
  originates by two heads, one lateral and one
  medial
• the medial head is attached to the posterior
  aspect of the distal femur just behind the
  adductor tubercle and above the articular surface
  of the medial condyle
• the lateral head originates from a facet on the
  upper lateral surface of the lateral femoral
  condyle where it joins the lateral supracondylar
  line.

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Table 6-7. Deep group of muscles in the posterior compartment of leg (spinal segments in bold are the major segments innervating the muscle)
Body_ID None
Function Innervation Insertion Origin Muscle
Body_ID T006007.50
Unlocks knee joint (laterally rotates femur on fixed tibia) Tibial nerve L4 to S1 Lateral femoral condyle Posterior surface of proximal tibia Popliteus
Body_ID T006007.100
Flexes great toe Tibial nerve S2,S3 Plantar surface of distal phalanx of great toe Posterior surface of fibula and adjacent interosseous membrane Flexor hallucis longus
Body_ID T006007.150
Flexes lateral four toes Tibial nerve S2,S3 Plantar surfaces of bases of distal phalanges of the lateral four toes Medial side of posterior surface of the tibia Flexor digitorum longus
Body_ID T006007.200
Inversion and plantarflexion of foot support of medial arch of foot during walking Tibial nerve L4,L5 Mainly to tuberosity of navicular and adjacent region of medial cuneiform Posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula Tibialis posterior
Body_ID T006007.250
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