Anatomy- Le1

Front 1

+ Femur Text

Back 1

Femur
1. head
2. neck
a. clinical
• site for fracture…traumatic or pathological
3. greater trochanter
4. lesser trochanter
5. adductor tubercle
6. medial/lateral condyles
7. medial/lateral epicondyles
8. patellar surface
9. intercondylar fossa (notch)
10. popliteal fossa

Front 2

+ Tibia and Fibula Text

Back 2

Tibia
1. medial/lateral condyles
2. tibial tuberosity
3. medial/lateral plateaus
4. medial malleolus

Fibula
1. head of fibula
2. lateral malleolus

Front 3

+ Foot Text

Back 3

Foot
1. tarsals - calcaneous, talus, cuboid, cuneiforms (3), navicular
2. metatarsals
3. phalanges – 2 for great toe; 3 for other four toes

Front 4

Back 4

Front 5

+ Hip Joint Text

Back 5

Hip joint
A. Femoral head articulates with acetabulum
1. acetabulum – margin, lunate, acetabular notch
2. acetabular labrum
3. head of femur – fovea capitis
4. clinical anatomy
a. THR (total hip replacement)
b. Childhood conditions
• Legg Calve Perthes
• Transient synovitis
• SCFE (slipped capital femoral epiphysis)
c. Dislocation of hip
• Trauma – posterior dislocation is MC….often d/t MVA’s
• Children – CHD (congenital hip dislocation)….newborn

Front 6

Back 6

Front 7

+ Hip Ligament Text

Back 7

Ligaments of hip joint
1. iliofemoral ligament (Y ligament) – largest ligament of hip, anterior, resists extension (especially in standing)
2. pubofemoral ligament – anterior inferior – resists abduction
3. ischiofemoral ligament – posterior, also resists extension and medial rotation
4. ligamentum teres (round ligament of head of femur)
a. Attaches to foves capitis of femur head
b. Provides pathway for acetabular branch of obturator artery
• Critical pathway for blood supply to femoral head during growth

Front 8

Back 8

Ligamentum Teres

Front 9

+ Blood Supply of the Hip Text

Back 9

Blood supply of the hip
1. medial and lateral circumflex arteries
2. acetabular branch of obturator artery
3. clinical
a. avascular necrosis (AVN)

Front 10

Back 10

Front 11

Back 11

hip flexion
a. iliopsoas
b. rectus femoris
c. sartorius

Front 12

Back 12

hip adduction
a. pectineus
b. adductor longus
c. adductor brevis
d. adductor magnus
e. gracilis

Front 13

Back 13

hip abduction
a. gluteus minimus
b. gluteus medius
c. TFL (tensor fascia lata)

Front 14

Back 14

hip extension
a. gluteus maximus
b. biceps femoris (long head)
c. medial hamstrings
• semimembranosus
• semitendinosus

Front 15

Back 15

external rotation of hip
a. “six lateral rotators” or short external rotators
• piriformis
• superior gemellus
• obturator internus
• inferior gemellus
• quadratus femoris
• obturator externus
b. gluteus maximus
c. biceps femoris
d. sartorius

Front 16

Back 16

internal rotation of hip
a. gluteus minimus
b. gluteus medius
c. TFL
d. medial hamstrings
• semimembranosus
• semitendinosus

Front 17

Back 17

Iliotibial Tract

Front 18

Fascia of the thigh

Back 18

Fascia of thigh
1. Deep – fascia lata (dense layer of connective tissue between subcutaneous tissue and muscles. Forms fibrous septa that separates muscles and also surrounds them. Works with contracting muscles to move blood and lymph towards thorax.
a. Illiotibial tract (conjoint aponeurosis of tensor of fascia lata and gluteus maximus;extends from iliac tubercle to tubercle on lateral condyle of tibia (Gerdy’s tubercle)
b. Medial, Lateral and Posterior Intermuscular septums

Front 19

Iliopsoas

Back 19

iliacus + psoas

Front 20

Psoas Major

Back 20

Psoas major
P = T12-L5 vertebrae and discs; transverse processes of all lumbar vertebrae
D = lesser trochanter
N = ventral rami of lumbar nerves (L1,L2, L3
A = flex thigh at hip, also can have influence on posture of pelvis in weight bearing

Front 21

Psoas Minor

Back 21

Psoas Minor
P = T12-L5 vertebrae and discs
D = Pectineal line, iliopectineal eminence via iliopectineal arch
N = Ventral rami of lumbar nerves (L1 and L2)
A = maybe some stability in pelvis but no direct influence on hip motion

Front 22

Illiacus

Back 22

Illiacus
P = iliac crest, iliac fossa, ala of sacrum, and anterior SI ligaments
D = tendon of psoas major, lesser trochanter and femur distal to it
N = Femoral N (L2, L3)
A = flex thigh at hip, also can have influence on posture of pelvis in weight bearing

Front 23

Back 23

Tensor of Fasciae Latae (TFL)
P = ASIS and anterior part of iliac crest
D = iliotibial tract that attaches to lateral tibial condyle
N = Superior gluteal N (L4 and L5)
A = Abducts, medially (internally) rotates and flexes thigh; helps to kept knee extended; steadies trunk on thigh

Front 24

Back 24

Sartorius
P = ASIS and superior part of notch inferior to it
D = superior part of medial surface of tibia
N = Femoral N (L2 and L3)
A = Flexes, abducts, and laterally (externally) rotates thigh at hip; flexes leg at knee joint,

Front 25

Quadriceps Femoris

Back 25

rectus femoris + vastus lateralis, medialis & intermedius

Front 26

Back 26

Rectus Femoris
P = AIIS and ilium superior to acetabulum
D = Base of patella and by ligament to tibial tuberosity
N = Femoral (L2, L3, and L4)
A = extends knee joint; also slightly flexes the hip

Front 27

Back 27

Vastus Lateralis
P = Greater trochanter and latral lip of linea aspera of femur
D = Base of patella and by ligament to tibial tuberosity
N = Femoral (L2, L3, and L4)
A = extends knee joint

Vastus Medialis
P = Intertrochanteric line and medial lip of linea aspera of femur
D = Base of patella and by ligament to tibial tuberosity
N = Femoral (L2, L3, and L4)
A = extends knee joint
Obliquus (VMO) distal fibers which primarily help to prevent patella to track laterally

Vastus Intermedius
P = Anterior and lateral surfaces of body of femur
D = Base of patella and by ligament to tibial tuberosity
N = Femoral (L2, L3, and L4)
A = extends knee joint

Front 28

Back 28

Articularis genu (small muscle in distal femur. It attaches to proximal end of synovial membrane of the knee joint and to the distal femur. It appears to pull on the synovial capsule to prevent pinching of the synovium.

Front 29

Back 29

lateral femoral cutaneous
a. sensory
• supplies lateral thigh

femoral nerve
a. enters thigh deep to inguinal ligament in femoral triangle
b. motor
• supplies the muscles of the quadriceps (rectus femoris, vastus lateralis, medialis & lateralis)and sartorius
c. sensory
• supplies sensation along anterior thigh

Front 30

Back 30

Femoral triangle
a. Boundaries
• Superior/base – inguinal ligament
• Medially – adductor longus
• Laterally – sartorius
• Apex – where sartorius and adductor longus meet
(i) This is the start of the adductor canal
• Floor – adductor longus, pectineus, iliopsoas
• Roof – fascia lata and cribriform fascia
b. Contents
• Femoral Vein
• Femoral Artery
• Femoral Nerve
• Profunda femoris artery
• Profunda femoris vein
• Inguinal lymph nodes

Front 31

Back 31

Saphenous Opening
a. allows superficial great saphenous vein to connect to femoral vein along with lymphatic vessels to deep inguinal lymph nodes.

Front 32

Back 32

Femoral Sheath, Ring and Canal (fig 5.16-5.18…p. 542-544)
a. Provides pathway for femoral artery/vein and lymph nodes to pass under the inguinal ligament
b. Femoral Sheath
• funnel-shaped fascial tube that is divided into three compartments
(i) Lateral compartment – contains femoral artery
(ii) Intermediate compartment – contains femoral vein
(iii) Medial compartment – space that is the femoral canal
1. Femoral Ring is the oval shaped opening to femoral canal
2. Clinical: this is site of femoral hernia

Front 33

Back 33

Adductor Canal (subsartorial)
a. Originates at the apex of the femoral triangle (where sartorius and adductor longus meet) and terminates at adductor hiatus
b. Boundaries
• Anaterior and laterally – vastus medialis
• Posterior – adductor longus and adductor magnus
• Medial – sartorius (acts as a roof)

c. Contents
• Femoral artery (supplies leg and foot)
• Femoral vein (drains
• Saphenous nerve
• Nerve to vastus medialis

Front 34

Back 34

Arteries
a. Femoral A.
• descends in adductor canal, passes through adductor hiatus and enters posterior knee region known as popliteal fossa
• provides blood supply to the leg/foot
b. Deep femoral A.
• Major artery to supply the thigh, gives of perforating branches that supply adductor magnus & hamstrings
c. Lateral femoral circumflex
• Provide blood to hip
d. Medial femoral circumflex
• Provide blood to hip

Front 35

Back 35

Veins
a. Overview of venous drainage of lower extremity
• The LE is drained via superficial and deep venous pathways that are also connected via a communicating venous system

Superficial veins
1. great saphenous vein
a. ascends along medial leg (can locate near medial malleolus) and drains into femoral vein at the saphenous opening just inferior to inguinal ligament
2. small (lesser) saphenous vein
a. ascends along posterior leg and drains into popliteal vein in popliteal fossa

Deep veins
1. ascend with arteries of the leg and eventually drain/merge and become femoral vein
2. clinical: DVT’s (deep vein thrombosis) commonly formed in deep veins
a. DVT’s caused by immobilization, CHF, obesity, etc...

communicating venous system
1. veins that connect the superficial to the deep veins
2. contain valves that force one way drainage from superficial veins to deep veins
3. “muscular pump” helps push blood through this system and eventually up to the heart
a. ex: compress small saphenous vein between gastrocnemius muscles
4. Clinical: valves fail = varicose veins blood allowed to flow from deep to superficial and pool

Femoral vein
• Continuation of the popliteal vein proximal to adductor hiatus
• Becomes external iliac vein as it passes into pelvis (deep to inguinal ligament)

Front 36

Back 36

Pectineus
P = superior ramus of pubis
D = pectineal line of femur, just inferior to lesser trochanter
N = femoral N (L2 and L3; may receive branch from obturator N
A = adducts and flexes thigh; assists with medial rotation

Front 37

Back 37

Adductor Longus
P = body of pubis inferior to public crest
D = middle 1/3 of linear aspera of femur
N = obturator N, branch of ant division (L2, L3, and L4)
A = adducts thigh

Front 38

Back 38

Adductor Brevis
P = body and inferior ramus of pubis
D = pectineal line and proximal part of linea aspera of femur
N = Obturator N (L2, L3, and L4) branch of ant division
A = adducts thigh and some flexion as well

Front 39

Back 39

Gracilis
P = body of inferior ramus of pubis
D = superior part of medial surface of tibia
N = Obturator N (L2 and L3)
A = adducts thigh, flexes leg, and helps to rotate leg medially

Front 40

Back 40

Adductor Magnus
P = adductor part: inferior ramus of pubis, ramus of ischium; hamstring part: ischial tuberosity
D = adductor part: gluteal tuberosity, linea aspera, medial supracondylar line; Hamstrings part;adductor tubercle of femur
N = adductor part: obturator N (L2, L3, and L4), branches of posterior division ; Hamstrings part: tibial part of sciatic nerve (L4)
A = adducts thigh; adductor part: flexes thigh, Hamstrings part extends thigh
Distal attachment forms an arch known as adductor hiatus (femoral artery & vein pass posterior through the hiatus)

Obturator Externus
P = margins of obturator foramen and obturator membrane
D = trochanteric fossa of femur
N = Obturator N (L3 and L4)
A = laterally rotates thigh; steadies head of femur in acetabulum

Front 41

Back 41

obturator nerve
a. motor
• adductor muscles (adductor longus, brevis & magnus, gracilis)
b. sensory
• small oval patch along medial thigh

Front 42

Structures of Gluteal Region

Back 42

Structures of gluteal region
1. greater sciatic foramen
a. formed by greater sciatic notch and the sacrospinous ligament
2. lesser sciatic foramen
a. formed by lesser sciatic notch and the sacrotuberous ligament

Front 43

Back 43

Gluteus Maximus (p551)
P = illium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, and sacrotuberous ligament
D = Most fibers end in iliotibial tract that inserts into lateral condyle of tibia; some fibers insert on gluteal tuberosity of femur
N = Inferior gluteal nerve (L5, S1, S2)
A = Extends thigh (especially from flexed position) and assists in its lateral rotation; steadies thigh and assists in rising from a sitting position (also helps to stabilize knee due to its attachment onto the iliotibial tract which crosses the knee joint)

Front 44

Back 44

Gluteus Medius (p551)
P = External surface of ilium between anterior and posterior gluteal lines
D = Lateral surface of greater trochanter of femur
N = Superior gluteal nerve (L5, S1)
A = Abducts and medially rotates thigh; keeps pelvis level when opposite leg is raised

Front 45

Back 45

Gluteus Minimus (p551)
P = External surface of ilium between anterior surface of ilium between anterior and inferior gluteal lines
D = Anterior surface of greater trochanter of femur
N = Superior gluteal nerve (L5, S1)
A = Abducts and medially rotates thigh; keeps pelvis level when opposite leg is raised

Front 46

Back 46

Piriformis (p551)
P = Anterior surface of sacrum and sacrotuberous ligament
D = Superior border of greater trochanter
N = Branches of ventral rami of S1, S2
A = Laterally rotates extended thigh and abducts flexed thigh; steady femoral head in acetabulum

Obturator Internus (p551)
P = Pelvic surface of obturator membrane and surrounding bones
D = Medial surface of greater trochanter (trochanteric fossa of femur)
N. = Nerve to obturator internus (L5, S1)
A = Laterally rotates extended thigh and abducts flexed thigh; steady femoral head in acetabulum

Superior Gemellus (p551)
P = Superior: ischial spine; Inferior: Ischial tuberosity
D = Gemellus muscle blends with obturator internus tendon as it attaches to greater trochanter of femur
N = Nerve to obturator internus (L5, S1)
A = Laterally rotates extended thigh and abducts flexed thigh; steady femoral head in acetabulum

Inferior Gemellus (p551)
P = Superior: ischial spine; Inferior: Ischial tuberosity
D = Gemellus muscle blends with obturator internus tendon as it attaches to greater trochanter of femur
N = same nerve as quadratus femoris (L5, S1)
A = Laterally rotates extended thigh and abducts flexed thigh; steady femoral head in acetabulum

Quadratus Femoris (p551)
P = Lateral border of ischial tuberosity
D = Quadrate tubercle on intertrochanteric crest of femur and area inferior to it
N = Nerve to quadratus femoris (L5, S1)
A = Laterally rotates extended thigh and abducts flexed thigh; steady femoral head in acetabulum

Front 47

Back 47

Obturator Externus (p540)
P = Margins of obturator foramen and obturator membrane
D = Trochanteric fossa of femur
N = Obturator nerve (L3, L4)
A = Laterally rotates extended thigh and abducts flexed thigh; steadies femoral head in acetabulum

Front 48

Back 48

sciatic nerve (largest nerve in the body)
a. consists of tibial and common fibular (peroneal) components, exits pelvis through greater sciatic foramen, varies as it passes by priformis (it may travel inferior, partially/completely through or above/below piriformis), descends down the posterior thigh
b. motor
• does not supply any muscles in gluteal region
• supplies hamstrings and all of the muscles below the knee
c. sensory…eventually provides sensation to
• posterior thigh
• posterior/lateral/anterior leg
• all of the foot except the medial foot

superior gluteal
a. exits pelvis through greater sciatic foramen and superior to the piriformis
b. motor supply
• gluteus medius, gluteus minimus and TFL

inferior gluteal
a. exits pelvis through greater sciatic foramen and inferior to the piriformis
b. motor supply
• gluteus maximus

nerve to obturator internus
a. motor
• supplies obturator internus and superior gemellus

nerve to quadratus femoris
a. motor
• supplies quadratus femoris and inferior gemellus

pudendal nerve
a. pass through greater sciatic foramen (inferior to piriformis) Passes lateral to sacrospinus ligament, re-entering pelvis through lessor sciatic foramen. SUPPLIES NO STRUCTURES IN GLUTEAL REGION
b. motor
• supplies perineal muscles
c. sensory
• sensation in perineal region

Front 49

Back 49

Semitendinosus
P = Ischial tuberosity
D = Medial surface of superior part of tibia
N = Tibial division of sciatic N (L5, S1, S2)
A = Extend thigh; flex leg and rotate it medially with knee flexed

Semimembranosus
P = Ischial tuberosity
D = Posterior part of medial tibial condyle; reflective attachment forms oblique popliteal ligament (to lateral femoral condyle)
N = Tibial division of sciatic N (L5, S1, S2)
A = Extend thigh; flex leg and rotate it medially with knee flexed

Front 50

Back 50

Front 51

Back 51

Biceps Femoris (long head)
P = Ischial tuberosity
D = lateral side of head of fibula; tendon is split by fibular collateral knee ligament
N = tibial division of sciatic N (L5, S1, S2)
A = Flexes leg and rotates it laterally when knee flexed; extends thigh at hip joint

Biceps Femoris (short head)
P = Linear aspera and lateral supracondylar line of femur
D = lateral side of head of fibula; tendon is split by fibular collateral knee ligament
N = Common fibular (peroneal) division of sciatic N (L5, S1, S2)
A = Flexes leg and rotates it laterally (IT DOES NOT HAVE A DIRECT EFFECT ON THE HIP)

Front 52

Back 52

Profunda femoris artery (deep femoral)
a. largest branch of femoral artery and chief artery of thigh – lies deep to femoral artery. Supplies adductor magnus and hamstrings via perforating femoral arteries
b. usually the perforating femoral arteries are branches of the deep femoral artery but may also arise directly from the femoral artery. They encircle the thigh, anastomose with each other and other arteries and supply the thigh muscles and the proximal end of the femur.

Front 53

Back 53

Front 54

Back 54

Popliteal Fossa - “Diamond-shaped depression of the posterior aspect of knee”
A. Boundaries of the popliteal fossa (p 571)
1. Superolaterally – biceps femoris
2. Superomedially – semimembransosus and semitendinosus
3. Inferiorly – two heads of the gastrocnemius
4. Roof (posteriorly)– skin and fascia
5. Floor (anteriorly)– popliteal surface of the femur, oblique popliteal ligament, expansion of the semimbransous tendon, popliteus fascia

Front 55

Contents of the Popliteal Fossa

Back 55

Contents of the popliteal fossa (p 571)
1. Popliteal Artery
a. Starts as it exits posterior through adductor hiatus, terminates at division of anterior and posterior tibial arteries
b. popliteal artery is direct continuation of the femoral artery - after it passes through adductor hiatus;
c. popliteal artery divides into anterior and posterior tibial arteries at inferior border of popliteus
d. Genicular branches (5 branches) form genicular anastomsoes
• Superior – medial and lateral
• Middle
• Inferior – medial and lateral
2. Popliteal vein
a. posterior tibial vein becomes popliteal vein as it enters the fossa
b. becomes femoral vein as it enters adductor hiatus
3. Small saphenous vein
a. Ascends in posterior leg and drains into popliteal vein
4. Tibial and Common Fibular Nerves
a. Supply all muscles of the leg and foot
5. Popliteal Lymph Nodes and Lymphatic Vessels

Front 56

Popliteus

Back 56

Popliteus
P = Lateral surface of lateral condyle of femur and lateral meniscus
D = Posterior surface of tibia superior to soleal line
N = Tibial N (L4, S1)
A = internally rotates tibia on femur
Function is to “unlock” knee to allow it to flex during gait

Front 57

Knee Joint

Back 57

Knee Joint
A. Consists of Tibiofemoral Joint (knee joint) and patella-femoral joint (p617-632)
B. Genu Varum (bow leg) vs. Genu Valgum (knock-knee) (p629)
C. Motion of the knee joint – flexion/extension also small amount of medial/lateral rotation

Front 58

Back 58

Menisci (p620-621) (IA)
1. fibrocartilage disks that deepen joint surface and reduce shock, and
2. provide proprioceptive feedback;
3. unattached edges in the interior of joint; firmly attached at their ends in the intercondylar area of tibia;
4. external margins attach to fibrous capsule

Medial meniscus (fig 5.60A-D)- GREEN
a. semilunar in shape (C- shaped)
b. broader posterior than anterior;
c. strong attachment to deep surface of medial tibial collateral ligament

Lateral meniscus – (fig 5.59D; fig 5.60A)- BLUE
a. circular in shape
b. nearly circular and smaller
c. more freely movable than medial

Front 59

Back 59

MCL (medial collateral ligaments)…AKA tibial collateral ligament
• Attachments: Medial epicondyle to the medial tibia plateau
• “Broad band” of CT…superficial layer
• blends into the joint capsule…deep layer
• also blends into medial meniscus
• Function: resist valgus stress (a blow or force going from the lateral thru the medial knee)

Front 60

Back 60

LCL (lateral collateral ligaments)…AKA fibular collateral ligament
• Attachments: Lateral epicondyle to the head of the fibula
• Cord like structure…easy to palpate in figure four position
• NO attachment with the joint capsule or lateral meniscus
• popliteus tendon passes deep to ligament; also splits biceps femoris tendon into two parts
• Function: LCL resist varus stress (a force going from the medial thru the lateral knee)

Front 61

Back 61

Patellar ligament (EC) (p623 fig 5.59A) attachment of patella and tibial tuberosity

Front 62

Back 62

Anterior Cruciate Ligament (ACL)
(i) Attachments: anterior tibia to posterior lateral femoral condyle
(ii) Function: Resist anterior translation of the tibia on the femur…injuries often result in forced hyperextension
(iii) OKC activity: Terminal knee extension (0-30 degrees), quad pulls the tibia anterior
(iv) CKC activity: Increasing knee flexion, reactive forces pushing tibia anterior
(v) NOTE: if MCL damaged…and knee is flexed then ACL plays significant role in trying to resist valgus stress (O’Donahue’s Triad)

Front 63

Back 63

Posterior Cruciate Ligament (PCL)
(i) Attachments: posterior tibia to inner aspect of medial femoral condyle
(ii) Function: Resist posterior translation of the tibia on the femur
(iii) Injuries often a result of trauma that directly puts posterior force onto the tibia plateau (MVA)

Front 64

Cruciate ligaments

Back 64

a. intraarticluar – located within articular joint capsule but located outside the synovium
b. Named for their tibial attachments
c. Considered intra-articular located outside synovium and under fibrous portion of the joint capsule

Front 65

Other Knee Ligaments I couldn't find pics of

Back 65

a. Coronary ligaments (meniscotibial) (p621 fig 5.57 and 5.59A)(capsular fibers that attach meniscal margins to tibia)
b. Oblique popliteal ligament (p622 fig 5.58) expansion of semimembranosus tendon
c. Arcuate popliteal ligament (p622 fig 5.58) arises from fibular head, over tendon of popliteus, spreads over posterior knee joint
d. Transverse ligament of the knee (p 625 fig 5.60A)(slender fibrous band connecting anterior edges of menisci – allows them to move together