Vessels & nerves of lower limb


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Vessels & nerves of lower limb

  1. 1. 4/19/2012Relations with femoral vein: Femoral arteryBase of ∆: vein medialApex of ∆: vein posterior Origin:Adductor canal: vein postro- external iliac at midinguinallateral point Course:Branches: Femoral Δ, Adductor canal3Superficial inguinal arteriesSuperf. External pudendal Termination:Superficial epigastric Popliteal artery, opening inSuperficial external iliac adduct magnusDeep external pudendalProfunda femorisDescending genicular 1
  2. 2. 4/19/2012Popliteal artery Profuda femoris arteryOrigin: Course: Posterolateral to femoralFemoral artery,Hiatus magnus arteryCourse: (deepest)Popliteal vein & med popliteal n: Branches:lat---superficial—medial Medial circumflex femoralTermination: Lateral circumflex femoralAnt & post tibial 3 perforating arteriesLower border of popliteus Termination:Branches: Pierces add magnus As 4th5 genicular: Upper medial, perforatingupper lateral, Lower medial,lower lateral & MiddleDorsalis pedis artery Anterior tibial arteryOrigin: Origin:Ant tibial artery () 2 malleoli Popliteal arteryCourse: Course:On dorsum of foot (1st () 2 heads of TP, membraneinterosseous space) Anterior tibial n: lateralEnter sole of foot Termination:Termination: Dorsalis pedis art, () 2Join planter arch in sole malleoliBranches: Branches:2 tarsal branchesArcuate artery 2 tibial recurrent (Ant & 2nd, 3rd, 4th dorsal metatarsal art Post)1st dorsal metatarsal 2 malleolar (med & lat)1st planter metatarsal Muscular branchesPosterior tibial artery Posterior tibial artery Branches: Origin: Posterior tibial artery branches: Popliteal artery 1-Circumflex fibular artery Course: 2-Medial malleolar Run () superficial & deep 3-Medial calcaneian groups 4-Nutrient artery to tibia Termination: Midway () med malleolus and 5-Communicating branch calcaneus 6- Peroneal artery Divide into medial & lateral •Lateral malleolar planter arteries •Lateral calcanian •Nutrient artery to fibula Branches: •Communicating branch Peroneal artery •Perforating branch 2
  3. 3. 4/19/2012 Branches of internal iliac artery Medial planter artery 1- Obturator artery Origin: posterior tibial artery Course: Course: Run () ms of 1st layer Pass through obturator canal Branches: Muscular,Digital Branches: Acetabular branch, Muscular branches Lateral planter artery Course: 2-Superior gluteal artery: Form planter arch Branches: 3-Inferior gluteal artery: 2nd,3rd,4th planter metatarsal arteries 3 posterior perforating arteries Planter digital to little toe Muscular branches Popliteal vein Beginning: Vena comitants of ant & post tibial arteries At lower border of popliteus Course: ……………………… Termination: Femoral vein (hiatus magnus) Tributaries: Genicular veins Short saphenous veinSuperficial veins Femoral veinTributaries of great saphenous v: Femoral veinSup inguinal veins Beginning: Sup external pudendal Saphenous Popliteal vein, opening in add magnus Sup epigastric opening Course: Superficial external iliac Termination: External iliac veinVeins from medial side of leg & thigh Tributaries: Great saphenous vein Popliteal vein Great saphenous External pudendal vein vein Profunda femoris vein Small saphenous Infront of med Med & lat circumflex femoral veins vein malleolus Behind lateral Dorsal venous malleolus arch 3
  4. 4. 4/19/2012 Origin: Ventral primary rami of L2,3,4 (dorsal division) Course: Deep to inguinal ligament Femoral nerve Outside femoral sheath Branches: Muscular: Sartorius, quadriceps, pectineus, iliacus Cutaneous: Med & middle cut n of thigh Saphenous nerve Dr. Rania Dr. RaniaSciatic nerve Obturator nerve Origin: ventral primary rami ofOrigin:Sacral plexus L4,5, S1,2,3 L2,3,4 (ventral division)Course: Course:Enter through greater sciatic Pass through obturator canalforamen below to the piriformis Branches:muscle. Muscular : gracilis, 3 adductors,Lies deep to gluteus maximus.Enter thigh at midpoint between the obturator externusischial tuberosity and the greater Cutaneous: Skin middle 1/3 of medialtrochanter. side of thighBranches:Tibial nerve (medial popliteal)Common peroneal nerve (lateralpopliteal)Distribution: Dr. Rania Dr. Rania 4
  5. 5. 4/19/2012Origin:Sciatic nCourse: Bisect fossaTermination:Post tibial art (lower borderpopliteus)Branches:Muscular:Gastrocnemius, PlantarisSoleus, popliteusCutaneous:Sural nerveLat side of leg (lower), Lateral side offoot, Lateral side of little toeGenicular:Sup medial, Inf medial,Middle:Origin:Sciatic nCourse:Lateral border of fossa (biceps)Lateral side of neck of fibulaTermination: divideSuperficial peroneal (musculocut)Deep peroneal (ant tibial)Branches:Cutaneous:Sural communicating, Lat cutaneous nof calfGenicular:Sup lateral, Inf lateral,RecurrentgenicularAnterior tibial (deep peroneal) nerve (deep peroneal) Superficial & deep peroneal nerves Origin: Sciatic nerve Common peroneal (lat popliteal) nerve Course: Medial popliteal n Lateral popliteal n Run with ant tibial artery Termination: Or Or Divides into medial & lateral Tibial n Common peroneal n divisions Branches: Muscular ???????????? Deep peroneal n Superficial peroneal n Cutaneous (sides of 1st & 2nd toes) Posterior tibial n Or Or Anterior tibial n Musculcutaneous n 5
  6. 6. 4/19/2012Superficial peroneal nerve Superficial peroneal nerve Origin:Distribution: (blue area) Common peroneal (latMedial side & middle of dorsum popliteal) nerveof foot Course: Sural n Descend () peroneus longus &Medial side of big toe brevisAdjacent sides of 2nd, 3rd toes Termination:,() 3rd, 4th and 4th, 5th toes Divides into medial & lateral divisions Branches: Muscular ????????????? Cutaneous (skin of lower part of ant surface of leg)Medial planter nerve Posterior tibial nerveOrigin: posterior tibial nerve Origin:Course: Continuation of tibial n At lower border of popliteusRun () ms of 1st layer Course: Run () superficial & deep groupsBranches: Termination:Muscular: Divides into medial & lateral planter1. Abductor hallucis nerves2. Flexor digitorum brevis Midway () medial malleolus & calcaneus3. 1st lumbrical Branches:4. Flexor hallucis brevis Muscular ????????????Cutaneous: medial 2/3 of skin of Medial calcenean branch: supplysole of foot, medial 3 & ½ toes heal Cutaneous innervation Lateral planter nerve Origin: posterior tibial nerve Termination: divide into superficial & deep branches Medial planter n Lateral planter n Branches: Muscular: all ms of sole except 4 Cutaneous: lateral 1/3 of skin of sole of foot, lateral 1 & ½ toes Posterior tibial 6
  7. 7. 4/19/2012Common peroneal n injury Superior gluteal n injury Foot drop Unilateral: Lurching gait Bilateral: Waddling gait 7