Lecture notes for medical students

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5. This will be an ACTIVE LEARNING SESSION x
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6. Good for self study also.
7. See notes for bibliography.

2. Lower Limb

3. Frolich, Human
Anatomy, Lower LImb
Lower Limb
• Skeleton (homologous with upper limb)
• Muscles--anterior, posterior compartments
• Nerves--sciatic, femoral
• Surface anatomy

4. Frolich, Human
Anatomy, Lower LImb
Upper-Lower Limb Comparison

5. Frolich, Human
Anatomy, Lower LImb
Upper-Lower Limb Comparison
See Table M&M, Table 8.1

6. Frolich, Human
Anatomy, Lower LImb

7. Tibia/fibula

8. Frolich, Human Anatomy, Lower LImb
Tibia/fibula
• Tibia--big toe side
• Fibula--little toe side
(no pronation/supination)

9. Ankle

10. Frolich, Human Anatomy, Lower LImb
Ank
• Tarsus--forms ankle
joint
• Calcaneus--forms heel

11. Frolich, Human
Anatomy, Lower LImb
Foot

12. Frolich, Human
Anatomy, Lower LImb
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

13. Joints of Lower Limb

14. Frolich, Human
Anatomy, Lower LImb
Joints of Lower Limb
 Hip (femur +
acetabulum)
 Ball + socket
 Multiaxial
 Synovial
 Knee (femur + patella)
 Plane
 Gliding of patella
 Synovial
 Knee (femur + tibia)
 Hinge
 Biaxial

15. Frolich, Human
Anatomy, Lower LImb
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

16. Lower Limb Moveme

17. Frolich, Human
Anatomy, Lower LImb
Lower Limb Moveme
• 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)

18. Frolich, Human Anatomy, Lower LImb
Anterior/Posterior compartments

19. Frolich, Human Anatomy, Lower LImb
Anterior/Posterior com
ANTERIOR
COMPARTMENT
POSTERIOR
COMPARTMENT
MOVEMENT Extension Flexion
MUSCLES Quads
Shin
Hamstrings
Gastrocs
NERVES Femoral n.
(lumbar plexus)
Sciatic n.
(sacral plexus)

20. Thigh movements by compartmen

21. Frolich, Human
Anatomy, Lower LImb
Thigh movements by compartmen

22. Frolich, Human Anatomy, Lower LImb
Posterior Thi
• Gluts (gluteal nn.)
– Maximus—extensor of thigh
– Medius--pelvic tilt
• Lateral rotators (spinal nn.)
– Piriformis syndrome
• Hamstrings (sciatic n.)
– Biceps femoris
– Semimembranous
– Semitendinous

23. Anterior thigh (femoral n

24. Frolich, Human Anatomy, Lower LImb
Anterior thigh (femoral n
• Sartorius (Tailor’s
muscle)
• Quads (four)
– Rectus femoris
(crosses hip)
– 3 vastus mm. (vast--
big)

25. Medial compartment (obturator n.

26. Frolich, Human Anatomy, Lower LImb
Medial compartment (obturator n.
• Adductor muscles
– Gracilis
– Adductor
• Magnus
• Longus
• brevis

27. Leg movements by compartment
leg all nn are branches of scia

28. Frolich, Human
Anatomy, Lower LImb
Leg movements by compartment
leg all nn are branches of scia

29. Anterior Leg (deep fibular n

30. Frolich, Human Anatomy, Lower LImb
Anterior Leg (deep fibular n
• Fibularis (peroneus)
longus
• Extensor digitorum
longus
• Extensor hallicus
longus
• Tibialis anteriorus

31. Lateral Leg (superficial fibular n

32. Frolich, Human Anatomy, Lower LImb
Lateral Leg (superficial fibular n
• Fibularis
brevis/longus

33. Frolich, Human Anatomy, Lower LImb
Posterior Leg (tibia

34. Frolich, Human Anatomy, Lower LImb
Posterior Leg (tibia
• Gastrocs and soleus
• Flexor digitorum
longus
• Flexor hallucus longus

35. Intrinsics of foot

36. Frolich, Human
Anatomy, Lower LImb
Intrinsics of foot

37. Frolich, Human
Anatomy, Lower LImb
• Lumbar plexus
(femoral nerve)
• Sacral plexus
(sciatic nerve)
With leg out to
side like
quadruped,
lumbar-anterior,
sacral-posterior
makes sense

38. Frolich, Human
Anatomy, Lower LImb
Dermatomes show twisting of le
in developme

39. Frolich, Human
Anatomy, Lower LImb
Dermatomes show twisting of le
in developme

40. Blood supply to lower limb

41. Frolich, Human
Anatomy, Lower LImb
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

42. Frolich, Human Anatomy, Lower LImb
Surface Anatomy:
Posterior Pelvis
pg 789

43. Frolich, Human Anatomy, Lower LImb
Surface Anatomy:
Posterior Pelvis
• Iliac crest
• Gluteus maximus = cheeks
• Natal/gluteal cleft = crack
• Gluteal folds = bottom of cheek
pg 789

44. Surface Anatomy: Anterior Thigh + Leg

45. Frolich, Human Anatomy, Lower LImb
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
pg 792

46. Frolich, Human Anatomy, Lower LImb
Surface Anatomy: Posterior Leg
pg 793

47. Frolich, Human Anatomy, Lower LImb
Surface Anatomy: Posterior Le
• 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

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