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Surface anatomy of lower limb

Surface Anatomy

Gluteal region and thigh

Leg

A branch of gross anatomy that examines shapes and markings on the surface of the body as they relate to deeper structures. Essential in locating and identifying anatomic structures prior to studying internal gross anatomy. Health-care personnel use surface anatomy to help diagnose medical conditions and to treat patients.
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anterior superior and inferior iliac spines tubercle of iliac crest ischial tuberosity greater trochanter pubic tubercle pubic crest superior border of pubic symphysis patella ligament tuberosity of tibia medial and lateral condyles and epicondyles tendon of biceps femoris tendons of semitendinosus and semimembranosus head of fibula

Ankle and foot

anterior border of tibia neck of fibula medial and lateral malleolus calcaneal tuberosity tuberosity of navicular bone tuberosity of fifth metatarsal bone

Knee

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Surface Anatomy

Gluteal Region

four techniques when examining surface anatomy visual inspection directly observe the structure and markings of surface features palpation feeling with firm pressure or perceiving by the sense of touch) precisely locate and identify anatomic features under the skin percussion tap sharply on specific body sites to detect resonating vibrations auscultation listen to sounds emitted from organs
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The inferior border of the gluteus maximus muscle forms the gluteal fold. The gluteal (natal) cleft extends vertically to separate the buttocks into two prominences. In the inferior portion of each buttock, an ischial tuberosity can be palpated; these tuberosities support body weight while seated. The gluteus maximus muscle forms most of the inferolateral fleshy part of the buttock. The gluteus medius muscle may be palpated only in the superolateral portion of each buttock.
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Gluteal Region: Landmarks

Lower Limb and Gluteal Region

Iliac crests Posterior superior iliac spine Sacroiliac joint Prominences of the buttocks

Natal cleft (gluteal cleft)

Vertical midline groove between cheeks Horizontal fold below each cheek

Gluteal fold

Cheeks of the buttocks Formed from subcutaneous fat and the gluteal muscles

Ischial tuberosities Greater trochanter of the femur

Located at the lateral hip

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The Gluteal Region

Lower Limb and Gluteal Region

Figure 11.37 13-6

Figure 11.38a 13-8

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The Thigh

Many muscular and bony features are readily identified in the thigh, which extends between the hip and the knee on each lower limb. An extremely important element of thigh surface anatomy is a region called the femoral triangle. The femoral artery, vein, and nerve travel through this region, making it an important arterial pressure point for controlling lower limb hemorrhage.

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Figure 11.38b 13-11

Thigh : Landmarks

The Thigh

Medial and lateral condyles of the femur Patella Three groups of muscles

The Femoral Triangle

Superior border inguinal ligament Inferior borders

Quadriceps femoris anterior thigh

Sartorius Adductor longus

Vastus lateralis injection site

Adductors medial thigh Hamstrings posterior thigh

Popliteal fossa

Diamond-shaped hollow on posterior knee

Defined by borders of hamstring tendons and gastrocnemius

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Femoral triangle
A triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligament

Thigh and Knee

Boundaries

Superiorly (base) : the inguinal ligament Laterally: medial border of sartorius Medially: medial border of adductor longus Apex: continuous with adductor canal Anterior wall: fascia lata Posterior wall: consists of iliopsoas, pectineus and adductor longus from lateral to medial side

On the distal part of the anterior thigh, are the three parts of the quadriceps femoris as they approach the knee. Still on the anterior side of the thigh, three obvious skeletal features can be observed and palpated:

(1) The greater trochanter is palpated on the superior lateral surface of the thigh; (2) the patella is located easily within the patellar tendon; and (3) the lateral and medial condyles of both the femur and tibia are identified and palpated at each knee.

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Femoral triangle
Contents

Femoral n. Femoral sheath Femoral a. and its branches Femoral vein and its tributaries. Femoral canal Deep inguinal lymph nodes Fatty tissue

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Figure 11.40a, c 13-16

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Foot and Toes

The phalanges, metatarsophalangeal joints, PIP and DIP joints, and toenails are obvious surface landmarks readily observed when viewing either the lateral side or the dorsum of the foot. The medial surface of the foot clearly illustrates the high, arched medial longitudinal arch. At the distal end of the medial longitudinal arch, the head of metatarsal I appears as a prominent bump.

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Bony Palpation

Medial Aspect

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Medial Calcaneous

Navicular Tubercle

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Talar Head

First Cuneiform

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First Metatarsal

First Phalanx

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First Metatarsalphalangeal Joint Soft Tissue Palpation

Medial and Plantar Aspect

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Tibialis Posterior tendon

Tom, Dick, Harry

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Tibialis Posterior tendon (blue) Flexor Digitorum Longus tendon (red) Flexor Hallucis Longus tendon (green)

Calcaneonavicular ligament (Spring ligament)

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Medial Longitudinal arch

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Transverse Arch

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