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FUNCTION OF THE LOWER LIMBS

A.
B.
C.

Supports body weight


Enables the individual to move from one
place to another (locomotion)
Maintains body balance (equilibrium)

Regions of the lower limbs (from the waist down)


A.
B.
C.
D.
E.
F.

Limits outward expansion of contracting


muscles, making muscular contraction more
efficient in compressing veins to push blood
toward the heart.

A.

Gluteal
Femoral
Knee
Leg
Ankle or Talocrural
Foot

Gluteal region fascia


Superficial fascia
o Thick especially in women

Fig.2 Lateral view of the fascia of the lower limbs

Campers Fascia (superficial layer of


superficial fascia)
o Scarpas Fascia ( deeper layer of
superficial fascia)

Deep fascia
o Gluteal Fascia/Gluteal Aponeurosis

Covers gluteus meduis mucles

Extends between iliac crest and


gluteus maximus muscles
superolateral boarder
o

Fig.1 Lower limbs: Surface anatomy

I. Fascia of the lower limbs


Divided into:

Subcutaneous fascia
Forms a continuous layer from the
anterolateral abdominal wall to the thigh
o Contains a variable amount of fat, cutaneous
nerves, superficial veins lymphatic vessels,
and lymph nodes.
o It varies in thickness in different parts of the
limb( ex. Thick fascia in the groin)
o

Deep Fascia
Named from its great extent, the fascia lata; it
constitutes an investment for the whole of this
region of the limb
o It varies in thickness in different parts. (ex. it is
thicker in the upper and lateral part of the
thigh)
o

B.

IIliotibial tract

Receives the greater part of the


insertion of the gluteus maximus

Thigh region fascia


Superficial fascia
o Membranous layer starts from the anterior
abdominal wall and down to the thigh and
is attached to the deep fascia near the
inguinal ligament.
o Fatty Fascia is from anterior abdominal
wall and extends into the thigh and

continues down over the lower limb


without interruption.

Deep fascia
o Fascia Lata

More confined to the lower


extremities.

Encloses the large thigh muscles,


especially laterally, where it is
thickened and strengthened by
additional reinforcing longitudinal
fibers to form the iliotibial tract.
o Iliotibial Tract

attached to the lateral condyle of the


tibia

forms a sheath for the tensor fasciae


latae muscle
o Saphenous Opening

Filled with cribriform fascia

it transmits the great saphenous vein,


and other, smaller vessels, and is
termed the fossa ovalis

forms thickened bands both superior


and anterior to the ankle joint (extensor
retinacula)

Fig.4 Intermuscular Septum (thigh region)

o
Fig.3 Saphenous opening

C.

Intermuscular Septum

Lateral intermuscular septum


strongest of the three septum
separates the anterior from the
posterior
separates the quadriceps group from
the hamstrings

Medial Intermuscular Septum


attaches to the medial lip of the linea
aspera of the femur
separates the vastus medialis from the
adductor group of muscles

Posterior Intermuscular Septum


separates the posterior group from
the middle group of muscles

Leg region fascia


Deep Fascia (crural fascia)
o attaches to the anterior and medial
borders of the tibia, where it is
continuous with its periosteum

Intermuscular septa divide the leg into


three compartments:
anterior (dorsiflexor), lateral (fibular),
and posterior (plantarflexor)
Anterior and posterior intermuscular
septa
From the deep surface of the lateral
deep fascia of the leg and attach to
the corresponding margins of the
fibula
Transverse intermuscular septa
Separates superficial and deep
plantarflexor muscle
Popliteal fascia
Covers the popliteal fossa
Protects neurovascular structures that
travels through that area

II. Gluteal Region

Transitional region between the trunk and free


lower limbs
Includes two parts of the lower limbs

Fig. 5 Deep fascia (leg region)

rounded, prominent posterior region


(buttocks)
o hip region
Boundaries
o Iliac crest (Superior)
o Intergluteal cleft (Medial)
o Gluteal fold ( Inferior)
o

Fig. 6 Parts of hip bones

A. Bones

Hip bones
o The two symmetrical hip bones are part of
the pelvic girdle
o Large, at pelvic bone formed by the fusion
of three primary bones (ilium, ischium and
pubis)

At puberty, the three bones are still


separated by a Y-shaped triradiate
cartilage centered in the acetabulum

At the age of 15-17, the three parts


begin to fuse
o The hip bones have three articulations:

Sacroiliac joint articulation with sacrum

Pubic symphysis articulation with the


corresponding hip bone.

Hip joint articulation with the head of


femur

Ilium
Largest and widest part of the hip bone
Superior part of the acetabulum
Body of the ilium joins the pubis and
ischium to form the acetabulum
Expands to form the wing (or ala)
Anterior boarder
anterior superior iliac spine
iliac crest serves as a protective
bumper
iliac tubercle prominence on the
external lip of the iliac crest
anterior inferior iliac spine
provides attachment for ligaments and
tendons of lower limb muscle
Posterior boarder
posterior superior iliac spine
posterior inferior iliac spine marks the
superior end of the greater sciatic notch
Medial boarder
iliac fossa is a large, smooth
depression
Ischium
Forms the posteroinferior part of the hip
bone
Posterior body of obturator foramen
Has a body and a ramus
Body of Ischium is the upper thicker
part
Ramus of Ischium is the lower thinner
part

combines with inferior pubic ramus


to form conjoined ischiopubic rami
Ischial spine
sacrospinous ligament along its
margins
projects from the posterior border
of the ischium and intervenes
between the greater and lesser
sciatic notches
Ischial tuberosity
when sitting, it is these tuberosities
on which our body weight falls
forms the posterior aspect of the
lower part of the body of the bone;
rough bony projection on which the
bodys weight rests when sitting.
Pubis
Forms the anteromedial part of the
hip bone
Anterior part of the acetabulum
Provides proximal attachment for
muscles of the medial thigh
Pubis consists of body, superior
ramus and inferior ramus
Symphysial surface is medial part
of the pubis body that articulates
with its opposite pubic body
Pubic crest formed by the
anterosuperior border of the united
bodies and symphysis which
provides attachment for abdominal
muscles
Pubic Tubercle is the medial end of
the inguinal ligament and ascending
loops of the cremaster muscle
Obturator foramen
large oval or irregularly triangular
opening in the hip bone
Fig.7 Lateral and medial aspect of the right hip bone of adult in anatomical position
bounded by the pubis and ischium
B. Muscles
and their rami
where the obturator nerve, artery and
The muscles of the gluteal region can be
vein pass through to reach the lower limb
broadly divided into two groups:

Acetabulum
o A deep cup-shaped hemispherical cavity on
the lateral aspect of the hip bone roughly
about its center
o articulates with the spherical head of the
femur to form the hip joint
o Acetabular notch marks the deficient
inferior margin of the acetabulum
o Acetabular fossa is nonarticular
roughened floor of the acetabulum which
contains fats and is lined by synovial
membrane

1.

Superficial abductors and


extenders

2.

Deep lateral rotators

proximal attachment of the vastus


lateralis

Gluteus Medius

Fig. 8 Muscles of gluteal region: supercial and deep


dissections

Superficial muscles
Gluteus Maximus

Most supercial gluteal muscle

The largest, heaviest, and most coarsely


bered muscle of the body

You do not sit on your gluteus maximus ;


you sit on the fatty brous tissue and the
ischial bursa that lie between the ischial
tuberosity and skin.

Origin: From the gluteal (posterior)


surface of the ilium, sacrum and coccyx.
It slopes across the buttock at a 45
degree angle

Insertion: into the iliotibial tract and the


gluteal tuberosity of the femur

Actions: It is the main extensor of the


thigh, and assists with lateral rotation.

Innervation: Inferior gluteal nerve (L5,


S1, S2)

Gluteal bursae separates the gluteus


maximus from adjacent structures
Membranous sacs lined by a synovial
membrane containing a capillary layer of
slippery uid resembling egg white
Trochanteric bursa separates superior
bers of the gluteus maximus from the
greater trochanter.
Ischial bursa separates the inferior part
of the gluteus maximus from the ischial
tuberosity; it is often absent
Gluteofemoral bursa separates the
iliotibial tract from the superior part of the

Fig. 9 Gluteal muscles and bursae

Fan-shaped and lies between to the


gluteus maximus and the minimus

Origin: from the gluteal surface of the


ilium

Insertion: the lateral surface of the


greater trochanter

Actions: Abducts and medially rotates


the lower limb. During locomotion, it
secures the pelvis, preventing pelvic drop
of the opposite limb

Innervation: Superior gluteal nerve (L5,


S1)
o Gluteus Minimus

Deepest and smallest of the superficial


gluteal muscles

Origin: from the ilium and converges to


form a tendon

Insertion: to the anterior side of the


greater trochanter

Actions: Abducts and medially rotates


the lower limb. During locomotion, it
secures the pelvis, preventing pelvic drop
of the opposite limb.

Innervation: Superior gluteal nerve (L5,


S1)
o Tensor Fasciae Latae

Fig.10 Waddling gait

CLINICAL SIGNIFICANCE: Weakness or paralysis of this muscle due damage of superior gluteal nerve can lead to trendelenburg
How the body compensate for this:
Gluteus medius gait person raises the pelvis and leans away from the unsupported side
Steppage exit lifting the foot higher as it is brought forward
Swing-out gait lateral swinging of the foot

Small superficial muscle which lies

Deep muscles
o Piriformis
towards the anterior edge of the iliac

pear-shaped piriformis
crest

key landmark in the gluteal region

Lies between the gluteal region and the

Lies below and parallel to the posterior


front of the thigh

Origin: from the anterior iliac crest,


border of the gluteus medius

Origin: from the anterior surface of the


attaching to the anterior superior iliac
sacrum
spine (ASIS).

Insertion: into the iliotibial tract, which

Insertion: into the greater trochanter of


itself attaches to the lateral condyle of the
the femur

Actions: Lateral rotation and abduction.


tibia.

Innervation: Nerve to piriformis (Ventral

Actions: Assists the gluteus medius and


rami of S1,2)
minimus in abduction and medial rotation
o Obturator Internus and Gemelli
of the lower limb

Innervation: Superior gluteal nerve


Superior and Inferior

Forms a tricipital muscle, the triceps


coxae, which occupies the gap between
the piriformis and the quadratus femoris

Small narrow, triangular extrapelvic


reinforcement of the obturator internus
o Quadratus Femoris

Flat, square-shaped muscle

Most inferior of the deep gluteal muscles,


located below the gemelli and obturator
internus

Origin: from the lateral side of the ischial


tuberosity

Insertion: quadrate tubercle and the area


below it on the intertrochanteric crest

Actions: Lateral rotation

Innervation: Nerve to quadrates


femoris (L5,S1)

Fig.11 Deep gluteal muscles