LOWER LIMB (17)

Write short notes on the anatomy of the hip joint.

Synovial joint connecting the pelvis to the lower limb

Ball and socket joint between the head of the femur and acetabulum

Articular Surfaces
Head of femur
- forms 2/3rds of a sphere
- covered in articular cartilage except at fovea for ligamentum teres
- more than 1/2 of femoral head is contained in the acetabulum

Acetabulum
- socket in infero lateral pelvis made up by intersection ilium/ischium/pubic bones
- central, non-articulating area for fat pad and ligamentum teres
- deepened by acetabular labrum
- inferior notch is bridged by transverse acetabular ligament

Capsule - fibrous capsule is strong and dense; cylindrical sleeve that encloses joint and NOF
- attached to edge of acetabulum, labrum and transverse acetabular ligament
- distal insertion to femoral neck at intertrochanteric line, GT and intertrochanteric crest
- lined by synovium

Ligaments
Iliofemoral - anterior thickening of capsule
Ischiofemoral - posterior thickening of the capsule
Pubofemoral - inferior/anterior thickening
Ligamentum teres - intracapsular, attaching non-articular acetabulum to fovea of femoral head;
may contain small artery to head of femur (from obturator a.)

Relations
Ant - (med to lat) - pectineus, femoral vein, iliopsoas, femoral artery + nerve, rectus femoris, ITB
Post - (sup to inf) - piriformis, obterator externus, obterator internus, gemelli, quadratus femoris,
sciatic nerve
Sup - glut miminus
Inf - obterator externus, pectineus
Lat - ITB

Arterial supply - medial and lateral circumflex (from profunda); artery of the femoral head (obturator
a.)
Trochanteric anastamosis - sup gluteal; med and lat circumflex; sometimes inf gluteal

Venous drainage - profunda to

Innervation
Femoral n, obturator n, superior gluteal n, n to quatratus femoris

Lymph
Deep and internal iliac nodes

Variation
Os acetabuli
Anteversion/retroversion

Write short notes on the anatomy of the gluteal muscles.

Gluteal muscles lie posterior to the pelvis

Extend and abduct the thigh

Gluteus maximus

Largest, most superficial muscle

Extends and laterally rotates thigh

O - Posterior iliac crest and ala, Dorsal sacrum/coccyx/sacrotuberous lig

Courses inferolateraly from pelvis across buttock at 45 degree angle

I - iliotibial tract, gluteal tuberosity

N - inferior gluteal nerve from sacral plexux

Arteries - superior and inferior gluteal arteries form the posterior and anterior divisions of IIA
respectiviely

Gluteus medius

Thick, fan shaped triangular muscle

Deep to glut maximus on external surface of ilium
Abductor, tilts hip, medially rotates

O - external surface of ilium between andterio and posterior gluteal lines

I - greater trochanter

N - Superior gluteal n from sacral plexus

Artery - Superior gluteal artery from posterior division of IIA

Gluteus Minimis

Fan shaped or triagular

Smallest gluteal muscle
Abducts and internally rotates

O - external surface of ilium between anterior and inferior gluteal line

I - greater trochanter

N - superior gluteal n (sacral plexus)

A - superior gluteal a (post division of IIA)

Write short notes on the anatomy of the inguinal ligament

Thickened inferior border of external oblique aponeurosis

Separates the lower extremity from the pelvis
Continuous inferiorly with fascia lata of the thigh
15cm long; 40 degree angle

Lacunar lig - thickened medial protion (2cm); cresent shaped extension of fibres to pectin pubis
Pectineal lig - fibres extending from the lacunar ligaemnt along the pectin pubis of the the pelvic
brim

Attachments
ASIS --> pubic tubercle and pectineal line

Relations

Anterior (passes over)

Inguinal canal
Boundaries
Ant - aponeurosis of external oblique and internal oblique laterally
Post - transversalis fascia
Roof (sup) - internal oblique
Floor (inf) - inguinal and lacunar ligments

Contents
- 3 arteries (a to vas, testicular, cremasteric a.)
- 3 fascias (external spermatic, internal spermatic, cremasteric
- 3 other (pampiniform plexus, vas deferens, lymphatics)
- 1 nerve - genitofemoral

Posterior (passes behind)

From lateral to medial
- lateral cutaneous femoral n
- iliacus/psoas
- femoral nerve
- femoral sheath (formed by transversalis fascia (femoral artery, vein, lymphatics)
- pectineus

Variants

Write short notes on the anatomy of the patella

Larges sesmoid bone in body within quadratus femoris tendon

Increases the leverage of the quads tendon
Triangular shaped with apex pointing inferiorly
Base is broad and superior for attachment of quadratus femoris m.
Two articular facets posteriorly covered in cartilage and slope away from a smooth raised edge

Articulations
Larger larger lateral facet articulates with medial aspect of lateral condyle
Medial facet articulates with medial femoral condyle
In the intercondylar groove/patellar surface

Relations
Sup - quads tendon and muscle
Inf quads ligament
Med - medial condyle, vastus medialis
Lat lateral condyle and vastus lateralis
Ant - skin and subcut tissue
Posteiror inter condyluar groove of femur

Arterial - patella anastamosic ring with superior/inferior geniculate aa. and anterior tibial recurrent a

Venous

Innervation

Ossification centres appear between 3 and 6. Fuse by puberty

Variation
Bipartate patella
Multipartate
Absence
Lateral emargination
Write short notes on the anatomy of the knee joint.
Articulation between the femur, tibia and patella in the lower limb

Synovial hinge joint between the femur, tibia and patella in lower limb
Mechanically weak, relies on ligaments for stability

Articular surfaces
Condyles and patella surfaces of the femur
Tibial plateau/flat condyles of the tibia
Patella facets

Capsule
Fibrous, strong, especially where local thickenings form its ligaments

Attachement
Sup - proximal to articular margins of the condyles and intercondylar line posteriorly; communicates
with supra patellar bursa superiorly

Inf - articular margin of the tibia except where tendon of popliteus crosses bone > capsule
extends inferiorly over the popliteus to the head of the fibula forming the arcuate popliteal lig

Strengthening ligaments
Patella, LCL, MCL, oblique popliteal and arcuate popliteal

Bursae (4 comminucate with joint

Suprapatella - saccular extension of synovial capsule between femur and quads tendon; extends 5-
8cm superior to the base of patella

Popliteus bursa - extension of synovial capsule btw popliteus tendon and lateral tibial condyle,
opens into knee joint inf to lateral meniscus

Anserine bursa - Separates tendons of sartorius, gracilis and semitond from tibia and MCL

Gastroc bursa - deep to proximal attachment of medial head

3 not communicating with joint

Semimebranous - between medial head of gastric and semimem

Infrapatealla - between patella liv and anterior surface of patella
Prepatella - between skin and anterior surface of patella
Synovium
Lines capsule, reflects on cruciates

Ligaments
Extracapsular

MCL
- strong flat ligament running from medial epicondyle to superior medial surface of tibia
- attaches to the medial meniscus and the joint capsule
- partically continuous with adductor magnums
- inferiorly separated from the tibia by medial inferior genicular vessels and n

LCL
- round, pencil like cord ~5cm long
- from lateral epicondyle of femur to lateral surface of head of fibula
- separated from the capsule by the popliteal tendon which passes deep to it
- fuses with fibrous capsule of knee joint superiorly

Patella lig
- very strong thick band continuous with quads tendon
- from apex of patella adjoining margins of patella to tibial tub
- blends with med and lat patella retinaculum
- infrapatella fat pad is deep
- keep infra patella bursa separates it from anterior tibia

Medal and lateral patellar retinacula

- aponeurtotic expansion of the vastus medialis and vastus lateralis and overlying fascia
- supports patella in groove

Arcuate popliteal lig

- Y shaped band of fibres stregthening capsule posteirorly
- fibular head > over tendon of popliteus > spreads over posterior knee joint > inserts on
intercondylar area of tibia and poster epicondyles of femur
- part of PLC

Oblique popliteal lit

- broad band
- expansion of semimembranosus m
- strengthens capsule posteiroly
- from posterior medial tibial condyle to central posterior fibrous capsule

Intraarctiular ligaments - see cruciate question

Mensici - see menisci question

Relations
Ant - quads, skin
Post - popliteal fossa - vessles, tibial and common peroneal n, small saphenous v, lymphatics,
gastroc, hamstrings, plantaris
Lat - biceps femoris tendon
Medial - pes muscles (S, G, Semitend,) semimembranosus, great saphenous

Arterial supply - genicular branches of femoral, popliteal, anterior and poster recurrent of tibial
recurrent and circumflex fibular
form genicular anastamosis
Middlle geniculate from popliteal pierces capsule to supply internal structures

Nerve - branches of obturator, tibial, common peroneal

Mvt

Variants
Discoid meniscus
Ring medial meniscus
Absent meniscofemoral lig
Transverse lig may be absent
Bipartate patella
Fabella
Patella baja or alta
Patella absence

Write short notes on the tibial plateau.

Proximal expanded end of the tibia which artciculates with the femoral condyles

Condyles
Articular surfaces have large medial and smaller lateral condyles
Medial is oval in shape and concave in TV and AP planes
Lateral is circular and concave in TV and convex in AP planes
Peripheral condyle supports mensici; central condyle articulates with femoral condyles

Intercondylar fossa and eminence

Articular surfaces are separated by roughened intercondylar area
Anterior intercondylar fossa - attachment for ant horns of menisci and ACL
Posterior intercondylar fossa - attachment for post horn of medial menisci and PCL

Intercondylar eminence - rises between fossa, medial and lateral tubercle

Attachements (ant to post)

Ant horn MM
ACL
Ant horn LM
Post horn LM
Post horn MM
PCL

Coronary lig
Transverse meniscal lig
Oblique menisomeniscal lig
Oblique and arcuate popliteal lig

Relations
Ant - infrapatella fat pad, patella lig, VMO, VLO
Post - popliteal fossa, popliteus, oblique popliteal lig
Med - MCL, pes, semimembranosus
Lat LCL, biceps tendon, ITB

Write short notes on the anatomy of the menisci of the knee.

Two cresenteric plates of fibrocartilage on articular surface of tibia
Triangular in cross section
Ends firmly attached to intercondylar area
External margins attached to fibrous capsule

Help distribute weight bearing forces

Deepen articular surface to stabilse joint
Provide lubrication to facilitate joint movement
Protect articular cartilage

Medial meniscus
Larger
Semilunar
Attached anteriorly and posteriorly hornsbto intercondylar notch
Attached to posterior capsule
Adnerent to the MCL
Broader and thicker posteriorly than anteriorly

Lateral meniscus
Smaller and more freely moveable but covers a larger area
Circular (more curved)
Uniform thickness
Less well attached to capsule
Attached anteriorly and posteriorly horns to the intercondylar notch
Posterio meinscofemoral lig attaces the menisucs to the PCL and inner aspect of MFC

Ligaments of the menisci

Coronary ligament
- attaches margins of the meniscus to the joint capsule at the tibial condyles

Transverse ligament of the knee

- joins anterior edges of menisci

Oblique meniscomeniscal ligament

- from anterioe horn of MM to posterior horn LM, obliquely through interdoncular notch between
tibial attachments of cruciates

Meniscofemoral ligament
- Anterior (of humphrey ) - from posterior horn lateral meniscus, anterior to PCL and inserts and
edge of femoral PCL attachment on MFC
- Posterior (of Wrisberg) - from posterior horn of lateral meniscus to MFC
- both straddle the PCL
Bloods supply
Thick peripheral margins are vascularised by genicular branches but thin unattached internal
margins are avascular (3 vascular zones important to management of injuries)
Variants

Discoid meniscus
Ring medial meniscus
Absent meniscofemoral lig
Transverse lig may be absent

Write short notes on the anatomy of the cruciate ligaments of the knee
Stong intracapsular ligaments joining the tibia and femur
Extrasynovial
Located between the medial and lateral condyles

ACL
Weaker of the two
Arises from internal medial posterior aspect of the lateral femoral condyle
Passes medially, anteriorly and inferiorly to the anterior tibial plateau
Prevents tibia from displacing anteriorly from the femur

PCL
Arises from lateral anterior part of the medial femoral condyle
Passes inferiorly, posteriorly and laterally
Medial to ACL
Attaches to the posterior intercondular area of the tibia
Prevents posteiror displaceemtn of the tibia on the femur

Relations
Write short notes on the anatomy of the joints between the talus and the calcaneus

Talocalcaneal joint or subtalar joint is an important and complex joint of the hindfoot

Comprises of three articulations:

- Anterior: Concave head of talus with convex anterior facet of calcaneus; small articulation just
lateral to the medial facet
- Middle: Medial (sustentacular) facet with the middle facet of the sustentaculum tali of the
calcaneus
- Posterior: Concave posterior facet of talus with the convex posterior facet of calcaneus; largest
articulation

Anterior and middle facets are often congruent ant therefore the division is often referred to anterior
(anterior and middle) and posterior articulations

(Sometimes the talocalcaneal part of the talocalcaneonavicular joint is also included)

Movement - eversion and inversion

Ligaments
Interosseus talocalcaneal ligament
- thick strong band that bind talus and calcaneus
- runs through the sinus tarsi (canal between the articulations of the two bones

Anterior talocalcaneal/interosseous ligament - attaches the neck of talus to superior calcaneus

Posterior talocalcaneal ligament - extends from lateral tubercle of talus to medial calc
Lateral talocalc - short, strong; attaches lateral talus from fibular facet to lateral calcaneus; parallel
to calcaneofibular ligament
MEdial talocalc - medial tubercle of talus to the sustentaculum tali

Synovial membrane lines capsule and capsule surrounds joint and is continous with the
talocalcaneonaviclar and calcaneocucuboid joints

Sinus tarsi
Cone shaped space between the inferolateral border of talus and superolateral surface of
calcaneus
Contents
- fat
- arterial anastamoses (branches of posterior tibial artery and peroneal artery
- nerve endings
- synovial capsules of posterior subtaler joint and talocalcaneonavicular joint
- 5 ligaments - interosseous talocalc lig, cervial lig, medial, intermediate and lateral roots of the
inferior extensor retinaculum

Tarsal tunnel
extends from the sinus tarsi medially; posterior to the sustentaculum tali

Write short notes on the sartorius muscle

Narrow, elongated straplike muscle; longest muscle in the body

Most superficial muscle in the anterior thigh
Acts across two joint
Runs obliquely inferomeidally across the thigh descending as far as the medial side of the knee,
passing behind the medial condyle of the femur to end in a tendon
Tendon curves anteirorly to joint the tendons of gracicils and semitendinosus muscles together to
form pes anserinus
Flexes, abducts and externally rotates the leg

Origin - ASIS
Insertion - pes anserine on proximal medial tibia
Innervation - femoral nerve (L2,3)
Artery - femoral artery

Relations
Superior - inguinal ligament
inferior - rectus femoris, VMO, tibia
Lat - TFL at origin, quadratus femoris, VMO, knee
Med - creates lateral border of femoral triangle with vein most proximal within the triangle; iliopsoas
Deep - femoral artery runs along its course

Variations
Multiple slips can occur (can be from lateral inguinal ligament, ilium, iliopectineal line or pubis
Split into two parts - may instead into fascia lata femur, patella ligament or tendon of
semitendinosis
May inset into knee joint or fascia of the leg
Absence
Write short notes on the anatomy of the fibularis (peroneus) longus and brevis

Muscles of the lateral compartment of the leg

Plantar flex and evert the foot
Enclosed in common synovial sheath
Innervated by superficial peroneal nerve from fibular nerve
Arterial supply from peroneal artery <posterior tibial artery <popliteal a

Peroneal longus
Longer and more superficial

Origin - head and upper lateral surface of fibula and inter muscular septum

Course
Fibres run inferiorly in lateral compartment of the leg
End in a long tendon which runs behind the lateral malleolus (posterior to brevis tendon) in a
groove covered by the superior peroneal retinaculum
Tendon extends obliquely anteriorly across the lateral side of the calcaneus, below the trochlear
process and the brevis tendon, under the cover of inferior fibular retinaculum
Crosses lateral side of cuboid then runs under it crossing the sole of the foot obliquely covered by
the long plantar ligament

Inserts into the base of the first metatarsal bone and lateral medial cuneiform

Action - eversion and plantar flexion, maintains transverse arch, postural muscle preventing
inversion

Variations
Occasional slip to second metatarsal

Peroneal brevis
Shorter, smaller muscle
Lies deep to longus

Origin
Distal two thirds of the lateral fibula surface and inter muscular septa

Course
Fibres pass vertically inferiorly ending in a tendon(shorter to longs)
Runs posterior to lateral malleoulus (anterior to longus tendon but enclosed in the same sheath
Passes lateral to calcaneus, superior to trochlear process

Inserts into base of 5th MT on its lateral side

Action - weak plantar flexion and eversion

Innervation - superficial peroneal nerve

Write short notes on the anatomy of the collateral ligaments of the ankle.
Capsule of ankle/talocrural joint is thickened by collateral ligaments on the medial and lateral side
Deficient anteriorly and posteriorly

Medial collateral ligament > Deltoid ligament complex

Strong triangular ligament extending from MM to talus, navicular and calcaneus
Strengthen joint
Made up of four components divided into superficial and deep fibres:

Superficial fibres (post to ant) - cross ankle and subtalar joints

Posterior tibiotalar - from posterior MM to posterior tubercle medial to groove for FHL tendon

Tibiocalcaneal - descends vertically and inserts on sustanaculum talk of calcaneus

Tibionavicular - runs from MM obliquely forward to insert on the navicular tuberosity blending with
themedial margin of the spring ligament (plantar calcaneonavicual ligament)

Deep fibres (cross ankle joint only)

Anterior tibiotalar - attached to anterior colliculus of the MM to the anteromedial talus

Lateral collateral ligaments

Provides lateral stabilisation to tibiotalar articulation, preventing inversion injuries
Attach lateral malleolus to the calcaneus and talus

Made up of three components:

Anterior talofibular ligement- anteiror margin of LM to the anterolateral talar neck
Calcaneoufibular ligament - attached on the postero medial LM and descends posteroinferioly to
the lateral calcaneus; deep to peroneal tendons

Posterior talofibular ligament - runs horizontally btw the neck of the talus and the medial side of the
lateral malleolus

Syndesmosis
AITFL
PITFL
Transverse tibiofibular ligament
Inferior transverse ligament
Interoosseus membrane

Spring ligament complex

Ligaments between the calcaneus and the navicular bones
Maintain the transverse arch of the foot
Supports head of talus

Made up of
Plantar calcaneonavicular ligament
- connects from the anterior margin of the sustentaculum tali
- to the plantar surface of the navicular
Tib post tendon
Plantar fascia
Plantar ligaments

Write short notes on the femoral artery and its relations in the femoral triangle.

Femoral triangle boundaries SAIL (sartorius, adductor longus, inguinal lig)

The external iliac artery becomes the femoral a (common femoral a) as crosses under the inguinal
ligament midway between the ASIS and the pubic symphysis

Runs through the femoral triangle bordered by:

Medial margin of Sartorius laterally
Adductor longus medially
Inguinal ligament superiorly
Deep to the artery (floor of triangle) - (lateral to medial ) iliopsoas, pectineus
Superficial to the artery (roof of triangle) - fascia lat, cribriform fascia, submit tissue and skin

Lateral - femoral nerve and terminal branches

Medial - femoral vein (with long saphenous and external pudenal pierces fascia to join) and
lymphatic vessels within femoral sheath with a

Branches within the triangle

- superficial circumflex iliac a (to ASIS anastamosis)
- superficial epigatric (supplies anterior abdo wall)
- superficial external pudendal (scrotum/labia)
- deep external pudendal a (scrotum/labia)
- Deep artery of the thigh - passes posteriorly between pectinous and adductor longus (lateral and
medial circumflex arterys branch before the a exits the triangle

Write short notes on the anatomy of the arterial supply of the foot. Write short notes on the
anatomy of the arterial supply of the foot, including normal variants.
Arterial supplyof the foot is from the terminal branches of the anterior and posterior tibial arteries
and lateral contribution from peroneal a

Plantar supply
Medial plantar artery
- branch of posterior tibial a
- small calibre vessel
- supplies medial side of the foot, abductor hallucis and FDB
- arterial supply to big toe and 1st webspace

Lateral plantar artery

- branch of posterior tibial a
- large calibre vessel
- crosses sole obliquely toward the base of 5th MT
- gives off cutaneous branches that perforate plantar aponeurosis
- continues as a deep trunk to form the plantar arch

Plantar arch
- anastomosis of the lateral plantar a and the dorsalis pedis a
- lies deep to plantar aponeurosis superficial to the long tendons
- joins DP in proximal part oath 1st inter metatarsal space

Plantar metatarsal aa
- four metatarsal arteries branch off the plantar arch
- supply four metatarsals and digits
- anastamose with the dorsal metatarsal a via perforators

Dorsal supply

Dorsalis pedia a
- continuation of anterior tibial a
- starts between the malleoli over the distal tibia
- lateral to EHL then crosses under it to sit laterally
- courses to the base of the 1t inter metatarsal space > deep branch joins plantar arch
- branches to form the medial tarsal, lateral tarsal and arcuate a

Medial and lateral tarsal aa

- branch off dorsalis pedis to supply underlying tarsals
Arcuate a
- branch of dorsalis pedis
- travels under EDM over bases of metatarsal bones
- gives off dorsal metatarsal aa

First dorsal metatarsal a

- continuation of dorsalis pedis
- suppies first webspace and medial and dorsal great toe

Deep plantar artery to the deep plantar arch

Dorsal metatarsal a
- three aa branching off the arcuate a
- communicate with plantar metatarsals

Pernoeal artery
Branch of posterior tibial a 2.5cmfrom origin
Pierces interosseous membrate 5cm above lateral malleoulus
Terminal branch is Lateral calcaneal branch in foot which supples lateral calcaneus

Variants
Absent dorsalis pedis
Absent arcuate artery
dorsalis pedis from peronaeal
DP cross EHL at ankle or above ankle
Arch may come from peroneal
Write short notes on the anatomy of the sciatic nerve

Largest nerve in the body and the main branch of the sacral plexus
Consists of tibial and common peroneal nerves bound together
Formed by ventral rami alf L4-S3
Formed in the pelvis at the lower margin of performmis by the union of the two component
Terminates at the apex of the popliteal fossa where it divides into the tibial and common peroneal
nerve

Innervates
All muscles of the posterior compartment of thigh and ischial part of adductor magnus
All muscles of the leg and foot
Skin on the lateral side of the leg and lateral plantar surface of the foot

Course
Leaves pelvis as thick flattened band and travels through greater sciatic foramen inferior to
piriformis
Enters gluteal region lateral to the inferior gluteal and pudendal nerves and vessels (most lateral)
Runs inferolaterally deep to gluteus maximus midway btw greater trochanter and ischial tuberosity

Rests on ishium passing posterior to obturator internus, quatratus femoris and adductor magnus
Enters posteiror compartment of the thigh under the cover of biceps femoris
Travels inferiorly and divides into terminal branches, common peroneal and tibial

Relations
In pelvis
Ant -, lateral sacral vessels, pelvic peritoneum
Post - piriformis

Gluteal region
Ant - ishcium, obturatur internus and gemelli, quadratus femoris
Post - glut max
Medial - posterior cutaneous nerve of the thigh, inferior gluteal a and nerve

Thigh
Ant - adductor magnus
Post - long head of biceps femurs
Medial - semimembranosis
Lateral - perforators

Branches
Articular, muscular to posterior compartment and ischial part of adductor magnus
Tibial and CP

Variations
Many variations in terminal branches of surgicall importance
High division prior to piriformis - either branch may pass superior or inferior to performs
Sciatic or early branches may pierce performs
Two terminal branches may remain separate from sacral plexus
Division may occur inferior to popliteall fossa

Write short notes on the common fibular/peroneal nerve

Common peroneal
Smaller terminal branch of sciatic nerve; half the size of tibial nerve
Dervied from dorsal branches of L4-S2
Descends obliquely along the lateral side of the popliteal fossa to the head of the fibula; close to
the medial margin of the biceps femoris muscle
Gives off communicating sural nerve and articular branches (lateral genicular and recurrent
articular)
Winds around femoral head and divides between the peroneus longus and bone

Branches
Superficial peroneal nerve
Descends in the lateral compartment deep to PL and innervates PL and PB
Penetrates the deep fascia of the leg and enters the foot where it divides into medial and lateral
branches
Supply dorsal foot except webspace btw the great and second toes
Lateral side of little toe (from sural n)

Deep peroneal nerve

Passes anteromedially through the inter muscular septum that separates the lateral from anterior
compartments
Passes deep to EDL
Reaches anterior interossus membrane wehre it meets and descends with anterior tibial artery
Supplies
- all muscles of the anterior compartment (TA, EHL, EDL, Peroneal Tertius)
- continues to dorsal aspect of foot where it innervates EDB, 1st two interossei and 1st webspace

Tibial nerve

Major branch of sciatic nerve

Descends in posterior compartmetn from the popliteal fossa
Passes under the tendinous arch formed between the fibular and tibial heads of the soles muscle
and passes vertically through the deep region of the posterior compartment on the surface of TP
with the posterior tibial vessels

Leaves the posterior compartement at the ankle by passes through the tarsal tunnel behind the
MM
Enters the foot to supply the intrinsic muscles and skin

Branches:
All muscles of posterior compartment
- branches to superficial muscles and popliteus originate superior in the leg and innervate gastroc,
planters, soleus
- branches to deep muscles originate deep to soleus m and innervate TP, FHL, FDL
Cutaneous branches
- sural n - originate btw heads of gastric, descends superficially on gastroc belly and penetrates
the deep fascia at the middle of the leg to be joined by sural communicating branch from
common peroneal n > passes posterior to lat malleoulus and supples skin on lower
posterolateral surface of the leg and lateral side of foot

- medial calcaneal n -branches at inferior part of nerve and supplies skin on medial surface of
sole

Write short notes on the anatomy of the great (long) and the small (short) saphenous veins,
including normal variants.

Make up the superficial venous drainage of the lower limb

Normal flow is from superficial to deep
Valves more prominent in deep system

Great saphenous
Formed by the union of the dorsal vein of the great toe and the dorsal venous arch
Commences on the medial side of the foot (dorsum)
Passes anterior to the medial malleolus
Ascends vertically, posterior to the medial femoral condyle
Ascends on medial aspect of thigh
Traverses the saphenous opening in the lower part of the inguinal triangle to drain into the femoral
vein (4cm below and lateral to the pubic tubercle)
~12 valves located inferior to the perforators

Tributaries
anterior femoral cutaneous
lateral femoral cutaneous
anastamoses freely with short saphenous
superficial external pudendal
Superifical circumflex iliac
superificial epigastric

Relations
Ant - subcut tissue and skin
Post - deep fascia
Accompanied by saphenous n inferiorly once it pierces the deep fascia at the medial side of the
knee

Short saphenous
Formed by the union of the dorsal vein of the little toe and dorsal venous arch
Commences on lateral side of the dorsum of the foot
Passes posterior to the lateral malleolus as the continuation of the lateral marginal vein
Runs along the posterior aspect of the leg with the sural nerve wehre it passes between the heads
of gastrocnemius m and drains into the popliteal v

Variation
SSV joins common gastrocnemius vein before draining into popliteal vein
SSV Can drain into great SV at variable levels
Accessory saphenous vein formed by tributaries in the medial and posterior thigh

Deep veins
Accompany the arteries and are usually paired
Comprised of anterior and posterior tibial veins
Peroneal v
Popliteal v
Medal and laterl inferior and superior veins to the knee
Superficial femoral v
Profunda fermosal v

Perforating veins carry blood from superficial to deep system

Medail and lateral plantar veins pass close to the arteries

Communicate with the GSV and SSV, then form the posterior tibial veins posterior to the lateral
malleoulus

Femoral nerve

larget branch of lumbar plexus

Dorsal branches of L2-4
Abdominal branches supply iliacus and pectineus mm

Course
Descends through psoas major
Runs caudally in iliopsoas groove, deep to iliac fascia
Courses lateral to the femoral artery and vein an the sheath enclosing them
Supplies anterior thigh muscles, articular branches to knee and hip, supplies skin on anteromedial
thigh

Divides into anterior and posterior divisions

Anterior
medial femoral cutaneous nerve
> lateral then anterior to femoral arteeru at apex of femoral triangle
- descneds on sartorius suppling skin as low as medial aspect of knee

intermediate femoral cutanous n - pierces fascia and descends on front of thigh

Posterior division - saphenous nerve

- descends through femoral triangle, lateral to femoral shealth
- descends in adductor canal lateral, then medial to femoral artery
- becomes superficial passing btw sartorius and gracicilis
- upplies medial thigh and leg, knee and foot

Variations
Saphenous may end a knee
femoral nerve may piecrs iliacus muscle
may enter thigh btw femoral a or vein
portion arising from L4 may run a separate course

Write short notes on the sacral plexus (see pelvis)

Write short notes on the relations of the psoas muscle (see pelvis)

Others

Obturator nerve
Adductor compartment
Popliteal fossa

Write short notes on the anatomy of the Great and Small saphenous veins.
Write short notes on the anatomy of the knee joint.
Write short notes on the anatomy of the inguinal ligament
Write short notes on the anatomy of the arterial supply to the foot
Write short notes on the anatomy of the long and short saphenous veins and normal variants.
Write short notes on the anatomy of the arterial supply to the foot and normal variants.
Write short notes on the anatomy of the Long Saphenous vein.
Write short notes on the menisci of the knee
Write short notes on the anatomy of the great saphenous vein.
Write short notes on the anatomy of the hip joint
Write short notes on the anatomy of the great and small saphenous veins (long and short
saphenous veins) and normal variants.