Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
LIMB
ANATOMY
CLASS NOTES
SPRING 2009
A. Regions
1. Gluteal Region
- the buttock, extends from the posterior iliac crest to the gluteal fold
a. Dorsal Region
- the superior part or dorsum of the foot
b. Plantar Region
- the inferior part or planta of the foot
- is divided into medial, lateral and central regions
c. Calcaneal Region
- the heel; medially, laterally and plantarly
B. Surfaces of the Lower Limb
- described relative to anatomic position
3. Medial Surface
- the inner side of a part, toward body’s midline
4. Lateral Surface
- the outer side of a part, opposite body’s midline
5. Flexor Surface
- the surface over the flexor muscles
- ex. the flexor surface of the leg is the posterior surface of the leg (opposite for
the upper limb, due to limb rotations)
6. Extensor Surface
- the surface over the extensor muscles
- ex. the extensor surface of the thigh is the anterior surface of the
thigh (opposite for the upper limb, due to limb rotations)
7. Adductor Surface
- the surface over the adductor muscles
- ex. the adductor surface of the thigh is the medial surface of the thigh
8. Abductor Surface
- the surface generally over the abductor muscles
- ex. the abductor surface of the thigh is the lateral surface of the thigh
9. Patellar Surface
- the anterior surface of the knee region, over the patella
2
II. ANATOMIC POSITION
- The anatomic position is one in which the body is standing erect with the toes and
palms facing anterior.
- the position of reference for much terminology
- In relaxed standing, the torso is slightly slouched; the toes are often directed slightly
lateral and the palms are facing medially.
III. TERMINOLOGY
A. Descriptive
- used to describe position
2. Inferior, Caudal
- away from the head
- The foot is inferior to the ankle.
3. Anterior, Ventral
- toward the front side
- ventral is usually reserved for embryology
- The patellar surface is anterior to the popliteal surface.
4. Posterior, Dorsal
- toward the back side
- dorsal is usually reserved for embryology, except when referring to the foot’s
dorsum
- The popliteal region is posterior to the patellar region.
5. Medial
- closer to the midline (central line) of the body
- The hallux (great toe) is medial to the 5th pedal digit.
6. Lateral
- farther from the midline
- The 4th pedal digit is lateral to the hallux.
7. Intermediate
- between 2 structures
- The ankle is intermediate to the leg and foot.
8. Ipsilateral
- on the same side of the body
- The right forearm is ipsilateral to the right lower limb.
- most often used for neurology
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terminology, descriptive, con’t
9. Contralateral
- on the opposite side of the body
- The left arm is contralateral to the right thigh.
- most often used for neurology
10. Proximal
- closer to the origin/main structure
- The thigh is proximal to the leg.
11. Distal
- farther from the origin/main structure
- The foot is distal to the knee.
12. Superficial
- closer to the surface
- Skin is superficial to bone.
13. Deep
- farther from the surface, closer to the center
- Muscles are deep to skin.
B. Terminology of Movement
1. Flexion
- decreasing the angle between body parts, generally
- usually an anterior direction except at the knee and more distal joints where it
is a posterior direction
2. Extension
- increasing the angle between body parts, generally
- usually a posterior direction except at the knee and more distal joints where it
is an anterior direction
a. Hyperextension
- extension beyond the anatomic position
- occurs normally at the neck, wrist, hip, ankle and MTP joints; The
term is not usually used for hip, ankle or MTP joints
3. Abduction
- moving a part away from the body’s midline
4. Adduction
- moving a part toward the midline of the body
5. Rotation
- moving around the long axis of a part
- occurs primarily at the hip and shoulder joints
4
terminology of movement, rotation, con’t
6. Circumduction
- movement of a part in a circular pattern
- combines flexion and extension with abduction and adduction; movements
must occur in alternating sequence
7. Eversion
- moving the sole of the foot away from the body’s midline
8. Inversion
- moving the sole of the foot toward the body’s midline
9. Dorsiflexion
- extension of the ankle joint or joints distal to the ankle joint
- bringing the dorsum of the foot closer to the anterior surface of the leg
11. Supination
- We will discuss supination as it relates to lower extremity anatomy, not the
upper limb.
- combination of plantar flexion, adduction and inversion of the foot
- motion occurs at the functional subtalar joint and the midtarsal joint
12. Pronation
- We will discuss pronation as it relates to lower extremity anatomy, not the
upper limb.
- combination of dorsiflexion, abduction and eversion of the foot
- motion occurs at the functional subtalar joint and the midtarsal joint
B. Transverse Planes
- divide the body or body parts into superior and inferior sections
C. Sagittal Planes
- divide the body or body parts into right and left sections
5
body planes, sagittal planes, con’t
2. Parasagittal Plane
- any sagittal plane except the midsagittal plane
V. JOINTS / ARTICULATIONS
- where two bones meet
A. Arthrology
- the study of joints
B. Classification
1. Functional
- based on the amount of movement available at a joint
2. Structural
- based on the material that unites the bone ends
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joints, structural classification, fibrous, con’t
iii. Syndesmosis – 2 bones held together by a sheet of fibrous tissue
ex. tibiofibular syndesmosis
- functional amphiarthroses
i. Plane/Planar/Gliding
- bone ends are both flat surfaces
- allow gliding movements only, no rotation
ex. intertarsal joints
ii. Hinge/Ginglymus
- complex surface shapes that may involve more than 2 bones
- allow movement in one plane; flexion and extension
ex. ankle joint
iii. Condyloid/Ellipsoid
- 1 rounded, ball-like projection and 1 shallow saucer-like surface
- allow movement in two planes; flexion and extension, abduction
and adduction, and circumduction
ex. metatarsophalangeal joints
iv. Saddle/Sellar
- 2 saddle shaped surfaces
- allow movement in two planes; flexion and extension or abduction
and adduction (not both at the same time)
- have a small amount of rotation due to joint surface shapes
ex. calcaneocuboid joint
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joints, synovial, con’t
v. Bicondylar
- 2 large rounded projections contacting 2 saucer-like areas
- allow movement primarily in one plane with a small amount
of rotation
ex. knee joint
VI. BONE
A. Osteology
- the study of bone
1. Ligament
- dense connective tissue that connects bone to bone
- often blend with articular capsules
B. Types
C. Classification
1. Placement
a. Axial Bones
- part of the axial skeleton
- includes the skull, vertebrae, ribs, sternum and manubrium
b. Appendicular Bones
- part of the appendicular skeleton/limbs
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bone, appendicular, con’t
ii. Lower Limb - pelvic girdle (os coxa), femur, patella, tibia, fibula,
tarsus (greater and lesser), metatarsus, and pedal phalanges (in the
toes)
2. Shape
a. Long Bones
- usually have greater length than width
- found in the limbs
- slight posterior/plantar concavity (curvature) in the lower limb for strength
ex. femur
i. Diaphysis/Shaft/Body
- the central tubular part
- primarily compact bone
iii. Metaphyses - flared part between the diaphysis and the epiphyses
- core of cancellous bone with a thin covering of compact bone
- metaphysis is singular
b. Short Bones
- roughly cube-shaped
- found only in the carpus and tarsus
- core of cancellous bone with a thin covering of compact bone
ex. cuboid and cuneiforms
c. Irregular Bones
- complex shapes with varying amounts of cancellous and compact bone
ex. vertebrae and facial bones
d. Flat Bones
- two parallel plates of compact bone with a minute amount of
cancellous bone between the two plates
ex. ribs and skull
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bone, shapes, con’t
e. Sesamoid Bones
- round or oval bones located within tendons and often joint capsules
- functions:
1. protect the tendon from wear
2. create a mechanical advantage for the muscle by changing the angle
of the pull and altering the muscle action
ex. patella - largest sesamoid in the body
and the sesamoids of the first metatarsal bone
D. Bone Markings
The parentheses contain plural forms of these terms, which are not typical
English plurals.
1. Foramen (foramina)
- an opening (hole) for the passage of vessels and nerves
ex. nutrient foramen, sacral foramina
3. Fossa (fossae)
- a depression in or on a bone
ex. iliac fossa, lateral malleolar fossa
4. Notch
- an indentation along the edge of a bone
ex. greater sciatic notch
5. Condyle
- a large rounded or depressed articular prominence
ex. medial femoral condyle
6. Epicondyle
- a small prominence superior to a condyle
ex. medial epicondyle of the femur
7. Facet
- a smooth flat surface for articulation
ex. middle facet of the calcaneus
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bone, bone markings, con’t
8. Tubercle
- a small rounded prominence for the attachment of soft tissue structures
ex. adductor tubercle of the femur
9. Tuberosity
- a large rounded prominence, often roughened for the attachment of soft
tissue structures
ex. tibial tuberosity
10. Trochanter
- a large blunt process only on the femur
ex. greater trochanter
11. Crest
- a prominent border or ridge
ex. median sacral crest
E. Ossification
- all lower extremity bones begin as cartilage except the tufts of the
distal phalanges
- the tufts of the distal phalanges ossify through a process called
intramembranous ossification
- the ossification process from cartilage to bone is called
endochondral bone formation or intracartilaginous ossification
1. Long Bones
c. Epiphyseal Plate/Physis
- area of cartilage between the diaphysis and the epiphyses
- allows for length-wise growth of bone
- form the metaphyses and part of the diaphysis
11
bone, ossification, con’t
2. Short Bones
a. Center of Ossification
- in the bone’s center
- The center of ossification of some short bones is present at birth.
- most only have one center of ossification
- the calcaneus is an exception
- secondary center of ossification is located posteriorly and is called
the calcaneal apophysis
b. Determination of Age
- The appearance of the centers of ossification of the short bones of the
foot can be used to determine a child's age radiographically. Using the
bones of the hand is more accurate as there is less variability in the age
of appearance of the centers of ossification of the manual short bones.
VII. MUSCLES
1. Associated Structures
aa. Mesotendon - where the layers of tendon sheath meet each other
- may remain as a single structure or partially or
completely degenerate
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muscles, associated structures, con’t
B. Types
1. Cardiac Muscle
- heart muscle tissue
3. Skeletal
- voluntary muscle
- also called striated muscle
- poor terminology because cardiac muscle is also striated
- preferable not to use this term
C. Naming
1. Direction of fibers
- with respect to the body midline/part midline
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muscles, naming, con’t
2. Location
- within the body
ex. tibialis anterior muscle and plantar interossei muscles
3. Size
a. Maximus - largest
ex. gluteus maximus muscle
b. Minimus - smallest
ex. gluteus minimus muscle
c. Magnus - large
ex. adductor magnus muscle
d. Longus - longest
ex. adductor longus muscle
e. Brevis - shortest
ex. adductor brevis muscle
4. Number of Origins
5. Shape
a. quadratus plantae muscle – quadrangular
b. trapezius muscle - trapezoid
a. sternocleidomastoid muscle
- mastoid process, sternum and clavicle
b. iliacus muscle
- iliac fossa
7. Action/Function
D. General Rule: Any muscle that crosses a joint has an action at that joint.
(If you know the origin, course and insertion of a muscle, you can figure out
the action or function.)
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VIII. VESSELS
A. Types
1. Arteries
- carry blood away from the heart
a. Conducting / Elastic
- large arteries
- lumen diameter greater than wall thickness
-ex. aorta, branches from aortic arch and the common iliac arteries
- conduct blood (from the heart) to medium-sized arteries
b. Distributing / Muscular
- medium-sized arteries
- lumen diameter about equal to wall thickness
-ex. external and internal iliac, femoral, popliteal, anterior and posterior
tibial, and peroneal arteries
- distribute blood to different body parts; to arterioles in these parts
c. Arterioles
- small to very small arteries
- large amount of smooth muscle in the walls that can change blood
pressure by contracting or relaxing
- supply individual structures within parts
- direct blood to capillary beds; for exchange of nutrients and wastes
d. End
- an artery that is the only blood supply for an area
- occlusion results in death of area
-ex. ophthalmic artery, proper digital arteries
2. Veins
- carry blood toward the heart
- distal to proximal direction in limbs
3. Capillaries
- microscopic vessels that allow exchange of nutrients and wastes for cells
- direct blood to venules
4. Lymph Vessels
- vessels that carry lymph fluid (like plasma), which extravasates (escapes)
from capillaries
b. Afferent Lymph Vessels - small vessels that carry lymph fluid to lymph
nodes
d. Efferent Lymph Vessels - small vessels that carry lymph fluid away from
from lymph nodes
e. Lymph Trunks - large lymph vessels that collect lymph fluid from
a region
-ex. lumbar trunk collects from lower limb
B. Anastomoses
- communications between arteries and/or veins
1. Arterial
- artery to artery communication
- provides alternate source of blood supply to an area; more than one route
to the same end
- often called "collateral circulation", however it is actually not because
collateral circulation has new vessels
ex. genicular anastomosis
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vessels, anastomoses, con’t
C. Arteriovenous Shunts
- communication between an arteriole and a venule
- help regulate body temperature by directing blood away from the surface to
deeper tissues or to the surface from deeper tissues
- can be traumatically induced as in gunshot wounds and may need to be
surgically repaired
D. General Rule: Arteries tend to cross the flexor surface of muscles to prevent
collapse, so they do not get stretched to closing or crushed.
IX. NERVES
1. Brain
- within the skull
b. Efferent Fibers - carry impulses to other (lower) nerve cell bodies in the CNS
2. Spinal Cord
- within the spinal column
3. Spinal Roots
- within the spinal column
- inferior to the spinal cord near the second lumbar vertebra, the spinal roots
are long and are called Cauda Equina which means horse's tail
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nerves, spinal roots, con’t
ii. Dorsal Root Ganglion - collection of nerve cell bodies in the dorsal root
i. Efferent Fibers - carry motor impulses from nerve cell bodies in the
central nervous system to peripheral areas (muscles)
1. Spinal Nerves
- junction of dorsal and ventral roots, located at the intervertebral foramina
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nerves, ANS, con’t
I. SUPERFICIAL FASCIA
B. Contents
- superficial veins, superficial lymph nodes and lymph vessels, and cutaneous nerves
1. Superficial Veins
- carry blood from inferior to superior
- can generally be seen through the skin
- in athletes, many bulge beneath the skin
- in general, pass superficial to the cutaneous nerves
19
superficial veins, con’t
c. Marginal Veins
- much variation with veins, can be difficult to distinguish these, may be absent
20
superficial fascia, contents, con’t
2. Lymph Nodes
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superficial fascia, contents, con’t
e. Deep Pedal Infections / Deep Infections of the Foot
- from any area, will create inflammation of the deep inguinal lymph nodes
- from dorsum of foot, will generally create inflammation of the anterior tibial
lymph node, first
- from planta of foot and calcaneal region, will generally create inflammation
of the popliteal lymph nodes, first
3. Cutaneous Nerves
- are nerves that exit the deep fascia and travel in the superficial fascia to supply
the skin, sensory and autonomic sympathetic fibers
- all are from ventral rami except where noted - know these
a. anterior view
22
cutaneous nerves, anterior view, con’t
viii. Lateral Cutaneous Nerve of the Calf, L-5, S-1 & S-2
- also called the lateral sural nerve
- exits the deep fascia at the posterolateral edge of the knee region
- supplies the lateral 1/2 of the leg from the knee to the inferior 1/3 leg
x. Superficial Fibular Nerve / Superficial Peroneal Nerve, L-4, L-5 & S-1
- exits the deep fascia at the anterolateral aspect of the leg near midlevel
- supplies the anterolateral aspect of the inferior 1/3 of the leg, the
anterolateral aspect of the ankle and the dorsum of the foot except the
lateral ½ of the 5th digit and the 1st web space
xi. Deep Fibular Nerve / Deep Peroneal Nerve, L-5, S-1 & S-2
- exits the deep fascia at the 1st webspace
- supplies the 1st web space and the adjacent sides of the 1st and 2nd toes
b. posterior view
ii. Superior Cluneal Nerves, dorsal rami of L-1, L-2 & L-3
- also called the superior cutaneous nerves of the gluteal region
- exit the deep fascia at the posterior aspect of the iliac crest
- supply skin of superolateral aspect gluteal region
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cutaneous nerves, posterior view, con’t
iii. Middle Cluneal Nerves, dorsal rami of S-1, S-2 & S-3
- also called the middle cutaneous nerves of the gluteal region
- exit the deep fascia over the sacrum
- supply skin of the medial aspect gluteal region
24
cutaneous nerves, posterior view, con’t
25
cutaneous nerves, dorsum of foot, con’t
iii. Deep Fibular Nerve / Deep Peroneal Nerve, L-5, S-1 & S-2
- exits the deep fascia in the 1st interspace, supplies it and divides
26
cutaneous nerves, planta of foot, con’t
A. Def'n: deep fascia - dense connective tissue layer that surrounds muscles and
attaches to many bony prominences and structures
- deep fascia is continuous from one region to the next
retinaculum - thickening of the deep fascia that holds soft tissue structures
in place (ex. tendons)
27
B. Deep Fasciae
1. Fascia Lata
- deep fascia of the thigh
b. Cribriform Fascia
- very thin area of the fascia lata over the fossa ovalis / saphenous opening
near the groin
2. Fascia Cruris
- deep fascia of the leg region
- aids in forming several retinacula near ankle
3. Popliteal Fascia
- deep fascia of the popliteal region
C. Retinacula
28
retinacula, con’t
29
III. NAIL ANATOMY
1. Nail Plate
- body of the nail (main part), normally .5 - .75 mm thick in an adult
- is a hardening of the epidermis
- cells have no nuclei, therefore are transparent, so can see the capillary bed
- function: protect the distal end of the digit / toe
2. Matrix
- "root" of the nail
- specialized cells within the roof and floor of the proximal nail fold
- attached to the base of the distal phalanx
- extends approximately 5 mm proximal to visible nail edge
- function: produce nail plate
4. Cuticle
- small ridge of transparent skin dorsal to the proximal edge of the nail plate
which is continuous with the eponychium
- creates a seal around the nail
- function: prevent infection by sealing the area adjacent to the nail plate
5. Nail Bed
- skin directly beneath and attached to the nail plate, contains some nail-
forming cells; the cells that are attached to the nail plate migrate distally and
are shed at the free edge of the nail
- from matrix and lunula to the hyponychium
- function: anchor the nail plate and allow its distal growth
- sensory innervation to the nail bed is variable and may be entirely from the
proper digital plantar nerves or from the plantar and dorsal proper digital
nerves; therefore, you must take care when anesthetizing (blocking) digits for
for nail procedures
- it is safest to anesthetize both sets of nerves
6. Lunula
- the small pale half-moon-shaped area near the eponychium; whitish because
the cells retain nuclei and the capillaries beneath this portion of the nail
plate are not visible
- function: produce nail
8. Hyponychium
- the thickened skin adjacent to the free edge of the nail plate
- function: prevent infection by sealing this area adjacent to the nail plate
30
nail anatomy, con’t
B. Growth of Nails
- nails grow primarily from the matrix and the proximal nail bed (level of the
lunula) and are pushed distally
- the cells of the nail bed migrate with the nail plate
- nails grow faster in younger people and faster in the summer
- finger nails grow faster than toe nails
- finger nail takes approximately 6 months for replacement
- toe nail takes approximately 9 months for replacement
- sickness causes a disturbance in growth of the nail plate
- nail growth requires much protein synthesis and illness retards this
- have a resultant transverse ridge / Beau’s Line
- little white spots - due to incomplete keratinization of the nail plate, cells still
have nuclei or an air bubble formed in the nail plate due to a minor disturbance
in growth
- longitudinal ridges - often due to mechanical damage to the matrix cells
IV. DERMATOMES
31
dermatomes, con’t
8. S-3, S-4, S-5 & Co-1 / third, fourth and fifth sacral and first coccygeal
- all begin posteriorly at the respective spinal vertebral level
- all form concentric arcs; with the third sacral being the largest over the
posteromedial gluteal area, and the first coccygeal being the smallest around
the perianal area
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V. MYOTOMES
A. Def'n: the group of muscles that are supplied by a single spinal nerve’s ventral root
B. Distribution
- described in terms of movements at joints
- have overlap of the segments
- are sometimes reported with slightly different levels because it is difficult to trace
nerves
1. Hip Joint
2. Knee Joint
a. Extension
- L-2 through L-4
b. Flexion
- L-5 & S-1
3. Ankle Joint
a. Dorsiflexion
- L-4 & L-5
b. Plantar flexion
- S-1 & S-2
4. Subtalar Joint
a. Inversion/Supination
- L-4 & L-5
b. Eversion/Pronation
- L-5 & S-1
5. Metatarsophalangeal Joints
a. Dorsiflexion
- L-5 & S-1
b. Plantar flexion
- S-1 & S-2
33
myotomes, con’t
1. Def'n:
b. spinal reflex
- a withdrawal response
- a protective reflex
- mediated in the spinal cord
a. Patellar Reflex
- at the anterior knee/patellar tendon; with the knee flexed and relaxed, tap
the tendon and normally will get a small extension response
- tests spinal segments L-2, L-3 & L-4, the knee extensor myotome
b. Achilles Reflex
- at the posterior ankle/Achilles tendon; with the ankle slightly dorsiflexed,
tap the tendon and normally will feel the contraction of the calf muscles
- tests spinal segments S-1 & S-2; the ankle plantar flexor myotome
3. Spinal Reflexes
a. Babinski Test
- stroke the sole of the foot from central plantar heel in an arc to the base of the
fifth metatarsal with a firm blunt object (ex. pen cap, finger nail tip)
- normally will see plantar flexion of the toes; expected reaction
- dorsiflexion of the hallux with abduction of the lesser digits (flaring of toes)
is abnormal after 2 years of age
34
osteology of pelvis, con’t
- Pelvic Girdle = 2 pelvic bones
- function: attach lower limb to the trunk
A. Sacrum
- forms a primary curvature of spinal column, same direction as fetal curvature
- 5 vertebrae fused into one wedge-shaped bone
- recognized by its distinctive shape
3. Sacral Promontory
- anterior superior edge of S-1 vertebra
- projects in anteroinferior direction in body
35
pelvic osteology, sacrum, con’t
2. Sacral Alae
- described above
3. Sacral Canal
- spinal canal of the sacrum for passage of cauda equina
5. Sacral Hiatus
- the inferior opening of the sacral canal
- formed by the lamina from S-5 that do not fuse
- for passage of meninges and spinal nerves
6. Sacral Cornu
- small projections at the lateral margins of the sacral hiatus
- formed by ligamentous attachment
9. Sacral Groove
- depressed area between median and intermediate sacral crests
- formed by fusion of the vertebral laminae S-1 through S-4
1. Coccygeal Cornu
- superior articular processes of Co-1 vertebra
- articulate with sacral cornu via ligamentous attachment
36
pelvic osteology, sacrum, con’t
1. Lateral Surfaces
a. Auricular Surface
- anterior part of the lateral surface, articulates with the pelvic bone
- part of the sacroiliac joint, a synovial joint
b. Sacral Tuberosity
- posterior part of the lateral surface, for attachment of ligaments
D. Ossification of Sacrum
37
pelvic osteology, con’t
1. Ilium (not ileum) - the large superior portion of the pelvic bone
i. femoral surface - the external surface; faces laterally (not seen on picture)
ii. pelvic surface - the internal surface; faces medially
i. obturator surface - the anterior surface at the medial end which spirals to
an inferior position at the lateral end and is the continuation of the femoral
surface of the body
- can not distinguish one bone from the other after fusion
medial view
1. Iliac Crest
- the superior border of the ilium or of the iliac ala
- can be palpated along its entire length
- most patients call this the hip bone
6. Iliac Fossa
- the flattened internal or pelvic surface of the ala (wing) of the ilium
- for attachment of a muscle
39
pelvic osteology, pelvic bone features, con’t
7. Iliac Tuberosity
- roughened area on the posteromedial surface of the ilium, posterior
to the iliac fossa and anterior to the posterior superior iliac spine
- for the attachment of ligaments
8. Auricular Surface
- the synovial joint surface on the posteromedial surface of the ilium, posterior
to the iliac fossa and inferior to the level of the posterior superior iliac spine
- for articulation with the auricular surface of the sacrum at the sacroiliac joint
9. Ischial Spine
- the small sharp projection on the posterior border of the ischium
- inferior to the posterior inferior iliac spine
- for attachment of ligament
40
pelvic osteology, pelvic bone features, con’t
lateral view
41
pelvic osteology, pelvic bone features, con’t
14. Acetabulum
- the large cup-like depression where the three bones meet
- articulates with the femur at the hip joint, a synovial spheroid joint
a. Lunate Surface
- the smooth, crescent-shaped, synovial articular surface of the acetabulum
- for articulation with the femoral head
b. Acetabular Fossa
- the roughened central depression within the acetabulum
- formed mostly by the ischial body
- for passage of ligament and neurovascular structures
c. Acetabular Notch
- the depressed area between the ends of the lunate surface
- formed mostly by the ischial body
- closed to the acetabular foramen by the transverse acetabular ligament
- for the passage of neurovascular structures
d. Acetabular Rim
- the outer, raised edge of the acetabulum
- for attachment of ligaments and muscle
42
pelvic osteology, pelvic bone features, con’t
1. Primary Centers
- one in each component bone
2. Secondary Centers
- appear near puberty and fuse from ages 15 to 25 years
a. iliac crest
b. acetabulum
c. pubic body
d. ischial tuberosity
H. Anatomic Position
- in a living being, the pelvis is situated so that the anterior superior iliac spines
and the pubic tubercles lie in the same coronal / frontal plane
- pelvis appears to be tilted forward
J. Pelvis
a. Linea Terminalis
- continuous line of the lateral and anterior walls of the pelvis, internally
- formed by four separate structures that align end to end
i. Arcuate Line
ii. Iliopectineal Line
iii. Pectineal Line / Pecten Pubis
iv. Pubic Crest
43
pelvic osteology, pelvis, con’t
b. imaginary line
- across the sacral promontory and sacral alae (from one arcuate line to the
other arcuate line)
c. imaginary line
- across the symphysis pubis
- from one pubic crest to the other pubic crest
4. Pelvic Outlet
- the inferior opening (exit) of the true pelvis
- border between pelvis and perineum
- generally larger in females for childbirth
II. FEMUR
- the bone of the thigh
- recognized by the angled head and the trochanters
- largest bone in the body
A. Features
anterior view
1. Proximal Extremity
- the superior end
b. Neck
- the cylindrical part connecting the head with the body (shaft)
44
osteology, femoral features, anterior view, proximal extremity, con’t
e. Intertrochanteric Line
- ridge from the greater trochanter to just inferior to the lesser trochanter
- for attachment of ligament and muscle
2. Shaft / Diaphysis
- smooth, cylindrical area
a. Medial Condyle
- the medial part of the epiphysis
- can be easily palpated at the medial aspect of the knee joint
- a synovial bicondylar joint
i. Medial Epicondyle
- the prominence on the medial aspect of the medial condyle
- can be palpated at the proximomedial aspect of the knee
- for attachment of ligament
b. Lateral Condyle
- the lateral part of the epiphysis
- easily palpated at the lateral aspect of the knee joint
i. Lateral Epicondyle
- the prominence at the lateral aspect of the lateral condyle
- easily palpated at the proximolateral aspect of the knee
- for attachment of ligament
c. Patellar Surface
- smooth anterior surface of the condyles for articulation with the patella
- can palpate the margins with the knee flexed
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osteology, femoral features, con’t
1. Proximal Extremity
i. Trochanteric Fossa
- on the medial surface of the greater trochanter where it meets the neck
of the femur
- the more posterior and more distinct depression
- for attachment of muscle
e. Intertrochanteric Crest
- ridge from the greater trochanter to the lesser trochanter (posteriorly)
i. Quadrate Tubercle
- small square-shaped projection about midway along the
intertrochanteric crest
- for attachment of muscle
2. Shaft
a. Linea Aspera
- ridge consisting of three lines that passes lengthwise along the entire shaft
on its posterior surface
- for attachment of muscle
i. Medial Lip
- medial edge of the linea aspera
- for muscular attachment
46
femoral features, posterior view, linea aspera, con’t
b. Popliteal Surface
- the posterior inferior surface of the shaft of the femur
c. Nutrient Foramen
- hole directed superiorly, because it angles away from the more rapidly
growing end of the bone
- usually near the midpoint of the femur and between the medial and lateral
lips of the linea aspera
- may be two: in which case one is more proximal and one more distal
- allows passage of vessels to nourish the shaft of the bone
3. Distal Extremity
47
femoral features, posterior view, distal extremity, con’t
d. Intercondylar Line
- superior edge of the intercondylar fossa
- for ligamentous attachment
1. Primary Center
- in the shaft of femur, near midshaft
- appears during the 7th fetal week
2. Secondary Centers
C. Anatomic Position
- in living beings, the head and neck are angled in an anteromedial direction and
the distal extremity is positioned medially (with the inferior surfaces of the
condyles roughly parallel to the floor)
- femoral shafts angle 10o to 15o in the frontal plane
- can be measured by angles and compared to normal
1. Angle of Inclination
- the angle formed by the long axis of the head and neck with the long axis of
the shaft; the angle varies with age
- frontal plane view
- greater at birth (about 150o) and decreases until adulthood (about 125o)
I. SYNDESMOLOGY
A. Anterior View
2. Sacrotuberous Ligament
- from the posterior superior iliac spine, posterior inferior iliac spine, the
dorsolateral aspect of the sacrum and the dorsolateral aspect of the coccyx
to the ischial tuberosity
- stabilized the sacroiliac joint
- closes the lesser sciatic notch and forms the lesser sciatic foramen
- for passage of a muscle and neurovascular structures
3. Sacrospinous Ligament
- from the dorsolateral margin of the inferior one-half of the sacrum and the
dorsolateral margin of the coccyx to the ischial spine
- stabilized the sacroiliac joint
- closes the greater sciatic notch and forms the greater sciatic foramen
- for passage of a muscle and neurovascular structures
7. Iliolumbar Ligament
- stabilizes the sacroiliac joint
a. Upper Band
- from the anterior aspect of the 5th lumbar vertebra to the posterior part of
the internal lip of the iliac crest
b. Lower Band
- from the anterior aspect of the 5th lumbar vertebra to the anterolateral
aspect of the sacrum, superiorly
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pelvic region, syndesmology, con’t
B. Dorsal View
2. Sacrospinous Ligament
- described above
3. Sacrotuberous Ligament
- described above
4. Obturator Membrane
- a sheet of deep fascia that covers most of the obturator foramen
- for muscular attachment
- closes the obturator groove to form the obturator canal
- allows passage of the obturator nerve and obturator artery
50
II. ARTHROLOGY OF THE PELVIS
A. Sacroiliac Joint
- the articulation between the auricular surface of the ilium and the auricular
surface of the sacrum
- vertebral levels S-1 through S-3
- articular surfaces are covered by fibrocartilage (instead of hyaline cartilage) and
adhesions form across the joints with age
- capsule attaches at margins of each surface
- structural synovial planar joint located between the lateral masses of the sacrum
and the posterior portion of iliac alae
- functional diarthrosis
1. Intrinsic Ligament
2. Extrinsic Ligaments
3. Accessory Ligaments
a. Sacrospinous Ligament
- prevents superior rotation of the pelvic bone on the sacrum during
weight-bearing to aid in stabilizing the sacroiliac joint
b. Sacrotuberous Ligament
- prevents superior rotation of the pelvic bone on the sacrum during
weight-bearing to aid in stabilizing the sacroiliac joint
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pelvic region, arthrology, pubic symphysis, con’t
1. Ligaments
PELVIC REGION
The nerves of the lumbosacral plexus pass through or arise within the pelvic cavity.
Many of these supply the lower limb. The arteries that supply the lower limb arise within the
pelvic cavity. The muscles of the pelvic region that act upon the lower extremity are hip joint
and thigh flexors.
A. Iliacus Muscle
O: superior iliac fossa (superior 2/3 and inner lip of the iliac crest)
I: lesser trochanter of the femur
- travels inferiorly and passes anteriorly over the hip joint and through the
muscular lacuna to its insertion
A: flexes the thigh
NS: femoral nerve; from dorsal divisions of ventral rami L-2, L-3 & L-4
AS: muscular branches of common, internal and external iliac arteries
- These two muscles are often considered one, and are called the iliopsoas muscle. They
function to flex the thigh.
52
II. NERVE PLEXUSES
- may be described as a single plexus, the “lumbosacral plexus"; as two plexuses, the
"lumbar plexus” and the "sacrococcygeal plexus"; or as three plexuses, the
"lumbar plexus", the "sacral plexus" and the "coccygeal plexus"
- will describe as separate plexuses here and draw as two plexuses
- all nerve branches in these plexuses are ventral rami
A. Lumbar Plexus
- consists of the ventral rami of L-1 through L-3 with contributions from the
ventral rami of T-12 and L-4
- most ventral rami have dorsal and ventral divisions
- lies within the psoas major muscle just anterior to the transverse processes of
of the vertebral bodies
- shaded areas represent dorsal divisions of ventral rami on the picture
1. Subcostal Nerve
- a sensorimotor nerve; cutaneous supply only in the lower limb
- branch of T-12 that supplies the superior anterolateral aspect of the thigh
- not usually considered part of the lumbar plexus
2. Iliohypogastric Nerve
- a sensorimotor nerve; cutaneous supply only in the lower limb
- from the ventral division of L-1 (may have a contribution from T-12)
- pierces the psoas major muscle near the kidney and passes within the
abdominal wall, inferior to the subcostal nerve, to reach the posterolateral
gluteal skin (near the iliac crest, posteriorly)
3. Ilioinguinal Nerve
- a sensorimotor nerve; cutaneous supply only in the lower limb
- from the ventral division of L-1 (may have a contribution from T-12)
- follows a course similar to the iliohypogastric nerve, but continues anteriorly
(along the inguinal ligament and through the inguinal canal) to reach the skin
of the superior medial thigh
4. Genitofemoral Nerve
- a sensorimotor nerve; cutaneous supply only in the lower limb
- from the ventral divisions of L-1 & L-2
- pierces the psoas major muscle anteriorly and enters the thigh dorsal to the
inguinal ligament, near its center
a. Genital Branch
- passes medially, along the inguinal ligament to supply part of the
external genitalia
b. Femoral Branch
- passes deep to the inguinal ligament with the femoral a. through the
vascular lacuna to supply the skin of the anterior superior thigh
- may aid or replace the intermediate femoral cutaneous nerve
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pelvic region, lumbar plexus, con't
8. Femoral Nerve
- a sensorimotor nerve; from the dorsal divisions of L-2 through L-4
- passes inferiorly intermediate to the psoas major and iliacus muscles, enters
the thigh by passing through the muscular lacuna deep to the inguinal
ligament near its midpoint to provide muscular branches to the thigh,
articular branches to the hip and knee joints and gives rise to the following
cutaneous nerve branches:
c. Saphenous Nerve
- dorsal divisions L-3 and L-4
- supplies the medial 1/2 of the leg
9. Obturator Nerve
- a sensorimotor nerve; from the ventral divisions of L-2 through L-4
- pierces the psoas major muscle medially near the linea terminalis, passes
anteroinferiorly into the lesser pelvis and passes through the obturator canal
to provide muscular branches to the thigh, articular branches to the hip and
knee joints, and the cutaneous branch to the small area of the medial aspect of
the thigh
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pelvic region, lumbar plexus, con't
B. Sacral Plexus
- formed by the ventral rami of L-5 through S-3 with contributions from ventral
rami of L-4 and S-4
- roughly triangular in shape and passes inferiorly toward the greater sciatic foramen
- shaded areas represent dorsal divisions on the picture
4. Sciatic Nerve
- the major formation of the sacral plexus
- a sensorimotor nerve; from the dorsal divisions of L-4 through S-2 and the
ventral divisions of L-4 through S-3
- exits the pelvis via the greater sciatic foramen and usually continues as a
single nerve to the lower thigh; however it may divide into its two component
parts at any level
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pelvic region, sacral plexus, common fibular nerve, con’t
b. Tibial Nerve
- a sensorimotor nerve; from ventral divisions of L-4, L-5, S-1, S-2 & S-3
- the medial portion of the sciatic nerve
- passes inferiorly through the leg, posterior to the medial malleolus and
divides into its terminal branches, the medial and lateral plantar nerves,
prior to entering the foot through the porta pedis
- provides muscular innervation in the knee and leg, articular innervation
to the knee and ankle joints and the following cutaneous nerve branches:
i. Sural Nerve
- a sensory nerve; from the ventral divisions of S-1 & S-2
- supplies small area of the posterior leg, posterolateral aspect of the
ankle, the lateral aspect of the foot, and the lateral ½ of the fifth toe
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pelvic region, sacral plexus, posterior femoral cutaneous nerve, con’t
7. Pudendal Nerve
- a sensorimotor nerve; from the ventral divisions of S-2, S-3 and S-4
- exits the pelvis via the inferomedial part of the greater sciatic foramen, passes
posterior to the sacrospinous ligament and re-enters the pelvis via the lesser
sciatic foramen
- supplies motor innervation to structures of the urogenital triangle and sensory
innervation to the reproductive organs
C. Coccygeal Plexus
- formed by the ventral rami of S-4, S-5 and Co-1
- provide muscular and cutaneous innervation
2. Cutaneous Branches
- from all rami
- supply sensory innervation to the skin over the coccyx and posterior to anus
57
III. PELVIC VASCULATURE
A. Arterial
1. Aorta
- abdominal aorta bifurcates at vertebral level L-4 into 2 common iliac
arteries (one for each lower limb)
i. Obturator Artery
- most lateral branch of the anterior trunk
- exits the pelvis via the obturator canal with the obturator nerve
- may be a branch from the internal iliac artery or sometimes (40%) a
branch of the external iliac artery at the pelvic brim
58
pelvic region, vessels, obturator artery, con’t
i. Iliolumbar Artery
- arises anterior to the sacroiliac joint and passes superolaterally in the
pelvis
- anastomoses near iliac crest with the superior gluteal, the deep
circumflex iliac and the lateral femoral circumflex arteries
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pelvic region, vessels, con’t
B. Venous
- small arteries have paired vena comitantes
- large arteries have a single vein (vena comitans)
- will draw veins only a few times as they usually follow the course of the arteries
C. Lymphatics
- deep lymph nodes associated with the pelvis
- collect lymph fluid from the areas drained by the respective veins
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pelvic region, vessels, lymphatics, con’t
6. Cisterna Chyli
- a dilated area that lies anterior to the vertebral bodies of L-1 and L-2
- receives fluid from the lumbar trunks
- empties into the thoracic duct which returns the lymph fluid to the systemic
circulation
GLUTEAL REGION
Much of the neurovascular supply to the gluteal region passes through the greater sciatic
foramen. The muscles of the gluteal region function generally to extend, abduct and laterally
rotate the hip and thigh.
A. Superficial Layer
O: external iliac ala posterior to posterior gluteal line, the posterior iliac crest,
the external surfaces of the sacrum and coccyx, and the sacrotuberous
ligament (also gluteal fascia)
I: gluteal tuberosity of the femur and the posterosuperior iliotibial tract
- passes obliquely from superomedial to inferolateral
A: extends and laterally rotates the thigh
NS: inferior gluteal nerve; dorsal divisions of ventral rami L-5, S-1 & S-2
AS: superior gluteal artery, inferior gluteal artery and the perforating branches
of the profunda femoris artery
i. Trochanteric Bursa
- located intermediate to the gluteus maximus muscle and the lateral
aspect of the greater trochanter of the femur
- inflammation of this bursa is called bursitis of the hip
- painful with extension or lateral rotation of thigh when inflamed
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gluteal region, muscles, bursae of gluteus maximus muscle, con’t
ii. Ischial Bursa
- located intermediate to the gluteus maximus muscle and the
ischial tuberosity
- inflammation of this bursa is associated with prolonged sitting in the
tailor position (Indian-style or cross-legged) or from riding horses/bicycles
- inflammation of this bursa is called weaver's bottom, sometimes
called saddle sore
- painful with sitting
b. Intramuscular Injections
- injections into the buttock must be placed so as to miss the major
neurovascular structures of this region, especially the sciatic nerve
- each buttock is divided into quadrants
- the injection is given in the superolateral / upper outer quadrant
B. Intermediate Layer
O: external iliac ala intermediate to the anterior and posterior gluteal lines
I: lateral aspect of the greater trochanter
- passes inferolaterally
A: abducts the thigh;
aids with both medial and lateral rotation of the thigh
NS: superior gluteal nerve; dorsal divisions of ventral rami L-4, L-5 & S-1
AS: superior gluteal artery
O: iliac ala intermediate to the anterior and inferior gluteal lines, and the
superior edge of the greater sciatic notch
I: anterior aspects of the greater trochanter and the hip joint capsule
- passes inferiorly
A: abduction and medial rotation of the thigh (medial rotation because the
insertion of the muscle is anterior to the hip joint axis)
NS: superior gluteal nerve; dorsal divisions of ventral rami L-4, L-5 & S-1
AS: superior gluteal artery
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gluteal region, muscles, con’t
2. Piriformis Muscle
- an important anatomic landmark as it aids in the identification of other
structures in this region
O: external border (of the posterior squared part) of the ischial tuberosity
I: quadrate tubercle of the femur
- passes directly lateral
A: lateral rotation of the thigh
NS: nerve to inferior gemellus muscle and quadratus femoris muscle, from
the sacral plexus; ventral divisions of ventral rami L-4, L-5 and S-1
AS: medial femoral circumflex artery
A. Pudendal Nerve
- from the ventral divisions of ventral rami S-2, S-3 and S-4
- exits the pelvis via the greater sciatic foramen, inferior to the piriformis muscle
- passes posterior to the sacrospinous ligament
- reenters the pelvis via the lesser sciatic foramen
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gluteal region, nerves, con't
E. Sciatic Nerve
- the largest nerve in the body, the primary formation of the sacral plexus
- from dorsal divisions of ventral rami L-4, L-5, S-1 and S-2, and ventral
divisions of ventral rami L-4, L-5, S-1, S-2 & S-3
- exits the pelvis via the greater sciatic foramen, deep to the gluteus maximus
muscle and usually inferior to the piriformis muscle
- passes inferiorly into the thigh usually midway between the ischial tuberosity
and the greater trochanter, and continues inferiorly along the posteromedial
aspect of the thigh, deep to the muscles to the level of the knee region where it
normally divides
variation:
- the common fibular part may exit the pelvis either superior to or through the
piriformis muscle belly and then course with the tibial part
- when this occurs, the sciatic nerve has split into its component parts already
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gluteal region, nerves, con't
III. ARTERIES
HIP JOINT
The hip joint is the articulation between the acetabulum of the pelvis and the head of the
femur. The acetabulum has contributions from the ilium, ischium and pubis. The hip joint is
structurally a synovial spheroid joint and functionally a diarthrosis type of joint. The hip joint
has motion in all three body planes, a triplanar joint. The movements available are flexion,
extension, abduction, adduction, circumduction, internal rotation and external rotation.
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pelvic region, hip joint, con’t
I. LIGAMENTS
anterior view
a. upper band
- attaches to the superior part of the intertrochanteric line
b. lower band
- attaches to the inferior part of the intertrochanteric line
2. Pubofemoral Ligament
- attaches proximally to the pubic part of the acetabular rim and the lateral part
of the superior pubic ramus
- passes distally and blends with the capsule of the hip joint (medially)
posterior view
2. Ischiofemoral Ligament
- attaches proximally to the ischial part of the acetabular rim
- passes superolaterally over the posterior surface of the hip joint to blend with
the capsule of the hip joint at the femoral neck
1. Zona Orbicularis
- the thickened constricted area of the capsule around the neck of the
femur (the fibers are circularly oriented)
- visible on the posteroinferior surface where extracapsular ligaments
are less prominent
- a ligament with no bony attachments
- initially believed to hold the femoral head into the acetabulum, but it is
not strong enough by itself
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gluteal region, hip joint, intracapsular ligaments, con’t
C. Other Structures
1. Capsule
- the fibrous joint capsule attaches proximally to the exterior rim of the
acetabulum
- distally the capsule attaches to the neck of the femur; anteriorly to the
inferior margin of the femoral neck at the intertrochanteric line and
posteriorly to the mid-region of the neck (only the proximal one-half of
the femoral neck is within the capsule posteriorly)
- the extrinsic ligaments are in the same location so the femoral neck on the
posterior side is covered only about ½ of the distance
b. Retinacula
- bundles of longitudinal capsular fibers that reflect superiorly along the
femoral neck after having reached the inferior margin of the capsular limits
- provide for passage of blood vessels from the capsule and synovial lining
to the head of the femur; main area for passage of vessels to nourish the
head and neck of the femur after 3 years of age
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gluteal region, hip joint, con’t
HIP ANASTOMOSES
The anastomoses around the hip allow alternate routes for blood flow to the area of the
proximal extremity of the femur between the internal iliac artery and the femoral artery.
I. TROCHANTERIC ANASTOMOSIS
- provides the major blood supply to the head and neck of the femur, after age 3 years
- is an arterial anastomosis around the femoral neck
- branches pass within the retinacula of the capsule
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gluteal region, hip anastomoses, con’t
I. PATELLA
- commonly called the knee cap
- is a sesamoid bone, largest sesamoid bone in body
- articulates only with the femur
- recognized by its roughly triangular shape
- provides leverage for the quadriceps femoris muscle
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thigh region, leg osteology, con’t
A. anterior view
- this surface is roughened from the pull of the quadriceps femoris tendon
- longitudinal ridges are called striae
- this surface is also subcutaneous and easily palpated at the anterior aspect of
of the knee region
- subcutaneous means that the deep fascia attaches to this surface
B. posterior view
- most of this surface is smooth for articulation with the femoral condyles
- the medial, lateral and superior edges are rough for attachment of the
quadriceps femoris tendon
- this surface has two facets which are separated by a vertical ridge
1. Lateral Facet
- the deeper and usually larger facet
- due to extra stress from the slight lateral angulation between the femur
and the tibia
- articulates with the lateral condyle of the femur
2. Medial Facet
- the shallower and usually smaller facet
- articulates with the medial condyle of the femur
3. Borders
- all borders, superior, medial and lateral are roughened for ligamentous
and tendinous attachment
II. TIBIA
- commonly called the shin bone
- located on the medial side of the leg
- recognized by the inferior medial projection known as the medial malleolus
- articulates with the femur superiorly, the fibula laterally, both proximal and
distal and the talus inferiorly
- transfers the body weight from the femur to the talus
anterior view
A. Proximal Extremity
- the superior end of the tibia
- articulates on its superior surface with the distal extremity of the femur and
laterally with the fibula
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thigh region, leg osteology, tibial proximal extremity, con’t
1. Medial Condyle
- the flattened superior medial projection
- larger than the lateral condyle
- can be palpated at the medial aspect of the knee region
2. Lateral Condyle
- the flattened superior lateral projection
- projects farther lateral and posterior from the shaft of the tibia (as compared
to the medial condyle)
- can be palpated at the lateral aspect of the knee region
a. Fibular Facet
- on the inferior surface of the lateral condyle, posteriorly
- for articulation with the fibular head
3. Intercondylar Eminence
- the central superior projection
4. Tibial Tuberosity
- large projection on the anterior surface
- provides attachment for the patellar ligament/patellar tendon
- easily palpated inferior to the patella
B. Shaft
- from the tibial tuberosity, proximally to the fibular notch, distally
- often divided into thirds (lengthwise) to aid in describing the origins and
insertions of muscles
2. Medial Surface
- the subcutaneous rounded surface that faces anteromedially
- can palpate its entire length along the medial side of the leg
72
thigh region, leg osteology, tibia; shaft con’t
C. Distal Extremity
- rectangular in shape
- articulates at its inferior surface with the talus at the ankle joint
1. Medial Malleolus
- the inferior medial projection
- is subcutaneous and easily palpated at the medial ankle region
posterior view
A. Proximal Extremity
1. Medial Condyle
- described above
2. Lateral Condyle
- described above
a. Fibular Facet
- described above
3. Intercondylar Eminence
- described above
73
1. Popliteal Line / Soleal Line
- extends from the fibular facet superolaterally to the medial border at the
junction of the proximal and middle thirds
- for muscular attachment
2. Vertical Line
- begins near the middle of the soleal line and extends inferiorly to the
inferior one-third
- separates muscle attachments
- may not be distinct
3. Nutrient Foramen
- located inferior to the popliteal line and usually lateral to the vertical line
- the largest in the body
- projects inferiorly as most growth of lower limb in length is at the knee
C. Distal Extremity
1. Medial Malleolus
- described above
2. Posterior Process
- posterior lateral prominence of distal tibial extremity
- sometimes called the third malleolus
3. Fibular Notch
- large triangular depression on the lateral surface of the distal extremity
- provides attachment sites for ligaments
- articulates with the fibula at the tibiofibular syndesmosis
superior view
A. Proximal Extremity
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thigh region, leg osteology, tibia, con’t
6. Tibial Tuberosity
- described above
medial view
A. Distal Extremity
a. Anterior Colliculus
- anterior projection at the inferior edge of the medial malleolus
- for ligamentous attachment
b. Posterior Colliculus
- posterior projection at the inferior edge of the medial malleolus
- for ligamentous attachment
2. Posterior Process
- described above
75
thigh region, leg osteology, distal tibia, con’t
inferior view
A. Distal Extremity
1. Primary Center
- in the shaft; appears near the 7th fetal week
2. Secondary Centers
- one in each extremity
- the proximal center appears by birth
- the distal center appears by age 1 year
- these fuse in reverse order between ages 15 and 18 years
- occasionally there are also centers in the tibial tuberosity and the medial malleolus
III. FIBULA
- commonly called the calf bone
- carries 15% of body weight
- very important for ankle stability as will not get adequate reduction (stable
alignment) of an ankle fracture without proper alignment of the fibula
- articulates with the tibia (proximally and distally) and with the talus (distomedially)
- recognized by its long slender shape
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thigh region, leg osteology, fibula, con’t
medial view
B. Shaft
- the borders and surfaces of the fibular shaft spiral externally from proximal to distal
1. Anterior Border
- sharp edge that begins superiorly at the head (on the anterior side) and continues
distally (on the lateral side)
- at the distal extremity, it splits and forms the smooth lateral surface
2. Interosseous Border
- found immediately posterior (and medial) to the anterior border
- extends from the head to the roughened triangular area at the distal extremity
- the interosseous membrane attaches to this border; fibers pass inferiorly from tibia
to fibula which allows a small amount of separation of the fibula from the tibia as
the fibula externally translates
a. Nutrient Foramen
- normally on the posterolateral surface, posterior to the medial crest
77
thigh region, leg osteology, fibular shaft, con’t
lateral view
A. Proximal Extremity
B. Shaft
1. Anterior Border
- described above
3. Posterior Border
- separates lateral and posterior surfaces
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thigh region, leg osteology, fibula, con’t
Ossification
- the fibula normally ossifies from 3 centers of ossification
A. Primary Center
- in the shaft appears during the 8th fetal week
B. Secondary Centers
- one in each extremity
- the distal extremity center appears during the first year
- the proximal extremity center appears during the third year
- these centers fuse in the same order between 15 and 19 years of age (puberty)
- most long bone secondary centers of ossification fuse opposite to their order of
appearance
Tibiofibular Torsion
- Tibiofibular torsion changes from birth to adulthood. This is measured as the axis of the
malleoli / transmalleolar axis relative to the plane of the tibial condyles. At birth, this
angle is zero degrees. It increases to 18 to 23 degrees externally rotated. This adult value
is usually obtained by age 6 years. The clinical measurement is called malleolar position.
The muscles of the posterior compartment of the thigh are hip and thigh extensors as
well as knee and leg flexors. They act on two joints because they cross two joints. However,
they generally can not act effectively on both joints simultaneously. These muscles are
innervated by the sciatic nerve. Arterial supply is from the perforating arteries of profunda
femoris, the inferior gluteal artery and the popliteal artery.
A. Superficial Layer
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thigh region, muscles, posterior compartment, con’t
2. Semitendinosus Muscle
- named for it's long, slender, tendon-like shape
B. Deep Layer
O: lateral lip of the linea aspera (inferior 2/3) and the lateral supracondylar
line (also the posterior femoral intermuscular septum)
I: lateral aspect of the head of the fibula and the lateral condyle of the tibia;
shared with the long head of biceps femoris muscle
- passes inferolaterally and blends with the long head of the biceps femoris m.
A: flexes and laterally rotates the leg
NS: common fibular part of sciatic nerve
AS: profunda femoral perforating arteries and popliteal artery
2. Semimembranosus Muscle
- named for its superior membrane-like part
- located anteromedial to the semitendinosus muscle
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thigh region, muscles, posterior compartment, con’t
C. Hamstring Muscles
- the three muscles of the posterior compartment of the thigh are collectively
known as the hamstring muscles / hamstring group
- O: the ischial tuberosity
- A: extend the thigh and flex the leg
- NS: sciatic nerve
The muscles of the anterior compartment of the thigh are primarily knee and leg
extensors. Two of these muscles also cross the hip joint and as such have some action at this
joint. Generally, these muscles are innervated by the femoral nerve. Arterial supply is primarily
from branches of the femoral, profunda femoris and popliteal arteries.
A. Superficial Layer
O: lateral lip of the iliac crest, anterior to iliac tubercle (and fascia lata)
I: iliotibial band which attaches at Gerdy's tubercle
- courses inferiorly along the lateral aspect of the thigh
A: flex and abduct the thigh, This stabilizes the hip during gait.;
extend the leg, This stabilizes the knee during gait.
NS: superior gluteal nerve
AS: lateral femoral circumflex artery and superior gluteal artery
2. Sartorius Muscle
- the longest muscle in the body; it’s strap-like (flat with constant width)
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thigh region, muscles, anterior compartment, superficial layer, con’t
C. Deep Layer
O: superior intertrochanteric line, the anterior and inferior greater trochanter, the
lateral edge of the gluteal tuberosity, and the superior lateral lip of the linea aspera
I: lateral border of the patella forming part of the quadriceps tendon, and then
tibial tuberosity via the patellar tendon
- muscle fibers pass inferiorly and circularly (internally) around the femur
- muscle belly is easily palpated along the anterolateral aspect of the thigh
during muscular contraction
A: extend the leg;
pull the patella laterally
NS: femoral nerve
AS: descending branch of lateral femoral circumflex artery
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thigh region, anterior compartment, con’t
O: inferior intertrochanteric line, the spiral line, the medial lip of the linea
aspera and the superior medial supracondylar line
I: medial border of the patella forming part of the quadriceps tendon, and then
tibial tuberosity via the patellar tendon
- muscle fibers pass inferiorly and circularly (externally) around the femur
- muscle belly is easily palpated along the anteromedial aspect of the thigh
during muscular contraction
A: extend the leg;
pull the patella medially
NS: femoral nerve
AS: femoral, profunda femoris, and superior medial genicular arteries
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thigh region, muscles, con’t
These muscles are the adductor group. They adduct the hip and thigh. One of these
muscles also crosses the knee joint and has some action there. These muscles are primarily
innervated by the obturator nerve. Arterial supply is from the obturator, profunda femoris and
popliteal arteries.
A. Anterior Layer
1. Pectineus Muscle
O: anterior pubic body (inferior to the pubic crest and lateral to the pubic symphysis)
I: medial lip of the linea aspera (middle 1/3)
- courses posteroinferolaterally
A: adduct and flex the thigh;
aids in lateral rotation of the thigh
NS: obturator nerve
AS: obturator artery and medial femoral circumflex artery
B. Intermediate Layer
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thigh region, muscles, medial compartment, con’t
C. Posterior Layer
- the inferior / vertical fibers of the adductor magnus muscle (which originate
on the ischial tuberosity, and insert on the medial lip of the linea aspera and
the adductor tubercle of the femur) are often termed the
hamstring part of the adductor magnus muscle
- can palpate the tendon of the hamstring part of the adductor magnus
muscle at the medial aspect of the knee region, anterior to gracilis and
sartorius muscles, with resisted adduction of the thigh
a. Adductor Hiatus
- the opening formed by the vertical fibers / hamstring part of adductor
magnus muscle as it passes to its insertion
- allows for passage of femoral vessels to the popliteal fossa and popliteal vessels
from the popliteal fossa
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thigh region, muscles, medial compartment, con’t
2. Gracilis Muscle
- the most medial muscle of the thigh and the medial femoral compartment
- crosses the knee joint
- described with posterior layer, but not in any one layer
O: anterior aspect of the pubic body (inferior part), inferior pubic ramus
(medial part) and pubic symphysis (inferior aspect)
I: proximal medial shaft of the tibia
- forms part of the pes anserinus
- courses inferiorly and passes posterior to the medial femoral condyle
A: adduct the thigh;
flex the leg;
aids in medial rotation of the leg (at the knee)
NS: obturator nerve
AS: medial femoral circumflex, obturator, and profunda femoris arteries
D. Pes Anserinus
- means goose's foot (webbed with toes)
- describes the shape of the insertions of the 3 muscles
- the soft tissue structure formed by the 3 tendons that insert at the proximomedial
aspect of the tibial shaft
1. Muscles
- 3 muscles contribute to the pes anserinus
- one from each compartment and this indicates the order of insertion (proximal
to distal, and anterior to posterior)
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