Objectives 1.4 Lower Limb

Osteology

Ilium:

  • Iliac crest
  • Iliac fossa
  • Anterior superior iliac spine
  • Anterior inferior iliac spine
  • Posterior superior iliac spine
  • Posterior inferior iliac spine

Ischium:

  • Ischial spine
  • Ischial tuberosity

Pubis:

  • Pubic tubercle

Pelvic bone (hip bone/os coxa = ischium, pubis, and ilium bones fused):

  • Greater sciatic notch
  • Lesser sciatic notch
  • Obturator foramen
  • Pubic arch
  • Acetabulum

Femur:

  • Head
  • Neck
  • Greater trochanter
  • Lesser trochanter
  • Lateral condyle
  • Medial condyle
  • Adductor tubercle
  • Linea aspera

Patella

Tibia:

  • Medial condyle
  • Lateral condyle
  • Tibial tuberosity
  • Shaft (Body)
  • Medial malleolus
  • Anterior border

Fibula:

  • Head of fibula
  • Lateral malleolus

Tarsal bones:

  • Talus
  • Calcaneus
  • Navicular
  • Cuboid
  • Medial (1st) cuneiform
  • Intermediate (2nd) cuneiform
  • Lateral (3rd) cuneiform

Metatarsals

Phalanges:

  • Proximal
  • Middle
  • Distal

Joints (Articulations)

Structural Classification of Joints:

1) Fibrous joints (lack a synovial cavity; bones joined by fibrous connective tissue).

  • Suture (e.g. coronal suture)
  • Syndesmosis (e.g. distal tibiofibular joint)
  • Interosseous membrane (e.g. found between tibia and fibula)

2) Cartilaginous joints (lack a synovial cavity; bones joined by cartilage).

  • Synchondrosis (bones joined by hyaline cartilage; e.g. joint between the first rib and manubrium of sternum)
  • Symphysis (bones joined by fibrocartilage; e.g. pubic symphysis)

3) Synovial joints (have a synovial cavity [joint cavity] between bones).

  • Plane joint (e.g. vertebrocostal joint)
  • Hinge joint (e.g. knee joint)
  • Pivot joint (e.g. atlanto-axial joint)
  • Condyloid joint (e.g. radiocarpal joint)
  • Saddle joint (e.g. carpometacarpal joint of thumb)
  • Ball-and-socket joint (e.g. hip joint)

Joints of Lower Limb Appendicular Skeleton:

  • Pubic symphysis
  • Sacroiliac joint
  • Hip (Acetabulofemoral) joint
  • Knee joint (tibiofemoral + patellofemoral)
  • Ankle joint (Talocrural joint)
  • Tarsometatarsal joints
  • Metatarsophalangeal joints

Muscles

Muscles of the anterior compartment of the thigh:

  • Iliopsoas
  • Sartorius
  • Quadriceps femoris (= rectus femoris + vastus lateralis + vastus intermedius + vastus medialis)

Muscles of the medial compartment of the thigh (adductor muscles):

  • Gracilis
  • Adductor longus
  • Adductor brevis
  • Adductor magnus

Gluteal muscles:

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Piriformis
  • Tensor fascia latae

Muscles of the posterior compartment of the thigh (hamstring muscles):

  • Biceps femoris
  • Semitendinosus muscle
  • Semimembranosus

Posterior leg muscles:

  • Gastrocnemius
  • Soleus
  • Plantaris

Anterior leg muscles

  • Tibialis anterior
  • Extensor hallucis longus
  • Extensor digitorum longus

Lateral leg muscles

  • Fibularis brevis
  • Fibularis longus

 

Anatomical Spaces/Regions

  • Femoral triangle
  • Adductor canal
  • Adductor hiatus
  • Popliteal fossa
  • Tarsal tunnel

 

Tendons/Ligaments/Connective Tissue Structures

  • Inguinal ligament
  • Fascia lata
  • Iliotibial tract (Iliotibial band)
  • Quadriceps femoris tendon
  • Patellar ligament
  • Calcaneal (Achilles’) tendon
  • Interosseous membrane
  • Iliofemoral ligament
  • Ischiofemoral ligament
  • Pubofemoral ligament
  • Tibial collateral ligament (medial collateral ligament of knee)
  • Fibular collateral ligament (lateral collateral ligament of knee)
  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Medial meniscus
  • Lateral meniscus
  • Medial collateral ligament of the ankle (deltoid ligament)
  • Lateral collateral ligament of the ankle

 

Neurovasculature

Nerves:

  • Femoral nerve
  • Saphenous nerve
  • Obturator nerve
  • Lateral femoral cutaneous nerve
  • Superior gluteal nerve
  • Inferior gluteal nerve
  • Posterior cutaneous nerve of the thigh (or posterior femoral cutaneous nerve)
  • Sciatic nerve
  • Tibial nerve
  • Common fibular nerve
  • Sural nerve
  • Superficial fibular nerve
  • Deep fibular nerve

 

Arteries and Veins:

  • Femoral artery
  • Deep artery of the thigh (deep femoral a. or profunda femoris a.)
  • Medial circumflex femoral artery
  • Lateral circumflex femoral artery
  • Popliteal artery
  • Anterior tibial artery
  • Posterior tibial artery
  • Dorsalis pedis artery
  • Superior gluteal artery & vein
  • Inferior gluteal artery & vein
  • Dorsal venous arch
  • Small saphenous vein
  • Great saphenous vein
  • Anterior tibial vein
  • Posterior tibial vein
  • Popliteal vein
  • Femoral vein

Clinical Correlates

  • Bone fracture
  • Dislocation of lower limb joints
  • Palpation of pulses at various areas in lower limb (femoral artery pulse, popliteal artery pulse, posterior tibial artery pulse, dorsalis artery pulse)
  • Lower limb reflexes (patellar reflex, calcaneal tendon reflex, plantar reflex)Understand signs and symptoms of injury to lower limb nerves (motor and/or sensory deficits)
  • Femoral hernia
  • Spread of infection through lymphatic drainage/lymph nodes of lower limb
  • Trendelenburg sign
  • Safe area to administer gluteal intramuscular injection
  • Anterior & posterior drawer sign
  • Unhappy triad injury
  • Genu varum (bow-leg) vs. genu valgum (knock-knee)
  • Calcaneal (Achilles) tendon rupture
  • Tarsal tunnel syndrome
  • Plantar fasciitis
    Heel spur
  • Flatfoot (pes planus)
  • Clubfoot (talipes equinovarus)
  • Hallux valgus