Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Netters Atlas Of Human Anatomy (5th Ed.).pdf
Скачиваний:
134
Добавлен:
13.03.2016
Размер:
29.62 Mб
Скачать

FACTS & HINTS

HIGH-YIELD FACTS

Anatomic Points

Functional Overview of the Lower Limb

The lower limb supports the bodyweight and permits locomotion. It is firmlyattached through the rigid pelvis to the vertebral column. The joints are relativelystable and influenced bythe line of gravity; this line passes posterior to the hip joint, anterior to the knee, and anterior to the ankle. Thus onlythe calf muscles need to contract to maintain an upright posture. Clinicallythe limb is divided into four compartments: gluteal, thigh, leg and foot.

page 243

page 244

Lower Limb Development

The general plan of the lower limb is similar to the upper limb; however, during development the lower limb undergoes medial rotation, bringing the extensors of the knee, ankle and toes anteriorlywith the knee pointing forwards. The hip is unaffected, so hip flexors remain anterior and the extensors posterior.

Clinical Points

Varicose Veins

Dilated superficial veins most commonlyseen in the posteromedial parts of the lower limb

Result from absent or faultyvalves in the communicating veins between the deep and superficial venous systems of the limb Secondaryfailure of the saphenofemoral valve mayoccur

Stagnation of blood in these vessels predisposes to thrombosis and subsequent inflammation = thrombophlebitis

380 / 425

50 Hip and Thigh

STUDYAIMS

At the end of your study, you should be able to:

Describe the structure of the hip joint and its movements

Identifythe different parts and surface markings of the femur

Know the origins, insertions and actions of the major muscles of the gluteal region

Know the origins, insertions and actions of the major muscles of the anterior, medial, and posterior thigh

Identifythe margins of the femoral triangle and describe its contents

Describe the course of the adductor canal

381 / 425

GUIDE

Lower Limb: Hip and Thigh

[Plate 493, Thigh: Serial Cross Sections]

382 / 425

[Plate 531, Hip Radiograph, Arthrogram, and MRI]

Hip Joint

383 / 425

[Plate 475, Hip Joint]

384 / 425

[Plate 476, Hip Joint: Anteroposterior Radiograph]

385 / 425

[Plate 478, Bony Attachments of Muscles of Hip and Thigh: Anterior View]

386 / 425

[Plate 479, Bony Attachments of Muscles of Hip and Thigh: Posterior View]

page 245 page 246

Multiaxial, ball-and-socket synovial joint

Movements

Flexion 140 degrees

Extension 10 degrees

Abduction 45 degrees

Adduction 30 degrees

Internal rotation 40 degrees

External rotation 50 degrees

Acetabulum (see Section 5-2: Pelvis and Perineum: Bones and Ligaments)

Head of femur fits within

Composed of contributions from ilium, ischium, pubis

Deepened byincomplete ring of fibrocartilaginous labrum, which is attached to bonyrim

Ring completed bytransverse acetabular ligament, which spans acetabular notch

Head of femur

Has a ligamentum teres (ligament of the head of the femur)

Attaches fovea (pit) in head of femur to transverse acetabular ligament

Contains branch from obturator artery

Capsule

Strong, fibrous and loose

Attaches to acetabular labrum, transverse acetabular ligament, intertrochanteric line of femur

Lower third of neck of femur is extracapsular.

Strengthened byligaments

Iliofemoral (Y-shaped)

Pubofemoral

Ischiofemoral ligaments

Blood supply(see Section 7-6: Lower Limb: Neurovasculature)

Medial and lateral circumflexarteries from deep branch of femoral or femoral artery

Arteryof head of femur (minor contribution)

Nerve supply

Femoral nerve

387 / 425

Nerve to quadratus femoris (posteriorly)

Articular branch of sciatic nerve

Anterior division of the obturator nerve (inferiorly)

Superior gluteal nerve (posteriorly)

Femur

Longest and heaviest bone in the body

Osteological features

Head with fovea (pit)

Neck-between head and shaft

Greater trochanter-large, lateral, posterosuperior projection from junction of neck and body

Lesser trochanter-rounded medial projection from junction of neck and body

Intertrochanteric line

Ridge running between greater and lesser trochanters

Indicates where neck joins body

Body(shaft)

Smooth and cylindrical

Wide, roughened line posteriorly: linea aspera

Runs vertically

Has medial and lateral lips (margins)

Medial and lateral condyles-medial and lateral rounded projections at its distal end

Medial and lateral epicondyles-central projection from each condyle

Neck is angled at 115 to 140 degrees (average 126 degrees) relative to the long axis of the shaft

Ligaments of the Hip Joint

Ligament

Attachments

Function

Iliofemoral

ASIS and acetabulum → intertrochanteric line. (Strong; Y-shaped

Prevents hyperextension

 

ligament)

 

Ischiofemoral

Acetabular rim → circles superiorlyand laterallyto medial base of

Prevents hyperextension

 

greater trochanter

Screws femoral head into acetabulum

Pubofemoral

Pubic ramus → laterallyand inferiorlyto joint capsule

Tightens during extension and

 

 

abduction

 

 

Limits abduction

Transverse

Joins the inferior ends of the labrum, crosses acetabular notch

Completes the acetabular ring

acetabular

 

 

Ligament of head of

Acetabular notch → fovea of femur

Contains arteryto head of femur (minute

femur

(Intracapsular but extrasynovial)

in adults)

page 246

page 247

Fascial Compartments of the Thigh

Superficial fascia

Contains variable amounts of fat

Cutaneous nerves, such as the saphenous and sural

Superficial veins, such as the great and small saphenous

Lymphatics Deep fascia = fascia lata

Separates the subcutaneous tissue from the muscles

Dense strong layer

Prevents bulging of muscles during contraction, which improves efficiencyof pumping blood through veins back to the heart

Attaches to the inguinal ligament, iliac crests, and sacrum superiorly, and is continuous with the crural fascia inferiorly(see Section 7-4: Lower Limb: Leg)

Fascial septa from the fascia lata divide the thigh into three compartments: anterior, medial, and posterior Iliotibial tract

Lateral thickening of fascia lata

Conjoint aponeurosis of tensor fasciae lata and gluteus maximus muscles

Attaches to tubercle on lateral condyle of the tibia (Gerdytubercle) Saphenous opening in fascia lata

Deficiencyinferior to medial inguinal ligament

Spanned bycribriform fascia

Saphenous vein and efferent lymphatic vessels form superficial inguinal nodes pass through opening and cribriform fascia

Muscles of the Gluteal Region

Extensor of hip: gluteus maximus

Also laterallyrotates hip

Through iliotibial tract, extends knee Abductors of hip

Gluteus medius

Gluteus minimus

Most important function of these muscles: contract to prevent sagging of unsupported side of hip during locomotion, enabling opposite foot to swing through (e.g., Trendelenburg test)

Lateral rotators of hip Gluteus maximus

388 / 425

Piriformis

Obturator internus

Obturator externus

Gemelli (superior and inferior)

Quadratus femoris

Extensors of knee

Gluteus maximus

Tensor fasciae latae

Muscle

Origin

Insertion

Innervation

Blood Supply

Action

Gluteus

Ilium posterior to posterior

Most fibers end in Iliotibial tract that

Inferior

Superior and inferior

Extends

maximus

gluteal line dorsal surface of

inserts into lateral condyle of tibia;

gluteal

gluteal arteries, first

thigh,

 

sacrum and coccyx,

some fibers insert gluteal

nerve (L5 -

perforating branch of

assists

 

sacrotuberous ligament

tuberosityof femur

S2)

deep femoral artery

lateral

 

 

 

 

 

rotation

Gluteus

Lateral surface of ilium

Lateral surface of greater

Superior

Deep branch of superior

Abducts

medius

between anterior and posterior

trochanter of femur

gluteal

gluteal artery

thigh,

 

gluteal lines

 

nerve (L4 -

 

rotates thigh

 

 

 

S1)

 

medially

Gluteus

Lateral surface of ilium

Anterior border of greater trochanter

Superior

Deep branch of superior

Abducts

minimus

between anterior and inferior

of femur

gluteal

gluteal artery

thigh,

 

gluteal lines

 

nerve (L4 -

 

rotates thigh

 

 

 

S1)

 

medially

Piriformis

Anterior surface of sacrum and

Superior border of greater

Ventral

Superior and inferior

Laterally

 

sacrotuberous ligament

trochanter of femur

rami of S1

gluteal arteries, internal

rotates

 

 

 

and S2

pudendal artery

thigh,

 

 

 

 

 

abducts

 

 

 

 

 

flexed thigh

Obturator

Pelvic surface of obturator

Medial surface of greater trochanter

Nerve to

Internal pudendal and

Laterally

internus

membrane and margins of

of femur

obturator

superior gluteal arteries

rotates

 

obturator foramen

 

internus

 

thigh,

 

 

 

(L5-S2)

 

abducts

 

 

 

 

 

flexed thigh

Gemellus

Outer surface of ischial spine

Medial surface of greater trochanter

Nerve to

Inferior gluteal artery

Laterally

superior

 

of femur

obturator

 

rotates thigh

 

 

 

internus

 

 

 

 

 

(L5-S2)

 

 

Gemellus

Upper margin of ischial

Medial surface of greater trochanter

Nerve to

Inferior gluteal artery

Laterally

inferior

tuberosity

of femur

quadratus

 

rotates thigh

 

 

 

femoris

 

 

 

 

 

(L4-S1)

 

 

Quadratus

Lateral margin of ischial

Quadrate tubercle on

Nerve to

Medial circumflex

Laterally

femoris

tuberosity

intertrochanteric crest of femur

quadratus

femoral artery

rotates thigh

 

 

 

femoris

 

 

 

 

 

(L4-S1)

 

 

Muscles of the Thigh

389 / 425

[Plate 480, Muscles of Thigh: Anterior Views]

390 / 425

[Plate 482, Muscles of Hip and Thigh: Lateral View]

391 / 425

[Plate 483, Muscles of Thigh: Posterior Views]

Anterior (= extensor) compartment

Flexors of hip

Sartorius (also abducts and laterallyrotates hip and flexes and mediallyrotates knee), Iliopsoas

Pectineus (also adducts hip)

Extensor of knee: quadriceps femoris, composed of

Rectus femoris (also flexes hip)

Vastus lateralis

Vastus intermedius

Vastus medialis (also stabilizes patella)

page 248 page 249

Anterior Thigh Muscles

Muscle

Origin

Insertion

Innervation

Blood Supply

Action

Iliopsoas/psoas

Sides of vertebra T12 to

Lesser trochanter of

Ventral rami of

Lumbar branches

Flexes thigh at hip and

major

L5 and transverse

femur

lumbar spinal

of iliolumbar artery

stabilizes the hip

 

processes of L1-L5

 

nerves 1-3

 

 

Iliacus

Iliac crest, iliac fossa,

Tendon of psoas major

Femoral nerve

Iliac branches of

Flexes thigh at hip and

 

ala of scrum, and

and bodyof femur,

(L2-L3)

iliolumbar artery

stabilizes the hip

 

anterior sacroiliac

inferior to lesser

 

 

 

 

ligaments

trochanter

 

 

 

Tensor fasciae

Anterior superior iliac

Iliotibial tract → lateral

Superior gluteal

Superior gluteal

Abducts, medially

latae

spine and anterior part

condyle of tibia

nerve (L4-L5)

arteries, lateral

rotates and flexes the

 

of external lip of iliac

 

 

circumflexfemoral

thigh, stabilizes trunk

 

crest

 

 

artery

on thigh

Sartorius

ASIS and superior part

Superior part of medial

Femoral nerve

Femoral artery

Abducts, laterally

 

of notch below it

surface of tibia

(L2-L3)

 

rotates and flexes the

 

 

 

 

 

thigh

Quadratus

Lateral margin of ischial

Quadrate tubercle on

Nerve to

Medial circumflex

Laterallyrotates thigh

femoris

tuberosity

intertrochanteric crest

quadratus femoris

femoral artery

 

392 / 425

 

 

of femur

(L4 to S1)

 

 

Rectus femoris

Anterior inferior iliac

Base of patella and to

Femoral nerve

Lateral circumflex

Extends the leg at the

 

spine and groove

tibial tuberosityvia

(L2-L4)

femoral artery,

knee joint and flexes

 

superior to acetabulum

patellar ligament

 

deep femoral

the thigh at the hip joint

 

 

 

 

artery

 

Vastus lateralis

Greater trochanter and

Base of patella and to

Femoral nerve

Lateral circumflex

Extends the leg at the

 

lateral lip of linea

tibial tuberosityvia

(L2-L4)

femoral artery,

knee joint

 

aspera of femur

patellar ligament

 

deep femoral

 

 

 

 

 

artery

 

Vastus medialis

Intertrochanteric line

Base of patella and to

Femoral nerve

Femoral artery,

Extends the leg at the

 

and medial lip of linea

tibial tuberosityvia

(L2-L4)

deep femoral

knee joint

 

aspera of femur

patellar ligament

 

artery

 

Vastus

Anterior and lateral

Base of patella and to

Femoral nerve

Lateral circumflex

Extends the leg at the

intermedius

surfaces of bodyof

tibial tuberosityvia

(L2-L4)

femoral artery,

knee joint

 

femur

patellar ligament

 

deep femoral

 

 

 

 

 

artery

 

Pectineus

Pecten pubis

Pectineal line of femur

Femoral nerve

Medial circumflex

Adducts and flexes

 

 

 

(L2-L3) and

femoral artery,

thigh

 

 

 

sometimes

obturator artery

 

 

 

 

obturator nerve

 

 

page 249 page 250

Medial (= adductor) compartment

Adductors of hip

Adductors longus

Adductor brevis

Adductor magnus (also assist lateral rotation of knee)

Gracilis (also flexes knee)

Obturator externus-laterallyrotates hip

Medial Thigh Muscles

 

Muscle

 

Origin

Insertion

 

Innervation

 

Blood Supply

Action

 

 

Adductor

Bodyof pubis, inferior

Middle third of linea

Obturator nerve

Medial circumflex

Adducts thigh

 

 

 

longus

to pubic crest

aspera of femur

(anterior division)

femoral artery,

 

 

 

 

 

 

 

 

 

 

(L2-L4)

obturator artery

 

 

 

 

Adductor

Bodyand inferior pubic

Pectineal line and

Obturator nerve

Medial circumflex

Adducts and flexes thigh

 

 

brevis

ramus

 

 

proximal part of linea

(L2-L4)

femoral artery,

 

 

 

 

 

 

 

 

aspera of femur

 

 

obturator artery

 

 

 

 

Adductor

Inferior pubis ramus,

Gluteal tuberosity, linea

Adductor part:

Deep femoral artery,

Adducts and flexes thigh

 

 

magnus

ramus of ischium

aspera, supracondylar

obturator nerve

popliteal artery,

(adductor part)

 

 

 

Hamstring part: ischial

line

 

(L2-L4)

obturator

Extends thigh (hamstring

 

 

 

tuberosity

Hamstring part:

Hamstring part:

 

 

 

part)

 

 

 

 

 

 

 

adductor tubercle

tibial nerve (L4)

 

 

 

 

 

 

 

Gracilis

Bodyof pubis and

Superior part of medial

Obturator nerve

Deep femoral artery,

Adducts thigh, flexes and

 

 

 

inferior pubic ramus

surface of tibia

(L2-L3)

medial circumflex

mediallyrotates the leg

 

 

 

 

 

 

 

 

 

 

femoral artery

 

 

 

 

Obturator

Margins of obturator

Trochanteric fossa of

Obturator nerve

Medial circumflex

Laterallyrotates the thigh and

 

 

externus

foramen and obturator

femur

 

(L2-L3)

femoral artery,

stabilizes head of femur in

 

 

 

membrane

 

 

 

 

obturator artery

acetabulum

 

 

 

Posterior (= flexor) compartment

 

 

 

 

 

 

 

 

 

 

 

Hamstrings

 

 

 

 

 

 

 

 

 

 

 

 

 

Biceps femoris-also lateral rotates knee

 

 

 

 

 

 

 

 

 

 

 

Semitendinosus-also medial rotates knee

 

 

 

 

 

 

 

 

 

 

Semimembranosus-also medial rotates knee

 

 

 

 

 

 

 

 

Together extend hip (except short head of biceps femoris) and flexknee

 

 

 

 

Hamstring part of adductor magnus-extends hip

 

 

 

 

 

 

 

 

Posterior Thigh Muscles

 

 

 

 

 

 

 

 

 

 

 

 

 

Muscle

 

Origin

Insertion

 

Innervation

 

 

Blood Supply

Action

 

 

Semitendinosus

 

Upper and medial

Superior part

Tibial division of

 

Perforating branch of deep

Flexes leg,

 

 

 

 

 

ischial tuberosity

of medial

 

sciatic nerve (L5-S2)

arteryof thigh, superior

extends thigh

 

 

 

 

 

 

 

surface of

 

 

 

 

muscular branches of

 

 

 

 

 

 

 

 

tibia

 

 

 

 

popliteal artery

 

 

 

 

Semimembranosus

Upper and lateral ischial

Posterior

 

Tibial division of

 

Perforating branch of deep

Flexes leg,

 

 

 

 

 

tuberosity

 

part of

 

sciatic nerve (L5-S2)

arteryof thigh, superior

extends thigh

 

 

 

 

 

 

 

medial

 

 

 

 

muscular branches of

 

 

 

 

 

 

 

 

condyle of

 

 

 

 

popliteal artery

 

 

 

 

 

 

 

 

 

tibia

 

 

 

 

 

 

 

 

 

Biceps femoris

 

Long head-ischial

Lateral side

Long head-tibial

 

Perforating branch of deep

Flexes and

 

 

 

 

 

tuberosity

 

of head of

 

division of sciatic

 

arteryof thigh, superior

laterallyrotates

 

 

 

 

 

 

 

fibula

 

nerve (L5-S2)

 

 

muscular branches of

leg, extends

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

393 / 425

Short head-lateral lip of linea aspera, lateral supracondylar line of femur

popliteal artery

thigh

Short head-common fibular division of sciatic nerve (L5-S2)

Femoral Triangle

Boundaries

Superiorly: inguinal ligament

Medially: medial border of adductor longus

Laterally: medial border of sartorius

Contents

Femoral nerve (descends outside of femoral sheath)

Femoral sheath

About 4 cm long, extending below inguinal ligament

Subdivided into three compartments

Lateral contains femoral artery

Intermediate contains femoral vein

Medial is femoral canal

Femoral canal

Potential space about 1.5 cm long

Contains loose connective tissue, lymphatic vessels, a deep inguinal lymph node (of Cloquet)

Femoral ring: abdominal entrance to femoral canal, closed byfattytissue and parental peritoneum

Beyond extent of sheath

Femoral arteryand branches

Femoral vein and tributaries

Adductor Canal (= subsartorial canal/Hunter's canal)

page 251 page 252

Boundaries

Superiorly: commences at apexof femoral triangle

Posteriorly: adductors longus and magnus

Anteromedially: sartorius and fascia

Anterolaterally: vastus medialis

Inferiorly: terminates at adductor hiatus (in tendon of adductor magnus)

Contents

Femoral arteryand femoral vein

Pass through adductor hiatus

Become popliteal arteryand vein when theyenter popliteal fossa

Nerves

Saphenous nerve

Nerve to vastus medialis

Lymphatics

394 / 425

Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]