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Medical online courses
By Dr. Khan
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mediclassonline.com
Series of courses
Anatomy
Lower Limb
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Overview of Regions, Bones Anatomy – Lower Limb
and Major Joints

Regions:
• Hip
• Thigh
• Leg
• Foot
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Anatomy – Lower Limb
Bones

Bones of the
Lower limb
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Lumbosacral Plexus Anatomy – Lower Limb

Lumbosacral Plexus
Lumbosacral plexus is formed by which
part of the Spinal nerves
Lumbosacral plexus is formed by Ventral
rami of L2 To S3

Nerves containing fibers originating from

upper part (L2 through L4) innervate
which parts of the limb -----
Anterior and medial thigh that act on hip
and knee joint

Nerves containing fibers originating from

lower part (S1 through S3) innervate
muscles of which part of the limb---
They innervate muscles of the leg that act
at the joints of the ankle and foot
Lumbosacral Plexus Anatomy – Lower Limb
Major Branches of Lumbosacral Plexus
Nerve Origin Muscles Innervated Primary action

Femoral L2 through L4 Anterior compartment Extend knee

posterior division of thigh (Quadriceps
femoris, Sartorius,
pectineus)

Obturator L2 through L4 Medial compartment of Adduct thigh

Anterior division thigh (Gracilis, adductor Medially rotate
longus, adductor brevis, thigh
anterior portion of
adductor magnus
Obturator externus)

Tibial L4 through S3 Posterior Compartment Flex knee

Anterior division of thigh Extend thigh
(Semimembranosus,
Semitendinosus, long
head of biceps femoris,
posterior portion of
adductor magnus)

Posterior Compartment Planter flexor

of leg (Gastrocnemius, foot (S1-S2)
soleus, flexor digitorum
longus, flexor hallucis
longus, tibialis
posterior)
Planter muscles of foot
Lumbosacral Plexus Anatomy – Lower Limb
Major Branches of Lumbosacral Plexus
Nerve Origin Muscles Innervated Primary action

Femoral L2 through L4 Anterior compartment Extend knee

posterior division of thigh (Quadriceps
femoris, Sartorius,
pectineus)

Obturator L2 through L4 Medial compartment of Adduct thigh

Anterior division thigh (Gracilis, adductor Medially rotate
longus, adductor brevis, thigh
anterior portion of
adductor magnus)

Common L4 through S3 Short head of biceps Flex knee

Posterior division femoris
fibular
nerve
Lumbosacral Plexus Anatomy – Lower Limb
Major Branches of Lumbosacral Plexus
Nerve Origin Muscles / Skin Innervated Primary action

Superior L4 through S1 Gluteus medius, gluteus Stabilize pelvis

posterior division minimus, tensor fasciae Abduct hip
gluteal latae
nerve

Inferior L5 through S2 Gluteus maximus Extension of

posterior division hip, lateral
gluteal rotation of
nerve thigh
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Terminal nerves of Lumbosacral Anatomy – Lower Limb
Plexus
Terminal Nerves of Lumbosacral Plexus
Nerve Origin Muscles Innervated Primary action

Superficial Division of Lateral compartment of Eversion of foot

common leg (Fibularis longus,
fibular fibularis brevis)
nerve fibular nerve

Deep Division of Anterior compartment Dorsiflex foot

common fibular of leg (Tibialis anterior, (L4-L5), Extend
fibular nerve extensor hallucis, digits, Inversion
nerve extensor digitorum,
fibularis tertius
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Collateral nerves of Lumbosacral Anatomy – Lower Limb
Plexus
Collateral nerves of Lumbosacral plexus
Nerve Origin Muscles / Skin Innervated Primary action
Nerve to L4 through S2 Superior gemellus, Lateral rotation
superior posterior division obturator internus of thigh
gemellus and
obturator
internus
Nerve to L4 through S1 Inferior gemellus, Lateral rotation
inferior posterior division quadratus femoris of thigh
gemellus and
quadratus
femoris
Lateral L2 through L3 Skin of anterolateral -
femoral posterior division thigh
cutaneous
nerve

Posterior S1 through S2 Skin of Posterior thigh -

femoral posterior division
cutaneous and S2 through
S3 anterior
nerve
division
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Segmental innervation of Anatomy – Lower Limb
muscles of lower limb
The muscles that cross The muscles that cross
the anterior side of the L2 and L3 L4 and L5 the posterior side of the
hip are innervated ---- Hip are innervated by ---
L2 and L3 L4 and L5

The muscles that cross The muscles that cross

the anterior side of the the posterior side of the
knee are innervated by--- L3 and L4 L5 and S1 knee are innervated by ---
L3 and L4 L5 and S1

The muscles that cross The muscles that cross

the anterior side of the the posterior side of the
ankle are innervated by --- L4 and L5 S1and S2 ankle are innervated by --
L4 and L5 S1 and S2
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Nerve injuries and Anatomy – Lower Limb
abnormalities of gait
Nerve injuries and abnormalities of gait
Nerve injured Consequences
Superior Gluteal Nerve Weakness in abduction of the hip
Impairment of gait – Patient cannot keep pelvis level
when standing on one leg
Trendelemburg gait
Inferior gluteal nerve Weakened hip extension
Difficulty rising from a sitting position or climbing stairs

Femoral nerve Weakened hip flexion

Weakened extension of the knee
Sensory loss on the anterior thigh, medial leg, and foot
Obturator nerve Loss of adduction of the thigh as well as sensory loss on
medial thigh
Sciatic nerve Weakened extension of the thigh
Loss of flexion of the knee
Loss of all functions below the knee
Sensory loss on the posterior thigh, leg (except medial
side), and foot
Nerve injuries and Anatomy – Lower Limb
abnormalities of gait
Nerve injuries and abnormalities of gait
Nerve injured Consequences
Common fibular nerve Causes –
Fracture neck of fibula (most frequently damaged
nerve of lower limb)
Fibular syndrome (When it passes through the
Piriformis)
Loss of dorsiflexion of the ankle (foot drop)
Loss of eversion
Sensory loss on the lateral surface of the leg and the
dorsum of the foot
Tibial nerve only Weakness in flexion of the knee
Weakness in planter flexion
Weakened inversion
Sensory loss on the leg (except medial) and plantar foot
Nerve injuries and Anatomy – Lower Limb
abnormalities of gait
Nerve injuries and abnormalities of gait
Nerve injured Consequences
Deep fibular nerve Weakened inversion
Loss of extension of the digits
Loss of dorsiflexion (foot drop)
Sensory loss on anterolateral leg and dorsum of the foot
Superficial fibula nerve Loss of eversion of the foot
Sensory loss on dorsum of foot except the first web
space
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Sensory innervation of lower Anatomy – Lower Limb
leg and foot
Sensory Innervation of the lower leg and foot
The lateral leg and the dorsum of the
foot are supplied mainly by the ----
Superficial fibular nerve

First dorsal web space is supplied by ---

Deep fibular nerve

The sole of the foot is supplied by –

Lateral and medial planter branches of
the tibial nerve

Posterior leg and lateral side of the

foot is supplied by ---
The Sural nerve

Medial leg and medial foot is supplied

by –
Saphenous nerve ( branch of femoral
nerve)
Sensory innervation of lower Anatomy – Lower Limb
leg and foot
Sensory Innervation of the lower leg and foot
The sole of the foot is supplied by –
Lateral and medial planter branches of
the tibial nerve

Posterior leg and lateral side of the

foot is supplied by ---
The Sural nerve

Medial leg and medial foot is supplied

by –
Saphenous nerve ( branch of femoral
nerve)
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
External Iliac artery becomes ---
Femoral artery in the thigh after crossing the inguinal
ligament

Branches of Femoral artery are ---

-Superficial epigastric artery
-Superficial circumflex Iliac artery
-Superficial external Pudendal artery
-Deep external Pudendal artery
-Descending genicular artery
-Profunda femoris artery: (Artery of thigh, supplies
all muscles of thigh)
Medial femoral circumflex (Supplies head of femur ---
Avascular necrosis)
Lateral femoral circumflex
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
External Iliac artery becomes ---
Femoral artery in the thigh after crossing the inguinal
ligament

Branches of Femoral artery are ---

-Superficial epigastric artery
-Superficial circumflex Iliac artery
-Superficial external Pudendal artery
-Deep external Pudendal artery
-Descending genicular artery
-Profunda femoris artery: (Artery of thigh, supplies
all muscles of thigh)
Medial femoral circumflex (Supplies head of femur ---
Avascular necrosis)
Lateral femoral circumflex
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
Internal Iliac artery branches ---
-Obturator artery ---- Supplies medial compartment of thigh
-Superior gluteal artery
-Inferior gluteal artery
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
Femoral artery becomes ---
Popliteal artery, at what level ---
After coming out from Hiatus in Adductor Magnus

Popliteal artery supplies ---

Knee joint

Popliteal artery divides into –

Anterior tibial artery
Posterior tibial artery

Anterior tibial artery supplies -----

Anterior compartment of leg

Anterior tibial artery becomes ---

Dorsalis pedis artery ---Pulse on the dorsum of the foot
lateral to extensor hallucis longus tendon
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
Posterior tibial artery supplies ---
Posterior compartment of leg

Branch of posterior tibial artery is ---

Fibular artery which supplies ---
Lateral compartment of leg

Posterior tibial artery divides into–

Medial planter artery
Lateral planter artery, which contributes to
Medial planter arch
Arterial supply and major Anatomy – Lower Limb
anastomosis
Arterial supply and Major anastomosis
Laceration of the anterior or posterior tibial arteries due to
Tibial shaft fracture can produce ---
Anterior or posterior Compartment syndrome
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Femoral Triangle Anatomy – Lower Limb

FEMORAL TRIANGLE
Femoral triangle is bounded by the ---
-Inguinal ligament
-Sartorius
-Adductor longus

Contents of Femoral triangle

Femoral sheath containing –
Femoral artery
Femoral vein
Femoral canal

Femoral nerve lies inside or outside the

femoral canal ?
Femoral nerve lies outside the femoral
sheath
Femoral Triangle Anatomy – Lower Limb

Arterial supply and Major anastomosis

In Femoral triangle Position of
structures are ---
Medial most ---
Femoral canal
Lateral to that ---
Femoral vein
Lateral most –
Femoral artery

Femoral canal contains ---

Inguinal lymph nodes (NAVEL)

Femoral canal is the site of ---

Femoral hernias
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Knee joint Anatomy – Lower Limb

Knee joint
Knee joint is a synovial joint formed by
the articulation of ---
Medial and lateral femoral condyles,
and medial and lateral tibial condyles,
and the patella
Knee joint Anatomy – Lower Limb

Tibial (medial) collateral ligament

extends between ---
Medial epicondyle of the femur
inferiorly to medial aspect of the tibia

Medial collateral ligament is also

attached to the capsule and medial
meniscus

The Tibial (medial) collateral ligament

prevents which movement of knee joint
? ----
Lateral displacement (abduction) of the
tibia under the femur
Knee joint Anatomy – Lower Limb

Fibular (lateral) collateral ligament

extends between ---
Lateral condyle of the femur inferiorly to
the head of the fibula

Lateral collateral ligament is also

attached to the lateral meniscus

The Fibular (lateral) collateral ligament

prevents which movement of knee joint
? ----
Medial displacement (adduction) of the
tibia under the femur
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Anterior Cruciate
ligaments is attached to
the tibia on its ---
Anterior aspect

It then courses posteriorly

to attach to the ---
Lateral condyle of femur
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Anterior Cruciate
ligaments is attached to
the tibia on its ---
Anterior aspect

It then courses posteriorly

to attach to the ---
Lateral condyle of femur
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Anterior cruciate ligament
prevents which movement
It prevents anterior
displacement of the tibia
under the femur

Tension in the ACL is

greatest when ---
The knee is extended and
it resists hyperextension
It is weaker than the
posterior cruciate ligament
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Posterior Cruciate ligaments is
attached to the tibia on its ---
Posterior aspect of tibia

It then courses Superiorly,

anteriorly, and medially to
attach to the ---
Medial condyle of femur
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Posterior Cruciate ligaments
prevents which movement---
It prevents posterior
displacement of the tibia under
the femur

Tension on the PCL is greatest

when ---
Knee is flexed
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Test for the integrity of the
anterior cruciate ligament is
called--
Anterior drawer test (Done at
90 degree flexion) or Lachman
test (Done at 20 to 30 degrees
flexion)

Tearing of anterior cruciate

ligament allows the tibia to be
easily pulled ---
Forward
Knee joint Anatomy – Lower Limb

Cruciate ligaments
Test for the integrity of the
Posterior cruciate ligament is
called--
Posterior drawer test

Tearing of Posterior cruciate

ligament allows the tibia to be
easily pulled ---
Posteriorly

Posterior Drawer Test

Knee joint Anatomy – Lower Limb

Medial and Lateral Menisci

Medial and Lateral Menisci are made
of ---
Fibrocartilage

Function ---
They make the articulating surfaces
more congruent
They serve to dissipate synovial fluid

Shape of medial meniscus is ----

C- shaped
Why it is more vulnerable to injury---
Because it is firmly attached to the tibial collateral ligament and therefore is less
mobile and more frequently injured than the lateral meniscus
Knee joint Anatomy – Lower Limb

Medial and Lateral Menisci

Shape of Lateral meniscus is ----
Circular
Knee joint Anatomy – Lower Limb

Medial and Lateral Menisci

Which structures are most commonly
injured in knee
MMA
M ---
Medial (Tibial) Collateral ligament
M ----
Medial Meniscus
A -----
Anterior cruciate ligament
 Anatomy
Lower Limb
o Overview of Regions, Bones and Major joints

o Bones

o Lumbosacral Plexus

o Terminal Nerves of Lumbosacral plexus

o Collateral Nerves of Lumbosacral Plexus

o Segmental Innervation of Muscles of Lower limb

o Nerve Injuries and abnormalities of Gait

o Sensory Innervation of Lower leg and Foot

o Arterial Supply and Major Anastomoses

o Femoral Triangle

o Knee Joint

o Ankle Joint
Ankle joint Anatomy – Lower Limb

Ankle joint
The ankle joint is reinforced
laterally by the----
Lateral ligament of the
ankle, which consists of ---
Three separate ligaments:--
(1) Anterior talofibular
ligament, a flat, weak band
(2) Calcaneofibular
ligament, a round cord
directed posteroinferiorly
(3) Posterior talofibular
ligament, a strong, medially-
directed horizontal ligament

Which ligament is most

commonly damaged
Anterior talofibular
ligament is most commonly
damaged
Ankle joint Anatomy – Lower Limb

Ankle joint
The ankle joint is reinforced
medially by the----
Medial ligament of the
ankle (deltoid ligament)
that attaches proximally to
the ---
Medial malleolus and fans
out from it to attach distally
to the talus, calcaneus, and
navicular via four adjacent
and continuous parts: Which sprains are more common, inversion
1. Tibionavicular part or eversion ?
2. Tibiocalcaneal part Inversion sprains are most common
3. Anterior tibiotalar part
4. Posterior tibiotalar parts.

The medial ligament stabilizes the ankle joint during ----

Eversion of the foot and prevents subluxation (partial dislocation) of the ankle
joint.