Vessels & nerves of lower limb
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Transcript of Vessels & nerves of lower limb
4/19/2012
1
Origin:external iliac at midinguinalpointCourse:Femoral Δ, Adductor canal
Termination:Popliteal artery, opening inadduct magnus
Femoral arteryRelations with femoral vein:Base of ∆: vein medial Apex of ∆: vein posteriorAdductor canal: vein postro-lateral
Branches:3Superficial inguinal arteriesSuperf. External pudendalSuperficial epigastricSuperficial external iliacDeep external pudendalProfunda femorisDescending genicular
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Profuda femoris arteryCourse:Posterolateral to femoral artery
Branches:Medial circumflex femoralLateral circumflex femoral3 perforating arteries
Termination:Pierces add magnus As 4th
perforating
Popliteal arteryOrigin:
Femoral artery,Hiatus magnus
Course: (deepest)
Popliteal vein & med popliteal n:lat---superficial—medial
Termination:
Ant & post tibial
Lower border of popliteus
Branches:
5 genicular: Upper medial,upper lateral, Lower medial,lower lateral & Middle
Origin:Popliteal arteryCourse:() 2 heads of TP, membraneAnterior tibial n: lateralTermination:Dorsalis pedis art, () 2malleoliBranches:
2 tibial recurrent (Ant &Post)
2 malleolar (med & lat)
Muscular branches
Anterior tibial arteryAnterior tibial arteryOrigin:Ant tibial artery () 2 malleoliCourse:On dorsum of foot (1st
interosseous space)Enter sole of footTermination:Join planter arch in soleBranches:2 tarsal branchesArcuate artery
2nd, 3rd, 4th dorsal metatarsal art
1st dorsal metatarsal1st planter metatarsal
Dorsalis pedis arteryDorsalis pedis artery
Origin:Popliteal arteryCourse:Run () superficial & deepgroupsTermination:Midway () med malleolus andcalcaneusDivide into medial & lateralplanter arteries
Branches:Peroneal artery
Posterior tibial arteryPosterior tibial arteryBranches:
Posterior tibial artery branches:
1-Circumflex fibular artery
2-Medial malleolar
3-Medial calcaneian
4-Nutrient artery to tibia
5-Communicating branch
6- Peroneal artery
•Lateral malleolar
•Lateral calcanian
•Nutrient artery to fibula
•Communicating branch
•Perforating branch
Posterior tibial arteryPosterior tibial artery
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Medial planter artery
Origin: posterior tibial artery
Course: Run () ms of 1st layer
Branches: Muscular,Digital
Lateral planter arteryCourse:Form planter arch
Branches:2nd,3rd,4th planter metatarsal arteries
3 posterior perforating arteries
Planter digital to little toe
Muscular branches
Branches of internal iliac artery1- Obturator arteryCourse:Pass through obturator canalBranches:Acetabular branch, Muscular branches
2-Superior gluteal artery:
3-Inferior gluteal artery:
Popliteal vein
Beginning:
Vena comitants of ant & posttibial arteries
At lower border of popliteus
Course:
………………………
Termination:
Femoral vein (hiatus magnus)
Tributaries:
Genicular veins
Short saphenous vein
Femoral vein
Beginning:Popliteal vein, opening in add magnusCourse:Termination:External iliac veinTributaries:Great saphenous veinExternal pudendal veinProfunda femoris veinMed & lat circumflex femoral veins
Superficial veins
Dorsal venous arch
Great saphenous vein
Small saphenousvein
Femoral vein
Popliteal vein
Infront of med malleolus
Saphenousopening
Behind lateral malleolus
Tributaries of great saphenous v:
Sup inguinal veins
Sup external pudendal
Sup epigastric
Superficial external iliac
Veins from medial side of leg & thigh
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Dr. Dr. RaniaRania
Femoral nerveFemoral nerve
Dr. Dr. RaniaRania
Origin:Ventral primary rami of L2,3,4(dorsal division)Course:Deep to inguinal ligamentOutside femoral sheathBranches:Muscular:Sartorius, quadriceps,pectineus, iliacusCutaneous:Med & middle cut n of thighSaphenous nerve
Dr. Dr. RaniaRania
Obturator nerveOrigin: ventral primary rami ofL2,3,4 (ventral division)Course:Pass through obturator canalBranches:Muscular : gracilis, 3 adductors,obturator externusCutaneous: Skin middle 1/3 of medialside of thigh
Dr. Dr. RaniaRania
Sciatic nerveSciatic nerveOrigin:Sacral plexus L4,5, S1,2,3Course:Enter through greater sciaticforamen below to the piriformismuscle.Lies deep to gluteus maximus.Enter thigh at midpoint between theischial tuberosity and the greatertrochanter.Branches:Tibial nerve (medial popliteal)Common peroneal nerve (lateralpopliteal)Distribution:
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Origin:Sciatic nCourse: Bisect fossaTermination:Post tibial art (lower borderpopliteus)Branches:Muscular:Gastrocnemius, PlantarisSoleus, popliteusCutaneous:Sural nerveLat side of leg (lower), Lateral side offoot, Lateral side of little toe
Genicular:Sup medial, Inf medial,Middle:
Origin:
Sciatic n
Course:
Lateral border of fossa (biceps)
Lateral side of neck of fibula
Termination: divide
Superficial peroneal (musculocut)
Deep peroneal (ant tibial)Branches:
Cutaneous:
Sural communicating, Lat cutaneous nof calf
Genicular:
Sup lateral, Inf lateral,Recurrentgenicular
Superficial & deep peroneal nervesSuperficial & deep peroneal nerves
Sciatic nerve
Medial popliteal n
Or
Tibial n
Superficial peroneal n
Or
Musculcutaneous n
Posterior tibial n
Lateral popliteal nOr
Common peroneal n
Deep peroneal n
Or
Anterior tibial n
Origin:Common peroneal (lat popliteal)nerveCourse:Run with ant tibial arteryTermination:Divides into medial & lateraldivisionsBranches:Muscular ????????????Cutaneous (sides of 1st & 2nd toes)
Anterior tibial (Anterior tibial (deep peronealdeep peroneal) nerve) nerve
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Origin:Common peroneal (latpopliteal) nerveCourse:Descend () peroneus longus &brevis
Termination:Divides into medial & lateraldivisions
Branches:Muscular ?????????????Cutaneous (skin of lowerpart of ant surface of leg)
Superficial peroneal nerveSuperficial peroneal nerve
Distribution: (blue area)
Medial side & middle of dorsumof foot
Medial side of big toe
Adjacent sides of 2nd, 3rd toes
,() 3rd, 4th and 4th, 5th toes
Superficial peroneal nerveSuperficial peroneal nerve
Sural n
Origin:Continuation of tibial nAt lower border of popliteusCourse:Run () superficial & deep groupsTermination:Divides into medial & lateral planternervesMidway () medial malleolus &calcaneusBranches:Muscular ????????????Medial calcenean branch: supplyheal
Posterior tibial nervePosterior tibial nerveMedial planter nerveOrigin: posterior tibial nerve
Course:
Run () ms of 1st layer
Branches:
Muscular:1. Abductor hallucis
2. Flexor digitorum brevis
3. 1st lumbrical
4. Flexor hallucis brevis
Cutaneous: medial 2/3 of skin of sole of foot, medial 3 & ½ toes
Lateral planter nerveOrigin: posterior tibial nerve
Termination: divide intosuperficial & deep branches
Branches:
Muscular: all ms of sole except 4
Cutaneous: lateral 1/3 of skin of sole of foot, lateral 1 & ½ toes
Posterior tibial
Late
ral plan
ter
n
Med
ial plan
ter
n
Cutaneous innervation
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Superior gluteal n injurySuperior gluteal n injury
Unilateral: Lurching gaitBilateral: Waddling gait
Common Common peronealperoneal n n injuryinjury
Foot drop