Vessels & nerves of lower limb

7
4/19/2012 1 Origin: external iliac at midinguinal point Course: Femoral Δ, Adductor canal Termination: Popliteal artery, opening in adduct magnus Femoral artery Relations with femoral vein: Base of ∆: vein medial Apex of ∆: vein posterior Adductor canal: vein postro- lateral Branches: 3Superficial inguinal arteries Superf. External pudendal Superficial epigastric Superficial external iliac Deep external pudendal Profunda femoris Descending genicular

description

 

Transcript of Vessels & nerves of lower limb

Page 1: 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

Page 2: Vessels & nerves of lower limb

4/19/2012

2

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

Page 3: Vessels & nerves of lower limb

4/19/2012

3

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

Page 4: Vessels & nerves of lower limb

4/19/2012

4

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:

Page 5: Vessels & nerves of lower limb

4/19/2012

5

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

Page 6: Vessels & nerves of lower limb

4/19/2012

6

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

Page 7: Vessels & nerves of lower limb

4/19/2012

7

Superior gluteal n injurySuperior gluteal n injury

Unilateral: Lurching gaitBilateral: Waddling gait

Common Common peronealperoneal n n injuryinjury

Foot drop