Gross Anatomy Forum Lower Limb

Lower Limb Forum

1) Describe the content of the subinguinal hiatus

Lacuna musculonervosa
Iliopsoas covered by fascia
Femoral nerve
Lateral cutaneous femoral nerve
Femoral sheath – lateral vasorum
Femoral artery
Femoral nerve
Lacuna lymphatica

2) Describe the borders and content of the femoral triangle

Superiorly by the inguinal ligament, Laterally by the sartorius muscle, and Medially by the
adductor longus (brevis is deep).

3) Describe the walls and content of the adductor canal

Borders are Sartorius muscle (anteromedial), Adductor longus and magnus (posterior), and
Vastus medialis (lateral). The canal contains the end of the femoral artery and vein, deep lymph
vessels, the saphenous nerve, the nerve to vastus medialis, and the end of the obturator nerve.

4) Describe the adductor hiatus

The gap in adductor magnos so the adductor canal vessels can get to the politeal space. Contains
the politeal vein and arteries.
James Lamberg
5) Describe the borders and contents of the popliteal fossa
Contains NeVA: Tibial nerve (sciatic nerve), the common perineal nerve branches lateral from
sciatic nerve, politeal artery, and popliteal vein.

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6) Describe the pathogenesis of the Baker’s cyst and the prepatellar bursitis
Prepatellar bursitis: Fluid filled bursa protrusion on the front of the patella from working on your
knees a lot (e.g. kneeling for gardening work)
Baker’s cyst: Popliteal cyst, so protrusion of capsule of knee joint, posteriorly. Check for a pulse
to make sure it isn’t a popliteal aneurysm.

7) Describe the pathogenesis of the foot drop

Damage to the common peroneal (fibular) nerve. No dorsiflexion or eversion anymore, thus food
will be plantar flexed and inverted (dragged) while walking. A common injury would be trauma
to the lateral knee causing the fibular head to break, and thus damaging the peroneal nerve.

8) Describe the unhappy triad and the Pott fracture

Unhappy (terrible) triad: Injury to the knee while the foot is flexed and the hips are rotated. It
wrecks the “money maker” (ATM): ACL, Tibial collateral ligament, Medial meniscus
Pott’s fracture: Injury to the ankle by falling onto an everted foot while twisting. It wrecks the
fibula (fracture), tears the anterior tibiofibular ligament, and fractures the medial maleolus above
the deltoid ligament

9) Describe the cutaneous innervation of the lower limb

10) Describe the borders of the femoral canal and the symptoms of the femoral hernia
The femoral canal goes from the inguinal region to the femoral triangle. The femoral sheath
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covers the triangle except for the saphenous hiatus. Bowel would travel through the femoral ring
and out the saphenous hiatus. The femoral hernia would show a bulge below the inguinal
line/ligament and is more common in women.

11) Describe the pes anserinus

The insertion point on the lateral knee for the sartorius (femoral inneration), gracilis (obturator
innervation), and semitendinous (sciatic innervation).

12) Describe the course of the saphenous nerve and the descending genicular artery
The saphenous nerve is a cutaneous posterior branch of the femoral nerve, which runs through
the adductor canal and pierces the vastoadductor membrane as it is leaving the canal. It runs
inferiorly and medially where it passes between the tendons of sartorius and gracilis. It then runs
inferior down the medial side of the leg in company with the great saphenous vein. It passes in
front of the medial malleolus and along the medial border of the foot, where it terminates in the
region of the ball of the big toe.
The descending genicular artery runs in the adductor canal with the femoral artery. It perforates
the vastoadductor membrane, leaving the adductor canal and descends on the medial side of the
knee passing between the sartorius and gracilis to the knee.

13) Describe the venous circulation of the lower limb

The great saphenous vein arises from the medial side of the dorsal venous arch and passes
upward directly in front of the medial malleolus. It continues to run superiorly on the medial side
of the thigh and passes through the lower part of the saphenous hiatus where it drains into the
femoral vein.
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The small saphenous vein arises from the lateral part of the dorsal venous arch and runs
behind/posterior to the lateral malleolus. It continues superiorly on the lateral side and up the
middle of the posterior side of the leg where it runs between the two heads of the gastrocnemius
muscle at the lower part of the politeal fossa, draining into the popliteal vein.

14) Describe the anatomy of the lesser and greater sciatic foramina
The greater sciatic foramen is formed by the greater sciatic notch of the hipbone and the
sacrotuberous and sacrospinous ligaments. It provides an exit from the pelvis into the gluteal
region. It contains:
Piriformis
Sciatic nerve
Posterior cutanous nerve of the thigh
Superior and inferior gluteal nerves
Nerves of the obturator internus and quadratus femoris
Pudendal nerve
Superior and inferior gluteal arteries and veins
Internal pudendal artery and vein
The lesser sciatic foramen is formed by the lesser sciatic notch of the hipbone and the
sacrotuberous and sacrospinous ligaments. It provides an enterance into the perineum from the
gluteal region. It contains:
Tendon of the obturator internus muscle
Nerve to obturator internus
Pudendal nerve
Internal pudendal artery and vein

15) Describe the ligaments supporting the plantar arch

Medial arch – plantar calcaneonavicular ligament (spring arch)
With hyaline cartilage that prevents talus from sinking between the calcaneus and navicular
bones
Connects anterior margin of sustentaculum tali of calcaneus to plantar surface of navicular
Also supports head of talus
Helps maintain the medial longitudinal arch of the foot
Strengthened by deltoid ligament of the ankle joint and supported inferiorly by the tendon
of tibialis posterior
Lateral arch – two ligaments span the calcaneocuboid joint
Long plantar ligament (long calcaneocuboid ligament)
Longest of all ligaments of tarsus
Attached behind to plantar surface of calcaneus in front of tuberosity on the plantar
surface of cuboid bones (Linfranc’s joint line)
Ligament converts groove on plantar surface of cuboid into canal for the tendon of
fibularis longus
Short plantar ligament (plantar calcaneocuboid ligament)
Deep to long plantar ligament
Short but wide band of great strength
From calcaneus to tuberosity of cuboid bone

16) Describe the arterial supply of the femoral head and the possible fracture sites

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The femoral head is supplied by the:

* Artery of the ligamentum capitis femoris into the fovea and acetabular branch of the
obturator artery; it is a branch of the internal iliac artery
* Ascending branch of the medial circumflex femoral artery from the deep femoral artery;
anastamotic ring around the femoral neck
* Ascending branch of the lateral circumflex femoral artery from the deep femoral artery;
anastamoses with ascending branch of lateral circumflex; mainly supplies the head and
neck of femur
If the femoral neck breaks, blood supply distally may be lost. From the descending branch of
medial and lateral circumflex femoral artery and from the deep femoral artery.
If fractured below the neck, circumflex arteries will supply the head of the femur. If fractured
within the capsule, necrosis may occur.

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