Shiraz University of Medical Sciences

Faculty of Medicine
Department of Anatomical Sciences

Handout of practical Limb anatomy

Upper Limb
Session 1
Bones of the upper limb, Surface anatomy & X‐ Ray

Shoulder girdle:

 Clavicle: Anatomical position, 2 surfaces,

2 ends (Sternal and acromial end), Conoid
tubercle, Trapezoid line, Subclavian
groove, Impression for costoclavicular
ligament,

- Surface anatomy : (Concave, convexity & 2 ends)

 Scapula: Anatomical position, 2 surfaces, 3 borders,

3 angles, 3 processes (spine, Acromial process,
Coracoids process), Supra & infra spinous fossa,
Acromial angle, Subscapular fossa, Glenoid cavity,
Supra & infraglenoid tubercle, Suprascapular notch,

‐ Surface anatomy: (spinous process, Medial

border, Acromial angle, Coracoid process,
Inferior angle)
 Humerus: Anatomical position
Upper end: Head, 2 necks (Surgical &Anatomical, 2 tubercles (greater & lesser), Intertubercular

groove)

Body: 3 borders & surfaces, Deltotid tuberosity, Radial (spiral) groove, Medial & lateral
supracondylar ridge.
Lower end: Articular = condyle (trochlea & capitulum) and non-articular =epicondyle
(medial & lateral epicondyle), Olecranon fossa, Coronoid fossa, Radial fossa,

Surface anatomy: greater & lesser tubercles, Deltoid tuberosity, Medial & lateral epicondyles.
Ulna: Anatomical position
Upper end: 2 processes (olecranon & coronoid),
2 notches (Trochlear & Radial), Ulnar
tuberosity
Body: 3border & surface, Supinator fossa,
Supinator crest,
Lower end: Head, Styloid process
Surface anatomy (Posterior border, Head,
Styloid process)

Radius: Anatomical position

Upper end: Head, Neck, Radial tuberosity
Body: 3borderes & surfaces, Pronator tubercle
Lower end: Surfaces, Dorsal tubercle, Ulnar notch, Styloid process
Surface anatomy: (Head, Dorsal tubercle, Styloid process)

Carpus : Pisiform, Triquetrum, Lunate ,Scaphoid,

Hamate ،Capitate, Trapezoid, Trapezium

Surface anatomy of above carpal bones

Metacarpus :
‐ Numbering
‐ Base, shaft, head
‐ Surface anatomy: shaft, head
Digits: proximal, middle, distal
Joints: Shoulder joint, elbow joint, radioulnar joint, wrist
joint, metacarpophalangeal joint (MCP) &interphalangeal joint
(PIP-DIP)
Session 2
Axillary cavity:
Walls, Function and Surface anatomy of muscles

 Muscles Connecting the Upper Limb to the Thoracic Wall

 Pectoral muscles
Pectoralis major, Pectoralis minor, Subclavius, Serratus anterior
 Muscles Connecting the Upper Limb to the Vertebral Column
 Back muscles
1- Superficial group:
a- Trapezius
b- Latissimus dorsi
2- Deep group:
a- Levator scapula
b- Rhomboid major
c-Rhomboid minor
 Muscles Connecting the Scapula to the Humerus
 Scapular muscles
Deltoid, supraspinatus, Infraspinatus, Teres minor, Teres major, Subscapularis
Rotator cuff muscles, triangular and quadrangular space

Function &Surface anatomy: Rhomboids, Trapezius, Latissimus dorsi, Pectoralis major, Deltoid,
supraspinatus, Infraspinatus, Teres minor, Teres major,
Session 3
Axillary cavity: Nerve and vessels & Surface anatomy

Axillary artery and its branches [Thoracoacromial, Lateral thoracic, Ant. & Pot. circumflex humeral,
Subscapular and branches (circumflex scapular artery and thoracodorsal artery)], axillary vein, cephalic vein,
roots, trunks, divisions & cords of brachial plexus.
The branches of the different parts of the brachial plexus which may be seen in cadaver, are as follows:
 Roots: C5, C6, C7, C8 T1
- Long thoracic nerve
 Upper trunk
- Suprascapular nerve
 Lateral cord
Lateral pectoral nerve
Musculocutaneous nerve
Lateral root of median nerve
 Medial cord
- Medial pectoral nerve
- Medial cutaneous nerve of arm
- Medial cutaneous nerve of
forearm
- Ulnar nerve
- Medial root of median
nerve
 Posterior cord
- Upper and lower
subscapular nerves
- Thoracodorsal nerve
- Axillary nerve
- Radial nerve
Session 4
Arm , Cubital fossa , Surface
anatomy

 Muscles (Biceps Brachii,

Coracobrachialis, Brachialis,
Triceps Brachii),
 Brachial artery and its branches
(Deep brachial, Superior & inferior
ulnar collateral)
 Brachial vein, Basilic vein, Median
cubital vein
 Ulnar nerve, Radial nerve, Median
nerve, Musculocutaneous nerve,
Superficial sensory nerves
 Cubital fossa :
- Borders
- Contents:
Median nerve, Brachial
artery, radial nerve

Surface anatomy: Biceps Brachii,

Coracobrachialis, Brachialis, Triceps
Brachii, Ulnar nerve, Radial nerve, Median nerve, Musculocutaneous nerve,
Lateral cutaneous nerve of forearm, medial cutaneous nerve of forearm, Brachial artery

Session 5
Muscles of Forearm , Function and Surface anatomy
Flexor Retinaculum, Carpal Tunnel, Extensor Retinaculum

Anterior compartment (8 muscles)

 - Superficial muscles of anterior
compartment
1. Pronator teres
2. Flexor carpi radialis
3. Palmaris longus
4. Flexor carpi ulnaris
- Middle muscle of anterior
compartment
1. Flexor digitorum superficialis
- Deep muscles of anterior
compartment
1. Flexor pollicis longus
2. Flexor digitorum profundus
3. Pronator quadratus

Lateral compartment (2 muscles)

1. Brachioradialis
2. Extensor carpi radialis longus

Posterior compartment (10muscles)

Superficial muscles of posterior
compartment: 5 muscle
1. Extensor carpi radialis brevis
2. Extensor digitorum
3. Extensor digiti minimi
4. Extensor carpi ulnaris
5. Anconeus

Deep muscles in posterior

compartment : 5 muscle
1. Supinator.
 2. Abductor pollicis longus.
3. Extensor pollicis longus.
3. Extensor indicis.
4. Extensor pollicis brevis

Surface anatomy: Flexor Retinaculum, Extensor Retinaculum

Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris, Flexor digitorum superficialis,
Extensor carpi radialis longus, Extensor carpi radialis brevis, Extensor digitorum, Extensor digiti minimi,
Extensor carpi ulnaris, Abductor pollicis longus, Extensor pollicis longus, Extensor indicis, Extensor pollicis
brevis

Session 6
Nerve and vessels of forearm & Hand , Surface anatomy, Upper limb MRI& CTS

Palmar aponeurosis, Carpal tunnel

Small Muscles of the Hand:

4 thumb
 Thenar muscles +Adductor pollicis

4 little finger
 Hypothenar Muscles + palmaris brevis

12 central
 4 lumbrical + 8 Interossei (4 Palmar Interossei & 4 Dorsal Interossei)
Arteries:
o Radial artery and its branches (Superficial palmar branch, First dorsal metacarpal artery, princeps
pollicis, radial indicis)
o Ulnar artery and its branches (Superficial and deep branches), Common interosseous artery and its
branch (Anterior and posterior interosseous arteries),
o Superficial palmar arch, Deep palmar arch, Palmar metacarpal artery, Common palmar digital artery,
o Princeps pollicis artery, Radialis indicis artery

Nerves: Ulnar nerve, Radial nerve, Posterior interosseous nerve, Median nerve, Anterior interosseous nerve,
Superficial sensory nerves, Deep branch of ulnar nerve

o Surface anatomy: Ulnar nerve, Radial nerve, Posterior interosseous nerve, Superficial radial nerve
Median nerve, Ulnar artery, Radial artery, Superficial palmar arch, Deep palmar arch
Lower Limb
Session 1
Bones of the lower limb , Surface anatomy & X‐ Ray

Hip: Anatomical position, External surfaces, Borders,

Gluteal surface, Iliac crest, Anterior
superior iliac spine ,
Anterior inferior iliac spine,
Posterior superior iliac spine,
Posterior Inferior iliac spine,
Iliac tubercle,
Lesser sciatic notches,
Greater sciatic notch, Greater and
lesser sciatic foramina, Ischial spine,
Ischial tuberosity, Symphysis pubis,
Ischiopubic ramus, Pectineal line,
Obturator crest, pubic tubercle, pubic
crest, Acetabulum, Acetabular notch,
Acetabular fossa, Lunate surface,
Obturator Foramen, Obturator
membrane, , Sacrotuberous ligament,
Sacrospinous ligament

Surface anatomy: (Iliac crest, Anterior superior iliac spine, Posterior superior iliac spine, Symphysis
pubis, pubic tubercle, Ischial tuberosity )
Femur: Anatomical position
o Upper end : Head, Neck , Fovea capitis, 2 trochanters (greater & lesser)

intertrochanteric line, Intertrochanteric crest , Quadrate tubercle

o Body : 3borders & surfaces, Linea aspera, Medial supracondylar ridge, Adductor tubercle
, Lateral supracondylar ridge, Gluteal tuberosity, Spiral line, Popliteal surface

o Lower end: Lateral and medial condyles, Intercondylar fossa, Medial and lateral epicondyles, Patellar
surface,

 Surface anatomy (Greater trochanter, Condyles of femur)

Patella: Anatomical position, Surfaces, base and apex

Tibia: Anatomical position
 o Upper end: Lateral and medial condyles, Anterior and
posterior intercondylar areas, Intercondylar eminence,
Lateral and medial intercondylar tubercles, Articular facet
for the head of the fibula, Tibial tuberosity
o Body : 3borders & surfaces, Soleal line
o Lower end: Lateral and medial condyles, Medial
malleolus, Articular surface for the talus, Fibular notch

 Surface anatomy (Tibial tuberosity,Anterior border of

tibia, Medial malleolus)

Fibula: Anatomical position

o Upper end : Head, Neck, Styloid process

o Body
o Lower end: Lateral malleolus, Malleolar fossa., articular facet for talus
 Surface anatomy (Head, Lateral malleolus )

Tarsal Bones
 Calcaneum : Anatomical position
6 surfaces, sulcus calcanei, Anterior, middle & posterior articular facets for the talus, Anterior
tubercle , Large medial and a smaller lateral tubercle, Sustentaculum tali, Peroneal tubercle

 Talus: Anatomical position

- Head: articular facets for the navicular bone, Anterior & middle articular facets for the calcaneus
- Neck: Sulcus tali, Sinus tarsi
- Body: Trochlear surface, Articular facet for articulation with the medial & lateral malleoluses,
Posterior process (Medial & lateral tubercle), Posterior articular facets for the calcaneus
Navicular, Cuneiformis (Medial, intermediate & lateral), Cuboid bone
 Surface anatomy of above trasal bones
(Peroneal tubercle, Sustentaculum tali, Navicular tuberosity, )

Metatarsus
‐ Numbering
‐ Base, shaft, head
‐ Surface anatomy: shaft, head

Digits: proximal, middle, distal

Hip Joint, Knee joint, Tibiofibular joint, Ankle joint, Tarsal joints, Tarsometatarsal and Intermetatarsal joints,
Metatarsophalangeal and Interphalangeal joints
Session 2
Antero‐medial aspect of the thigh , Surface anatomy
Fasia lata, Iliotibial tract, Femoral
triangle, Femoral sheath, femoral canal,
Adductor (subsartorial) canal, Great
saphenous vein

Muscles
Sartorius, Quadriceps muscle (Rectus
femoris, Vastus lateralis , Vastus
intermedius, Vastus medialis),

Tensor fascia lata, Iliopsoas, Pectineus,

Gracilis, Adductor longus,

Adductor brevis, Adductor magnus,

Nerve and Vesseles

Femoral artery and its branches (Deep
femoral artery, Lateral circumflex femoral
artery), Femoral vein, Great saphenous vein, Obturator nerve, Femoral nerve (Anterior & Posterior divisions
[saphenous n and nerve to vastus medialis])

Surface anatomy: Femoral artery, Femoral nerve, Quadriceps muscle, Adductor canal, Great saphenous vein
Session 3
Gluteal region , Post aspect of the thigh & Surface anatomy

Muscles
Gluteal muscles
Gluteus maximus, Gluteus medius, Gluteus
minimus, Tensor fascia lata, Piriformis,
Gemelus superior, Obturator internus,
Gemelus inferior, Quadratus femoris

Posteriot group muscles of thigh

Biceps femoris, Semitendinosus,
Semimembranosus, Adductor magnus
(hamstring part)

Nerve and Vesseles

Pudendal nerve,Nerve to obturator internus,
superior & inferior gluteal nerves, Sciatic
nerve, Common peroneal nerve, Tibial nerve,
Superficial sensory nerves (Posterior
cutaneous N. of thigh) , Perforating arteries from deep femoral artery, Internal pudendal artery, superior &
inferior gluteal arteries

Surface anatomy: Biceps femoris, Semitendinosus, Semimembranosus

Session 4
Popliteal fossa and Leg, Surface anatomy

Muscles

Anterior group muscles of leg

 Tibialis anterior
 Extensor hallucis longus
 Extensor digitorum longus
 Peroneus tertius


Posterior group muscles of leg

 Superficial layer triceps surae muscle

- Gastrocnemius
- Soleus
- Plantaris
  Deep layer
- Popliteus
- Flexor digitorum longus
- Flexor hallucis longus
- Tibialis posterior

Lateral group muscles of leg

 Peroneous longus
 Peroneus brevis

Popliteal fossa angles

Nerve and Vesseles

Popliteal artery & its branches (Anterior &
posterior tibial artery [fibular/peroneal artery
and perforating branch], genicular arteries),
Popliteal vein, Small saphenous vein, Tibial
nerve, Common peroneal nerve, Deep
peroneal nerve, Superficial peroneal nerve,
sural nerve, Sural communicating, lateral
cutaneous n. of the calf (lat. Sural)

Flexor, extensor & peroneal retinaculum

Surface anatomy: Tibialis anterior, Extensor

hallucis longus, Extensor digitorum longus
Gastrocnemius, Tibial nerve, Common
peroneal nerve, Deep peroneal nerve,
Superficial peroneal nerve, Anterior &
posterior tibial artery

Session 5
Foot, Surface anatomy, Lower limb
MRI& CTS
Plantar aponeurosis

Dorsal muscle of foot

 Extensor digitorum brevis , extersor

 hallucis brevis

Plantar muscles of foot

 First layer:

- Abductor hallucis

- Flexor digitorum brevis

- Abductor digiti minimi

 Second layer:

- Quadratus plantae

- Lumbricals

- Tendons: Flexor digitorum longus

&Flexor hallucis longus

 Third layer:

- Flexor hallucis brevis

- Adductor hallucis

- Flexor digiti minimi

 Fourth layer:

- Interossei: Dorsal (4) & Plantar (3)

- Tendons: Peroneus longus &Tibialis posterior

Nerve and Vesseles

Medial and lateral plantar arteries (Deep plantar arch), Dorsalis pedis artery, Dorsal metatarsal artery,

Plantar metatarsal artery, Medial and lateral plantar nerves

Session 2
The axillary cavity 1
The axilla or armpit is a pyramidal space situated between the upper part of arm and the chest wall

Apex (Boundaries)

 Anteriorly: Clavicle
 Posteriorly: Scapula (Superior border)
 Medially: First rib (Outer border)

Base

 Skin
 Fascia

Walls

Anterior:

 Pectoralis major (in front)

 Clavipectoral fascia enclosing
pectoralis minor and subclavius (behind)

Posterior:

 Subscapularis (above)
 Latissmus dorsi and teres major (below)

Medial:

 Serratus anterior (Upper part)

 Upper 4 ribs with their intercostal muscles

Lateral (is very narrow):

 Coracobrachialis
 Shaft of humerus (upper part)
 Biceps muscles (Long head)
Muscles
 Deltoid
 Supraspinatus
 Infraspinatus
 Teres minor
 Teres major
 Subscapularis

Subscapularis

Rotator cuff muscles

 Supraspinatus
 Infraspinatus
 Teres Minor
 Subscapularis

Intermuscular spaces
Three intermuscular spaces are to be seen in the scapular region
Upper triangular space
 Medial: Teres minor
 Lateral: Triceps (Long head)
 Inferior: Teres major
 Contents: Circumflex scapular artery

Lower triangular spaces

 Medial: Triceps (Long head)
 Lateral: Humerus (Lateral border)
 Superior: Teres major
 Contents: Radial nerve, Profunda brachii vessels

Quadrangular space

 Superior: Subscapularis (in front), Shoulder joint (Capsule), Teres minor (Behind)
 Inferior: Teres major
 Medial: Triceps (Long head)
 Lateral: Humerus (Surgical neck)
 Contents: Axillary nerve, Posterior circumflex humeral vessels
 Session 3
The axillary cavity 2
The axilla or armpit is a pyramidal space situated between the upper part of arm and the chest wall

Contents of the Axilla

• Axillary artery and its branches

• Axillary vein and its branches
• Brachial plexus (Infraclavicular part)
• Axillary lymph nodes and associated lymphatic
• Intercostobrachial nerve (lateral cutaneous branch of T2)
• Axillary fat and areolar tissue

Axillary artery

• The axillary artery gives six branches:

 From first part:

 Superior thoracic artery
• May not be found during dissection
 From second part:
 Thoraco-acromial artery
 Lateral thoracic artery

 From third part:

 Subscapular artery
• Gives off the circumflex scapular artery and thoracodorsal artery
 Anterior circumflex humeral artery

 Posterior circumflex humeral artery

• Passes through the quadrangular intermuscular space

Axillary vein

• It is the continuation of the basilica vein

• It is joint by the venae comitance of the brachial artery
• Lies on the medial side of the axillary artery
• Receives the cephalic vein at its upper part

Brachial plexus
The plexus consists of root, trunks, divisions and cords
 Roots
1
 • Constituted by the anterior primary rami of spinal nerves C5-T1
• Joints to form trunks
• Branches:
 Long thoracic nerve (C5-C7) supplies serratus anterior
 Dorsal scapular nerve (C5) supplies the rhomboids

 Trunks
• Root C5 and C6 joint to form the upper trunk
• Root C7 forms the middle trunk
• Root C8 and T1 joint to form the lower trunk
• Branches:
 Suprascapular nerve (From upper trunk)
 Nerve to subclavius (From upper trunk)

 Divisions
• Each trunk divides into ventral
and dorsal divisions
• Divisions joint to form the cords
• Has no branches

 Cords
• The lateral cord is formed by
union of the ventral divisions of
the upper and middle trunks
• Branches:
 Lateral pectoral
 Musculocutaneous
 Lateral root of median nerve

• The medial cord is formed by the

ventral division of the lower trunk
• Branches:
 Medial pectoral
 Medial cutaneous nerve of arm
 Medial cutaneous nerve of forearm
 Ulnar nerve
 Medial root of median nerve

• The posterior cord is formed by union of the dorsal divisions of all the trunks
• Branches:
 Upper subscapular nerve
 Thoracodorsal nerve
 Lower subscapular nerve
 Axillary nerve
 Radial nerve

2
Session 4
The upper arm and the cubital fossa

Arm’s anatomical layers

 Skin
 Superficial fascia
 Contents:
 Superficial sensory nerves:
 Supraclavicular nerve
 Upper lateral cutaneous nerve of arm
 Lower lateral cutaneous nerve of arm
 Medial cutaneous nerve of arm
 Intercostobrachial nerve
 Posterior cutaneous nerve of arm
 Superficial veins
 Cephalic vein
 Basilic vein

 Deep fascia
 Anterior fascial compartment
 Contents:
 Muscles; Biceps brachii, Corachobrachialis, and Brachialis
 Blood supply; Brachial artery
 Nerve supply; Musculocutaneous nerve

 Structure passing through the compartment

 Musculocutaneous, median and ulnar nerves
 Brachial artery
 Basilic vein
 Radial nerve (in the lower part )

 Posterior fascial compartment

 Contents:
 Muscles; The three head of the triceps muscle
 Blood supply; Profunda brachii and ulnar collateral arteries
 Nerve supply; Radial nerve

 Structure passing through the compartment:

 Radial nerve
 Ulnar nerve

1
 Brachial artery

 Branches:
 Muscular branches
 Nutrient artery to the humerus
 Profunda artery
 Superior ulnar collateral artery
 Inferior ulnar collateral artery
 Radial artery
 Ulnar artery

The cubital fossa

 Is a triangular depression that lies in front of the elbow

 Boundaries:
 Laterally; The brachioradialis muscle
 Medially; The pronator teres muscle
 The base; An imaginary line drawn between the two epicondyles of the humerus
 The floor; The supinator muscle (Laterally) and Brachialis muscle (Medially)
 The roof; Skin, Superficial fascia (Median cubital vein) and Deep fascia, Bicipital aponeurosis

 Contents (From the medial to the lateral side):

 The median nerve
 The bifurcation of the brachial artery into the ulnar and radial artery
 The tendon of biceps muscle
 Radial nerve and its deep branches

Surface anatomy

2
Session 5
The forearm 1

Forearm’s anatomical layers

 Skin
 Superficial fascia
 Contents:
 3 superficial sensory nerves:
 Lateral cutaneous nerve of the forearm (from musculocutaneous nerve)
 Medial cutaneous nerve of the forearm (from medial cord)
 Posterior cutaneous nerve of forearm (from radial nerve)
 2 superficial veins:
 Cephalic vein
 Basilic vein

 Deep fascia
 Anterior fascial compartment
 Contents:
 Muscles (8 muscles in 3 layers):
o Superficial layer (4): Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris*.
o Intermediate layer (1): The flexor digitorum superficialis
o Deep layer (3): Flexor pollicis longus, flexor digitorum profundus*(Medial part), and pronator
quadratus.
 Blood supply (2): Ulnar and radial arteries
 Nerve supply (2): Ulnar* and median nerves

 Lateral fascial compartment

 Contents:
 Muscles (2): The brachioradialis and extensor carpi radialis longus
 Blood supply (2): Radial and brachial arteries
 Nerve supply (1): Radial nerve

 Posterior fascial compartment

 Contents:
 Muscles (10 muscles in 2 layers):
o Superficial layer (5): Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi,
extensor carpi ulnaris, and anconeus.
o Deep layer (5): Supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis
longus, and extensor indicis.
 Blood supply (2): Anterior and posterior interosseous arteries
 Nerve supply (1): Radial nerve (Deep branch)

1
Surface anatomy

2
Session 6
The forearm 2 & the hand

Forearm vessels and nerves

 Superficial vessels
 Dorasal venous network
 Cephalic vein
 Basilic vein

 Deep vessels and nerves

 Anterior fascial compartment

 Ulnar artery
 Branches:
o Muscular branches
o Recurrent branches (Anterior and posterior)
o Common interosseous artery (is common between the anterior and posterior interosseous
arteries)

 Radial artery
 Branches:
o Muscular branches
o Recurrent branches
o Superficial palmar branch

 Median nerve
 Branches:
o Muscular branches
o Anterior interosseous nerve
o Palmar cutaneous branch

 Ulnar nerve
 Branches:
o Muscular branches
o Palmar cutaneous branch
o Dorsal cutaneous branch

 Lateral fascial compartment

 Radial nerve
 Branches:

1
 o Muscular branches
o Deep branch
o Superficial branch

 Posterior fascial compartment

 Posterior interosseous artery

 Anterior interosseous artery

 Radial nerve (Deep branch)

Hand

 Muscles (are in three groups)

 Central muscles:
 Lumbrical
 Interossei (4 palmar and 4 dorsal)

 Lateral muscles:
 Abductor Pollicis Brevis
 Flexor Pollicis Brevis
 Opponens Pollicis
 Adductor Pollicis

 Medial muscles:
 Palmaris brevis
 Abductor digiti minimi
 Flexor digiti minimi brevis
 Opponens digiti minimi

 Arteries
 Ulnar artery
 Branches:
o Superficial branch
 Anastomose with radial artery
 Gives of 4 digital branches
o Deep branch
 Joints the radial artery

 Radial artery
o Continues as deep palmar arch
 Branches
o Radialis indicis
o Princeps pollicis
2
 o Superficial palmar branch

 Median nerve
o Enters the hand posterior to the flexor retinaculum
 Branches
o Muscular & Recurrent branches
o Cutaneous (digital) branches

 Ulnar nerve
 Branches
o Superficial branch
o Deep branch

Surface anatomy

3
Session 8
Lower limb osteology

Lower limb bones

 The hip bone

 Femur
 Patella
 Tibia
 Fibula
 Tarsus
 Metatarsus
 Phalanges

 The hip bone

 Ilium
 3 Surfaces
1) Gluteal surface
 Has 3 Gluteal lines: Posterior, anterior and inferior
2) Iliac surface (iliac fossa)
3) Sacropelvic surface
 Has 3 parts: Iliac tuberosity, auricular surface and pelvic surface

 4 Borders
1) Superior border (iliac crest)
 ASIS
 Tuberculum
 PSIS
2) Anterior border
 ASIS
 AIIS
3) Posterior border
 PSIS
 PIIS
 Greater sciatic notch
4) Medial border
 Arcuate line
 Iliopubic eminence

 Pubis
 Body
 1 Border: Superior border (pubic crest + pubic tubercle)
1
  3 Surfaces:
1) Anterior surface
2) Posterior surface (Pelvic surface)
3) Medial surface (Symphyseal surface)

 Superior ramus
 3 Borders:
1) Superior border (pectineal line or pectin pubis)
2) Anterior border (obturator creat)
3) Inferior border
 3 Surfaces:
1) Pectineal surface
2) Pelvic surface
3) Obturator surface (presents obturator groove)

 Inferior ramus
 2 Borders
1) Upper border
2) Lower border
 2 Surfaces
1) Inner surface
2) Outer surface

 Ischium
 Body
 2 Ends:
1) Upper end
2) Lower end (ischial tuberosity)
 3 Borders:
1) Anterior border
2) Posterior border: Ischail spine and Lesser sciatic notch
3) Lateral border
 3 Surfaces:
1) Femoral surface
2) Dorsal surface
3) Pelvic surface

 Ramus
 2 Borders
1) Upper border
2) Lower border
 2 Surfaces
1) Inner surface
2) Outer surface

 Acetabulum
 Limbus of acetabulum
 Lunate surface
 Acetabular notch
 Acetabular fossa

2
 Obturator foramen

 Conjoint ischiopubic rami

 The inferior ramus of the pubis
 The ramus of the ischium

 Femur

 Upper end
 Head
 Fovea
 Neck
 2 Borders: Upper and lower borders
 2 Surfaces: Anterior and posterior surfaces
 2 Trochanters
1) Greater trochanter
o Apex
o Trochanteric fossa
2) Lesser trochanter
 Intertrochanteric line
 Intertrochanteric crest
 Quadrate tubercle

 Shaft
 Upper one-third:
 4 Borders: Medial and lateral borders, spiral line and gluteal tuberosity
 4 Surfaces: Anterior, medial, lateral and posterior surfaces

 Middle one-third:
 3 Borders: medial, lateral and posterior (Linea aspera) borders
 3 Surfaces: Anterior, medial and lateral surfaces

 Lower one-third:
 4 Borders: Medial and lateral borders, medial and lateral supracondylar lines
 4 Surfaces: Anterior, medial, lateral and popliteal surfaces

 Lower end
 2 Condyles: Medial and lateral condyles
 2 Articular surfaces
1) Patellar surface
2) Tibial surface
 2 Epicondyles:
1) Medial epicondyle: presents adductor tubercle
2) Lateral epicondyle: presents popliteal groove
 Intercondylar notch
 Intercondylar line
3
 Patella

 2 Surfaces
1) Anterior surface
2) Posterior surface: has 2 eras; Larger lateral area and smaller medial area
 Base (Superior border)
 Apex
 Borders: Superior, medial and lateral borders

 Tibia

 Upper end
 2 Condyles:
1) Medial condyle
2) Lateral condyle
o Gerdy’s tubercle
o Fibular facet
 Intercondylar area
 Intercondylar eminence
 2 Intercondylar tubercles: Medial and lateral intercondylar tubercles
 Tibial tuberosity

 Shaft
 3 Borders: Medial, lateral (interosseus) and anterior borders
 3 Surfaces:
 Medial surface
 Lateral surface
 Posterior surface
o Soleal line
o Vertical line
o Nutrient foramen

 Lower end:
 5 surfaces
1) Medial surface: presents medial malleolus
2) Lateral surface: presents fibular notch
3) Anterior surface
4) Posterior surface
5) Inferior surface

4
  Fibula

 Upper end
 Head
 Apex (Styloid process)
 Articular facet
 Neck

 Shaft
 3 Borders: Anterior, medial (interosseus) and posterior borders
 3 Surfaces: Medial, lateral and posterior (presents medial crest) surfaces

 Lower end
 4 surfaces
 Lateral malleolus
 Malleolar fossa

 Tarsus

 Proximal row
 Talus
 Head
o Navicular facet
 Neck
 Body
o 5 surfaces
 Superior surface: presents a trochlear surface
 Inferior surface: presents 3 Calcaneal facets and sulcus tali
 Medial surface: presents a Comma-shaped artricular surface
 Lateral surface: presents a triangular articular surface and lateral tubercle
 Posterior surface: presents an oblique groove , medial and lateral tubercles

 Calcaneus
 6 surface
o Lateral surface: presents fibular trochlea (or tubercle)
o Medial surface: presents sustentaculum tali
o Posterior surface: presents calcanean tuberosity
o Inferior (Plantar) surface: marked by 3 tubercles (Medial, lateral and anterior)
o Superior (Dorsal) surface: presents sulcus calcanei and 3 facets for talus
o Anterior surface: bears a facet for cuboid
 Sinus tarsi

 Intermediate row
 Navicular
 Navicular tubrosity
5
 Distal row
 3 Cuneiform bones
o Medial cuneiform
o Intermediate cuneiform
o Lateral cuneiform
 Cuboid
o Oblique groove
o Tuberosity

 Metatarsus

 Base
 Shaft
 Head

 Phalanges

 14 phalanges in each foot

 2 for the great toe
 3 for each of the other toies

6
Session 8
The front and medial aspects of the thigh

 Skin
 Superficial fascia
 Deep fascia
 Fascial compartments of the thigh
 Spaces
 Femoral artery
 Femoral vein
 Femoral nerve
 Obturator artery
 Obturator vein
 Obturator nerve

 Skin

 Cutaneous nerves
 The lateral cutaneous nerve of the thigh (L2 and L3)
 The genitofemoral nerve (L1 and L2)
 The femoral branch
 The ilioinguinal nerve (L1)
 Obturator nerve
 Anterior division
 Femoral nerve (L2, L3 and L4)
 Anterior division
o Medial cutaneous nerve of the thigh
o Intermediate cutaneous nerve of the thigh
o Saphenous nerve

 Superficial fascia

 Has 2 layers
 The membranous layer
 Fatty layer
 Contents:
o Cutaneous nerves
1
 o Cutaneous arteries
 Superficial circumflex iliac artery
 Superficial epigastric artery
 Superficial external pudendal artery
o Saphenous vein and its tributaries
 Superficial circumflex iliac vein
 Superficial epigastric vein
 Superficial external pudendal vein
 Accessory saphenous vein
o Superficial inguinal lymph nodes
 Horizontal group
 Vertical group
o Subcutaneous bursae
 Prepatellar bursa
 Subcutaneous infrapatellar bursa

 Deep fascia

 Modifications
 The iliotibial tract
 Saphenous opening
 Falciform margin
 Cribriform fascia
 Intermuscular septa
 Anterior intermuscular septum
 Medial intermuscular septum
 Posterior intermuscular septum

 Fascial compartments of the thigh

 Anterior (Extensor) compartment

 Muscles
1) Sartorius
2) Iliacus
3) Psoas
4) Pectineus
5) Quadriceps femoris
 Rectus femoris
 Vastus lateralis
 Vastus medialis
 Vastus intermedius
 Vessels
1) Femoral artery
2
 2) Femoral vein
 Nerve supply
1) Femoral nerve
2) Obturator nerve for posterior fibers of the pectineus

 Medial (Adductor) compartment

 Muscles
1) Gracilis
2) Adductor longus
3) Adductor brevis
4) Aductor magnus (Adductor part)
5) Obturator externus
 Vessels
3) Profunda femoris artery and vein
4) Obturator artery and vein
 Nerve supply
3) Obturator nerve
4) Femoral nerve for anterior fibers of the pectineus

 Posterior (Flexor) compartment

 Spaces

 Femoral triangle
 Boundaries
 Laterally: Medial border of the Sartorius
 Medially: Medial border of the adductor longus
 Superiorly: Inguinal ligament
 Roof
o Skin
o Superficial fascia containing:
 Superficial inguinal lymph nodes
 Femoral branch of genitofemoral nerve
 Ilioinguinal nerve
 Superficial branches of the femoral artery
1) Superficial circumflex iliac artery
2) Superficial epigastric artery
3) Superficial external pudendal artery
 Great saphenous vein and its terminal tributaries
1) Superficial circumflex iliac vein
2) Superficial epigastric vein
3) Superficial external pudendal vein
o Deep fascia with its modifications
 Saphenous opening
 Cribriform fascia
3
 Floor
o Medially: Adductor longus and pectinus
o Laterally: Iliacus and posas major
 Contents
 Femoral artery and its branches
 Femoral vein and its tributaries
 Femoral sheath
o Is formed by 2 fascial layers
 Facsia transversalis
 Fascia iliaca
o Is divided into 3 compartments
 Lateral or arterial compartment
 Intermediate or venous compartment
 Medial or lymphatic compartment (Femoral canal)
 Femoral nerve
 Nerve to pectineus
 Femoral branch of genitofemoral nerve
 Lateral cutaneous nerve of thigh
 3 Deep inguinal lymph nodes

 Femoral canal
 This is medial compartment of femoral sheath
 Being wide above and narrow blow
 It is about 1.5 cm long and about 1.5 cm wide at base
 The base or upper end is called femoral ring
 Boundaries
 Anteriorly: Inguinal ligament
 Posteriorly: Superior ramus of the pubis, pectineus and its fascia
 Medially: lacunar ligament
 Laterally: Femoral vein
 Contents:
o Fatty connective tissue
o All the efferent lymph nodes
o One of the deep inguinal lymph node

 Adductor, subsartorial or Hunter’s canal

 Boundaries
 Upper end: Apex of the femoral triangle
 Lower end: Adductor hiatus in the adductor magnus
 Anterior or lateral wall: Vastus medialis
 Medial or anteromedial wall:
o Sartorius,
o Subsartorial plexus which is formed by branches from:
 Medial cutaneous nerve of thigh
 Saphenous nerve
 Anterior division of the obturator nerve
4
 o A fibrous membrane which joins anterior and posterior walls
 Floor or posterior wall:
o Adductor longus (above)
o Adductor magnus (blow)
 Contents
 Femoral artery
 Femoral vein
 Saphenous nerve
 Nerve to the vastus medialis
 Obturator nerve

 Femora artery

 Relations
 Anteriorly
o In the upper part:
 Skin
 Fascia
o In the lower part:
 Sartorius,
 Medial cutaneous nerve of thigh
 Saphenous nerve
 Posteriorly
 Psoas major and hip joint
 Pectineus
 Adductor longus and femoral vein
 Medially
 Femoral vein
 Laterally
 Femoral nerve
 Branches
1) Superficial circumflex iliac artery
2) Superficial epigastric artery
3) Superficial external pudendal artery
4) Deep external pudendal artery
5) Profunda femoris artery
 Medial circumflex femoral artery
 Lateral circumflex femoral artery
 4 Perforating arteries
6) Descending genicular artery
7) Muscular branches

 Femoral vein

 Relation to femoral artery

5
  At the mid-inguinal point: lies medial to the artery
 At the apex of femoral triangle: lies posterior to the artery
 At the end of femoral canal: lies lateral to the artery

 Branches
 Superficial circumflex iliac vein
 Superficial epigastric vein
 Superficial external pudendal vein
 Deep external pudendal vein
 Profunda femoris vein
 Medial circumflex femoral vein
 Lateral circumflex femoral vein
 Great saphenous vein

 Femoral nerve
 Course
 Emerges from lateral border of the psoas major
 Passes in the interval between the psoas and ilaicus
 Enter the thigh lateral to femoral sheath
 Branches
 Muscular branches for muscles of the anterior fascial comartment
 Cutaneous branches
o Saphenous nerve
o Medial cutaneous nerve of the thigh
o Intermediate cutaneous nerve of the thigh
 Articular branches for hip and knee joints
 Vascular branches for femoral artery

 Obturator nerve
 Course
 Emerges from medial border of the psoas major
 Runs on the lateral wall of the pelvis
 Divides into anterior and posterior division at the upper part of obturator foramen
 Branches
 Muscular branches for muscles of the medial fascial comartment
 Cutaneous branches for medial side of the thigh
 Articular branches for hip and knee joints
 Vascular branches for popliteal artery

6
7
8
9
Session 10
The Gluteal region

The Gluteal region

 Skin and superficial fascia
 Deep fascia
 Deep structures

 Skin and superficial fascia

 Cutaneous nerves

 The upper medial quadrant

 Posterior rami of the upper 3 lumber nerves
 Posterior rami of the upper 3 sacral nerves

 The upper lateral quadrant

 Lateral branch of the iliohypogastric nerve
 Twelfth thoracic nerve

 The lower medial quadrant

 Perforating cutaneous nerve
 Posterior cutaneous nerve of thigh

 The lower lateral quadrant

 Lateral cutaneous nerve of thigh

 Blood supply

 Perforating branches of the superior gluteal artery

 Perforating branches of the inferior gluteal artery

 Lymphatic drainage

 The lateral group of the superficial inguinal lymph nodes

1
 Deep fascia

 Deep structures

 Muscles
 Nerves
 Vessels

 Muscles

 Are organized in 4 layers

 First layer
o Gluteus maximus
o Tensor fascia lata

 Second layer
o Gluteus medius

 Third layer
o Gluteus minimus
o Piriformis
o Superior gemellus
o Obturator internus
o Inferior gemellus
o Quadratus femoris

 Fourth layer
o Obturator externus

2
 Nerves

 The nerves which enter the gluteal region through the greater sciatic notch

 Above piriformis

o Superior gluteal nerve which supplies:

 Gluteus medius
 Gluteus minimus
 Tensor fascia lata

 Below piriformis

o Sciatic nerve which supplies:

 The muscles of the posterior compartment of the thigh
 The muscles of the leg
 The muscles of the foot
 The skin of the leg and foot except for their medial sides
 The joints of the lower limb

o Posterior cutaneous nerve of thigh which supplies the skin of:

 The lower medial quadrant of the gluteal region
 The posterior two thirds of the scrotum and labium major
 The roof of the popliteal fossa
 The upper half of the posterior of the leg

o Inferior gluteal nerve which supplies:

 Gluteus maximus

o Nerve to the obturator internus which supplies:

 Superior gemellus
 Obturator internus

o Pudendal nerve which supplies:

 External anal sphincter
 Mucous membrane of lower half of anal canal
 Perianal skin
 Skin of penis, scrotum, clitoris, labia majora and labium minora

o Nerve to quadratus femoris which supplies:

 Inferior gemellus
 Quadratus femoris

o Perforating cutaneous nerve which supplies:

 The skin of the lower medial quadrant of the gluteal region

 The nerves which enter the ischiorectal fossa through the lesser sciatic notch
o Pudendal nerve
3
 o Nerve to the obturator internus

 Vessels

 The vessels which enter the gluteal region through the greater sciatic notch

 Above piriformis
o Superior gluteal vessels

 Below piriformis
o Inferior gluteal vessels
o Internal pudendal vessels

 The vessels which enter the ischiorectal fossa through the lesser sciatic notch
o Internal pudendal vessels

 Trochanteric anastomosis is situated near trochanteric fossa and is formed by:

 Superior gluteal artery
 Inferior gluteal artery
 Medial circumflex femoral artery
 Lateral circumflex artery

 Cruciate anastomosis is situated at level of the lesser trochanter and is formed by:
 Inferior gluteal artery
 Medial circumflex femoral artery
 Lateral circumflex artery
 First perforating artery

 Lymphatic drainage

 Drain into the internal iliac lymph nodes

4
Session 11
The back of the thigh and the popliteal fossa

The back of the thigh (Posterior or flexor compartment)

 Cutaneous nerves

 Posterior cutaneous nerve of thigh

 Obturator nerve
 Medial cutaneous nerve of thigh
 Lateral cutaneous nerve of thigh

 Deep structures

 Muscles
 Nerves
 Vessels

 Muscles (Hamstring muscles)

 Semitendinosus
 Origin: Ischial tuberosity
 Insertion: Tibia (upper part of the medial surface of the shaft)
 Function:
o Flexes and medially rotates leg at knee joint
o Extends thigh at hip joint

 Semimembranosus
 Origin: Ischial tuberosity
 Insertion: Tibia (medial condyle)
 Function:
o Flexes and medially rotates leg at knee joint
o Extends thigh at hip joint

 Biceps femoris
 Origin:
o Long head: Ischial tuberosity
o Short head: Linea aspera, lateral supracondylar ridge

1
  Insertion: Fibula (head)
 Function:
o Flexes and laterally rotates leg at knee joint
o Extends thigh at hip joint

 Adductor magnus (Hamstring portion)

 Origin: Ischial tuberosity
 Insertion: Femur (adductor tubercle)
 Function: Extends thigh at hip joint

 Nerves

 Sciatic nerve

 Tibial nerve which supplies:

o All hamstring muscles except short head of biceps femoris

 Common peroneal nerve which supplies:

o The short head of the biceps femoris

 Vessels

 Perforating branches of the profunda femoris vessels

 Lymphatic vessels

 Upper part drain into internal iliac lymph nodes

 Lower part drain into deep inguinal lymph nodes

 The popliteal fossa


 The boundaries

 Superolaterally
 The biceps femoris

 Superomedially
 The semitendinosus
 The semimembranosus
 Suplemented by:
o The sartorius
o The gracilis
2
 o The adductor magnus

 Inferolaterally
 The gastrocnemius (lateral head)
 Supplemented by:
o The plantaris

 Inferomedially
 The gastrocnemius (medial head)

 Roof
 Skin
 Superficial fascia which contains:
o The short saphenous vein
o 3 cutaneous nerves:
 The posterior cutaneous nerve of thigh (Terminal part)
 Medial cutaneous nerve of thigh (Posterior division)
 Peroneal (sural) communicating nerve
 Deep fascia

 Floor
 The popliteal surface of the femur
 The capsule of the knee joint
 Oblique popliteal ligament
 Popliteal fascia covering the popliteus muscle

 The contents

 The popliteal artery and its branches

 Muscular branches
 Cutaneous branches
 Genicular branches
o Superior genicular arteries (Medial and lateral)
o Inferior genicular arteries (Medial and lateral)
o Middle genicular artery

 The popliteal vein and its tributaries

 The veins corresponding to the branches of the popliteal artery
 The small saphenous vein

 The tibial nerve and its branches

 Muscular branches to
o The gastrocnemius
o The soleus
o The plantaris
o The popliteus
3
  3 genicular branches
o The superior medial genicular nerve
o The middle genicular nerve
o The inferior medial genicular nerve
 Cutaneous branch (Sural nerve)

 The common peroneal nerve and its branches

 2 cutaneous branches
o The peroneal (Sural) communicating nerve
o The lateral cutaneous nerve of the calf

 3 genicular branches
o The superior lateral genicular nerve
o The inferior lateral genicular nerve
o The recurrent genicular nerve

 The posterior cutaneous nerve of the thigh

 The genicular branch of the obturator nerve
 The popliteal lymph node
 Fat

 The surface anatomy



4
Session 12
The leg

 Skin
 Superficial fascia
 Contents
 Cutaneous nerves
 Superficial veins
 Superficial lymphatic vessels

 Deep fascia
 Derivatives
 Fascial compartments of the leg
 Anterior compartment
 Lateral compartment
 Posterior compartment
 Contents
 Muscles
 Vessels
 Nerves

 Superficial fascia

 Cutaneous nerves

 The front of the leg

 The saphenous nerve
 Lateral cutaneous nerve of the calf
 Superficial peroneal nerve

 The back of the leg

 The saphenous nerve
 The posterior division of the medial cutaneous nerve of the thigh
 The posterior cutaneous nerve of the thigh
 Lateral cutaneous nerve of the calf
 The sural nerve
 The sural communicating nerve
 The medial calcaneal branch

1
  Superficial veins

 The great (long) saphenous vein

 The small (short) saphenous vein

 Lymphatic vessels

 The lymph vessels from skin and superficial fascia drain into
 Vertical group of superficial inguinal nodes
 The popliteal nodes

 Deep fascia

 Derivatives of deep fascia

 Intermuscular septa
 Anterior intermuscular septum
 Posterior intermuscular septum
 Transvers septa
o Deep transverse septum
o Superficial transverse septum
 Interosseous membrane
 Retinacula of the ankle
 Superior extensor retinaculum
 Inferior extensor retinaculum
 Flexure retinaculum
 Superior peroneal retinaculum
 Inferior peroneal retinaculum

 Fascial compartments of the leg

 Anterior compartment

 Muscles
o Tibialis anterior
o Extensor digitorum longus
o Peroneus tertius
o Extensor halluces longus
 Nerve supply: Deep peroneal nerve
 Blood supply
2
 o Anterior tibial artery
o Perforating branch of the peroneal artery
 Lymphatic drainage: Popliteal nodes

 Lateral compartment

 Muscles
o Peroneus longus
o Peroneus brevis
 Nerve supply: Superficial peroneal nerve
 Blood supply: Branches from the peroneal artery
 Lymphatic drainage: Popliteal nodes

 Posterior compartment

 Muscles
o Superficial group
 Gastrocnemius
 Plantaris
 Soleus
o Intermediate group
 Popliteus
 Flexor digitorum longus
 Flexor hallucis longus
o Deep group
 Tibialis posterior
 Nerve supply: Tibial nerve
 Blood supply: Posterior tibial artery
 Lymphatic drainage: Popliteal nodes

 Muscles

 Tibialis anterior
 Extensor digitorum longus
 Peroneus tertius
 Extensor halluces longus
 Peroneus longus
 Peroneus brevis
 Gastrocnemius
 Plantaris
 Soleus
 Popliteus
 Flexor digitorum longus
 Flexor hallucis longus
 Tibialis posterior
3
 vessels

 Anterior tibial artery

 Course
 Begins at the lower border of popliteus
 Terminates at a point midway between the two malleoli

 Branches
 Muscular branches
 Anastomotic branches
o Anterior tibial recurrent artery
o Posterior tibial recurrent artery
o Anterior medial malleolar artery
o Anterior lateral malleolar artery

 Posterior tibial artery

 Course
 Begins at the lower border of popliteus
 Terminates deep to the flexor retinaculum

 Branches
 The peroneal artery
o Muscular branches
o Nutrient artery to the fibula
o Anastomotic branches
 Perforating branch
 Communicating branch with the posterior tibial artery
 Calcaneal branch
 Muscular branches
 The nutrient artery to the tibia
 Anastomotic branches
o Circumflex fibular artery
o Communicating branch with the fibular artery
o Malleolar branch
o Calcaneal branch
 Terminal branches
o Medial plantar artery
o Lateral plantar artery

 Deep lymphatic vessels

 Terminates into the popliteal nodes

 Venae comitantes of the arteries

4
 Nerves

 Deep peroneal nerve

 Course
 Begins on the lateral side of the neck of the fibula
 Terminates on the dorsum of the foot

 Branches
 Muscular branches supply
o The muscles of the anterior compartment of the leg
o The extensor digitorum brevis
o 1st and 2nd dorsal interossei
 Cutaneous branch supplies
o Adjacent sides of the 1st and 2nd toes
 Articular branches supply
o Ankle joint
o Tarsal joints
o Tarsometatarsal joints
o Metatarsophalangeal joint
 Terminal branches
o Lateral terminal branch
o Medial terminal branch

 Superficial peroneal nerve

 Course
 Begins on the lateral side of the neck of the fibula
 Terminates at the junction of the upper two third and lower one third of the leg

 Branches
 Muscular branches supply
o The muscles of the lateral compartment of the leg
 Terminal cutaneous branches supply
o The lower one third of the lateral side of the leg
o The greater part of the dorsum of the foot

 Tibial nerve

 Course
 Begins at the superior angle of the popliteal fossa
 Terminates deep to the flexor retinaculum

 Branches
 Muscular branches supply
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 o The muscles of the posterior compartment of the leg
 Cutaneous branch
o Medial calcaneal branch
 Articular branch supplies
o Ankle joint
 Terminal branches
o Medial plantar nerve
o Lateral plantar nerve

 Surface anatomy

6
Session 13
The foot

 The dorsum of the foot

 Skin

 Superficial fascia

 Contents:

 Cutaneous nerves
o Superficial peroneal nerve
 Medial dorsal cutaneous nerve
 Intermediate dorsal cutaneous nerve
o Saphenous nerve
o Sural nerve
 Lateral dorsal cutaneous nerve
o Deep peroneal nerve
 Medial terminal branch
o Plantar nerves
 Digital branches

 Superficial veins
o Dorsal venous arch
o Dorsal metatarsal veins
o Marginal veins
o Great saphenous vein
o Small saphenous vein

 Superficial lymphatic vessels drain into:

o Popliteal nodes
o Superficial inguinal nodes

 Deep fascia

 Contents:

 Muscles
o Extensor digitorum brevis
 Origin: Calcaneum
 Insertion: Proximal phalanx of big toe and long flexor tendons
 Innervation: Deep peroneal nerve
1
  Function: Extends toes
o Tendons
 Tibialis anterior
 Extensor hallucis longus
 Extensor digitorum longus
 Peroneus tertius

 Nerves
o Deep peroneal nerve
 Lateral branch which supplies:
1. Extensor digitorum brevis
2. Tarsal joints
3. Sometimes the 2nd dorsal interosseus

 Medial branch which supplies:

1. The skin of the 1st interdigital cleft
2. The proximal joints of big toe
3. Sometimes the 1st dorsal interosseus muscle

 Vessels

 Arteries
o Dorsalis pedis artery
 Beginning: In front of ankle between the 2 malleoli
 Termination: 1st intermetatarsal space
 Branches:
1. Medial tarsal arteries
2. Lateral tarsal artery
3. Arcuate artery
4. Dorsal metatarsal arteries

 Deep veins accompany arteries

 Deep lymphatic vessels drain into anterior tibial nodes

 The sole of the foot

 Skin

 Superficial fascia

 Derivatives
 Superficial transverse metatarsal ligament

 Contents

 Cutaneous nerves
2
 o Tibial nerve
 Medial calcaneal branch
 Medial plantar nerve
 Lateral plantar nerve
o Sural nerve
o Femoral nerve
 Saphenous branch

 Superficial veins drain into:

o Small saphenous vein
o Great saphenous vein

 Superficial lymphatic vessels drain into:

o Popliteal nodes
o Superficial inguinal nodes

 Deep fascia

 Derivatives
 Plantar aponeurosis
 Deep transverse metatarsal ligament
 Fibrous flexor sheath

 Contents

 Muscles which divide into 4 layers:

o First layer
 Abductor hallucis
 Flexor digitorum brevis
 Abductor digiti minimi

o Second layer
 Quadratus plantae (Flexor digitorum accessories)
 Lumbricals (4)
 Flexor digitorum longus tendon
 Flexor hallicis longus tendon

o Third layer
 Flexor hallucis brevis
 Adductor hallucis
 Flexor digiti minimi brevis

o Forth layer
 Interossei (7)
 Peroneus longus
3
  Tibialis posterior

 Nerves

o Medial plantar nerve

 Sensory branches supply:

1. Skin of the medial part of the sole
2. Skin of medial 3.5 toes

 Motor branches supply:

1. Abductor hallucis
2. Flexor digitorum brevis
3. First lumbrical
4. Flexor hallucis brevis

 Articular branches supply:

1. Joints of tarsus
2. Joints of metatarsus

o Lateral plantar nerve

 Main trunk supplies

1. Flexor digitorum accessories
2. Abductor digiti minimi
3. Skin of the sole

 Superficial branch supplies:

1. Flexor digiti minimi brevis
2. 3 plantar interosseous
3. 4 dorsal interosseous
4. Skin of lateral 1.5 toes

 Deep branch supplies (Lies between 3rd and 4th layers of the sole)
1. 2nd, 3rd, and 4th lumbricals
2. Adductor hallucis
3. 5 interossei of the first 3 intermetatarsal space

 Vessels
 Arteries
o Medial plantar artery gives off:
 Muscular branches
 3 superficial digital branches

o Lateral plantar artery gives off:

 Muscular branches
 Superficial branches
 Anastomotic branches
 Calcaneal branch
 Plantar arch
1. Beginning: the base of the 5th metatarsal bone
4
 2. Termination: 1st intermetatarsal space
3. Location: between 3rd and 4th layers of the sole
4. Branches:
1. Three proximal perforating arteries
2. Four plantar metatarsal arteries which give off:
1. Four distal perforating arteries
2. Plantar digital arteries

 Deep veins accompany arteries

 Deep lymphatic vessels drain into the popliteal nodes

 Relation of the ankle joint

 Structures that pass anterior to the extensor retinacula from medial to lateral
o Saphenous nerve
o Great saphenous vein
o Superficial peroneal nerve
 Medial branch
 Lateral branch
 Structures that pass beneath or through the extensor retinacula from medial to lateral
o Tibialis anterior tendon
o Extensor hallucis longus tendon
o Anterior tibial artery with venae comitantes
o Deep peroneal nerve
o Extensor digitorum longus tendons
o Peroneus tertius
 Structures that pass in front of the medial malleolus
o Great saphenous vein
o Saphenous nerve
 Structures that pass behind the medial malleolus beneath the flexor retinaculum from medial
to lateral
o Tibialis posterior tendon
o Flexor digitorum longus
o Posterior tibial artery with venae comitantes
o Tibial nerve
o Flexor hallucis longus
 Structures that pass behind the lateral malleolus superficial to the superior peroneal
retinaculum
o The sural nerve
o Small saphenous vein
 Structures that pass behind the lateral malleolus beneath the superior peroneal retinaculum
o The peroneus longus tendon
o The peroneus brevis tendon
 Structures that lie directly behind the ankle
o The fat
o Tendo calcaneus

5
 Surface anatomy