surface anatomy lower limb.pdf

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Surface Anatomy

A branch of gross anatomy that examinesshapes and markings on the surface of thebody as they relate to deeper structures.

Essential in locating and identifying anatomicstructures prior to studying internal grossanatomy.

Health-care personnel use surface anatomyto help diagnose medical conditions and totreat patients.

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Surface Anatomy four techniques when examining surface anatomy

visual inspection

directly observe the structure and markings of surfacefeatures

palpation

feeling with firm pressure or perceiving by the sense oftouch)

precisely locate and identify anatomic features under theskin

percussion

tap sharply on specific body sites to detect resonatingvibrations

auscultation

listen to sounds emitted from organs

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Surface anatomy of lower limb

Gluteal region and thigh anterior superior and inferior iliac

spines tubercle of iliac crest ischial tuberosity greater trochanter pubic tubercle pubic crest superior border of pubic symphysis

Knee patella ligament tuberosity of tibia medial and lateral condyles and

epicondyles tendon of biceps femoris tendons of semitendinosus and

semimembranosus head of fibula

Leg anterior border of tibia neck of fibula

Ankle and foot medial and lateral malleolus calcaneal tuberosity tuberosity of navicular bone tuberosity of fifth metatarsal bone

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Gluteal Region

The inferior border of the gluteus maximus muscleforms the gluteal fold.

The gluteal (natal) cleft extends vertically to separatethe buttocks into two prominences.

In the inferior portion of each buttock, an ischialtuberosity can be palpated; these tuberositiessupport body weight while seated.

The gluteus maximus muscle forms most of theinferolateral fleshy part of the buttock.

The gluteus medius muscle may be palpated only inthe superolateral portion of each buttock.


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Gluteal Region: Landmarks

Iliac crests

Posterior superior iliac spine

Sacroiliac joint

Prominences of the buttocks

Cheeks of the buttocks

Formed from subcutaneous fat and thegluteal muscles

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The Gluteal Region

Figure 11.37

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Lower Limb and Gluteal Region

Natal cleft (gluteal cleft)

Vertical midline groove between cheeks

Gluteal fold

Horizontal fold below each cheek

Ischial tuberosities

Greater trochanter of the femur

Located at the lateral hip

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Lower Limb and Gluteal Region

Figure 11.38a


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The Thigh

Many muscular and bony features are readilyidentified in the thigh, which extends between thehip and the knee on each lower limb.

An extremely important element of thigh surfaceanatomy is a region called the femoral triangle.

The femoral artery, vein, and nerve travel throughthis region, making it an important arterial pressurepoint for controlling lower limb hemorrhage.

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Thigh : Landmarks

Medial and lateral condyles of the femur

Patella

Three groups of muscles

Quadriceps femoris anterior thigh

Vastus lateralis injection site

Adductors medial thigh

Hamstrings posterior thigh

13-11Figure 11.38b

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The Thigh

The Femoral Triangle Superior border inguinal ligament

Inferior borders Sartorius

Adductor longus

Popliteal fossa Diamond-shaped hollow on posterior knee

Defined by borders of hamstring tendons and

gastrocnemius


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Femoral triangle

A triangular depressed area situated in theupper part of the medial aspect of the thigh justbelow the inguinal ligament

Boundaries

Superiorly (base) : the inguinal ligament

Laterally: medial border of sartorius

Medially: medial border of adductor longus

Apex: continuous with adductor canal

Anterior wall: fascia lata

Posterior wall: consists of iliopsoas, pectineusand adductor longus from lateral to medial side

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Femoral triangle

Contents Femoral n.

Femoral sheath

Femoral a. and its branches

Femoral vein and its tributaries.

Femoral canal

Deep inguinal lymph nodes

Fatty tissue

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Thigh and Knee

On the distal part of the anterior thigh, are the threeparts of the quadriceps femoris as they approach theknee.

Still on the anterior side of the thigh, three obviousskeletal features can be observed and palpated: (1) The greater trochanter is palpated on the superior lateral

surface of the thigh;

(2) the patella is located easily within the patellar tendon;and

(3) the lateral and medial condyles of both the femur andtibia are identified and palpated at each knee.

13-16Figure 11.40a, c


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Foot and Toes

The phalanges, metatarsophalangeal joints, PIP andDIP joints, and toenails are obvious surfacelandmarks readily observed when viewing either thelateral side or the dorsum of the foot.

The medial surface of the foot clearly illustrates thehigh, arched medial longitudinal arch.

At the distal end of the medial longitudinal arch, thehead of metatarsal I appears as a prominent bump.

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Bony Palpation

Medial Aspect


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Medial Calcaneous

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Talar Head

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Navicular Tubercle

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First Cuneiform


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First Metatarsal

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First Metatarsalphalangeal Joint

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First Phalanx

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Soft Tissue Palpation

Medial and Plantar Aspect


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Tibialis Posterior tendon

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Tibialis Posterior tendon (blue)Flexor Digitorum Longus tendon (red)Flexor Hallucis Longus tendon (green)

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Tom, Dick, Harry

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Calcaneonavicular ligament(Spring ligament)


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Medial Longitudinal arch

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Transverse Arch

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