UAMS Gross Anatomy

Gross Anatomy

Overview of the Lower Limb; Anterior Thigh Muscles, Medial Thigh Muscles


Anatomy Tables for Today's Topic

Bones of the Lower Limb
Muscles
Nerves
Arteries
Veins
Topographic Anatomy
Lymphatics

Bones of the Lower Limb

Bone Structure Description Notes
pubis an angulated bone the forms the anterior part of the pelvis one of three bones that form the os coxae: ilium, ischium, pubis; its body forms 1/5 of the acetabulum; its symphyseal surface unites with the pubis of the opposite side to form the pubic symphysis; the superior and inferior pubic rami participate in the formation of the obturator foramen
body superolateral portion of the pubis the body of the pubis forms about 1/5 of the acetabulum
pubic crest ridge on the superior border of the superior ramus attachment of rectus abdominis & pyramidalis mm.
pubic tubercle process at the lateral end of pubic crest attachment point of the medial end of the inguinal ligament
superior ramus superior "limb" that passes medially from the body of the pubis articulates with the superior ramus of the opposite side at the pubic symphysis
pecten ridge on superior surface of the superior pubic ramus attachment point of the pectineal ligament
inferior ramus inferior "limb" that passes inferolaterally from the pubic symphysis articulates with the ischial ramus to form the ischiopubic ramus; attachment site for the root of the penis (clitoris)
obturator groove groove on the inferior surface of the superior pubic ramus marks the area of passage of the obturator vessels and n. in the obturator canal
femur   the bone of the thigh the femur is the longest and strongest bone in the body
  head smooth, rounded proximal end the head of the femur articulates with the acetabulum of the pelvis
fovea capitis femoris a shallow pit in the head of the femur it is the attachment site of the ligamentum capitis femoris; a small artery for supply of the head is found within this ligament
neck the constricted area distal to the head of the femur most of the blood supply to the head of the femur courses along the surface of the neck; fractures of the neck of the femur may result in avascular necrosis of the head
greater trochanter a large process that projects superiorly from the junction of the neck and shaft of the femur the greater trochanter is the insertion site of the gluteus medius m., gluteus minimus m., piriformis m. and obturator internus m.
gluteal tuberosity a roughened area located on the posterior surface of the femur at the superior end of the lateral lip of the linea aspera it is one of the insertion sites of the gluteus maximus m.
lesser trochanter a large process that projects from the posteromedial surface of the femur just distal to neck it is the insertion site of the common tendon of the psoas major and iliacus mm. (iliopsoas m.)
trochanteric fossa a depression on the medial side of the greater trochanter on its posterior surface where the greater trochanter joins the neck it is the insertion site of the obturator internus m., superior gemellus m. and inferior gemellus m.
intertrochanteric line a ridge on the anterior surface of the femur that connects the greater and lesser trochanters it is the line of attachment of the fibrous joint capsule
intertrochanteric crest a heavy ridge on the posterior surface of the femur that connects the greater and lesser trochanters the quadratus femoris m. inserts on the intertrochanteric crest
body the long slender shaft of the femur the linea aspera runs the entire length of the posterior surface of the body
linea aspera a vertical ridge on posterior surface of the femur it is the insertion site of the medial (adductor) group of thigh muscles and the origin of the vastus intermedius m. and the short head of the biceps femoris m.
adductor tubercle a process that projects superior to the medial epicondyle of the femur it is the insertion site of the ischiocondylar part of the adductor magnus m.
medial epicondyle the enlargement of bone on the medial side of the femur just superior to the medial condyle it is the attachment site of the tibial collateral ligament of the knee joint
lateral epicondyle the enlargement of bone on the lateral side of the femur just superior to the lateral condyle it is the attachment site of the fibular collateral ligament and the site of origin of the popliteus m.
medial condyle the rounded inferior end of the femur on the medial side it articulates with the medial condyle of the tibia
lateral condyle the rounded inferior end of the femur on the lateral side it articulates with the lateral condyle of the tibia
intercondylar fossa the deep depression on the posterior surface of the femur between the condyles the anterior and posterior cruciate ligaments are located here
  patellar surface the smooth anterior surface at the inferior end of the femur it articulates with the posterior surface the patella
patella   the bone that forms the knee cap the patella is a sesamoid bone in the tendon of the quadriceps femoris muscle; it provides a protective function by withstanding the grinding forces of the quadriceps femoris tendon against the patellar surface of the femur, especially in full knee flexion
tibia   the bone on the medial side of the leg the tibia is the weight-bearing bone of the leg
  medial condyle the heavy prominence on the medial side of the proximal end of the tibia the medial condyle articulates with the medial condyle of the femur; it is larger than the lateral condyle of the tibia
lateral condyle the heavy prominence on the lateral side of the proximal end of the tibia the lateral condyle articulates with the lateral condyle of the femur and with the head of the fibula
intercondylar eminence the ridge of bone on the proximal end of the tibia that projects between the condyles the intercondylar eminence has a medial and a lateral tubercle; it is the attachment site for the cruciate ligaments, medial meniscus and lateral meniscus
tibial tuberosity the roughened protuberance on the anterior surface of the tibia located just distal to the condyles it is the attachment site of the patellar ligament, which represents the insertion of the quadriceps femoris tendon

Muscles

Muscle Origin Insertion Action Innervation Artery Notes
adductor brevis inferior pubic ramus pectineal line and linea aspera (deep to the pectineus and adductor longus mm.) adducts, flexes, and medially rotates the femur anterior division of the obturator nerve obturator a., deep femoral a. anterior and posterior divisions of the obturator nerve lie on the anterior and posterior surfaces of adductor brevis
adductor longus medial portion of the superior pubic ramus linea aspera of the femur adducts, flexes, and medially rotates the femur anterior division of the obturator nerve obturator a., deep femoral a. the most anterior of the adductor group of muscles
adductor magnus ischiopubic ramus and ischial tuberosity linea aspera of the femur; the ischiocondylar part inserts on the adductor tubercle of the femur adducts, flexes, and medially rotates the femur; extends the femur (ischiocondylar part) posterior division of the obturator nerve; tibial nerve (ischiocondylar part) obturator a., deep femoral a., medial femoral circumflex a. the ischiocondylar part of adductor magnus is a hamstring muscle by embryonic origin and action, so it is innervated by the tibial nerve
articularis genu anterior surface of the femur above the patellar surface articular capsule of the knee elevates the articular capsule of the knee joint femoral nerve descending genicular a. articularis genu is formed by muscle fascicles deep to the vastus intermedius m.
gracilis pubic symphysis and the inferior pubic ramus medial surface of the tibia (via pes anserinus) adducts the thigh, flexes and medially rotates the thigh, flexes the leg anterior division of the obturator nerve obturator a. the pes anserinus is the common insertion of the gracilis, sartorius, and semitendinosus mm.
iliacus iliac fossa and iliac crest; ala of sacrum lesser trochanter of the femur flexes the thigh; if the thigh is fixed it flexes the pelvis on the thigh femoral nerve iliolumbar a. inserts in company with the psoas major m. via the iliopsoas tendon
iliopsoas iliac fossa; bodies and transverse processes of lumbar vertebrae lesser trochanter of the femur flexes the thigh; flexes and laterally bends the lumbar vertebral column branches of the ventral primary rami of spinal nerves L2-L4; branches of the femoral nerve iliolumbar a. a combination of the iliacus and psoas major mm.
obturator externus the external surface of the obturator membrane and the superior and inferior pubic rami trochanteric fossa of the femur laterally rotates the thigh obturator nerve obturator a. the tendon of the obturator externus m. passes inferior to the neck of the femur to reach its insertion site
pectineus pecten of the pubis pectineal line of the femur adducts, flexes, and medially rotates the thigh femoral nerve and possibly the anterior division of the obturator nerve medial femoral circumflex a. pectineus often has a dual innervation
psoas major bodies and transverse processes of lumbar vertebrae lesser trochanter of femur (with iliacus) via iliopsoas tendon flexes the thigh; flexes & laterally bends the lumbar vertebral column branches of the ventral primary rami of spinal nerves L2-L4 subcostal a., lumbar aa. the genitofemoral nerve pierces the anterior surface of the psoas major m.
psoas minor bodies of the T12 & L1 vertebrae iliopubic eminence at the line of junction of the ilium and the superior pubic ramus flexes & laterally bends the lumbar vertebral column branches of the ventral primary rams of spinal nerves L1-L2 lumbar aa. absent in 40% of cases
quadriceps femoris anterior surface of the femur and the anterior side of the medial and lateral intermuscular septa tibial tuberosity via the patellar ligament extends the knee; rectus femoris flexes the thigh femoral nerve lateral circumflex femoral a., deep femoral a. composed of 4 muscles: rectus femoris, vastus lateralis, vastus intermedius and vastus medialis
rectus femoris straight head: anterior inferior iliac spine; reflected head: above the superior rim of the acetabulum patella and tibial tuberosity (via the patellar ligament) extends the leg, flexes the thigh femoral nerve lateral circumflex femoral a. rectus femoris is part of the quadriceps femoris muscle
sartorius anterior superior iliac spine medial surface of the tibia (pes anserinus) flexes, abducts and laterally rotates the thigh; flexes leg femoral nerve lateral femoral circumflex a., saphenous a. sartorius means "tailor"; its actions put the lower limb in the traditional cross-legged seated position of a tailor
tensor fasciae latae anterior part of the iliac crest, anterior superior iliac spine iliotibial tract flexes, abducts, and medially rotates the thigh superior gluteal nerve superior gluteal a. tensor fascia latae redirects the rotational forces of the gluteus maximus m.
vastus intermedius anterior and lateral surface of the femur patella extends the leg femoral nerve lateral femoral circumflex a. vastus intermedius is part of the quadriceps femoris muscle
vastus lateralis lateral intermuscular septum, lateral lip of the linea aspera and the gluteal tuberosity patella and lateral patellar retinaculum extends leg femoral nerve lateral femoral circumflex a., perforating branches of the deep femoral a. vastus lateralis is part of the quadriceps femoris muscle
vastus medialis medial intermuscular septum, medial lip of the linea aspera patella and medial patellar retinaculum extends leg femoral nerve lateral femoral circumflex a. vastus medialis is part of the quadriceps femoris muscle

Nerves

Nerve Source Branches Motor Sensory Notes
femoral n. lumbar plexus (ventral primary rami of spinal nerves L2-L4) anterior femoral cutaneous brs., nn. to: sartorius m., rectus femoris m., vastus lateralis m., vastus intermedius m., vastus medialis m., pectineus m. sartorius, rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, pectineus skin of anterior thigh passes under inguinal ligament lateral to femoral a.
femoral cutaneous, anterior femoral no named branches sympathetic motor innervation to skin skin of the anterior thigh cutaneous nn. carry postganglionic sympathetic axons to skin
femoral cutaneous, lateral lumbar plexus (ventral primary rami of spinal nerves L2-L3) anterior & posterior brs. sympathetic motor innervation to skin skin of the lateral thigh cutaneous nn. carry postganglionic sympathetic axons to skin
obturator n. lumbar plexus (ventral primary rami of spinal nerves L2-L4) anterior and posterior brs. muscles of the medial thigh: adductor longus m., adductor brevis m. and adductor magnus m., gracilis m., obturator externus m. skin of the lower medial thigh obturator n. passes through the obturator canal
saphenous n. femoral n. infrapatellar br. none skin of the medial side of the leg and medial side of the foot saphenous n. travels with the great saphenous v.; it does not pass through the adductor hiatus at the knee; it passes anterior to the medial malleolus at the ankle

Arteries

Artery Source Branches Supply to Notes
circumflex femoral, lateral deep femoral a. ascending br., transverse br., descending br. lateral thigh and hip lateral circumflex femoral a. arises from the femoral a. in ~14% of cases
circumflex femoral, medial deep femoral a. ascending br., descending br. medial thigh and hip medial circumflex femoral a. arises from the femoral a. in ~20% of cases
deep femoral femoral a. medial circumflex femoral a., lateral circumflex femoral a., perforating aa. (3 or 4) hip joint, proximal thigh, posterior thigh deep femoral a. is the primary blood supply to muscles of the posterior compartment of the thigh
femoral external iliac a. superficial epigastric a., superficial circumflex iliac a., superficial external pudendal a., deep external pudendal a., deep femoral a., descending genicular a., popliteal a. thigh, leg and foot femoral a. is continuous with the popliteal a., the name change occurs at the adductor hiatus
iliac, common abdominal aorta external iliac a., internal iliac a. pelvis, lower limb abdominal aorta bifurcates at the level of the L4 vertebral body to form the right and left common iliac aa.; the common iliac artery bifurcates anterior to the sacroiliac articulation into its terminal brs. (external iliac a. and internal iliac a.)
iliac, external common iliac a. inferior epigastric a., deep circumflex iliac a., femoral a. lower limb external iliac a. is continuous with the femoral a., the name change occurs at the inguinal ligament; the common iliac artery bifurcates anterior to the sacroiliac articulation
obturator internal iliac a., anterior division pubic br., acetabular br., anterior br., posterior br. medial thigh and hip anterior and posterior brs. pass on the anterior and posterior sides of the adductor brevis m.; aberrant obturator a. arises from the inferior epigastric a. in 30% of cases
popliteal femoral a. anterior tibial a., posterior tibial a., 5 genicular brs. knee, leg and foot the popliteal a. is the continuation of the femoral a., the name change occurs at the adductor hiatus

Veins

Vein Tributaries Drains Into Regions Drained Notes
dorsal venous arch of the foot dorsal digital vv. and dorsal metatarsal vv. great saphenous v. medially, small saphenous v. laterally dorsum of the digits and the superficial structures of the dorsum of the foot dorsal venous arch is visible through the thin skin on the dorsum of the foot
saphenous, greater medial end of dorsal venous arch of foot, perforating communications with deep veins, superficial epigastric v., superficial circumflex iliac v., superficial external pudendal v. femoral v. skin and superficial fascia of the medial side of the foot and leg; skin and superficial fascia of most of the thigh; lower abdominal wall; perineal region greater saphenous v. is frequently used as graft material in coronary bypass surgery
saphenous, lesser lateral end of the dorsal venous arch of foot popliteal v. skin and superficial fascia of the lateral side of the foot and leg passes deeply into the popliteal fossa

Topographic Anatomy

Structure/Space Description/Boundaries Significance
adductor canal a musculo-fascial canal that contains the large neurovascular bundle of the anterior thigh; its boundaries are: anterior - sartorius m.; lateral - vastus medialis m.; posterior - adductor longus m. and adductor magnus m.; it begins proximally at the inferior angle of the femoral triangle and ends distally at the adductor hiatus adductor canal contains the femoral a. and v., the saphenous n. and the nerve to the vastus medialis m.; also known as: Hunter's canal, subsartorial canal
adductor hiatus an opening in the tendon of insertion of the adductor magnus m.; its boundaries are: medial - portion of the tendon of adductor magnus that attaches to the adductor tubercle, lateral - insertion of the adductor magnus into the linea aspera, inferior - femur femoral a. and v. pass through the adductor hiatus to reach the posterior surface of the knee, where their name changes to popliteal a. and v.
anterior compartment, thigh a connective tissue compartment that contains muscles that extend the knee; its boundaries are: anterior and lateral - fascia lata of the thigh; posterior ; femur, medial intermuscular septum and lateral intermuscular septum anterior compartment of the thigh contains the quadriceps femoris m.and sartorius m.; also known as extensor compartment of the thigh
fascia lata deep fascia forming a tubular investment of the thigh fascia lata is thickened laterally to form the iliotibial tract/band; it is connected to the femur by the lateral and medial intermuscular septa which divide the thigh into compartments; Scarpa's fascia attaches to the external surface of the fascia lata inferior to the inguinal ligament
femoral canal a short diverticulum within the femoral sheath that extends distal to the inguinal ligament on the medial side of the femoral vessels; its boundaries are: medial - lacunar ligament; lateral - fascia on the femoral vein; anterior - inguinal ligament; posterior - fascia on the pectineus m. femoral canal is the medial compartment of the femoral sheath; it opens into the abdominal cavity superiorly at the femoral ring; it may be the site of a femoral hernia; usually contains a deep inguinal lymph node (gland of Cloquet)
femoral ring opening into the femoral canal; its boundaries are: medial - lacunar ligament, lateral - fascia on the femoral vein, anterior - inguinal ligament, posterior - fascia on the pectineus m. if a femoral hernia develops, the herniated gut passes through the femoral ring
femoral triangle a musculo-fascial triangle on the anterior surface of the thigh; its boundaries are: superior - inguinal ligament, lateral - sartorius m., medial - medial edge of the adductor longus m. femoral triangle contains the femoral a., v. and n.; textbooks may disagree on the medial boundary of this triangle
Hunter's canal a musculo-fascial canal that contains the large neurovascular bundle of the anterior thigh; its boundaries are: anterior - sartorius m.; lateral - vastus medialis m.; posterior - adductor longus m. and adductor magnus m.; it begins proximally at the inferior angle of the femoral triangle and ends distally at the adductor hiatus Hunter's canal contains the femoral a. and v., the saphenous n. and the nerve to the vastus medialis m.; also known as: adductor canal, subsartorial canal
medial compartment, thigh a connective tissue compartment that contains the muscles that adduct the thigh; its boundaries are: anterior - medial intermuscular septum; posterior - fascia between the medial and posterior compartments; medial - fascial lata; lateral - femur medial compartment of the thigh contains: pectineus m., adductor longus m., adductor brevis m., adductor magnus m., gracilis m., obturator externus m.; also known as: adductor compartment of the thigh
popliteal fossa the shallow depression on the posterior surface of the knee; its boundaries are: superomedial - tendons of semimembranosus and semitendinosus mm., superolateral - tendon of biceps femoris m., inferior - medial and lateral heads of the gastrocnemius m. popliteal fossa contains: popliteal a. and v. and their branches; tibial n, common fibular n., popliteus m.
saphenous hiatus an opening in the fascia lata located inferior to the inguinal ligament and lateral to the pubic tubercle saphenous hiatus is the site of passage of the greater saphenous vein which joins the femoral vein; it is closed by the cribriform fascia
subsartorial canal a musculo-fascial canal that contains the large neurovascular bundle of the anterior thigh; its boundaries are: anterior - sartorius m.; lateral - vastus medialis m.; posterior - adductor longus m. and adductor magnus m.; it begins proximally at the inferior angle of the femoral triangle and ends distally at the adductor hiatus subsartorial canal contains the femoral a. and v., the saphenous n. and the nerve to the vastus medialis m.; also known as: adductor canal, Hunter's canal

Lymphatics

Structure Location Afferents from Efferents to Regions drained Notes
deep inguinal nodes along the medial side of the femoral v. deep to the fascia lata and inguinal ligament superficial inguinal nodes, popliteal nodes external iliac nodes lower limb, external genitalia, lower part of the anterior abdominal wall the deep inguinal node in the femoral canal is called the node (or gland) of Cloquet
external iliac nodes along the external iliac vessels superficial inguinal nodes; deep inguinal nodes; inferior epigastric nodes common iliac nodes lower limb; external genitalia; lower part of the anterior abdominal wall external iliac nodes are 8 to 10 in number
lateral aortic nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lumbar nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
lumbar nodes along the inferior vena cava and abdominal aorta from the aortic bifurcation to the aortic hiatus of the diaphragm common iliac nodes; lymphatic vessels from the posterior abdominal wall and viscera efferents form one lumbar trunk on each side lower limb; pelvic organs; perineum; anterior and posterior abdominal wall; kidney; suprarenal gland; respiratory diaphragm also known as: lateral aortic nodes; the intestinal trunk drains into to the left lumbar trunk; the lumbar trunks unite to form the thoracic duct/cisterna chyli
popliteal nodes in the popliteal fossa along the popliteal vessels lymphatic vessels that accompany the anterior tibial , posterior tibial and fibular vessels deep and superficial inguinal nodes leg and foot 5 or 6 nodes located in the fat of the popliteal fossa
superficial inguinal nodes in the superficial fascia parallel to the inguinal ligament and along the terminal part of the greater saphenous v. lymphatic vessels from the superficial lower limb, superficial abdominal wall, perineum external iliac nodes; deep inguinal nodes lower abdominal wall; external genitalia; superficial parts of the lower limb superficial inguinal nodes are 12-20 in number; they become inflamed during infections of the lower limb; they may become inflamed during infections of the external genitalia

Other Tables of Interest:


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Some of the material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest and Jaye Schlesinger
Published by ILOC, Inc., New York. Copyright 1995.

Content of these tables has been edited for use in this course by Patrick W. Tank, Ph.D.
Copyright 2006, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences.

Unauthorized use is prohibited.