Anatomy and Function in the Lower Extremity

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Last modified 08/03/2015

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Chapter 13 Anatomy and Function in the Lower Extremity

Note: Unless otherwise noted, arrows in figures indicate the direction of patient motion.

Figure 13-1 Lower extremity nerves of the lumbar plexus.

Figure 13-2 Iliopsoas: Psoas and Iliacus Muscles

• Muscle attachments: Sides of T12 through L5 vertebrae to lesser trochanter of femur (psoas)

• Innervation: upper part of iliac fossa to lesser trochantor (iliacus)

• Psoas major: Lumbar nerves (L1, L2, and L3)

• Iliacus: Femoral nerve (L2 and L3)

• Function: Flexion of hip joint

• Physical examination: The patient lies supine with the leg flexed at the knee and hip and tries to flex the thigh against resistance.

Figure 13-3 Overview of the obturator nerve.

Figure 13-4 Hip Adductor Muscles: Obturator Externus, Adductor Brevis, Adductor Longus, and Adductor Magnus

• Muscle attachments

• Obturator externus: Obturator foramen to trochanteric fossa

• Adductor brevis: Body and inferior ramus of pubis to femur

• Adductor longus: Pubic crest to femur

• Adductor magnus: Inferior ramus of pubis, ramus of ischium, and ischial tuberosity to gluteal tuberosity, linea aspera, medial supracondylar line and adductor tubercle of femur

• Innervation

• Obturator externus: Obturator nerve (L3 and L4)

• Adductor brevis: Obturator nerve (L2, L3, and L4)

• Adductor longus: Obturator nerve (L2, L3, and L4)

• Adductor magnus: Obturator nerve (L2, L3, and L4)

• Hamstring portion of adductor magnus: Sciatic nerve (L4) and Function: Adduction of hip joint

• Physical examination: The patient lies supine with the leg extended at the knee and tries to adduct the hip joint against resistance.

Figure 13-5 Overview of the femoral nerve.

Figure 13-6 Sartorius Muscle

• Muscle attachments: Anterior superior iliac spine to tibia

• Innervation: Femoral nerve (L2 and L3)

• Function: Flexion and abduction of hip joint

• Physical examination: The patient sits in the “tailor’s position” (hip flexed and at maximal internal rotation, knee flexed) and attempts to flex the hip further against resistance applied at the medial surface of knee.

Figure 13-8 Sensory distribution of the saphenous nerve and the anterior femoral cutaneous branch.

Figure 13-9 Overview of the nerves of the sacral plexus I.

Figure 13-11 Gluteus Maximus Muscle

• Muscle attachments: Ilium, dorsal surface of sacrum and coccyx, and sacrotuberous ligament to gluteal tuberosity of femur and iliotibial tract

• Innervation: Inferior gluteal nerve (L5, S1, and S2)

• Function: Extension of thigh and lateral rotation

• Physical examination: The patient lies prone with legs extended and tries to elevate the leg against resistance.

Figure 13-12 Piriformis, Gemellus Inferior, Gemellus Superior, and Obturator Internus Muscles

• Muscle attachments

• Piriformis: Sacrum to greater trochanter

• Gemellus inferior: Ischial tuberosity to medial surface of greater trochanter

• Gemellus superior: Ischial spine to medial surface of greater trochanter

• Obturator internus: Obturator membrane to medial surface of greater trochanter

• Innervation

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