Regions and muscle groups of the lower limb
The lower limb is divided into several topographic zones, each containing specific muscle groups:
- Gluteal region (regio glutealis). Bounded superiorly by the iliac crest and inferiorly by the gluteal fold (sulcus glutealis). This zone contains the gluteus maximus and medius muscles, the piriformis muscle, and the obturator muscles with adjacent vessels and nerves.
- Thigh (femur). The upper boundary lies 3–5 cm above the patella, and the lower boundary is a transverse line 3–4 cm above the popliteal crease. The anterior region (regio femoralis anterior), housing the quadriceps and sartorius muscles, and the posterior region (regio femoralis posterior), containing the thigh flexors, are distinguished.
- Knee (regio genus). Includes the anterior region (above and to the sides of the patella) and the posterior popliteal fossa (fossa poplitea), which is formed between the muscles of the posterior thigh.
- Leg (crus). The extensor muscles of the foot lie in the anterior region (regio cruris anterior). The posterior region (regio cruris posterior) contains the foot flexors, which are anatomically divided into superficial and deep layers.
- Foot (pes). Divided into the dorsum (dorsum pedis), sole (planta pedis), calcaneal region (regio calcanea), and digits (digiti pedis).
Clavicle as the bony support of the upper limb
The clavicle (Clavicula) is an S-shaped curved long bone. Its main function is to connect the upper limb to the trunk and create reliable support for muscles.
- Body of the clavicle (Corpus claviculae). On its rough inferior surface (facies inferior) lies the groove for the subclavius muscle (Sulcus musculi subclavii). Meanwhile, the superior surface (facies superior) remains smooth.
- Sternal end (Extremitas sternalis). This is the medial, flattened end of the bone. It articulates with the clavicular notch of the manubrium sterni via the articular surface (Facies articularis sternalis). The impression for the costoclavicular ligament (Impressio ligamenti costoclavicularis) is located here as well.
- Acromial end (Extremitas acromialis). The lateral flat end articulating with the acromion of the scapula (Facies articularis acromialis). It features the tuberosity of the coracoclavicular ligament (Tuberositas ligamenti coracoclavicularis), which consists of the conoid tubercle (attachment site of the conoid ligament) and the trapezoid line (attachment site of the trapezoid ligament).
Fasciae and superficial lymphatic drainage of the lower limb
The muscle masses of the lower extremities are covered by dense connective tissue sheaths. Fascia lata (Fascia lata) covers the muscles of the thigh, while crural fascia (Fascia cruris) covers the muscles of the leg. The fascia lata features an important opening—the saphenous hiatus (Hiatus saphenus)—through which the great saphenous vein dives deep to empty into the femoral vein.
Superficial lymphatic vessels (Vasa lymphatica superficialia) originate on the dorsum of the foot. They form a medial group running parallel to the great saphenous vein (V. saphena magna). On the leg and thigh, these vessels lie in the subcutaneous adipose tissue strictly superficial to the fasciae.
Lymph from the legs is directed to the superficial inguinal lymph nodes (Nodi lymphoidei inguinales superficiales), located in the upper third of the thigh below the inguinal ligament. They are divided into:
- Superomedial nodes: lie closer to the pubic symphysis, collecting lymph from the perineum and lower abdomen.
- Superolateral nodes: located below the anterior superior iliac spine, receiving lymph from the lateral part of the buttocks.
- Inferior nodes: located vertically along the great saphenous vein, serving as the main collectors for the entire lower limb.
Lymph nodes of the upper limb, head, and neck
Lymph drainage from the upper limb, pectoral girdle, and mammary gland is directed into the axillary lymph nodes (Nodi lymphoidei axillares). On the surface of the pectoralis major muscle, near the lateral edge of the mammary gland, lie the paramammary nodes—the first barrier to metastasis in breast cancer.
Lymph from the soft tissues of the head is collected into the occipital, mastoid, parotid, submandibular, and submental nodes. It then proceeds to the cervical nodes located along the neurovascular bundles (e.g., superficial lateral cervical nodes along the course of the external jugular vein, jugulodigastric, and jugulo-omohyoid nodes).
All lymph from the right half of the head, neck, and right arm is collected into the right jugular and right subclavian trunks. Uniting, they form the short (1–1.5 cm) right lymphatic duct (Ductus lymphaticus dexter), which empties into the right venous angle.
To quickly determine the side of the clavicle, use the rule of three: direct the sternal (flattened) end medially, the acromial (flat) end laterally, and the completely smooth surface superiorly. This instantly places the bone in the correct anatomical position.
Class and exam questions
Which muscles form the anterior region of the thigh?
In the anterior femoral region (regio femoralis anterior) lie the quadriceps femoris and sartorius muscles.
Where do the superficial lymphatic vessels of the legs run?
They originate on the dorsum of the foot and run in the subcutaneous adipose tissue superficial to the fasciae of the leg and thigh, accompanying the great saphenous vein.
Where does the right lymphatic duct empty?
This short vessel, 1–1.5 cm long, empties into the right venous angle—the anatomical zone where the internal jugular and subclavian veins merge.
Which structures pass through the saphenous opening of the thigh?
The great saphenous vein passes through the saphenous opening (Hiatus saphenus) in the fascia lata of the thigh to empty into the deep femoral vein, and lymphatic drainage is also directed there.
What else to study on this topic
- Topography and subgroups of the superficial inguinal lymph nodes.
- Anatomy of the lymph nodes of the head and neck (occipital, mastoid, parotid).
- Formation of the right lymphatic duct and its entry into the venous angle.
- Paramammary lymph nodes and their clinical significance.
- Bony landmarks of the lower limb: medial malleolus and anterior superior iliac spine.
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