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It ascends through the mediastinum to and course upward behind and in front of the tibia to the back of join the superior vena cava at the level of the fourth thoracic the knee 300 mg tinidazole fast delivery, where they merge to form the popliteal vein. Tributaries of the azygos include the ascending lumbar popliteal vein receives blood from the knee region. Just above the veins, (not illustrated) which drain the lumbar and sacral re- knee, this vessel becomes the femoral vein. Just above this point, the femoral veins, which form the major tributaries to the left of the verte- vein receives blood from the great saphenous (sa˘-fe-nus) vein and bral column. The external iliac curves upward to the level of the sacroiliac joint, where it merges with the internal iliac vein at the pelvic and genital regions to form the common iliac vein. At Veins of the Lower Extremity the level of the fifth lumbar vertebra, the right and left common The lower extremities, like the upper extremities, have both a iliacs unite to form the large inferior vena cava (fig. The deep veins accompany corresponding arteries and have more valves than do the superficial veins. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 577 FIGURE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 578 Unit 6 Maintenance of the Body Inferior vena cava Right common iliac v. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 579 The superficial veins of the lower extremity are the small soids). The right and left hepatic veins that drain the venous and great saphenous veins. The small saphenous vein arises blood from the liver and empty it into the inferior vena cava from the lateral side of the foot and ascends deep to the skin (fig. As a consequence of the hepatic portal system, the along the posterior aspect of the leg. It empties into the popliteal absorbed products of digestion must first pass through the liver vein, posterior to the knee.

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These range from injury to the bones and surrounding muscles generic 500mg tinidazole with amex, Sprains are usually accompanied by synovitis, an inflammation of tendons, vessels, and nerves to damage of the joints in the form the joint capsule. Dislocation of the hip is a common and severe result of an automobile accident when a seat belt is not worn. When the hip Diseases of the Hip and Lower Extremity is in the flexed position, as in sitting in a seat, a sudden force ap- As in the shoulder and upper extremity, infections in the hip and plied at the distal end of the femur will drive the head of the lower extremity–such as bursitis and tendinitis–can be localized femur out of the acetabular socket, fracturing the posterior ac- in any part of the hip or lower extremity. In this kind of injury, there is usually damage to the of arthritis may affect joints in these regions. A variety of skin diseases afflict the foot, including ath- Trauma to the nerve roots that form the sciatic nerve may lete’s foot, plantar warts, and dyshidrosis. Most of the diseases of also occur from a herniated disc or pressure from the uterus dur- the feet can be prevented, or if they do occur, they can be ing pregnancy. Sciatic nerve dam- Because arterial occlusive disease is common in elderly peo- age is usually very painful and is expressed throughout the poste- ple, palpation of the posterior tibial artery is clinically important rior length of the lower extremity. This can be accomplished by gently Fractures are common in any location of the hip and lower palpating between the medial malleolus and the tendo calcaneus. Athletes (such as skiers) and elderly people seem to Many neuromuscular diseases have a direct effect on the be most vulnerable. Osteoporosis markedly weakens the bones of functional capabilities of the lower extremities. Muscular dystro- the hip and thigh regions, making them vulnerable to fracture. A phy and poliomyelitis are both serious immobilizing diseases be- common fracture site, especially in elderly women, is across the cause of muscle paralysis. A fracture of this kind may be complicated by vas- cular and nerve interruption. A potentially more serious knee trauma, however, is a clipping injury, caused by a blow to the lat- Clinical Case Study Answer eral side.

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Popliteal fossa Lateral epicondyle of femur Medial epicondyle of femur Medial head of gastrocnemius m buy tinidazole 300mg. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 329 Medial head of Lateral head of gastrocnemius m. Medial malleolus Lateral malleolus Calcaneus Calcaneus Extensor digitorum Abductor hallucis m. Lateral malleolus of fibula Medial malleolus of tibia Tendo calcaneus Site for palpation Medial malleolus of dorsal pedal a. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 330 Unit 4 Support and Movement (a) (b) (c) FIGURE 10. Iliac crest Gluteus medius muscle Gluteus minimus muscle Greater trochanter Sacrum of femur Piriformis muscle Sacrotuberous ligament Superior gemellus muscle Coccyx Obturator internus muscle Gluteus maximus Inferior gemellus muscle muscle Quadratus femoris Anus muscle Biceps femoris muscle Semitendinosus muscle FIGURE 10. Internal Anatomy CLINICAL CONSIDERATIONS The internal anatomy of the buttock and lower extremity in- clude the structures of the hip, thigh, knee, leg, and foot. The Head and Neck Regions principal structures of these regions are shown in the cadaver dis- sections in figures 10. The highly specialized head and neck regions are extremely vul- nerable to trauma and disease. Furthermore,because of the in- Knowledge Check credible complexity of these body regions,they are susceptible to numerous congenital conditions that occur during prenatal 21. List the clinically important structures that can be ob- penchant for contact sports and fast-moving vehicles, puts the served or palpated in the buttock and lower extremity. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 331 Iliacus m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 332 Unit 4 Support and Movement Patella Patella Patellar ligament Patellar ligament Tibialis anterior m. Tendo calcaneus Inferior extensor retinaculum Superior extensor retinaculum Tendons of extensor digitorum longus m. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 333 readily gain access to the internal structures of the head and neck Sciatic n. Also, the risk for contracting certain diseases is greatly increased by the social na- Biceps femoris m.

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