12 - Gluteal Region, Posterior Thigh, Posterior Leg & Popliteal Fossa

Question 1

Gluteus maximus action

Answer 1

-Action - extends a flexed thigh at hip

Question 2

tensor fasciae latae m. action

Answer 2

-Action: hip flexion

functions to help stabilize the the hip and knee joints

Question 3

Iliotibial tract/band

Answer 3

• thickening of the lateral aspect of the fascia lata.
• connects the iliac tubercle and proximal tibia
• site of insertion for the gluteus maximus and tensor fasciae latae muscles

Question 4

bursae

Answer 4

• membranous sacs containing synovial fluid that act to reduce friction
• often found between a soft tissue structure and a bony prominence or ligament

Question 5

ischial bursa

Answer 5

separates gluteus maximus from ischial tuberosity

Question 6

trochanteric bursa

Answer 6

separates gluteus maximus and iliotibial tract from greater trochanter

Question 7

lesser gluteals action and function

Answer 7

• intermediate muscle layer of gluteal region
• gluteus medius
• gluteus minimus
• Actions: Abduct thigh/ medially rotate thigh
• Function: prevent pelvic drop of contralateral hip during stance phase

Question 8

lateral rotators of the hip and innervation

Answer 8

piriformis
In - n. to piriformis

obturator internus
In - n. to obturator internus

Question 9

Structures passing through greater sciatic foramen (between pelvis and gluteal region)

Answer 9

• internal pudendal artery/vein
• pudendal nerve
• superior gluteal V AN
• piriformis muscle
• inferior gluteal V AN
• n. to obturator internus
• n. to quadratus femoris
• sciatic nerve
• posterior femoral cutaneous nerve

Question 10

structures passing through lesser sciatic foramen (between perineum and gluteal region)

Answer 10

• internal pudendal artery/vein
• pudendal nerve
• n. to obturator internus
• obturator internus muscle/tendon

Question 11

intragluteal injections

Answer 11

should be performed in the upper lateral quadrant of the gluteal region so as not to damage the sciatic nerve or structures passing through the sciatic foramina

Question 12

problems associated with excessive use of gluteal muscles

Answer 12

may develop hypertrophy and spasm of the piriformis muscle which can result in compression of any of the structures passing through the greater sciatic foramen.

Question 13

insertion of semitendinosus and semitendinosus

Answer 13

medial side of proximal tibia (at pes anserinus)

Question 14

origin and insertion of biceps femoris

Answer 14

inserts on head of fibula
long head originates from ischial tuberosity
short head arises from femoral shaft

Question 15

innervation of the posterior thigh

Answer 15

tibial nerve (off sciatic nerve)
common fibular only innervates short head of biceps femoris

Question 16

main blood supply of posterior thigh

Answer 16

perforating branches of deep femoral artery

Question 17

origin, innervation, and action of hamstrings

Answer 17

-arise from ischial tuberosity, cross two joints
innervated by tibial portion of sciatic nerve
extend hip and flex knee
SEMITENDINOSUS, SEMIMEMBRANOSUS and LONG HEAD OF BICEPS FEMORIS ARE THE ONLY HAMSTRING MUSCLES
(short head of biceps femoris lacks all three criteria and therefore is not considered to be a hamstring muscle

Question 18

boundaries of popliteal fossa

Answer 18

-popliteal fossa is a diamond shaped depression on the posterior aspect of the knee
-boundaries are:
Superolateral - biceps femoris
Superomedial - semimembranosus (semitendinosus)
Inferolateral - lateral head of gastrocnemius
Inferomedial - medial head of gastrocnemius

Question 19

contents of popliteal fossa

Answer 19

• Popliteal artery and vein (including genicular branches)
• tibial and common fibular nerves
• Lymph
• small saphenous vein

Question 20

popliteal pulse

Answer 20

The Popliteal artery is the deepest structure in the popliteal fossa (deep to both the tibial nerve and popliteal vein).
-pulse of the popliteal a. pulsations are best felt when you push hard on superior aspect of popliteal fossa (where the artery lies on the posterior surface of the femur). Weakening or loss of popliteal pulse is a sign of femoral artery obstruction

Question 21

what could result from fractures of distal femur

Answer 21

damage to the popliteal artery

Question 22

genicular anastomosis

Answer 22

periarticular anastomosis around the knee joint that provides collateral circulation for bypassing

popliteal artery
branches arise from:
-femoral a.
-lateral circumflex femoral a.
-popliteal a.
-anterior tibial a.

Question 23

when does genicular anastomosis come into play

Answer 23

during common occlusion of popliteal a. during full knee flexion

Question 24

how does blood get to the leg if there is an occlusion of femoral a. after branching of profunda femoris

Answer 24

via the descending branch of the lateral circumflex femoral artery and its communication with the genicular anastomosis

Question 25

which joints are involved in eversion and inversion of foot

Answer 25

subtalar and transverse tarsal joints

Question 26

what forms compartments in the leg

Answer 26

anterior and posterior septa (from crural fascia) and interosseous membrane

Question 27

Leg: posterior compartment a, v, and innervation

Answer 27

• plantarflexors/ toe flexors/ inverters
• tibial nerve
• posterior tibial & fibular arteries

Question 28

Leg: anterior compartment a, v, and innervation

Answer 28

• dorsiflexors/ toe extensors/ inverters
• deep fibular nerve
• anterior tibial artery

Question 29

Leg: lateral (fibular) compartment a, v, and innervation

Answer 29

• everters of foot
• superficial fibular nerve
• supplied by perforating branches of the fibular artery.

Question 30

flexor retinaculum

Answer 30

forms the roof of the tarsal tunnel on the posteromedial aspect of the ankle joint

Question 31

where do all superficial muscles of posterior leg insert

Answer 31

calcaneal tuberosity

Question 32

what is the action of all superficial muscles of the posterior leg

Answer 32

plantarflexion of the foot at the ankle

Question 33

ankle jerk reflex

Answer 33

Strike the calcaneal tendon (just proximal to the calcaneal tuberosity) with a reflex hammer when the patient’s legs are dangling over the side of a table. The normal result is plantar flexion
of the ankle joint. If the S1 nerve root is injured or compressed, the ankle reflex is virtually absent.

Question 34

action of flexor digitorum longus

Answer 34

Plantarflexion & flexion of all joints of the lateral 4 toes

Question 35

action of tibialis posterior

Answer 35

plantarflexion and inversion

Question 36

action of popliteus

Answer 36

medial rotation of leg. “unlocks” knee joint

does not cross ankle

Question 37

action of flexor hallucis longus

Answer 37

plantarflexion and flexion of all joints of the hallux

Question 38

poplitial artery origin and end

Answer 38

begins at the adductor hiatus, travels through the popliteal fossa and ends by dividing into the anterior and posterior tibial arteries.

Question 39

anterior tibial artery

Answer 39

pierces the interosseous membrane to reach the anterior compartment of the leg.

Question 40

posterior tibial artery

Answer 40

-gives off the fibular artery, supplies structures of the posterior compartment of the leg and then enters the sole of the foot by passing through the tarsal tunnel.

Question 41

tarsal tunnel

Answer 41

depression on the posteromedial aspect of the ankle between the medial malleolus and calcaneal tuberosity. It’s roof is formed by the flexor retinaculum. It is a pathway for structures passing between the posterior leg and the plantar surface of the foot.

Question 42

tarsal tunnel components

Answer 42

Medial malleolus
Tibialis posterior
Flexor Digitorum Longus Posterior tibial Artery
Posterior tibial Vein (not shown) 
Tibial Nerve
Flexor Hallucis longus