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MSK > 9 - Gluteal Region and Posterior Thigh > Flashcards

9 - Gluteal Region and Posterior Thigh Flashcards

1
Q

What is valgus knee alignment?

A

Knees go inwards. Feet wider apart than knees

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2
Q

What is varus knee alignment?

A

Knees go outwards “var is ze pig?” Bow legged with increases gap between knees. Smaller joint space on medial side/worn down cartilage and menisci like after running.

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3
Q

What are the boundaries of the gluteal region?

A

Iliac crest to the gluteal folds created by the inferior gluteal muscles

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4
Q

Why is the hip bone described as a innominate bone?

A

No-name bone. Is formed from the fusion of the ischium, ilium and pubis

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5
Q

What makes up the pelvis?

A

The hip bone, sacrum and coccyx

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6
Q

Important features/landmarks on the hip bone

A 
iliac crest
ilium
ASIS
AIIS
ischial spine (most posterior - numb in child birth as lots of nerves)
pubic tubercle (points anterior)
inferior/superior pubic rami
iliac spine (between ASIS and AIIS)
ischium
pubis
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7
Q

What are the two major ligaments that bind the hip bones to the pelvis?

A

The sacrospinous ligament (anterior) and sacrotuberous ligament (longer and more posterior)

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8
Q

The ligaments divide the sciatic notch into 2 smaller spaces - what are these?

A

Greater Sciatic Foramen
- vessels enter the lower limb/gluteal region i.e. sciatic nerve
Lesser Sciatic Foramen
- vessels return to the pelvis/peroneal region to the midline

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9
Q

Sacrospinous Ligament?

A

Sacrum (inferior) > Ischial Spine

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10
Q

Sacrotuberous Ligament?

A

Sacrum (superior) > ischial tuberosity

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11
Q

What forms the Greater Sciatic Foramen?

A

The sacrotuberous ligament

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12
Q

What forms the lesser sciatic foramen?

A

The sacrospinous ligament

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13
Q

How many gluteal muscles are there and what are they?

A 
9 muscles
Superficial:
Gluteus Maximus
Deep:
Gluteus Medius
Gluteus Minimus 
Short External Rotators:
Piriformis
Obturator Externus
Superior Gemelli
Inferior Gemelli
Quadratus Femoris

Tensor Fascia Lata

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14
Q

Gluteus Maximus

A
  • most superficial and biggest in body
  • when you sit down it slides forward so you sit on ischial tuberosity not glut

O = Upper ilium, posterior sacrum, coccyx and sacrotuberous ligament
I = Illiotibial Band and Gluteal Tuberosity on posterior Femur
> thigh extension
> INFERIOR gluteal nerve

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15
Q

What are the 3 bursa associated with gluteus maximus?

A
  1. Trochanteric Bursa
    > Most superior on the greater trochanter
    > Get inflammed and painful in elderly
  2. Ischial Bursa
    > Over the ischial tuberosity
    > Rubs every you sit. Often problems in cyclist
  3. Gluteofemoral Bursa
    > Is lateral between the ITB insertion and vastus lateralis (clear plane here)

> balloons filled with fluid to help with lubrication with movement and structures gliding over each other

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16
Q

Gluteus Medius and Minimus

A

O: Upper iliac crest
I: Greater Trochanter
> Gluteus medius and minimus come off superior to maximus hence supplied by the Superior Gluteal Nerve
> Hip ABDuction which holds the pelvis level rather than moving from side to side even when on one foot
> Have different fibre orientation to gluteus maximus. Are almost vertical compared to maximus which is more oblique
> fascia plane between them and maximus

17
Q

Tensor Fascia Lata

A 
O: ASIS and iliac crest
I: ITB
> abducts thigh and stabiliser 
> Superior Gluteal Nerve
See anteriorly but is a gluteal muscle
18
Q

What are the short external rotator muscles, what do they do and what is their nerve supply?

A
  1. Piriformis (pear shaped)
  2. Superior Gemelli
  3. Inferior Gemelli
  4. Obturator Internus (inbetween the 2 gemelli)
  5. Quadratus Femoris
    > They are inferior to gluteus minimus and medius and externally rotate the thigh (ballet muscles)
    > Nerves off of the sacral plexus
19
Q

Piriformis

A 
Pear shaped. Landmark. 
O: Sacrum 
I: Greater Trochanter
> Sacral plexus
> externally rotates thigh
20
Q

All the gluteal muscles insert onto the greater trochanter except 2/3… what are they?

A

Gluteus Maximus - ITB laterally and gluteal tuberosity on posterior upper femur
Quadratus Femoris - intertrochanteric CREST of the femur
Tensor Fascia Lata - ITB

21
Q

What gluteal muscles act as a three headed muscle and where do they originate and insert?

A 
Superior Gemelli
> O: Ischial Spine
Obturator Internus 
> O: Obturator Foramen 
Inferior Gemelli
> O: Ischial Tuberosity
The 3 tendons insert together at the greater trochanter
> nerves off sacral plexus
> externally rotate thigh
22
Q

Quadratus Femoris

A

O: Ischial Tuberosity
I: Intertrochaneteric crest of the posterior femur
> nerves off sacral plexus
> externally rotates thigh

23
Q

What are the posterior thigh (hamstring) muscles, what are their actions and nerve supply?

A 
Biceps Femoris (most lateral)
Semitendinosus 
Semimembranosus 
Adductor Magnus (hamstring head)
> Tibial nerve from the sciatic nerve 
> Flex the leg
24
Q

Where do all the hamstring muscles originate from (apart from the short head of biceps femoris?)

A

The ischial tuberosity

short head of biceps femoris origin is linea aspera

25
Q

Biceps Femoris

A

Most Lateral
O: L. head ischial tuberosity
S. head linea aspera
I: Lateral so head of FIBULA

> flexes and externally rotates leg. Extends thigh
tibial n.

26
Q

Semitendinosus

A

O: Ischial tuberosity
I: Pes Anserinus
> flex and internally rotates leg. Extends thigh
> tibial n.

27
Q

Semimembranosus

A

Deeper and more medial
O: Ischial tuberosity
I: Medial condyle of tibia and joint capsule
> Extend thigh, flex and internally rotate leg
> tibial n.

28
Q

Adductor Magnus

A

O = Ischia tuberosity (and inf. pubic ramus)
I = Linea aspera, medial supracondylar ridge and adductor tubercle (femur NOT tibia)
> extends and flexes thigh by different fibres. Adducts thigh.
> tibial n. (and obturator)

29
Q

How does Piriformis act as a landmark muscle in the gluteal region?

A
  • the superior and inferior gluteal arteries/nerve run superior and inferior to the piriformis muscle supplying G.Med/Mine and G.Max
  • there is a neurovascular bundle both inferior and superior
30
Q

What is the path of the gluteal arteries?

A

Aorta > CIA > Int. Iliac A. > inf. and sup. gluteal arteries leave the pelvis by the Greater Sciatic Foramen along with the Sup and Inf Gluteal Nerves > the sup and inf gluteal arteries anastomose with the femoral circumflex arteries off Profunda femoris

31
Q

Where will you find the sciatic nerve?

A

Inferior to Piriformis. Is the largest nerve in the body thumb or 2 thumbs thick.

32
Q

Which of the gluteal arteries has a branch and what does it do?

A

The inferior gluteal artery branches into the Artery of the Sciatic Nerve

33
Q

What does the Sciatic nerve divide into?

A

Tibial and common peroneal usually in the distal thigh but can occur much higher - can be injured in surgery if not considered

34
Q

How does a hamstring injury occur?

A
  • during kicking and running
  • can get muscular strains/tears or ischial tuberosity avulsion where you can tear the tendon off or even the tuberosity itself especially in young as the bone hasn’t fused yet
35
Q

Describe a Trendelenburg Gait

A
  • occurs when you damage gluteus medius and minimus or the supplying superior gluteal nerve
  • these muscles hold the pelvis level and stabilise it especially when standing on one leg it stops you falling
  • thigh ABduction on the affected side is weakened resulting in the trendelenburg swing gait
  • if right side is affected then will lean over to the ride side to compensate falling to the left
  • if right side affected then the left leg will drop when lifted/pelvis fall on the non affected side
36
Q

Which side of the gluteal region is common and safer for intra-muscular injection?

A

Superior lateral - large muscular area for venous absorption and away from sciatic nerve which is more medial and inferior

37
Q

Piriformis Syndrome?

A

When the Sciatic Nerve is compressed by Piriformis causing pain, tingling numbness in buttocks and along sciatic nerve

38
Q

Where does the sciatic nerve run in a cross section diagram?

A

Deep to biceps femoris and between adductor magnus (between posterior compartment and medial compartment)

39
Q

How is the pelvis stabilised?

A

Gluteus Medius is the major muscle to stabilise the pelivs - abducts the thigh to stabilise during walking/lifted leg. Tensor Fascia Lata also stabilises

MSK (29 decks)

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