A: Gluteal region & back of thigh Flashcards
Ligaments in posterior hip bone
Sacrospinous
Sacrotuberous
Deep muscles of gluteal region:
- Piriformis
- Gemellus superior
- Obturator internus
- Gemellus inferior
- Quadratus femoris
Superficial muscles of gluteal region
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Tensor fasciae latae
3 Hamstring muscles:
- Lateral side = biceps femoris (two heads)
- Semitendinosus
- Semimembranosus
Sciatic nerve passage
Enters gluteal region through greater sciatic foramen, inferior to piriformis.
Runs downwards on posterior surface of short muscles of hip joint, deep to gluteus maximus.
Enters posterior compartment deep to hamstrings on posterior surface of adductor magnus.
Popliteal fossa boundaries
Top medial: semitendinous + semimembraneous
Top lateral: tendon of bicep femoris
Bottom medial: Medial head of gastrocnemius
Bottom lateral: lateral head of gastrocnemius
Contents of popliteal fossa
Popliteal artery, popliteal vein, tibial + common fibular branches of sciatic nerve, popliteal lymph nodes.
Bicep femoris
- Long head: ischial tuberosity. Short head: linea aspera of femur
- Head of fibula
- Flexion at knee, extension at hip, lateral rotation at hip + knee joints, extend trunk on fixed femur.
- Sciatic nerve
Semitendinosus
- Ischial tuberosity
- Upper part of shaft of tibia
- Extend hip, flex knee, medial rotation at hip + knee, extend trunk on fixed femur
- Sciatic nerve
Semimembranosus
- Ischial tuberosity
- Medial condyle of tibia
- Flexion at knee, extension at hip, medial rotation at hip + knee, extend trunk on fixed femur.
Gluteus maximus
- External surface ilium, sacrum, sacrotuberous ligament
- Iliotibial tract of fascia lata, gluteal tuberosity of femur
- Extension + lateral rotation of thigh at hip, extends trunk on LL, stabilizes hip + knee joint
- inferior gluteal nerve
Gluteus medius
- External surface of ilium
- Greater trochanter of femur
- Abducts + medial rotates hip joint, tilts pelvis when walking + prevents pelvis from dropping on side of swinging limb
- superior gluteal nerve
Gluteus minimus
- External surface of ilium
- Greater trochanter of femur
- Abducts + medial rotates hip joint, tilts pelvis when walking + prevents pelvis dropping on side of swinging limb
- superior gluteal nerve
Tensor fascia latae
- Iliac crest
- Iliotibial tract
- Abduction, stabilizes knee joint
- Superior gluteal nerve
Which blood vessels are the main blood supply to the hip joint
Medial + lateral circumflex femoral arteries
What is the saphenous opening and where is it located
An opening in the fascia lata through which the great saphenous vein passes to drain into the femoral vein.
Located inferior to the medial end of the inguinal ligament.
describe course taken by obturator nerve
Medial border of psoas major muscle–> obturator canal–> medial compartment of thigh.
What type of joint is found between the two pubic bones?
secondary cartilaginous joint
Where can you palpate the femoral artery pulse?
At mid-inguinal point: midway between anterior superior iliac spine + pubic symphysis.
List the muscles that cause flexion at the knee joint
Iliopsoas, Sartorius, Rectus femoris, Pectineus, Adductor longus, Adductor brevis, Adductor magnus.
List the muscles that cause adduction at hip
Adductor longus, Adductor brevis, Adductor magnus, Pectineus, Gracilis, Obturator externus.
Piriformis
- Anterior surface of sacrum
- Greater trochanter of femur
- Lateral rotation at hip, stabilizes hip
- Sacral plexus
Superior gemellus
- Spine of ischium
- Greater trochanter of femur
- Lateral rotation at hip joint, stabilizes hip joint
- Sacral plexus
Obturator internus
- Internal surface of obturator membrane + adjacent bone
- Runs posteriorly to exit pelvis through lesser sciatic foramen. Passes laterally behind hip joint, to insert in greater trochanter of femur.
- Lateral rotation of hip joint, stabilizes hip joint
- Sacral plexus
Inferior gemellus
- Ischial tuberosity
- Greater trochanter of femur
- Lateral rotation at hip joint
- Sacral plexus
Quadratus femoris
- Ischial tuberosity
- Intertrochanteric crest of femur
- Lateral rotation at hip joint, stabilizes hip joint
- Sacral plexus
Identify this and its function
Iliofemoral ligament - prevents over-extension
What is the acetabular fossa?
Non-articulating part of acetabulum
What are the attachments of the ligament of head of femur? What does it contain?
Head of the femur –> acetabular notch, transverse acetabular ligament & acetabular fossa.
Contains acetabular branch of obturator artery which contributes to the blood supply of head of femur.
A woman with osteoporosis falls and fractures the head of her right
femur. Why is there a risk of avascular necrosis of the femoral head?
Branches of medial and lateral circumflex femoral arteries run along femoral neck to reach femoral head. These may be damaged by the fracture.
Avascular necrosis of femoral head will occur if there is an inadequate blood supply through the acetabular branch of obturator artery (which passes from the acetabulum to the femoral head, through the ligament of head of femur).
List the articulating surfaces of the knee
Condyles of femur (Medial & lateral),
Condyles of tibia (Medial & lateral),
Patella.
What are the attachments of the cruciate ligaments
Intercondylar area of tibia and femoral condyles.
Identify this + what structures run through it
Knee capsule, Tendon of popliteus muscle, which exits the joint cavity posteriorly.
Why is the medial collateral ligament prone to injury?
Is attached to medial meniscus, so is less mobile.
List the bursae in the knee with their locations. Mention which communicate with the knee joint.
- Suprapatellar (between quadriceps femoris muscle / tendon + femur). Communicates with knee joint.
- Prepatellar (between skin and patella)
- Infrapatellar (between skin and tibia)
Superior tibiofibular joint:
Surfaces: Head of fibula & lateral condyle of tibia.
Synovial plane joint.
Slight gliding movement occurs during dorsiflexion / plantarflexion
Inferior tibiofibular joint
Fibrous joint.
Very little movement
What does the posterior cutaneous nerve of the thigh innervate
Posterior aspect of thigh
Popliteal fossa
Upper part of back of leg
Skin of gluteal fold, upper medial thigh + perineum.
Medial plantar nerves
Gives rise to common plantar digital nerves which give rise to proper plantar digital nerves.
Supplies abductor hallucis, flexor hallucis brevis, flexor digitorum brevis + 1st lumbrical.
Supplies skin of anterior 2/3 of sole and medial 3/5 digits.
Where does the popliteal artery begin?
In adductor hiatus as continuation of femoral artery
At what position should intramuscular injections be given in the
gluteal region? Explain why.
Upper lateral quadrant - avoid injuring sciatic and gluteal nerves.
What does posterior cutaneous nerve of thigh innervate
Skin over posterior aspect of thigh, popliteal fossa and upper part of the back of leg.
Skin of gluteal fold, upper medial thigh and perineum
Muscles that cause medial rotation at hip?
Gluteus medius, Gluteus minimus, Adductor longus, Adductor brevis, Adductor magnus, Semitendinosus, Semimembranosus.
Lateral rotation at hip?
Gluteus maximus, Piriformis, Superior gemellus, Inferior
gemellus, Obturator internus, Obturator externus, Biceps femoris.
After it passes through space behind knee, what is the course of the popliteal vein
exits fossa by passing through the adductor hiatus (in
adductor magnus) to enter the adductor canal and becomes the femoral
vein
Where can you palpate the pulse of popliteal artery? Why is it difficult to palpate?
Deeply in centre of Popliteal fossa.
Difficult to palpate: deepest of neurovascular structures in fossa
