ALL CONTENT P2 Flashcards
Three parts of the pelvis and what do they consist of
Bowl: hip bones + sacrum
Joints: sacroilic and symphysis
Girdle: hip bones + some sacrum
What are three functions of the pelvis
Support and protect viscera, provide muscle attatchment site, supports weight of upper body
What are the two parts of the basin
Pelvic inlet and outlet
What is superior to pelvic inlet
False or greater pelvis (IGF)
What is inferior to pelvic inlet
True or lesser pelvis
What makes up the pelvic inlet
Pubic crest, sacral promontory, pectineal line, arcuate line
What makes up the pelvic outlet
Apex of coccyx, ischial tuberosities, pubic symphysis
Classify pubic symphysis and sacroiliac joint
1) symphysis: fibrocartilage 2) sacroiliac: ant (synovial) and post (fibrous)
Name the posterior pelvic ligaments
1) sacrotuberous 2) posterior sacroiliac ligament 3) sacrospinous
Name the anterior pelvic ligaments
1) interosseous sacroiliac 2) anterior sacroiliac ligament 3) illiolumbar
Weight transfer through pelvis four steps
Weight pushes sacrum inferiorly
Sacrum becomes ‘wedged’ in
Irregular joint surfaces interlock
Ligaments come under tension
What causes the sacroiliac joint to move
External forces
Overall movement of the sacroiliac
Slight gliding and rotation
Define nutation
Anterior rotation of superior sacrum
Define counter nutation
Anterior rotation of inferior sacrum
Nutation is resisted by which ligaments
Sacrotuberous and sacrospinous
Define form closure
How passive structures contribute to the stability of joints
Define force closure
How active structures contribute to the stability of joints
What structures does form closure consist of
Ligaments, gravity, rigid structures
What structures does force closure consist of
Muscles and fascia
Purpose of form closure
Create rigid interlocking surfaces
Purpose of force closure
Enhances compression of joints
What muscles produce pelvic drop around AP axis
Ipsilateral gluteus maximus, contralateral EO and IO, contralateral hip adductors
What muscles produce anterior pelvic tilt around AP axis
Erector spinae, hip flexors
What muscles produce pelvic rotation to the R
Left EO, Right IO, Left hip lateral rotators, right hip medial rotators
What movement does the sacrotuberous and sacrospinous resist
Nutation
What is meant by true vs false pelvic
Anything above pelvic inlet is an accessory
What are three factors that contribte to form closure
Shape of joint surface, tension in ligaments, keystone like wedge shape of sacrum
What is contralateral vs ipsilateral
Controlateral: opposite
Ipsilateral: same
Is contralateral abduction or adduction in drop (acronym)
Contalateral: adduction (CODD contralateral, opposite, adduction, drop)
During lift and drop which side of the pelvic is adduction
Higher side: adduction (smaller angle)
What is the windlass effect
The plantar fascia supports the foot during weight bearing activities
What are the three sections of pelvic organs
1) Lower urinary tract 2) reproductive 3) lower GIT
What do the three sections of the pelvic organs consist of
1) Bladder & urethera 2) uterus & prostate 3) rectum & anal canal
Explain the pelvic floor
Dome shaped muscular sheet seperating the pelvic cavity and perineal region below
What is the pelvic floor made up of
Muscle and fascia
What are the four functions of pelvic floor
Supports pelvic viscera
Contributes to increase intra abdominal pressure
Acts as sphincters for the passageways through the pelvis
Assists in childbirth: forms a ‘gutter’
What is the endopelvic fascia made up of
Webs of
1) loose connective tissue
2) adipose tissue
3) smooth muscle
What are the two functions of endopelvic fascia
Maintains organ placement, conduit for passageway of nerves and blood to organs
Explain the location of the perineum
Between pubic symphysis and coccyx
What is the perineum made up of
1) Perineal body
2) Skeletal muscle & fascia
3) Urogenital and anal triangle
What muscles make up the peroneal muscle categories
1) ischiocavernosus, bulbospongiosus, super and deep transverse perineal
2) external anal sphincter
List the two categories of peroneal muscles
1) Urogenital triangle 2) anal triangle
What are the three functions of peroneal muscles
1) Provid added closure to vagina & anus
2) support and fix perineal body
3) maintain erection of penis
What is the perineal body
Irregular fibromuscular mass
Where is the perineal body located
Midline between anus and vagina/penis
What is the perineal body a site of attatchment for
Bulbospongiosus
What are the muscles of the pelvic floor supplied by
Nerve to levator ani (slight input from pudenal nerve)
What are the muscles of the perineum supplied by
Pudinal nerve (slight input from nerve to levator ani)
In terms of blood supply what do arteries and viens have
1) Arteries (branches) 2) Viens (tributaries)
What are the three aortic branches
1) Arch of aorta
2) descending aorta
3) common iliac arteries
How do deep viens run
Run with arteries but in the opposite direction
What are vena commitantes
Two+ small viens that match with the artery
What is anastomose in terms of superficial viens
Communication
Two reasons of significance of having two sets of viens
1) Two ways to return blood to heart
2) Temperature control
Purpose of retinacula in lower leg
Hold the tendons in place and prevent bow stringing
Superior and inferior extensor retinaculumbinds to which muscle’s tendons
TA, EHL, EDL, FT (anterior muscle group)
Two types of peroneal retinacula
Superior and inferior peroneal retinaculum
The peroneal retinacula binds down which two muscles tendons
PL and PB (lateral muscle group)
What does the flexor retinaculumconvert bony grooves into and why
Into canals for the TP, FHL, FDL (posterior deep muscle groups) tendons
Purpose of synovial sheaths
Facilitate sliding of the tendons
Origin and insertions of intrinsic vs extrinsic foot muscles
Intrinsic: both in foot
Extrinsic: origin leg and insertion foot
Three functions of plantar aponeurosis of the foot
Bind to skin, attatchment site for foot muscles, helps maintain arches of foot
What are the dorsal muscles of the foot
Extensor digitorum brevis, extensor hallicus brevis
Where is aponeurosis located in foot
Superificial immediately under the skin
Three foot functions
Weight bearing, propulsion, shock absorption
List five characteristics of step off
Foot is rigid
Mid tarsal joint locks
Plantarflex ankle and extend MTP joints
Tightens plantar aponeurosis
Raises medial longitudinal arch
List three characteristics of heel strike
Foot is flexible
Mid tarsal joint unlocks
Subtalar joint pronates
Five features of medial longitudinal arch
Calcaneus, talus, navicular, 3 cuneiforms, 1-3 metatarsals
Four features of lateral longitudinal arch
Calcaneus, talus, cuboid, 4-5 metatarsals
What plane does the transverse arch run in
Coronal plane
What is the proximal end of the transverse arch formed from
All three cuniform bones, metatarsal bases, cuboid
What is the distal end of the transverse arch formed from
Head of metatarsal
Two purposes of arches
Shock absorber and weight bearing
What is the bowstring of dynamic support
Pulls the end of the arch together
Ligamentous support (plantar aponeurosis explain)
Toe extension creates tension in aponeurosis which lifts up longitudinal arch creating a windlass effect
Static support factors that help arches
1) Shape
2) Ligaments: long and short plantar ligament, spring ligament, plantar aponeurosis, interossei
When is muscular (dynamic) support used & 2 types of support
Walking and running (support includes bowstring and sling)
Structures of medial longitunal arch (dynamic support)
Abductor hallicus,
FHL
FDL
tibialis posterior
tibialis anterior
What is the sling of dynamic support
Lifts the summit upwards
Structures of lateral longitunal arch (dynamic support)
Fibularis longus
fibularis brevis
fibularis tertius
tibialis posterior
abductor digiti minimi
Dorsal digital expansionallows the toes to do what
Extend simultaneously
Dorsal digital expansionis important for what
Digital sweep
What is digital sweep
Longest possible sweep of the tips of the digits
Are foot movements pure
No
How does digital sweep occur
Interplay between the extrinsic and intrinsic foot muscles
Flexion of MTP (IP maintained in extension) -> flexion of IP
Lumbricals prevent
Toe clawing
What consists of digital sweep
Intrinsic muscles (extend IP joints), interossei and lumbricals
Lumbricals flex and extend what
Flex: MTP joint Extend: IP joint
What is clawing of the toes
Long flexor and long extensor work unopposed
Clawing of the toes pulls what into flexion and extension
FDL: IP flexion | EDL: MTP extension
Clawing of the toes creates what rest
A new abnormal position
Two main phases of gait
Stance (foot in contact with ground) and swing (foot not in contact with ground)
What is cyclical
Repetitious sequence of limb motion to move body foward
Plane of hip, knee and ankle during gait
Sagittal
Define gait
Manner or style of walking
Gait is how many strides
One stride
Plane of pelvis during gait
Sagittal and coronal
Knee motion gait degree of flexion and extension
60 degrees + 0 degrees = 60 degrees
Hip motion gait degree of flexion and extension
30 degrees + 20 degrees = 50 degrees
Failure of this coronal plane is called what
Trendelenburg gait
Ankle motion gait degree of plantar and dorsiflexion
20 degrees + 5 degrees = 25 degrees
What weak muscles cause trendelenburg
Weak hip abductors of stance leg
Describe the phases of ankle motion during gait
Plantarflexion: loading response (reduces impact of heel contact)
Dorsiflexion: mid to terminal stance (facilitates body weight over foot)
Plantarflexion: prep for swing phase (transforming extended knee to freely flexing joint)
Dorsiflexion: swing (foot clearance)
Describe the coronal plane of pelvic motion during gait
Lift and drop around anteroposterior axis
Activation of what limits drop during stance phase
Activation of contralateral gluteus medius and minimus
Explain the motion trendelenburg
As patients drop the left foot during stance the contralateral hip drops
Describe the sagittal plane of pelvic motion during gait
Tilt around the transverse axis
L3 action
Hip flexion
Knee extension
L1 action
None
L2 action
Hip flexion
L4 action
Hip extension
Knee extension
Ankle dorsiflexion
L5 action
Hip extension
Knee flexion
Ankle dorsiflexion
Toe extension
Loading response ROM
15-25 flex
15-20 flex
0-5 plantar
S1 action
Knee flexion
Ankle plantarflexion
Toe extension + flexion
Initial contact ROM
30 flex
5 flex
0-5 dorsiflex
S2 action
Ankle plantarflexion
Toe flexion
Initial contact action
Extending
Flexing
Plantarflexing
Initial contact muscles
Extensor
Extensor
Dorsiflexor
Mid stance ROM
5-10 flex
5-10 flex
5-10 dorsiflex
Terminal stance ROM
5-10 extend
5-10 flex
5-10 dorsiflex
Loading response action
Extending
Flexing
Plantarflexing
Mid stance action
Extending
Extending
Dorsiflexing
Loading response muscles
Extensor
Extensor
Dorsiflexor
Terminal stance action
Extending
Flexing
Dorsiflexing
Terminal stance muscles
Flexor
Flexor
Plantarflexor
Mid stance muscles
Extensor
Extensor
Plantarflexor
Initial contact purpose
Pulls knee into extension
Shock absorb
Lower foot to ground
Loading response purpose
Pulls knee into extension
Prevent knee collapse
Lower foot to ground -> prevent slap
Mid stance purpose
Finishes pull of knee into extension
Pushes knee into extension
Slow foward shank motion
Terminal stance purpose
Controls hip extension
Bends knee for foot clearance
Continues to slow foward motion
Motor distribution femoral nerve
Pectineus, illiacus, sartorius, quad
Motor distribution saphenous nerve
None
Motor distribution obturator nerve
Pectineus
Gacilis
Add brevis
Add longus
1/2 add magnus
Obturator externus
Motor distribution lateral cutaneous nerve
None
Motor distribution muscular branches 1
Illiopsoas
Sensory distribution saphenous nerve
Skin of medial thigh -> great toe
Motor distribution genitofemoral nerve
None
Sensory distribution femoral nerve
Skin of anterior and medial thigh
Sensory distribution obturator nerve
Skin of medial thigh
Sensory distribution lateral cutaneous nerve
Skin of lateral thigh
Sensory distribution genitofemoral nerve
Skin of medial thigh + skin of genitalia
Sensory distribution muscular branches 1
Hip joint
Motor distribution posterior femoral cutaneous nerve
None
Motor distribution tibial nerve
All posterior lower leg muscles
Sensory distribution tibial nerve
Knee + ankle joint
Motor distribution muscular branches 2
External rotators except obturator externus
Motor distribution inferior gluteal
Gluteus maximus
Motor distribution superior gluteal
Gluteus medius
Gluteus minimus
Tensor fascia lata
Sensory distribution posterior femoral cutaneous nerve
Skin of posterior and lateral leg -> mid calf
Sensory distribution superior gluteal
Hip joint
Sensory distribution inferior gluteal
Hip joint
Motor distribution sural nerve
None
Sensory distribution muscular branches
Hip joint
Motor distribution medial plantar nerve
Abductor hallicus
FDL
FHL
Lumbrical 1
Motor distribution sciatic nerve
Hamstrings
1/2 adductor magnus
Motor distribution lateral plantar nerve
Adductor hallicus
Lumbrical 2-4
Interossei
FDMB
ABDM
FA
Motor distribution common peroneal
None
Motor distribution deep peroneal
All anterior lower leg muscles
Sensory distribution medial plantar nerve
Skin of medial 3 1/2 digits + corresponding sole
Motor distribution superficial peroneal
Fibularis longus
Fibularis brevis
Sensory distribution sciatic nerve
Hip + knee joint
Sensory distribution lateral plantar nerve
Skin of lateral 1 1/2 digits + corresponding sole
Sensory distribution sural nerve
Skin of lateral and posterior leg
Sensory distribution superficial peroneal nerve
Skin of lateral leg
Sensory distribution common peroneal nerve
Skin of ant, post, lat upper leg
Sensory distribution deep peroneal
Skin between digits 1-2
Dermatome of L1
Lower back, pelvis
Dermatome of L2
Lower back, upper anterior thigh
Dermatome of L5
Gluteal
Pelvis
Post + lateral thigh
Lateral leg
Dorsal of foot
Toe 1-3
Dermatome of L3
Lower back
Anterior thigh
Medial leg
Dermatome of S2
Gluteal
Medial and posterior thigh + leg
Dermatome of L4
Medial gluteal
Lateral thigh
Medial leg
Dorsal foot
Toe 1-3
Dermatome of S1
Gluteal
Lateral and posterior thigh + leg
Dermatome S3
Pelvis
Medial thigh