ANA 211 Lower Limb Osteology and Gluteal Region Flashcards
What are the types of bones
Flat
Long
Irregular
Short
Sesamoid
Function of flat bones and examples
- They shield and protect organs
- They can provide large areas of attachment for muscles
Eg. Scapula, sternum, ribs, cranial bones
Function and examples of long bones
1.Supports weight
2. Facilitates movements
Eg. Humerus, femur, tibia, fibula, ulna, radius, metacarpal, metatarsal and phalanges
Function of lower limb bones?
Locomotion
Carry the weight of the entire erect body
Support
Points for muscular attachments
Components of the lower limb bones
1.Hip (Pectoral girdle)
Ilium
Ischium
Pubis
Acetabulum
2.Thigh
Femur
3.Knee
Patella
Leg
Tibia (medial)
Fibula (lateral)
4.Foot
Tarsals (7)
Metatarsals (5)
Phalanges (14)
What are the bones of the hip?
Ilium
Ischium
Pubis
Acetabulum
How many phalanges, metatarsals and tarsals do we have?
phalanges, (14)
metatarsals (5)
tarsals (7)
What is the epiphyseal plate?
Line of hyaline cartilage between epiphysis and diaphysis where the developing bone lengthens
Responsible for:
The proliferation of the cartilage cells responsible for the length of the developing bone
It disappears when growth in bone length stops
Where is the red bone marrow located in a long bone?
The epiphysis
The medullary/marrow cavity is filled with _
Yellow bone marrow
Yellow bone marrow makes white blood cells TRUE/FALSE
FALSE the yellow bone marrow stores fats and nutrients for the bone
Where are red and white blood cells produced?
Both are produced in the red bone marrow
What age does yellow bone marrow develop in humans?
7/8 years
Which bone-type functions in strengthening the bone?
Compact bone (dense and closely packed cell material)
What are the types of bone structures in a long bone?
Spongy bone
Compact bone
What is the function of the spongy bone?
To house the red bone marrow
to make the bones light, for ease of movement
Purpose of the arteries in the bone?
To deliver nutrients and transport new blood cells throughout the body
Function of the periosteum
Consists of a layer of osteoblasts for bone material to grow and heal if broken
What is the metaphysis?
Part of the diaphysis adjacent to the epiphyseal plate
The most active site of bone formation in the developing bone
Highly vascularized
List and explain the types of epiphysis
- Pressure Epiphysis
Found at the ends of long bones
Articular in nature
Takes part in the transmission of weight - Traction Epiphysis
Produced due to the pull of the muscle and therefore provides attachment to the muscle(s)
Non-articular in nature
Does not take part in the transmission of weight - Atavistic Epiphysis
An independent bone in lower animals, but part of another bone in humans - Aberrant Epiphysis
Not present in everybody
Examples of the different types of epiphyses
Pressure e.g. head of femur, humerus, the lower end of the radius
Traction e.g. greater and lesser tubercles of the humerus, greater and lesser trochanters of the femur, and the mastoid process of the temporal bone.
Atavistic e.g. Coracoid process of scapula, posterior tubercle of talus
Aberrant: e.g. epiphysis at the head of first metacarpal and base of other metacarpals
Flat bones such as the cranial bones and clavicle are developed by which form of ossification?
Intramembranous ossification
Long bones such as the humerus and femur are developed by which form of ossification?
Endochondral ossification
Types of joint functions
- Synarthrosis: no movement
- Amphiarthrosis: little movement
- Diarthrosis: full movement
Examples of synarthrosis joints
Skull sutures
Articulations of bony sockets
Teeth in facial skeleton bone
Example of amphiarthrosis joints
Distal joint between the tibia and the fibula
Pubic symphysis
Example of diarthrosis joints
Elbow, shoulder, ankle
Types of joints according to structure
Fibrous joint
Cartilaginous joint
Synovial joint
Why are most fibrous joints immovable
They have no joint cavity and are connected via fibrous connective tissues (synarthroses)
Types of fibrous joints
1.SUTURESare nonmoving joints that connect bones of the skull. These joints have serrated edges that lock together with fibers of connective tissue.
2.The fibrous articulations between the teeth and the mandible or maxilla are calledGOMPHOSES and are also immovable.
3.ASYNDESMOSISis a joint in which a ligament connects two bones, allowing for a little movement (amphiarthroses). The distal joint between the tibia and fibula is an example of a syndesmosis.
Types of cartilaginous joints
(1) ASYNCHRONDOSIS is an immovable cartilaginous joint. One example is the joint between the first pair of ribs and the sternum.
(2) A SYMPHYSIS consists of a compressible fibrocartilaginous pad that connects two bones. This type of joint allows for some movement. The hip bones, connected by the pubic symphysis, and the vertebrae, connected by intervertebral discs, are two examples of symphyses.
Types of synovial joints
(1) Gliding joints move against each other on a single plane. E.gs. intervertebral joints and the bones of the wrists and ankles.
(2) Hinge joints move on just one axis. These joints allow for flexion and extension. E.gs. the elbow and finger joints.
(3) A pivot joint provides rotation. At the top of the spine, the atlas and axis form a pivot joint that allows for rotation of the head.
(4) A condyloid joint allows for circular motion, flexion, and extension. The wrist joint between the radius and the carpal bones is an example of a condyloid joint.
(5) A saddle joint allows for flexion, extension, and other movements, but no rotation. In the hand, the thumb’s saddle joint (between the first metacarpal and the trapezium) lets the thumb cross over the palm, making it opposable.
(6) The ball-and-socket joint is a freely moving joint that can rotate on any axis. The hip and shoulder joints are examples of ball and socket joints.
What is an ossification center and what are the types of ossification?
A point where ossification starts
1.Primary
2. Secondary
Which joint in the thumb allows for opposition?
condyloid joint
Synchrondoses is a _ cartilaginous joint
Primary
What is the fibrous joint found in the skull?
suture
What is the fibrous joint found between the ulna and radius?
syndesmosis
What are the fibrous articulations between the teeth and the mandible or maxilla?
gomphosis
What kind of joint can be found between the epiphysis and diaphysis of long bones?
a cartilaginous joint
Name the secondary cartilaginous joint
Symphysis
What is the joint between the first pair of ribs and the sternum?
synchondrosis
What cartilaginous joint is located at the pubis symphyses?
Symphysis/ symphyses
Syndesmosis possesses which type of joint mobility?
Amphiarthrosis
Gomphosis and Synchondrosis possess which type of joint mobility?
Synarthrosis
The gluteal region is between
The iliac crest and gluteal fold
What is the line dividing the buttock
nata (intergluteal) cleft
What is the clinical relevance of the superficial fascia?
intramuscular drug delivery
Functions of the Superficial Fascia
Gives the characteristic convexity to the buttock
Forms a thick cushion over the ischial tuberosity
What are the muscles of the lower limb?
Gluteus maximus
Gluteus medius
gluteus minimus
tensor fascia lata
piriformis
superior gemellus
Inferior gemellus
obturator internus
quadratus femoris
What is the largest muscle in the body?
Gluteus Maximus
Where are the points of origin of the Gluteus Maximus?
Posterior surface of the sacrum and coccyx
Lumbar fascia
Outer Ilium posterior to the gluteal line
Sacrotuberous ligament
What is the point of insertion for the Gluetus Maximus?
Most of the muscle (3/4th) inserted into the iliotibial tract
Deeper fibers inserted into the gluteal tuberosity
What is the nerve supply of the Gluteus Maximus?
Inferior gluteal nerve (L5, S1 & 2)
What are the actions of the gluteus Maximus?
Extends and laterally rotates hip joint extends the knee joint through iliotibial tract
Gives simultaneous stability to the hip and knee joints through the iliotibial tract
What is the chief anti gravity muscle of the hip?
Gluteus Maximus
What makes up the inferior gluteal nerve?
L5, S1 and 2
What makes up the superior gluteal nerve?
L4, 5 and S1
What can be the result of damage to the superior gluteal nerve?
Damage to the superior gluteal nerve results in paralysis of the gluteus medius muscle resulting in a characteristic gait on walking and standing known as the Trendelenburg
What is the origin of the gluteus medius?
Outer surface of the ilium between the anterior and posterior gluteal lines
Which gluteal muscle, extends from the pelvis to the gluteal tuberosity of femur?
Gluteus maximus
What is the blood supply of the gluteus maximus?
Inferior gluteal and superior gluteal arteries
Which gluteal muscle extends from the ilium to the proximal femur?
Gluteus medius
What is the insertion of the gluteus medius?
Lateral surface of the greater trochanter of the femur
Action of gluteus medius?
Hip joint: Thigh abduction, thigh medial rotation
Stabilizing the pelvis whilst walking
Connects pelvis to femur by crossing over the acetabulofemoral joint (aka hip joint)
What is the blood supply of the gluteus medius?
Deep branch of superior gluteal artery, trochanteric anastomosis
What is the innervation of the gluteus medius?
Superior gluteal nerve L4,L5 and S1
Which gluteal muscle spans from the gluteal surface of the ilium to the proximal end of the femur
Gluteus minimus
What is the origin of the gluteus minimus?
Outer surface of ilium between the anterior and interior gluteal lines
What is the insertion of the gluteus minimus?
Anterior aspect of greater trochanter of femur
What is the innervation of the gluteus minimus?
Superior gluteal nerve: L4,L5 and S1
What is the action of the gluteus minimus?
Thigh abduction, thigh medial rotation
Stabilizing the pelvis whilst walking
The hip joint is also known as the
acetabulofemoral joint
What is the origin of the Tensor Fascia Lata?
Outer edge of iliac crest between anterior superior iliac spine & iliac tubercle
What is the insertion of the Tensor Fascia lata?
The iliotibial tract
Nerve supply of tensor fascia lata?
Superior gluteal nerve (L4,5, S1)
Action of tensor fascia lata?
Maintains the knee in extended position
One of the important landmarks in the gluteal region is _
Piriformis
Origin of the piriformis
Anterior surface of S2,3,4 vertebrae of the sacrum
Insertion of piriformis
Upper border of greater trochanter
Nerve supply of piriformis
Anterior rami of S1,2
Action of piriformis
Lateral rotator of thigh
Assists in stabilizing hip joint especially in abduction
What is the landmark between the gluteus maximus and tensor fascia lata?
Iliotibial tract
Origin of the obturator internus
Inner surface of obturator membrane and adjacent bone
Insertion of the obturator internus
Upper border of greater trochanter along with gemelli
Nerve supply to obturator internus
Nerve to obturator internus (L4,S1)
Action of obturator internus
Lateral rotator of thigh
Origin of superior and inferior Gemelli
Superior from ischial spine
Inferior from ischial tuberosity
Insertion of the superior and inferior gemelli
Upper border of greater trochanter
Nerve supply of the gemelli?
Superior from nerve to obturator internus (L4, S1)
Inferior from nerve to quadratus femoris (L4, S1)
Action of gemelli
Lateral rotators of thigh
Origin of the quadratus femoris
Lateral border of ischial tuberosity
Insertion of the quadratus femoris
Quadrate tubercle of femur
Insertion of the quadratus femoris
Quadrate tubercle, intertrochanteric crest of femur
Nerve supply of quadratus femoris
Nerve to quadratus femoris (L4,S1)
Action of quadratus femoris
Lateral rotator of thigh
Problems that could lead to a positive trendelenburg test
Fracture neck of femur
Dislocation of hip joint
Coxa Vara
Nonfunctioning gluteus medius and minimus due to:
Neurological damage (L4 – 5 disc herniation)
Any disease affecting muscles (myopathy)
How does arthritis occurs
Inflammation of one or more joints, causing pain and stiffness that can worsen with age.
It occurs when the synovial fluid begins to dry up leading to more friction between bones
What are the nerves of the gluteal region?
Sciatic
posterior cutaneous nerve of the thigh superior gluteal
inferior gluteal
nerve to quadratus femoris
pudendal nerve
nerve to obturator internus
What converts the the sciatic notch of the hip bone into a greater and lesser foramina?
Sacrotuberous and sacrospinous ligament
Use of the greatest sciatic foramen
And division
The greater sciatic foreman forms a passageway through which structures entering and leaving the pelvis passes e.g. sciatic nerve
It can be divided into
Suprapiriform foramen
superior gluteal vessels
superior gluteal nerve
Infrapiriform foramen
inferior gluteal vessels
internal pudendal vessels
nerves of the sacral plexus
inferior gluteal nerve
pudendal nerve
sciatic nerve
posterior femoral cutaneous nerve
nerve to obturator internus
nerve to quadratus femoris
Use of the lesser sciatic foramen
The lesser sciatic foramen serves as a passageway for structures entering and leaving the perineum eg. pudendal nerve
The cluneal nerves innervates…?
The skin of the gluteal region
Specifically the e skin over the iliac crest, between the posterior superior iliac spines and I’ve ever iliac tubercle
Consequently these nerves are vulnerable to injury when bone is taken from the ilium for grafting
Describe the superior cluneal nerves
The superior cluneal nerves are the lateral cutaneous branches of the dorsal rami of L1-L3
They supply the skin of the gluteal region as far as the greater trochanter
Describe the medial cluneal nerves
The medial cluneal nerves are the lateral cutaneous branches of the dorsal rami of S1-S3
Supplies the skin and subcutaneous tissue over the sacrum and the adjacent area of the buttock
Describe the inferior cluneal nerves
The inferior cluneal nerves are gluteal branches of the posterior cutaneous nerve of the thigh, a derivative of the sacral plexus (ventral rami S1-S3)
These nerves curl around the inferior border of the gluteus maximus
supplies the inferior half of the buttock
Describe the perforating cutaneous nerve
The perforating cutaneous nerve (S2 and S3) passes through the sacrotuberous ligaments and the inferior part of the gluteus maximus
What are the deep gluteal nerves?
Entering the Gluteal region from the pelvis through the greater sciatic foramen:
Superior gluteal nerve
inferior gluteal nerve
sciatic nerve
pudendal nerve
nerve to the quadratus femoris
nerve to the obturator internus
posterior cuntaneous nerve of the thigh
Entering the Gluteal region by passing through the sacrotuberous ligament:
The perforating cutaneous nerve
Nerves derived from the sacral plexus
superior and infeior gluteal nerves
sciatic nerve
posterior femoral cutaneous
pudendal
Arteries of the gluteal region
Superior and inferior gluteal arteries enter the gluteal region from the pelvic cavity through the greater sciatic foramen.
They supply structures in the gluteal region and posterior thigh and have important collateral anastomoses with branches of the femoral artery.
Discuss the superior gluteal artery
Originates from the posterior trunk of the internal iliac artery in the pelvic cavity.
It leaves the pelvic cavity with the superior gluteal nerve through the greater sciatic foramen above the piriformis muscle.
In the gluteal region, it divides into a superficial branch and a deep branch: the superficial branch supplies the gluteus maximus
the deep branch supplies the gluteus medius and minimus muscles.
It also contributes to the supply of the hip joint.
Branches of the artery also anastomose with the lateral and medial femoral circumflex arteries from the deep femoral artery in the thigh, and with the inferior gluteal artery.
Discuss the inferior gluteal artery
Originates from the anterior trunk of the internal iliac artery in the pelvic cavity.
It leaves the pelvic cavity with the inferior gluteal nerve through the greater sciatic foramen inferior to the piriformis muscle.
The inferior gluteal artery descends through the gluteal region and into the posterior thigh and anastomoses with perforating branches of the femoral artery.
It also supplies a branch to the sciatic nerve.
Arterial supply to femoral head
Medial & lateral femoral circumflex arteries
Superior and inferior gluteal arteries
Post. obdurator artery via artery of femoral ligament
Trendelenberg test
To assesses whether the hip abductors (particularly gluteus medius) are functioning normally
Observe patient from behind, ask him/her to stand on one foot and then the other
Negative test: Pelvis ‘tilts up’ on contralateral side
Positive test: Pelvis ‘sags’ on contralateral side
Problems that could lead to a positive Trendelenburg test:
Fracture neck of femur
Dislocation of hip joint
Coxa Vara
Nonfunctioning gluteus medius and minimus due to:
Neurological damage (L4 – 5 disc herniation)
Any disease affecting muscles (myopathy)
Clinical significance of an intramusular injection
Intramuscular injection enables a large amount of a drug to be introduced at once but absorbed gradually.
This procedure must be carried out without injuring neurovascular structures.
A typical site for an intramuscular injection is the gluteal region, the upper lateral quadrant of the gluteal region being the safest region
The sciatic nerve passes through this region and needs to be avoided.
A needle placed in this region enters the gluteus medius anterosuperior to the margin of the gluteus maximus.
