B6-028 Gluteal Region and Thigh Flashcards
chief extensor of the thigh
gluteus maximus
what part of the gluteus maximus can help extend the leg at the knee?
iliotibial tract
inferior gluteal nerve innervates
gluteus maximus
[…] nerve arises in the gluteal region from the spinal chord and descends down into the posterior thigh
sciatic
gluteus medius and gluteus minimus are important for normal […]
gait
responsible for thigh abduction and medial rotation [2]
gluteus minimus
gluteus medius
superior gluteal nerve innervates [3]
gluteus medius and minimus
tensor fascia lata
-abducts, medially rotates, and flexes thigh at hip
-can aid gluteus maximus in slight extension of knee
tensor fascia lata
most superior lateral rotator of the hip
piriformis
superior gluteal nerve and artery emerge superior to […]
piriformis
the sciatic nerve emerges inferior to […]
piriformis
(so does inferior gluteal nerve)
what three muscles form the triceps coxae
superior gemellus
inferior gemellus
obturator internus
lateral rotators of the femur [6]
piriformis
superior gemellus
inferior gemellus
quadratus femoris
obturator internus
obturator externus
most inferior lateral rotator of the hip
quadratus femoris
vertically oriented group of gluteal muscles [5]
gluteus medius
gluteus minimus
tensor fascia latae
gluteus maximus
piriformis
horizontally oriented group of gluteal muscles [5]
quadratus femoris
obturator internus
obturator externus
gemelli pair
the bulk of the anterior muscles of the thigh act as […]
extensors
the leg extensors of the anterior thigh mostly insert onto the
tibial tuberosity
muscles of the anterior thigh [4]
iliopsoas
pectineous
sartorius
quadriceps femoris
chief flexor of the thigh
illiopsoas
comes off T12-L5 and inserts onto the lesser trochanter of the femur
illiopsoas
what two muscles make up illiopsoas?
illiacus
psoas major
illiacus is innervated by
femoral nerve
L1-L3 ventral rami innervates
psoas
longest muscle in body
sartorius
sartorius is innervated by
femoral nerve
quadriceps femoris is innervated by
femoral nerve
only muscle of the quad that acts on the hip and knee to extend the leg and flex the thigh
rectus femoris
the vasti of the quadriceps femoris works to […] the leg
extend
superficial medial thigh muscle [4]
pectineus
adductor longus
adductor brevis
gracillis
deep medial thigh muscles [2]
obturator externus
adductor magnus
pectineus is innervated by
femoral nerve
adductor longus is innervated by
obturator nerve
primary function of the medial thigh muscles is
adduction
**some do a bit of flexion
only adductor to cross the knee joint
gracilis
gracilis is innervated by
obturator nerve
lies deep to pectineus and adductor longus
adductor brevis
adductor brevis is innervated by
obturator
largest adductor muscle
adductor magnus
2 parts of adductor magnus
adductor portion
hamstring portion
the hamstring part of the adductor magnus arises from
ischial tuberosity
the adductor part of the adductor magnus arises from
ischiopubic ramus
the hamstring part of the adductor magnus inserts at the
adductor tubercle
the adductor part of the adductor magnus inserts distally at
linea aspera
in general, the medial compartment of the thigh contains […] and is innervated by […]
adductors
obturator nerve
in general, the anterior compartment of the thigh contains […] and is innervated by […]
extensors
femoral nerve
in general, the posterior compartment of the thigh contains […] and is innervated by […]
flexors
sciatic nerve
most of the hamstrings are innervated by
tibial division of sciatic
**except short head of biceps femoris (fibular division)
in the general, the hamstrings act to […] and the hip and […] at the knee
extend at hip
flex at knee
**short head of biceps only flexes at knee
-long cordlike tendon that runs down the posterior thigh
-extends thigh at hip, medially rotates leg
semitendinosus
semitendinosus is innervated by
tibial division of sciatic
what muscles/nerves make up the pes anserinus
gracilis -obturator
semitendinosus- tibial division of sciatic
sartorius- femoral nerve
the pes anserinus is located on the medial aspect of the
tibia
semimembranosus sends off the […], which reinforces the capsule of the knee
oblique popliteal ligament
hyperextension of the knee could damage […]
oblique popliteal ligament
the long head of biceps femoris is innervated by
tibial division of sciatic nerve
the short head of biceps femoris is innervated by
fibular division of sciatic nerve
which head of the biceps femoris flexes the knee and extends the thigh?
long head
**short only flexes
both heads of biceps femoris insert distally at […]
head of fibula
short head of the biceps femoris originates at […]
linea aspera of femur
long head of biceps femoris originates at […]
ischial tuberosity
the adductor part of adductor magnus inserts distally at […]
adductor tubercle on medial epicondyle of femur
adductor magnus originates from […]
ischial tuberosity
hamstring portion of adductor magnus is innervated by
tibial division of sciatic
hamstring that acts only at the hip to assist in extension
hamstring portion of adductor magnus
**does not cross knee= no flexion
adductor portion of adductor magnus is innervated by
obturator
posterior thigh muscles [5]
semimembranosus
semitendonosus
biceps femoris
popliteus
**not pictured: hamstring portion of adductor magnus
abductors of the hip [2]
gluteus medius
gluteus minimus
adductors of the hip [3]
adductor magnus
adductor longus
adductor brevis
extensors of hip [4]
gluteus maximus
semitendonosus
semimembranosus
long head of biceps femoris
flexors of hip [5]
illiopsoas
rectus femoris
tensor fascia latae
pectineous
sartorius
internal rotators of hip [3]
gluteus medius
gluteus minimus
tensor fascia latae
external rotators of hip [5]
illiopsoas
gluteus maximus
piriformis
obturator internus
obturator externus
provides sensory to medial thigh
obturator
provides sensory to anterior thigh, medial leg
femoral
provides sensory to anterior and lateral thigh
lateral femoral cutaneous
compression of the lateral femoral cutaneous causing tingling, numbness, burning pain in anterolateral thigh
meralgia paresthetica
decreased medial thigh sensation and weakened adduction may indicate a lesion in
obturator
common cause of injury to obturator nerve
pelvic surgery
weakened leg extension and patellar reflex could indicate a lesion in
femoral nerve
common causes of injury to femoral nerve
pelvic fracture
compression from retroperitoneal/psoas abscess
the sciatic nerve splits into [2]
common peroneal (fibular)
tibial nerve
common causes of injury to sciatic nerve
posterior hip dislocation
herniated disc
piriformis syndrome
pelvis tilts because weight bearing leg cannot maintain alignment of pelvis through hip abduction
Trendelenburg sign
positive trendelenburg sign indicates injury to
contralateral superior gluteal nerve
common cause of injury to inferior gluteal nerve
posterior hip dislocation
common cause of injury to superior gluteal nerve
iatrogenic injury caused by IM injection
difficulty climbing stairs, rising from seated position, and loss of hip extension may indicate injury to
inferior gluteal nerve
in trendelenburg gait, the lesion is contralateral to […], ipsilateral to […]
side of hip that drops
extremity on which the patient stands
overuse injury of the lateral knee that occurs primarily in runners
pain develops secondary to friction against lateral femoral epicondyle
illiotibial band syndrome
inflammation of prepatellar bursa caused by repeated trauma or pressure from excessive kneeling
prepatellar busitis
what artery runs through the femoral triangle?
femoral artery
what ligament forms the greater sciatic foramen?
sacrospinus
what ligament forms the lesser sciatic foramen?
sacrotuberous
provides cutaneous sensation to inferior 1/3 of posterior thigh
posterior cutaneous (S1-S3)
L4-S3
sciatic
superior gluteal nerve supplies motor innervation to [3]
gluteus maximus
gluteus minimus
tensor fasciae latae
inferior gluteal nerve supplies motor innervation to [1]
gluteus maximus
what nerve runs superior to piriformis
superior gluteal nerve
what nerves lie inferior to piriformis [6]
sciatic
pudendal
posterior cutaneous
inferior gluteal
obturator internus
quadratus femoris
the sciatic nerve divides into […] and […] about halfway down the thigh
tibial
fibular
does the sciatic nerve supply gluteal structures?
no
largest cutaneous nerve
posterior cutaneous
muscles that leave the pelvis via greater sciatic foramen and reenters the pelvis via lesser sciatic foramen
superior gemellus/obturator internus
anterior divisions of S2-S4
greater pudendal
exits the greater sciatic foramen and reenters the pelvis via lesser sciatic foramen to supply perineal structures
pudendal nerve
superior gluteal artery travels with
superior gluteal nerve
inferior gluteal artery travels with
inferior gluteal nerve
superior gluteal, inferior gluteal, and internal pudendal arteries arise from
internal illiac a
largest internal iliac artery branch
superior gluteal a.
provides a way to bypass femoral artery in thigh
cruciate anastomosis of thigh
what arteries make up the cruciate anastomosis of the thigh [4]
medial circumflex femoral
lateral circumflex femoral
first perforating artery
inferior gluteal artery
what vessel of the cruciate anastomosis is key to getting blood all the way down the leg?
descending branch of lateral circumflex (goes all the way to genacular anastomosis)
what muscles insert on the greater trochanter of the femur? [3]
gluteus medius
gluteus minimus
piriformis
origin of gluteus minimus and gluteus medius?
iliac blade
what muscles keep the pelvis level and maintain a smooth gait?
gluteus medius and minimus
contraction of […] and […] on stance side keeps the greater trochanter in proximity to the iliac blade
gluteus medius and minimus
if there is gluteus medius/minimus dysfunction, the pelvis will tilt toward the […] side
swing (contralateral)
[…] nerve supples gluteus medius and minimus
superior gluteal
**lesion here can cause pelvic tilt toward swing side
gluteal gait/Duchenne’s limp and positive trendelenburg sign indicates an injury to what nerve?
superior gluteal nerve
lean toward effected side during stance phase of gait
positive trendelenburg
**indicates superior gluteal nerve injury
attaches into illiotibial band [2]
tensor facia lata
gluteus maximus
abducts, medially rotates, and flexes thigh
slight extension of knee
tensor fascia lata
runs from iliac tubercle to lateral tibial condyle
IT band
what structure can compensate for quadriceps paralysis?
IT band
pulls the patella laterally
acts as an antagonist to vastus medialis
IT band
what structure should be stretched to treat chondromalacia patella?
IT band
if the center of rotation of the femur is within the boundaries of the IT band, the band acts as an […] when gluteus maximus contracts
extensor
if the center of rotation of the femur is anterior to the boundaries of the IT band, the band acts as an […] when gluteus maximus contracts
flexor
lateral rotators of the hip [3]
triceps coxae
piriformis
quadratus femoris
medial rotators of hip [3]
gluteus medius
gluteus minimus
tensor fasciae latae
[…] rotation at hip of planted limb advances opposite side of pelvis and free limb
medial rotation
[…] rotation at hip of advancing limb keeps foot parallel to line of advancement
lateral
bursa that lies under the IT band and up against the greater trochanter
trochanteric bursa
what nerve innervates the anterior compartment of the thigh?
femoral
muscles in the anterior compartment of the thigh are generally leg […]
extensors
what nerve innervates the medial compartment of the thigh?
obturator
what nerve innervates the posterior compartment of the thigh?
sciatic
muscles in the medial compartment of the thigh are generally […]
adductors of thigh
muscles in the posterior compartment of the thigh are generally […]
flexors at knee
meralgia parethetica compresses the […] nerve
lateral femoral cutaneous
patients with meralgia paresthetica will have pain along the […]
lateral thigh
where is the nerve compressed in meralgia paresthetica?
compression of lateral femoral cutaneous as it passes under inguinal ligament
what types of occupations are more commonly associated with meralgia paresthetica?
police, construction workers, military
**tool belt compresses
nerve roots to know:
femoral:
obturator:
sciatic:
tibial :
common fibular:
femoral: L2-L4
obturator: L2-L4
sciatic: L4-S3
tibial : L4-S3
common fibular: L4-S2
what nerves lie inferior to piriformis [3]
sciatic
posterior cutaneous
inferior gluteal
what artery supplies the posterior thigh?
deep femoral
what artery supplies the medial thigh?
obturator
absence of patellar reflex is […] sign
Westphal’s
testing the patellar reflex tests the function what nerve/nerve roots?
femoral, L2-L4
the calcaneal tendon reflex tests what nerve roots?
S1-S2
contents of femoral triangle
femoral N
femoral A
femoral V
femoral canal (Empty space)
Lymph node
NAVEL
does the femoral sheath contain the nerve?
no
contents of femoral sheath
femoral a
femoral v
femoral canal w/ lymph
weak area in anterior abdominal wall where a loop of intestine can protrude into femoral canal
femoral ring
muscles innervated by femoral nerve [4]
iliacus
sartorius
quadriceps femoris
pectineus
cutaneous branches of the femoral nerve [3]
anterior cutaneous
lateral cutaneous
saphenous
terminal branch of the femoral nerve
saphenous
supplies sensory to anterior and medial knee/leg and medial foot
saphenous nerve
what nerves exit the medial side of the adductor canal?[2]
saphenous
saphenous branch of descending genicular
what muscles attach at the pes anserinus?
gracilis
semitendinosus
sartorius
**allows gracilis to be used for ACL graft
what nerve innervates gracilis?
obturator
what nerve innervates semitendinosus?
tibial division of sciatic
what nerve innervates sartorius?
femoral
artery that perforates through the thigh muscles to supply the posterior compartment
deep femoral
what vessel supplies the head of the femur?
deep femoral a. via the medial and lateral circumflex
what vessels are at risk in hip fx? [3]
deep femoral
medial and lateral circumflex
used for graft in CABG procedure
great saphenous vein
**can injure the saphenous nerve causing paresthesia
what can you do to slow a bleed from the femoral artery?
press down on the head of femur
cannulation of the […] is used for radiographic visualization of the left heart and coronary vessels
femoral a.
what nerves lie inferior to piriformis [3]
sciatic
posterior cutaneous
inferior gluteal
the adductor muscle group receives blood supply from the […] iliac artery
internal
**via obturator
the […] iliac gives rise to the femoral a.
external
failure of the valves in the perforating veins of the legs causes
varicose veins
main extender of the hip used in running, jumping, climbing and standing from a sitting position
gluteus maximus
a positive trendelenburg sign is caused by
loss of contralateral gluteus medius/minimus activity
what muscle inserts on the lesser trochanter of the femur
illiopsoas
primary muscle used to flex the thigh at the hip
illiopsoas
advances the trailing limb by producing flexion at the hip
illiopsoas
what muscle initiates the swing phase of gait?
illiopsoas
what 3 muscles insert on the pes aserinus, just distal to the medial tibial plateau?
sartorius
gracilis
semitendinosus
the IT band inserts on the […] aspect of the tibia
lateral