Bones & Gluteal region Flashcards
What three bones form the acetabulum?
Ilium, ischium, pubis
What are the three gluteal lines? What region of the ilium are they located? What muscles originate from these lines?
Posterior, anterior, and inferior gluteal lines
They are located on the ala (posterior side of ilium)
Gluteal muscles originate from these lines
What part of the ilium is thick and what part is thin?
Thick- medial body
Thin- Lateral ala (PSIS, ASIS, AIIS, PIIS)
What muscle originates on the iliac fossa?
Iliacus (hip flexor)
What two features is the ischial spine located between?
Lower border of greater sciatic notch and upper border of lesser sciatic notch
What is the ischial tuberosity located under? What is clinically significant about this landmark?
Located under lower border of lesser sciatic notch
it is what bears weight when sitting
The ischial ramus makes up what border of the obturator foramen
Inferior/lateral border
The ischial ramus joins what other ramus
ramus of pubis
both pubis bones medial bodies articulate at what point
pubis symphysis
What pubis landmark makes up the anterior portion of the acetabulum?
Superior rami
What pubis landmark makes up the inferior/medial border of the acetabulum?
Inferior rami
What is the acetabular notch also called?
chipped cup
What is the obturator foramen covered by?
obturator membrane and muscles
Where does the sacrotuberous ligament originate and insert on? What does it turn the sciatic notch into?
Origin: posterior ilium, lateral sacrum, and coccyx
Insertion: ischial tuberosity
Turns it into sciatic foramen
Where does the sacrospinous ligament originate and insert? What does it subdivide the sciatic foramen into?
Origin- lateral sacrum and coccyx
insertion: ischial spine
subdivides foramen into greater & lesser sciatic foramina
Where is the greater sciatic foramen located and what is it a passageway for?
between true pelvis and gluteal region
passageway for neurovascular structures
Where is the lesser sciatic foramen located?
between gluteal region & perineum
What is the weakest part of the femur?
The neck
What bone is the longest & heaviest of the body?
femur
What type of bone is the patella? where is it found?
sesamoid
within quadriceps tendon (O- femur/I- tibia)
What is the function of the patella?
To protect the quadriceps tendon when kneeling
What is the angle of inclination on the femur? What is clinically important about this angle? What happens with this angle as we get older?
It is the head/neck angle in relation to the shaft (125 degrees)
Advantages for bipedal walking/repositions line of gravity in proportion to knee
The angle decreases with age
What is the angle of declination on the femur? What movements does this angle allow for?
It is the head/neck angle in relation to condyles (7-12 degrees)
Rotation, adduction, abduction, flexion, extension
What muscle inserts on the lesser trochanter of the femur?
iliopsoas
What sides of the femur are the intertrochanteric line and crest?
line is anterior; crest is posterior
What muscles insert on the linea aspera?
adductors
What direction is the femoral shaft?
convex anteriorly
What are the three lips of the posterior femur?
1) . Medial lip, to spiral line, to intertrochanteric line
2) . Lateral lip to gluteal tuberosity
3) . Intermediate lip (pectineal line) to lesser trochanter
What are the two lines on the posterior femur branching from the popliteal surface?
Medial and lateral supracondylar lines
What is the function of the medial & lateral condyles? What are they separated by?
They allow tibial condyles to glide
Separated by intercondylar fossa
What is superior to the femur medial epicondyle? What muscle attaches to this feature?
the adductor tubercle
Adductor magnus inserts on this tubercle
What is significant about Gerdy’s tubercle?
it is where the iliotibial tract inserts (anterior)
What three things make up the triangular shaft?
anterior tibial tuberosity
Lateral interosseous membrane
posterior soleal line
What attaches to the anterior tibial tuberosity?
patellar ligament (knee reflex)
What bone does the medial malleolus articulate with?
Talus
What can be compressed on the fibular head? Why is this clinically significant?
The common fibular nerve can be compressed
this causes foot drop, which is commonly seen in bed ridden patients
What does the talus transmit weight to?
calcaneus and metatarsals
What tarsal is the only one to not have any muscle attachments?
Talus
What two bones make up the Hindfoot?
Talus and calcaneus
What are the two longitudinal arches of the foot?
medial and lateral
What bone is the keystone of the medial longitudinal arch?
talus
What tendon lays in the groove on the talus body
flexor hallucis longus
What does the calcaneus transmit weight to?
transmits weight to the ground through calcaneal tuberosity
What are the two functions of the shelf-like medial sustentaculum tali?
1) . supports head of talus
2) . pulley for flexor hallucis longus
What is the function of the calcaneus’s lateral fibular trochlea?
Pulley for fibularis longus & brevis
What inserts on the calcaneus
calcaneal (Achilles) tendon
What five muscles give the calcaneus dynamic support?
Tibialis anterior, tibialis posterior, flexor hallucis longus, fibularis longus, intrinsic plantar muscles
What are the four layers of passive support to the calcaneus?
plantar aponeurosis, short plantar ligament, long plantar ligament, plantar calcaneonavicular ligament
What longitudinal arch is the navicular apart of?
medial
What longitudinal arch is the cuboid apart of?
lateral
What longitudinal arch are the cuneiforms apart of?
medial
What muscle runs through the cuboid groove?
fibularis longus
What muscle attaches to the inferior navicular process?
tibialis posterior
What metatarsal is the shortest/widest? Which one is the longest? which one articulates with the cuboid bone? Which on articulates with cuneiforms?
1st; 2nd; 4th and 5th. 1st through 3rd
What feature of the 5th metatarsal overlaps the cuboid?
Proximal tuberosity
Describe the idea of transition zone for the gluteal region?
Transition zone between posterior trunk and lower limb
trunk- physically
lower limb- functionally
What are the seven nerves of the sacral plexus? What spinal cord levels is this at?
sciatic, pudendal, superior gluteal, inferior gluteal, nerve to quadratus femoris, nerve to obturator internus, posterior cutaneous nerve of thigh
ventral rami of L4-S4
What are the four superficial muscles of the gluteal region?
Gluteus maximus, medius, minimus
Tensor fasciae latae
What is the largest & heaviest muscle of the gluteal region superficial muscles?
gluteus maximus
What is the origin and insertion of the gluteus maximus? What is its 2 movements? What nerve innervates it
O: ilium (posterior to posterior gluteal line) & sacrotuberous ligament
I: iliotibial tract (75%) and gluteal tuberosity (25%) of femur
extends, laterally rotates thigh
innervated by inferior gluteal nerve
What is the origin and insertion of the tensor fasciae latae? What are its three movements? what nerve innervates it? what position is it best observed in?
O: ASIS; anterior iliac crest
I: iliotibial tract (tibial tubercle/gerdy runs superficial to linea aspera of lateral intermuscular septum)
flexes, abducts, medially rotates thigh (all weakly)
superior gluteal nerve
supine position
What are the three compartments of the fascia lata? What divides the compartments? What are the weakest septa?
anterior, posterior, and medial
intermuscular septa (which extends to linea aspera)
postero & antero-medial septa
What is the IT band a lateral thickening of? what does it share an aponeurosis of? what does it extend to? what is it fixed to?
fascia latae
aponeurosis of gluteus maximus and tensor fasciae latae
extends to anterolateral tibial plateau (inserts on Gerdy tubercle)
fixed to linea aspera via lateral intermuscular septum
What is the origin and insertion of gluteus medius?
O: between anterior and posterior gluteal lines
I: greater trochanter
What is the origin and insertion of gluteus minimus?
O: between anterior and inferior gluteal lines
I: greater trochanter
What are the 2 actions of gluteus minimus and medius? what nerve innervates them?
abduct and medially rotate thigh
superior gluteal nerve
What are the five muscles of the deep group- gluteal region?
piriformis
obturator internus
superior and inferior gamelli
quadratus femoris
What is o and I of piriformis? what does it leave pelvis via? what is its movement? what two vessels lie above and below it?
O: anterior sacral surface I: greater trochanter via greater sciatic foramen laterally rotates thigh superior gluteal artery and nerve above inferior gluteal artery and nerve below
What are the three muscles of the triceps coxae?
obturator internus, superior and inferior gamellus
origin and insertion of obturator internus. what nerve innervates it. where does it leave the pelvis
o- pelvic surface of obturator membrane
I- intertrochanteric fossa
nerve to obturator internus
via lesser sciatic foramen
o and I of superior gamellus. what nerve innervates it
o- ischial spine
I- intertrochanteric fossa
nerve to obturator internus
o and I of inferior gamellus. what nerve innervates it
o- ischial tuberosity
I- intertrochanteric fossa
nerve to quadratus femoris
What is the action of the triceps coxae? what is it incapable of doing
laterally rotates thigh
independent action
o and I of quadratus femoris. what is its movement and what nerve innervates it
o- ischial tuberosity
I- intertrochanteric crest
laterally rotates thigh
nerve to quadratus femoris
What is the action of the obturator externus? what direction on the thigh is this muscle
lateral rotation
medial thigh
what structure do the gluteal arteries and branches of internal iliac exit
greater sciatic foramen
What is the vasculature inferior to piriformis, medial to lateral (seven things)
pudendal nerve, internal pudendal artery, nerve to obturator internus, inferior gluteal artery and nerve, posterior cutaneous nerve of thigh, sciatic (nerve to quadratus femoris is deep)
What are the two divisions of the sciatic nerve? what are the variations of this nerve and percentage
tibial and common fibular
85%- common fibular is inferior to piriformis (divisions separate in posterior thigh)
15%- common fibular through or superior to piriformis (divisions separate in pelvis)
What are the three types of femoral fractures?
Transcervical, intertrochanteric, intracapsular (all are unstable)
Which is the worst femoral fracture and why?
intracapsular- avascular necrosis risk and hip arthroplasty
What is the best place to do a gluteal injection
upper outer quadrant (under summit of iliac crest and above superior gluteal nerve on gluteus maximus)
What are the bony landmarks you want to avoid during a gluteal injection?
greater trochanter
PSIS (skin dimple)- gluteus medius
ASIS - tensor fasciae latae
(thickest part of region is unsafe)
What is a varus deformity? explain cox varum and genu varum
distal element of a bone/joint deviates midline
cox- femur, decreased angle of inclination (limb shortening)
genu- tibial, “bowlegged”, stresses medial knee joint
what is a valgus deformity? explain cox, genu, and hallux valgus
distal element of a bone/joint deviates from midline
cox- hip, increased angle of inclination, limb lengthening
genu- tibia, “knock kneed”, stresses lateral knee joint
hallux- great toe, high heels, lateral displacement of sesamoid bones, leads to bunions and corns
