Exam 3 Flashcards
Be able to identify the following landmarks, and note on which bone (ilium, ischium, pubis)
these feature may be found: Iliac crest, Iliac fossa, Acetabulum, Anterior Superior Iliac Spine,
Anterior Inferior Iliac Spine, Posterior Superior Iliac Spine, Posterior Inferior Iliac Spine,
Greater sciatic notch, Lesser sciatic notch. Ischial tuberosity, Obturator foramen, Pubic Tubercle,
Ischial ramus, Ischial spine, Superior pubic ramus, Inferior pubic ramus, Auricular surface
illium- Iliac crest, Iliac fossa, Acetabulum, Anterior Superior Iliac Spine,
Anterior Inferior Iliac Spine, Posterior Superior Iliac Spine, Posterior Inferior Iliac Spine,
Greater sciatic notch
illiac- Lesser sciatic notch. Ischial tuberosity, Obturator foramen, ischial spine, ischial ramus
pubis- pubic tubercle, superior pubic ramis, inferior pubic ramus,
auricular surface= auricular surfaces of illium and sacrum is where the sacroilliac joint goes
Be able to identify the following landmarks, and note on which bone (ilium, ischium, pubis)
these feature may be found: Iliac crest, Iliac fossa, Acetabulum, Anterior Superior Iliac Spine,
Anterior Inferior Iliac Spine, Posterior Superior Iliac Spine, Posterior Inferior Iliac Spine,
Greater sciatic notch, Lesser sciatic notch. Ischial tuberosity, Obturator foramen, Pubic Tubercle,
Ischial ramus, Ischial spine, Superior pubic ramus, Inferior pubic ramus, Auricular surface
Note the fusion of the ilium, ischium, and pubis at the acetabulum. Note that the ilium and
ischium make a greater contribution (approx. 4/5) to the acetabulum; while the pubis contributes
to 1/5 of the acetabular surface
acetabulum is the large cup shaped socket on the lateral aspect of the hip bone. Articulates with the head of the femur to form the hip joint. all three primary bones forming the hip bone contribute to the formation of the acetabulum
Distinguish between the greater pelvis and lesser pelvis
Identify the compartments of the thigh, the muscle group in that compartment, and the nerve that
supplies most of the muscles
No real lateral compartment. The muscles that would be in the lateral compartment (gluteus medius and minimus) do not extend past the greater trochanter of the femur tensor fascia lata as well but it continues down the thigh as the IT band, muscle at the hip
What is the function of the fascia lata? What is the function of the iliotibial band?
fascia lata function= flex, abdduct medially rotate hip
Innervation= superior gluteal nerve
origin= ASIS
insertion= It band, IT band attaches to lateral condyle of tibia
function of IT band= tensor fascia lata tenses the fascia lata and IT band. When the knee is fully extended, the tensor fascial lata contirbutes to the extending force, adding stability, and plays a role in supporting the femur on the tibia when standing if lateral sway occurs.
Pectineus
Identify the muscles of the thigh: anterior, medial, and posterior thigh muscles. Identify the bone
attachments, innervation, and action of each muscle
origin= superior rami of pubis
insertion= pectineal line of femur, just inferior to lesser trochanter
innervation=femoral nerve
actions= adducts and slightly flexes hip joint, assists with lateral rotation
illiopsoas
Psoas major
PSoas minor
Psoas major origin: sides of T12-L5 vertebrae, transcerse processes of all lumbar vertebrae
Psoas minor origin: sides of T12-L1 vertebrae
Psoas major insertion= lesser trochanter of femur
Psoas minor= pectineal line and illiopubic eminenece
Innervation for both= anterior rami of lumbar nerve
Action for both= act conjointly in flexion and lateral rotation of hip joint
Illiacius
Origin= illiac crest, illiac fossa, ala of sacrum,
insertion= tendons of psoas major, lesser trochanter
innvervation= femoral nerve
action= act conjointly in flexion and lateral rotation of hip joint (exact same as Illiopsoas muscles)
Sartorius
origin= ASIS
insertion= superior part of medial surface of tibia
innervation= femoral nerve
action= flexes, abducts, laterally rotates hip joints, flexes knee joint
Quadriceps femoris-
Rectus femoris
Vastus lateralis
Vastus medialis
vastus intermedius
Rectus femoris origin: AIIS
vastus lateralis origin: greater trochanter and lateral lip of aspera of femur
vastus medialis origin: interochanteric line and medial lip of linea aspera of femur
vastus intermedius: anterior and lateral surface of shaft of femur
Insertion for all= via quadriceps tendon (common tendinosus) and independent attachemnts to base of patella. medial and lateral vasti also attach to tibia and patella
innervation= femoral nerve
function= extend knee joint, rectus femoris helps illiopsoas with hip flexion as well
adductor longus
origin= body of pubis inferior to pubic crest
insertion= middle third of linea aspera of femur
innervation= obturator nerve
adducts thigh
adductor brevis
origin= body and inferior ramus of pubis
insertion= pectineal line and proximal part of linea aspera of femur
innervation= obturator nerve
action= adducts thigh and and to some extent flexes it
adductor magnus
origin= adductor part: inferior ramus of pubis, ramus of ischium
hamstring part: ischial tuberosity
insertion:
adductor part=gluteal tuberosity, linea aspera
hamstring part= adductor tubercle of femur
innervation=
adductor part: obturator nerve
hamstring part: tibial part of sciatic nerve
action= adducts thigh, and flexes thigh
hamstring part extends it
gracilis
origin= body and inferior ramus of pubis
insertion= superior part of medial surface of tibia
innervation= obturator nerve
action= adducts thigh, flexes leg, medialy rotation
obturator externus
origin= margin of obturator foramen and obturator membrane
insertion= trochanteric fossa of femur
innervation= obturator nerve
action= laterally rotates hip joints
semitendinosus
origin= ischial tuberosity
insertion= superior part of medial surface of tibia
innervation= tibial divison of sciatic nerve part of tibia
action= extend hip joints, flex knee joints, and medially rotate it when flexed.
when hip and knee joints are flexed (like when sitting) the muscles can extend trunk at hip joints
semimembranosus
origin= ischial tuberosity
insertion= posterior part of medial condyle of tibia
innervation= tibial division of sciatic nerve part of tibia
main action=extend hip joints, flex knee joints, and medially rotate it when flexed.
when hip and knee joints are flexed (like when sitting) the muscles can extend trunk at hip joints
biceps femoris
Long head origin= ischial tuberosity
short head origin= linea aspera and lateral supracondylar line of femur
insertion= lateral side of head of fibula
innvervation:
long head= tibial division of sciatic nerve
short head= common fibular divison of sciatic nerve
action= flexes knee joint and laterally rotates it when flexed. long head extends hip joints.
Note that the quadriceps tendon surrounds the patella, classifying it as a sesamoid bone. Note
the role of the patella to increase the torque exerted by the quadriceps muscle group
The patella is the largest
sesamoid bone in the body
The patella
increases the
amount of torque
produced by the
quadriceps group
What is the most common direction for a recurrent patellar dislocation? Name an anatomical
feature that helps to prevent this dislocation: (
lateral direction
vastus medialis obliques
Describe the location (lateral to medial) of the femoral nerve, artery, and vein in the femoral
triangle
femoral triangle= boundaries are inguinal ligament, adductor longus, sartorius
NAVy lateral to medial
What is the purpose and contents of the adductor canal?
Adductor canal a.k.a Hunter’s
Canal
This is a fibrous tunnel that prevents the
femoral vessels from getting squeezed
closed by the contraction of the large
thigh muscles
The apex of the femoral
triangle marks the opening of
the adductor canal
The femoral artery, femoral
vein, the saphenous nerve
and nerve to vastus
medialis (branches of the
femoral nerve) enter the
adductor canal
exit of femoral artery and vein from adductor canal? what do they continue as
Note the exit of the femoral artery (and vein) from the adductor canal at the adductor hiatus and
its continuation in the leg as the popliteal artery (and vein)
The femoral artery and vein
exit the adductor canal at the
adductor hiatus; they
continue as the popliteal
artery and vein behind the
knee
Identify the great saphenous vein and note its potential as blood vessel material used for
coronary bypass procedures. Identify the function of valves in large veins in the lower extremity
to assist in blood return against gravity back to the heart.
Large veins of the lower extremity have
valves to help keep blood from pooling
FUNCTION
Describe the structure and function of the collateral ligaments of the knee. Note that the deep
fibers of the tibial collateral ligament are attached to the medial meniscus; while the fibular
collateral ligament is separated from the lateral meniscus by the tendon of popliteus.
THEY ARE EXTRASCAPULAR LIGAMENTS OF THE KNEE
fibular collateral ligament (LCL)= extends inferioly from lateral epicondle of femur to lateral surface of the fibular head
tibial collatearl ligament (MCL) = extends from medial epicondyle of the femur to the medial condyle of the tibia.
MCL is attaches to medial meniscus, MCL is weaker then the LCL and is more often damaged. This causes the MCL and medial meniscus to tear together
the collateral ligaments are taut when the knee is fully extended which gives stability when standing
During flexion they become increasingly slack, which permits rotation at the knee
identify the location and function of the cruciate ligaments of the knee
what does ACL serve as?
THEY ARE INTRASCAPULAR LIGAMENTS OF THE KNEE
the cruciate ligamentsare intracapsular but
extrasynovial
The cruciate ligaments
prevent displacement of
the tibia in the direction of
their names
Anterior Cruciate Ligament (ACL):
Prevents Anterior Displacement of
the Tibia. Weaker of the two ligaments.
Posterior Cruciate Ligament (PCL):
Prevents Posterior Displacement of
the Tibia. weight-bearing flexed knee PCL is main stabilizing factor for femur (walking downhill)
The ACL and PCL are not uniform bands—they are made of an anteromedial and a
posterolateral portions, which act differently as the knee moves through its range
The anteromedial bundle
(a) lies parallel to the
posterolateral bundle in
extension; but tightens up
as it wraps around the
posterolateral bundle (b)
in knee flexion. The
anteromedial bundle
serves as the primary
restraint to anterior tibial
movement in the flexed
knee.
THEY
Describe the anterior drawer test; posterior drawer test
Anterior Drawer
Test: Assesses
the status of the
ACL
Posterior drawer test: status of PCL
Describe the structure and function of the knee menisci
which meniscus is held tighter to tibia?
acts to cushion the bones of the knee joint
The menisci are
incomplete rings of
fibrocartilage attached
to the tibial plateau
The menisci provide a little
more contact for the femoral
condyles on the tibial plateau
The menisciare cup-shaped;steepest attheir outer
margins
menisci are attached to the tibial plateteau by the coronary ligaments
medial meniscus is held to the tibia more tightly than lateral meniscus, it has less give when a force is applied
Tears of the medial meniscus are
especially common-its firmer
attachment to the tibial plateau
leaves it less able to withstand
forces put on the knee
Note the difference in structure between the medial and lateral menisci. Note the larger
anterior-to-posterior distance in the medial meniscus. Describe the significance of this larger
distance for the “screw-home” mechanism of the knee
The medial meniscus is
larger in the anterior-to-
posterior dimension
The medial femoral condyle
slides posteriorly, slightly
more than the lateral
femoral condyle, because
the medial compartment is
larger in the anterior-
posterior direction
The knee “locks” into place
(called the “screw home”
mechanism), resulting in a
stable, weight-bearing
position
In full extension, the knee is
stable to allow prolonged
standing with minimal
muscle activity
popliteus is needed to move back into flexion when the knee is fully extended
Locate the suprapatellar, subcutaneous infrapatellar, and subcutaneous prepatellar bursae of
the knee. Which bursa is inflamed in housemaid’s knee and clergyman’s knee? What is a Baker’s
cyst?
Inflammation of the subcutaneous
prepatellar bursa = housemaid’s knee
Inflammation of the subcutaneous
infrapatellar bursa = monk’s knee
(clergyman’s knee)
bakers cyst= popiteal cyst
Leg compartments with nerves
Tibialis anterior
Leg muscles…. Know the muscles in each compartment of the leg; proximal and distal
attachments; what nerve innervates the muscle, describe the action of the muscles
origin= lateral condyle and superior half of lateral surface of tibia
insertion= medial and inferior surfaces of medial cunfeiform and base of 1st metatarsal
innervation= deep fibular nerve
action= dorsiflex ankle, invert foot
Extensor hallucis longus
origin= middle part of anterior surface of fibula
insertion= dorsal aspect of base of distal phalanx of great toe
innervation= deep fibular nerve
action= extends great toe, dorsiflexes ankle
extensor digitorum longus
origin= lateral condyle of tibia
insertion= middle and distal phalanges of lateral four digits
innervation= deep fibular nerve
action= extends lateral four digits, dorsiflexes ankle
fibularis (peroneus) tertius
origin= anterior surface of tibula
insertion= dorsal surface of base of the 5th metatarsal
innercation= deep fibular nerve
action= dorsiflexion and eversion of the foot at ankle
gluteus maximus
Identify the muscles of the gluteal region (gluteus maximus, gluteus medius, gluteus minimis).
Note the bone attachment sites, origin, insertion, innervation, action. Identify the deep gluteal
muscles (lateral rotators of the hip): piriformis, superior and inferior gemelli, obturator internus,
quadratus femoris). Include obturator externus as a lateral rotator of the hip.
Gluteus Maximus –powerful hip
extensor (as in stair climbing or
rising from a seated position;
also lateral rotation of thigh
origin= illium, dorsum of sacrum and coccyx
insertion= IT band, some fibers insert on gluteal tuberosity
innervation= inferior gluteal nerve
extends thigh, lateral rotation
Describe the role of gluteus medius and minimis as abductors of the hip and their role in
stabilizing the pelvis during gait. Describe the role of the lesser gluteal muscles and the superior
gluteal nerve in Trendelenburg gait. Pg. 750
lesser gluteal muscles= gluteus medius and minimus, they abduct the thigh at the hip
When the foot is free to move (open chain)-
gluteus medius and minimus will abduct the
thigh at the hip
When the foot is planted (closed chain)-
gluteus medius and minimus will contract to
keep the pelvis level
This allows the contralateral leg to clear
the ground when taking a step forward
Trendelenburg Sign (aka Trendelenburg Gait)
Cause: Injury to Gluteus Medius and/or
Gluteus Minimus; e.g. damage to
Superior Gluteal Nerve
Trendelenburg Sign (aka Trendelenburg Gait)
The pelvis sags on the side contralateral to
the injured muscle/nerve
The contralateral leg moving forward (swing
leg) cannot clear the ground (will drag)
To compensate, the trunk leans toward the
damaged side to help the swing leg clear
the ground
Trendelenburg gait requires a lot
more muscle activity for walking—
so walking can be very tiring
Note the relationship of the femoral neck and head to the shaft of the femur. Define the angle of
inclination and note the value of the typical angle of inclination of the femur (125 degrees).
Identify the cases when the angle is greater than (coxa valga) or less than (coxa vara) the typical
value. How does that influence the alignment of lower extremity joints? (Coxa vara may be
accompanied by genu valgus to compensate, commonly called “knock-knees”; Coxa valga may
be accompanied by genu varus, commonly called “bow-legged”
angle of inclination= the angle between the neck and the shaft of the femur, typical angle is 125 degrees
Varus = the distal part of the
body segment is located more
medially than normal,
Valgus = the distal part of the
body segment is located more
laterally than normal,
coxa valga= angle is greater than typical value
coxa vara= angle is less than typical value
Identify the angle of torsion (anteversion) and describe the impact of this angle on the position of
the femur and patella
angle of torsion= a line through the femoral condyles in the transverse plane and another line following the head and neck of the femur. The angle between these two lines is the angle or torsion (averages 12-15 degrees). Values greater than 15 degree called anteversion. Values less than 15 are called retroversion
Distinguish between visceral and parietal serous membranes (pleura, pericardium, peritoneum)
and note their relationship to organs and the body wall.
The lungs are surrounded
by a serous membrane
called pleura
Serous membrane = mesothelium +
thin connective tissue; mesothelium
secretes serous fluid
Serous membranes
Pleura - Lungs
Pericardium - Heart
Peritoneum - Abdominal Organs
Serous membranes have two layers
outer layer- parietal
inner layer- visceral
identify the structures located at the hilus of the lung
(primary bronchus, pulmonary artery,
pulmonary vein)
Hilus: Site where
nerves, blood vessels,
primary bronchi enter
the lung
identify the divisions of the respiratory tree. .
Be able to identify how many primary, secondary, and tertiary bronchi may be located on the left
and on the right lungs
identify the divisions of the respiratory tree. (trachea, primary, secondary, tertiary bronchi, etc).
right lung: 1 primary bronchi, 3 secondary bronchi, 10 teritary bronchi
left lung: 1 primary bonchi, 2 secondary bronchi, 8 tertiary bronchi
Describe the gross anatomy of the heart. Describe the external and internal features of the atria
and ventricles. Describe the differences in myocardial thickness between the right and left
ventricles pgs. 366-37
go through heart slides
Note the thicker walls of
the left ventricle as
compared to the right
ventricle
Identify and describe the structure of all heart valves: aortic, pulmonary, tricuspid, mitral
(bicuspid)
The left atrioventricular (AV)
valve = bicuspid valve
The right atrioventricular
valve = tricuspid valve
- Aortic Valve
Location: Between the left ventricle and the aorta.
Structure: It has three cusps (leaflets) named the left, right, and posterior cusps.
Function: Opens to allow oxygen-rich blood to flow from the left ventricle into the aorta and then to the rest of the body. It prevents blood from flowing back into the left ventricle - Pulmonary Valve
Location: Between the right ventricle and the pulmonary artery.
Structure: Composed of three cusps named the left, right, and anterior cusps.
Function: Opens to allow deoxygenated blood to flow from the right ventricle into the pulmonary artery, which carries it to the lungs for oxygenation. It prevents blood from flowing back into the right ventricle - Tricuspid Valve
Location: Between the right atrium and the right ventricle.
Structure: It has three cusps (anterior, posterior, and septal).
Function: Opens to allow blood to flow from the right atrium to the right ventricle. It prevents blood from flowing back into the right atrium when the right ventricle contracts - Mitral (Bicuspid) Valve
Location: Between the left atrium and the left ventricle.
Structure: It has two cusps (anterior and posterior).
Function: Opens to allow oxygen-rich blood to flow from the left atrium to the left ventricle. It prevents blood from flowing back into the left atrium when the left ventricle contracts12.
These valves are crucial for maintaining the unidirectional flow of blood through the heart and ensuring efficient circulation throughout the body
