Exam 3 Flashcards
Identify
ASIS- Os Coxae- ilium anterior superior iliac spine
AIIS- anterior inferior iliac spine
PSIS- posterior superior iliac spine
PIIS- posterior inferior iliac spine
Pubic tubercle
Ischial spine
Ischial tuberosity
Greater sciatic notch
Lesser sciatic notch
Acetabulum
Arcuate line
Pectin pubis- also called the pectineal line
Os coxae- hip bone
Femur head
Femur: fovea capitis
Femur: greater trachanter
Femur: lesser trachanter
Femur: intertrochanteric crest
Femur: linea aspera
Femur: adductor tubercle
Femur: medial condyle
Femur: lateral condyle
Femur: medial epicondyle
Femur: lateral epicondyle
Femur: intercondylar fossa
Femur: patellar surface
Fibula: lateral malleolus
Fibula: head
Patella: apex
Tibia: medial condyle
Tibia: lateral condyle
Tibia: intercondylar eminence
Tibia: anterior crest
Tibia: medial malleolus
Tibia: tibial tuberosity
Tibia: fibular notch
Tarsal bones: talus- body - neck and head
Tarsal bones: calcaneous
Tarsal bones: sustenaculum tali- also called the talar shelf
Tarsal bones: navicular
Tarsal bones: cuboid
Tarsal bones: cuneiform medial
Tarsal bones: cuneiform intermediate
Tarsal bones: cuneiform lateral
Metatarsals: base
Metarsals: shaft
Metatarsals: head
Phalanges: proximal
Phalanges: middle
Phalanges: distal
Femur: gluteal tuberosity
Femur: adductor tubercle
Patella: facet for medial condyle of femur
Patella: surface for patellar ligament
Patella: facet for lateral condyle of femur
Femur: patellar surface
Interosseous membrane
Triradiate cartilage
Base of patella
Patella: articular surface
What does Os Coxae include- how many parts?
Patellar- verticle ridge
what is another name for talar shelf?
Sustennaculum tali
What is another name for pectineal line?
Pubis pectin
The lower extremity specializes for?
- Locomotion
- supporting body weight
- maintenance of balance
The lower extremity bones include?
- Os coxae
- femur
- tibia
- fibula
- patella
- tarsals
- metatarsals
- phalanges
The development of the LE is similiar to the UE however the LE rotates _______ which is considered _____ so the ______ (toe) is medially.
- LE rotates medially
- pronation
- Great toe- large toe
Gluteal region includes-
- Gluteal muscles
- hip joint
- pelvis- ilium, ishium, pubis
Knee region includes-
- Distal femur
- paterlla
- proximal tibia and fibula
- popliteal fossa
Calf region is also known as?
Crural region
The ankle is known as the?
Talocrural regoin
Foot region includes-
- Tarsus
- metatarsus
- phalanges
Anterior thigh muscles
- Psoas
- Iliacus
- Sartorius
- Rectus femoris
- Vastus medialis
- Vastus intermedius
- Vastus lateralis
- Musculus articularis
Gluteal muscles
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Tensor fascia lata
- Piriformis
- Superior and inferior gemellus
- Obturator internus
- Quadratus femoris
Posterior thigh muscles
- Semitendinosus
- Semimembranosus
- Biceps femoris
- Hamstring muscles
Medial thigh muscles
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracilis
- Obturator externus
The lower extremity is specialized for (3 things)
- Locomotion
- supporting body weight
- maintainance of balance
The bones including in the lower extremity include?
- Os coxae
- femur
- tibita
- fibula
- patella
- tarsals
- metatarsals
- phalanges
The LE rotates _____ which is pronation so the great toe is _____.
- Medially
- medial
Gluteal region includes?
- Gluteal muscules
- hip joint
- pelvis- includes ilium, ishium, pubis
The knee region includes?
- Distal femur
- patella
- proximal tibia and fibula
- popliteal fossa
Another name for calf region is?
Crural region
The ankle region is called?
Talocrural region
The foot region includes?
- Tarsus
- metatarsus
- phalanges
The most common site of sesmoid bone in the foot would be where?
In the tendon of flexor hallicus brevis at the metatarsophalangeal joint.
Why do sesmoid bones develope?
They form in the tendon where there is tensor or stress
How is body weight transferred?
- Spine
- SI Joints
- pelvic girdle
- hip joints
- femur
- knee
- ankle
- foot
- ground
What are the 3 parts of the os coxae?
- Pubis
- ischium
- ilium
These three parts are held together by what?
The tri-radiate cartilage begins to fuse at _____ (age) and completes fusion at ____ years old.
- 15-17 years
- 20-25 years
This structure joint the pubis and ischium to the acetabulum.
Body of the ilium
This part of the ischium joins the ilium and superior ramus of the pubis to form the acetabulum- what part is it?
The ischial body
This structure of the ischium joins the inferior ramus of the pubis which is called ______. What is the structure?
- Ramus
- ishiopubic ramus
The ramus of the ischium forms the inferior border of the ________.
Obturator foreamen
The lesser sciatic notch serves as a trochlea or a “sling” for which muscles?
Muscles emerging from the pelvis.
The anterior superior iliac spine and _______ are in the same vertical plane.
Anterior superior pubis
Symphysial surface lies in which plane?
Vertical
Acetabulum faces _____ with the _______ notch directed _____.
- Inferolaterally
- acetabular notch
- inferiorly
This structure is bound by the pubis, isnchium and their rami- what is it?
Obturator foramen
What structure closes the obturator foreamen and leaves the obturator canal open?
Obturator membrane
This membrane connects the obturator internis and externis- what is the structure?
Obturator membrane
This structure articulates with the head of the femur
Acetabulum
What does “acetabulum” mean?
Vinagers cup
The acetabulum is formed by ______ bones of the hip.
3 bones of the hip
- Pubis
- Ilium
- Ishium
The acetabulum has an incomplete inferior margin called_____ what is attached there?
- Acetabular notch
- transverse acetabular ligament
This structure is a superior extension of the floor of the acetabulum.
Acetabular fossa
This structure is a superior extension of the floor of the acetabulum.
Acetabular fossa
This structure is the actual articular surface of the acetabulum with the femur.
Lunate surface
Whose pelvis is greater than >90 degrees and can be up to 120 degrees?
Female pelvis-
This pelvis has a wider- more shallow false pelvis-
Female pelvis
Whose pelvis is less than <90 degrees?
The male pelvis
On this pelvis the ischial spine is wider and the sacrum is tilted back.
Female
This pelvis is heart shaped and sacrum tilted forward.
Male
This pelvis has a big pelvic outlet and the ilia spread wider.
Female
This pelvic has a small pelvic outlet and the ilia closer together.
Male
The longest and heaviest bone of the body would be?
Femur
How much length does the femur contribute to a persons height?
1/4th
The head of the femur is covered by _______ cartilage.
Hylaline
What is the fovea capitis?
A pit for the round ligament
The trochanters are attachment for _____ and ______ muscles.
Abductors and rotators
The greater and lesser trochanter is seperated by what?
Intertrochanteric line
The lesser trochanter sit medial at the junction of the _____ and ____ of the femur
Neck and shaft
The lesser trochanter is attachment for the primary ________ called _____.
- Primary thigh flexor
- iliopsoas
Identify
What shape is the neck of femur
Trapezoidal in shape
This structure has medial and lateral lips and is the attachment for adductors.
Linea aspera of femur
What ligament is in the acetabular notch?
Transverse acetabular ligament
The quadrate tubercle on the femur is attachment for which muscle?
Quadratus femoris
5 facts about angle of inclination-
- 115-140 degrees
- greater in females
- greatest at birth
- gradually diminishes into adulthood
- increases the mobility of the femur
This angle of inclination is in a ____ (age)
135 degrees- 3 year old child
This angle of inclination is in ______. (Age)
Adult- 126 degrees
This angle of inclination is ______ (age)
Old age- 120 degrees
Angle of declination- or _______ is the angle between the _____ and _____ and the angle of the __________. 7 degrees in _____ and 12 degrees in ______.
- Torsion angle
- head and neck
- Femoral condyles
- males
- females
Identify
Normal
Identify
Coxa vara
Identify
Coxa valga
This bone is a sesmoid bone that forms within the patellar tendon.
Patella
The base of the patella is the _______ border
Superior
The apex of the patella is the _____ border
Inferior border
The posterior side of the patella is the ______.
Articular surface
This is the second largest bone in the body.
Tibia
Where does the tibia articulate with the femur?
The medial and lateral condyles
What is the main function of the Tibia?
The main function is weight bearing
What structures- bones does the tibia articulate with?
- Articulate with femur- medial and lateral condyles
- with the talus
- fibula- articular facet with the head, notch with the inferior fibula
The tibis forms the ______ malleolus.
Medial
Identify
Soleal line of the tibia
This structure joins the tibia and fibula
Interosseous membrane
This bone is located posterior and lateral to the tibia.
Fibula
This bone serves as a site for muscle attachment.
Fibula
This bone forms the lateral malleolus.
Fibula
The fibula malleolus is 1 cm (distal or proximal) to the tibia medial malleolus.
1 cm distal
The tibia malleolus is 1 cm (proximal or distal ) to the fibula?
Proximal
The tibia and fibula are permanently (pronated or supinated) ?
Pronated- the great toe is medial vs. the lateral thumb in the hand
The ____ and ____ are permanently pronated making the ______ the most medial phalangy.
Tibia and fibula
great toe
The ankle or tarsus is formed by how many bones?
7 bones
The talus articulates with the leg at the _____ .
Navicular
The navicular is a _____, ____ and _____
Head, neck and body
The trochlea of the talus is gripped by the _____ and receives the body weight, it splits the weight distribution between the _____ and the _____ foot.
- Malleoli
- calcaneus
- fore foot
The posterior process of the calcaneus has a groove for the tendon of the _____ (muscle)
Flexor hallicus longus
The talus has no ______ or _____ attachments
Muscular or tendinous
This structure is between the talus and cuboid.
Calcaneous
What does the talar shelf support?
Supports the head of the talus
This portion of the calcaneous is weight bearing and in contact with the ground.
Medial calcaneal tuberosity
This structure transmits the tendons for foot everters.
the fibular trochlea
This bone is between the talus and cuneforms.
Navicular bone
The _____ allows tendons to attach and forms part of the ______ arch of the foot.
Navicular tuberosity
longitudinal arch
The cuneiform bones include ______ ____ and ____ and each articulate with the _____ (bone)
- Medial, intermediate and lateral
- navicular
The subcutaneous tissue of the hip and thigh is continuous with the_____.
Inferior abdominal wall and buttock
At the knee the subcutaneous tissue loses fat and blends with ____
Deep fascia
Give characteristics of deep fascia:
- Strong and inelastic
- limits outward expansion of contracting musculatrue- which helps to increase the pressure of blood.
The increased pressure in the deep fascia pumps blood _____ through the veins.
Proximally
Deep fascia is also called ?
Fascia lata
The fascia lata (deep fascia) attached to and is continuous with?
- Inguinal ligament
- pubic arch
- body of the pubis and pubic tubercle
- scarpas fascia of the inferior abdominal wall
- iliac crest
- sacrum
- coccyx
- sacrotuberous ligament
- ischial tubersotity poerteriorly
- exposed parts of bones at the knee and deep fascia of the leg
Scarpas fascia of the inferior abdominal wall attaches to?
The deep LE fascia inferior to the inguinal ligament
Fascia lata encloses ______ (muscles)
Large thigh muscles
Laterally the fascia lata forms the _______
Iliotibial tract- IT band
The IT band is?
Thickened fascia lata that forms the aponeurosis of the tensor of the fascia lata and glueus maximus
The IT band extends from ______ to ______ which is called _____
Iliac tubercle
anterior - lateral tibial tubercle called GERDY
How many fascial compartments are in the thigh?
3 compartments
These lymphatics are on the plantar surface and accompany the saphenous veins great and small.
Superficial lymphatics
The superficial lymphatics end at the _______ nodes.
Superficial inguinal nodes
Most of the lymph from the superficial inguinal nodes drain to the ______ nodes, some drains to the _______ nodes.
- External iliac nodes
- deep inguinal nodes
The small saphenous lymphatics drain to the _______ nodes which is located _______.
- Popliteal nodes
- back of the knee fossa- poplitieal fossa
Identify these lymphatics
Superficial inguinal nodes- horizonal group
The horizontal and vertical superficial inguinal nodes project to ____?
External iliac nodes
The ______ group of nodes is located along the greater saphenous vein.
Vertical group of nodes
The vertical group of nodes recieved lymph from the ______ and projects to the ______ nodes.
- Lower limb
- external iliac nodes
1-3 of the deep inguinal nodes are located on the ____ side of the ____ vein under the fascia.
- Medial side
- femoral vein
The deep inguinal nodes recieve from ____ and deeper drainage, and they project to the _______ nodes.
- Popliteal nodes
- external iliac nodes
The horizontal group is along the ______ ligament and recieves from ______ ______ ____ _____ and _____ .
- Inguinal ligament
- abdominal wall
- buttock
- penis
- scrotum
- perineum
The gluteal lines are found on which bones?
Ilium
The articular surface of the acetabulum is called the?
Lunate surface
The popliteal nodes project to ____?
Deep inguinal nodes
Middle cluneal nerve innervates?
Sacral area
Inferior cluneal nerve innervates
Lower buttock- branch of posterior femoral nerve
The seven bones that make up the ankle are called the?
Tarsal bones
This bone distrubutes the weight of the body to the heel and forefoot?
Talus
This structure acts as a trochlea (sling) for muscles emerging from the pelvis.
Lesser sciatic notch
The sieve like membrane that covers the saphenous opening is called the?
Cribiform fascia
The thickened fascia lata known as the iliotibial tract forms the aponeurosis of what two muscles?
- Tensor fascia lata
- gluteus maximus
This vessel formed by the unikon of the dorsal digital vein of the great toe and the dorsal venous arch ascends anterior to the medial malleous?
Great saphenous vein
The extensor and flexor retinaculum of the ankle are formed by which fascia?
Crural fascia
The small saphenous vein drains into which vein?
Popliteal vein
How many deep inguinal nodes are located on the medial side of the femoral vein?
1-3
How many popliteal nodes are located in the popliteal fossa?
6-7
The iliopsoas muscle is the _______ hip (thigh, femur) ______ with the widest range of ______. It is the _____.
- Strongest hip
- flexor
- motion
- psoas
Regarding dermatomes: sensory input comes from the _____ and ____ plexus
Lumbar and sacral plexus
The 4 compartments of thigh muscles include?
- Anterior compartment
- medial compartment
- posterior compartment
- lateral compartment
Anterior compartment overall action is___ and is innervated by___?
- Flex the thigh (femur)
- extend the leg
- innervated by the femoral nerve
Pectineus is innervated by which nerve?
Femoral
Hamstring portion of the adductor magnus innervation is?
Tibial part of sciatic nerve
This adductor crosses two joints?
Gracilis- crosses knee and hip joint
This muscles inserts in the trochanteric fossa
Obturator externus
Regarding the femoral triangle, the pectineus muscle forms?
The medial floor
The following structures are not in the sheath?
Femoral nerve
Tibial branch of the sciatic nerve innervates all to the posterior compartment muscles except?
The short head of biceps femoris
The hamstring muscles are responsible for what actions?
Extend leg at hip and flex the knee
This muscle inserts at the pes anserinus with the sartorius and gracilis muscles?
Semitendinosis
This muscle covers the sciatic nerve as it descends from the medial gluteal region
Long head of biceps femoris
The medial compartment overall action and innervation?
- Adduct the thigh
- innervated by the obturator nerve
Posterior compartment overall action and innervation is?
- Extend the thigh
- flex the leg
- innervated by the tibial portion of the sciatic nerve
Lateral compartment overall action and innervation is?
- Abduct the thigh
- considered major thigh extensors also considered the gluteal muscles.
O,I,A,In for Psoas muscle:
- Origin: arises from the transverse processes and bodies of the lumbar vert.
- Insertion: tapers inf. Crossing anterior to the sacrum and SI joint to join with the iliacus and inserts on the lesser trochanter of the femur.
- Action: flexes the thigh, flexes the trunk, lateral lumbar spine flexor. A major postural muscle- active in gait performing an eccentric contraction to resist acceleration due to gravity.
- Innervation- ventral rami of L1-3
The purpose of the 3 fascial compartments is?
- Isolates blood supply and innervation
Describe the fascial compartments of the thigh. Structures included?
- Compartments surrounded by fascia lata
- 3 intermuscular septa formed by deep extensions of fascia lata
- fascia lata connecting to the linea aspera of the femur
The lateral intermuscular septa is strong comes from the _______ to the ______ of the _______ and lateral _______ of the femur
- Iliotibial tract
- lateral lip
- linea aspera
- lateral supracondylar line of the femur
This is a gap in the fascia lata, infero-lateral to the inguinal ligament and lateral to the pubic tubercle.
Saphenous opening
The medial margin smoothand lateral margin sharp form this ligament.
Falciform ligmament
This fascia is a “sieve” like membrane covering the saphenous opening.
Cribiform fascia
This fascia is deep fascia to the leg.
Crural fascia
Crural fascia is continuous with _____?
Fascia lata
Crural fascia attaches to the _____ and ____ borders of the tibia and is continuous with the ____.
- Anterior and medial borders
- periosteum
In the leg- this fascia is thinner distally but thickens to form the extensor and flexor retinaculum in the leg
Crural fascia
The anterior and posterior intermuscular septa of the leg passes from the deep crural fascia to attach to the margins of what bone?
Fibula
This structure traverses the tibia and fibula
- Interosseous membrane
Name the 4 compartments of the leg.
- Anterior- dorseflexors
- Lateral- fibular compartment (everter)
- Posterior- plantarflexor compartment- deep and superficial (3a, 3b)
What structure divides the posterior compartment of the leg
The transverse intermuscular septum
The anterior comparment of the leg includes ______ (muscles)
Dorsiflexors
The lateral compartment of the leg includes?
Fibular- everter compartment muscles
The posterior compartment of the leg includes?
Plantar flexors
The lower limb has_____ and _____ veins.
Superficial and deep veins
The superficial veins are located in the ______ tissue and run independantly from what?
- Superficial tissue
- named arteries
The deep veins are beneath ? And are accompanied by what?
- Deep fascia
- all major arteries
Deep and superficial veins of the lower limb have “valves” but they are more numerous in ?
Deep veins
What are the two major superficial veins of the lower limb?
- Great saphenous
- small saphenous
The great saphenous is formed by the union of what two veins?
- Dorsal digital vein of the great toe
- Dorsal venous arch of the foot
The great saphenous vein ascends anterior to ______ (structure) and posterior to the ______ of the femur. It then anastomoses with the ______ vein.
- Medial malleolus
- medial condyle of the femur
- small saphenous vein
Where does the great saphenous anastomose with the femoral?
At the falciform margin of saphenous opening
The small saphenous is on the _____ side of the foot and is formed from the union of the ______ with the _______.
- Lateral side of the foot
- dorsal vein of the little toe
- dorsal venous arch
The small saphenous runs on the _____ malleolus- lateral to the _____ tendon. It runs superiorly and medial to the ____ (bone) and penetrates the deep fascia of the _____ fossa- where it joins the ______ vein.
- Lateral
- calcaneal
- fibula
- popliteal fossa
- popliteal vein
These veins penetrate the deep fascia close to their origin from the superficial veins and contain valves.
Perforating veins
Perforating veins only allow blood to flow from ____ to _____
- Superficial to deep
Perforating veins pass from superficial to deep at _____ angle which helps pressure increase when muscles contract.
Oblique angle
Compression of the perforating veins prevents blood from flowng from the deep to the superficial veins. This pattern is important enables muscular contraction- sending blood toward the heart- this is called?
Musculovenous pump
Deep veins of the LE are paired with their named ______inside a vascular sheath.
Named arteries
Regarding the LE - the vascular sheath that the deep veins and artery are in allow arterial _______to force blood _____.
- Pulsation
- proximally
Which vein does the popliteal vein join in the popliteal fossa?
Femoral vein
Where does the popliteal vein join the femoral?
Popliteal fossa
The femoral vein is joined by _____?
Deep vein of the thigh- same as profunda femoral
The femoral vein passes deep to the ______ ligament to become the ______
- Inguinal ligament
- external iliac
This muscle complex is the strongest hip flexor with the widest range of motion.
Iliopsoas muscle complex which includes psoas and iliacus
Psoas origin- insertion- action- innervation
- Origin- tvp’s and bodies of the lumbar
- insertion: tapers inferiorly crossing anterior to the sacrum and SI joint to join the iliacus and inserts on the lesser trochanter of the femur
- action: flexes the thigh, flexes the trunk. Lateral lumbar spine flexor- is a major postural muscle- active in gait performance- eccentric contraction to resist acceleration due to gravity.
- Innervation: ventral rami of L1-L3
This muscle is a major postural muscle.
Psoas
This muscle is active in gait- performing an eccentric contraction to resist acceleration due to gravity.
Psoas
Which muscles are a part of the iliopsoas muscle complex?
Psoas and illiacus
This muscle inserts on the lesser trochanter of the femur with its partner iliacus.
Psoas
In 1/2 of people this muscle is present on the anterior surface of the psoas. Ps
Psoas minor
Origin- insertion- innervation- action of iliacus
- Origin: inner surface of the ALA of the ilium (iliac fossa)
- insertion- fibers blend with the psoas and insert on the lesser trochanter of the femur.
- Innervation- femoral nerve
- action: action in unison with the psoas
These muscles play a major role in trunk stability and posture.
Iliiopsoas muscles
This muscle is known as the “tailors muscle” it is also the longest muscle in the body.
Sartorius
This muscle crosses the hip and knee joint while crossing from lateral to medial.
Sartorius
Origin- insertion- action- innervation of sartorius.
- Origin: anterior superior iliac spine
- insertion: superior protion of the medial surface of the tibia close to the insertion of the gracilis and semitendinosus
- action: flexion, abduction and lateral rotation of the thigh at the hip. At the knee it flexes the leg. Also helps stabilize the pelvis.
- Innervation: femoral
- sartorius is a small muscle and serves as a synergist in all its functions.
This lower limb muscle is anterior compartment smaller muscle and serves as a synergist in all its functions.
Sartorius
Quadriceps group of muscles include?
- Rectus femoris
- vastus medialis
- vastus intermedius
- vastur lateralis
This muscle is the main bulk of the anterior thigh musculature.
Quadriceps
These muscles are major leg extenders that also flexes the hip.
Quadriceps
These muscles are used in rising from a chair, climbing and walking and going downhill.
Quadriceps
Quadriceps- rectus femoris- origin- insertion- action- innervation
- Origin: 2 seperate heads- straight head- anterior inferior iliac spine/ reflected head- from the ilium just superior to the acetabulum
- insertion: base of the patella
- action: extends knee- flexes the thigh at the hip
- innervation: femoral nerve
this is the only quad muscle that crosses the hip joint.
This is the only quad muscle that crosses the hip joint.
Rectus femoris
Vastis medialis- origin, insertion, action, innervation
- Origin: intertrochantric line and medial lip of the linea aspera and medial intermuscular septum
- insertion: inserts on the medial border of the quadriceps tendon, some inferior fibers insert directly into the medial side of the patella
- action: extends leg at the knee
- innervation: femoral nerve
Which vastus muscles contribute aponeurotic fibers to the joint capsule of the knee.
All of them
Vaastus intermedius- origin- insertion- action- innervation
- Origin: anterior and lateral aspects of the femoral shalft and the lateral intermuscular septum.
- Insertion: the posterior surface of the base of the patella - forming part of the quad. Tendon
- action: extends the leg at the knee
- innervation: femoral nerve
Vastus lateralis- origin- insertion- action- innervation
- Origin: posterior aspect of the femur at the greater trochanter and continues along the lateral lip of lina aspera
- insertion: most of the muscle inserts into the lateral patella and quadriceps tendon (with rectus tendon) - also attached to the tibia and patella via aponeurosis.
- Action: extension of the leg at the knee- support the knee joint
- innervation: femoral
Musculus articularis genus- origin- insertion- action- innervation
- Origins: Slips of muscle from vastus intermedius.
- Insertion: attaches to synovial membrane of the knee joint and suprapatellar bursa.
- Action: distract the synovia membrane preventing folds of the membrane from being compressed between the femur and patella.
- Innervation: femoral nerve
it consists of variable number of muscle bundles 1-7 originating from bellow the distal 1/5th of the anterior femur.
This muscle is formed by variable number of 1-7 bundles orignating from below the distal 1/5 of the anterior femur.
Musculus articularis genes
This muscle functions to distract the synovial membrane in the knee to prevent folds of the membrane from being compressed between the femur and patella.
Musculus articularis genes
Origin of what muscle?
Medial thigh muscles include?
- Adductor longus
- adductor brevis
- gracilis
- pectineus
- adductor magnus
- obturator externus
The medial thigh muscles are mainly what kind of muscle?
Adductors
Medial thigh muscles are mainly innervated by what nerve? The exception is what muscle?
- Obturator nerve
- pectineus
Most medial thigh muscles are ______ and innervated by _____. They attach ____ to the anterior inferior bony pelvis and _____ membrane and distally to the ______.
- Adductors
- obturator nerve
- Proximally
- obturator membrane
- linea aspera
Pectineus- origin- insertion- action- innervation
- Origin: pectin pubis
- insertion: pectinealline of femur inferior to lesser trochanter
- action: adducts and flexes thigh at the hip and assists with medial rotation of the thigh
- innervation: femoral NOT OBTURATOR
Adductor longus- origin- insertion- innervation- action
- Origin: superior pubic ramus
- insertion: medial 1/3 linea aspera
- innervation: anterior branch obturator nerve
- action: adducts the thigh
Adductor brevis- origin- insertion- action- innervation
- Origin: body and inferior ramus of the pubis
- insertion: pectineal line and proximal part of the linea aspera
- action: adducts thigh and medial rotates and some flexor function
- innervation: anterior branch obturator nerve
the obturator nerve and artery SPLIT to surround the adductor brevis- anterior and posterior divisions
As the obturator nerve emerges from the ob. Canal to enter the medial compartment it splits into ant. And post divisions. What muscle do these two divisions pass?
Adductor brevis
Adductor magnus- origin- insertion- action- innervation
- Origin: has 3 origins- 1. Inferior pubic ramus- adductor- 2. Ischial ramus- adductor- 3. Ischial tuberosity- hamstring
- insertion: has 4 insertions- 1. Gluteal tuberostiy- 2. Linea aspera- 3. Medial supracondylar line (adductor)- 4. Adductor tubercle (hamstring)
- action: adducts and medial rotates and flexes the thigh (adductor) AND extends thigh (hamstring)
- innervation: 2 innervation- 1. Posterior branch obturator- adductor portion- 2. Tibial part of sc
This muscle is a small flat muscle in the medial comparment which constitues the upper, lateral part of the adductor magnus muscle.
Adductor minimus
Other names for adductor minimus are?
- Adductor femoris minimus
- adductor quartus
This adductor is the only adductor to cross the hip and knee joint.
Gracilis
Gracilis- origin- insertion- innervation- action
- Origin: inferior ramus of the pubis
- insertion: superior medial tibia also called PES ANSERINUS (which means gooses foot)
- innervation: anterior branch of the obturator nerve
- action: adducts thigh, flexes and medially rotates the leg
- this muscle has distal insertion on pes anserinus along with sartorius- semitendinosus
- this muscle adds medial stability to the extended knee.
This muscle has distal insertion into the pes anserinus with sartorius and semitendinosus.
Gracilis
This muscle adds medial stability to the extended knee.
Gracilis
This structure is a common insertion point for muscles from anterior, medial and posterior compartment.
Pes anserinus
What does Say Grace Twice stand for?
Medial thigh muscles that insert on pes ansirinus
- sartorius
- gracilis
- semitendinosus
Obturator externus- origin- insertion- innervation- action
- Origin: superior ramus of the pubis- obturator membrane - ischial ramus
- insertion: trochanteric fossa of femur
- innervation: posterior branch obturator nerve
- action: external rotation of the limb- steadies the head of the femur in acetabulum
- insertion on the posterior aspect of the proximal femur results in external or lateral rotation with contraction.
Insertion of this muscle on the posterior aspect of the proximal femur results in external (lateral) rotation with contraction.
Obturator externus
Identify origin muscles
Identify muscles insertion.
These adductors insert on the back of the femur.
- Pectinius
- adductor brevis
- adductor longus
What functions do the adductors of the thigh contribute?
- Adduction of the abducted thigh
- flexion of the extgended thigh
- extension of the flexed thigh
Which muscles are involved in all adduction?
- Adductor magnus
- adductor longus
- adductor brevis
These muscles assist in stabilization of the bipedal stance.
Adductors of the thigh
Despite large muscle mass the body can withstand up to 70% function loss without much dysfunction. Which muscles of the thigh are these?
Adductors
Where is the femoral triangle located?
The anterior- superior medial thigh
What are the borders of the femoral triangle?
- Superior border- inguinal ligament
- medial border- adductor longus
- lateral border- sartorius
- floor- ilipsoas (lateral) - pectineus (medial)
- roof- fascia lata, cribiform fascia, skin and subcutaneous tissue
This space is created by the inguinal ligament spanning between the anterior superior iliac spine and the pubic tubercle.
Subinguinal space
The inguinal ligament acts as a ______ for the anterior thigh neurovascular structures.
Flexor retinaculum
This structure acts as a flexor retinaculum for the anterior thigh neurovascular structures.
Inguinal ligament
The subinguinal space is divided into 2 divisions- they are?
- Muscular lacuna
- vascular lacuna
What structures are included in the muscular lacuna?
- Psoas major
- iliacus
- femoral nerve
What structures are included in the vascular lacuna?
- Femoral vein
- femoral artery
- lymphatics
The femoral sheath surrounds the _____, ______ and _____ but NOT the _____.
- Femoral canal
- femoral vein
- femoral artery
- NOT the femoral nerve
The femoral canal contains the ______ from the lower limb and the _____ lymphoids.
- Lymphatics
- cloquets lymphnodes
This structure allows the femoral artery and vein to glide with hip movement.
Femoral sheath
The femoral sheath is formed by a prolongation of the inferior portion of the _______ and ______
- Transversalis fascia
- iliopsoas fascia
What are the 3 major components to the femoral sheath- lateral to medial?
- Lateral- femoral artery
- intermediate- femoral vein
- medial- the femoral canal
The most lateral structure in the femoral sheath is what?
Femoral artery
The intermediate structure in the femoral sheath is what?
Femoral vein
The medial structure in the femoral sheath is what?
The femoral canal
What structure is housed in the femoral canal what does the empty space allow?
- Contains lymphatics
- the empty space allows expansion of the femoral vein during blood flow
Which structure is the most lateral in the femoral triangle?
The femoral nerve
Which structure is NOT in the femoral sheath?
Femoral nerve
What structure surrounds the femoral canal?
The femoral ring
What are the borders of the femoral sheath (canal) check it?
- Lateral- femoral septum
- posterior- superior ramus of the pubis covered by the pectineus
- medial- lacunar ligament
- anterior- medial inguinal ligament
Adductor canal is also called what?
Hunters canal
What structures does the adductor canal (hunters canal) transmit?
- Transmits the femoral artery, vein, saphenous nerve and nerve to the vastus medialis.
The apex of the femoral triangle leads to what structure?
Adductor hiatus
This is a gap in the aponeurosis of the distal adductor magnus, between the adductor and hamstring.
Adductor hiatus
This gap transmits the femoral artery and vein from the anterior comparment of the thigh to the popliteal fossa, posterior to the knee.
Adductor hiatus
Hamstring muscles include?
- Semimembranosus
- semitendinosus
- biceps femoris
The hamstrings have proximal attachment to the ______.
Ischial tuberosity
The hamstring muscles span how many joints- and what are they?
- They span 2 joints
- hip
- knee
The hamstring actions include _____ the thigh and _____ the leg.
- Extending the thigh
- flexing the leg
The hamstring muscles are innervated by what nerve?
Tibial branch of sciatic nerve
Hamstring muscles do not include what muscle?
Short head of biceps femoris
With regard to hamstring action: what two actions cannot be performed maximally at the same time?
- Full flexion of the knee impairs hip extension
- full hip extension impairs knee flexion
The inability of a muscle, which spans two or more joints, to exert enough tension and shorten sufficiently to cause a full range of movement in all joints at the same time. This is called what?
Active insufficiency
The inability of a muscle that spans two or more joints to be stretched sufficintly to produce a full range of motion in all the joints simultaneously. Identify-
Passive insufficiency
When the thigh and leg are fixed what are the hamstrings doing?
The hamstrings extend the trunk at the hip joint
What type of action are the hamstrings involved with- when are they most active?
Hamstrings are invloved in walking and are most active suring an ECCENTRIC CONTRACTION resisting hip flexion and knee extension.
Semitendinosus- origin- insertion- nerve- action
- Origin: ischial tuberosity
- insertion: pes anserinus, medial tibia
- nerve: tibial division, sciatic nerve
- action: flexes leg- extends the trunk when the leg or thigh is fixed.
Which muscle tendons are attached to pes anserinus?
- Semitendinosus tendon
- Gracilis tendon
- sartorius tendon
Under the Pes Anserinus there is a bursa- what is it called?
It is called pes anserinus bursa
Semimembranosus- origin- insertion- nerve- action
- Origin- ischial tuberosity
- insertion- posterior medial condyle of tibia
- nerve- tibial division, sciatic nerve
- action- flexes leg, extends thigh, extends the trunk when the leg/thigh is fixed.
With regards to semimembranosis- there are distal attachment in 3 parts: what are they?
- Direct attachement to the posterior medial tibial condyle
- part blends with popliteal fascia
- reflected part reinforces the intercondylar part of the knee capsule
Biceps femoris- origin- insertion- nerve- action
- Origin: 2 heads- long head: ischial tuberosity/ short head: linea aspera and supracondylar ridge of femur
- insertion: head of fibula
- nerve: long head- tibial division, sciatic nerve. / short head: common peroneal division, sciatic nerve
- action: flexes leg- extends thigh
the long head covers the sciatic nerve as it descends from the medial gluteal region through the posterior thigh to the popliteal fossa.
The long head of this muscle covers the sciatic nerve as it descends from the medial gluteal region through the posterior thigh to the popliteal fossa.
Biceps femoris
Which nerve is covered by the long head of biceps femoris as it descends from the medial gluteal region throught the posterior thigh to the popliteal fossa. ?
Sciatic nerve
The _____ of biceps femoris covers the ______ nerve as it descends from the ______ region through the ________ thigh to the _______ fossa.
- Long head of biceps femoris
- sciatic nerve
- medial gluteal region
- posterior thigh
- popliteal fossa
The adductor canal run at the border of the ____ and ____ compartments
Medial and anterior compartments
Identify muscle origins
Identify muscle origin
Identify muscle insertion
During a sprint what happens to the hamstring muscles?
They develop the highest tension to DECELERATE THE TIBIA as the knee extends.
What happens to the hamstrings once the foot is on the ground?
The hamstrings function in extending the hip back which in turn allows the other leg to move forward.
When is it - that the hamstring becomes most prone to injury? Which portion is vulnerable?
- Just before the foot strikes the ground the hamstrings are most commonly injured.
- Biceps femoris is the most injured
Regarding hamstring injury: hamstrings become injured as the muscles are ________ activated or ________and are approaching their maximum _____.
- Maximally activated or eccentric
- length
What are the factors that increase the risk of individual pulling hamstring?
- Age
- previous injury
- flexibility
- hamstring strength
- impingement of lumbosacral nerve root
- fatigue and fitness
Hamstring injury: the older/younger the person is poses greater risk of pulled hamstring?
Older
Hamstring injury: prior injuries to the _____ or the _____ muscles can increase the risk of future damage.
- Hamstrings
- adductor muscles
Hamstring injury: research suggest that greater/lesser flexibility the less prone you are to injury?
Greater flexibility
Hamstring injury: studies have shown that the _____ of this is linked to susceptibility to a hamstring pull.
Lack of strength
Hamstring injury: nerve root impingement in _____ to ____ can lead to associated hamstring weakness.
L5-S1
Hamstring injury: when player is fatigued and coordination is at a loss- there is risk of damage due to what?
- Dual innervation of biceps femoris- fatigue lends to lack of synchronization between the two nerves- common fibular and tibial which can lead to mismatch in firing resulting in hamstring injury.
Hamstring injury: the mismatched firing of which two nerves of what muscle can cause hamstring injury?
The biceps femoris is at risk due to dual innervation from common fibular and tibial which can lead to mismatched of firing causing injury.
Hamstring injury: The _______ muscle is at risk of damage (when fatigued) due to ______. Fatigue causes lack of _____ between the ____ and ____ (nerves) and can lead to mismatch in ____ resulting in hamstring injury.
- Biceps femoris
- dual innervation
- synchronization
- common fibular and tibial
- firing
Hamstring injuries: indentify grade - may feel tightness in the posterior thigh- can still walk normal but with discomfort- minimal swelling- lying prone does NOT produce much pain.
Grade 1 - minor tear in muscle
Hamstring injury: identify grade- gait is affected, may be a limp, twinges of sudden pain during activity- swelling- pressure increases pain- flexing the knee against resistance causes pain- not able to fully staighten the knee.
Grade 2- partial tear in muscle
Hamstring injury: identify grade- walking is severely affected- may require crutches- severe pain especially during knee flexion- swelling is visible immediately
Grade 3- severe tear or complete rupture
Treatment for hamstring injury grade 1-2 includes?
- RICE- rest, ice, compression, elevation
- NSAID;s
- stretch and strengthen
- may require 2-4 weeks
Treatment for hamstring injury grade 3 includes?
- 10 weeks to recover
- may require surgery especially if avulsion of origin occurs.
The gluteal muscles are located in the _____ compartment where they ____ the thigh. Their superior posterior location allows them to be major thigh _____.
- Lateral comparment
- ABduct the thigh
- extensors
How many layers are there for gluteal muscles?
Two layers- superficial and deep
The superficial layer of gluteal muscles attach to what?
- Attach to the posterolateral surface and margins of the ala of the liliac bone.
The superficial layer of gluteal muscles includes?
- Gluteus maximus
- gluteus medius
- gluteus minimus
- tensor of the fascia lata
What is the action of the superficial layer of gluteus muscles?
Extensor, abductors and rotators
The deep layer of gluteus muscles attach to what?
- Distal attachement to the intertrochateric crest of the femur
What muscles are included in the deep gluteus muscles?
- Piriformis
- obturator internus and externus
- gemelli superior and inferior
- quadratus femoris
What is the action of the deep layer of gluteal muscles?
Stabalize the hip joint and laterally rotate
Identify
The pelvis, hip, sacrum and coccyx are bound together by?
Dense ligaments
This ligament of the pelvis converts the lesser sciatic notch into the lesser sciatic foramen.
Sacrotuberous ligament
This ligament turns the greater sciatic notch into the greater sciatic foramen.
Sacrospinous ligament
Which gluteous ligament is attached to the ischial spine?
Sacrospinal ligament
Gluteus maximus- origin- insertion- action- innervation
- Origin: ilium posterior ro the posterior gluteal line- dorsal surface of the sacrum- coccyx- sacrotuberous ligament
- insertion: upper 3/4 iliotibial tract into the lateral condyle of the tibia/ lower 1/4 inserts on the gluteal tubercle of the femur
- action: extends the thigh (especially when the thigh is flexed) - assists lateral rotation- extends the trunk when the LE is fixed- stabilizes the extended knee- abducts thigh
- innervation: inferior gluteal nerve
- extremely good blood supply from the superior and inferior gluteal arteries. This large muscle has little involvement in walking on a flat surface in climbing.
This muscle is the largest muscle of the body.
Gluteus maximus
This large muscle has little involvement in walking or in climbing.
Gluteus maximus
This muscle has extremely good blood supply from the superior and inferior gluteal artery.
Gluteus maximus
What are the 3 gluteal bursas?
- Trochateric bursa
- ischial bursa
- gluteo-femoral bursa
This bursa is over the greater trochanter, usually the largest bursa in the body and present at birth.
Trochanteric bursa
This bursa is located between the inferior gluteus maximus and ischial tuberosity
Ischial bursa
This bursa is between the iliotibial tract and proximal attachment of the vastus lateralis
Gluteo-femoral bursa
Gluteus medius- origin- insertion- nerve- action
- Origin: external surface of the ilium between the anterior and posterior gluteal lines
- insertion: lateral surface of the greater trochanter
- nerve: superior gluteal nerve
- action: chief abductor of the thigh- weak medial rotation
This muscle is the CHIEF abductor of the thigh
Gluteus minimus- origin- insertion- nerve- action
- Origin: external surface of the ilium between the anterior and posterior gluteal lines.
- insertion: anterior surface of the greater trochanter
- nerve: superior gluteal nerve
- action: abducts the thigh weak medial rotation.
- medius and minimus are separated by the deep branches of the superior gluteal neurovascular bundle
This muscle is under gluteus medius.
Gluteus minimus
Gluteus minimus and medius are both antagonistic or synergistic?
Synergistic
Gluteus medius is antagonistic or synergistic?
Both
What structure seperates gluteus minimus and medius?
Separated by deep branches of the superior gluteal neurovasucular bundle.
Tensor fascia lata- origin- insertion- nerve- action
- Origin: ASIS iliac crest
- insertion: iliotibial tract- attaches to lateral condyle of the tibia
- nerve- superior gluteal nerve
- action- chief action is flexion of the thigh- withilipsoas and rectus femoris- stabilizes the extended knee
This muscle is enclosed between layers of the fascia lata-
Tensor fascia lata
Piriformis- origin- insertion- nerve- action
- Origin- anterior sacrum S1-S4
- insertion- superior border of greater trochanter
- nerve- nerve to piriformis- anterior rami of S1 and S2
- action- laterally rotate thigh abduct thigh
This muscle is a landmark muscle of the gluteal region.
Piriformis
Superior gluteal vessels and nerves emerge superior to this muscle.
Piriformis
Which nerve emerges inferior to piriformis?
Sciatic
Occasionally the sciatic nerve goes through which muscle?
Piriformis
Superior gemellus, obturator internus and inferior gemellus for what?
Triceps coxae
What 3 muscles form the triceps coxae?
- Superior gemellus
- obturator internus
- inferior gemellus
The triceps coxae are located between the ____ and ______.
- Piriformis
- quadratus femoris
The common tendon of the _____ runs horizontally to the greater trochanter of the femur.
Triceps coxae
Superior and inferior gemellus- origin- insertion- action- innervation
- Origin: superior= ischial spine/ inferior= ischial tuberosity
- insertion: greater trochanter (common tendon)
- action: laterally rotate extended thigh- abduct the flexed thigh- stabilize femoral head in acetabulum
- innervation: superior=nerve to obturator internus/ inferior=nerve to quadratus femoris
The superior gemellus is innervated by?
Nerve to obturator
The inferior gemellus is innervated by which nerve?
Nerve to quadratus femoris
Obturator internus- origin- insertion- nerve- action
- Origin: pelvic surface of the obturator membrane- obturator foramen- bony ring
- insertion: greater trochanter
- nerve: nerve to obturtor internus
- action: laterally rotate extended thigh- abduct the flexed thigh- stabilize femoral head in acetabulum- exits the pelvis through the lesser sciatic foramen
Quadratus femoris- origin- insertion- nerve- action
- Origin: ischial tuberosity
- insertion: quadrate tubercle on intertrochanteric crest
- nerve: nerve to quadratus femoris
- action: laterally rotates thigh- stabilize femoral head in acetabulum
This small muscle block is the strongest lateral rotator of the thigh.
Quadratus femoris
How is piriformis syndrome caused?
Caused by an entrapment of the sciatic nerve as it exits the greater sciatic notch in the gluteal region.
Regarding piriformis syndrome: what are the two Normal Variants for exit of the sciatic nerve?
1st variance: Emerges inferior to the piriformis but superior to the gemelles muscles.
2nd variance: The sciatic pierces the piriformis
When the sciatic nerve emerges inferior to the piriformis what is entrapement likely due to?
- Entrapment in this area is likely due to myospasm or contracture- tightening and shortening of either piriformis or gemelles muscles.
In piriformis syndrome- what variant is only present in 1-10% of population?
2nd variance- The sciatic pierces the piriformis itself.
In the 2nd variance of sciatic exit what symptoms occur and what is it commonly mistaken for?
- Myospasm and contraction of the piriformis muscle itself can lead to pain along the back of the thigh to the knee, loss of sensation or numbness and tingling in the sole of the foot.
- This commonly confused with sciatica
What is the most common variant of sciatic nerve exit?
The fibular component of the sciatic nerve piercing the muscle- piriformis.
What is the main difference between sciatica and piriformis syndrome?
Main difference is the CAUSE
What is sciatica due to?
- Sciatica is due to a lumbar disc directly pressing on a nerve root as it exits the intervertebral forament in the lumbar spine.
- Sciatica is a SYMPTOM not a disorder
This nerve comes from roots L2-L3- L4 and is the largest branchof the lumbar plexus.
Femoral nerve
Where does the femoral nerve form?
Forms in the psoas muscle in the abdomen
This nerve passes beneath the mid part of the inguinal canal under the inguinal ligament. In the femoral triangle it divides into terminal branches to the anterio thigh muscles. Send articular branches to the hip and knee joints.
Femoral nerve
This nerve is a continuation of the femoral nerve.
Saphenous nerve
The _____ nerve is a distal extension of the femoral nerve- passes through the _____ canal with the femoral artery and vein close to the adductor hiatus it passes between the ____ and _____ (muscles)
- Saphenous
- adductor canal
- sartorius and gracilis
This nerve comes from nerve root L2 L3 and L4 and passes on the medial border of the psoas and enter the obturator foramen.
Obturator nerve
The obturator nerve splits into ___ and ____ branches- the ______(muscle) lies between the two branches
- Anterior
- posterior
- adductor brevis
The anterior branch of the obturator nerve innervates what muscles? (3)
- Adductor longus
- adductor brevis
- gracilis
The posterior branch of the obturator nerve innervates what muscles? (2)
- Obturator externus
- adductor magnus
This ARTERY is an extension of the external iliac artery beyond the inguinal ligament
Femoral artery
This nerve supplies sensory innervation to the anterior - medial aspect of the knee and foot.
The femoral nerve
Distal to the inguinal ligament the femoral artery produces?
- Superficial epigastric artery
- superficial circumflex iliac artery
- external pudendal arteries
The femoral artery descends on the _______ border of the ____ and _____ which is the floor of the _______.
- Lateral border
- iliopsoas and pectineus
- femoral triangle
The femoral artery enters the ______ canal under sartorius muscle and passes through the ______ to become popliteal artery.
- Adductor canal
- Adductor hiatus
What are the branches of the femoral artery?
- Below inguinal-
- Superficial circumflex iliac artery
- superficial epigastric artery
- profunda femoris
- perforating branches
- circumflex femoral branches (lateral and medial branches)
- external pudendal
- descending genicular
goes through canal and hiatus and becomes popliteal
Where does the profunda femoris arise from?
From the femoral artery in the femoral triangle.
The perforating branches pass posterior to the femur- name the muscles that they supply and what compartments?
Perforating arteries supply- adductor magnus- hamstrings- and vastus lateralis- all 3 compartments of the thigh.
These arteries arise from the femoral artery and encircle the femur and anastomose
Circumflex femoral branches
Draw the arterial supply to lower limbs
This artery usually arises from the internal iliac artery- 20 % of people have an enlarged pubic branch of the inferior epigastric artery which replaces this artery. If this is the case then it would arise from _______ artery.
- Obturator artery
- external iliac artery
20 % of people have enlarge pubic branch of the _____ and it takes the place of the _____ in which case it would arise from the _____ artery.
- Inferior epigastric artery
- obturator
- external iliac artery
The obturator artery supplies what muscles?
- Obturator externus
- pectineus
- all adductors
- gracilis
The obturator enters the _______compartment of the thigh through what structure?
- Medial compartment
- obturator foramen
In the medial thigh the obturator artery splits into _____ and _____ branch surrounding _____ (muscle)
- Anterior
- posterior
- adductor brevis
This VEIN is a continuation of the popliteal veins which ascends in the adductor canal posterior to the femoral artery.
Femoral vein
This vein enters the femoral sheath lateral to the adductor canal.
Femoral vein
This vein becomes the external iliac vein at the inguinal ligament
Femoral vein
How are the deep veins of the thigh formed?
- They are formed by the union of the deep perforating veins join the femoral vein inferior to the inguinal ligament.
This vein joins distal to the inguinal ligament.
Great saphenous
These nerves supply sensory of the gluteal region
Cluneal nerves
Superior cluneal nerve come from which roots and serves what portion of the buttock?
Superior cluneal come from posterior rami of L1, L2 and L3- they run across the iliac crest and serve the superior buttock.
Middle cutaneous cluneal come from the posterior rami of _____ exit through the posterior sacral foramen- sacrum adjacent to buttock
S1 S2 and S3
Inferior cutaneous cluneal comes from posterior rami of ____ exit inferior border of the ________ and ascend inferior buttock as far as the _____.
- S2 to S3
- gluteus maximus
- greater trochanter
Superior gluteal nerves come from what?
The posterior divisions of the anterior rami of L4 and L5
How do the superior gluteal nerves enter the gluteal region?
They enter through the GREATER SCIATIC FORAMEN superior to the piriformis
The superior gluteal nerve runs between _____ and ____ with the deep branch of the superior gluteal artery. It innervates what 3 muscles?
- Gluteus medius and minimus
- glueus medius
- gluteus minimus
- tensor tascia lata
The inferior gluteal nerve comes from what roots?
Posterior divisions of the anterior rami of L5 and S1
How does the inferior gluteal nerve enter the gluteal region?
The inferior gluteal nerve enters the gluteal region through the GREATER SCIATIC FORAMEN INFERIOR to the piriformis and under the inferior gluteus maximus
The inferior gluteal nerve runs superficial to the _____ nerve and is accompanied by branches of the _____ artery. It splits into several muscular branches and innervates ____ .
- Sciatic nerve
- inferior gluteal artery
- Gluteus maximus which is inferior to gluteal minimus
The sciatic nerve is formed by the posterior and anterior division ?
L4- L5- S1 - S2- S3
This nerve is the largest nerve in the body.
Sciatic nerve
The ramis of this nerve converge at the inferior border of piriformis and create a band 2 cm wide what nerve is this?
Sciatic nerve
This nerve is the lmost lateral structure emerging inferior to the piriformis.
Sciatic nerve
What structures lie medial to the sciatic nerve as it emerges?
- Inferior gluteal nerve, artery and vein
- internal pudendal vessels and nerve.
The sciatic nerve passes beneath the _____ midway between the greater ____ and the ____ tuerosity resting the the _____ .
- Gluteus maximus
- greater trochanter
- ischial tuberosity
- ischium
The sciatic nerve is big enough it has its own blood supply- what is this artery and where does it derive from?
- The artery is called “artery to the sciatic nerve”
- derives from inferior gluteal artery
The sciatic nerve supplies all/nothing in the gluteal region?
Nothing
The Tibial portion of the sciatic nerve supplies? Except what muscle?
The tibial portion of sciatic nerve innervates the posterior thigh muscles EXCEPT the short head of the beceps femoris
The tibial and common fibular branches share a common sheath that splits in the ______.
Superior popliteal fossa
The superior gluteal artery exits through the ______ superior to the _____ (muscle) and divides into 2 branches _____ and _____.
- Greater Sciatic foramen
- Piriformis
- superficial and deep branches
The superficial branch of the superior gluteal artery supplies ________ (muscles) and is innervated by _______ nerve.
- Supplies gluteus max and cutaneous skin
- Inferior gluteal nerve
The superficial branch of the superior gluteal artery supplies what structures? What nerve also innervates these structures?
- Gluteus maximus and subcutaneous tissue
- Inferior gluteal nerve
The deep branch of the superior gluteal artery supplies what muscles and what innervates these structures?
- Gluteus medius
- gluteus minimus
- tensor fascia lata
- Innervated by the superior gluteal nerve
The inferior and superior gluteal arteries anastomose with what other artery?
- Medial circumflex femoral artery
Where does the internal pudendal artery rise from?
Internal iliac and lies anterior to the inferior gluteal artery
The pudendal artery runs parallel to the ____ nerve and enters the region through the _____ inferior to the piriformis.
- Pudendal nerve
- greater sciatic foramen
How does the pudendal artery enter the perineum?
It crosses the ischial spine and sacropinous ligament and enter the perineum through the lesser sciatic foramen.
Where are the popliteal lymph nodes located?
Subcutaneous tissue
Gluteus maximus Origin
Origin-1. ilium posterior to the posterior gluteal line 2. Dorsal surface of sacrum 3. Coccyx 4. Sacrotuberous ligament
Gluteus maximus Insertion
- Upper 3/4th- ilitibial tract
- Lower 1/4th gluteal tubercle of femur
Gluteus maximus action
- Extends the thigh
- Assist lateral rotation
- Extends the trunk when the LE is fixed
- Stabilizes the exgended knee
- Abducts the thigh
Gluteus maximus innervation
Inferior gluteal nerve
Gluteus medius insertion
Lateral surface of the greater trochanter
Gluteus medius action
Chief abductor of the thigh Weak medial rotation
Gluteus medius innervation
Superior gluteal nerve
Gluteus minimus origin
External surface of the ilium between the anterior and posterior gluteal ines
Gluteus minimus insertion
Anterior surface of the greater trochanter
Gluteus minimus action
Abducts the thigh Weak medial rotation
Gluteus minimus
Superior gluteal nerve
Tensor fascia lata origin
ASIS Iliac crest
Tensor faxcia lata insertion
Iliotibial tract
Tensor fascia lata action
Laterally rotate thigh Abduct thigh
Tensor fascia lata innervation
Superior gluteal nerve
Piriformis origin
Anterior sacrum s1-s4
Piriformis insertion
Superior border of greater trochanter
Piriformis action
Laterally rotate thigh Abduct thigh
Piriformis innervation
Nerve to the piriformis L5, s1, s2
Superior and inferior gemellus origin
Superior- ischial spine Inferior- ischial tuberosity
Superio and inferior gemellus insertion
Greater trochanter
Superior and inferior gemellus action
Laterally rotates extended thigh Abduct the flexed thigh Stabilize femoral head in acetabulum
Superior and inferior gemellus innervation
Superior- nerve to obturator internus Inferior- nerve to quadratus femoris
Obturator internus origin
Pelvic surface of the obturator membrane Obturator foramen (bony ring)
Obturator internus insertion
Greater trochanter
Obturator internus action
Laterally rotate extended thigh Abduct the flexed thigh Stabilize femoral head in acetabulum
Obturator internus innervation
Nerve to obturator internus
Qudratus femoris origin
Ischial tuberosity
Quadratus femoris insertion
Quadrate tubercle on intertrochanteric crest
Quadratus femoris action
Laterally rotates thigh Stabilize femoral head in acetabulum
Quadratus femoris innervation
Nerve to quadratus femoris
Semitendinosus origin
Ischial tuberosity
Semitendinosus insertion
Pes anserinus Medial tibia
Semitendinosus action
Flexes leg Extends thigh Extends trunk when lef/thigh is fixed
Semitendinosus tibial innervation
Tibial division Sciatic nerve
Biceps femoris origin
Long head-ischial Short head- linea aspera and supracondylar ridge of femur
Biceps femoris insertion
Head of fibula
Biceps femoris action
Flexes leg Extends thigh
Biceps femoris innervation
Long head- tibial division and sciatic nerve Short head- common peroneal division and sciatic nerve
Pectineus origin
Pectin pubis
Pectineus insertion
Pectineal ine of femur inferior to lesser trochanter
Pectineus action
Adducts and flexes thigh at the hip and assists with medial rotation of thigh
Pectineus innervation
Femoral nerve
Adductor longus origin
Superior pubic ramus
Adductor longus insertion
Medial 1/3 linea aspera
Adductor longus action
Adducts thigh
Adductor longus innervation
Anterior branch of obturator nerve
Adductor brevis origin
Body and inferior ramus of pubis
Adductor brevis insertion
Pectineal line and proximal part of the linea aspera
Adductor brevis action
Adducts thigh Some medial rotation Some flexor function
Adductor brevis innervation
Anterior branch of obturator nerve
Adductor magnus origin
Inferior public ramus- ischial ramus- ischial tuberosity (hamstring)
Adductor magnus insertion
- Gluteal tubersity 2. Linea aspera 3. Medial supercondylar line 4. Adductor tubercle
Adductor magnus action
- Adducts and medial rotates thigh 2. Flexes thigh 3. Extends thigh and externally rotates
Adductor magnus innervation
Posterior branch obturator nerve Tibial part of sciatic nerve
Gracilis origin
Inferior ramus of pubis
Gracilis insertion
Superior medial tibia insertion here with sartorius and semitendinosus- adds stability to the extended knee
Gracilis action
Adducts thigh Flexes thigh Medially rotates leg
Gracilis innervation
Anterior branch obturator nerve
Obturator externus origin
Superior ramus of pubis Obturator membrane Ischial ramus
Obturator externus insertion
Trochanteric fossa of femur
Obturator externus action
Laterally rotates leg Steadies head of femur in acetabulum
Obturator externus innervation
Posterior branch obturator nerve
Psoas origin
TVP’s and bodies of lumbar vert
Psoas insertion
Lesser trochanter of femur
Psoas action
Flexes the thigh and trunk Lateral lumbar spine flexor Major postural muscle Active in gait-eccentric contraction to resist acceleration due to gravity
Psoas innervation
Ventral rami of L1- L3
Iliacus origin
Arises from the inner surface of the ala of the ilium
Iliacus insertion
Lesser trochanter of the femur fibers blend with psoas
Iliacus action
Acts in unison with the psoas Trunk stability and posture
Iliacus innervation
Femoral nerve
Sartorius origin
Anterior superior iliac spine
Sartorius insertion
Superior portion of the medial surface of the tibia
Sartorius action
Flexion, abduction and lateral rotation of the thigh at the hip At knee flexes leg Helps stabilize pelvis serve as a synergist in all its functions
Sartorius innervation
Femoral nerve
Rectus femoris origin
Straight head- anterior inferior iliac spine Reflected head- from the ilium just superior to the acetabulum
Rectus femoris insertion
Base of patella
Rectus femoris action
Extends knee At hip- flexes thigh
Rectus femoris innervation
Femoral nerve
Vastus medialis origin
Interochanteric line and medial lip of linea aspera Medial intermusculur septum
Vastus medialis insertion
Medial border of quadriceps tendon Some inferior fibers- directly into medial side of patella
Vastus medialis action
At the knee- extends the leg
Vastus medialis innervation
Femoral nerve
Vastus intermedius origin
Anterior and lateral aspects of femoral shaft Lateral intermuscular septum
Vastus intermedius origin
Anterior and lateral aspects of femoral shaft Lateral intermuscular septum
Vastus intermedius insertion
Posterior surface of base of patella- forms part of the quadriceps tendon
Vastus intermedius action
Extends the leg at the knee
Vastus intermedius innervation
Femoral nerve
Vastus lateralis origin
Posterior aspect of femur at greater trochanter
Vastus lateralis insertion
Lateral patella Quadriceps tendon Tibia and patella via and aponeurosis
Vastus lateralis action
At the knee- extension of the leg Supports knee joint
Vastus lateralis innervation
Femoral nerve
Musculus articularis origin
Small flat slip of muscle from vastus intermedius muscle distally
Gluteus medius origin
External surface of the ilium between the anterior and posterioR gluteal lines
Musculus articularis insertion
Synovial membrane of the knee joint Suprapatella bursa
Musculus articularis action
Function- distract synovial membrane preventing folds of the membrane from being compressed between the femur and patella
Musculus articularis innervation
Femoral nerve
