Exam 4

Question 1

hip bone

Answer 1

• Acetabulum – cup shaped depression articulates with head of femur
o Acetabular fossa - nonarticular fossa
o Lunate surface- peripheral acetabulum is articular portion
o Acetabular notch

Question 2

ilium

Answer 2

• Two portions:
1. Wing (Ala)
External Surface (Dorsum Ilii)
1. Posterior gluteal line
o Shortest
o Gluteus maximus origin posterior to posterior gluteal
2. Anterior gluteal line
o Longest
o Gluteus medius origin between 1 & 2
3. Inferior gluteal line
o Least distinct
o Gluteus minimus origin between 2 & 3
**Rectus Femoris origin btwn inferior gluteal line & margin actebulum
Internal Surface

Question 3

ilium cont

Answer 3

•	Superior- Iliac Crest 
o	Anterior- Anterior superior iliac spine (ASIS)
o	Posterior- Posterior superior iliac spine (PSIS)
o	External Lip
	Fascia Lata
	Tensor fascia latae
o	Internal Lip
	Iliac fascia 
	Iliacus 
•	Inferior-Arcuate Line
•	Anterior Border
o	Anterior superior iliac spine (ASIS)
	Sartroius 
	Iliacus
	Tensor fasciae latae m 
	Inguinal ligament
o	Anterior INFERIOR iliac spine 
	Iliofemoral ligament
	Straight head rectus femoris 
	Porstion iliacus m 
o	Notch between two spines
o	Groove medial to AIIS for psoas major/iliacus

Question 4

ilium 3

Answer 4

o	Iliopectineal eminence 
	Site of fusion btwn pubis/ilium medial to groove for iliopsoas
•	Posterior Border
o	Posterior Superior iliac spine (PSIS)
	Sacroiliac ligament 
o	Posterior Inferior iliac spine 
•	Iliac Fossa- concave area 
					Nutrient foramen in its center 
					Iliacus m 
•	Sacroiliac joint
					Posterior to iliac fossa 
					Articulation between sacrum and ilium 
•	Iliac tuberosity- attachment sacroiliac ligaments 
					Poateior to articular area 
2.	Body 
External Surface
				-forms portion acetabulum 
Internal Surface 
	-part wall bony pelvis 
	-Obterator internus takes origin 
•	No ramus 
•	Body joins lateral projection of superior ramus of pubis @ acetabulum 
•	Body/Wing Separated externally margin acetabulum 
		       Internally arcuate line 
•	Greater Sciatic Notch 
o	Both ischium and ilium 
o	Proximally- Inferior to PIIS 
o	Distally- ends ischial spine

Question 5

ischium

Answer 5

•	Single ramus
•	Body joins lateral projection of superior ramus of pubis @ acetabulum 
•	Strongest/most inferior hip bone 
•	Body
o	External Surface
	Forms part of acetabular fossa 
	Part of lunate surface  
	Ischial Spine 
•	separates greater/lesser sciatic notches 
•	Attachments:
o	Sacrospinalis ligament 
o	Superior gemellus muscle

Question 6

ischium 2

Answer 6

 Ischial tuberosity
• Other attachments:
o Quadratus femoris- lateral tuberosity tear-dropped facet
o Inferior gemellus- superomedial tuberosity
• Quadrilateral Portion: upper part
o Oblique line – separates hamstring origins
 Semimebranosus- upper lateral
 Long head biceps femoris & semitendinosus–below
• Triangular Portion: lower region
o Adductor Magnus
o Sacrotuberous ligament

o Internal Surface
 Obterator Internus attaches

Question 7

ischium 3

Answer 7

•	Ischial Ramus
o	Directed anteriorly from ischial tuberosity 
o	Joins inferior pubic ramus 
o	External Surface
	Adductor magnus
	Obturator externus
o	Internal Surface 
	Obturator internus 
o	Lateral border
	sharp/thin 
	Forms margin obturator foramen 
o	Medial border
	Perineum attachments

Question 8

pubis

Answer 8

•	Body
o	Gracilis
o	Adductor Longus
o	Adductor Brevis 
•	Superior Rami
o	Medial to LAteral Portion
	Pubic crest – most medial
	Pubic tubercle- lateral to pubic crest, inguinal ligament attachment 
o	Lateral Portion
	Pectin Pubis – laeral to pubic tubercle
•	Pectineus attaches 
	Iliopectineal line- lateral extension pubic crest

Question 9

pubis cont

Answer 9

•	Inferior rami
o	 fused to ischial ramus > ischiopubic ramus
o	Directed posterolateral from pubic symphysis 
o	Adductor compartment attachments:
	Gracilis
	Adductor brevis
	Adductor magnus
	Obturator externus

Question 10

sacrum

Answer 10

• Five fused sacral vertebrae
• Base: superior, articulates 5th lumbar vertebra
o ALAE – large triangle areas
 Lateral
 Support Psoas major & lumbosacral trunks
 Anterior ¾ each ala = Costal process
 Posterior ¼ each= Transverse process
• Apex: inferior end, articulates w/ coccyx
• Vertebral canal: dorsal, ventral rootlest of spinal nerves

Question 11

sacrum 2

Answer 11

•	Surfaces
o	Anterior “pelvic surface”
	Iliacus origin- superolateral 
	Piriformis orgin – segments 1-4
o	Posterior
	Convex 
	Narrower
	Middle Sacral Crest- midline longitudinal ridge 
•	Rudimentary spinous processes of sacral vertebrae
	Sacral grooves
•	Laminae of vertebrae 
•	Between middle sacral crest & articular crest… longitudinal ridge of articular processes
	Posterior Sacral Foramina
•	Lateral to articular crests 
o	Lateral x2
	Broad superior, thin inferior

Question 12

sacrum 3

Answer 12

 Auricular surface
• covered hyaline cartilage
• articulates with ilium at sacroiliac joint
 Sacral Tuberosity
• Posterior to auricular suface
• 3 depressions for dorsal sacroiliac ligament
 Thin Inferior
o Gluteus Maximus
o Sacrospinous
o Sacrotuberous
• Ossifcation
o Primary center & 2 epiphyseal plates: body each sacral vertebra
o 2 ossifcation centers: each vertebral arch
o 2 epiphyseal plates: each lateral seface
o 1 ossifcation center: lateral portion each upper 3 vertebrae

Question 13

coccyx

Answer 13

•	4 verebrae (can range 3-5)
•	No laminae, pedicles, spinous processes
•	Lateral Processes
o	Sacrotuberous lig
o	sacrospinous lig
o	Gluteus Maximus 
•	Anterior surface- concave
o	Sacrococcygela ligament attached 
•	Posterior Surface
o	Cocygeal Cornua- large pair of superior articular processes 
•	Ossifcation:
o	1st    1-4y
o	2nd    5-10y
o	3rd    10-15y
o	4th    15-20y

Question 14

hip joint

Answer 14

•	Ball/Socket 
•	Acetabulum 
o	Articular/nonarticular regions
o	1/5 pubis- medial
o	2/5 ischium – lateral 
o	Ilium- superior 
•	Acetabular Fossa
o	Deepest, nonarticulating 
o	Primarily ischium 
•	Lunate Surface
o	Aricualr surface
o	Cartilage covered 
o	Acetabular labrum¬- attaches to lateral margin & synovial membrane 
	deepens acetabulum 
	Fibrocartilagnious ring 
o	Acetabular Notch- lunate incomplete inferiorly 
	Cont w/ fossa 
	Transverse acetabular ligament –bridges notch 
•	Foramen for blood vessels to supply joint
•	Head of Femur
o	Direction superior/medial 
o	Surface covered articular cartilage – thicker above supporting weight 
	Exception: rough depression center = fovia captiis femoris 
•	Ligament capitus femoris attaches

Question 15

hip joint 2

Answer 15

• Ligaments:
1. Articular Capsule
• Strong, loose around joint
• Attach: margins acetabulum few mm from labrum
o Lateralarlly to medial side of greater trochanter
o Anteriorly intertrochanteric line
o Posterirly 1 cm above intertrochanteric crest
o Fibers over neck of femur > acetabular rim
• Inferioly- blends transvers acetabular ligament
• THICK anterior/superior for greater R area
• Thin posterior/inferior
• Distally become zona orbicularis
• Proximally become iliofemorla, pubofemoral, ischiofemoral
2. Acetabular Labrum
• Triangular
• Fibrocartilaginous
• Deepens cavity
• Blends transverse acetabular at acetabular notch
• Helps hold head femur in acetabulum

Question 16

hip joint 3

Answer 16

3. Transverse Acetabular
4. Zona Orbicularis
   • DISTAL part of articular capsule become this
   • Around neck fo femur
5. Iliofemoral
   • longest, widest, strongest
   • inverted Y
   o stem: ilium immed below AIIS
   o Base 1: anterior part greater trochanter
    Often called Iliotrochanteric ligament
   o Base 2: intertrochanteric line
   • Anterior joint
   • Transversed by: articular branch deep branch medial femoral circumflex
6. Pubofemoral
   • Not well developed
   • Anterior to iliofemoral
   • Origin:
   o obturator crest
   o superior ramus of pubis (anterior iliopectineal eminence)
   • direction inferiorlateral
   • Attach: Neck of femur
   • Blend w/ iliofemoral

Question 17

hip joint 4

Answer 17

7. Ischiofemoral
   • Triangular
   • Posterior capsule
   • Origin:
   o Posterior body ischium
   o Inferior acetabulum
   • Dreiction superior lateral in spiral course
   • Attach:
   o Posterosuperior part neck fo femur below greater trochanter
   • Below this ligament the capsule of hip is thin
8. Ligament capitus femoris
   • 4 cm long
   • Btwn head femur & acetabulum
   • Intracapsular
   • Enclosed by tub- like extension of synovial membrane
   • Proximal (3 bands)
   o 2 lateral bands: fixed to margins acetabular notch
   o Medial band blends transverse acetabular ligament
   • Distal:
   o Fovea capitus on femur

Question 18

hip joint 4

Answer 18

• Synovial Membrane- inner surface of articular capsule
o Acetabulum corsses over transverse acetabular ligament to acetabular fossa
o Tubal reflexion around ligamentum capitus femoris

•	Nerve to hip joint: 
o	Femoral
o	Obturator 
o	Accessory obturator
o	Inferior gluteal nerves 
•	Blood vessels to hip joint:
o	Medial/lateral femoral circumflex
o	Superior/inferior gluteal 
o	Obterator 
o	1st perforating 
**HEAVY LIGAMENTS AVASCULAR

Question 19

sacroiliac joint

Answer 19

•	Synovial joint 
•	Auricular sacrum & ilium at 1st 3 sacral vertebrae 
•	Lined by cartilage 
•	Narrow joint cavity surrounded by articular capsule 
•	Ligaments
1.	Anterior Sacroiliac
•	Ventrolateral surface sacrum to margins of auricular suface of ilium 
2.	Posterior Sacroiliac
•	Strong 
•	2 sets fibers: 
o	Deep/Short Fibers
	Origin: tuberosity of ilium & PIIS
	Passes inferomedially
	Attach: posterolateral sacrum
o	Superical/Long Fibers
	Oblique 
	Origin: PSIS 
	Attach: 3rd tubercle of sacrum 
	Blends sacrotuberous ligament 
3.	Interosseous
•	Strong fibers unite 2 articular bones
•	Blend posterior sacroiliac lig
•	Suspend sacrum between 2 iliac bones

Question 20

psoas major m

Answer 20

Origin:
• transverse process lumbar vertebrae
• intervertebral discs last thoracic/all lumbar vertebrae
• tendinous arches (allow passage lumbar A/V
**Deep to inguinal ligament
Insertion:
• lesser trochanter femuer medial to iliacus
• bursa spearats tendon from pubis & hip joint capsule
Nerve: L2/L3
Function: Flex hip & lumbar spine

Question 21

psoas minor m

Answer 21

Inconstant muscle
	Anterior to Psoas major
	Origin: 
•	T12 & L1 vertebrae & intervertebral disc 
Insertion:
•	Iliopecitneal eminence
•	Iliac fascia 
Nerve: L1
Function: Flex lumbar spine

Question 22

iliacus m

Answer 22

Origin: 
•	Upper 2/3 iliac fossa 
•	iliac crest to ASIS/AIIS
•	 superolateral Ala
•	Sacroiliac lig 
•	Iliolumbar lig 
**Tapers to tendon on lateral side psoas major m 
Insertion:
•	Base lesser trochanter femur 
Nerve: femoral
Function: Flex hip

Question 23

iliacus minor m

Answer 23

Iliacus Minor- detached part iliacus occasionaly present
O: ASIS
I: Intertrochanteric line femur or iliofemoral lig

Question 24

fascia of gluteal region

Answer 24

Subcut fascia: cont thigh/back layers: superficial fatty layer/ deep membranous layer
Deep fascia: Cont fascia lata
Fascia lata divides around gluteus maximus
Tendon gluteus maximus ends in IT band
Gluteal aponeruosis = vertical fibers between iliac crest and superior gluteus maximus

Question 25

gluteus maximus m

Answer 25

``` Origin: • Posterior gluteal line ilium • Posterior surface coccyx • Aponeurosis sacrospinalis m • Sacrotuberous lig • Gluteal aponeurosis (covering m body) Insertion: • IT band- proximal/superifical fibers • Gluteal tuberosity- deep fibers ``` ****3 bursae on deep surface o Greater trochanter- LARGEST o Ischial tuberosity- most commonly missing o Btwn tendon gluteus maximus & vastus lateralis Nerve: inferior gluteal n Function: Extend, lateral rotate, abduct thigh

Question 26

gluteus medius m

Answer 26

``` Posterior ½ covered gluteus maximus Anterior ½ covered gluteal aponuerosis Origin: • Outer ilium btwn iliac crest & posterior gluteal line posteriorly • Anterior gluteal line anteriorly Insertion: • Oblique bony ridge greater trochanter (laterally) Nerve: superior gluteal n Function: • Abduct thigh • Medially rotate extended hip • Anterior fibers: flex/medial rotate hip • Posterior portion: lateral rotate hip • STABILIZE PELVIS IN MOVEMENT ```

Question 27

gluteus minimus m

Answer 27

``` Deep gluteus medius Between medius and minimus = superior gluteal n/ deep superior gluteal vessels Anterior ½ covered gluteal aponuerosis Origin: • Outer ilium btwn anterior & inferior gluteal line • Greater sciatic notch Insertion: • Anterior greater trochanter **Bursa- btwn tendon & greater trochanter Nerve: superior gluteal n Function: • Abduct hip • Medially rotate extended hip • Weak hip flexor • STABILIZES PELVIS DURING MOTION ```

Question 28

tensor fascia latae

Answer 28

``` Enclosed upper fibers Iliotibial band Origin: • Anterior iliac crest near ASIS Insertion: • Iliotibial tract just distal to level greater trochanter o IT attaches inferior lateral tibial condyle/forms part knee capsule Nerve: superior gluteal n Function: • Medially rotate hip • Hip flexor ```

Question 29

piriformis

Answer 29

``` Origin: • Anterior Sacrum btwn 1-4 sacral foramina **Through Greater sciatic foramen Insertion: • Supieror greater trochanger posterior to obeterator internus/gemelli Nerve: S1 or S1/S2 Function: • Lateral rotator • Abductor of flexed hip • Assist hip extension ```

Question 30

obturator internus m

Answer 30

``` Origin: • Superior/inferior pubic rami • Ischial ramus • Ilial/ischial wall of true pelvis • Obturator membrane **Through lesser sciatic foramen > right angle over bone btwn spine/tuberosity of ischium BURSA HERE **Tendon gest fibesr from gemelli m **2nd bursa btwn hip joint capsule/ tendon Insertion: • medial greater trochanger anterior to trochanteric fossa Nerve: N to obturator Internus (L5-S1/S2) Function: • Lateral rotator • Abductor of flexed hip • hip extension ```

Question 31

superior gemellus m

Answer 31

``` Origin: • outer surface ischial spine **partial fusion obeterato internus tnedon Insertion: • medial greater trochanter Nerve: n obturator internus Function: • Lateral rotator hip ```

Question 32

inferior gemellus m

Answer 32

``` Origin: • Superomedial ischial tuberosity **partial fusion obeterato internus tnedon Insertion: • medial greater trochanter Nerve: n quadratus femoris Function: • Lateral rotator hip ```

Question 33

quadratus femoris

Answer 33

``` (Between inferior gemellus & adductor magnus) Origin: • Lateral edge ischial tuberosity Insertion: • Quadrate tubercle femur Nerve: n quadratus femoris (L4-S1) Function: • Lateral rotator hip • Adducts hip ```

Question 34

obturator externus m

Answer 34

``` *Covers outer suface anterior pelvic wall Origin: • Ischium/Pubis surrounding medial margin obturator foramen/membrane Insertion: • Trochanteric fossa femur Nerve: posterior division obturator n Function: • Lateral rotator hip • Adducts hip ```

Question 35

lumbar plexus

Answer 35

* Anterior primary rami L1-L3, part of L4, some T12 * Posterior/in psoas major * T12/L1 forms

Question 36

iliiohypogastric n

Answer 36

 iliohypogastric(T12/L1) • cranial end of lateral psoas major • crosses quadratus lumborum, passes iliac crest, enters intneral surface of transversus abdominis & internal oblique • Lateral cutaneous branches – posterior gluteal area • Anterior cutaneous branches – hypogastric region • Muscle branches: transversus abdominis & internal oblique

Question 37

ilioinguinal n

Answer 37

 Ilioinguinal (L1) • Lateral border psoas major • Caudal to iliohypogastric • Parallel w/ iliohypogastric across quadratus lumborum to iliac crest, pierces trasnversus abdominis • Communication w/ iliohypogastric: btwn transversus abdominis & internal oblique • w/ sperm cord through superifical inguinal ring • TO: Medial thigh, root of penis, anterior scrotum

Question 38

genitofemoral n

Answer 38

 genitofemoral (L1, L2) • passes through Psoas major to ventral surface • genital branch: joins spermatic cord/round ligament o lateral scrotum & adjacent thigh • femoral branch o lateral to genital branch o deep to inguinal ligament in lateral femoral sheath o skin over anterior thigh

Question 39

Anterior | L2, L3, L4

Answer 39

```  obturator (L2,3,4) • medial to psoas major • enters pelvis under iliac vessels • exitsthrough obturator canal  accessory obturator (L3,L4) • Present 10% • Medial psoas • Leaves pelvis: passing superior to pubic ramus • Deep to pectineus in thigh > m branch • Hip joint articular branch ```

Question 40

posterior | L2, L3, L4

Answer 40

o Posterior:  Femoral (L2,3,4) • Through psoas major • Distal between psoas major & iliacus • Leaves pelvis deep to inguinal ligament • Lateral femoral artery  lateral femoral cutaneous (L2,L3) • Middle/lateral border psoas major • Over iliacus • To ASIS • Inferior inguinal ligament • Over Sartorius • Anterior branch- skin over lateral/anterior thigh • Posterior branch – skin lateral thigh from greater trochanter distally to mid-thigh

Question 41

sacral plexus

Answer 41

• Lumbosacral trunk: pats L4, L5-S3, part S4 • Medial to piriformis • Converge at greater sciatic foramen • All branches EXCEPT S4 branch into anterior/posterior divisions ***L4= Nervus furcalis > divided ino two plexuses • ANTERIOR DIVISION o N to quadratus femoris/inferior gemellus (L4-S1)  Greater sciatic foramen, ventral to sciatic n  Articular branch to hip joint o N to obturator internus/superior gemellus (L5-S2)  greater sciatic foramen  reenters through lesser sciatic foramen to bturator internus

Question 42

sacral plexus 2

Answer 42

``` • POSTERIOR DIVISION o N to piriformis (S2 or S1/S2) o Superior gluteal (L4-S1)  Greater sciatic foramen superior to piriformis  Superior branch to gluteus minimus  Inferior branch to gluteus medius/minimus, tensor fascia latae o Inferior gluteal (L5-S2)  Greater sciatic foramen  Inferior piriformis  Supplies gluteus maximus ```

Question 43

sciatic

Answer 43

• SCIATIC o Largest n in body, largest branch sacral plexus o Anterior division: L4-S3 o Posterior divison L4-S2 o Supplies: posterior leg M, all M leg, foot, skin foot most skin leg, all joints in LE o Greater sciatic formane inferior to piriformis o Cranial end: rests posterior ischium btwn ischial tuberosity & greater trochanter of femur o Crosses obturator internus tendon, gemelli m, quadratus femoris o Accompanied: posterior femoral cutaneous, inferior gluteal A o Articular branches to hip joint o 1 antaomic n

Question 44

sciatic 2

Answer 44

o 2 physiologic n in 1 connective sheath  Tibial (anterior L4-S3)  Common peroneal (posterior L4-S2) o Posterior femoral cutaneous (S2, S3A or S1/S2P) o Skin gluteal region, posterior thigh, perineum, upper leg o Gluteal branches  Inferior cluneal – lateral gluteus maximus o Perineal branches o Medial to proximal thigh, perineum, scortum, base penis/labia majora o Femoral branches o Skin posterior/medial thigh & popliteal fossa o Sural branches o skin distal popliteal fossa Coccygeal Plexus • part S4, S5, coccygeal anterior rami

Question 45

common iliac a 1

Answer 45

``` o common iliac artery o splits between L5-S1 o external iliac  larger terminal branch  medial border psoas major  intervertebral disc to inguinal ligament  deep to ligament btwn symphysis pubis & ASIS  Crossed by: • Ureter • Ovarian A/V • Gential branch genitofemoral n • Deep circumflex iliac v • Ductus deferens • Round ligament  Inferior epigastric • Ascends superior/medial subperitoneal tissues o Through transversalis fascia o Btwn rectus abdominis & posterior rectus sheath • Forms lateral umbilical fold • Anastomoses w/ branches superior epigastric a above umbilicus ```

Question 46

common iliac a 2

Answer 46

```  Deep circumflex iliac • Opposite origin inferior epigastric on medial side • Lateral deep to inguinal ligament • Ascends toward ASIS o  Femoral Artery o Superifical external pudendal o Deep external pudendal  Distal to superifical branch  Medially across pectinues/adductor longus  Anastomoses internal puedendal artery o Profunda femoris  2-5 cm distal to inguinal lig  Largest branch of femoral  From lateral aspect femoral  Spirals posteriorinferior then to medial  Lateral femoral circumflex • Goes form rectus femoris & sartorius • Ascending branch o Superior deep to fascia lata o Enter fibrous capsule as retinacular branches o Anastamose:  medial femoral circumflex  superior gluteal  deep circumflex iliac ```

Question 47

profunda femoris a cont

Answer 47

 Medial femoral circumflex • MOST IMPORTANT ADULTS FOR NECK FO FEMUR • 25% comes off femoral • Disappear btwn pectineus & psoas • Enter fibrous capsule as retinacular branches • Acetabular branches: opposite acetabular notch o Enters with acetabular branch of obturator o Supplies fat in acetabular fossa & around round ligament to head of femur • Anastamose: o Lateral femoral circumflex

Question 48

internal iliac

Answer 48

 supply viscera, walls pelvis  Obturator Artery • Joines obturator n lateral wall pelvis to enter obturator canal o Foveolar branch – w/ ligament head of femur, supplies head femur  NEED FOR KIDS! –during ossification  Adults doesn’t matter

Question 49

veins

Answer 49

o Internal Iliac Vein  Superior gluteal’ • Above piriformis • Greater sciatic foramen  Inferior gluteal • Anastomose medial femoral circumflex & 1st perforating • Greater sciatic foramen inferior to piriformis

Question 50

superficial inguinal nodes

Answer 50

``` o lop-sided T o stem T parallels great saphenous  known as Inferior group  foot, le, thigh, perineum  4-6 nodes o cross T parallels inguinal ligament  Known as superior group  Superifical, lateral protion gluteal region, anterior abdominal wall  5-7 nodes  Pass primarily to external iliac nodes within false pelvis  Some go deep inguinal lymph nodes ```

Question 51

deep inguinal nodes

Answer 51

o 1-3 nodes o Within femoral sheath o Medial to femoral vein o Lowest/ most constant node belwo termination great saphenous vein in femoral vein o Intermediate node: most variable, midway along length femoral canal o Uppermost: near femoral ring, superior femoral canal – cloquet or node of Rosenmuller o Vessles from: femoral, deep femoral, perineum, superirfical inguinal nodes o Efferent go to external iliac

Question 52

nodes cont

Answer 52

``` External iliac nodes o Above pelvic brim o Afferent-from inguinal nodes o Efferent- merge to common iliac  Internal iliac nodes o Within pelvis o Afferent- pelvic organs, deeper gluteal regions o Coruse with superior/inferior gluteal bv o Efferent- common iliac ```