Exam 5 Flashcards
What are the superior and inferior borders of the pelvic region ?
Superior: pelvic inlet
Inferior: pelvic outlet/pelvic diaphragm
What does the pelvic brim divide?
Pelvic brim divides the superior greater pelvis from the inferior false pelvis.
The greater pelvis is bowl shaped to hold up abdominal organs
What are the four parts of pelvis?
Ilium, ischium, pubis, sacrum
How does the os coxae meet with the public symphysis and sacrum?
Ox coxae meets anteriorly at public symphysis
- articulates posteriorly with sacrum
What do the pelvis joints attach?
Iliolumbar, anterior/posterior sacroiliac, sacrospinous, sacrotuberus, and anterior/posterior sacrococcygeal
Iliolumbar ligament: superior/inferior attachment between ilia and lumbar spine transverse processes
Anterior/posterior sacroiliac: laterally attach ilium and sacrum
Sacrospinous: attaches sacrum to ischial spine
Sacrotuberus: attaches sacrum to ischial tuberosities
Anterior/posterior sacrococcygeal: ligaments attach sacrum to coccyx
What element does semen have to survive in the vagina?
Semen has alkaline elements to differ urethra acidity and vagina
What are the three zones of the penis urethra?
Prostatic urethra: extends through the prostate gland
Membranous urethra: external urethra sphincter
Spongy urethra: encased within erectile tissue
Transports urine and semen
What is the trigone of the bladder?
The rugae?
Triangle shaped space between ureter orifices-location of stretch receptors that trigger urge to urinate
Rugae allow it to expand as it fills.
Why does someone is pregnant use the restroom more?
They would have less room for bladder to expand, causing more pressure on receptors.
Feature of vaginal urethra
Just for urine, very short (3cm)
What are the fimbriae?
Finger like projections that hover outside of the ovary. Do not touch ovary
What are the three walls of uterus? What is shed during menstruation? Which one contracts during labor?
Endometrium (shed) , myometrium (contracts) perimetrium
What does the Iliohypogastric innervate?
L1 and T12 fibers
Innervates: internal oblique and transversus abdominus. Sensory innervation in pubic region
What does ilioinguinal nerve innervates?
L1 Fibers
Innervates: internal oblique and transversus abdominus. Sensory innervation in pubic region
What does the genitofemoral nerve innervate?
L1 and L2 nerve
Innervates: sensory to genitalia and upper anterior thigh
What does the Lateral Femoral Cutaneous Nerve innervate?
L2 and L3
Innervates: sensory only for skin of the anterio-lateral thigh
What does the femoral nerve innervate?
L2, L3, L4
Muscle innervation to hip flexors/knee extensors. Sensory innervation to anterior thigh and medial leg
What does the obturator nerve innervate?
L2,L3,L4
Innervates the adductor muscles and the skin over the medial thigh
What are the two major nerves from the sacral plexus?
And what verterbrae they come from
Sciatic (L4, L5, S1, S2, S3) and Pudendal (S2, 3, 4)
What muscles does the sciatic nerve innervate and what is it made of?
Largest nerve in the body (2cm wide)
L4-S3
Posterior thigh muscles, all leg and foot muscles, all joints of the lower limb
Sciatic nerve is made of two nerve joined in a connective tissue sheath: common peroneal and tibial
What does the Pudendal nerve innervate?
Main nerve of the perineum and genitalia
S2-S4
Exits pelvis posteriorly through greater sciatic foramen, then re-enters anteriorly through lesser sciatic foramen.
What are the actions of the Tensor facia latae and IT Band
Major hip abductor and has some flexion contribution
OIAN of Tensor Facia Latae
O: anterior iliac crest
I: lateral condyle of tibia via IT band
A: stabilizes knee, flexes hip, abducts hip, internally rotates hip
N: superior gluteal nerve
OIAN of Gluteus Minimus
O: inferior posterior ilium
I: anterior surface of greater trochanter of femur
A: Abducts hip, internally rotates hip
N: superior gluteal nerve
OIAN of Gluteus Medius
O: middle posterior ilium
I: greater trochanter of femur
A: abducts hip, internally rotates hip
N: superior gluteal nerve
Where are the hip stabilizers?
the muscles along the lateral and posterior sides of the hip joints. (gluteus medius, gluteus maximus, piriformis)
OIAN of gluteus maximus
O: posterior sacrum and sacrotuberous ligament, superior posterior ilium
I: gluteal tuberosity of femur, lateral condyle of tibia via IT band
A: extension of hip, external rotation of the hip
N: inferior gluteal nerve
OIAN of Superior Gemellus
Lateral rotators of the femur
O:Ischial spine
I: Medial surface of greater trochanter of femur (via tendon of obturator internus)
A: Hip joint: Thigh external rotation, thigh abduction (from flexed hip); stabilizes head of femur in acetabulum
N: Nerve to obturator internus (L5-S1)
Six deep lateral rotators of the femur
piriformis, superior gemellus, obturator internus, inferior gemellus, obturator externus, quadratus femoris
OIAN of Piriformis
Origin: - Anterior sacrum
Insertion: - Greater trochanter of femur
Action: - External rotation of hip
Nerve Supply: - Anterior rami S1-2
OIAN of Obturator Internus
Origin:
- Obturator membrane
- Superior pubic ramus
Insertion: - Greater trochanter of femur
Action: - External rotation of hip
Nerve Supply: - Sacral Plexus L5, S1, S2
OIAN of Inferior gemellus.
O: lateral surface of ischial tuberosity
I: medial surface of greater trochanter of femur
A: External rotation of thigh, thigh abduction
N: quadratus femoris nerve
OIAN of obturator externus
Origin:
- Obturator membrane
- Pubic and ischial rami
Insertion: - Greater trochanter of femur
Action: - External rotation of hip
Nerve Supply: - Obturator Nerve
OIAN of quadratus femoris
Origin: - Ischial tuberosity
Insertion: - Quadrate tubercle
Action: - External rotation of hip
Nerve Supply: - Nerve to quadratus femoris L4, L5, S1
What is the main extensor of the hip
Gluteus maximus
What increases the stability of the hip joint?
-shape of articulating surfaces
- acetabular labrum
-joint capsule
- 3 strong ligaments (iliofemoral, pubofemoral, ischiofemoral)
What are the three strong ligaments of hip joint
iliofemoral( prevents excessive extension), pubofemoral (prevents excessive abduction), ischiofemoral (provides stability during extension)
What are the prime hip flexors
Iliopsoas (Iliacus and psoas major together)
Sartorius
Prime Hip abductors
tensor fascia latae and IT band
Prime Hip adductors
pectineus, adductor longus/brevis/magnus, gracilis
Primary hip extensors
gluteus maximus
Primary hip lateral rotators
piriformus, inferior and superior gemellus, obturator internus, obturator externus, quadriceps femoris
Primary hips medial rotators
gluteus medius, minimus
OIAN Iliacus
O: iliac fossa
I: lesser trochanter of femur
A: flexes hip, flexes vertebral column
N: femoral nerve
OIAN Psoas Major
O: T12-L5 vertebral bodies and discs, L1-5 transverse processes
I: lesser trochanter of femur
A: flexes hip, flexes lumbar vertebral column
N: anterior rami-spinal nerves L2-3
OIAN Sartorius
O: anterior superior iliac spine
I: pes anserinus (medial tibia)
A: flexes, abducts, externally rotates hip; flexes and internally rotates knee
N: femoral nerve
OIAN pectineus
Origin: - Superior ramus of pubis
Insertion: - Between lesser trochanter and linea aspera
Action:
- Adduction of hip
- Flexion of hip
Nerve Supply: - Femoral nerve
OIAN of Adductor magnus
Origin:
- Anterior Head – Inferior ramus of pubis
- Posterior Head – Ramus of ischium, ischial
tuberosity
Insertion:
- Anterior head – Linea aspera of femur
- Posterior head – Adductor tubercle of femur
Action:
- Both Heads – Adduction of hip
- Anterior head – Flexion of hip
- Posterior head – Extension of hip
Nerve Supply:
- Anterior head – Obturator nerve
- Posterior head – Tibial division of sciatic nerve
OIAN adductor brevis
Origin: - Body and inferior ramus of pubis
Insertion: - Linea aspera
Action:
- Adduction of hip
- Flexion of hip
Nerve Supply: - Obturator nerve
OIAN of Adductor longus
Origin: - Anterior surface of body of pubis
Insertion: - Linea aspera
Action:
- Adduction of hip
- Flexion of hip
Nerve Supply: - Obturator nerve
OIAN of Gracilis
Origin: - Body and inferior ramus of pubis
Insertion: - Pes anserinus
Action:
- Adduction of hip
- Flexion of hip
- Internal rotation of flexed knee
Nerve Supply: - Obturator nerve
What are the two heads of the adductor magnus?
Posterior head: crosses hip joint on posterior side, is an adductor and hip extensor
Anterior head: crosses hip joint or anterior side, is an adductor and hip flexor
Why is the knee asymmetrical ?
Due to the Q-angle of the hip joint
What is the incorporation of fibrocartilage in the knee that bears the weight
Lateral and medial menisci
What are the 4 main ligaments of the knee
Anterior Cruciate Ligament (ACL)
Posterior Cruciate Ligament (PCL)
Tibial/Medial Collateral ligament (TCL or MCL)
Fibular/Lateral Collateral ligament (FCL or LCL)
What do Cruciate, collateral, arcuate, oblique, and coronal mean?
Cruciate-cross shaped
Collateral- situated side by side in parallel
Arcuate-shaped like a bow
Oblique-slanted
Coronal-like a crown
The collateral ligaments are taught in _____, but more important in slight _____
taught in extension, but more important in slight flexion
Where does the transverse ligament join in the knee?
Joins the anterior edges of the menisci
How do the coronary ligaments wrap ?
the coronary ligaments wrap anterior-to-posterior sitting between the menisci and the tibia
What are the two degrees of freedom of the knee?
Flexion/extension
Internal/external rotation
Flexion occurs posteriorly and extension occurs anteriorly
When is knee injury most likely ?
during times with the knee is flexed and the foot is planted
What are the four knee extensors
rectus femoris, vastus lateralis, medialis, intermedius
What are the six knee flexors
Semimembranosus, biceps femoris, sartorius, popliteus, gastrocnemius, plantaris
What are the three borders of the popliteal fossa? (directions)
Superolaterally by the biceps femoris
- superomedially by the semimembranosis
-inferolaterally and inferomedially by the lateral and medial heads of the gastrocnemius
OIAN of Popliteus
Origin - Lateral condyle of femur
Insertion - Proximal posterior tibia
Action
- “Unlocks” extended knee by internal
rotation of tibia (normal) or external
rotation of femur (reverse)
Nerve Supply - Tibial nerve
OIAN of Gastrocnemius
Origin
- Medial Head – medial epicondyle of femur
- Lateral head – lateral epicondyle of femur
Insertion - Calcaneus via calcaneal tendon
Action
- Plantarflexion of ankle
- Flexion of knee
Nerve Supply - Tibial nerve
OIAN of Plantaris
Origin - Lateral supracondylar ridge of femur
Insertion - Posterior calcaneus
Action
- Plantarflexion of ankle
- Flexion of knee
Nerve Supply - Tibial nerve
OIAN of Rectus Femoris
Origin:
- Anterior inferior iliac spine
- Ilium above acetabulum
Insertion:
- Patella
- Tibial tuberosity via patellar ligament
Action:
- Extension of knee
- Flexion of hip
Nerve Supply: - Femoral nerve
OIAN of Vastus Lateralis
Origin:
- Linea aspera
- Greater trochanter and intertrochanteric line of femur
Insertion:
- Patella
- Tibial tuberosity via patellar ligament
Action: - Extension of knee
Nerve Supply: - Femoral nerve
OIAN of Vastus Medialis
Origin:
- Linea aspera
- Intertrochanteric line of femur
Insertion:
- Patella
- Tibial tuberosity via patellar ligament
Action: - Extension of knee
Nerve Supply: - Femoral nerve
OIAN Vastus intermedius
Origin: - Anterior and lateral femoral shaft
Insertion:
- Patella
- Tibial tuberosity via patellar ligament
Action: - Extension of knee
Nerve Supply: - Femoral nerve
OIAN of Semimembranosus
Origin: - Ischial tuberosity
Insertion: - Posterior medial tibial condyle
Action:
- Flexion of knee
- Internal rotation of flexed knee
Extension of hip
Nerve Supply: - Tibial division of sciatic nerve
OIAN of Biceps Femoris
Origin:
- Long head - Ischial tuberosity
- Short head – Linea aspera
Insertion:
- Lateral surface of head of fibula
- Lateral condyle of tibia
Action:
Both heads:
- Flexion of knee
- External rotation of flexed knee
Long head:
- Also: extension of hip
Nerve Supply:
- Long head – Tibial division of sciatic nerve
- Short head – Common peroneal division of sciatic nerve
OIAN of Sartorius
Origin: - Anterior superior iliac spine
Insertion: - Pes Anserinus
Action:
- Flexion of hip
- Abduction of hip
- External rotation of hip
- Flexion of knee
- Internal rotation of knee
Nerve Supply: - Femoral nerve
OIAN Semitendinosus
Origin: - Ischial tuberosity
Insertion: - Pes Anserinus
Action:
- Flexion of knee
- Internal rotation of flexed knee
- Extension of hip
Nerve Supply: - Tibial division of sciatic nerve
What does the popliteal fossa contain?
sciatic nerve to the tibial and common peroneal nerves
popliteal vein/artery/lymph nodes
subcutaneous adipose fat
OIAN Tibialis Anterior
Origin
- Lateral surface of tibia
- Interosseous membrane
Insertion
- Base of first metatarsal
- Medial cuneiform
Action
- Dorsiflexion of ankle
- Inversion of foot
Nerve Supply - Deep peroneal nerve
OIAN Extensor Hallucis Longus
Origin
- Anterior surface of Fibula
- Interosseous membrane
Insertion - Base of distal phalanx of big toe
Action - Extension of big toe
Nerve Supply - Deep peroneal nerve
OIAN Extensor Digitorum Longus
Origin
- Proximal anterior shaft of fibula
- Interosseous membrane
- Lateral condyle of tibia
Insertion - Extensor expansion of toes 2-5
Action
- Extension of toes 2-5
- Dorsiflexion of ankle
Nerve Supply - Deep peroneal nerve
OIAN Peroneus Tertius
Origin - Distal anterior fibula
Insertion - Base of 5th metatarsal
Action
- Eversion of foot
- Dorsiflexion of ankle
Nerve Supply - Deep peroneal nerve
OIAN Peroneus Brevis
Origin - Distal lateral shaft of fibula
Insertion - Base of 5th metatarsal
Action
- Eversion of foot
- Plantarflexion of ankle
Nerve Supply - Superficial peroneal nerve
OIAN Peroneus Longus
Origin - Head and proximal lateral shaft of fibula
Insertion
- Base of 1st metatarsal
- Medial cuneiform
Action
- Eversion of foot
- Plantarflexion of ankle
Nerve Supply - Superficial peroneal nerve
OIAN of Tibialis Posterior
Origin
- Posterior tibia
- Proximal posterior fibula
- Interosseous membrane
Insertion
- Navicular tuberosity
- All cuneiforms
- Cuboid
- Bases of metatarsals 2-4
Action
- Inversion of foot
- Plantarflexion of ankle
Nerve Supply - Tibial nerve
OIAN Flexor Digitorum Longus
Origin - Posterior tibia
Insertion - Distal phalanges of toes 2-5
Action
- Flexion of toes 2-5 at DIP joints
- Plantarflexion of ankle
Nerve Supply - Tibial nerve
OIAN Flexor Hallucis Longus
Origin
- Distal posterior fibula
- Interosseous membrane
Insertion - Distal phalanx of big toe
Action - Flexion of big toe
Nerve Supply - Tibial nerve
OIAN of Soleus
Origin
- Soleal line of tibia
- Proximal fibula
Insertion - Calcaneus via calcaneal tendon
Action - Plantarflexion of ankle
Nerve Supply - Tibial nerve
The ____ form a cradle into which the ___ of the talus fits
Malleoli into which the trochlea
What are the three articular surfaces of the talocrural ?
The superior gliding surface of the talus and the inferior surface of the tibia
The medial malleolus of the tibia articulates with the medial surface of the talus
The lateral surface of the talus articulates with medial surface of the fibula
What are three foot joints?
Talocalcaneal: talus and calcaneus
Talonavicular: talus and navicular
Calcaneocuboid: cuboid and calcaneus
OIAN Abductor Hallucis
Origin - Calcaneus
Insertion - Base of proximal phalanx of big toe
Action - Flexion of big toe at MTP joint - Abduction of big toe at MTP joint
Nerve Supply - Medial plantar nerve
OIAN Abductor Digiti Minimi
Origin - Calcaneus
Insertion - Base of proximal phalanx of toe 5
Action - Abduction of toe 5 at MTP joint
- Flexion of toe 5 at MTP joint
Nerve Supply - Lateral plantar nerve
OIAN Flexor Digitorum Brevis
Origin - Calcaneus
Insertion - Bases of middle phalanges of toes 2-5
Action - Flexion of toes 2-5 at PIP joints Nerve Supply - Medial plantar nerve
OIAN Quadratus Plantae
Origin - Calcaneus
Insertion - Lateral surface of flexor digitorum longus tendon
Action - Flexion of toes 2-5 at DIP joints Nerve Supply - Lateral plantar nerve
OIAN Lumbricals
Origin - Tendons of flexor digitorum longus
Insertion - Extensor expansion 2-5
Action - Flexion of toes 2-5 at MTP joints
- Extension of toes 2-5 at IP joints
Nerve Supply -
Toes 2 – medial plantar nerve
Toes 3-5 – lateral plantar nerves
OIAN Flexor Hallucis Brevis
Origin - Cuboid and lateral cuneiform bones
Insertion - Both sides of base of proximal phalanx of big toe
Action - Flexion of big toe at MTP joint Nerve Supply - Medial plantar nerve
OIAN of Adductor Hallucis
Origin
- Oblique head: bases of 2nd – 4th metatarsals
- Transverse head: deep transverse metatarsal ligament and plantar plates of 3-5 MTP joints
Insertion - Base of proximal phalanx of big toe
Action - Adduction of big toe at MTP joint
- Flexion of big toe at MTP joint
Nerve Supply - Lateral plantar nerve
OIAN Flexor Digiti Minimi
Origin - Base of 5th metatarsal
Insertion - Base of proximal phalanx of toe 5
Action - Flexion of toe 5 at MTP joint Nerve Supply - Lateral plantar nerve
OIAN Dorsal Interossei
Origin - Posterior surfaces from adjacent metatarsals
Insertion - Extensor expansions of toe 2 and lateral sides of toes 2-4
Action
- Abduction of toes 2-4 at MTP joints
- Flexion of toes 2-4 at MTP joints
- Extension of toes 2-4 at IP joints
Nerve Supply - Lateral plantar nerve
OIAN Plantar Interossei
Origin - Medial sides of metatarsals 3-5 Insertion - Extensor expansions of toes 3-5
Action
- Adduction of toes 3-5 at MTP joints
- Flexion of toes 3-5 at MTP joints
- Extension of toes 3-5 at IP joints
Nerve Supply - Lateral plantar nerve
OIAN Extensor Digitorum Brevis
Origin - Anterior and lateral calcaneus
Insertion - Extensor expansion of toes 2-5 Action - Extension of toes 2-5
Nerve Supply - Deep peroneal nerve
Four lateral ligaments of foot
Anterior Talofibular Ligament (ATFL)
Posterior Talofibular Ligament (PTFL)
Superior Peroneal Retinaculum (Retinacula)
Calcaneofibular Ligament (Calcaneofibular)
What causes sprains? What causes strains?
Sprains are caused by stretches or tears in ligaments. They tend to occur at a precise moment when the joint is in an unnatural position.
Strains are tears or stretches in tendons. They can occur at a precise moment or through repetitive movement
4 Medial Deltoid Ligaments of foot
Posterior tibiotalar Ligament
Tibiocalcaneal Ligament
Anterior tibiotalar ligament
Tibionavicular Ligament
What is responsible for sexual dimorphism in the pelvis?
Estrogen
