Exam III Flashcards
What are the primary functions of the lower extremity?
Support the body, provide a stable foundation when standing, and allow locomotion
In general, how are the bones, joints, muscles, and blood vessels of the lower extremity different from the upper extremity?
Bones are heavier and stronger
Joints are stronger and more stable
Muscles are more powerful and less capable of delicate movements
Blood vessels are larger
The pelvic bone consists of a single bone on each side, known as what?
Innominate bone
What three parts does each innominate bone consist of?
Ilium, ischium, and pubis
This structure is a large depression on the lateral aspect of each innominate and it receives the head of the femur to form the hip joint.
Acetabulum
This is the horseshoe shaped articular surface of the acetabulum.
Lunar surface
Is the rough non-articular center portion of the acetabulum
Acetabular fossa
This structure is the outside edge of the acetabulum and is bridged by the transverse acetabular ligament.
Acetabular notch
This is the largest and uppermost portion of the innominate bone.
Ilium
This is the “L” shaped bone of the innominate, which consists of a body and a ramus.
Ischium
This bone of the innominate consists of a body and two rami and articulates with the pubis from the opposite innominate.
Pubis
This is a large oval opening found at the inferior aspect of each innominate and is closed by a piece of connective tissue known as the obturator membrane.
Obturator foramen
The ___ pelvis is bounded by the lumbar vertebrae, laterally by the ilium and anteriorly by the abdominal wall; it helps to support and protect much of the abdominal viscera
False or major pelvis
The ___ pelvis is bounded posteriorly by the sacrum and coccyx, laterally and anteriorly by the ilium, ischium, and pubis; this portion of the pelvis surrounds the birth canal in females.
True or minor pelvis
What are the functions of the pelvic bone?
- Protects the pelvic viscera
- Transmits body weight to the limbs and absorbs the stresses of muscular activity
- Allows locomotion by causing the pelvic bone to swing from side to side
- In the female, provides bony support for the birth canal
This is the term used to describe differences in bone structure and physical characteristics between males and females.
Sexual dimorphism
In terms of general structure how does the male pelvis differ from a female’s?
Male: thicker; prominent processes; longer
Female: thinner; processes not so prominent; shorter
In terms of pelvic inlet and outlet how does a male pelvis differ from a female’s?
Male: Inlet-heart shaped; Outlet- Narrower
Female: Inlet-round or oval; Outlet-farther apart
In terms of anterior iliac spine, how does a male pelvis differ from a female’s?
Male: Closer together
Female: Farther apart
In terms of greater sciatic notch, how does a male pelvis differ from a female’s?
Male: Narrower
Female: Wider
In terms of obturator formaen, how does a male pelvis differ from a female’s?
Male: Round
Female: Triangular
In terms of acetabulum, how does a male pelvis differ from a female’s?
Male: Face laterally
Female: Face more anteriorly
In terms of symphysis pubis, how does a male pelvis differ from a female’s?
Male: Longer
Female: Shorter
In terms of pelvic arch, how does a male pelvis differ from a female’s?
Male: Acute angle
Female: Obtuse angle
What is the name for a typical male pelvis?
Android pelvis
What is the name for a typical female pelvis?
Gynecoid pelvis
`What is the name for an exaggerated male pelvis?
Anthropoid pelvis
What is the name for an exaggerated female pelvis?
Platypelloid pelvis
A fracture of this bone can result from direct trauma or during a fall on the feet or knees. This fracture has a high morbidity and mortality rate due to hemorrhagic shock and subsequent organ damage.
Fracture of the pelvis
Most common fracture sites include: pubic rami, acetabulum, region of the sacroiliac joint and the most lateral aspect of the ilium
This is a common painful contusion injury of the soft tissue associated with the iliac crest. They are common in contact sports and usually result in a painful hematoma in the area of the injury.
Hip Pointers
This bone has three primary centers of ossification, five secondary centers of ossification, and it completes its ossification between 20-22 years of age
Pelvic bone
This is the longest, heaviest, and strongest bone in the body. It has one primary center of ossification, four secondary centers, and completes ossification by 15 years in females and 17.5 years in males.
Femur
The way the neck of the femur meets the shaft of the bone creates an angle known as what?
Angle of inclination
What is a typical angle of inclination at birth? Adulthood?
About 145 degrees at birth and 125 degrees as an adult
What is the function of the angle of inclination?
It allows greater mobility at the hip joint by increasing the leverage of the muscles that attach to the proximal part of the femur
This condition is characterized by an increase in the angle of inclination, which can occur with developmental dysplasia of the hip.
Coxa valga
This condition is characterized by a decrease in the angle of inclination, which occurs in fractures of the proximal part of the femur and in the condition known as rickets. Causes a mild shortening of the affected limbs.
Coxa vara
This is a fracture through the neck of the femur and what we commonly call a “broken hip”
Subcapital fracture of the femur
This condition is often caused by a subcapital fracture of the femur interrupting the blood supply to the femoral head, leading to degeneration of the head.
Avascular necrosis
This is a large triangular shaped sesamoid bone that develops within the common tendon of insertion of the quadriceps. It has a single ossification center that completes ossification by 10 years in females and 13 in males.
Patella
What is the main function of the patella?
To provide additional leverage to the quadriceps during the last part of extension of the leg.
Fractures due to ____ trauma usually result in a patella that is broken into a number of small fragments that are not displaced.
Direct
Fractures due to ____ trauma are usually the result of the quadriceps muscles contracting suddenly and causing a transverse fracture through the body of the patella. These fractures can be displaced or non-displaced.
Indirect
Severe pain, swelling and tenderness, and inability to carry out extension at the knee joint are common symptoms of what clinical condition?
Fracture of the patella
This condition is characterized by a patella in which the superior lateral portion of the bone remains unossified.
Patella emarginata
This condition is characterized by the superior lateral portion of the patella ossifying independently. This is clinically significant in being able to distinguish this condition from a fracture of the patella.
Bipartite or tripartite patella
This is a condition in which there is a softening and fissuring of the articular cartilage on the posterior aspect of the patella. It is usually caused by trauma, overuse or muscle weakness, which causes misalignment of the patella. Is usually accompanied by a dull pain around or under the patella that worsens with exercise or going from a position of flexion to extension at the knee joint
Chondromalacia
This is the connective tissue investment (deep fascia) of the thigh region. It provides a dense sheath for the thigh and prevents the quadriceps from bulging outward during contraction.
Fascia lata
This is the thickened lateral aspect of the fascia lata, which received insertions from teh tensor fascia lata and gluteus maximus muscles.
Iliotibial tract
This is an opening found in the proximal anterior aspect of the fascia lata that allows the great saphenous vein to reach its termination at the femoral vein.
Saphenous opening
This is an overuse syndrome, which occurs at the distal end of the iliotibial band where it repetitively rubs over the lateral condyle of the femur, thus irritating and inflaming the bursae. It is often an overuse of the gluteus maximus pulling on the iliotibial tract, which causes this.
Iliotibial band syndrome (ITBS)
What movements of the femur can be carried out at the hip joint?
Flexion, extension, hyperextension, abduction, adduction, lateral rotation, and medial rotation.
What muscles compose the anterior hip region?
Iliacus, psoas major, and psoas minor
What is the origin of the iliacus?
Iliac fossa and sacrum
What is the insertion of the iliiacus?
Lesser trochanter of the femur
What is the action of the iliacus?
- Flexion of the femur at the hip joint
- Flexion of the vertebral column
- Helps maintain posture (integrity of the vertebral column)
What is the nerve supply of the iliacus?
Femoral nerve (L2, L3, and L4)
What is the origin of the psoas major?
Bodies and transverse processes of the lumbar vertebrae
What is the insertion of the psoas major?
Lesser trochanter of the femur
What are the actions of the psoas major?
- Flexion of the femur at the hip joint
- Flexion of the vertebral column
- Helps maintain posture (integrity of the vertebral column)
What is the nerve supply of the psoas major?
Femoral nerve (L2, L3, L4)
Weakness of what muscles will result in a marked disability in carrying out such activities as stair climbing, walking up inclines, and getting up from reclined positions.
Psoas major and iliacus
Since the bulk of these muscles are found within the abdominal cavity, many of the organs of the abdomen are superficial to them (kidneys, parts of the lower intestinal tract, pancreas, appendix) and several of the vertebral joints and the sacroiliac joint are found deep to them; any disease or inflammation of these structures may result in pain when the muscles are contracting. What muscles are being described?
Psoas major and iliacus
What is the origin of the psoas minor?
Bodies of the lumbar vertebrae
What is the insertion of the psoas minor?
Iliopubic eminence of the pubis
What the action of the psoas minor?
Flexion of the pelvic bone (upward movement)
What is the nerve supply of the psoas minor?
L1 (sometimes L2)
What muscles compose the anterior thigh muscles?
Sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
What is the origin of the sartorius?
Anterior superior iliac spine
What is the insertion of the sartorius?
Superior medial shaft of the tibia
What is the action of the sartorius?
- Flexion at the hip joint and knee joint (functions when both are carried out at the same time)
- Abducts and laterally rotates the femur
- Medially rotates the leg
What is the nerve supply of the sartorius?
Femoral (L2, L3, L4)
What muscles compose the quadriceps femoris?
Rectus femoris, vastus lateralis, vastus intermedius, vastus medialis
What is the insertion for the quadriceps femoris?
Base of the patella
What is the nerve supply of the quadriceps femoris?
Femoral (L2, L3, L4)
What is the origin of the rectus femoris?
- Anterior inferior iliac spine
- Acetabulum of the pelvic bone
What is the origin of the vastus lateralis?
Greater trochanter and linea aspera of the femur
What is the origin of the vastus medialis?
Linea aspera of the femur
What is the origin of the vastus intermedius?
Anterior-lateral aspect and linea aspera of the femur
What are the actions of the quadriceps femoris?
- All muscles: extend the leg at the knee joint, tonus of the muscle plays a role in strengthening the knee joint
- The rectus femoris is also involved with:flexion of the femur at the hip joint
- When the articularis genu is present it is involved with: retraction of the synovial membrane of the knee joint to help stabilize the knee
Occasionally a distinct bundle of muscle fibers separates from the deepest layers of the vastus intermedius, which attaches to the synovial membrane of the knee joint. It is known as what?
Articularis genu
An individual with atrophy of these muscles will have difficulty extending their leg against resistance and will usually press on the distal end of the femur during walking to prevent flexion from occurring at the knee joint.
Quadriceps
This muscle is tested with the patient lying down sitting with their legs flexed at the knee joint, the patient is then asked to extend their knee against resistance.
Quadriceps
This is a term used to indicate a cramping or spasm of the quadriceps. It is also used to indicate trauma to the muscles, which can cause tearing of muscle fibers and lead to the formation of a painful hematoma and bruising.
Charley horse
This condition is a painful overuse injury of the common tendon of insertion of the quadriceps and/or the patellar ligament. It is common in individuals who participate in activities where there is continuous jumping or running. Individuals will complain of pain and soreness in the area of the common tendon or patellar ligament and this pain is intensified with activity.
Jumper’s knee (Patellar tendonitis)
The patellar reflex is carried out by tapping the patellar ligament and is used to test for the segmental innervation of what?
L2, L3, and L4
What muscles compose the medial thigh?
Gracilis, pectineus, adductor longus, adductor brevis, and adductor magnus
What is the common action of the medial thigh muscles?
Adduction of the femur
What is the common nerve supply of the medial thigh muscles?
Obturator nerve (L2, L3, L4)
What is the origin of gracilis?
Ramus of the ischium and inferior ramus of the pubis
What is the insertion of gracilis?
Superior medial shaft of the tibia
What is the action of gracilis?
Flexion of the leg and adduction of the femur
What is the nerve supply of gracilis?
Obturator nerve (L2, L3, L4)
Due to the fact that this muscle is a relatively weak adductor, it can be removed without noticeable loss of action and surgeons can transplant it to replace a damaged muscle, typically in the hand.
Gracilis
What is the origin of the pectineus?
Superior ramus (pubic pecten) of the pubis
What is the insertion of the pectineus?
Pectineal line of the femur
What is the action of the pectineus?
Adduction of the femur and flexion at the hip joint