Final: Lecture 19 Flashcards
Hip relevant palpable features
•Greater sciatic notch, ischial spine, lesser sciatic notch, ischial tuberosity, articular (lunate) surface, acetabular fossa, acetabular notch, obturator foramen, auricular surface
Hip muscle attachment sites
•Anterior gluteal line, posterior gluteal line, inferior gluteal line
Hip palpable feature
•Iliac crest
Sacrum muscle attachment, relevant impalpable, and palpable features
- Muscle: lateral sacral crest
- Impalpable: auricular surface, posterior sacral foramina, lumbosacral articular surface, sacral part of pelvic brim, anterior sacral foramina
- Palpable: median sacral crest
Femur muscle attachment sites
•Greater trochanter, trochanteric fossa, intertrochanteric crest, greater trochanter, quadrate tubercle, gluteal tuberosity
Structures exiting the Greater Sciatic Foramen
- Gluteal neurovascular bundles
- Piriformis m.
- Sciatic nerve
- Posterior Femoral cutaneous n
- Pudendal n and internal pudendal n
- Obturator internus/superior gemellus nerve
Structures entering the Lesser Sciatic Forament
- Pudendal n and internal pudendal artery
* Obturator internus/superior gemellus nerve
T/F the Obturator internus enters the Lesser Sciatic Foramen
•False, exits
Superior gluteal nerve
- Leaves pelvis uperior to piriformis with superior gluteal artery
- Runs between gluteus medius and minimus
- **Supplies gluteus medius, minimus, and tensor fascia latae
Inferior gluteal nerve
- Leaves pelvis inferior to piriformis with inferior gluteal artery
- **supplies gluteus maximus
Sciatic nerve
- Leaves pelvis inferior to piriformis
- Runs inferiorly deep to gluteus maximus
- Usually divides about halfway down thigh into tibial and common fibular nerves
- L4-S3, doesn’t supply any gluteal structures
Pudendal Nerve
- Anterior divisions of S2-S4 ventral rami
- S2, 3, 4 keeps your penis off the floor
- Most medial structure exiting greater sciatic foramen
- Reenters pelvis via lesser sciatic foramen to supply perineal structures
Superior Gluteal Artery
- Largest internal iliac artery branch
- Superficial branch: gluteus maximus
- Deep branch: gluteus medius, minimus, and tensor fascia lata
Inferior Gluteal Artery
- Supplies: Maximus, small lateral rotators, superior hamstrings
- Participates in cruciate anastomosis of thigh
Internal Pudendal Artery
- Reenters pelvis via lesser sciatic foramen
- Supplies perineal muscles of ext genitalia
- Does not supply any gluteal structures
Gluteus Maximus
- Chief extensor of thigh and lateral rotation
- Slight extension of leg when working with TFL, through IT band
- Innervation: Inferior gluteal (L5-S1)
- Attach at posterior gluteal line
Gluteus Medius and Minimus
- Medius over minimus
- Thigh abduction and medial rotation
- Innervation: superior gluteal (L5-S1)
Tensor Fascia Lata
- Innervation: superior gluteal
* Function: abducts, medially rotates, and flexes thigh, slight extension of knee along with maximus
Iliotibial track of TFL
- Runs from iliac tubercle to tubercle (Gerdy’s) on lateral tibial condyle
- Reinforced by tendinous fibers from TFL and maximus
- Functions: assists in decelerating adduction of thigh (abduction), laterally stabilizes knee, Extends leg, compensate for quads paralysis, pulls patella laterally, antagonist of vastus medialis, and synergist with flexing vastus lateralis
- Stretch to treat chondromalacia patella
What is it called when a patient has a superior gluteal nerve injury and loses steadying action of gluteus medius and minimus?
- Gluteal gait or limp, Positive Trendelenburg’s sign
* Will lean away from side that doesn’t work
Piriformis
- lies deep to maximus
- medial to medius
- Demarcates gluteal blood vessels and nerves
Obturator Externus
- Deep to pectineus
- Attachments: external margins of obturator foramen, trochanteric fossa
- Innervation: Obturator nerve (L3, L4)
Which of the small lateral rotators is least effective when the thigh is flexed?
•quadratus femoris
Posterior Thigh Muscles
- Hamstrings
- Common proximal attachment: ischial tuberosity, except short head of biceps femoris
- Common Innervation: tibial division of sciatic nerve, except short head (common fibular portion)
- Functions: thigh extension, except short head, leg flexion (all four)
Semitendinosus
- long, cordlike tendon that begins 2/3 of the way down the thigh
- Function: extend thigh, flex leg (med rotate)
- Innervation: tibial division of sciatic nerve
- Attachments: ischial tuberosity, medial surface of superior aspect of tibia
Biceps Femoris
- Long head: flex leg, extend thigh, tibial division of sciatic, attach ischial tuberosity
- Short head: only flexed leg, common fibular branch of sciatic, attach distal lateral lip of linea aspera
- common insertion on the head of the fibula
Adductor Magnus
- Attaches proximally at ischial tuberosity and distally to the adductor tubercle of the medial epicondyle of femur
- Function: extend thigh
- Innervation: tibial division of sciatic
The diamond-shaped region posterior to the knee is call the ______ _______.
•Popliteal fossa
Popliteal Fossa boundaries
- superomedially: semitendinosus and semimembranosus
- Superolaterally: biceps femoris
- Inferolaterally: lateral head gastrocnemius
- Inferomedailly: medial head gastrocnemius
Popliteal fossa contents (superficial to deep)
- Nerves
- Popliteal vein, lymph nodes and branches
- popliteal artery and branches
What view terminates the popliteal vein?
•Small saphenous vein
What nerve winds around the head and neck of the fibula and is susceptible to injury?
•Common Fibular (Peroneal) nerve
