Glute and Thigh Flashcards
regions and corresponding bones of the LE
thigh - femur leg - tibia and fibula foot - tarsal bones hip - coxal bone, femur knee - patella, femur, tibia ankle (talocrural) - tibia, fibula, talus
tarsal bones (9)
calcaneus talus navicular cuboid medial (first) cuneiform intermediate (second) cuneiform lateral (third) cuneiform metatarsal bones phalanges
coxal bone components
ilium
ischium
pubis
femur components
head neck body greater trochanter lesser trochanter intertrochanteric line intertrochanteric crest gluteal tuberosity spiral line pectineal line linea aspera medial and lateral condyles intercondylar notch (fossa) adductor tubercle medial and lateral epicondyles ligament of head of femur
intertrochanteric line
- location
- function
anterior
attachment of ligaments that support hip joint
intertrochanteric crest
- location
- function
posterior
attachment of muscles
spiral line
-location
medial lip of linea aspera
pectineal line
-location
continuation of intertrochanteric line
linea aspera
- splits to form…
- categorization function
splits to form medial and lateral supracondylar lines
divides thigh into compartments
ligament of head of femur
- location
- held in place by…
- function
attached to inferior portion of acetabulum
held in place by transverse acetabular ligament
allows insertion of vasculature of head of femur
fracture of the neck of the femur
- primary culprit
- primary determinant of healing
culprit
-aging
determinant
-blood supply
patella
- what type of bone?
- points of interest
- location of points
sesamoid bone apex -points inferiorly base -superiorly
tibia
-points of interest
medial and lateral condyles medial and lateral tibial plateaus intercondylar eminence tibial tuberosity (attachment of patellar ligament) medial malleolus fibula rnotch shaft or body interosseus border (lateral) soleal line, vertical line popliteal area
hip joint
- motions allowed
- points of interest
motions -flexion-extension -abduction-adduction -medial-lateral rotation -circumduction acetabular labrum fibrous capsule
acetabular labrum
- composed of what type of tissue
- function
fibrocartilage
deepens the acetabular fossa
fibrous capsule
- ligaments
- additional part
- ligament origin and attachment
ligaments
-iliofemoral ligament (“Y” ligament)
–static stabilizer for upright posture
-ischiofemoral ligament
-pubofemoral ligament
-circular part of each ligament forms an orbicular (circular) part
origin
-acetabular rim
attachments
-intertrochanteric line (iliofemoral and pubofemoral)
-neck of the femur medial to base of greater trochanter
ligament of head of the femur origin and attachment
from acetabular wall and transverse acetabular ligament to the pit in the head of the femur
hip joint blood supply
- from which arteries
- how do they provide blood to the femur?
blood supply from articular arteries off of the medial and lateral femoral circumflex arteries
-they anastosome (I think this means that they branch and interconnect a lot) around and through the head with an artery in the ligament of the head of the femur
avascular necrosis
- what
- how
deterioration of the head of the femur following a compromise in the blood supply
causes
-age
-broken hip (Bo Jackson)
knee joint
- type of joint
- permits which actions
hinge type synovial joint permitting some rotation
permits
-flexion and extension of the leg
-rotation of the leg when fixed
when knee is fully extended and “locked”
- relation between femur and tibia
- how do you unlock?
femur is medially rotated on the tibia
to unlock
-popliteus muscle laterally rotates the femur (tibia fixed due to standing)
knee intrinsic capsular ligament (external ligaments of the knee)
lateral and medial collateral ligaments
patellar ligament
oblique popliteal ligament
arcuate popliteal ligament
oblique popliteal ligament
-portion of…
portion of the tendon of semimembranosus that supports the posterior part of the joint capsule
arcuate popliteal ligament
-what is it?
branched ligament
from head of fibula to the intercondylar space of the thigh and lateral epicondyle of the femur
internal ligaments of the knee
anterior and posterior cruciate ligaments
medial and lateral collateral menisci (not really ligaments but seemed like a good place to put them)
how is the knee joint supplied with blood?
genicular arteries from an anastomotic circulation around it
gluteal region
- superior and inferior boundaries
- marked superficially by..
superiorly bounded by iliac crest
inferiorly bounded by inferior border of gluteus maximus
marked superficially (surface anatomy) by gluteal sulcus
lateral surface of ilium
- marked by limits of…
- how do these mark it
- what do we call these “marks”
marked by limits of the origins of the named gluteal muscles (maximus, medius, minimus)
these muscle attachments leave small elevation or roughened surface on the bone
knows as the posterior, anterior, and inferior gluteal lines
more likely to be seen or real bone than models
obturatur internus
-originates where and with what muscle?
within pelvic cavity with piriformis
piriformis
- originates where
- how does it leave pelvis
- where does it insert?
originates on
-pelvic side of the sacrum
-associated ligaments
-ilium at edge of the greater sciatic notch
leaves pelvis in an anterolateral direction through the greater sciatic foramen
insert on the greater trochanter of the femur
obturator internus
- originates…
- exits…
- inserts…
originates
-within limits of the pelvis
-bony surfaces of the ischium and ilium surrounding the obturator foramen
-obturator membrane
exits
-somewhat posteriorly below the sacrospinous ligament through the less sciatic foramen (notch)
inserts on the medial surface of the greater trochanter after bending anterolaterally after moving through lesser sciatic foramen
obturator internus tendon
-protected by
protected by a bursa as it swings around the bony edge of the ischium
obturator foramen
-partially covered by ____ with a small opening called___
obturator membrane
obturator canal
obturator externus
-originates…
on external side of the obturator membrane
adjacent rami of the ischium and pubic bones
piriformis
-separates…
separates the exiting of the superior and inferior gluteal nerve and artery from the pelvis
sciatic nerve
- exits where
- “usual” orientation relative to piriformis
- what are other configurations
exits the pelvis through the greater sciatic notch in relation to the piriformis "usual" orientation -comes out inferior to piriformis other configurations -split around or through piriformis
glute muscle action and walking
-medius and minimus
gluteus medius and minimus extremely important in walking
- to take step with right foot, thigh and leg of the left side must be fixed
- allows elevation of the right leg and foot on the opposite side
- achieved by having these muscles tilt and stabilize pelvis, so hip doesn’t sag on the right side when its support is removed
- this allows opposite foot to clear the ground
if pelvis sags during walking
- name
- causes
- how do patients compensate?
Trendelenberg’s sign
causes
-neuromuscular damage to the superior gluteal nerves and/or the muscles
-broken bone so that muscles don’t have a fixed point from which to pull
compensation
-patients walk with a lurching gait
plexuses in general
-formed from
formed from primary ventral rami of spinal nerves
primary ventral rami
- divide into…
- plexus is formed by…
- what type of nerves are ventral rami?
divide into a dorsal and ventral division
plexus is formed by the dividing and mixing of individual spinal nerves into the formation of peripheral nerves
ventral rami are mixed nerves
-contain both sensory and motor axons
sacral plexus
- created by…
- form…
- also gives rise to…
created by dorsal division of the ventral rami of L4, L5-S2
form the common peroneal part of the sciatic nerve
also gives rise to
-superior and inferior gluteal nerves
superior and inferior gluteal nerves
-function
innervate three named gluteus muscles and the piriformis
superior and inferior gluteal nerves
- leave the pelvis via…
- ventral divisions give rise to…
via greater sciatic foramen
ventral divisions give rise to
-tibial part of the sciatic nerve
-nerves of the obturator internus and quadratus femoris
damage to the sciatic nerve in the gluteal region results in…
affects ability to
- extend and abduct the thigh
- flex the leg
- dorsiflex the foot (foot drop)
sacral plexus nerve divisions also give rise to…
the pudendal nerve
-seen in gluteal region
pudenal nerve
-function
carries sensory information and autonomic fibers to and from genital region
lumbar plexus
-which nerves?
collections of dorsal and ventral divisions of ventral rami of spinal nerves (T12), L1-L5
femoral nerve created by
dorsal division of ventral rami of L2-L4
obturatur nerve created by
ventral divisions of ventral rami of L2-L4
lumbosacral trunk created by
dorsal division of L4 and L5
superior and inferior gluteal arteries
- branches off of…
- travel where and with what?
branches off of the internal iliac artery
travel into the gluteal region with superior and inferior gluteal nerves
superior gluteal artery vascular distribution
provides blood for all named gluteal muscles
inferior gluteal vascular distribution
provides blood to
- gluteus maximus
- other small muscles of the gluteal region
superior gluteal and inferior gluteal arteries participate in…
anastomotic circulation
anastomotic circulation of superior and inferior gluteal arteries formed between
-termed the
these two arteries
medial and lateral circumflex femoral arteries
first branch of the profunda femoris artery (deep femoral artery)
termed the
-cruciate anastomosis of the thigh
anastomotic circulation of thigh supported by…
-this is a branch of the…
artery that is following the ligament to the head of the femur
-branch of the obturator artery
branches of cruciate anastomosis send…
retinacular vessels along the neck of the femur
cruciate anastomosis compromise
- cause
- result
cause
-aging common
result
-difficulty in repair of fractures of the neck of the femur
-bone maintenance and repair process is marginal at best, and the neck or head of the femur begins to deteriorate
-this is known as avascular necrosis
internal pudendal artery
- branch off of…
- where does it travel?
- function
branch off of the internal iliac artery
leaves the pelvis via the greater sciatic foramen and then re-enters via the lesser sciatic foramen
-loops around the ischial spine, underneath the sacrotuberous ligament
function
-gives blood to the external genitalia and deep muscles of the pelvis and gluteal region
fascia lata
- what
- how is it attached?
- lateral side of fascia lata
dense connective tissue sheath that forms the deep fascia of the thigh
attached in a ring fashion to much of the pelvis and invests the thigh muscles
lateral side
-thicked as the iliotibial band (tract)
IT band
- what inserts into it
- purpose of this insertion
TFL and gluteus maximus insert into and tight it
aid in stabilization of pelvis
superficial veins of thigh
-seen where?
seen overlying the dense connective tissue (fascia lata)
run in the subcutaneous space
deep veins
-located where?
run along with paired named arteries
how are superficial and deep veins connected?
by valved interconnections
deep veins of the thigh and leg contain…
valves that help in the prevention of pooling of blood in the lower extremities
what happens if this venous system breaks down?
blood pools in peripheral veins
leads to vericose veins
3 important veins
great saphenous vein
lesser saphenous vein
femoral vein
great saphenous
- saphenous opening
- what is a common use of this vein
saphenous opening
-area in fascia lata that allows great saphenous vein to dump into femoral vein
great saphenous commonly used in cardiac bypass surgery
arteries of the thigh and popliteal fossa
- external iliac artery becomes femoral artery after passing inguinal ligament
- deep femoral artery (profundis femoris)
- perforating branches
- lateral and medial circumflex femoral arteries
- descending branch of lateral circumflex femoral arteries
- descending genicular branch
- popliteal artery (femoral artery after it passes through adductor canal)
- superior - medial and lateral - and inferior - medial and lateral - genicular arteries
- anterior tibial artery
- posterior tibial artery
- peroneal artery
branches of internal iliac artery that reach the thigh
superior and inferior gluteal artery obturator artery (adductor region)
nerves of thigh and popliteal fossa
femoral sciatic obturator ilioinguinal genitofemoral
femoral nerve
- formed from
- innervates…
formed from lumbar plexis -dorsal divisions of L2-L4 innervates -anterior thigh muscles -cutaneous innervation of anterior and medial sides of leg
saphenous nerve
-location
enters femoral triangle with femoral nerve
travels with femoral artery through adductor canal
obturator nerve
-formed from…
formed from ventral divisions of L2-L4
femoral triangle
- clinical significance and location of this
- boundaries
can palpate femoral pulse in this region location -2-3 cm inferior to inguinal ligament boundaries -superior (base) - inguinal ligament -medial - lateral border of adductor longus -lateral - medial border of sartorius -floor - bodies of pectineus and iliopsoas
femoral triangle
-contents
contents
- femoral artery, nerve, vein
- profunda femoris artery - chief after of thigh
- lymph nodes
femoral triangle
-important contents from lateral to medial
femoral nerve
femoral artery
femoral vein
femoral canal
femoral sheath
-what is it?
extension of abdominal transversalis fascia and iliac fascia that encases all of the contents of the femoral triangle for 4 cm, except the femoral and saphenous nerves
femoral sheath compartments
-purpose of compartments
3 compartments
-for femoral artery, vein, and canal
femoral canal
- contents
- function
- superior border
- covered by
- what happens if ruptured?
contents
-empty with few lymph nodes and vessels
function
-allows for venous expansion of vein during times of high venous return
superior border
-femoral ring
covered by a weak covering of abdominal peritoneum
if ruptured
-small intestine can bulge into and/or become strangulated (different than inguinal hernia)
adductor canal
- location
- purpose
- where does it end?
- boundaries
tunnel beneath the sartorius
carries
-femoral artery and vein
-saphenous nerve
ends at the adductor hiatus in adductor magnus
boundaries
-lateral - vastus medialis
-posteromedial - adductor longus and magnus
-anterior - sartorius
-roof - sartorius and subsartorial fascia
popliteal fossa
- location and appearance
- boundaries
diamond shaped area at the posterior aspect of the knee
boundaries
-superolateral: biceps femoris
-superomedial: semitendinosus and semimembranosus
-inferomedial and inferolateral: medial and lateral heads of gastrocnemius
-floor: next slide
-roof: skin and fascia
floor of popliteal fossa
popliteal surfaces of femur and tibia
oblique popliteal ligament
part of the semimembranosus tendon
popliteus fascia
popliteal fossa contents
popliteal artery and genicular anastomosis
popliteal vein
tibial nerve
-branch of sciatic nerve usually branches at/near superior point of popliteal fossa
common peroneal nerve - other branch of sciatic nerve
