Gluteal and Thigh Flashcards
Femoral Triangle
Borders: 1. Inguinal Ligament 2. Sartorius 3. Adductor Longus Floor: psoas major, pectineus Contents: femoral artery/vein and their branches, great saphenous vein, femoral nerve
Adductor Canal
- Borders: medially adductor longus, laterally vastus medialis, roof: sartorius
- Contents: femoral artery/vein, saphenous nerve (branch of femoral nerve), nerve to vastus medialis
- thickening of fascia holds all these contents together on medial leg above knee
Creation of Greater Sciatic Foramen
- Sacrospinous ligament attaches ischial spine to sacrum/coccyx to divide greater sciatic notch and lesser sciatic notch
- Sacrotuberous ligament connects ischial tuberosity to ilium/sacrum/coccyx and turns notches into foramen
interosseous membrane
-connect tibia and fibula bones
interosseous border
- receives more of weight bearing in the tibia
- made of fibers
patella
- anterior side is convex
- posterior side has 2 concave facets which articulate with femoral condyles
- base is superior and apex is inferior, upside down triangle
intergluteal cleft
- groove that separates buttocks from each other, buttcrack
- coccyx runs at superior border
gluteal fold
- marks inferior aspect of gluteals and beginning of thigh
OINA: Gluteus maximus
- O: dorsal surface of sacrum and coccyx, sacrotuberous ligament, ilium posterior to posterior gluteal line
- I: (2 distal attachments) iliotibial tract which inserts into lateral condyle of tibia (most, superficial), some fibers (part, deep) on gluteal tuberosity by way of lateral intermuscular septum
- N: inferior gluteal nerve (L5, S1, S2)
- A: hip extension, external rotation, steadies thigh, helps sit to stand, posterior pelvic tilt (relative hip ext), help walk uphill/stairs
OINA: Gluteus medius
- O: between anterior and posterior gluteal line on ilium
- I: lateral surface of greater trochanter
- N: superior gluteal nerve (L5, S1)
- A: hip abduction, internal rotation (because where it attaches on greater trochanter), HUGE in gait, keep pelvis level when ipsilateral limb is weight bearing and opposite limb being advanced
open chain vs closed chain
- open: distal part of limb is moving in space
- closed: in contact or stable with ground/surface
OINA: Gluteus minimus
- O: between anterior and inferior gluteal line of ilium
- I: anterior surface of greater trochanter
- N: superior gluteal nerve (L5, S1)
- A: hip abduction, internal rotation
Exercises to Strengthen Glut Med
exercise- clam shells with fire hydrant so you get more abd instead of ER (glut max), isometric hold is better neural connection, functional exercise: side lunge, monster walks (hinging), marching, sidelying hip abd (cue bend bottom knee and angle foot down at diagnol)
OINA: Tensor Fascia Latae
- O: anterior aspect of iliac crest, ASIS
- I: iliotibial tract to gerdy’s tubercle on lateral tibial condyle
- N: superior gluteal nerve (L5, S1)
- A: hip abduction, internal rotation, hip flexion because it sits anteriorly
“P- GO- GO-Q”
-superior to inferior: piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratus femoris
OINA: Piriformis
- O: anterior surface of sacrum, sacrotuberous ligament (S2-S4)
- I: superior surface of greater trochanter
- N: N to piriformis S1,S2 (composed of anterior rami S1,2)
- A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum, if 90 degrees hip flex then acts as internal rotator
Sciatic Nerve
- exits inferior to piriformis normally
- can also exit above, to the side, or through piriformis variable
triceps coxae
- made of superior gemellus, obturator internus, and inferior gemellus
- these work as a unit altogether even though they are separate
OINA: Gemellus Superior
- O: ischial spine
- I: (medial surface of greater trochanter) intertrochanteric fossa
- N: nerve to obturator internus (L5,S1)
- A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum
OINA: Gemellus Inferior
- O: ischial tuberosity (superior)
- I: (medial surface of greater trochanter) intertrochanteric fossa
- N: nerve to quadratus femoris (L5,S1)
- A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum
OINA: Obturator Internus
- O: internal pelvic surface of obturator membrane and surrounding bones
- I: (medial surface of greater trochanter) intertrochanteric fossa
- N: nerve to obturator internus (L5,S1)
- A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum, dancing
- SPECIAL: start on inside of pelvis and exits lesser sciatic foramen making 90 degree turn, sits in pelvis but it is a hip muscle
- deeper muscles have to work harder after sitting all day because glutes are lengthened and create symptoms
OINA: Quadratus Femoris
- O: lateral border of ischial tuberosity
- I: quadrate tubercle of intertrochanteric crest and area inferior to it
- N: nerve to quadratus femoris (L5,S1)
- A: laterally rotates thigh, steadies femoral head in acetabulum
OINA: Obturator Externus
- found underneath quadratus femoris
- O: margins of obturator foramen and membrane
- I: trochanteric fossa
- N: obturator nerve (L3,4)
- A: lateral rotates thigh and steadies femoral head in acetabulum
Bursae
- minimize friction and allow greatest ease of movement
- fluid filled sacs lined with synovial membranes
- located in areas of high fricition
Gluteofemoral Bursae
-separates iliotibial tract from superior part of proximal attachment of vastus lateralis
Ischial Bursae
- separates inferior part of glute max from ischial tuberosity
- can be bothered during sitting, rowing, cycling possibly
Trochanteric Bursae
- separates superior fibers of glute max from greater trochanter
- weak glut meds and rubbing of IT band walking uphill can irritate this
- plunging good for blood flow at bursae because it is inflamed so you don’t want to put pressure on it
Fascia Lata
- surrounds entire thigh
- IT band is continuous with fasia lata but just thicker on the lateral side of leg
- can’t change length of IT band
- work on parts anterior and posterior to IT band to relieve symptoms, but you are actually working on fascia of IT band
Intermuscular Septums and Compartments
- Lateral femoral intermuscular septum: separates antreior and posterior compartments of thigh, strongest
- Posteromedial FIS: separates posterior and medial compartments
- Anteromedial FIS: separates anterior and medial compartments
- Compartments: Anterior(quad and hip flexors), medial (adductors), and posterior (hamstrings)
OINA: Sartorius
- O: ASIS and superior part of notch inferior to it
- I: superior part of medial tibia via pes anserine
- N: Femoral nerve (L2,L3)
- A: Hip flexion, abd, ER, weak knee flex, IR the leg with knee flexed, FABER
- longest muscle in body so mainly a synergist
OINA: Rectus Femoris
- O: AIIS and ilium superior to acetabulum
- I: base of patella via quad tendon/tibial tuberosity via patellar lig
- N: femoral nerve (L2,L3,L4)
- A: knee ext, hip flex
OINA: Vastus Medialis
- O: intertrochanteric line and medial lip of linea aspera
- I: via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
- N: femoral nerve (L2,L3,L4)
- A: Knee ext
OINA: Vastus Lateralis
- O: greater trochanter, and lateral lip of linea aspera
- I:via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
- N: femoral nerve (L2,L3,L4)
- A: knee ext
- largest of quads
OINA: Vastus Intermedius
- O: anterior and lateral surface of shaft of femur
- I:via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
- N: femoral nerve (L2,L3,L4)
- A: knee ext
OINA: Pectineus
- O: superior ramus of pubis
- I: pectineal line of femur, just inferior to lesser trochanter
- N: Femoral n. (L2,3), may receive branch from obturator nerve, shares same nerve root level as gracilis
- A: Hip flex, add, assists in med rotation of thigh
- seen as a transitional muscle between anterior and medial compartments
Layers of Medial Thigh
- Superficial Layer: pectineus and adductor longus
- Intermediate Layer: adductor brevis lies deep to adductor longus and pectineus
- Adductor magnus separates hamstrings and adductors
- Adductors contribute to hip flexion from full extension and hip extension from fully flexed position when running or against resistance
OINA: Adductor Longus
- O: body of pubis inferior to pubic crest
- I: middle 1/3 of linea aspera
- N: obturator nerve (L2,L3,L4)
- A: hip add
OINA: Adductor Brevis
- O: body of inferior pubic ramus
- I: pectineal line and proximal part of linea aspera
- N: obturator nerve (L2,L3,L4)
- A: hip add, some flex of hip
OINA: Adductor Magnus
-adductor and hamstring
-O: adductor- inferior ramus of pubis and ramus of ischium
hamstring: ischial tuberosity
-I: adductor- gluteal tuberosity, linea aspera, and medail supracondylar line
hamstring- adductor tubercle
-N: adductor- obturator nerve (L2,L3,L4)
hamstring- tibial branch of sciatic nerve (L4)
-A: adductor- add of hip, hip flex
hamstring- hips ext, add
OINA: Gracilis
- O: body of inferior ramus of pubis
- I: medial aspect of anterior tibia via pes anserine
- N: obturator nerve L2,L3
- A: hip adduction, weak flex and IR
pes anserine
- muscles that attach here: say grace before tea
1. sartorius
2. gracilis
3. semitendinosus - provide medial support to extended knee
OINA: Semimembranosus
- O: ischial tuberosity
- I: posterior aspect of medial tibial condyle
- N: tibial divison of sciatic nerve (L5,S1,S2)
- A: hip ext, knee flex, IR of knee with knee flex
- Has 3 distal attachment parts:
1. posterior aspect of medial tibial condyle
2. blends with popliteal fascia
3. attaches to oblique popliteal ligament to reinforce posterior joint capsule at intercondylar part
OINA: Semitendinosus
- O: ischial tuberosity
- I: medial surface of superior part of tibia
- N: tibial divison of sciatic nerve (L5, S1,S2)
- A: hip ext, knee flex, IR of knee with knee flexed
- becomes tendon early on in thigh
OINA: Biceps Femoris Long Head
- O: ischial tuberosity
- I: lateral side of fibular head
- N: tibial division of sciatic nerve (L5, S1,S2)
- A: hip ext, knee flex, ER of knee with knee flexed
OINA: Biceps Femoris Short Head
- O: linea aspera and lateral supracondylar line of femur
- I: lateral side of fibular head, tendon is split by fibular collateral lig of knee
- N: common fibular branch of sciatic n (L5,L1,L2)
- A: accelerating mass during first step of gait
Neural Tension Testing
- creates tension in structures to duplicate pain
- work on soft tissue around nerves so you don’t inflame nerve more but actually make it easier to glide in muscles
- Sciatic Nerve: ankle dorsiflexion, knee ext, hip flex, trunk flex, SLUMP
- femoral nerve: hip ext, knee, flex, dorsiflexion of ankle, trunk ext
- obturator nerve: hip abd, IR hip, knee flex, dorsiflex of ankle
Cluneal Nerve
- superficial nerves that supply skin in gluteal region
Superior cluneal nerve
- post Rami L1, L2, L3
- passes inferiorly along iliac crest
- sensory to superior buttock as far as tubercle of iliac crest
Middle cluneal nerve
- post Rami S1,2,3
- exit via sacral foramen and supply gluteal region just laterally
- sensory to skin covering sacrum adjacent to buttocks
Inferior cluneal nerve
- ant rami S2,3 via branches from posterior cutaneous femoral nerve of thigh
- come from inferior border of gluteus maximus and ascend vertically
- sensory to inferior half of buttocks as far laterally as greater trochanter
Peripheral Cutaneous Distribution vs Dermatomes
- myotomes: primary spinal neurosegments that create motor activation, voluntary control
- dermatomes: focus on A/B map slide 37, nerve root, plexuses from APR/PPR
- Peripheral Cutaneous: what is formed from branches, more of nerve itself, sensory function
- focus on ASIA
Lesion to L4 nerve root vs femoral root
L4 nerve root
- weak knee ext, ankle dorsiflex, hip ext
-impaired sensation along anterior and medial aspect of lower leg
-not as sever symptoms because of dermatome overlap and distance between nerve and muscle
Femoral nerve root damage
-paralysis of knee ext, only nerve applying muscle to extend knee
-altered sensation along anterior surface of thigh, minus lateral portion from lateral femoral cutaneous nerve
