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Anatomy > Gluteal Region > Flashcards

Gluteal Region Flashcards

1
Q

boundaries of the gluteal region

A

iliac crest, intergluteal cleft (natal cleft), gluteal fold

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2
Q

How is the femur adapted in regards to our center of gravity

A

they are oblique so that they can be as close to the center of gravity axis as possible. midline.

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3
Q

where is our center of gravity really located?

A

L5

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4
Q

Coxa valga

A

when the angle between the head and neck of the femur (medial) is larger that 135

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5
Q

Coxa Vara

A

when the angle between the head and neck of the femur is less than 120

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6
Q

coxa norma

A

when the angle between the head and neck of the femur is between 135 and 120

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7
Q

True (lesser) pelvis vs false (greater) pelvis

A

false pelvis contains abdominal viscera and extends from the iliac crest down to the pelvic brim. The true pelvis extends from the pelvic brim to the perenium and contains our reproductive organs.

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8
Q

which 3 bones make up the os coxae

A

ilium, ischium and pubis

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9
Q

whats special about the os coxae?

A

the three bones are connected by triradiate cartialge during childhood (black on radiograph). the three bones begin to fuse (where the Y shaped triradiate cartilage is) around puberty.

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10
Q

Important features of the os coxae

A

greater sciatic notch, ischial spine, lesser sciatic notch, ischial tuberosity, acetabulum, pubic tubercle, anterior inferior iliac spine, anterior superior iliac spine, posterior superior iliac spine, posterior inferior iliac spine, obturator groove, pectineal line, superior pubic ramus, inferior pubic ramus, ramus of ischium, body of ischium. gluteal lines (all three)

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11
Q

More to know for the bones

A

greater sciatic foramen, lesser sciatic foramen, sacrospinous ligament, sacrotuberous ligament, obturator foramen, margin of pelvic inlet

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12
Q

which ligament separates the greater sciatic foramen form the lesser sciatic foramen?

A

sacrospinous ligament which connects the sacrum to the ischial spine

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13
Q

which ligament connects the sacrum to the ischial tuberosity?

A

sacrotuberous liagment

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14
Q

what passes through the lesser sciatic foramen?

A

obturator internus muscle tendon, nerve to obturator internus muscle, internal pudendal vessels, pudendal nerve

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15
Q

what passes through the Greater sciatic foramen

A

piriformis muscles fills the foramen; provides pathway for superior and inferior gluteal vessels and nerves, internal pudendal vessels, pudendal nerve, posterior femoral cutaneous nerve, nerves to obturator internus and quadratis femoris muscle.

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16
Q

inguinal ligament attachement

A

anterior superior iliac crest to the pubic tubercle

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17
Q

what runs under the inguinal ligament

A

femoral artery (runs down), femoral vein (runs up), femoral nerve

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18
Q

what type of joint is the sacroiliac joint?

A

synovial

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19
Q

differences between male and female pelvis?

A

female=circular pelvic inlet and wider angle between the pubic symphysis
Male=heart shaped pelvic inlet and smaller angle between pubic symphysis

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20
Q

How is the length of the femur related to height?

A

height=femur length x 4

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21
Q

know the following femur bone structures

A

Head, neck, greater trochanter, lesser trochanter, angle of inclination, intertrochanteric line, shaft, lateral epicondyle, lateral condyle, patellar surface, medial condyle, medial epicondyle, adductor tubercle, fovea for ligament of head, trochanteric fossa, intertrochanteric crest, quadrate tubercle, pectineal line, spiral line, gluteal tuberosity, lateral and medial lips of the linea aspera, medial and lateral supracondylar line, popliteal surface, adductor tubercle, medial and lateral epicondyles, intercondylar line, medial and lateral condyles, intercondylar fossa

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22
Q

What attaches to the adductor tubercle?

A

the hamstring portion of the adductor magnus

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23
Q

what is on the head, patellar surface and medial and lateral condyles of the femur?

A

articulate cartilage

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24
Q

What attaches to the greater trochanter?

A

insertion site of the gluteus medius, gluteus minimus, piriformis and obturator internus

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25
Q

what attaches to the lesser trochanter?

A

insertion of the common tendon of the psoas major and iliacus (iliopsoas muscle)

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26
Q

what attaches to pectinal line?

A

it is inferior and continuous with the lesser trochanter. there are two pectineal lines (pecten pubis and femur) related to attachements of pectineus muscle.

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27
Q

what attaches to the trochanteric fossa

A

obturator externus tendon

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28
Q

what attaches to the intertrochanteric crest

A

(its on the posterior surface of the femur) and connects the greater and lesser trochanter. That quadratus femoris muscle inserts on the intertrochanteric crest at the quadrate tubercle

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29
Q

what attaches to the intertrochanteric line?

A

on the anterior femur from greater trochanter and descending downward towards lesser, capsule of hip joint attaches; continues as spiral line.

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30
Q

what attaches to the gluteal tuberosity?

A

distal attachment of glut max

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31
Q

what attaches to the linea aspera?

A

medial lip derived from spiral line. lateral lip descends from gluteal tuberosity. they form the medial and lateral supracondylar lines. Medial line ends at adductor tubercle, proximal to medial epicondyle. lateral line ends at lateral condyle of femur

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32
Q

what part of the femoral head is not covered in cartilage and why?

A

the fovea capitis because it attaches the ligamentum teres and transmits the acetabular branch of the obturator artery to the femoral head (the artery to the fovea travels through the ligamentum teres as its not a true ligament but folds of connective tissue)

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33
Q

what ligament spans the acetabular notch?

A

the transverse ligament

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34
Q

what is the acetabular labrum?

A

its a ring of cartilage that surrounds and deepens the acetabulum

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35
Q

which arteries supply blood to the head of the femur?

A

the circumflex arteries (most importantly the medial femoral circumflex artery)

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36
Q

what would happen if the neck of the femur was fractured?

A

blood supply to the head would be interrupted leading to avascular necrosis of the femoral head and arthritis

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37
Q

name the pathway of blood to the head of the femur

A

common iliac artery–>external iliac artery–>deep femoral artery of the thigh–>medial and lateral branches of the circumflex artery

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38
Q

once the external iliac artery goes underneath the inguinal ligament it is now called the…

A

femoral artery

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39
Q

the deep femoral artery, while it provides the medial circumflex artery that supplies blood to the head of the femur it also gives off…

A

perforating branches which perforate the muscles to go supply blood to the posterior side of the femoral region
***so posterior blood supply comes from the anterior

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40
Q

fractures of the femoral neck present how?

A

shortness and lateral rotation of the lower limb

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41
Q

what are the results of arthritis of the hip?

A

osteophytes and eroded articular cartilage

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42
Q

a femoral neck Fx usually requires

A

hip replacement (arthroplasty)

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43
Q

what about intertrochanteric Fxs?

A

lower than the femoral neck, bone blood flow remains intact, do not require hip replacements

44
Q

how many cluneal nerves are there and where do they come from?

A

superior cluneal nerves: from the dorsal rami of L1-L3
medial cluneal nerves: from dorsal rami of S1-S3
inferior cluneal nerves: ventral rami and comes from the gluteal branch of the posterior femoral cutaneous nerve

the posterior femoral cutaneous nerve is located medially to the sciatic nerve.

the superior cluneal nerves come over the iliac crest
the medial cluneal nerves come from the sacral foramina and come over the gluteus max
the inferior cluneal nerves come from the posterior femoral cutaneous nerve which comes from just below the piriformis muscle

45
Q

name the cutaneous nerves

A

lateral femoral cutaneous nerve, anterior cutaneous branch of femoral nerve, cutaneous branch of obturator nerve, saphenous nerve, lateral sural cutaneous nerve, sural nerve

46
Q

A disorder that occurs when lateral femoral cutaneous nerve is compressed

A

Meralgia Paresthetica (CK syndrome or tingling thigh syndrome)

47
Q

1st layer of gluteal muscles

A

gluteus max

48
Q

2nd layer

A

medius, piriformis (with sciatic coming out from underneath it) and quadratis femoris

49
Q

The inferior half of the deep part of the gluteus maximus attaches to…

A

the gluteal tuberosity

50
Q

Glut max OINA

A

O: ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; sacrotuberous ligament

I: IT band (which inserts into lateral condyle of tibia; some fibers insert on gluteal tuberosity

N: inferior gluteal nerve (S1,S2)

A: extends thigh and laterally rotates (assists in rising from sitting position)

51
Q

Glut medius OINA

A

O: external surface of ilium between anterior and posterior gluteal lines

I: lateral surface of greater trochanter of femur

N: superior gluteal nerve (L5, S1)

A: abduct and medially rotate thigh. Keeps pelvis level when ipsilateral limb is weightbearing

52
Q

Glut min OINA

A

O: external surface of ilium between anterior and inferior gluteal lines

I: anterior surface of greater trochanter of femur

N: superior gluteal nerve

A: same as glut med

53
Q

Tensor fasciae latae OINA

A

O: anterior superior iliac spine; anterior part of iliac crest

I: IT band

N: superior gluteal nerve

A: same as glut med

54
Q

piriformis OINA

A

O: anterior surface of sacrum; sacrotuberous ligament

I: superior border of greater trochanter of femur

N: branches of anterior rami of S1 and S2

A: laterally rotate, extend thigh and abduct flexed thigh. Steady femoral head in acetabulum

55
Q

Obturator internus OINA

A

O: pelvic surface of obturator membrane and surrounding bones

I: medial surface of greater trochanter (trochanteric fossa) of femur

N: nerve to obturator internus (L5, S1)

A: same as piriformis

56
Q

Superior and inferior gemelli OINA

A

O: superior: ischial spine
Inferior: ischial tuberosity

I: Medial surface of greater trochanter (trochanteric fossa of femur)

N: superior: same as obturator internus
Inferior: same as quadratis femoris

A: same as piriformis

57
Q

Quadratus femoris OINA

A

O: lateral border of ischial tuberosity

I: quadrate tubercle on intertrochanteric crest of femur and area inferior to it

N: nerve to quadratus femoris (L5, S1)

A: laterally rotates thigh, steadies femoral head in acetabulum

58
Q

The most anterior of the gluteal muscles is the…

A

TFL

59
Q

Arteries to the TFL

A

superior gluteal artery and the lateral femoral circumflex artery

60
Q

IT band syndrome

A

IT band not attached to bone as it courses between Gerdy’s tubercle and the lateral femoral epicondyle. Allows for movement anteriorly and posteriorly with knee flexion and extension. causes rubbing against lateral femoral condyle

61
Q

Gluteus minimus is deep to…

A

glut med

62
Q

Paralysis of glut max does not affect…

A

walking on level ground

63
Q

Damage to the superior gluteal nerve affects which muscles and produces which signs?

A

TFL, glut medius and minimus. signs are Trendelenburg gait and Trendelenburg sign

64
Q

Trendelenburg gait

A

downward tilting of hip on non weight bearing side due to inability of glut med and min to actively abduct the hip on the weight bearing side during walking.

65
Q

Trendelenburg sign

A

clinical test to determine the integrity of the superior gluteal nerve. Pt’s hip tilts down when the limb is not weight bearing because the superior gluteal nerve is damaged on the weight bearing side

66
Q

the superior gluteal n. a. and v. emerge from

A

suprapiriform foramen (and can be seen under the reflected glut med muscle)

67
Q

the pudendal nerve and internal pudendal a. and v. emerge from

A

infrapiriform foramen

68
Q

inferior gluteal n, a, v emerge from

A

infrapiriform foramen

69
Q

the sciatic nerve and the posterior femoral cutaneous nerve emerge…

A

together

70
Q

The common iliac artery becomes…

A

the internal and external iliac artery before passing deep to the inguinal ligament

71
Q

the internal iliac artery becomes the…

A

gluteal arteries, internal pudendal (perenium and external genitalia) and the obturator artery (adductor muscles)

72
Q

The external iliac artery becomes the…

A

femoral artery has a branch that becomes the deep femoral (adductors, hamstrings, quadriceps).

The femoral artery continues down, through the adductor canal and out through the adductor hiatus to become the popliteal artery. The popliteal artery then becomes the genicular artery (knee), anterior tibial (ant. leg muscles with farther branches to feet) and the posterior tibial artery (flexor muscles, plantar arch, branches to toes)

73
Q

What muscles make up the pelvic diaphragm?

A

piriformis, obturator internus, levator ani (iliococcygeus muscle, pubococcygeus muscle, puborectalis muscle), coccygous muscle, anal aperture, urogenital hiatus

74
Q

how to remember the lateral rotators from top to bottom

A

Play Golf Or Go On Quaaludes (piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratis femoris; also gluteus maximus

75
Q

suprapiriform foramen

A

superior gluteal n, a, v

76
Q

infrapiriform foramen

A 
inferior gluteal nav
pudendal nav
internal pudendal a v
sciatic n
posterior femoral cut. n
77
Q

piriformis syndrome

A

neuromuscular disorder involves compressed sciatic n or aggravation caused by piriformis m. causes pain, tingling and numbness in the gluteal region and the sciatic nerve path down the lower thigh and leg

78
Q

Positive piriformis sign

A

ipsilateral foot is externally rotated

79
Q

What quadrant of the buttock is safest for intramuscular injection?

A

upper outer quadrant because its farthest from sciatic n

80
Q

obturator externus OINA

A

O:outer surface of obturator membrane, superior and inferior pubic rami (deep to quadratus femoris)

I: trochanteric fossa

A: adduction and external rotation of the hip

N: obturator nerve

81
Q

bursae of the hip

A

ischial, iliopsoas, greater trochanteric

82
Q

see slide 55

A

see slide 55

83
Q

see note on how to do shortcut for the sacral plexus

A

see note on how to do shortcut (SIPPS)

84
Q

SIPPS

A 
superior glut n
inferior glut n
post fem cut n
pudendal n 
sciatic n
85
Q

The sciatic nerve is actually made up of two nerves

A

the tibial nerve (goes medial) and the common fibular (peroneal) nerve (goes laterally)

86
Q

tibial nerve

A

(L4, L5, S1-3)-all hamstrings except short head of biceps femoris and enters leg to supply the posterior leg and plantar foot

87
Q

common fibular nerve

A

L4, L5, S1, S2-short head of the biceps femoris, lateral and anterior leg and dorsal foot

88
Q

the sacroiliac joint

A

is synovial and fibrous (a compound synovial joint because it anteriorly involves cartilage covered articular surfaces within an encapsulated synovial cavity and a posteriorly a syndesmosis of powerful ligaments.

both facets of the joint are rugose to prevent slippage.

89
Q

anterior sacroiliac ligament

A

connected to anterior surfaces of ilium and sacrum

90
Q

posterior sacroiliac ligament

A

posterior superior iliac spine to the posterior aspect of the sacrum (very strong)

91
Q

interosseous sacroiliac ligament

A

short and deep transverse fibers attached to the iliac and sacral tuberosities in between the bones (very strong)

92
Q

sacrotuberous and sacrospinous ligaments

A

not directly connected to the SI joint but are essential in its control

93
Q

the SI joint is a

A

shock absorber with only enough motion to tilt the pelvis

94
Q

The hip joint parts

A

acetabulum, lunate surface, acetabular fossa, synovial membrane, synovial fluid

95
Q

lunate surface

A

the part of the acetabulum that articulates with the head of the femur. covered with articulate cartilage

96
Q

acetabular fossa

A

non-articular, inside the C which contains a fat pad and vessels

97
Q

synovial membrane

A

internal lining of capsule and all other non-articulating internal joint structures, produces synovial fluid, contains blood supply, sensory innervation and is subject to inflammation. the membrane does not cover weight bearing articulating surfaces

98
Q

synovial fluid

A

lubricates the articular surfaces

99
Q

transverse acetabular ligament

A

attached to the opposite margins of the lunate C shaped articular area. Bridges the acetabular notch (allows acetabular artery to get inside the joint) continuous with acetabular labrum

100
Q

ligament of the head of femur (ligamentum teres capitis femoris)

A

attached to the fovea on femoral head; its wide end attached to the transverse ligament and acetabular notch. Transmits small artery to the head

101
Q

hip joint capsule

A

attached to acetabular rim, edge of labrum and transverse ligament. anteriorly, it extends to intertrochanteric line, posteriorly to the femoral neck. Not attached to trochanters of the intertrochanteric crest. its lined by synovial membrane

*the reflected capsule fibers along with the synovial lining form the retinacluae which enclose the blood vessels surrounding the neck

102
Q

3 important ligaments

A
  1. iliofemoral (ligament of bigelow) strongest ligament in the body
  2. ischiofemoral ligament
  3. pubofemoral ligament
103
Q

iliofemoral ligament

A

AIIS to intertrochanteric line where it blends with joint capsule. Resists medial and lateral rotation

104
Q

Ischiofemoral ligament

A

ischial body at the acetabular rim and curves superolaterally to attach to femoral neck
weakest of extrinsic ligaments
tightens during extension

105
Q

pubofemoral ligament

A

attached to pelvic bone and femur
inferior reinforcement of the hip
tightens during extension and abduction

106
Q

iliofemoral ligament is particularly important…

A

in standing when it resists backward rotation of the trunk on the femur. it maintains upright posture at the hip joint without enlisting muscles

107
Q

posterior hip dislocation

A

flexed, internally rotates and adducted

Anatomy (13 decks)

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