gluteal region and hip

Question 1

gluteus maximus

  - actions
  - origin
  - insertion
  - innervation

Answer 1

• posterior to posterior line of os coxa, sacrotuberous ligament
• iliotibial band on lateral thigh

Question 2

gluteus medius

  - actions
  - origin
  - insertion
  - innervation

Answer 2

• abductor of thigh. rotation of thigh
• ilium
• ## greater trochanter

Question 3

gluteus minimus

  - actions
  - origin
  - insertion
  - innervation

Answer 3

-

- between anterior and inferior gluteal lines on os coxa

Question 4

structures between gluteus maximus and gluteus minimus

Answer 4

superior gluteal nerve and artery branches

Question 5

muscles that externally rotate the hip

Answer 5

obturator internus and externus
quadratus femoris
piriformis
gluteus maximus

Question 6

muscles that internally rotate the hip

Answer 6

gluteus medius and minimus

TFL

Question 7

muscles involved in balance

Answer 7

gluteal
TFL (by tensing iliotibial tract)
adductor

Question 8

trendelenburg test

Answer 8

for femoral head dislocation, gluteus medius rupture or weakness, and superior gluteal nerve damage

ask patient to stand on one leg - positive test if there’s a significant drop of the unsupported hip - suggests that the gluteus medius on the supported side isn’t working

Question 9

greater sciatic foramen

Answer 9

most nerves and vessels to the gluteal region pass though here
filled by piriformis
pass superior to piriformis:
- superior gluteal artery and vein and nerve
pass inferior to piriformis:
- inferior gluteal nerve, artery, and vein
- pudendal nerve
- internal pudendal artery and vein
- sciatic nerve
- posterior femoral cutaneous nerve

Question 10

posterior femoral cutaneous nerve

Answer 10

passes through greater sciatic foramen inferior to piriformis
supplies skin on back of the thigh
branch of sacral plexus - arises from upper sacral nerve roots

Question 11

sciatic nerve

Answer 11

tibial and fibular nerves

usually enter gluteal region inferior to piriformis but varies

Question 12

ligaments of hip joint

Answer 12

prevent hyperextension of femur on pelvis
useful while standing cause don’t have ot use hip flexor muscles to prevent yourself from falling over backwards - rest in slight extension on hip joins
ligaments tighten with extension
iliofemoral = anterior = strongest
posterior weakest - dislocations occur here if not also accompanied by a fracture (rare)

Question 13

acetabular labrum

Answer 13

fibrocartilage that deepens acetabulum

inside of synovial capsule of joint and ligamentous capsule that covers joint

Question 14

ligamentum teres

Answer 14

in head of femur

carries artery of the head of the femur

Question 15

blood flow to femoral head

Answer 15

from artery of head of femur and from blood vessels that enter femur near trochanter and extend along the neck to the head
implications: before closure of epiphyseal plate, blood can’t get from neck into head - get avascular necrosis if artery to head damaged
artery of head can be insufficient in older people, fracture of neck of femur can also lead to necrosis of head of femur

Question 16

what would a patient’s leg look like if he/she fractured the neck of his/her femur?

Answer 16

stronger muscles displace femur => externally rotated and superiorly displaced lower extremity

Question 17

innervation to skin over gluteal area

Answer 17

upper routes to this skin from lumbar area

lower routes to this skin from sacral area

Question 18

innervation of hamstring muscles

Answer 18

all innervated by tibial nerve except short head of biceps = fibular nerve

Question 19

iliotibial band

Answer 19

inserts on lateral tibial plateau at Gerty’s tubercle (where biceps femoris inserts on fibular head)
distal end passes over lateral femoral condyle - can be irritated here by repetitive flexion of knee (iliotibial band syndrome - common in runners)

Question 20

pes anserine

Answer 20

where tendons from semitendinosus, gracilis, and sartorius insert (semitendiousus closest to bone)

Question 21

blood supply to posterior thigh

Answer 21

from perforating branches of deep femoral artery

penetrate insertion of adductor magnus muscle (so not one large blood vessel)

Question 22

cruciate anastomosis

Answer 22

around posterior aspect of hip joint

anastomosis between perforating branches of deep femoral artery and branches of medial and lateral femoral circumflex vessels and inferior gluteal vessels