Gluteal Region and Posterior Thigh Flashcards
What 3 fused bones does the hip bone consist of
Each ‘hip bone’ consists of three fused primary bones: ilium, ischium and pubis which fuse late teenage years.
What is the cup that holds the head of the femur called?
the acetabulum
Identify
What is a hip pointer?
a bruise or contusion of the iliac crest, usually in the anterior part; this term may also refer to contusions/avulsions of the greater trochanter, ASIS, AIIS or an avulsion of the muscles from the crest. These more correctly should be termed avulsion fractures
On the anterior surface of the pelvic wing there are three gluteal lines, which do what?
they delineate the attachment for the gluteal muscles
posterior, inferior, and anterior
What ligament extends from the sacrum and coccyx to the ischial tuberosity of the pelvis?
the sacrotuberous ligament
What ligament extends from the sacrum and coccyx to the ischial spine of the pelvis?
the sacrospinous ligament
The sacrotuberous and sacrospinous ligaments converte the greater and lesser sciatic notches into what?
the greater and lesser sciatic foramen
The greater sciatic foramen is a passageway for structures entering or leaving the _____.
The lesser sciatic foramen is a passageway for structures entering or leaving the ____.
pelvis
perineum
Both the sacrotuberous and the sacrospinous ligaments prevent the sacrum from moving in what direction?
outward thrust
What important posterior thigh muscle divides the greater sciatic foramen into superior and inferior portions?
the piriformis muscle
What is the only important structures that passes out from the pelvis ABOVE the piriformis?
the superior gluteal vessels and nerve
Which muscle leaves the pelvis via the lesser sciatic foramen?
the obturator internus
What artery are all the major vessels of the gluteal region branches of?
the internal iliac artery
What are the three major blood vessels of the gluteual region?
- superior gluteal
- inferior fluteal
- internal pudendal
What does the gluteus maximus do?
It extends and laterally rotates the thigh at the hip joint
extends the leg at the knee joint through insertion into the iliotibila tract
stabilizes the knee
WHat nerve innervates the gluteus maximus?
the inferior gluteal nerve
What do the gluteus medius and minimus do?
they abduct the thigh at the hip joint and stabilize the pelvis
What nerve innervates the gluteus medius and minimus?
the superior gluteal nerve
What does the tensor fasciae latae do?
it aids the gluteus maximus in extending the knee joint
What nerve innervates the tensor fasciae latae?
the superior gluteal nerve
What are the lateral rotators of the thigh at the hip joint starting proximally and going dorsally?
- Piriformis
- superior gemellus
- Obturator internus
- inferior gemellus
- quadratus femoris
(Pyramus says Oberon is quacked)
Branches of the anterior rami of what spinal level innervate the piriformis?
L5, S1, and S2
What nerves innervate the following?
Obturator Internus
Superior and Inferior Gemellus
Quadratus Femoris
Obturator Internus: nerve to the obturator inernus
Gemellus superior/inferior: nerve to the obturator internus and nerve to the Q femoris
QUadratus femoris: nerve to the Q femoris
All the nerves to the gluteal region leave the pelvis via the ___ sciatic foramen.
the greater sciatic foramen
(except the sperior gluteal, will all leave below the piriformis)
What 5 nerves come off the sacral plexus that we’re concerned about?
sciatic nerve
pudendal nerve
posterior femoral cutaneous nerve
superior gluteal nerve
inferior gluteal nerve
there are other branches that go off to the quadratus femoris, obturator internus and piriformis
Which is the largest nerve in the body?
the sciatic nerve
note that it doesn’t have any branches in the gluteal region
WHat nerve supplies structures in th perineum?
the pudendal nerve
What is sciatica?
It’s a neuritis of the sciatic nerve characterized by intense pain at the back of the leg and/or thigh
this can be caused by pressure on the root of a nerve either by a herniated disc or spasm of the piriformis
Where is the best site for intragluteal injections? WHy?
The upper outer (superolateral) quadrant
or superior to a line extending from the posterior superior iliac spine to the superior border of the greater trochanter
you want to aboid injurying the sciatic nerve
What will cause a trendelenburg sign?
It’s a gluteus gait/limp
caused by paralysis of the gluteus medius and minimus due to injury of the superior gluteal nerve
or congenital dislocation of the hip or nonunion of a femoral neck fracture
(when the foot is rase on the normal side, the pelvis falls on that side - contralateral to the injured side.
The deep fascia of the thigh is called what?
the fascia lata
Laterally the fascia lata splits to nclose the belly to the tensor fasciae latae muscle, which pulls on a thickened portion of the fascia lata distally, which is called…
the iliotibial tract
WHat divides the thigh muscle into anterior, posterior and medial compartments?
the intermuscular septa
WHat nerve supplies the posterior flexor compartment of the thigh?
the sciatic nerve
What are the 3 hamstring muscles?
the biceps femoris
the semitendinosus
semimembranosus
How is the biceps femoris innervated?
semiteninosus?
semimembranosus?
the long head (medial) is supplied by the tibial portion of the sciatic nerve
the short head (lateral) is supplied by the common fibular portion of the sciatic nerve
semiteninosus and semimembranosus are both the tibial portion as well
What do the hemstrings do?
they extend the thigh at the hip and flex the leg at the knee
What are the two divisions of the sciatic nerve?
the tibial nerve and the common fibular nerve (only to the short head of the biceps femoris)
Blood supply to the posterior compartment of the thigh is mainly from perforating branches of …….
the deep femoral artery and bein
also from some of the branches of the inferior gluteal artery and vein
What is a charley horse?
a contusion and tearing of muscle fibers that is severe enough to cause a thigh hematoma
usually in quadriceps
causes locatlized pain and stiffness
trochanteric bursitis will cause pain where?
deep pain in the lateral thign - it’s from a fruction bursitis of the trochanteric bursa after repetivie actions
Ischial bursitis is also called…..
what causes it?
Weaver’s bottom
It’s a friction bursitis of the ischial bursa from repetitive hip extension while seated (like in cycling) or prolonged sitting on hard surfaces
a recurrent trauma will cause inflammation between the ischial bursa and ischial tuberosities
What is the wedge-shaped, fat filled area on either side of the rectum that allows distention of anal canal during defecation?
the ischioanal fossa
What is the gluteus aponeurosis?
a thick fascia over the gluteus medius
What causes ilitibial band syndrome?
irritation of the distal portion of the ilitibial tendon as it rubs against the lateral femoral condule
it’s an overuse injury with symptoms of inflammation and irritation of the IT band
common in long distant runners and weight lifters (heavy squats)
Piriformis syndrome is associated with what symptoms?
piriformis spasm causing sciatica
What is the landmark to feel for when doing a pudendal nerve block of S2-4 dermatomes?
the ischial spine
the pudendal nerve runs over it on its way to pass back to the perineum through the lesser sciatic foramen
What can sometimes be avulsed in hamstring injuries?
the edge of the ischial tuberosity
