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MSK exam 3 > gluteal region and posterior thigh > Flashcards

gluteal region and posterior thigh Flashcards

1
Q

longest bone in body

A

femur

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2
Q

hip bone if formed by fusion of three bones

A

ilium, ischium, pubis

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3
Q

Lunate surface

A

is the articular surface where the head of femur articulates

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4
Q

In youngsters- the 3 hip bones are separated by a Y-shaped cartilage

A

tri radiate cartilage

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5
Q

at what age do the primary bones fuse together in the hip?

A

20-25

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6
Q

The fusion site is the _____ the large cup-shaped socket that articulates with the head of the femur

A

acetabulum

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7
Q

the articular surface where the head of femur articulates

A

Lunate surface

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8
Q

attachment site for the lesser trochanter

A

iliopsoas muscle

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9
Q
A
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10
Q

functions mainly to extend and laterally rotate the thigh/hip

A

gluteus maximus

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11
Q

innervation of gluetus maximus

A

inferior gluteal nerve L5, S1, S2

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12
Q

innervation of hamstrings

A

sciatic nerve L5, S1, S2

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13
Q

most commonly injured hamstring muscle

A

biceps femoris

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14
Q

muscles of hamstring

A

semitendinosus

semimembranosus

biceps femoris (lateral)

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15
Q

linea aspera

A

rough prominent ridges (lips) located along the posterior shaft of femur

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16
Q

located posteriorly between the femoral condyles- cruciate ligaments attach here

A

intercondylar fossa

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17
Q

congenital hip dysplasia/dislocation CHD

A

the head of the femur is not positioned within the developing acetabulum

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18
Q

prevalence of CHD and demographic

A

1:1000 births

girls

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19
Q

how can CHD be determined?

A

utilize the position of the tri-radiate cartilgae and femur to determine angles

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20
Q

quadrants about the developing acetabulum and hip joint

A

formed by hilgenreiner’s horizontal line and perkins’ vertical line

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21
Q

Acetabular index should be about ____ in a normal hip

A

30º or less

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22
Q

denoted by a continuous and symmetrical line between the obturator foramen and the medial aspect of the femur

A

Shenton’s line (S)

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23
Q

x ray findings of congenital hip dislocation

A

shenton’s line is broken

proximal displacement of femoral neck

acetabular index >30

delayed ossification of the femoral head

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24
Q

hip joint type

A

ball and socket

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25
Q

ossification center for the developing femoral head should be found within the

A

lower inner quadrant N

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26
Q

hip joint capsule

A

strong and dense fibrous capsule that surround the joint

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27
Q

articular capsule is strengthened by 3 intrinsic ligaments

A
  • iliofemoral ligament
  • pubofemoral ligament
  • ischiofemoral ligament
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28
Q

(or the Y ligament of Bigelow)- strongest and located on anterior aspect of joint- prevents hyperextension of the joint

A

iliofemoral ligament

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29
Q

anterior/inferior aspect of the joint capsule (prevents hyperabduction)

A

Pubofemoral Ligament

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30
Q

(ligament of Bertin) -a strong triangular ligament located posteriorly

A

ishiofemoral ligament

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31
Q

Fibers of all three hip ligaments are oriented in a ____ fashion around the hip so as to become tight in extension

A

spiral

This stabilizes the joint and reduces muscular energy when standing

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32
Q

The rim of the acetabulum is surrounded by a strong fibrocartilagenoustissue called the

A

acetabular labrum

(helps protect and deepen the joint cavity)

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33
Q

The labrum stretches across the inferior aspect of the lunate surface forming the

A

transverse Acetabular Ligament

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34
Q

attaches to this transverse acetabular ligament and to the femoral head at the fovea

A

ligament of the head

ligament teres or ligamentum captis femoris

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35
Q
A
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36
Q

artery of the head

A

small branch of the obturator artery that courses within the transvere acetabular ligament and helps vascularize the femoral head

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37
Q

artereies that vascularize the head of the femur

A

medial circumflex artery (major contributor)

lateral circumflex artery

retinacular arteries (aka femoral neck vessels)

artery of the head

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38
Q

major contributor of vascular supply to the head of femur

A

medial circumflex artery

39
Q

proximal femoral fractures often referred to as

A

hip fractures

40
Q

femoral neck fractures are often associated with

A

osteoporosis

.. avascular necrosis of the femoral head due to rupture of reintacular arteries

41
Q

hip fractures common in elderly patients that usually result from a fall

A

intertrochanteric fractures

42
Q

strong synovial joints between the sacrum and the hip bones

A

sacroiliac joints

43
Q

sacroiliac ligaments

A

include both dorsal and ventral sacroiliac ligaments which strengthen and help stabilize the sacroiliac joints

44
Q

a cartilaginous joint in the anterior midline that joins the pubic portions of the hip bones with an intervening fibrocartilaginous disk

A

pubic symphysis

45
Q

originates from the sacrum and inserts onto the ischial tuberosity

A

Sacrotuberous ligament

46
Q

originates on the sacrum and inserts on the ischial spine

A

Sacrospinous ligament

47
Q

pelvic ligaments help prevent

A

upward tilting of sacrum

48
Q

foramens of the pelvis

A
  1. Greater sciatic foramen
  2. Lesser sciatic foramen
  3. Obturator canal
  4. Beneath the inguinal ligament
49
Q
A
  1. Greater sciatic foramen
  2. Lesser sciatic foramen
  3. Obturator canal
  4. Beneath the inguinal ligament
50
Q

structures that traverse the greater sciatic foramen GSF

A
  1. Piriformis muscle
  2. Sciatic nerve
  3. Superior & inferior gluteal nerves & vessels
  4. Posterior femoral cutaneous nerve
  5. Pudendal nerve and the Internal pudendal artery exit the GSF
51
Q

structures that traverse the lesser sciatic foramen

A
  1. After exiting the GSF…the Pudendal nerve and the Internal pudendal artery then enter the LSF and travel to the perineum (external genitalia)
  2. Obturator internus tendon
52
Q

Large-heavy muscle overlying other gluteal muscles

A

gluteal maximus

53
Q

innervation of gluteal maximus

A

innervated by the inferior gluteal nerve (L5,S1, S2)

54
Q

mainly used when “raising up” from a sitting position

A

gluteaus maximus

55
Q

Fibers course inferolaterally at 45º inserting into the gluteal tuberosity and the iliotibial tract

A

gluteus maximus

56
Q

smaller fan shaped muscles deep to the gluteus maximus, arise from the lateral aspect of the ilium and insert onto the greater trochanter

A

gluteus medius and minimus

57
Q

abductors of the hip and tensor fascia lata

A

gluteus medius and minimus

58
Q

These muscles play essential role during ambulation by stabilizing the opposite side of the pelvis

A

gluteus medius and minimus

helps us stay parallel to ground when walking

59
Q

innervation of gluetus minimus and medius

A

superior gluteal nerve L4, L5, S1

60
Q

a “compensatory” gait… where an individual shifts their body weight over the weakened side to swing the contralateral limb through the gait cycle

A

Trendelenburg Gait

61
Q

mechanism of trendelenburg gait and nerve involved

A

secondary to weakness of the medius/minimus or damage to the superior gluteal nerve

62
Q

Trendelenburg test

A

when a patient is asked to stand on one leg to check the strength of these hip abductors…positive test is when the pelvis sags on the contralateral side which indicates weak hip abductors on the stance leg side

63
Q

Lateral Rotators of the Hip Joint

A
  1. Obturator Internus
  2. Superior Gemellus
  3. Inferior Gemellus
  4. Quadratus Femoris
  5. Piriformis

all deep to glueteus maximus

64
Q

sacral plexus lies on the anterior surface of what muscle

A

piriformis

65
Q

pear shaped muscle that exits the great sciatic foramen and attaches to the greater trochanter

A

Piriformis muscle

66
Q

covers most of the lateral wall of the pelvis

A

obturator internus muscle

67
Q

the “twin” muscles assist the obturator internus

A

Gemelli Muscles

68
Q

most powerful lateral rotator of the hip

A

quadratus femoris

69
Q

piriformis innervation

A

nerve to piriformis (off sciatic)

70
Q

Obturator internus & superior gemellus are both innervated by

A

nerve to obturator internus

71
Q

Quadratus femoris & gemellus inferior are both innervated by the

A

“nerve to quadratus femoris”

72
Q

posterior thigh muscles

A

The Hamstrings

  1. Semitendinosus
  2. Semimembranosus
  3. Biceps Femoris
73
Q

most commonly injured of the hamstring muscles

A

biceps femoris

74
Q

innervation of hamstrings

A

sciatic nerve L5, S1, S2

75
Q

vascular supply of hamstrings

A

the perforating arteries that arise from the deep (profundus) femoral artery

76
Q

they are flexors of the knee joint and extensors of the hip joint (thigh)

A

hamstrings

77
Q

muscles that cross 2 joints

A

more prone to injury

78
Q

a small flexor of the knee joint…helps to “unlock” the knee from an extended position

A

popliteus

79
Q

mechanism of pulled hamstring

A
  • Common sports related injury seen in football (i.e. punting), track (sprinters, jumping hurdles), and soccer
  • Often a result of inadequate “warming” of the muscles prior to athletic events
  • Sudden acceleration of hamstring muscles can tear the proximal tendinous attachments OR avulse a small fragment of the tuberosity
  • can be accompanied by hematomas
80
Q

contains two nerves within a common sheath

A

tibial nerve and common fibular (peroneal) nerve

81
Q

larget nerve in body

A

sciatic nerve L4, L5, S1, S2, S3

82
Q

gluteal injections

A

Intramuscularly injection are common sites for antibiotic administration

83
Q

how to avoid large sciatic and superior gluteal nerve in a gluteal injection

A
  • glueteus is separated into quadrants
  • Upper outer injection placement ensures safety and a large muscle mass for the IM (intramuscular) medication
84
Q

posterior hip dislocations often result from

A

motor vehicle accidents when the femur is flexed and adducted (sitting)

medical emergency! could result in AVN due to torn/damaged femoral neck vessels

85
Q

posterior hip dislocations can fracture the posterior acetabulum and cause

A

sciatic nerve injury (10%)

86
Q

presentation of posterior hip dislocation

A

characteristic shortened, adducted, flexed, and internally rotated position of the affected extremity

87
Q

posterior femoral cutaneous nerve

A

S1, S2, S3

88
Q
A
89
Q
A
90
Q

innervates the gluteus medius, minimus, and tensor fascia latamuscles after exiting the greater sciatic foramen

A

The superior gluteal nerve (L4, L5 & S1)

91
Q

major vascular contributor to the femoral head

A

Medial circumflex artery

92
Q

Which of the following anatomical structures is located within the femoral canal?

A. Femoral Nerve

B. Femoral Artery

C. Femoral Vein

D. Lymph node(s)

E. Great saphenous Vein

A

lymph nodes

93
Q

what nerve is damaged here?

A

right superior gluteal

The superior gluteal nerve innervates the hip abductors (gluteus medius & minimus). These muscle stabilize the pelvis during single leg stance and during ambulation. When they are weak…or the superiorgluteal nerve is damaged…the contralateral hip sags (tilts) during single leg stance and/or while ambulating

94
Q

hypertrophy of the piriformis can

A

compress the accompanying sciatic nerve

MSK exam 3 (7 decks)

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