Gluteal Region and Thigh Flashcards
What are the four main neuromuscular bundles that pass through the thigh?
Sciatic Nerve and Gluteal Neurovascular Bundle
Internal Pudendal Neurovascular Bundle
Obturator Neurovascular Bundle
Femoral Neurovascular Bundle
Describe the gluteal region (buttock)
Bounded superiorly by the iliac crest and inferiorly by the fold of the buttock.
Largely made up of the gluteal muscles and a thick layer of superficial fascia.
• Extensors of the hip joint (gluteus maximus)
• Abductors of the hip joint (gluteus medius and minimus)
• Rotators of the hip joint
What are the gluteal muscles?
Gluteus maximus, medius and minimus
External rotators of the thigh
Describe the gluteus maximus
Gluteus maximus is the prime extensor of the hip
− while standing up from sitting position and climbing stairs
− Externally rotates, abducts (can it also adduct?) the femur
− Deep fibres insert on gluteal tuberosity; Superficial fibres insert on iliotibial tract
− Extends and locks the knee via iliotibial tract
Describe the gluteus medius and minimus
Gluteus medius lying deep to gluteus maximus, and gluteus minimus lying deep to gluteus medius are the abductors of the thigh
Tensor fascia latae and Gluteus maximus, which attach to the iliotibial tract, also aids gluteus medius and minimus in hip abduction
Describe the abductors of the thigh
Muscles that pass from the pelvis to the femur, lying lateral to the sagittal axis of the hip joint will abduct it
Abductors, with contralateral adductors keep the pelvis level when walking or standing on one leg
What are the lateral rotators of the thigh?
The piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris and obturator externus
Describe the lateral rotators of the thigh?
A group of muscles that pass from the pelvis to the femur, lying close to and posterior to the hip joint
They stabilise the joint and laterally rotate the femur to keep the foot pointing forwards during walking
Piriformis is supplied by S1-S2; Superior gemellus and obturator internus by obturator internus nerve; inferior gemellus and quadratus femoris by nerve to quadratus femoris;
What is the origin and insertion of the gluteus maximus?
Origin
Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; and sacrotuberous ligament
Insertion
Iliotibial tract and gluteal tuberosity
What is the origin and insertion of the gluteus medius?
Origin
External surface of ilium between anterior and posterior gluteal lines
Insertion
Greater trochanter of femur
What is the origin and insertion of the gluteus minimus?
Origin
External surface of ilium between anterior and inferior gluteal lines
Insertion
Greater trochanter of femur
What is the origin and insertion of the tensor fascia latae?
Origin
Anterior superior iliac spine; anterior part of iliac crest
Insertion
Lateral condyle of tibia via Iliotibial tract
What are the inevitable rules and exceptions of the gluteal muscles?
All gluteal muscles are supplied by the superior gluteal nerve except gluteus maximus (inferior gluteal nerve)
All abductors of one side keep pelvis level when limb of the same side is weight bearing
What is the course of the sciatic nerve within the gluteal region?
Sciatic nerve emerges into the gluteal region inferior to piriformis
Where would one perform a intragluteal injection?
Midway between ischial tuberosity and greater trochanter
Safe area for intramuscular injections is the upper, outer quadrant
What are the flexors of the thigh?
Iliacus and Psoas major
Sartorius and Rectus femoris
Describe the flexors of the thigh
Muscles that pass from the pelvis to the femur, anterior to the transverse axis of the hip joint will flex the thigh
Sartorius and Rectus femoris flex the hip but they act on the knee joint as well
Where do iliacus and psoas major pass?
Iliacus and psoas major pass through the retro-inguinal space into the femoral region
- The fascia of psoas divide the space into muscular and vascular compartments
- Iliopsoas and femoral nerve pass through the muscular compartment
What is the origin and insertion of the iliacus?
Origin
Iliac fossa
Insertion
Lesser trochanter of femur
What is the origin and insertion of psoas major?
Origin
Posterior abdominal wall (lumbar transverse processes, intervertebral discs, and adjacent bodies from T12 to L5 and tendinous arches between these points)
Insertion
Lesser trochanter of femur
What is the origin and insertion of rectus femoris?
Origin
Straight head: AIIS
Reflected head: ilium just superior to the acetabulum
Insertion
Base of patella via common Quadriceps femoris tendon
What is the origin and insertion of sartorius?
Origin
Anterior superior iliac spine (ASIS)
Insertion
Medial surface of medial tibial condyle (pes anserinus)
What is the origin and insertion of pectineus?
Origin
Superior ramus of pubis
Insertion
Pectineal line of femur
What is the origin and insertion of the tensor fascia latae?
Idk go look it up
What are the anatomical rules and exceptions of the flexors of the thigh?
All supplied by the femoral nerve except psoas major (L1-L3) and tensor fascia lata (superior gluteal)
What are the compartments of the thigh?
Anterior compartment
Posterior compartment
Medial compartment
How are the compartments of the thigh divided by function?
These are medial (adductor), anterior (extensor), and posterior (flexor) compartments
What separates the compartments of the thigh?
Muscles in the thigh are separated into three compartments by layers of fascia
Discuss the posterior compartment of the thigh
Muscles that pass from the pelvis to the lower limb, posterior to the transverse axis of the hip joint will extend the thigh
Hamstring muscles extend between the ischial tuberosity and the leg
- They span 2 joints
Biceps femoris, semitendinosus and semimembranosus
- They extend the hip but also flex the leg
- They extend the body if the thigh is fixed
What are the hamstrings
Biceps femoris (long and short head)
Semitendinosus
Semimembranosus
What is the origin and insertion of the biceps femoris?
Origin
Ischial tuberosity and lateral lip of linea aspera
Insertion
Head of fibula
What is the origin and insertion of semitendinosus?
Origin
Ischial tuberosity
Insertion
Medial surface of medial tibial condyle (pes anserinus)
What is the origin and insertion of semimembranosus?
Origin
Ischial tuberosity
Insertion
Medial condyle of tibia; reflected attachment forms oblique popliteal ligament
What are the anatomical rules and exceptions of the extensors of the thigh?
All hamstrings are supplied by the sciatic nerve (All hamstrings except the short head of the biceps femoris are supplied by the tibial nerve component)
All hamstrings except the short head of the biceps femoris originate from the ischial tuberosity
All hamstrings except the short head of the biceps femoris cross, therefore, act on both the hip and knee joints
What muscles are found in the medial compartment of the thigh?
Adductor magnus
Adductor longus
Adductor brevis
Gracilis
Where does the sciatic nerve lie in the medial compartment of the thigh?
The sciatic nerve descends between the adductor magnus and biceps femoris
What is the origin and insertion of adductor longus?
Origin
Body of pubis inferior to pubic crest
Insertion
Middle third of linea aspera of femur
What is the origin and insertion of adductor brevis?
Origin
Body and inferior ramus of pubis
Insertion
Proximal part of linea aspera of femur
What is the origin and insertion of adductor magnus?
Origin
Adductor part: ischiopubic ramus Hamstring part: ischial tuberosity
Insertion
Linea aspera, medial supracondylar line, adductor tubercle of femur
What is the origin and insertion of gracilis?
Origin
Body and inferior ramus of pubis
Insertion
Medial surface of medial tibial condyle (pes anserinus)
What is the origin and insertion of obturator externus?
Origin
Margins of obturator foramen and external surface of obturator membrane
Insertion
Trochanteric fossa of femur
What are the anatomical rules and exception of the adductors of the thigh?
All originate from pubis or ischiopubic ramus except hamstring part of adductor magnus
All attach to the femur except gracilis (medial condyle of tibia)
All supplied by the obturator nerve except Pectineus (femoral nerve) and adductor magnus (both tibial and obturator nerves)
Describe the anterior compartment of the thigh
Muscles in this compartment either flex the hip or extend the knee joint
• Quadriceps femoris
• Sartorius (flexes NOT extends the knee) • Iliopsoas
• Pectineus
Supplied by the femoral nerve except iliopsoas
What are the muscles of the anterior compartment of the thigh?
- Quadriceps femoris
- Sartorius (flexes NOT extends the knee)
- Iliopsoas
- Pectineus
Describe the extensors of the knee
Quadriceps femoris is the main extensor of the knee joint
• Rectus femoris (acts on both hip and knee joints)
• Rectus intermedius
• Vastus medialis
• Vastus lateralis
− Knee joint stability is hugely dependent upon quadriceps
What are the extensors of the knee?
Quadriceps femoris is main extensor of the knee joint
• Rectus femoris (acts on both hip and knee joints)
• Rectus intermedius
• Vastus medialis
• Vastus lateralis
What is the origin and insertion of quadriceps femoris?
Origin
Rectus femoris: Anterior inferior iliac spine and ilium superior to acetabulum
Vastus lateralis: Greater trochanter and lateral lip of linea aspera
Vastus medialis: Intertrochanteric line and medial lip of linea aspera
Vastus intermedius: Anterior and lateral surfaces of shaft of femur
Insertion
Base of patella
Tibial tuberosity via patellar ligament Patella and tibia via Medial and lateral patellar retinacula
What are the anatomical rules and exceptions of the extensors of the knee?
Quadriceps femoris is supplied by the femoral nerve
What is the pes anserinus?
Common attachment of sartorius, gracilis and semitendinosus on tibia
Attaches posterior to the transverse axis of rotation of the knee
− Flex the knee
Adds significant dynamic stability to the medial side of the knee
What is the knee reflex?
Deep tendon reflex
Elicited by tapping the patellar ligament [patellar tendon, quadriceps tendon]
Tests the Femoral Nerve
Spinal Segments L3 and L4
What results may one get from the knee reflex?
- Absent
- Trace (Diminished)
- Normal
- Brisk
- Hyperactive
- ? Clonus
Describe the femoral triangle
Bounded by the inguinal ligament (base), the sartorius muscle laterally, and the adductor longus muscle medially.
Iliopsoas Pectineus
Floor: pectineus (medially) and the iliopsoas (laterally).
Roof: fascia lata, subcutaneous tissue and skin.
− The femoral sheath encloses the femoral artery and vein BUT NOT the nerve.
Contains femoral vessels and branches of the femoral nerve, opening of the great saphenous vein and deep inguinal lymph nodes
What is the clinical significance of the femoral triangle in cases of physical trauma?
Artery at risk in groin lacerations
Describe the femoral canal
Is a short and conical space between the medial wall of the femoral sheath and the femoral vein
− Femoral sheath is the continuation of the abdominal transversalis fascia
Deep inguinal lymph node
Contains deep inguinal lymph node.
Allows the femoral vein to expand
The base of the canal (opening) is the femoral ring
Femoral ring is a weak areafemoral hernia
What key structures of the femoral canal should you go over?
Deep inguinal lymph node (Cloquet node)
Pectineal ligament
Lacunar ligament
Saphenous opening
What is the femoral ring?
Is the opening of the femoral canal at the abdominal side
What forms the boundaries of the femoral ring?
- Anteriorly by the medial part of the inguinal ligament
- Medially by the lacunar ligament
- Laterally by the septum between the femoral canal and vein
- Posteriorly by Pectineus muscle and fascia (superior ramus of the pubis)
What is the femoral ring a common site for?
Femoral hernias
Describe femoral hernias
In femoral hernia, there is a protrusion of abdominal viscera through the
femoral ring and into the femoral canal.
If left untreated, the abdominal viscera (commonly parts of the small
intestine) can undergo necrosis, especially as a result of strangulation of the tissue due to the surrounding femoral ring and lacunar ligament boundary
What are some other names for the adductor canal?
Hunter’s or Subsartorial canal
Describe the adductor canal
Starts at the inferior corner of the
femoral triangle
Ends at adductor hiatus
– On adductor magnus
Femoral vessels and saphenus nerve* enter
– Saphenus nerve pierces anteromedial wall and becomes superficial
– Femoral vessels exit through adductor hiatus
What forms the boundaries of the adductor canal?
– vastus medialis (anterolaterally) – adductor longus and adductor magnus (posteriorly) – sartorius (anteromedially)
