Gluteal Region and Thigh

Question 1

What are the four main neuromuscular bundles that pass through the thigh?

Answer 1

Sciatic Nerve and Gluteal Neurovascular Bundle

Internal Pudendal Neurovascular Bundle

Obturator Neurovascular Bundle

Femoral Neurovascular Bundle

Question 2

Describe the gluteal region (buttock)

Answer 2

 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

Question 3

What are the gluteal muscles?

Answer 3

 Gluteus maximus, medius and minimus

 External rotators of the thigh

Question 4

Describe the gluteus maximus

Answer 4

 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

Question 5

Describe the gluteus medius and minimus

Answer 5

 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

Question 6

Describe the abductors of the thigh

Answer 6

 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

Question 7

What are the lateral rotators of the thigh?

Answer 7

The piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris and obturator externus

Question 8

Describe the lateral rotators of the thigh?

Answer 8

 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;

Question 9

What is the origin and insertion of the gluteus maximus?

Answer 9

Origin
Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; and sacrotuberous ligament

Insertion
Iliotibial tract and gluteal tuberosity

Question 10

What is the origin and insertion of the gluteus medius?

Answer 10

Origin
External surface of ilium between anterior and posterior gluteal lines

Insertion
Greater trochanter of femur

Question 11

What is the origin and insertion of the gluteus minimus?

Answer 11

Origin
External surface of ilium between anterior and inferior gluteal lines

Insertion
Greater trochanter of femur

Question 12

What is the origin and insertion of the tensor fascia latae?

Answer 12

Origin
Anterior superior iliac spine; anterior part of iliac crest

Insertion
Lateral condyle of tibia via Iliotibial tract

Question 13

What are the inevitable rules and exceptions of the gluteal muscles?

Answer 13

 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

Question 14

What is the course of the sciatic nerve within the gluteal region?

Answer 14

Sciatic nerve emerges into the gluteal region inferior to piriformis

Question 15

Where would one perform a intragluteal injection?

Answer 15

 Midway between ischial tuberosity and greater trochanter

 Safe area for intramuscular injections is the upper, outer quadrant

Question 16

What are the flexors of the thigh?

Answer 16

Iliacus and Psoas major

Sartorius and Rectus femoris

Question 17

Describe the flexors of the thigh

Answer 17

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

Question 18

Where do iliacus and psoas major pass?

Answer 18

 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

Question 19

What is the origin and insertion of the iliacus?

Answer 19

Origin
Iliac fossa

Insertion
Lesser trochanter of femur

Question 20

What is the origin and insertion of psoas major?

Answer 20

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

Question 21

What is the origin and insertion of rectus femoris?

Answer 21

Origin
Straight head: AIIS
Reflected head: ilium just superior to the acetabulum

Insertion
Base of patella via common Quadriceps femoris tendon

Question 22

What is the origin and insertion of sartorius?

Answer 22

Origin
Anterior superior iliac spine (ASIS)

Insertion
Medial surface of medial tibial condyle (pes anserinus)

Question 23

What is the origin and insertion of pectineus?

Answer 23

Origin
Superior ramus of pubis

Insertion
Pectineal line of femur

Question 24

What is the origin and insertion of the tensor fascia latae?

Answer 24

Idk go look it up

Question 25

What are the anatomical rules and exceptions of the flexors of the thigh?

Answer 25

All supplied by the femoral nerve except psoas major (L1-L3) and tensor fascia lata (superior gluteal)

Question 26

What are the compartments of the thigh?

Answer 26

Anterior compartment Posterior compartment Medial compartment

Question 27

How are the compartments of the thigh divided by function?

Answer 27

These are medial (adductor), anterior (extensor), and posterior (flexor) compartments

Question 28

What separates the compartments of the thigh?

Answer 28

Muscles in the thigh are separated into three compartments by layers of fascia

Question 29

Discuss the posterior compartment of the thigh

Answer 29

 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

Question 30

What are the hamstrings

Answer 30

Biceps femoris (long and short head) Semitendinosus Semimembranosus

Question 31

What is the origin and insertion of the biceps femoris?

Answer 31

Origin Ischial tuberosity and lateral lip of linea aspera Insertion Head of fibula

Question 32

What is the origin and insertion of semitendinosus?

Answer 32

Origin Ischial tuberosity Insertion Medial surface of medial tibial condyle (pes anserinus)

Question 33

What is the origin and insertion of semimembranosus?

Answer 33

Origin Ischial tuberosity Insertion Medial condyle of tibia; reflected attachment forms oblique popliteal ligament

Question 34

What are the anatomical rules and exceptions of the extensors of the thigh?

Answer 34

 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

Question 35

What muscles are found in the medial compartment of the thigh?

Answer 35

Adductor magnus Adductor longus Adductor brevis Gracilis

Question 36

Where does the sciatic nerve lie in the medial compartment of the thigh?

Answer 36

The sciatic nerve descends between the adductor magnus and biceps femoris

Question 37

What is the origin and insertion of adductor longus?

Answer 37

Origin Body of pubis inferior to pubic crest Insertion Middle third of linea aspera of femur

Question 38

What is the origin and insertion of adductor brevis?

Answer 38

Origin Body and inferior ramus of pubis Insertion Proximal part of linea aspera of femur

Question 39

What is the origin and insertion of adductor magnus?

Answer 39

Origin Adductor part: ischiopubic ramus Hamstring part: ischial tuberosity Insertion Linea aspera, medial supracondylar line, adductor tubercle of femur

Question 40

What is the origin and insertion of gracilis?

Answer 40

Origin Body and inferior ramus of pubis Insertion Medial surface of medial tibial condyle (pes anserinus)

Question 41

What is the origin and insertion of obturator externus?

Answer 41

Origin Margins of obturator foramen and external surface of obturator membrane Insertion Trochanteric fossa of femur

Question 42

What are the anatomical rules and exception of the adductors of the thigh?

Answer 42

 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)

Question 43

Describe the anterior compartment of the thigh

Answer 43

 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

Question 44

What are the muscles of the anterior compartment of the thigh?

Answer 44

* Quadriceps femoris * Sartorius (flexes NOT extends the knee) * Iliopsoas * Pectineus

Question 45

Describe the extensors of the knee

Answer 45

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

Question 46

What are the extensors of the knee?

Answer 46

Quadriceps femoris is main extensor of the knee joint • Rectus femoris (acts on both hip and knee joints) • Rectus intermedius • Vastus medialis • Vastus lateralis

Question 47

What is the origin and insertion of quadriceps femoris?

Answer 47

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

Question 48

What are the anatomical rules and exceptions of the extensors of the knee?

Answer 48

Quadriceps femoris is supplied by the femoral nerve

Question 49

What is the pes anserinus?

Answer 49

 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

Question 50

What is the knee reflex?

Answer 50

 Deep tendon reflex  Elicited by tapping the patellar ligament [patellar tendon, quadriceps tendon]  Tests the Femoral Nerve  Spinal Segments L3 and L4

Question 51

What results may one get from the knee reflex?

Answer 51

* Absent * Trace (Diminished) * Normal * Brisk * Hyperactive * ? Clonus

Question 52

Describe the femoral triangle

Answer 52

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

Question 53

What is the clinical significance of the femoral triangle in cases of physical trauma?

Answer 53

Artery at risk in groin lacerations

Question 54

Describe the femoral canal

Answer 54

 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 areafemoral hernia

Question 55

What key structures of the femoral canal should you go over?

Answer 55

Deep inguinal lymph node (Cloquet node) Pectineal ligament Lacunar ligament Saphenous opening

Question 56

What is the femoral ring?

Answer 56

Is the opening of the femoral canal at the abdominal side

Question 57

What forms the boundaries of the femoral ring?

Answer 57

* 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)

Question 58

What is the femoral ring a common site for?

Answer 58

Femoral hernias

Question 59

Describe femoral hernias

Answer 59

 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

Question 60

What are some other names for the adductor canal?

Answer 60

Hunter’s or Subsartorial canal

Question 61

Describe the adductor canal

Answer 61

 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

Question 62

What forms the boundaries of the adductor canal?

Answer 62

``` – vastus medialis (anterolaterally) – adductor longus and adductor magnus (posteriorly) – sartorius (anteromedially) ```