Gluteal Region and Thigh (Week 4--Miller) Flashcards

1
Q

Structures of gluteal region

A

Gluteal muscles (maximus, medius, minimus)

Superior and inferior gluteal vessels and nerves

Sciatic nerve

Posterior femoral cutaneous nerve

Muscles that laterally rotate the thigh (piriformis, superior/inferior gemilli, obturator internus, quadratus femoris)

Pudendal nerve

Internal pudendal vessels

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2
Q

Cluneal nerves

A

Cutaneous innervation of gluteal region

Superior cluneal: from dorsal rami of L1-3

Middle cluneal: from dorsal rami of S1-3

Inferior cluneal: from posterior femoral cutaneous nerve (which is a branch of sacral plexus, so ventral rami nerves)

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3
Q

Gluteal muscles

A

Gluteus maximus (superficial): inferior gluteal nerve; extention and lateral rotation of thigh

Gluteus medius (intermediate): superior gluteal nerve; abduction and medial rotation of thigh

Gluteus minimus (deep): superior gluteal nerve; (abduction and) medial rotation of thigh

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4
Q

Trendelenburg Test

A

Evaluates strength of gluteus medius as an abductor

Patient asked to stand on one leg

Point of reference is posterior superior iliac spines (PSIS)

Negative (normal): pelvis slightly elevates as gluteus medius contracts (abducts) on supported side

Positive: pelvis remains in position or descends (indicates weak or nonfunctioning gluteus medius on supported side)

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5
Q

Trochanteric bursa

A

Separates gluteus maximus from lateral side of greater trochanter of femur

Membranous sac containing synovial fluid to reduce friction

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6
Q

Sciatic nerve

A

Halfway between greater trochanter and ischial tuberosity, comes out below piriformis muscle

Largest branch of sacral plexus

Formed by ventral rami fibers from L4-S3

Two divisions: tibial division innervates hamstrings and posterior leg muscles and common peroneal (fibular) division innervates short head of biceps femoris and anterior and lateral compartment of leg muscles

Controls basically everything below gluteal region except for anterior compartment of thigh

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7
Q

Sacral plexus

A

Somatic nerve plexus formed by ventral rami fibers from L4-S4

Branches: sciatic nerve, superior/inferior gluteal nerves, posterior femoral cutaneous nerve, pudendal nerve, nerves to lateral rotator muscles of hip and levator ani

Part of lumbosacral plexus

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8
Q

Lumbosacral plexus

A

Sacral plexus plus lumbar plexus

Responsible for innervation of lower limb

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9
Q

Course of the sciatic nerve

A

Leaves pelvis to enter gluteal region

Courses inferiorly in posterior compartment of thigh

Divides in popliteal region into tibial nerve and common peroneal nerve

Safe area for intragluteal injections is upper outer (lateral) quadrant of gluteal region so don’t hit sciatic nerve

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10
Q

What exact movements does the sciatic nerve control?

A

Tibial nerve: controls posterior compartment of leg (plantar flexion) and all of the foot

Common peroneal nerve: controls anterior (dorsiflexion) and lateral (eversion) compartments of leg

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11
Q

Piriformis muscle

A

Laterally rotates and abducts the extended thigh

Right above piriformis muscle is superior gluteal vessels and nerves

Right below piriformis muscle is sciatic nerve and inferior gluteal vessels and nerve, and other muscles that laterally rotate thigh

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12
Q

Superior and inferior gluteal arteries

A

Branches of internal iliac artery

Originate in pelvis then reach gluteal region by going through greater sciatic foramen

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13
Q

Superior and inferior gluteal nerves

A

Branches of the sacral plexus

Originate in pelvis and reach gluteal region by going through greater sciatic foramen

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14
Q

Muscles that rotate the thigh laterally

A

Superior and inferior gemelli muscles

Obturator internus

Quadratus femoris

(Piriformis)

All are innervated by branches from sacral plexus

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15
Q

Greater sciatic foramen

A

Formed by greater sciatic notch, sacrospinous ligament and sacrotuberous ligament

Doorway from pelvis to gluteal region

Superior/inferior gluteal nerves and vessels, piriformis muscle comes out of it

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16
Q

Lesser sciatic foramen

A

Formed by sacrospinous and sacrotuberous ligaments

Doorway from gluteal region to perineum

Pudeneal nerve/vessels go from gluteal region to perineum

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17
Q

3 compartments of the thigh

A

Anterior (extensor): sartorius, iliopsoas, quadriceps; femoral nerve; femoral artery

Posterior (flexor): hamstrings; sciatic nerve; perforating branches of profunda femoris artery

Medial (adductor): adductors, gracilis, pectineus; obturator nerve; obrurator artery and profunda femoris artery

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18
Q

What separates the 3 compartments of the thigh?

A

Fascial (intermuscular) septa that attach from linea aspera of femur to fascia lata of thigh

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19
Q

Fascia lata

A

Fascial sleeve of deep fascia that completely surrounds all of muscles of lower limb like a sock

In the thigh, is called fascia lata and is continuous with inguinal ligament (above)

In the leg, it is called crural fascia

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20
Q

Posterior compartment of the thigh

A

Hamstring muscles (biceps femoris, semitendinosus, semimembranosus) to flex knee and extend hip

Sciatic nerve (tibial division except short head of biceps femoris)

Perforating branches of profunda femoris (deep femoral artery)

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21
Q

3 muscles of the hamstrings (posterior thigh)

A

To be a true hamstring muscle must be innervated by tibial division of sciatic nerve and must attach to ischial tuberosity

Semitendinosus: medial; superficial to semimembranosus;

Semimembranosus: medial; deep to semitendinosus

Biceps femoris: lateral; 2 heads; long head is true hamstring but short head is NOT true hamstring because innervated by common peroneal division of sciatic nerve and attaches to linear aspera!

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22
Q

Anterior compartment of the thigh

A

Femoral triangle

Adductor canal

Sartorius, iliopsoas, quadriceps

Femoral nerve

Femoral artery

23
Q

Cutaneous innervation of anterior and medial thigh

A

Femoral nerve

Obturator nerve

Lateral femoral cutaneous nerve

Also subcostal, iliohypogastric, ilioinguinal nerves

24
Q

Great saphenous vein

A

From dorsal venous arch of foot –> anterior to medial malleolus –> medial aspect of leg and thigh –> dives through saphenous opening in fascia lata –> femoral vein

Note: use graft of portion of great saphenous vein to do bypass for CAD caused by atherosclerosis but have to put the vein graft in reverse so valves don’t obstruct blood flow!

25
Q

Saphenous opening

A

Opening in fascia lata that allows the great saphenous vein to pass through and drain into femoral vein

26
Q

Muscles of the anterior compartment

A

Iliopsoas

Sartorius

Quads: rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

27
Q

Femoral triangle

A

In anterior compartment of thigh

Contains femoral nerve, artery, vein, inguinal lymph nodes

28
Q

Adductor canal

A

In anterior compartment of thigh

Deep to sartorius, between anterior and medial compartment muscles

“Tunnel-like” space also known as subsartorial canal or Hunter’s Canal

Contains 2 nerves and 2 vessels: saphenous nerve, nerve to vastus medius, femoral artery, femoral vein

29
Q

Femoral vein

A

Popliteal vein –> crosses adductor hiatus to become femoral vein –> travels superiorly through adductor canal then femoral triangle –> crosses inguinal ligament to become external iliac vein

Medial to femoral artery

Catheter inserted here used when rapic access to large veing is needed, but because of high incidence of thrombosis and pulmonary embolism, remove catheter ASAP

30
Q

Femoral artery

A

External iliac artery –> crosses inguinal ligament to become femoral artery –> travels inferiorly through femoral triangle then adductor canal –> crosses adductor hiatus to become popliteal artery

Lateral to femoral vein

Catheter inserted here is used to image SMA, IMA, celiac artery, renal arteries, aorta, everything

Catheter inserted here is used to take pressure recordings through aortic valve into left ventricle

31
Q

Boundaries that form femoral triangle

A

Sartorius (lateral)

Adductor longus (medial)

Inguinal ligament (superior)

32
Q

Muscles that make up floor of femoral triangle

A

Adductor longus (medial compartment)

Pectineus (medial compartment)

Iliopsoas (anterior compartment)

33
Q

Where is the femoral artery within the femoral triangle?

A

Halfway between pubic tubercle and ASIS, along inguinal ligament

34
Q

Femoral nerve

A

From ventral rami of L2-4

Branch of lumbar plexus

Mixed nerve: sensory, motor, symp post (to blood vessels, glands)

Nerve of the anterior compartment of thigh and innervates all anterior muscles

Participates in innervation of hip and knee joints

35
Q

Femoral sheath

A

Derived from transversalis fascia

Contains femoral vein and femoral artery (NOT femoral nerve–that is lateral to femoral sheath)

Divided into 3 compartments: lateral (artery), intermediate (vein), medial (aka femoral canal, which connects to abdominopelvic cavity and can get femoral hernias here)

36
Q

Inguinal lymph nodes

A

Lie in superficial fascia of femoral triangle region

If enlarged, may be sign of infection ascending from lower extremity, or local pelvic problem

37
Q

Medial compartment of thigh

A

Adductor compartment with 3 muscles:

Gracilis

Pectineus

3 adductor muscles: adductor longus, adductor brevis, adductor magnus

Obturator nerve

Obturator artery, profunda femoris artery

38
Q

3 layers of adductor muscles

A

Superficial: adductor longus

Intermediate: adductor brevis

Deep: adductor magnus

39
Q

Adductor hiatus

A

Formed by split tendon of adductor magnus

Between adductor part (innervated by obturator nerve) and hamstring part (innervated by sciatic nerve) of adductor magnus

Doorway from anterior thigh to popliteal region

Femoral vessels pass through here

40
Q

Obturator nerve

A

From ventral rami of L2-4 (smooth obturator…)

Branch of lumbar plexus

Mixed nerve: sensory, motor, symp post (to blood vessels, glands, etc)

Nerve of the medial compartment and innervates medial compartment muscles

Participates in innervation of hip and knee joints

41
Q

Blood supply of medial compartment of thigh

A

Profunda femoris artery (branch of femoral artery)

Obturator artery (branch of internal iliac artery)

42
Q

Popliteal fossa

A

Diamond-shaped region on back of knee

Contains fat, blood vessels, lymphatic vessels and nerves

43
Q

Boundaries of popliteal fossa

A

Superior: hamstrings (biceps femoris laterally; semitendinosus/semimembranosus medially)

Inferior: heads of gastrocnemius

44
Q

Contents of the popliteal fossa

A

2 vessels and 2 nerves:

Popliteal artery, popliteal vein (both continuations of femoral vessels)

Tibial nerve, common peroneal nerve (both divisions of sciatic nerve)

45
Q

3 pelvic girdle joints

A

1) Sacroiliac joint: synovial joint, between sacrum and lilum
2) Pubic symphysis: cartilagenous joint (fibrocartilagenous disc between 2 bones), between 2 pubic bones
3) Hip joint: synovial joint (ball and socket), reinforced by 3 ligaments (iliofemoral, pubofemoral, ischiofemoral ligaments), innervated by femoral, obturator, sciatic and superior gluteal nerves

46
Q

Knee joint

A

Synovial joint (hinge type)

Largest joint in the body

Strengthened by 5 intrinsic ligaments/external ligaments (thickenings of fibrous joint capsule)

Cruciate ligaments/internal ligaments (intracapsular and extrasynovial)

Menisci

47
Q

5 intrinsic ligaments of the knee joint

A

All help strengthen knee joint and are thickenings of fibrous joint capsule

1) Patellar ligament
2) Fibular (lateral) collateral ligament (LCL)
3) Tibial (medial) collateral ligament (MCL)
4) Oblique popliteal ligament
5) Arcuate popliteal ligament

48
Q

Cruciate ligaments of the knee joint

A

Intracapsular and extrasynovial

1) Anterior cruciate ligament (ACL): weaker; from anterior intercondylar area of tibia to lateral condyle of femur; prevents posterior displacement of femur on tibia and hyperextension; when joint flexed at right angle, tibia can’t be pulled anteriorly because held by ACL
2) Posterior cruciate ligament (PCL): stronger; from posterior intercondylar area of tibia to medial condyle of femur; prevents anterior displacement of femur on tibia/posterior displacement of tibia, and hyperflexion

49
Q

Menisci of knee joint

A

Crescentic plates of fibrocartilage on articular surface of tibia

Shock absorbers that deepen articular surfaces of tibia where they articulate with femoral condyles

Medial meniscus attached firmly to MCL

Lateral meniscus

50
Q

Unhappy triad

A

Medial meniscus

MCL

ACL

“Clipping” injuries to the knee (hit knee from lateral side) involve these

51
Q

Blood supply to knee joint

A

10 vessels that form geniculate anastomosis

Includes branches of femoral artery, popliteal artery, anterior tibial artery

52
Q

Innervation of knee joint

A

Branches of femoral nerve, obturator nerve, tibial nerve, common peroneal nerve

53
Q

Muscles that attach at pes anserine (medial condyle of tibia)

A

Say Grace at Tea

Sartorius

Gracilis

Semitendonosus and Semimembranosus