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Gluteal Region & Pelvis Flashcards

1
Q

Shape of pelvic inlet

A

Females: oval shaped
Males: heart shaped

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2
Q

Shape of pelvic outlet

A

Females; round (facilitate childbirth)

Males: oblong/oval

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3
Q

Subpubic angle

A

Males: very narrow, ~30 degrees (approximate with “peace fingers)
Females: much larger angle (approximate with thumb and forefinger)

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4
Q

General gender differences in pelvis

A

Females have a wider, shorter pelvis

Males have thicker bones, narrower and taller pelvis

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5
Q

What is the Q angle?

A

Angle between vertical bisection of tibial tuberosity and the ASIS to midpoint of patella line.
Q-angle is affected by shape of pelvis, is ~16 degrees in females and ~11 degrees in males.
*Males have a smaller Q angle

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6
Q

Clinical correlation with Q angle

A

Larger Q angles (especially in genu valgum) can be associated with patellar dislocation
Some foot orthotics can decrease the Q angle

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7
Q

Posterior sacroiliac ligament has ___ fibers, Anterior sacroiliac ligament has ___ fibers

A

Long; short

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8
Q

Which ligament separates the greater and lesser sciatic foramen?

A

Sacrospinous ligament

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9
Q

What ligament goes from the sacrum to the ischial tuberosity?

A

Sacrotuberous ligament

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10
Q

What is in between the sacrospinous and sacrotuberous ligament?

A

the lesser sciatic foramen

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11
Q

What nerve lies in the lesser sciatic foramen?

A

Pudendal n

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12
Q

How many vertebrae in sacrum?

A

~ 5 fused together

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13
Q

Auricular surface

A

sacrum and iliac articulation

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14
Q

Median sacral crest

A

formed from spinal processes

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15
Q

Articular crest

A

formed from articular spinous processes

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16
Q

Lateral sacral crest

A

formed from transverse spinous processes

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17
Q

What 3 bones fuse around puberty?

A

Ilium, ishium, and pubis

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18
Q

The acetabulum consists of

A

the body of each of the ilium, ishium, and pubis (1/3 of each)

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19
Q

What is the Ala?

A

(wing) of the ilium

Iliac fossa is medially and dorsum illi is laterally

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20
Q

Between which bones is the greater sciatic notch?

A

the ilium and the ischium

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21
Q

ASIS is origin of what?

A

Sartorius
Iliacus
Tensor Fascia Lata
Inguinal Lig

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22
Q

AIIS is origin of what?

A

Iliofemoral ligament
Straight head of the Rectus Femoris
Part of the Iliacus

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23
Q

PSIS attachments

A

Posterior sacroiliac ligaments

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24
Q

Anything behind posterior gluteal line is going to be origin of?

A

gluteus maximus

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25
Between posterior and anterior gluteal line is
gluteus medius origin
26
between anterior and inferior gluteal line is where
gluteus minimus originates
27
Origins from ischial tuberosity (7)
``` Semimembranosus Long head of biceps femoris Semitendinosus Adductor magnus Quadratus femoris Inferior gemilus Sacrotuberous ligament ```
28
Ischial ramus attachments
Adductor magnus | Obturator internus
29
Body of Pubis attachments
Gracilis Adductor Longus Adductor Brevis
30
Superior pubic ramus attachments
Pectineus
31
Inferior pubic ramus attachments
Gracilis Adductor Brevis Adductor Magnus Obturator Externus
32
Where is the obturator groove and what runs in it?
Runs inferior to the superior pubic ramus/body of the pubis | Obturator nerve and artery run in the groove
33
Psoas major
Actions: flexes hip, flexes lumbar spine (bending over), spinal flexion (left and right) Origin: vertebrae inserts: lesser trochanter of femur Innervated: L2-L3
34
Psoas minor
Action: synergistic with major, spinal flexion (left and right tilt) Origin: upper lumbar vertebrae insertion: iliopectineal eminence and iliac fossa innervated: L1
35
Iliacus
Action: hip flexion Origin iliac fossa insertion: lesser trochanger of femur (along with psoas) innervated: L2-L4 *note inserts same as psoas major and becomes iliopsoas
36
What are the muscles of the iliac region?
Psoas major, psoas minor, iliacus
37
Gluteus maximus
Origin: posterior side of the ilium and part of the sacrum/coccyx Inserts: deep fibers on the gluteal tuberosity of the femur, iliotibial tract action: extend and laterally rotate the leg (rising from sitting) innervation: inferior gluteal nerve, L5-S2
38
Tensor fasciae latae
origin: iliac crest near ASIS inserts: broad fascia, iliotibial tract action: hip flexion, medial rotation of thigh innervation: superior gluteal n (also supplies glut. med & min.) L4-S1
39
Gluteus medius
origin: between posterior and anterior gluteal lines, ilium insertion: great trochanter of the femur action: abductor of thigh and medially rotate extended thigh, stabilizes hip in locomotion and balance innervation: superior branch of superior gluteal n
40
what is piriformis syndrome?
when piriformis and gluteus medius fuse... makes it difficult to walk
41
gluteus minimus
origin: ilium between anterior and inferior gluteal lines inserts: on greater trochanter of femur (near medius) action: synergist of medius. Abductor of thigh, medially rotates extended thigh, important in hip balance and locomotion innervation: superior gluteal nerve, L4-S1
42
Piriformis
Attached to gluteus medius or receives fibers from superior gemilus. May be pierced by sciatic n. origin: anterior portion of sacrum inserts: greater trochanter of femur Action: laterally rotates thigh or abducts a flexed hip, hip extension innervation: S2, some fibers from S1
43
Obturator internus
Inside of obturator foramen, inside of pelvic bowl, wraps around ischium to insert on greater trochanter femur. Looks like a white tendon. Action: synergist to piriformis; lateral hip rotation, abduction of flexed thigh, hip extension innervation Nerve to obturator internus, L5-S1 (NOT the obturator n)
44
Superior gemellus
often small, sometimes absent. origin: ischial spine insert: greater trochanter of femur action: lateral rotation of thigh innervation: nerve to obturator internus, L5-S1
45
inferior gemellus
same action and insertion as superior gemellus origin: ischial tuberosity innervated: nerve to quadratus femoris, L5-S1
46
Quadratus femoris
origin: ischial tuberosity inserts: linea quadrata of femur action: adduct and laterally rotate hip innervation: nerve to quadratus femoris, L4-S1
47
Obturator externus
Found directly opposite of obturator internus. It is on outside ofpelvis. Complete synergist with quadratus femoris - adduct and laterally rotate hip. Origin: ischium and pubis (external part of obturator foramen) insertion: trochanteric fossa innervation: posterior division of the obturator nerve (this one IS innervated by the obturator nerve) L2-L4
48
What are the muscles of the gluteal region?
``` Gluteus maximus Tensor fasciae latae Gluteus medius Gluteus minimus Piriformis Obturator internus Superior gemellus Inferior gemellus Quadratus femoris Obturator externus ```
49
Sacral plexus
Part of L4 L5, S1, S2, S3 Part of S4
50
Coxygeal plexus
Part of S4 | S5
51
What is the Nervus Furcalis?
"forked nerve" L4 **know this
52
Lumbar plexus
Part of T12 L1, L2, L3 Part of L4
53
Lateral femoral cutaneous innervates?
lateral compartment
54
Femoral n innervates?
anterior compartment
55
Obturator n innervates?
obturator externus and medial compartment
56
Posterior division of the sacral plexus
Superior gluteal L4-S1 Inferior gluteal L5-S2 Nerve to Piriformis S2 (occasionally S1
57
Superior gluteal n
L4-S1 Branches: splits after greater sciatic foramen Superior branch: goes deep to gluteus medius Inferior branch: goes to gluteus minimus, medius, and tensor fasciae latae
58
Inferior gluteal n
L5-S2 | Gluteus maximus
59
Nerve to Piriformis
S2 (occasionally S1) | Piriformis
60
What nerve is the posterior division of the sciatic?
Common peroneal
61
What nerve is the anterior division of the sciatic?
Tibial n
62
Anterior division of the sacral plexus
Nerve to Quadratus femoris L4-S1 Nerve to Obturator internus L5-S2 Pudendal
63
Which nerve runs parallel to sciatic?
Posterior femoral cutaneous (mix of anterior/posterior divisions) S1-S3
64
The superior gluteal n is superior to what m?
Piriformis Superior gluteal n always comes out above the piriformis, the inferior gluteal n always comes out below it
65
Branches of External Iliac artery?
Aberrant obturator | Deep circumflex iliac
66
Branches of internal iliac artery?
``` Iliolumbar Lateral sacral Obturator Superior gluteal Inferior gluteal Internal pudendal ```
67
What muscles does the iliolumbar artery supply?
Iliacus and psoas major
68
What muscle does the lateral sacral artery supply?
Piriformis
69
Which artery goes to all the (superficial) gluteal muscles?
Superior gluteal a | goes to gluteus minimus, medius, with some branches to maximus and tensor fasciae latae
70
What artery goes to the femoral head?
Obturator a. It travels with obturator n. It is important in children during ossification.
71
Inferior gluteal artery goes where?
to gluteus maxiums and sometimes branches to piriformis
72
Important sensory sacral plexus spinal cord levels
``` Medial thigh, proximal to distal: L1-L3 Medial leg: L3, L4 *Big Toe: L4 *Digits 2,3,4: L5 *Little Toe: S1 Lateral leg: L5, S1 Lateral thigh, proximal to distal: L1-L5 Posterior thigh: S1,S2 ```
73
Patellar Ligament reflex
L4 | four quadriceps muscles
74
Extensor digitorum and Hallucis longus
L5 | five toes
75
Calcaneal tendon reflex
S1 | Achille's 1 weak spot
76
Plantar reflex
Babinski sign - normal in babies (up to ~4 years old) if positive in adult problem with corticospinal tract
77
What are the variations in the sciatic nerve orientation?
Can emerge under piriformis Can pierce piriformis Can emerge above piriformis
78
Where should injections be done on the gluts?
Laterally and superiorly to avoid the sciatic
79
Trendelenburg sign
unaffected side drops down

Lower Limb Written (3 decks)

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