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Anatomy Unit 4 > Gluteal Region, Posterior Thigh, & Hip Joint > Flashcards

Gluteal Region, Posterior Thigh, & Hip Joint Flashcards

1
Q

What is the fascial covering over the gluteal region and where is it thick / thin?

A

It is fascia continuous with the fascia lata of the thigh / Scarpa’s. It is thin over the gluteus maximus (gluteal fascia), but thick in the superior-lateral quadrant (gluteal aponeurosis)

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2
Q

What is the gluteal aponeurosis?

A

The thin fascia layer covering the gluteus medius muscle.

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3
Q

What nerves supply cutaneous innervation of the gluteal region and what spinal cord segments do they correspond to?

A

Superior / lateral - Superior cluneal nerves - dorsal rami L1-L3
Medial - Middle cluneal nerves - dorsal rami S1-S3
Inferior - Inferior cluneal nerves S1-S3

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4
Q

Where do the inferior cluneal nerves come from?

A

Posterior femoral cutaneous nerve

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5
Q

What are the muscles of the gluteal region involved in?

A

Extension, abduction, and medial / lateral rotation of the thigh

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6
Q

How does the sciatic nerve enter the gluteal region?

A

Exits the pelvis via the greater sciatic foramen, enters the gluteal region inferior to the piriformis muscle

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7
Q

How do the superior and inferior gluteal arteries course?

A

They are branches of the internal iliac artery
Posterior trunk gives superior gluteal, which enters superior to the piriformis muscle
Anterior trunk gives inferior gluteal, which enters inferior to piriformis muscle

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8
Q

What muscle passes through the greater sciatic foramen?

A

Piriformis muscle

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9
Q

What nerves pass through the greater sciatic foramen?

A
  1. Sciatic nerve
  2. Posterior femoral cutaneous nerve
  3. Nerve to obturator internus
  4. Nerve to quadratus femoris
  5. Pudendal nerve (to lesser)
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10
Q

What arteries pass through the greater sciatic foramen?

A

Superior + inferior gluteal, internal pudendal (bound for lesser sciatic foramen)

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11
Q

What muscle leaves the lesser sciatic foramen?

A

Obturator internus muscle

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12
Q

What are the origin, insertions, innervation, and action of the gluteus maximus?

A

Origin: Ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, and sacrotuberous ligament
Insertion: Gluteal tuberosity of femur and iliotibial tract
Innervation: Inferior gluteal nerve
Action: During walking, prevents forward trunk movement and controls flexion at hip during swing. Also brings thigh into extension.

Also stabilizes the knee joint via IT tract attachment, and laterally rotates thigh.

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13
Q

What are the origins of the gluteus medius and minimus muscles? Where do they both attach? What innervates them?

A

Gluteus medius: Ilium, Between posterior and anterior gluteal lines

Gluteus minimus: Ilium, between anterior and inferior gluteal lines

Attachment: Lateral and anterior surfaces respectively of greater trochanter of femur
Innervation: Superior gluteal nerve (along with TFL)

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14
Q

What are the actions of gluteus medius and minimus?

A

Thigh abduction, internal (medial) thigh rotation

During swing phase, contraction of these muscles on the stance side prevents pelvic drop due to thigh abduction at hip joint

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15
Q

What innervates the piriformis muscle?

A

Anterior rami of S1/S2

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16
Q

What two muscles does the nerve to obturator internus innervate?

A

Superior gemellus and obturator internus

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17
Q

What two muscles does the nerve to quadratus femoris innervate?

A

Inferior gemellus and quadratus femoris

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18
Q

What muscles are the external (lateral) rotators of the thigh at the hip joint?

A

Piriformis, superior gemellus, inferior gemellus, quadratus femoris, Obturator internus

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19
Q

What are the origin and insertion of the piriformis muscle?

A

Origin: Anterior surface of sacrum
Insertion: Greater trochanter of femur (lateral)

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20
Q

What are the origin and insertion of the obturator internus muscle?

A

Origin: Internal margin of the obturator foramen and inner surface of the obturator membrane
Insertion: Greater trochanter of femur (lateral)

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21
Q

What are the origin and insertion of the superior gemellus / inferior gemellus muscles?

A

Origins:
Superior - Ischial spine
Inferior - Ischial tuberosity

Insertion: Greater trochanter of femur and obturator internus tendon

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22
Q

What are the origin and insertion of the quadratus femoris?

A

Origin: Ischial tuberosity (with inferior gemellus)
Insertion: Quadrate tubercle (lateral) which is just below the greater trochanter

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23
Q

What spinal cord levels give rise to the sciatic nerve and where does it divide? How does it travel through the posterior thigh?

A

L4-S3. Typically divides into tibial and common fibular nerves at superior border of popliteal fossa, but this is HIGHLY variable

It travels thru the posterior thigh between the adductor magnus muscle and the hamstring muscles

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24
Q

Where does the posterior femoral nerve travel and what are its main branches?

A

Travels medial to sciatic nerve, superificially. It is a sensory-only cutaneous nerve supplying posterior thigh, popliteal region, and proximal posterior leg.

It comes from S1-S3. It’s branches include the inferior cluneal nerves supplying the inferior gluteal region

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25
Q

What segments give superior gluteal nerve and what is its course?

A

L4-S1. Only nerve to enter gluteal region superior to piriformis muscle. Travels between gluteus medius and minimus along with the deep branch of the superior gluteal artery!

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26
Q

What spinal cord levels give inferior gluteal nerve and what does it travel with?

A

L5-S2, travels with inferior gluteal artery, below the piriformis muscle

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27
Q

What spinal cord levels give nerve to obturator internus and where is it found?

A

Small branch found between posterior femoral cutaneous and pudendal nerves. L5-S2

28
Q

What spinal cord levels give nerve to quadratus femoris and where is it found?

A

L4-S1. Travels deep to lateral rotator muscles, you can locate the nerve by spreading scissors between inferior gemellus and quadratus femoris.

29
Q

What are the branches of the superior gluteal artery?

A

Superficial branch: Supplies gluteus maximus

Deep branch: Goes between gluteus medius and gluteus minimus to supply them. Travels with superior gluteal nerve

30
Q

What arteries supply gluteus maximus?

A

Superior and inferior gluteal arteries.

The muscle is only supplied by the inferior gluteal nerve.

31
Q

Where do the veins of the gluteal region ultimately drain?

A

They follow their arteries back to drain into the pelvic plexus of veins

32
Q

How does superficial vs deep lymphatic drainage differ in the gluteal region?

A

Deep: Follow gluteal vessels to internal iliac nodes
Superficial: Drain anteriorly into superficial inguinal nodes

33
Q

What articulation forms the hip joint and what is its design for?

A

Synovial joint for articulation between head of femur and acetabulum of pelvic bone.

Designed for stability and weight-bearing at expense of mobility

34
Q

What makes the superior and inferior rim of the hip joint?

A

Superiorly: Acetabular labrum
Inferiorly: Transverse acetabular ligament

35
Q

What is the acetabular foramen and what goes through it?

A

Gap between transverse acetabular ligament and the acetabular fossa which passes the ligament of head of femur.

Ligament of head of femur is soft, and carries artery of head of femur (branch of obturator artery)

36
Q

What happens to the artery of head of femur overtime?

A

It becomes more ineffective and less important

37
Q

What are the medial and lateral attachments of the fibrous hip joint capsule?

A

Medially: Margin of acetabulum, transverse acetabular ligament, margin of obturator foramen
Laterally: Intertrochanteric line, neck of the femur

38
Q

What three ligaments contribute to the formation of the fibrous joint capsule? Which is strongest? Why is the synovial membrane partially exposed?

A

Iliofemoral - strongest ligament in body

Pubofemoral -

Ischiofemoral - does not totally surround to intertrochanteric chest, exposing synovial membrane

39
Q

How do the ligaments of the hip joint work?

A

Flexion - relaxed
Extension - taut

They serve to prevent overextension of the femur

40
Q

How do intracapsular and extracapsular fractures differ?

A

Intracapsular - disrupt blood supply to femoral head, thus causing necrosis to head
Extracapsular - do not disrupt blood supply to the head

41
Q

What arteries supply the hip joint?

A

Superior + inferior gluteal arteries, medial + lateral circumflex femoral arteries, 1st perforating branch of deep artery of thigh

42
Q

What arteries form the cruciate anastomosis and what is its surgical significance?

A

Inferior gluteal artery, medial + lateral circumflex arteries, and 1st perforating branch of deep artery of thigh.

If you have to clamp the femoral artery at the level of the external iliac, blood can still reach the lower limb via the cruciate anastomosis.

Internal iliac -> inferior gluteal -> cruciate anastomosis -> descending lateral circumflex femoral -> geniculate collaterals above knee joint -> popliteal artery

43
Q

What are the muscles of the posterior thigh?

A
  1. Biceps femoris
  2. Semitendinosus
  3. Semimembranosus

They collectively form the hamstrings

44
Q

What is the origin, insertion, innervation, and actions of the biceps femoris?

A

Origin:
Long head - ischial tuberosity
Short head - Shaft of the femur

Insertion: Head of the fibula

Innervation:
Long head: Tibial div. sciatic nerve
Short head: Common fibular division sciatic nerve

Actions: Long head extends thigh and flexes leg. Short head only flexes leg. They also laterally rotate leg at knee joint.

45
Q

What is the origin, insertion, innervation, and actions of the semitendinosus muscle?

A

Origin: Ischial tuberosity
Insertion: Medial proximal tibia (contributes to pes anserinus with gracilis and sartorius)
Innervation: Tibial division of sciatic nerve
Actions: Extends thigh and flexes leg, can medially rotate at knee joint

46
Q

What is the origin, insertion, innervation, and actions of the semimembranosus muscle?

A

Origin: Ischial tuberosity
Insertion: Medial condyle tibia (forms oblique popliteal ligament of knee joint)
Innervation: Tibial division of sciatic nerve
Actions: Extends thigh and flexes leg. Can medially rotate leg at knee jiont

47
Q

How can the semitendinosus and semimembranosus be distinguished?

A

Semitendinosus - contributes to pes anserinus by having a distal cord-like tendon

Semimembranosus - has a proximal membrane-like tendon

48
Q

What forms the anterior boundary of the posterior thigh compartment?

A

Hamstring portion of the adductor magnus muscle.

49
Q

Where does the posterior cutaneous nerve of the thigh travel in relation to the sciatic nerve?

A

Medial to the sciatic nerve, before travelling superficially to innervate the skin of the posterior thigh

50
Q

What artery supplies the posterior thigh compartment?

A

Perforating branches from the deep artery of the thigh which travel through the adductor magnus muscle from the anterior thigh compartment.

51
Q

What are the contents of the popliteal fossa from superficial to deep?

A

Tibial / common fibular nerves,
Popliteal vein
Popliteal artery
Popliteus muscle and posterior joint capsule of knee

52
Q

What are the muscles of the popliteal fossa superomedially, superolaterally, inferomedially, inferolaterally, and at the floor?

A

Superomedial - insertions of semitendinosus + semimembranosus muscles
Superolateral - Insertion of biceps femoris muscle
Inferomedial - origin of medial head of gastrocnemius muscle
Inferolateral - origin of lateral head of gastrocnemius muscle and plantaris muscle
Floor - Popliteus muscle

53
Q

What happens to the two nerves that split from the sciatic above the popliteal fossa?

A

Tibial - Passes deep to plantaris muscle and gastrocnemius, innervates posterior leg compartment

Common fibular - parallels biceps femoris tendon, passes superficial to the plantaris muscle and lateral head of the gastrocnemius. Travels toward the lateral and anterior compartments of the leg

54
Q

What arteries branch off the popliteal artery in the popliteal fossa?

A

Superior and inferior geniculate branches, medial and lateral - 4 total

They wrap around and form anastomoses around the knee joint which will communicate with descending branch of lateral circumflex femoral

55
Q

What does the popliteal artery become distally?

A

Enters the posterior leg compartment with the tibial nerve to supply the posterior leg compartment

56
Q

What becomes of the popliteal vein and what drains into it?

A

It is called the posterior tibial vein distal to the popliteal fossa.

Receives blood from small saphenous vein near the inferior border of the popliteal fossa

57
Q

What happens to the great saphenous vein?

A

Travels in the skin behind the knee joint on the medial side but does not enter the popliteal fossa.

58
Q

What is the lymphatic drainage around the popliteal fossa?

A

Popliteal lymph nodes are located around where popliteal vein receives small saphenous vein. These drain the superficial and deep structures of the leg into the deep and superficial inguinal nodes

59
Q

What is one possible complication of a high splitting sciatic nerve?

A

Common fibular nerve sometimes emerges from the middle of the piriformis muscle. This could result in leg pain and weakness of leg muscles innervated by the common fibular nerve (anterior and lateral compartments of leg, short head of biceps femoris)

60
Q

Where are intramuscular gluteal injections made?

A

In the gluteus medius muscle, superior lateral quadrant. This is to avoid the sciatic nerve

61
Q

What is an eccentric contraction and how does it relate to injury?

A

Muscle contraction during lengthening (load exceeds force)

It is the cause of strains and tears, when you have to contract when the muscle was previously stretched by a load

62
Q

What causes hamstring strain commonly?

A

Sprinting - knee is extended and the you land on it, forcing hamstring to flex and push off the extended leg.

63
Q

What causes gluteal strain commonly and what is a hallmark symptom?

A

Running, explosive jumps, or loaded squats / lunges. You will have difficulty resisting thigh flexion so the patient would extend their back to compensate.

64
Q

What is the Trendelenburg sign?

A

Nerve lesion which appears due to superior gluteal nerve injury. You will have pelvic drop from lack of hip abduction for the stance leg during walking (contralateral side droops due to those muscles on ipsilateral side not working).

Patient compensates by lurching the trunk towards the affected side.

Make them stand on one leg to confirm

65
Q

What is antalgic gait?

A

Abnormal gait to avoid pain - Lurching towards affected side due to pain, but will not be associated with pelvic drop when standing on one leg

Anatomy Unit 4 (10 decks)

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