Gluteal Region/Thigh Flashcards
boundaries of gluteal region
superior- iliac crest
inferior - gluteal fold
laterally - greater trochanter
medially - intergluteal cleft
*covered by thick layer of fascia
greater and lesser sciatic foramina
formed by greater and lesser sciatic notches, sacrotuberus,
and sacrospinous II
transmits muscles, nerves, arteries and veins from pelvis to gluteal region and gluteal region to pelvis1
hip joint type
synovial , ball and socket
articulations of hip joint
head a femur and acetabulum
movements of hip joint
flexion/extension , ADD/ABD, MR/LR, circumduction
acetabular labrum
attached to margin of acetabulum
increases articular area
hip extension
winds spiraling ll. tightly
pulls femoral head into acetabulum
limits extension
hip flexion
unwinds spiraling ll.
permits considerable flexion
transverse acetabuluar l.
continuation of acetabular labrum
bridges acetabular notch
most common type of hip dislocation
posterior
causes of hip dislocation
most commonly car accidents
limb position when hip dislocation happnes
flexed, ADD, and MR
knees strike dash
femoral head in hip dislocation
head is pushed out of acetabulum
limb position after hip dislocation
semi flexed and MR
sciatic nerve in hip dislocation
weakness/paralysis of hamstrings and everything distal to knee
sensation loss in dislocation of hip
posterolateral leg and much of foot
anterior dislocation of hip
result from violent injury
limb forced into extension, ABD and LR
femoral head in anterior hip dislocation
inferior to acetabular margin
femoral n. in anterior dislocation of hip
weakness/paralysis to sartorius and quadriceps mm
sensation in anterior dislocation of hip
medial leg and foot
what muscles exit the greater sciatic foramen? lesser?win
piriformis/ obturator internus m
do ligaments of hip wind of unwind with extension?
wind
what direction of hip dislocation is most common
posterior
what nerve might be damaged with posterior dislocation of hip? anterior?
sciatic/ femoral
superficial layer of gluteal muscles
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae (located anteriorly but innervated by superior gluteal n)
deep layer of gluteal muscles
*lateral rotators
piriformis
gemellus superior
obturator internus
gemellus inferior
obturator externus
quadratus femoris
gluteus maxiumus
covers other gluteal muscles
moves superiorly when sitting (sit on ischial tuberosity)
actions of gluteus maximus
extension of thigh
LR of thigh
extension of trunk
innervation of gluteus maxiumus
inferior gluteal n.
gluteus medius
palpable just inferior to iliac crest posteriorly
gluteus medius actions
ABD of thigh
MR of thigh
keeps pelvis level when ipsilateral leg is weight bearing and unsupported side is in swing phase
gluteus medius innervation
superior gluteal n.
gluteus minimus
deep to gluteus medius
has shiny white fan shaped tendon
actions of gluteus medius
ABD of thigh
MR of thigh
keeps pelvis level when ipsilateral leg is weight bearing and unsupported side is in swing phase
gluteus minimus innervation
superior gluteal n.
tensor fascia latae
located more anteriorly
enclosed between layers of fascia lata
actions of tensor fascia latae
flexion of thigh
ABD of thigh
MR of thigh
helps knee extend by tensing IT band
tensor fascia latae innervation
superior gluteal n.
piriformis
has intra and extrapelvic parts
exits greater sciatic foramen
piriformis superior and inferior vasculature
pass above and below this muscle respectively
*other contents leaving GSF exit below
piriformis actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
innervation of piriformis
ventral rami S1 and S2
gemellus superior
*sometimes absent
acts as extrapelvis reinforcement of obturator internus m
gemellus superior action
LR of extended thigh
ABD of flexed thigh
steadies femoral head
gemellus superior innervation
N. to obturator internus
obturator internus
triceps coxae formed by this muscle and gemelli
fills gaps between piriformis and quadratus femoris
incapable of independent action
path of obturator internus
leaves pelvis via lesser sciatic foramen
makes 90 degree turn inferior to ishcial spine
obturator internus actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
obturator internus innervation
N to obturator internus
gemellus inferior
also serves as extrapelvic reinforcement of obturator internus m
gemellus inferior actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
gemellus inferior innervation
N. to quadratus femoris
obturator externus (not on lab exam)
obturator canal opens superiorly to this
deep in superomedial part of thigh
obturator externus path
tendon passes under acetabulum and neck of femur
visible deep to quadratus femoris
obturator externus actions
LR of thigh
steadies femorial head
innervation of obturator externus
obturator n.
quadratus femoris
inferior to inferior gemellus
sciatic nerve lies over it
may look small depending on how thigh is rotated
quadratus femoris actions
LR of thigh
steadies femoral head
quadratus femoris innervation
N. to quadratus femoris
superior gluteal n. VPR
VPR L4-S1
superior gluteal n. innervates
gluteus medius
gluteus minimus
tensor fascia latae
inferior gluteal n. VPR
VPR L5- S2
inferior gluteal n. innervates
gluteus maximus
sciatic n. VPR
VPR L4-S3
sciatic n. innervates
nothing in gluteal region
what two nerves is the sciatic nerve?
common fibular
tibular
N to quadratus femoris VPR
N to quadratus femoris VPR
VPR L4-S1
N to quadratus femoris innervates
gemellus inferior
quadratus femoris
N to obturator internus orgin
VPR L5-S2
N to obturator internus innervates
gemellus superior
obturator internus
pudendal n. orgin
VPR S2- 4
pudendal n. innervates
nothing in gluteal region
leaves GSF and enters LSF
injury to superior gluteal n. caused by
pelvic fracture
wound to gluteal region
compression by fetal head
injury to superior gluteal n. muscles impaired
gluteus minimus and medius
injury to superior gluteal n. sign
Positive Trendelenburg Sign
when asked to stand on one leg pelvis descends on unsupported side
tilts toward undamaged side
indicates mm on supported side are weakened or not fully functional
results of injury to superior gluteal n.
gluteal gait - list of body to weakened side; raises pelvis and allows foot room to clear ground
cause of injury to sciatic nerve
intragluteal injections
posterior dislocation of hip
muscles affected in injury to sciatic nerve
hamstrings
all muscles of leg and foot
* would maintain extension of leg (femoral nerve), rest of leg useless
sensory loss in injury to sciatic nerve
all areas below knee (exception medial leg and foot - saphanous n.)
sciatica
compression of sciatic nerve or related roots
causes of sciatica
piriformis syndrome (muscle pinches
spinal tumors/injections
pregnancy
lumbar herniated discs
lumbar spinal stenosis
symptoms of sciatica
may be mild or intense
shooting pain - lower back, gluteal region, thigh, leg and foot
severe symptoms can make walking or standing difficult
what muscles of the gluteal regions MR the thigh?
gluteus medius and minumus
if your standing on your left leg which gluteus med and min are contracting to keep pelvis level
left side
which nerves pass through gluteal region but dont innervate anything
sciatic and pudendal
fascia lata
forms IT band laterally
from ilia tubercle to anterolateral tibial tubercle (gerdy’s tubercle)
fascia latta compartments
3 intermuscular septa which extend centrally to femur
3 compartments - anterior, posterior, medial
posterior compartment of thigh muscles
semimembranosus
semitendinosus
biceps femoris
joints crossed by muscles of posterior thigh
hip and knee
what is the common origin of the muscles of the posterior thigh muscles
ischial tuberosity (pulled hamstring usually happens here)
common innervation of posterior compartment of thigh
majority by tibial division of sciatic n. (except short head of biceps femoris)
common functions of muscles of posterior compartment of thigh
extension of hip
flexion of leg
semitendinosis
“true hamstring” attaches at ischial tuberosity
distal part has cord like tendon (hence name)
actions of semitendinosis m
extension of thigh
flexion of leg
MR of leg when knee is flexed
innervation of semitendinosis
tibial division of sciatic n.
semimembranosus
true hamstring
flattened membranous proximal attachment
actions of semimembranosus
extension of thigh
flexion at knee
MR of leg when knee is flexed
innervation of semimembranosus
tibial division of sciatic n.
biceps femoris heads
long head-crosses hip and knee
short head( most lateral) - crosses knee
biceps femoris long head
only long head is true hamstring
covers sciatic nerve
biceps femoris actions
extension of thigh - long head only
flexion of leg - both heads
LR of leg when knee is flexed - both
biceps femoris innervations
long head- tibial division of sciatic n.
short head - common fibular division of sciatic nerve
hamstring injuries common in
those that kick or run hard
inadequate warm up
most common torn in hamstring
semimembranosus
causes of hamstring injuries
violent muscular extension may tear proximal part of hamstrings from ischial tuberosity
what could result in avulsion of ischial tuberosity
forcible flexion of hip with knee extended (proximal part of biceps femoris and semitendinosis)
hamstring injury damage
bruising(contained by fascia lata) and tearing of muscle
innervation of posterior compartment of thigh
sciatic and post femoral cutaneous
sciatic nerve origin
VPR L4-S3
sciatic nerve divisions
tibial - L4-S3; semibranosus, semitendinous, long head of biceps femoris and hamstring portion of adductor magnus
common fibular - L4 -S2: supplies short head of biceps femoris
posterior femoral cutaneous n origin
VPR S1- S3
posterior femoral cutaneous n, innervates
skin over posterior thigh and popliteal fossa
posterior femoral cutaneous n. AKA
posterior cutaneous nerve of thigh
the it band is a thickening of what fascia
fascia lata
what actions would be affected by avulsion of ischial tuberosity
extension of thigh
flexion of knee
where is sciatic nerve located?
deep to biceps femoris long head
anterior compartment of thigh muscles
pectineus
iliospsoas
sartorius
quadriceps femoris
pectineus
between ant and post compartments of thigh
forms part of floor of femoral triangle
actions of pectineus
ADD of thigh
flexion of thigh
innervation of pectineus
femoral n.
may receive branch from obturator n.
iliopsoas
chief flexor of thigh
forms part of floor of femoral triangle
iliopsoas composition
ilicaus and psoas major
iliopsoas actions
flexion of thigh or trunk
stabilize hip joint
iliopsoas innervations
iliacus - femoral n.
psoas major -VPR L1 - L3
sartorius m.
tailors muscle
forms border of femoral triangle
sartorius m. joints crossed
hip and knee
sartorius m. permits
crossed knee flexion
sartorius m. actions
ABD of thigh
LR of thigh
flexion of thigh
flexion of leg
MR of leg when knee is flexed
pes anserinus
gooses foot
3 muscles from 3 compartments insert here
rectus femoris joints crossed
hip and knee
rectus femoris actions
flexion of thigh
extension of leg (limited when thigh is flexed)
steadies hip joint
rectus femoris innervation
femoral n.
vastus muscles joints crossed
just knee
vastus muscles
vastus lateralis, vastus intermedius,vastus medialis
vastus muscles action
extension of leg
vastus muscles innervation
femoral n.
vastus lateralis
deep to IT band
vastus intermedius
deep to rectus femoris
vastus medialis
forms part of adductor canal
medial compartment of thigh muscles
adductor longus
adductor brevis
adductor magnus
gracilis
obturator externus
medial compartment of thigh common innervation
obturator n.
medial compartment of thigh common function
ADD of thigh
adductor longus
most anterior of adductors
forms border of femoral triangle
covers anterior aspects of adductor brevis and magnus
adductor longus action
ADD of thigh
adductor longus innervation
obturator n.
adductor brevis
deep to adductor longus
2 division of obturator n pass anterior and posterior to this muscle
adductor brevis actions
ADD of thigh
limited flexion of thigh
adductor brevis innervation
obturator nerve
adductor magnus
largest most powerful and most posterior of ADD group
adductor magnus parts
adductor - horizantal
hamstring-vertical
adductor magnus actions
ADD of thigh
adductor part - flexes thigh
hamstring part - extends thigh
adductor magnus innervation
adductor part - obturator n.
hamstring part - tibial division of sciatic n.
adductor hiatus
opening between parts of adductor magnus
transmits femoral a./ v. to and from adductor canal, to and from popliteal fossa
gracilis joints crossed
hip and knee
gracilis actions
ADD of thigh
flexion of leg
MR of leg
gracilis innervation
obturator n
groin pull indivduals affected
quick starts
hockey, baseball, sprinting
groin pull types of injuries
strains
stretching and tearing of proximal attachments in medial thigh
muscles involved in groin pull
adductor muscles
most commonly adductor longus
femoral a path
direct continuation of external iliac a. distal to inguinal ligament
passes through femoral triangle lateral to femoral
one of 4 places to take pulse
femoral a,
femoral a. branches
profunda femoris (deep a of thigh)- supplies perforating aa. to posterior thigh
termination of femoral a.
becomes politeal a. as traverse adductor hiatus
femoral v.
continuation of popliteal v. as it goes through adductor hiatus
great saphenous v.
greatest tributary
great saphenous v. path
arises from medial aspect of dorsal venous arch of foot
ascends ant to medial maleolus
passes posterior at medial femoral condyle
found in subcutaneous tissue of medial thigh
traverses saphenous opening (hiatus)
drains into femoral v
saphenous vein grafts uses
CABG (used to bypass blocked arteries)
veins are inverted as to not block blood flow
readily accesible
usable lengths to be harvested
walls contain higher number of muscular and elastic fibers
femoral n. origin
posterior division of VPR L2-4
located in femoral triangle lateral to femoral a.
femoral cauda equina
collective term for numerous branches of femoral n.
femoral n. innervates
anterior compartment of thigh
sensory to anterior thigh and anteromedial leg
femoral n. branches
saphenous n. - runs in adductor canal
- bypasses adductor hiatus
- doesn’t supply anything in thigh
obturator n. origin
anterior division of VPRL2- 4
obturator n. exits pelvis via
obturator canal
obturator n. innervates
adductor compartment mm.
obturator externus
adductor part of adductor magnus
sensory:skin of medial thigh just above knee
lateral femoral cutaneous n.
VPR L2-3
supplies skin of anterior and lateral thigh
femoral branch of genitofemoral n,
VPR L1-2
supplies skin over lateral femoral triangle
ilioinguinal n.
VPR L1
supplies skin of inguinal region
injury to femoral n. causes
pelvis fracture
psoas absess
gunshot of penetrating wound
injury to femoral n. muscles affected
anterior compartment of thigh
injury to femoral n. sensory loss
anterior and parts of medial thigh
anteriomedial leg and foot (saphenous n.)
injury to femoral n. function affected
weakened flexion of hip
loss of leg extension
diffculty walking up stairs/ uphill (person will push into thigh to force knee into extension)
which quadriceps femoris cross hip and knee
rectus femoris
what medial thigh muscle crosses hip and knee
gracilis
where is adductor hiatus
inferior portion of adductor magus
contains femoral a./v. become popliteal a./v on when through
femoral triangle borders
superior- inguinal ligament
medial border- adductor longus
lateral border -sartorius
floor - pectineus, ilospsoas
roof -skin/fascia
femoral triangle contents
femoral N -> A-> V
retro inguinal space
deep to inguinal ligament
2 compartments formed by iliopectenal arch
from inguinal l. to iliopubic eminence
retro inguinal space lateral compartment
outside femoral sheath
ilispsoas and femoral n. (femoral n does not sit in femoral sheath - outside)
retro inguinal space medial compartment
encloses femoral sheath
femoral a.
femoral v.
femoral canal - deep inguinal lymph nodes/vessels
area of lymphatics in femoral sheath is weak so
site for hernias
femoral seath
funnel shaped fascial tube
terminates inferiorly by blending with adventitia of femoral vessels
enclosed proximal parts of femoral vessels and makes femoral canal medial to them
femoral sheath compartments
lateral - femoral a.
intermediate - femoral v.
medial - femoral canal - lymph nodes
femoral canal location
between medial edge of femoral canal and femoral v.
extends to level of saphenous opening
purpose of femoral canal
allows for venous expansion
temporary stasis
increases venous return from lower limb
contents of femoral canal
loose connective tissue and lymphatic
base of femoral canal
femoral ring(small opening at proximal end of canal)
adductor hiatus
opening between distal attachements of 2 adductor magnus parts
location of adductor hiatus
lateral and superior to adductor tubercle
contents of adductor hiatus
Femoral a.v. to/from adductor canal to/from popliteal fossa
does NOT contain saphenous vein
femoral hernias more common in
females (wider pelvis)
femoral hernias
protrusion of abdominal viscera through femoral ring (passes through femoral canal
location of mass of femoral hernias
femoral triangle and inferolateral to pubic tubercle
femoral hernias boundaries
femoral v. laterally, lacunar l. medially, inguinal l. superiorly
how can femoral hernias enlarge
pass through saphenous hiatus into thigh
risk of femoral hernias
strangulation (necrotic)
