Gluteal, Thigh, & Popliteal Fossa Learning Objectives

Question 1

Explain the organization of the fascia lata and its thickening, the iliotibial tract.

Answer 1

Fascia lata

• extension of inguinal ligament
• iliotibial tract (insertion of TFL & glute max)
• lateral intermuscular septum (separates ant/post compartments)
• medial intermuscular septum (separates ant/middle compartments)
• saphenous opening (great saphenous v. travels through here to meet femoral v.)

THICKENING?

Question 2

Describe the fascial compartments of the thigh and list their contents, general actions, innervation, and blood supply.

Answer 2

Anterior compartment:

• hip flexors, knee extensors
• femoral n. (exception: TFL via superior gluteal n.)

Posterior compartment:

• hip extensors, knee flexors
• sciatic n.

Medial compartment:

• thigh adductors
• obturator n./a. (exception: adductor magnus via sciatic n.)

BLOOD SUPPLY?

Question 3

Name the boundaries and contents of the femoral triangle.

Answer 3

Borders:

• inguinal ligament
• adductor longus
• sartorius

Floor:

• iliopsoas
• pectineus

Contents:
- femoral n./a./v. (typical pattern)

Question 4

Name the structures that pass through the greater sciatic foramina.

Answer 4

Contents:
Piriformis
Sciatic n.
Posterior femoral cutaneous n.
Superior gluteal n./a./v.
Inferior gluteal n./a./v.
Internal pudendal a./v.
Pudendal n.

Question 5

Name the structures that pass through the lesser sciatic foramen.

Answer 5

Contents:
Obturator internus
Internal pudendal a./v.
Pudendal n.

Question 6

Explain what a Trendelenburg gait looks like and what structures are impaired in this condition.

Answer 6

Hip abductor weakness

Small gluteal muscle weakness:
- Pelvis tilts up and away on affected side (sags down on opposite side).

• Duchenne’s limp (pelvis position maintained, shifted center of gravity of upper body)

Could be caused by disc herniation affecting superior gluteal n. (L4, 5, S1)

See video example.

Question 7

Name the contents of the femoral sheath.

Answer 7

• continuation of iliacus and transversalis fascia
• inferior to inguinal ligament
• is not part of the fascia lata

Contents:

• femoral a.
• femoral v.
• femoral canal

Question 8

Describe the typical blood supply of the head and neck of the femur and how this changes with age.

Answer 8

Children (<10 years old)
- Primary arterial supply is the obturator a.

Adults
- Primary supply becomes the medial circumflex femoral a.

Question 9

Describe the locations where one would take the femoral pulse.

Answer 9

Between ASIS and pubic symphysis with hip in slightly flexed position.

Question 10

Name the primary motions that occur at the joints of the hip, thigh, and knee.

Answer 10

Hip

• flexion
• extension
• medial rotation
• lateral rotation

Thigh

Knee

• flexion
• extension

Question 11

Sacrotuberous ligament

Answer 11

attachments- from posterior iliac spine & lateral margin of the sacrum to the ischial tuberosity

Question 12

Sacrospinous ligament

Answer 12

attachments- from the ischial spine to lateral margin of the sacrum

Question 13

Fibrous joint capsule of hip

Answer 13

attachments- from the margin of the acetabulum to the neck, intertrochanteric line (anterior) & intertrochanteric crest (posterior) of the femur

Question 14

Iliofemoral ligament

Answer 14

attachments- from the anterior inferior iliac spine to the intertrochanteric line of the femur

function- limits extension of thigh at the hip joint

(capsular ligament)

Question 15

Pubofemoral ligament

Answer 15

attachments- from the iliopubic eminence and superior pubic ramus to the fibrous capsule

function- limits abduction of the femur

Question 16

Ischiofemoral ligament

Answer 16

attachments- from the ischium posterior to the acetabulum to the greater trochanter & iliofemoral ligament

function- assists the iliofemoral lig. in limiting extension of the femur

Question 17

Ligament of the head of femur (ligamentum teres)

Answer 17

attachments- from the fovea of the femoral head to the acetabular notch

Question 18

Transverse acetabular ligament

Answer 18

attachments- interconnects the margins of the acetabular notch

Question 19

Identify the ligaments that are closely applied to joint capsules (thickening of joint capsules).

Answer 19

Iliofemoral “Y” ligament

• Can hold the body weight balanced over the femoral heads
• largest/strongest/thickest

Ischiofemoral ligament

Pubofemoral ligament

Ligamentum teres

All of the capsular ligaments at the hip become taut during extension (spiral wrapping)

Question 20

Sacroiliac joint, synovial classification

Answer 20

plane

Question 21

Pubic symphysis, joint classification

Answer 21

secondary cartilaginous

Question 22

Hip, synovial classification

Answer 22

ball and socket