Glutes, Thigh, Popliteal Fossa Flashcards
What kind of joint is the sacroiliac?
plane
What kind of joint is the tibiofemoral?
bi-condylar
What kind of joint is the proximal tibiofibular?
plane
What kind of joint is the Distal tibiofibular?
syndesmosis
What kind of joint is the Talocrural?
ginglymus or hinge
What kind of joint is the Subtalar?
plane
What kind of joint is the Tarsometatarsal?
plane
What kind of joint is the Metatarsophalangeal?
ellipsodial
What kind of joint is the Interphalangeal?
ginglymus or hinge
Iliacus (part of the Iliopsoas L1-4)
ATTACHMENTS- from iliac fossa, iliac crest, sacral ala & sacroiliac ligaments to lesser trochanter of femur
ACTIONS- flexes and stabilizes the hip joint
INNERVATION- femoral nerve
L2-4
Psoas major (Part of the Iliopsoas L1-4)
ATTACHMENTS- from anterior transverse processes, vertebral bodies & discs (T12-L5) to the lesser trochanter of femur
ACTIONS- flexes and stabilizes the hip joint
INNERVATION- ventral rami L1-4 (from lumbar plexus)
Rectus femoris L2-4
ATTACHMENTS- from anterior inferior iliac spine and groove superior to the acetabulum to the base of the patella
ACTIONS- flexes hip, and extends knee
INNERVATION- femoral nerve
Sartorius L2-3
ATTACHMENTS- from anterior superior iliac spine to the medial aspect of the proximal tibia
ACTIONS- flexes, abducts & laterally rotates hip, and flexes & assists medial rotation of the knee
INNERVATION- femoral nerve
Tensor fasciae latae L4-5, S1
ATTACHMENTS- from anterior superior iliac spine & external lip iliac crest to iliotibial tract
ACTIONS- abducts, flexes & medially rotates hip, and assists in maintaining knee
extension
INNERVATION- superior gluteal nerve
Vastus intermedius L2-4
ATTACHMENTS- from the anterior aspect of the proximal 2/3rds of the femoral shaft to the lateral border of the patella
ACTIONS- extends knee
INNERVATION- femoral nerve
Vastus lateralis L2-4
ATTACHMENTS- from the intertrochanteric line, greater trochanter, gluteal tuberosity & linea aspera to the base & lateral border of the patella
ACTIONS- extends knee
INNERVATION- femoral nerve
Vastus medialis L2-4
ATTACHMENTS- from the intertrochanteric line, spiral line, linea aspera & medial supracondylar line to the base & medial border of the patella
ACTIONS- extends leg
INNERVATION- femoral nerve
Articularis genu L2-4
ATTACHMENTS- from the distal anterior shaft of femur to proximal portion of synovial membrane of knee joint
ACTIONS- pulls articular capsule proximally
INNERVATION- femoral nerve (a branch of the nerve from the vastus intermedius)
Adductor brevis L2-4
ATTACHMENTS- from inferior pubic ramus to distal 2/3 pectineal line and medial lip linea aspera
ACTIONS- adducts and flexes hip
INNERVATION- obturator nerve
Adductor longus L2-4
ATTACHMENTS- from pubic crest to medial lip linea aspera
ACTIONS- adducts, medially rotates, and flexes hip
INNERVATION- obturator nerve
Adductor magnus (hamstring part: L4-5, S1)
ATTACHMENTS- medial supracondylar ridge & adductor tubercle of the femur (hamstring part)
ACTIONS- extends (hamstring part) hip
INNERVATION- tibial division of the sciatic nerve (hamstring part)
Adductor Magnus (Adductor part L2-4)
ATTACHMENTS- from the inferior pubic ramus, ischial ramus & tuberosity to gluteal tuberosity, linea aspera (adductor part)
ACTIONS- adducts, flexes (adductor part)
INNERVATION- obturator nerve (adductor part)
Gracilis L2-4
ATTACHMENTS- from the body of the pubis & inferior pubic ramus to the medial surface of tibia, distal to condyle, proximal to insertion of semitendinosus, lateral to insertion of sartorius
ACTIONS- flexes & medially rotates the knee, and adducts hip
INNERVATION- obturator nerve
Pectineus L2-4
ATTACHMENTS- from superior pubic ramus to the femur between the lesser trochanter & linea aspera (pectineal line)
ACTIONS- adducts, flexes hip
INNERVATION- femoral nerve & obturator nerve
Obturator externus L3-4
ATTACHMENTS- from rami of the pubis and ischium; external surface obturator membrane to trochanteric fossa
ACTIONS- laterally rotates hip
INNERVATION- obturator nerve
Superior gemellus L5,S1,S2
ATTACHMENTS- external surface spine of ischium via obturator internus tendon to greater trochanter
ACTIONS- laterally rotates hip
INNERVATION- sacral plexus
Inferior gemellus L4-5, S1
ATTACHMENTS- proximal ischial tuberosity via obturator internus tendon to greater trochanter
ACTIONS- laterally rotates hip
INNERVATION- sacral plexus
Gluteus maximus L5, S1-2
ATTACHMENTS- from the aponeurosis of the erector spinae, sacrum, sacrotuberous ligament & posterior gluteal line (innominate) to the greater trochanter, gluteal tuberosity of the femur & the iliotibial tract
ACTIONS- extends & laterally rotates hip
INNERVATION- inferior gluteal nerve
Gluteus medius L4-5, S1
ATTACHMENTS- from the external iliac surface to the oblique ridge on the lateral aspect of the greater trochanter; gluteal aponeurosis
ACTIONS- abducts & medially rotates hip; and keeps the pelvis level when opposite leg is raised
INNERVATION- superior gluteal nerve
Gluteus minimis L4-5, S1
ATTACHMENTS- from the external iliac surface and margin of the greater sciatic notch to the anterolateral aspect of the greater trochanter
ACTIONS- abducts & medially rotates hip; and keeps the pelvis level when opposite leg is raised
INNERVATION- superior gluteal nerve
Obturator internus L5, S1-2
ATTACHMENTS- from the anterolateral wall of the pelvis & obturator membrane to the medial surface of the greater trochanter
ACTIONS- laterally rotates hip
INNERVATION- nerve to the obturator internus (from sacral plexus)
Piriformis S1-2
ATTACHMENTS- from the anterolateral sacrum & posterior inferior iliac spine to the upper border of the greater trochanter
ACTIONS- abducts & laterally rotates hip
INNERVATION- nerve to piriformis
Quadratus femoris L4-5, S1
ATTACHMENTS- from the ischial tuberosity to the quadrate tubercle of the femur
ACTIONS- laterally rotates hip
INNERVATION- nerve to the quadratus femoris (from sacral plexus)
Biceps femoris (long head,L5, S1-3)
ATTACHMENTS- from the ischial tuberosity & sacrotuberous lig.
ACTIONS- flexes & laterally rotates the knee (both heads) & extends hip (long head only)
INNERVATION- tibial division of sciatic (long head)
Biceps Femoris (short head, L5, S1-2)
ATTACHMENTS- lateral lip of linea aspera & lateral supracondylar line to the lateral side of fibular head
ACTIONS- flexes & laterally rotates the knee (both heads)
INNVERATION- fibular division of the sciatic nerve (short head)
Semimembranosus L4-5, S1-2
ATTACHMENTS- from ischial tuberosity to posterior aspect of the medial tibial condyle
ACTIONS- extends hip, and flexes & medially rotates knee
INNERVATION- tibial division of the sciatic nerve
Semitendinosus L4-5, S1-2
ATTACHMENTS- from the ischial tuberosity to the proximal, medial tibia
ACTIONS- extends hip, and flexes & medially rotates knee
INNERVATION- tibial division of the sciatic nerve
What are the capsular ligaments of the hip?
Ischiofemoral
Iliofemoral
Pubofemoral
What do the capsular ligaments of the hip do?
Become taut during extension of the thigh at the hip
Describe the Fascia Lata
- wraps all the way around the thigh- deep fascia
- lateral femoral cutaenous nerve punches through and then lays on top to become the cutaenous n
- extension of inguinal ligament
What are the 3 fascial compartments of the thigh?
Anterior, posterior, and medial compartments
What are the contents of the anterior compartment of the thigh?
Hip flexors
knee extensors
What are the contents of the posterior compartment of the thigh?
Hip extensors
knee flexors
What are the contents of the medial compartment of the thigh?
adductors of thigh
What innervates the anterior compartment of the thigh?
Femoral nerve
except for TFL which is innervated by the superior gluteal nerve
What innervates the posterior compartment of the thigh?
Tibial division of sciatic nerve,
except shorthead of biceps femoris which is innervated by the fibular division of sciatic nerve
What innervates the medial compartment of the thigh?
The obturator nerve
except for hamstring part of adductor magnus, which is innervated by the tibial division of the sciatic nerve.
What is the general blood supply of the anterior compartment of the thigh?
femoral a
What is the general blood supply of the medial compartment of the thigh?
obturator a
What is the general blood supply of the posterior compartment of the thigh?
internal iliac a
What are the borders of the femoral triangle?
Inguinal Ligament
adductor longus
sartorius
What makes up the lateral floor of the femoral triangle?
Iliopsoas
What makes up the medial floor of the femoral triangle?
pectineus
What are the contents of the femoral triangle?
femoral n,a,v
What passes through the greater sciatic foramen?
Piriformis Sciatic N posterior femoral cutaneous n Superior and Inferior gluteal NAV internal pudendal A and V pudendal n.
What passes through the lesser sciatic foramen?
Obturator internus
internal pudendal A and V
pudendal n.
What structures are impaired in tredelenburg gait?
glute medius and minimus muscles cause the opposite hip to sag when walking
due to lesion on superior gluteal n
What are the contents of the femoral sheath?
Femoral artery, vein, and canal.
Where can you palpate the femoral pulse?
In the femoral triangle, inferior to the midinguinal point.
What are the attachments of the (Tibial) Medial Collateral ligament?
medial epicondyle of femur to the medial condyle and shaft of tibia
What motion does the MCL restrict?
- stabilizes the medial aspect of the joint
- prevents abduction of the tibia
What are the attachments of the (fibular) Lateral Collateral ligament?
lateral epicondyle of the femur to head of the fibula
What motion does the LCL restrict?
- stabilizes the lateral aspect of the joint
- prevents adduction of the tibia
What are the attachments of ACL?
medial part of the anterior intercondylar area of the tibia to posterior part of the medial surface of the lateral condyle of the femur
What is the function of ACL?
Prevents posterior displacement of the femur on the tibia and hyperextension of the knee
What are the attachments of PCL?
posterior intercondylar area of the tibia to lateral surface of the medial condyle of the femur
What is the function of PCL?
Prevents anterior displacement of the femur on the tibia
What are the attachments of the patellar ligament?
apex of the patella to tibial tuberosity
What is the function of the patellar ligament?
resists knee flexion
What are the attachments of the iliofemoral ligament?
AIIS to the intertrochanteric line of femur
What is the function of the iliofemoral and ischiofemoral ligaments?
limits extension of thigh at hip
What are the attachments of the ischiofemoral ligament?
ischium posterior to the acetabulum to the greater trochanter and iliofemoral ligament
What are the attachments of the pubofemoral ligament?
iliopubic eminence and superior pubic ramus to the fibrous capsule
What is the function of the pubofemoral ligament?
limits abduction of femur
Which dermatome is the 1st toe?
L4
Which dermatome is the 5th toe?
S1
Which dermatome is half of the 1st toe and toes 2-4?
L5
Where do the superficial inguinal nodes go?
superficial inferior to umbilicus
Where do the deep inguinal nodes go?
deep thigh, pop and superficial inguinal nodes
Where do the popliteal nodes go?
knee, deep leg, foot
What do Menisci do?
Absorb shock, decrease friction and increase contact area
Differentiate between the medial and lateral menisci
Medial “C” larger
Lateral “O” smaller
Where is the medial meniscus attached?
MCL
Describe meniscus injury
total meniscectomy
- more popular procedure in the past
- removal may increase wear on articular cartilage
- increase chance for developing degenerative joint disease
- eventual total knee replacement
Explain menisci blood supply
blood flow= greatest in the peripheral 1/3
least in central 1/3
Where does the innervation come from for the lumbar plexus?
posterior abdominal wall
Which bones form the innomiate?
Ilium
ischium
pubis
Where do the innominate bones meet?
acetabulum
Describe innominate bones
- They fuse at different time points
- full fusion= innominate bone
- ischiopubic ramus fuses at 7-8 years
- full fusion at 15-25 years
- most susceptible for fractures at fusion locations
- acetabulum+ischiopubic ramus=high risk fracture
Explain the gender differences in the pubic area
subpubic angle on females is larger=90 degrees
men its only 50-80 degrees
-iliac flare also greater in female
Explain the acetabulum
- lunate surface is incomplete
- closed off by transverse acetabular ligament
- lined by articular cartilage
- transverse acetabular ligament is site of attachment for ligament head of femur
Explain Wolff’s Law
There are 2 types of lines; compressive and tension
- channels of bone grow in response to force
- lines resorb with advancing age and predisposition to fracture because the channels are less strong
- bone densitometry used to assess risk of fracture
- lines go away with a sedentary lifestyle
Explain posterior hip dislocation
- outnumbers anterior by 9:1
- usually happens through MVA
- may injure posterior acetabulum/labrum
- most critcially injure sciatic n
What are the boundaries of the greater sciatic foramen?
anterior sacroiliac lig
sacrotuberous lig
sacrospinous lig
greater sciatic notch
What are the boundaries of the lesser sciatic foramen?
spine of ischium
sacrotuberous lig
tuberosity of ischium
What is genu varum?
knees apart
bow legged
coxa valga
What is genu valgum?
knees together
knock kneed
coxa vara
Explain the angle of inclination for coxa valga
anything greater than 125
- leads to genu varum
- lengthens lower extremity
- increases load on femoral head, decreases load on femoral neck
- distal femoral shaft is pointed more laterally compared to head and neck
Explain the angle of inclination for coxa vara
anything less than 125
- leads to genu valgum
- shortens lower extremity
- reduces load on femoral head, increases load on femoral neck
- distal femoral shaft is pointed medially compared to head and neck
Explain Q angle
where the line of the shaft of femur and the line of shaft of tibia intersect
- men=12
- women= 17
What is the goal for stability?
To fully sit the head of femur in acetabulum
What is anteversion?
increased angle
what is retroversion?
decreased angle
What would anterversion cause at the feet?
pigeon toed
What would retroversion cause at the feet?
duck feet
Explain joint elements
- joint capsule lined interiorly by synovial membrane
- blood and nerve supply-articular branches
- joint position senses pain at joint in articular b of a peripheral n.
- when a nerve innervates a muscle that crosses the joint, n also innervates that joint
Explain avascular necrosis (AVN)
- small amount of people who don’t convert from obturator to medial circumflex femoral
- caused by dislocation or fracture leading bone to die
- discolation can interrupt acetabular branch of obturator
Explain Legg-Calve-Perthes disease
usually in boys 4-10
- limp, pain, reduced ROM
- typically unilateral
- need to reduce loading of joint to improve
- dead bone replaced in 2-3 years
- unknown cause
