L39 Gluteal Region and Posterior Thigh Flashcards
What are the main arteries and nerves supplying the gluteal region?
What are the main actions of the gluteal region?
Superior and inferior gluteal aa.
Superior and inferior gluteal nn. (L5-S2)
Hip extension, abduction, stabilization
Describe the hip joint
Synovial ball and socket: lots of motion, but limited compared with UE
3 degrees of freedom: Flexion/Extension, add/abduction, medial/lateral rotation
Multiaxial: circumduction
With hip rotation, medial the shaft swings anteriorly and lateral the shaft swings posteriorly
What 3 parts make up the acetabulum of os coxae?
Lunate surface: articular surface covered by hyaline cartiladge, transfer of body mass
Labrum: fibrocartilage, deepens socket for more stability
Transverse acetabular ligament: spans acetabular notch
What are the 3 parts that make up the head of the femur?
Femoral head: covered by articular cartilage, except at fovea capitis
Ligamentum teres femoris (round ligament of femur): weak, carries neurovasculature to femoral head. Attaches at fovea capitis. Can have long term effects if dislocated
What are 3 ligaments of the hip joint?
Which one is the strongest?
iliofemoral: strongest, thickest, center of gravity is posterior, ligament keeps us erect without muscle use
pubofemoral
ischiofemoral: posterior
*picture is of anterior ligaments
What is femoral hip dislocation?
What position is most common?
Most common posteriorly, when ligaments are least taut and hip is flexed, medially rotated, and adducted
Ligaments are no longer able to hold femur in place
What is hip fracture?
fracture of the femoral neck
Trabeculae less dense at zone of weakness (ward’s triangle)
What is the normal angle of inclincation of the hip joint?
What is coxa vara?
What is coxa valga?
When do these typically present?
What can having an abnormal angle affect?
Normal = 126 degrees adult
Coxa vara: decreased angle of inclination
Coxa valga: increased angle of inclincation
Typically presents when person first starts walking
Abnormal angle may affect gait, leg length, hip mobility
What is in-toeing (anteverted)?
What is out-toeing (retroverted)?
What is a normal torsion angle?
What are the consequences of an abnormal torsion angle?
In toeing: increased torsion angle, distal femur rotated medially
Out-toeing: decreased torsion angle, distal femur rotated laterally
normal = 12 degrees adults
abnormal angle usually painless, no delay in walking
Tensor fascia lata m.
PA: ASIS, iliac crest
DA: anterolateral tubercle
Act: hip abduction
Inn: superior gluteal n
Gluteus maximus m.
PA: ilium, sacrum, sacro-
tuberous ligament
coccyx
DA: anterolateral tubercle,
gluteal tuberosity
Act: hip extension
Inn: inferior gluteal n
Gluteus medius and minimus mm.
PA: ilium
DA: greater trochanter
Act: hip abduction
Inn: superior gluteal n
*Minimus is deep to medius
What nerve should be linked with hip abduction?
Superior gluteal n.
Piriformis
superior gemellus
obturator internus
inferior gemellus
quadratis femoris
PA: sacrum, ischial tuberosity/
spine, obturator membrane
DA: greater trochanter
Act: hip stabilization &
lateral rotation
Inn: lumbosacral plexus
*converge on greater trochanter
What is IT band syndrome?
Overuse injury
inflammation of IT band over: greater trochanter (hip extension) and lateral femoral epicondyle (knee flexion)
Inserts onto the anterolateral tubercle on tibia
What is the function of bursae?
What are the 3 main bursae of the gluteal region?
What is bursitis?
Bursae reduce friction, ease movement, secrete fluid
Ischial bursa: between gluteus maximus and ischial tuberosity
Trochanteric bursa: between gluteus maximus and greater trochanter
Gluteofemoral bursa: between IT band and vastus lateralis
Bursitis is localized pain from repetitive hip extension
Where does the superior gluteal artery and inferior gluteal artery come from?
What does the sacral plexus and the lumbosacral trunk come from?
Superior gluteal a. exits greater sciatic foramen superior to piriformis
Inferior gluteal a. exits greater sciatic foramen inferior to piriformis m.
Sacral plexus and lumbosacral trunk gives rise to superior and inferior gluteal nn and sciatic nn.
What does the clunial nn. do?
What do the superior and inferior gluteal aa. and n. do?
What does the sciatic n. do?
Where do all these structures come from?
Superior clunial nn: cutaneous to superior buttocks
Medial/middle clunial nn: cutaneous to medial buttocks
Inferior clunial nn: cutaneous to inferior buttocks via posterior femoral cutaneous n.
Superior gluteal artery and nerve (L4-S1): motor to gluteus medius and minimus and tensor fascia lata
Inferior gluteal artery and nerve (L5-S2): motor to gluteus maximus
Sciatic nerve (L4-S3): main nerve of posterior thigh
What is Trendelenburg sign?
What nerve is implicated?
What type of gait presents?
Superior gluteal nerve damage
deficit to primary hip abductors (medius, minimus, TFL)
Trendelenburg sign is hip drop on contralateral side when balanced on one limb
Gait presents as waddling
Where does the lumbar plexus, lumbosacral plexus, and sacral plexus originate?
Lumbar plexus: L1-L4, within psoas major
Lumbosacral plexus: L2-S4, links lumbar and sacral plexuses
Sacral plexus: S1-S4, overlays piriformis m.
Where does the sciatic nerve come from?
What are its divisions?
What nerves do these divisions give rise to?
Sciatic nerve (L4-S3)
Anterior divisions (back of leg): hip extension, abduction, knee flexion
Posterior division (front of leg): hip flexion, adduction, knee extension
Tibial division: anterior divison that gives rise to the tibial nerve. Does motor innervation to the posterior thigh and leg, plantar foot
Common fibular division: posterior division that gives rise to common fibular n. Does motor to anterior and lateral leg, dorsal foot
12% divisions separate as they exit greater sciatic foramen, ususally divide in popliteal fossa
What is piriformis syndrome?
piriformis hypertrophy or spasm affects sciatic n, mostly common fibular division
variable relationship between piriformis and sciatic nerve divisions
11% common fibular n. pierces through piriformis
1% common fibular passes over piriformis
What is the main artery and nerve of the posterior thigh?
What is the main action of the posterior thigh?
Deep femoral artery (via perforating branches)
Sciatic n. (L4-S3) mostly tibial division
Hip extension, knee flexion
Semitendinosus
PA: ischial tuberosity
DA: medial tibial condyle
Act: hip extension, knee flexion,
knee medial rotation
Inn: tibial division of sciatic n
Semimembranosus
PA: ischial tuberosity
DA: medial tibial condyle
Act: hip extension, knee flexion,
knee medial rotation
Inn: tibial division of sciatic n
Biceps femoris, long head
PA: ischial tuberosity
DA: head of fibula
Act: hip extension, knee flexion,
knee lateral rotation
Inn: tibial division of sciatic n
Biceps femoris, short head
PA: linea aspera
DA: head of fibula
Act: knee flexion, lateral rotation
Inn: common fibular division of
sciatic n
If tibial division is damaged, there will still be some knee flexion via the short head of biceps femoris
What are hamstring injuries?
Semitendinosus, semimembranosus, and biceps femoris long head
Tendon avulsion near proximal attachment (ischial tuberosity)
Can also have avulstion fracture of ischial tuberosity
Injury most common during extreme flexion of hip
Semitendinosus tendon graft
Used for ligament and tendon repair (ie. ACL)
tendon stripper is used to remove a strip from the middle 1/3 of tendon, heals with time
What is pes anserinus? Where is it located?
What are some clinical correlations associated with pes anserinus?
“Goose’s foot”
Common attachment site for:
Sartorius: anterior compartment
Gracilis: medial compartment
Semitendinosus: posterior compartment
Medial side of tibia
Can have bursitis, tendinitis, fascitis: localized pain, side to side movements
What spinal cord levels does the sciatic nerve come from?
What are the two branches of the sciatic nerve that innervate the posterior thigh? What muscles do they innervate?
What artery supplies the posterior thigh?
L4-S3
Tibial division: semitendinosus, semimembranosus, biceps femoris long head
Common fibular division: biceps femoris short head
What is the popliteal fossa?
Where is it?
What conditions can result in swelling of the popliteal fossa?
posterior knee, diamond shaped
passageway for neurovasculature, provides protection
structures more easily palpated when knee is semi flexed
Swelling can be caused by abscess, tumor, aneurysm, bursitis, popliteal (baker’s) cyst (effused synovial fluid)
What are the boundaries of the popliteal fossa?
Superior boundary: hamstrings
semitendinosus, semimembranosus medially
biceps femoris laterally
Inferior boundary: medial and lateral heads of gastrocnemius
What are the two tendons that you can palpate when the knee is flexed on either side of the popliteal fossa?
Semitendinosus tendon (medial)
Biceps femoris tendon (lateral)
What is the popliteal artery?
Where does it come from?
What does it become?
continuation of the femoral a. name change at adductor hiatus
supplies the knee joint via genicular aa.
terminates at branching of anterior and posterior tibial aa.
fibular a. is a branch off the anterior tibial a.
What are the genicular aa.?
branches of the popliteal artery that supplies the knee joint
superior medial genicular a.
middle genicular a.
inferior medial genicular a.
superior lateral genicular a.
interfior lateral genicular a.
circumflex fibular a. (goes around the head of the fibula)
What arteries make up the anastomoses around the knee?
descnding branch of the lateral femoral circumflex a.
genicular aa.
saphenous branch of the femoral a.
circumflex fibular a.
What are the two big divisions of the sciatic nerve?
Where does it typically divide?
Typically divides in the popliteal fossa, although it can be very variable
Tibial nerve: supplies posterior leg, terminal branches supply plantar foot (medial and lateral plantar nerves)
Common fibular nerve: courses anterolaterally. branches supply anterior and lateral leg, dorsal foot
What are some clinical correlations associated with the popliteal artery?
popliteal pulse when flexed
popliteal obstruction or compression
popliteal aneurysm
What is a clincal concern with the common fibular nerve?
Courses around the head of the fibula
superficial location is a clinical concern
it is the most common LE nerve injury
anterolateral and dorsum of foot
