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Anatomy > Lec 15 Lumbarsacral Plexus, Pelvis and Hip > Flashcards

Lec 15 Lumbarsacral Plexus, Pelvis and Hip Flashcards

1
Q

Know bony landmarks!

A
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2
Q

Inguinal ligament - where does it attach?

A

ASIS and pubic tubercle

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3
Q

What is important about the long axis of the shaft of the humerus?

A

its at an angle compared to the vertical weight-bearing line of gravity

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4
Q

Why would a femoral neck injury occur and who is it common in?

A

There is lots of pressure on the femoral neck because the angle of the femur

Common in people > 60, especially women because of lower bone density (estrogen) and greater femoral angle

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5
Q

What is meant by the femoral neck fracture is intrascapular?

A

fracture occurs inside the capsule, so surgery to repair fracture would have to cut open the joint capsule

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6
Q

Where does the sacrotuberous ligament run? What opening does it help create?

A

From the sciatic notch of the illium/sacrum to the ischial tuberosity

forms greater sciatic foramen

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7
Q

Where does the sacrospinous ligament attach? What opening does it help create?

A

from the sacrum to the ischial spine

forms the lesser sciatic notch

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8
Q

What does the greater sciatic foramen create a passage way for?

Lesser sciatic foramen?

A

Greater - structures entering or leaving the pelvis (like sciatic nerve)

Lesser - structures entering or leaving the perineum (pudendal nerve) aka going to the pelvic floor

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9
Q

What ligament is continuous inferiorly with the sacrotuberous ligament?

A

posterior sacroiliac ligament

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10
Q

What are the anterior SI joint ligaments?

A

lumbosacral ligament

iliolumbar ligament

know where they are!

(also anterior sacroiliac but not boxed)

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11
Q

What is the obturator membrane?

A

thing strong fibrous sheet that closes the obturator foramen

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12
Q

Where is the obturator foramen?

A

large opening in the pelvis, formed by the pubis and ischium bones. It is covered by the obturator membrane, with only a small opening for the obturator nerve and vessels to pass through. (obturator canal)

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13
Q

Where is the obturator canal?

A

smaller passage that is located at the superior part of the obturator foramen. It allows for the passage of the obturator nerve and blood vessels from the pelvis into the thigh. The canal is bordered by the obturator membrane and the bony edges of the foramen.

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14
Q

What else covers the obturator foramen (while leaving a tiny canal space)?

A

Obturator internas and externas muscles

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15
Q

Can the lower lumbar, SI, Sacral or Pelvic and Hip regions be moved independently?

A

No, they are tied together with ligaments and anatomical shaping of SI joint

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16
Q

What are the muscles of the posterior abdominal wall? What are these muscles commonly associated with?

A

Quadratus Lumborum
Psoas major and minor
illiacus

Back pain

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17
Q

What are the muscles of the anterior thigh acting at the hip joint?

A

Pectineus and Sartorius

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18
Q

Pectineus

A

MA: adducts and slightly flexes hip joint, assists with lateral rotation

PA: superior ramus of pubis

DA: pectineal line of femur

N: femoral nerve L2, L3 (may recive branch from obturator nerve)

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19
Q

Sartorius

A

MA:
- Flex, Abduct, lateral rotation of hip joint
- Flex knee and medial rotation leg when knee is flexed

PA: Anterior superior iliac spine (ASIS)

DA: superior medial tibia as part of pes anserinus

N: Femoral N L2 L3

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20
Q

The sartorius is __articulate

A

biarticulate

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21
Q

Superficial gluteal region consists of what?

What are their main actions?

A

consists of three large overlapping glutei - maximus, medius and minimus and the tensor fasciae latae

mainly hip extensors, abductors and rotators

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22
Q

Gluteus Maximus

A

MA: Extend hip (especially from flexed pos), assists in lateral rotation, fixes hip joint and rising from seated position

PA: ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; sacrotuberous ligament

DA: most fibers end in iliotibial tract (IT band) , which inserts into anterolateral tibial tubercle. some fibers insert on gluteal tuberosity

N: **Inferior gluteal nerve L5, S1, S2

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23
Q

What is a common problem/condition with the glute max?

A

It gets weak

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24
Q

Gluteus Medius

A

MA: abduct and medially rotate hip joint
- posterior fibers externally rotate (clam)
- keeps pelvis level when ipsilateral limb is weight-bearing and adv unsupported side during swing phase

PA: external surface of ilium between anterior and posterior gluteal lines

DA: lateral surface of greater trochanter

N: Superior gluteal nerve L5, S1

25
Q

Gluteus Minimus

A

MA: Abduct and medially rotate hip
- also keeps pelvis level when ipsilateral limb is weight-bearing and adv unsupported side during swing phase

(same as medius without ER, just weaker at it)

PA: external surface of ilium between anterior and inferior gluteal lines

DA: Anterior surface of greater trochanter of femur

N: Superior gluteal nerve L5, S1

26
Q

What is the most important muscle of the upper leg?

A

Glute medius

27
Q

Tensor Fasciae Latae

A

MA: medially rotate hip! and abduct hip
- also keeps pelvis level when ipsilateral limb is weight-bearing and adv unsupported side during swing phase

PA: ASIS, anterior part of iliac crest

DA: iliotibial tract (IT band), which attaches to anterolateral tibial tuberosity

N: superior gluteal nerve L5, S1

28
Q

*Which two muscles attach to the IT band?

A

TFL attaches to front of it

Glute max attaches to back of it

29
Q

IT band syndrome

A

overuse condition

repetitive strain of IT band

runners and cyclists

friction between the soft tissue and lateral epicondyle causes pain and inflammation

30
Q

What 6 muscles make up the deep gluteal layer? What action do they all do?

A

Piriformis

Obturator Internus (and externus?)

Superior and Inferior Gamelli

Quadratus Femoris

All do lateral hip rotation

31
Q

Piriformis

A

MA: Laterally rotate extended hip, abduct hit when flexed, stabilize hip

PA: anterior surface of sacrum, ST ligament

DA: Superior border of greater trochanter of femur

N: Branches of anterior rami of S1 S2 (think sciatic!)

32
Q

Obturator Internus

A

MA: Laterally rotate extended hip, abduct hip when flexed, stabilize hip

PA: pelvic surface of obturator membrane and surrounding bones

DA: medial surface of greater trochanter (trochanteric fossa of femur)

N: Nerve to obturator internus L5, S1

33
Q

Superior and Inferior Gemelli

A

MA: Laterally rotate extended hip, abduct hit when flexed, stabilize hip

PA:
- superior; ischial spine
- inferior; ischial tuberosity
(think s for s)

DA: medial surface of greater trochanter (trochanteric fossa) of femur

N:
- superior; nerve to obturator interns L5 S1
- inferior; nerve to quadratus femoris L5 S1
(think whats above and below them!)

34
Q

Quadratus Femoris

A

MA: laterally rotates hip and stabilizes hip

PA: lateral border of ischial tuberosity

DA: quadrate tubercle on the intertrochanteric crest of femur and area inferior to it

N: nerve to quadratus femoris L5 S1

35
Q

Do a quick review of the 4 abdominal muscles!

A

External obliques - laterally flex and rotate contra, felx vertebral column

Internal obliques - laterally flex and rotate to same side, flex vertebral column

Rectus abdominis - flex vertebral column, tilt pelvis posteriorly

Transverse abdonmins - compresses and supports abdominal viscera

36
Q

What spinal level does the aorta enter through the diaphragm? What does it come out as?

A

T12

Abdominal aorta

37
Q

What does the abdominal aorta split into?

A

R common iliac
L common iliac

38
Q

What does the R and L common illiac arteries split into?

A

internal and external iliac

small arterial branch comes off - internal iliac, then abdominal artery becomes external iliac artery

39
Q

When does the external iliac artery become the femoral artery?

A

when it travels under the inguinal ligament

40
Q

What is AAA?

A

Abdominal Aorta Aneurysm

41
Q

What muscles make up the medial thigh group?

A

Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilias
Obturator Externus

42
Q

Adductor Longus

A

MA: adducts hip

PA: body of pubis inferior to pubic crest

DA: Middle third of linea aspera of femur

N: Obturator nerve and branch of anterior division L2 L3 L4

43
Q

Adductor Brevis

A

MA: Adducts hip joint, to some extent flexes

PA: body and inferior ramus of pubis

DA: Pectineal line and proximal part of linea aspera of femur

N: Obturator Nerve and branch of anterior division L2 L3 L4

44
Q

Adductor Magnus

A

MA:
- adduct hip
- adductor part: flexes hip
- hamstring part: extends hip

PA:
- adductor; inferior ramus of pubis and ramus of ischium
- hamstring; ischial tuberosity

DA:
- adductor; gluteal tuberosity, linea aspera, medial supracondylar line
-hamstring; adductor tubercle of femur

N:
- adductor: obturator nerve L2 L3 L4, branches of posterior division
- hamstring; tibial part of sciatic nerve L4

45
Q

Gracilis

A

MA: adducts hip, flexes knee, medially rotates flexed knee

PA: body and inferior ramus of pubis

DA: Superior part of medial surface of tibia as part of pes anserinus

N: Obturator nerve L2 L3

46
Q

Obturator Externus

A

MA: laterally rotates hip, stabilizes hip

PA: margins of obturator foramen and obturator membrane

DA: Trochanteric fossa of femur

N: Obturator N L3 L4

47
Q

What three muscles compose the pes anserinus?

A

SARGENT

SGT

sartorius, semitendinosis, gracilis

48
Q

What covers the saphenous opening? What goes through it?

A

The femoral sheath of TFL acts as a flap over the saphenous opening where the great saphenous vein can go through and empty into the femoral vein

IN THE FEMORAL TRIANGLE
saps drains into femoral

49
Q

Where does the saphenous nerve begin? Sensory or motor?

A

starts in inguinal as a branch of femoral nerve

sensory innervation

50
Q

What are the borders of the femoral triangle?

A

Adductor longus
Pectineus (floor)
Sartorius
Inguinal ligament

51
Q

What travels through the femoral triangle?

A

VAN

femoral artery, vein, nerve

and saphenous nerve but not on slide?

52
Q

What happens at the adductor hiatus? Where does the adductor canal start?

A

opening near the end of the femur where the femoral artery and vein cross knee posteriorly

they don’t stay anterior!

adductor canal starts at the apex of the femoral triangle

53
Q

Are there any nerves lying directly on the femur?

A

No, so limited injury can occur in that sense

54
Q

Describe the parent structures/name changes of venous return starting with the IVC

A

IFC splits into L and R common iliac vein, the internal iliac vein comes off as a branch and the external iliac vein continues
becomes femoral vein under the inguinal ligament

just like arterial!

**great saphenous vein drains into femoral vein

55
Q

what can the great saphenous vein be used for?

A

can be cut out in surgery and used for bypass for clogged coronary artery

56
Q

What are the big 5 of the lumbosacral plexus?

A

Femoral N L2-L4

Obturator N L2-L4

Sciatic N L4 L5 S1 S2 S3

Superior Gluteal Nerve L4-S1

Inferior Gluteal N L5-S2

(don’t forget pudendal S2-S4!)

57
Q

Know what foramen the big 5 go through

A

Femoral Nerve: Passes through the inguinal canal, but is primarily located in the iliopsoas muscle area after emerging from the pelvis.

Obturator Nerve: Exits the pelvis through the obturator foramen.

Superior Gluteal Nerve: Exits the pelvis through the greater sciatic foramen, above the piriformis muscle.

Inferior Gluteal Nerve: Also exits the pelvis through the greater sciatic foramen, but below the piriformis muscle.

Sciatic Nerve: Exits the pelvis through the greater sciatic foramen, typically below the piriformis muscle.

58
Q

PERIPHERAL AND MOTO INNERVATION PATTERNS

A

MOTOR
posterior leg - sciatic nerve, common fibular branch comes off at knee

anterior leg - mostly femoral nerve, obturator on upper medial thigh, common fibular nerve wraps around to outer lower leg

PERIPHERAL

59
Q

What is compartment syndrome? How can it be trated?

A

when the fascia between compartments gets so tight it compresses the muscles

pain, pallor, paresthesia, pulselessness, paralysis

fasciotomy - cut strips of fascia to let muscles breathe

Anatomy (20 decks)

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