Lecture 11 Flashcards
What is the mechanical axis?
Axis of hip joint that rotation of hip joint happens around (connects centre of hip to center of knee joint)
Any muscle located posterior to the center of rotation will cause?
lateral rotation
Any muscle located anterior to the centre of rotation will cause?
medial rotation
A tough fibrous sheath that invests the thigh like a sleeve.
deep fascia of thigh (fascia lata)
Fascia lata is thickened laterally where it forms a band.
Iliotibial tract or band (ITT or ITB)
The __ is split in its upper part and invests the tensor fascia lata muscle between its two layers and acts as a tendon for this muscle.
ITT/ITB (Iiliotibial tract/band)
Deep fascia on thigh attaches to deep fascia in abdomen, therefore for abdominal palpation what do you ask of your patient?
- that they flex their hip joint
What are the superficial gluteal muscles?
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fascia lata
What are the innervations of the superficial gluteal muscles?
- Glut max: innervated by inferior gluteal nerve
- Glut med, glut mini, & tensor fascia lata: innervated by superior gluteal nerve
What is an immigrant muscle of the superficial gluteal muscles? Why?
Tensor fascia lata is not located in the gluteal region, it is on lateral side of upper thigh –> immigrant muscle (muscle forms close to gluteal legion but migrates to upper lateral side of thigh)
What is the origin & insertion of gluteus maximus?
Ori:
- Posterior Iliac crest
- Sacrum
- Coccyx
- Sacrotuberous ligament
Ins:
- Iliotibial tract (band)
- Gluteal tuberosity of femur
What are the functions of gluteus maximus?
- Extension of thigh (hip joint) – MAIN FUNCTION
- Abduction of thigh (hip joint) – upper 1/3
- Adduction of thigh (hip joint) – lower 2/3
- Lateral rotation of thigh (hip joint)
- Posterior pelvic tilt
- Helps lock knee in extension
What is the innervation of gluteus maximus?
- inferior gluteal nerve
What is the MAIN FUNCTION of gluteus maximus?
- extension of thigh (hip joint)
The attachment of the gluteus maximus to the ITT causes?
- knee stability - helps lock knee in extension
Which muscle has their posterior third covered by the gluteus maximus?
gluteus medius
What is the origin & insertion of gluteus medius?
Ori: External surface of ilium between the anterior and posterior gluteal lines
Ins: Lat. surface of greater trochanter
What are the functions of gluteus medius?
- Abduction of thigh (hip joint) - entire muscle – MAIN FUNCTION
- Flexion of thigh (hip joint) – anterior fibers
- Medial rotation of thigh (hip joint) – anterior fibers
- Extension of thigh (hip joint) – posterior fibers
- Lateral rotation of thigh (hip joint) – posterior fibers
What is the innervation of gluteus medius?
superior gluteal nerve
What is the origin & insertion of gluteus minimus?
Ori: Gluteal surface of ilium; between the anterior and inferior gluteal lines
Ins: Anterior surface of greater trochanter
What are the functions of the gluteus minimus?
- Abduction of thigh (hip joint) – entire muscle
- Flexion of thigh (hip joint) – anterior fibers
- Medial rotation of thigh (hip joint) – anterior fibers
- Extension of thigh (hip joint) – posterior fibers
- Lateral rotation of thigh (hip joint) – posterior fibers
What is the innervation of gluteus minimus?
superior gluteal nerve
Which two muscles of the superficial gluteal muscles have the same fucntions?
- gluteus medius
- gluteus minimus
What the deltoid muscles of the hip joint (i.e., don’t do adduction)?
- gluteus medius
- gluteus minimus
When is the Trendelenburg sign/gait positive?
- When leg is raised (hip joint if flexed) pelvis would fall down
What is the origin & insertion of tensor fascia lata?
Ori: Lateral side of ASIS & anterior part of the iliac crest
Ins: Tibia (Gerdy’s tubercle) via ITB (ITT) (1/3 of the way down the thigh)
What are the functions of tensor fascia lata?
- Flexion of thigh (hip joint)
- Abduction of thigh (hip joint)
- Medial rotation of thigh (hip joint)
- Anterior pelvic tilt
- Tenses ITB to support femur on tibia during standing
What is the innervation of tensor fascia lata?
superior gluteal nerve
What muscles comprise the deep gluteal muscles?
- Piriformis
- Superior Gemellus
- Obturator internus
- Inferior gemellus
- Quadratus femerus
- Obturator externus
Which deep gluteal muscle is commonly considered a part of the adductor group?
obturator externus
What are the common functions of the deep gluteal muscles?
- Lateral rotation of thigh (hip joint) - ALL
- Abduction - piriformis, superior gemellus, obturatory internus, inferior gemellus
- Adduction - quadratus femerus, obturator externus
What is the innervation of the deep gluteal muscles?
- sacral plexus
What is the origin & insertion of piriformis?
Ori: Anterior sacrum
Ins: Superior border of greater trochanter
What are the functions of piriformis?
- Lateral rotation of thigh (hip joint) – when hip is extended
- Horizontal abduction of thigh (hip joint)
What is the innervation of piriformis?
- nerve to piriformis from sacral plexus
What is piriformis syndrome?
If one (or both) branches of the sciatic nerve pass through the piriformis –> muscle can pinch nerve –> piriformis syndrome
What is the origin & insertion of superior gemellus?
Ori: Ischial spine
Ins: Medial surface of the greater trochanter
What are the functions of superior gemellus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
What is the innervation of superior gemellus?
nerve to obturator internus (from sacral plexus)
What is the origin & insertion of obturator internus?
Ori: Inner surface of obturator membrane
Ins: Medial surface of the greater trochanter
What are the functions of obturator internus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
What is the innervation of obturator internus?
Nerve to obturator internus (from sacral plexus)
What is the origin & insertion of inferior gemellus?
Ori: Ischial tuberosity
Ins: Medial surface of greater trochanter
What are the functions of inferior gemellus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
What is the innervation of inferior gemellus?
Nerve to quadratus femoris (from sacral plexus)
Which three deep gluteal muscles run together?
- Superior gemellus
- obturator internus
- inferior gemellus
What is the origin & insertion of quadratus femoris?
Ori: Ischial tuberosity
Ins: Quadrate tubercle of femur
What are the functions of quadratus femoris?
- Lateral rotation of thigh (hip joint)
- Adduction of thigh (hip joint) - weak
What is the innervation of quadratus femoris?
Nerve to quadratus femoris (from sacral plexus)
What is the origin & insertion of obturator externus?
Ori: Outer surface of the obturator membrane
Ins: Trochanteric fossa
What are the functions of the obturator externus?
- Lateral rotation of thigh (hip joint)
- Adduction of thigh (hip joint) - weak
What is the innervation of obturator externus?
obturator (from lumbar plexus)
What divides the thigh into 3 compartments?
3 intermuscular septae
What are the 3 compartments of the thigh?
- anterior (extensor) compartment
- medial (adductor) compartment
- posterior (flexor) compartment
What compartment houses the extensor muscles of the thigh?
anterior (extensor) compartment
What is the anterior (extensor) compartment innervated by?
femoral nerve
What is the one exception to the anterior (extensor) compartment?
The sartorius muscle is located in this compartment and is innervated by the femoral nerve; however, it is an exception in that it flexes the hip and knee joints
What muscle houses the adductor muscles of the thigh?
medial (adductor) compartment
What is the innervation of the medial (adductor) compartment?
obturator nerve
What are the 2 exceptions to the medial (adductor) compartment?
exception for pectineus muscle that is innervated by femoral nerve and adductor magnus muscle that is innervated by both obturator and tibial nerves
What compartment houses the flexor muscles in the thigh?
posterior (flexor) compartment
What is the posterior (flexor) compartment innervated by?
sciatic nerve
What is the origin & insertion of biceps femoris?
Ori:
- Long head: Ischial tuberosity
- Short head: Linea aspera
Ins:
- Head of fibula
- Lateral condyle of tibia
What are the muscles of the posterior (flexor) compartment of the thigh?
- biceps femoris
- semitendinosus
- semimembranosus
What are the functions of biceps femoris?
- Flexion of leg (knee joint) - entire muscle
- Extension of thigh (hip joint) – long head
- Lateral rotation of leg @ knee joint (when knee is flexed)
What is the innervation of biceps femoris?
Tibial (long head) and common fibular (peroneal) (short head) branches of sciatic nerve
What is the origin & insertion of semitendinosus?
Ori: Ischial tuberosity
Ins: Proximal part of medial surface of shaft of tibia (forms Pes anserine tendon)
What are the functions of semitendinosus?
- Flexion of leg (knee joint)
- Extension of thigh (hip joint)
- Medial rotation of leg @ knee joint) – when knee if flexed
What is the innervation of semitendinosus?
tibial branch of sciatic nerve
What is the origin & insertion of semimembranosus?
Ori: Ischial tuberosity
Ins: Posterior aspect of medial condyle of tibia
What are the functions of semimembranosus?
- Flexion of leg (knee joint)
- Extension of thigh (hip joint)
- Medial rotation of leg @ knee joint - when knee is flexed
What is the innervation of semimembranosus?
tibial
What is the lateral hamstring?
Biceps femoris
What are the medial hamstrings?
semitendinosus & semimembranosus
What does shortening of the hamstring cause?
low back pain
- Shortening can pull on ischial tuberosity –> posterior pelvic tilt –> lumbar spine follows movement of pelvis and changes tension of ligaments & mucles –> low back pain
What is the girdle that attaches the lower limb to the axial skeleton called?
pelvic girdle
What is the pelvic girdle made up of?
hip bones & sacrum
What are the 4 parts of the lower limb?
- gluteal
- thigh (from hip to knee)
- leg (crura) (from knee to ankle)
- foot (pes) (from heel to toes)
What make bones make up the thigh?
femur & patella
What bones make up the gluteal region?
hip
What bones make up the leg region?
tibia & fibula
What bones make up the foot region?
- tarsal bones
- metasarsal bones
- 14 phalanges
What is the sacrum made up of?
- 5 rudimentary vertebrae fused later on in life (20-30 years of age)
What does the sacrum articulate with superiorly?
L5
What does the sacrum articulat w/ inferiorly?
coccyx
What does the sacrum articulate with laterally?
- 2 hip bones (sacroiliac joints vix auricular surfaces)
What does the vertebral canal become in the sacrum?
sacral canal
What is the premature opening at the bottom of the sacral canal?
sacral hiatus