Lecture 4 Gluteal Region and Posterior Thigh

Question 1

Hip Joint

Synovial joint (ball & socket) -________
​
Stability over wide range of movement
​
Flexion ____ joint capsule ligaments to increase mobility
​
Extension is ____ by ligaments

Answer 1

Synovial joint (ball & socket) -femoral head, acetabulum

Stability over wide range of movement

Flexion unwinds joint capsule ligaments to increase mobility

Extension is limited by ligaments

Question 2

Femoral head is covered with ____

_____
(fibrocartilage) increases articular area

Transverse ____ bridges acetabular notch

More than half femoral head fits within ______

Answer 2

Femoral head is covered with **articular cartilage **

Acetabular labrum
(fibrocartilage) increases articular area

Transverse acetabular ligament bridges acetabular notch

More than half femoral head fits within acetabulum

Question 3

3 intrinsic ligaments of the joint capsule

_____
(Lig. of Bigelow) -strongest, thickest
-prevents ______

____ ligament -prevents
______

____ ligament

Answer 3

Iliofemoral ligament
(Lig. of Bigelow) -strongest, thickest
-prevents hyperextension

Pubofemoral ligament -prevents
overabduction

Ischiofemoral ligament

Question 4

Clinical note: ____ can occur when hip is flexed, adducted, and medially rotated.

Head of femur is driven ____, out of the ____

Endangers ____ n.

Answer 4

Clinical note: Posterior Dislocation can occur when hip is flexed, adducted, and medially rotated.

Head of femur is driven posteriorly, out of the acetabululm.

Endangers sciatic n.

Question 5

Hip Join nerou

Medial Circumflex:
Obturator
Deep Femoral
Lateral Cirmcumflex

Answer 5

Question 6

Coxa _____: decreased angle of inclination
functionally ____ limb: Typically caused by injury: ____

Coxa ____ : increased angle of inclination
functionally ____ limb: Typically caused by ____

Answer 6

Coxa vara: decreased angle of inclination
functionally shorter limb: Typically caused by injury: fracture, bone disorders

Coxa valga: increased angle of inclination
functionally longer limb: Typically caused by slipped epiphysis of femoral head

Question 7

Arterial supply: Gluteal

____ aa.

Nerve supply:
____ nn.
(except hip stabilizers: ____ L5-S2)

Main actions: ____

Answer 7

Superior & inferior gluteal aa.

Nerve supply:
Superior & inferior gluteal nn.
(except hip stabilizers: lumbosacral plexus L5-S2)
Main actions: Hip Extension, Hip abduction, Hip lateral roation and hip Medial Roation

Question 8

Question 9

Gluteal minimas and Max

PA
DA
ACT
INN

PA
DA
ACT
INN

Answer 9

PA: Ilium between posterior and anterior gluteal lines
DA: Greater trochanter (lateral)
Act: Abduct thigh; medial rotation of thigh
Inn: Superior gluteal n. (L5, S1)

PA: Ilium between anterior and inferior gluteal lines
DA: Greater trochanter (anterior)
Act: Abduct thigh; medial rotation of thigh
Inn: Superior gluteal n. (L5, S1)

Question 10

Piriformis

PA: Anterior surface of sacrum
DA: Greater trochanter (superior)
Act: Lateral rotation of extended thigh,
abduct flexed thigh Inn: Ant. rami S1, S2

Answer 10

Question 11

Superior gemellus
Inferior gemellus

Answer 11

Question 12

Obturator internus
Quadratus femoris

Answer 12

Question 13

Clinical note: Repetitive hip extension can lead to ____ Causes localized pain.

Answer 13

Clinical note: Repetitive hip extension can lead to bursitis (inflammation of bursa). Causes localized pain.

Question 14

Answer 14

Question 15

Sciatic nerve
Tibial (division) nerve (____)
-motor: posterior thigh & leg, plantar foot
​
Common fibular (peroneal) nerve (____)
-motor: anterior & lateral leg, dorsal foot

Answer 15

Sciatic nerve (L4-S3)
Tibial (division) nerve (**anterior **division)
-motor: posterior thigh & leg, plantar foot

Common fibular (peroneal) nerve (posterior division)
-motor: anterior & lateral leg, dorsal foot

Question 16

Clinical note: ____ – Avoid ____ n. damage
by injecting in upper outer quadrant.

Answer 16

Clinical note: Intragluteal injection – Avoid gluteal & sciatic n. damage
by injecting in upper outer quadrant.

Question 17

Awks lecture 18

____ joint (hinge)
Distal femur, proximal tibia
Patella: sesamoid bone (pulley, protection)

Mechanically weak: ____

Stability provided predominantly by ____, also ligaments
-most stable when ______ (“”)

Answer 17

Synovial joint (hinge)
Distal femur, proximal tibia
Patella: sesamoid bone (pulley, protection)

Mechanically weak: poor congruence

Stability provided predominantly by muscles, also ligaments
-most stable when fully extended (“locked”)

Question 18

Awks lecture 18

Taut during full extension Permit knee rotation when slack

Named for their distal attachment
Tibial (medial) ____
Medial femoral epicondyle to tibial condyle
Attached to medial meniscus
Fibular (lateral) ____
Lateral femoral epicondyle to fibular head Cord-like

Answer 18

Taut during full extension Permit knee rotation when slack

Named for their distal attachment
Tibial (medial)** collateral lig. (TCL)**
Medial femoral epicondyle to tibial condyle
Attached to medial meniscus
Fibular (lateral) collateral lig. (FCL)
Lateral femoral epicondyle to fibular head Cord-like

Question 19

Awks lecture 18

BLANK
Medial-lateral course from tibia to femur Limits anterior movement of tibia Weaker, poor blood supply

BLANK
Lateral-medial course from tibia to femur Limits posterior movement of tibia Stronger

Answer 19

Anterior cruciate ligament (ACL)
Medial-lateral course from tibia to femur Limits anterior movement of tibia Weaker, poor blood supply

Posterior cruciate ligament (PCL)
Lateral-medial course from tibia to femur Limits posterior movement of tibia Stronger

Question 20

Awks lecture 18

lateral and Medial Meniscus

Answer 20

Lateral meniscus
Nearly circular Attached to the PCL More mobile

Medial meniscus
C-shaped, deeper Attached to the TCL

Question 21

Superficial gluteal tissues drain to ______

Deep gluteal tissue drainage follows ______

Answer 21

Superficial gluteal tissues drain to superficial inguinal nodes

Deep gluteal tissue drainage follows** gluteal vessels**

Question 22

Posterior Thigh

Arterial supply to compartment: ______

Nerve supply to compartment: ______

Main actions of compartment muscles: ______

Answer 22

Arterial supply to compartment:
Deep femoral a. (via perforating branches)

Nerve supply to compartment: Sciatic n. (mostly tibial division)

Main actions of compartment muscles: **Hip Extesnion and Knee Flexion **

Question 23

Answer 23

Semitendinosus
Biceps femoris, long head
PA: Ischial tuberosity
DA: Tibia (superior medial) Act: Extend thigh; flex leg Inn: Tibial n. (L5, S1, S2)

Semimembranousus:
PA: Ischial tuberosity
DA: Medial condyle of tibia
Act: Extend thigh; flex leg
Inn: Tibial n. (L5, S1, S2)

Question 24

Answer 24

Biceps femoris, long head
PA: Ischial tuberosity
DA: Head of fibula
Act: Extend thigh; flex leg
Inn: Tibial n. (L5, S1, S2)

Biceps femoris, short head
PA: Lateral lip of linea aspera
DA: Head of fibula
Act: Flex leg
Inn: Common fibular n. (L5, S1, S2)

Question 25

Clincial Note
The “hamstrings” (____) can be injured when the hip is ___

____ avulsion occurs near the common proximal attachment and can cause associated ____

Answer 25

Clincial Note
The “hamstrings” (semitendinosus, semimembranosus, and biceps femoris long head) can be injured when the hip is flexed and knee extended.

Tendon avulsion occurs near the common proximal attachment and can cause associated avulsion fracture of the ischial tuberosity

Question 26

Answer 26

Pes anserinus (“Goose’s foot”)
Common attachment on superior medial tibia of:
Sartorius (anterior compartment) Gracilis (medial compartment) Semitendinosus (posterior compartment)

Question 27

Posterior thigh

Arterial supply: ____

Motor Innervation:
Tibial division of sciatic nerve:
_____

Common fibular division of sciatic nerve:
______

Answer 27

Arterial supply: Perforating branches of the deep femoral artery

Motor Innervation:
Tibial division of sciatic nerve:
semitendinosus semimembranosus biceps femoris long head

Common fibular division of sciatic nerve:
biceps femoris short head