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MSK Exam I > Lecture 7: Gluteal Region + Lumbosacral Plexus > Flashcards

Lecture 7: Gluteal Region + Lumbosacral Plexus Flashcards

1
Q

What is the nerve network supplying the lower extremities with sensory and motor nerves?

A

Lumbosacral plexus

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2
Q

Where does the lumbosacral plexus originate?

A

Ventral primary rami of spinal nerves including L1-S3

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3
Q

What 9 branches of the lumbosacral plexus emerge in the gluteal region?

A 
Superior gluteal n.
Inferior gluteal n.
Nerve to piriformis
Sciatic n.
Posterior femoral cutaneous n.

Motor nerves to quadratus femoris, inferior and super gemelli, and obturator internus

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4
Q

Where does the sciatic n. originate?

A

Spinal cord levels L4-S3

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5
Q

What does the sciatic n. pass through to get into the gluteal region?

A

Greater sciatic foramen

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6
Q

What are the 2 divisions of the sciatic n.?

A

Tibial division

Peroneal division

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7
Q

Which division of the sciatic n. supplies the hamstring muscles in the posterior thigh?

A

Tibial division

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8
Q

The tibial division of the sciatic n. passes through what to get into the posterior compartment of the leg?

A

Popliteal fossa

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9
Q

What nerve supplies all muscles in the posterior compartment of the leg?

A

Tibial n. (Branch of sciatic n.)

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10
Q

The tibial division of the sciatic n. eventually enters the tarsal tunnel and divides to supply the sole of the foot as what 2 nerves?

A

Lateral plantar n.

Medial plantar n.

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11
Q

The peroneal division of the sciatic n. begins as what major nerve positioned next to the head of the fibula?

A

Common peroneal n. (Fibular)

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12
Q

Why is the position of the common peroneal n. a potential issue?

A

Its position next to the head of the fibula makes it susceptible to traumatic injury

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13
Q

What are the 2 branches of the common peroneal n. and what do they supply?

A

Superficial peroneal n. - lateral compartment of the leg

Deep peroneal n. - anterior compartment of the leg

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14
Q

Where does the posterior femoral cutaneous n. originate?

A

Spinal cord levels L2-L4

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15
Q

The posterior femoral cutaneous n. passes under what structure to enter the anterior thigh?

A

Inguinal ligament

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16
Q

What is the final branch of the posterior femoral cutaneous n.?

A

Saphenous n.

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17
Q

Where does the obturator n. originate?

A

Spinal cord levels L2-L4

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18
Q

What does the obturator n. pass through to get into the medial thigh?

A

Obturator foramen in the obturator membrane

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19
Q

The obturator n. supplies all muscles in the medial compartment of the thigh except which one? What nerve supplies that muscle?

A

Pectineus - femoral n.

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20
Q

The lumbar aspect of the lumbosacral plexus is located in the lumbar region within what muscle?

A

Psoas major m. (Anterior to transverse processes of lumbar vertebrae)

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21
Q

The lumbar aspect of the lumbosacral plexus is formed by the _______ rami of L__-__

A

Anterior; L1-4

[also receives contributions from T12]

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22
Q

What are the 6 major peripheral nerves of the lumbar aspect of the lumbosacral plexus?

A 
Iliohypogastric n.
Ilioinguinal n.
Genitofemoral n.
Lateral cutaneous n. of the thigh
Obturator n.
Femoral n.
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23
Q

The iliohypogastric n. is the first major branch of the lumbar plexus. It runs to the iliac crest, across the _____ ______ muscle, and perforates the _____ ______ muscle where it divides into its terminal branches

A

Quadratus lumborum

Transversus abdominis

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24
Q

What are the roots of the iliohypogastric n.?

A

L1 (with contributions from T12)

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25
Q

The iliohypogastric n. supplies motor function to what 2 muscles?

A

Internal obliques

Transversus abdominis

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26
Q

Iliohypogastric n. supplies sensory innervation to what area?

A

Posterolateral gluteal skin in pubic region

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27
Q

What nerve of the lumbar plexus also stems from L1 and follows the same course as the iliohypogastric n.?

A

Ilioinguinal n.

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28
Q

After innervating the muscles of the anterior abdominal wall, the ilioinguinal n. passes through what structure to innervate the skin of the genitalia and middle thigh?

A

Superficial inguinal ring

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29
Q

The ilioinguinal n. supplies motor function to what 2 muscles? (Hint: same as iliohypogastric n.)

A

Internal oblique

Transversus abdominis

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30
Q

The ilioinguinal n. supplies sensory innervation to what areas?

A

Skin on upper middle thigh

Males: skin over root of penis and anterior scrotum

Females: skin over mons pubis and labia majora

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31
Q

After leaving the psoas major m., the genitofemoral n. quickly divides into what 2 branches?

A

Genital branch

Femoral branch

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32
Q

What are the roots of the genitofemoral n.?

A

L1-2

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33
Q

Genitofemoral n. provides motor function to what muscle?

A

Cremasteric m.

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34
Q

Genitofemoral n. supplies sensory function to what areas (genital branch vs. femoral branch)

A

Genital branch: skin of anterior scrotum or skin over mons pubis and labia majora

Femoral branch: skin on upper anterior thigh

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35
Q

Which nerve of the lumbar plexus has ONLY sensory function?

A

Lateral cutaneous nerve of the thigh

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36
Q

The lateral cutaneous nerve of the thigh enters the thigh at the lateral aspect of what structure?

A

Inguinal ligament

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37
Q

What are the roots of the lateral cutaneous n. of the thigh?

A

L2-3

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38
Q

The lateral cutaneous nerve of the thigh provides sensation in which area?

A

Anterior and lateral thigh down to the level of the knee

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39
Q

What are the roots of the obturator n.?

A

L2-4

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40
Q

The obturator n. supplies motor function to what 6 muscles?

A 
Obturator externus
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
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41
Q

Where does the obturator nerve supply sensation?

A

Medial thigh

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42
Q

What are the roots of the femoral n.?

A

L2-4

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43
Q

The femoral n. supplies motor function to what 5 muscles?

A 
Iliacus
Pectineus
Sartorius
Quadriceps femoris
Rectus femoris
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44
Q

Where does the femoral n. supply sensation?

A

Skin on anterior thigh and medial leg

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45
Q

What are the 5 major peripheral nerves of the sacral plexus?

A 
Superior gluteal
Inferior gluteal
Sciatic
Posterior cutaneous
Pudendal

[mnemonic: Some Irish Sailor Pesters Polly]

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46
Q

The sacral plexus is located on the surface of the posterior pelvic wall, anterior to what muscle?

A

Piriformis

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47
Q

The sacral plexus is formed by _______ rami of sacral spinal nerves S__-__

A

Anterior; S1-4

[also receives contributions from L4-5

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48
Q

The sacral plexus is made up of 5 major peripheral nerves that have what 2 potential destinations?

A

Some leave the pelvis via greater sciatic foramen and enter gluteal region

Some remain in the pelvis and supply pelvic muscles, organs, and perineum

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49
Q

The superior gluteal nerve leaves the pelvis via what foramen? What accompanies this nerve as it enters the gluteal region?

A

Greater sciatic foramen

Accompanied by superior gluteal artery and vein

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50
Q

What are the roots of the superior gluteal n.?

A

L4, L5, S1

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51
Q

The superior gluteal n. supplies motor funciton to what 3 muscles?

A

Gluteus minimis
Gluteus medius
Tensor fascia lata

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52
Q

Which 2 nerves of the sacral plexus have NO sensory function?

A

Superior gluteal n.

Inferior gluteal n.

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53
Q

Which nerve of the sacral plexus has ONLY sensory function?

A

Posterior femoral cutaneous n.

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54
Q

The inferior gluteal n. leaves the pelvis via what foramen? What accompanies this nerve as it enters the gluteal region?

A

Greater sciatic foramen

Accompanied by inferior gluteal artery and vein

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55
Q

What are the roots of the inferior gluteal n.?

A

L5, S1, S2

56
Q

The inferior gluteal n. supplies motor function to what muscle?

A

Gluteus maximus

57
Q

What are the roots of the sciatic n.?

A

L4, L5, S1-3

58
Q

The tibial portion of the sciatic n. supplies motor function to what muscles?

A

All muscles of posterior thigh, including hamstring portion of adductor magnus. NOTE that it does NOT supply short head of biceps femoris (common fibular n.)

All muscles of posterior compartment of leg and sole of foot.

59
Q

The common fibular portion of the sciatic n. supplies motor function to what muscles?

A

Short head of biceps femoris

All muscles in anterior and lateral leg

Extensor digitorum brevis

60
Q

The tibial portion of the sciatic n. supplies sensation to what areas?

A

Skin on posterolateral and medial surfaces of the foot as well as sole of foot

61
Q

The common fibular portion of the sciatic n. supplies sensation to what areas?

A

Skin on anterolateral surface of leg and dorsal aspect of foot

62
Q

The posterior femoral cutaneous n. leaves the pelvis through what foramen?

A

Greater sciatic foramen

63
Q

The posterior femoral cutaneous n. leaves the pelvis via the greater sciatic foramen and enters the gluteal region inferior to the _______ muscle. It descends deep to the _______ ______ muscle and runs down the posterior thigh to the knee.

A

Piriformis

Gluteus maximus

64
Q

What are the roots of the posterior femoral cutaneous n.?

A

S1-3

65
Q

The posterior femoral cutaneous n. supplies sensation to what areas?

A

Skin on posterior surface of thigh and leg

Skin of perineum

66
Q

The pudendal n. leaves the pelvis via the ______ _____ foramen, then re-enters via the _____ ______foramen, moving anterosuperiorly along the lateral wall of the ________ ________. It terminates by dividing into branches.

A

Greater sciatic

Lesser sciatic

Ischiorectal fossa

67
Q

What are the roots of the pudendal n.?

A

S2-4

68
Q

The pudendal n. supplies motor function to what muscles?

A

Skeletal muscles in perineum
External urethral sphincter
External anal sphincter
Levator ani

69
Q

The pudendal n. supplies sensation in what areas?

A

Penis or clitoris

Most skin of perineum

70
Q

Other branches of the sacral plexus tend to directly supply muscles (except the perforating cutaneous n. and the pelvic splanchnic nn.) What are 3 of these branches?

A

Nerve to piriformis
Nerve to obturator internus
Nerve to quadratus femoris

71
Q

What nerve supplies sensation in the skin over inferior gluteal region?

A

Perforating cutaneous n.

72
Q

Which nerves innervate the abdominal viscera?

A

Pelvic splanchnic nerves

73
Q

Cutaneous innervation of the gluteal region comes from the lateral cutaneous branches of _____ as well as the _________ nerve and 3 sets of ______ nerves

A

T12; iliohypogastric (L1); cluneal

74
Q

The chief cutaneous nerve supply of the gluteal region comes from 3 sets of cluneal nerves. What are they from superior to inferior?

A

[Superior]

Lateral branches of dorsal primary rami of L1-L3

Lateral branches of dorsal primary rami of S1-S3

Branches of posterior femoral cutaneous nerve

[Inferior]

75
Q

The fascia of the gluteal region can be described in terms of superficial fascia and deep fascia. What is characteristic of the superficial fascia?

A

Relatively thick layer of fat; continuous with adjoining regions like the superficial fascia of the back, abdomen, perineum, and thigh

76
Q

The fascia of the gluteal region can be described in terms of superficial fascia and deep fascia.

The deep fascia is attached above the crest of the _______ and ______.

A

Ilium

Sacrum

77
Q

The deep fascia of the gluteal region covers what 2 muscles?

A

Gluteus maximus

Gluteus medius

78
Q

The deep fascia of the gluteal region can be traced laterally or inferiorly to become continuous with what?

A

Fascia lata of thigh

79
Q

What are the 2 major bony origins of the muscles in the gluteal region?

A

Os coxae

Sacrum

80
Q

Origin of gluteus maximus

A

Posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament

81
Q

Insertion of gluteus maximus

A

Gluteal tuberosity of femur and IT band

82
Q

Action of gluteus maximus

A

Thigh extension

83
Q

Innervation of gluteus maximus

A

Inferior gluteal n.

84
Q

Origin of gluteus medius

A

Outer surface of wing of ilium and deep fascia covering this muscle

85
Q

Insertion of gluteus medius

A

Greater trochanter of femur

86
Q

Action of gluteus medius

A

Abduction and medial rotation of thigh

87
Q

Innervation of gluteus medius

A

Superior gluteal n.

88
Q

Origin of gluteus minimis

A

Outer surface of wing of ilium

89
Q

Insertion of gluteus minimis

A

Greater trochanter of femur

90
Q

Action of gluteus minimis

A

Abduction and medial rotation of the thigh

91
Q

Innervation of gluteus minimis

A

Superior gluteal n.

92
Q

Origin of tensor fascia lata

A

Iliac crest, anterior superior iliac spine

93
Q

Insertion of tensor fascia lata

A

IT tract

94
Q

Action of tensor fascia lata

A

Flexion and abduction of thigh

Also assists in medial rotation of thigh and extension of leg

95
Q

Innervation of tensor fascia lata

A

Superior gluteal n.

96
Q

The piriformis muscle passes through what foramen?

A

Greater sciatic

97
Q

Origin of piriformis

A

Pelvic surface of sacrum and sacrotuberous ligament

98
Q

Insertion of piriformis

A

Medial side of greater trochanter

99
Q

Action of piriformis

A

Lateral rotation of thigh

100
Q

Innervation of piriformis

A

Nerve to piriformis

101
Q

Origin of Obturator internus

A

Pelvic surface of obturator membrane and the bone surrounding the membrane

102
Q

As the obturator internus exits the pelvis, it makes a sharp turn through what foramen?

A

Lesser sciatic foramen

103
Q

Insertion of obturator internus

A

Greater trochanter of femur

104
Q

Action of obturator internus

A

Lateral rotation of thigh

105
Q

Innervation of obturator internus

A

Nerve to obturator internus

106
Q

Vascular supply to obturator internus

A

Inferior gluteal a.

107
Q

Origin of superior gemellus

A

Ischial tuberosity

108
Q

The tendon of the inferior gemellus m. blends with the tendon of what other muscle?

A

Obturator internus

109
Q

The insertion, innervation, and function of what muscles are identical to the obturator internus?

A

Superior gemellus

[inferior gemellus has same insertion and action, but innervation is different - nerve to quadratus femoris]

110
Q

Origin of inferior gemellus

A

Ischial tuberosity

111
Q

Innervation of inferior gemellus

A

Nerve to quadratus femoris

112
Q

Like with the superior gemellus, the tendon of inferior gemellus blends with the tendon of what muscle?

A

Obturator internus

113
Q

Origin of quadratus femoris

A

Ischial tuberosity

114
Q

Insertion of quadratus femoris

A

Intertrochanteric crest

115
Q

Innervation of quadratus femoris

A

Nerve to quadratis femoris

116
Q

Action of quadratus femoris

A

Lateral rotation of the thigh

117
Q

What are the 9 major muscles of the gluteal region?

A 
Gluteus maximus/medius/minimis
Tensor fascia lata
Piriformis
Obturator internus
Superior+inferior gemelli
Quadratus femoris
118
Q

Muscle origin/insertion/action/innervation:

Gluteus maximus

A

Origin: posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament

Insertion: gluteal tuberosity of femur and IT tract

Action: thigh extention

Innervation: inferior gluteal n.

119
Q

Muscle origin/insertion/action/innervation:

Gluteus medius

A

Origin: outer surface of wing of ilium and deep fascia

Insertion: greater trochanter

Action: abduction and medial thigh rotation

Innervation: superior gluteal n.

120
Q

Muscle origin/insertion/action/innervation:

Gluteus minimis

A

Origin: outer surface of wing of ilium

Insertion: greater trochanter

Action: abduction and medial thigh rotation

Innervation: superior gluteal n.

121
Q

Muscle origin/insertion/action/innervation:

Tensor fascia lata

A

Origin: iliac crest and anterior superior iliac spine

Insertion: IT tract

Action: flexion and abduction of thigh, medial rotation of thigh, extension of leg

Innervation superior gluteal n.

122
Q

Muscle origin/insertion/action/innervation:

Piriformis

A

Origin: pelvic surface of sacrum and sacrotuberous ligament

Insertion: medial side of greater trochanter

Action: lateral thigh rotation

Innervation: nerve to piriformis

123
Q

Muscle origin/insertion/action/innervation:

Obturator internus

A

Origin: pelvic surface of obturator membrane and bone surrounding membrane

Insertion: greater trochanter

Action: lateral rotation of thigh

Innervation: nerve to obturator internus

124
Q

Muscle origin/insertion/action/innervation:

Superior gemellus

A

Origin: ischial spine

Insertion: greater trochanter

Action: lateral rotation of thigh

Innervation: nerve to obturator internus

125
Q

Muscle origin/insertion/action/innervation:

Inferior gemellus

A

Origin: ischial tuberosity

Insertion: greater trochanter

Action: lateral thigh rotation

Innervation: nerve to quadratus femoris

126
Q

Muscle origin/insertion/action/innervation:

Quadratus femoris

A

Origin: ischial tuberosity

Insertion: intertrochanteric crest

Innervation: nerve to quadratis femoris

Action: lateral rotation of thigh

127
Q

Branches of what artery supply the gluteal region?

A

Internal iliac a.

[branches = superior gluteal a. and inferior gluteal a.]

128
Q

The superior gluteal a. exits the pelvis via what foramen to enter the buttock?

A

Greater sciatic foramen

129
Q

The superior gluteal a. lies between what muscles?

A

Piriformis and gluteus medius and minimis

130
Q

The superior gluteal a. lies between the piriformis and gluteu medius and minimis. It sends a superficial branch into what overlying muscle?

A

Gluteus maximus

131
Q

The superficial branch of the superior gluteal a. supplies the gluteus maximus. Its 2 deeper branches supply what 3 muscles?

A

Gluteus medius
Gluteus minimis
Tensor fascia lata

132
Q

The inferior gluteal a. enters the buttock below what muscle?

A

Piriformis

133
Q

What muscles are supplied by the inferior gluteal a.?

A 
Gluteus maximus
Obturator internus
Superior + inferior gemelli
Quadratus femoris
Superior part of hamstrings
134
Q

The inferior gluteal artery sends an unnamed branch laterally and downward to anastomose with other vessels to form what major arterial network in the hip?

A

Cruciate anatomosis

135
Q

The cruciate anastomosis in the hip consists of what vessels?

A

Medial and lateral femoral circumflex arteries and the first perforating branch of profunda femoris

MSK Exam I (18 decks)

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