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MSK Exam 2 > Lecture 9: Gluteal Region > Flashcards

Lecture 9: Gluteal Region Flashcards

1
Q

Where is the gluteal region located and what are the superior and inferior boundaries?

A

Posterior to the pelvis.

Superior boundary: iliac crests

Inferior: gluteal sulcus

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2
Q

Other names for the hip bone

A
  1. Os coxae

2. Innominate bone

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3
Q

Why is the ox coxae plural?

A

At birth, the ilium, ischium and pubis bones were separate.

Overtime, they fused together at the acetabulum.

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4
Q

What two ligaments form the important foramina for the passage of structures in and out of the gluteal region?

A
  1. Greater sciatic foramen

2. Lesser sciatic formen

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5
Q

Gluteus Maximus M.

Innervation:

Action:

A

Innervation: Inferior gluteal nerve

Action:

  1. Extend thigh
  2. Laterally rotate thigh
  3. When working with tensor fascia lata m, it slightly helps to extend.
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6
Q

Gluteus Medius M.

Innervation:

Action:

A

Innervation: Superior gluteal n.

Action:

  1. Abduct thigh
  2. Medially rotate thigh
  3. Stabilize the pelvis
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7
Q

Gluteus Minimus M.

Innervation:

Action:

A

Innervation: Superior Gluteal N.

Action:

  1. Abduct thigh
  2. Medially rotate thigh
  3. Stabilize the pelvis
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8
Q

Tensor Fascia Lata M

Innervation:

Action:

A

Innervation: Superior Gluteal N.

Action:

  1. Abduct thigh
  2. Medially rotate thigh
  3. Flex thigh
  4. Helps to extend knee, along with the gluteus maximus
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9
Q

Tensor fascia late M origin and insertion

A

Origin- ASIS (anterior superior iliac spine)

Insert: iliotibial tract

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10
Q

What encloses the tensor fascia lata?

A

Fascia lata

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11
Q

Piriformis M.

Innervation:

Action:

A

Innervation: Nerve to the piriformis m.

Action:

  1. Laterally rotates the extended thigh
  2. Abduct flexed thigh
  3. Stabilize femoral head in acetabulum
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12
Q

Superior Gemellus M

Innervation:

Action:

A

Innervation: nerve to the obturator internus m. and superior gemellus m.

Action:

  1. Laterally rotate extended thigh
  2. Abduct flexed thigh
  3. Stabilize the femoral head in acetabulum
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13
Q

Obturator internus m.

Innervation:

Action:

A

Innervation: nerve to the obturator internus m. and superior gemellus m.

Action:

  1. Laterally rotate the extended thigh
  2. Abduct flexed thigh
  3. Stabilize the femoral head in acetabulum
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14
Q

Inferior Gemellus M

Innervation:

Action:

A

Innervation: Nerve to the quadratus femoris m. and inferior gemellus m.

Action:

  1. Laterally rotate the extended thigh
  2. Abduct the flexed thigh
  3. Stabilize the femoral head
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15
Q

What muscles are innervated by the superior gluteal N?

A
  1. Gluteus medius m.
  2. Gluteus minimus m.
  3. Tensor Fascia Lata m.
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16
Q

What muscle is innervated by the inferior gluteal n?

A
  1. Gluteus maximus m.
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17
Q

What muscle is innervated by the nerve to the piriformis m.?

A
  1. Piriformis m.
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18
Q

What muscle is innervated by the nerve to the obturator internus m?

A
  1. Superior Gemellus m.

2. Obturator internus m.

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19
Q

What muscles are innervated by the nerve to the quadratus femoris m?

A
  1. Inferior gemellus m.

2. Quadratus femoris m.

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20
Q

Quadratus Femoris M

Innervation:

Action:

A

Innervation: Nerve to the quadratus femoris m. and inferior gemellus m.

Action:

  1. Laterally rotate thigh
  2. Stabilize the femoral head in acetabulum
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21
Q

Obturator Externus M

Innervation:

Action:

A

Innervation: Obturator N.

Action:

  1. Laterally rotate thigh
  2. Stabilize the femoral head in acetabulum
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22
Q

What forms the cruciate anastomosis?

A
  1. Inferior gluteal artery
  2. transverse branch of the medial circumflex femoral artery (MCFA)
  3. Transverse branch of the lateral circumflex femoral artery (LCFA)
  4. 1st perforating artery of the ascending branch of the deep femoral a.
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23
Q

Where should intragluteal injections be made?

A

Supero-lateral part of the gluteal region in order to avoid the sciatic nerve and other gluteal nerves

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24
Q

Where should you draw the line to do an intragluteal injection?

A
  1. Lateral line from the PSIS to the greater trochanter of the femur
  2. Draw a line from the midpoint to the iliac crest

Inject in the supero-lateral part.

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25
Q

Gluteus maximus m fibers

A

parallel

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26
Q

Gluteus medius m fibers

A

up and down

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27
Q

What is the single largest muscle in the body

A

Gluteus maximus m.

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28
Q

What is the chief extensor of the thigh and lateral rotation?

A

Gluteus maximus

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29
Q

Where does the Gluteus maximus m insert?

A
  1. Gluteal tuberosity of the femur

2. IT band

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30
Q

What muscle can we reference to view the superior and inferior neurovascular bundles?

A

Piriformis m.

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31
Q

The [posterior femoral cutaneous nerve] comes out where?

A

below the piriformis m.

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32
Q

During the gait cycle, what muscles fire in the STANCE phase and relax in the swing phase?

A

Gluteus medius m.

Gluteus minimus m.

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33
Q

As we go into _____ phase, the gluteus minimus and gluteus medius m will begin to flex.

A

Stance

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34
Q

As we go into _____ phase, the gluteus minimus and the gluteus medius m will begin to relax.

A

Swing

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35
Q

What makes us able to walk bipedally?

A

The repositioning of the ileum in our pelvis.

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36
Q

Why do monkeys walk with limp?

A

They do not have gluteus minimus and maximus mucles. To walk, they have to bend their knees to pull their center of mass rearward. As they walk, they move their center of mass back,

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37
Q

Duchenne’s limp is also called

A

gluteal gait

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38
Q

What is Duchenne’s limp?

A

Gluteus medius and minimus muscle abductors do not work because their is injury to the [superior gluteal nerve].

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39
Q

What is the effect of Duchenne’s limp?

A
  1. Gluteus minimus and gluteus maximus do not keep the patient steady.
  2. Person will lean toward the effect side during the stance phase of gait to compensate for opposite pelvis dropping.
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40
Q

IT band runs from where to where?

A

Iliac tubercle to Gerdy’s tubercle on the lateral tibial condyle

41
Q

IT band is reinforced by tendinous fibers from where?

A
  1. Tensor fasciae lata m.

2. Gluteus maximus m.

42
Q

Functions of the iliotibial band (IT Band)

A
  1. Adduct thigh
  2. Laterally stabilize knee
  3. If the center of rotation is within the boundaries of the IT band, it EXTENDS the knee when the glut contracts, compensating for quadriceps paralysis
  4. if the center of rotation is ANTERIOR to the boundaries of the IT band, it FLEXES the knee when the glut max contracts.
  5. Pulls the patella laterally, antagonist of the vastus medialiis and synergist with flexing vastus lateralis.
  6. Can be stetched to treat chondromalacia patella
43
Q

What is special about the IT band?

A

if the center of rotation is within the boundaries of the IT band, it will extend (straighten) the knee when the glut contracts.

This can make up for quadriceps paralysis.

If the center of rotation is ANTERIOR to the IT band, it will FLEX the knee when your glut mac contracts

44
Q

How can we treat condromalacia patella?

A

Stretch IT band

45
Q

What sign is indicative of Duchenne’s limp

A

A positive Trendelenburg sign

46
Q

Piriformis and the sciatic nerve

A

Usually, the sciatic nerve comes out BELOW the piriformis m.

Sometimes, the [common fibular branch of the sciatic n] and [tibial branch of the sciatic n] can seperate around or through it and rejoin after they pierce out.

47
Q

Obturator internus means

A

to occlude

48
Q

What are the extrapelvic parts of the obturator internus?

A

Superior and inferior gemellus m.

49
Q

What are the tripceps coxae?

A
  1. Superior gemellus m.
  2. Inferior gemellus m.
  3. Obturator internus m.
50
Q

What are the vertically oriented groups of glut muscles?

A

5 muscles

  1. Glut max, min and med
  2. Tensor fascia lata m.
  3. Pirformis m.

All other are horizontal.

51
Q

Bursa of gluteal region

A
  1. Ischial bursa
  2. Trochanteric bursa
  3. Gluteofemoral bursa
52
Q

What gluteal region bursa is easily inflamed.

A

Trochanteric bursa: inflamed easily in repetitive movements

53
Q

For hip pain, what is the first things docs look at?

A

trochanteric bursa.

54
Q

BS of the gluteus maximus m.

A
  1. Superficial branch of the superior gluteal a.

2. Inferior gluteal a.

55
Q

BS of the gluteus medius m.

A

Deep branch of the superior gluteal a.

56
Q

BS of the gluteus minimus m.

A

Deep branch of the superior gluteal a.

57
Q

BS of tensor fascia lata m.

A

Deep branch of the superior gluteal a.

58
Q

BS of the superior gemellus m

A

Inferior gluteal a.

59
Q

BS of the obturator internus m.

A

inferior gluteal a

60
Q

BS of the inferior gemellus m.

A

inferior gluteal a

61
Q

BS of the quadratus femoris m.

A

Inferior gluteal a.

62
Q

BS of the superior hamstring muscles

A

inferior gluteal a.

63
Q

BS of obturator externus

A

Obturator artery

64
Q

Superior gluteal A
Inferior gluteal A
Internal pudendal A

are all branches of what artery?

A

Internal iliac A

65
Q

Gluteus Maximus M

Innervation
B.S

A

Innervation: Inferior gluteal N.

B.S:
[Superficial branch of the superior gluteal A] and the [inferior gluteal A.]

66
Q

Gluteus Medius M.

Innervation
B.S

A

Innervation: Superior Gluteal N

B.S: Deep branch of the superior gluteal A

67
Q

Gluteus Minimus M

Innervation
B.S

A

Innervation: Superior gluteal N

B.S: Deep branch of the superior gluteal A

68
Q

Tensor Fascia Lata M

Innervation
B.S

A

Innervation: Superior gluteal N

B.S:

  1. Deep branch of the superior gluteal a
  2. Lateral circumflex femoral A
69
Q

Piriformis M

Innervation
B.S

A

Innervation: Nerve to the piriformis m.

B.S: Inferior gluteal A and superior gluteal a.

70
Q

Superior gemellus m.

Innervation
B.S

A

Innervation: Nerve to the obturator internus and superior gemellus m

B.S: Inferior gluteal A

71
Q

Obturator internus m.

Innervation
B.S

A

Innervation: Nerve to the obturator internus m and the superior gemellus m

B.S: Inferior gluteal A

72
Q

Inferior gemellus m.

Innervation
B.S

A

Innervation: Nerve to the quadratus femoris and inferior gemellus m.

B.S: Inferior gluteal A

73
Q

Quadratus femoris m.

Innervation:
B.S:

A

Innervation: Nerve to the quadratis femoris m and inferior gemellus m.

B.S: Inferior gluteal A

74
Q

Obturator externus m.

Innervation:
B.S:

A

Innervation: Obturator N

BS: Obturator A.

75
Q

What ligament is under sacrotuberous ligament

A

sacrospinous ligament

76
Q

What is PIN

A
  • Pudendal nerve
  • Internal pudendal artery
  • Nerve to the obturator internus and superior gemellus m.
77
Q

Superficial branch of the superior gluteal artery supplies blood to

A
  1. Gluteus maximus m.
78
Q

Deep branch of the superior gluteal artery supplies blood to

A
  1. Gluteus medius m.
  2. Gluteaus minimus m.
  3. Tensor fascia lata m.
79
Q

What happens if the femoral head is DISLOCATED posteriorly?

A

We see a shortening and the hip is internally (medially) rotated

80
Q

What happens if the femoral head is FRACTURED?

A

We see a shortening and the hip is externally (laterally) rotated.

81
Q

What ligament is the major divider of the greater sciatic foramen?

A

Sacrospinous ligament

82
Q

What ligament is the major divider of the lesser sciatic foramen?

A

Sacrotuberous ligament

83
Q

What enters & exits the lesser sciatic foramen?

A

The lesser sciatic foramen is divided by the sacrotuberous ligament.

Exits: Obturator internus

Enters: PIN

  1. Pudendal nerve
  2. Internal pudendal A.
  3. Nerve to the obturator internus and superior gemellus m.
84
Q

What exits the greater sciatic foramen?

A
  1. Superior gluteal artery, nerve and vein
  2. Inferior gluteal artery, nerve and vein
    - Piriformis M
  3. Sciatic nerve
  4. Posterior femoral cutaneous n.
  5. PIN

PIN will exit the greater sciatic foramen and re-enter the lesser sciatic forament.

85
Q

What happens if we damage the [Ligament of the Head of the Femur]?

A

During childhood, a branch of the obturator artery goes to the head of the femur to give blood to the neck.

In some adults, the branch is still present and damage to the ligament of the head of the femur can damage the artery.

Result: Avascular necrosis of the femoral head

86
Q

Where do the spinal nerve roots of the [superior gluteal nerve] come from?

87
Q

Where do the spinal nerve roots of the [inferior gluteal nerve] come from?

88
Q

Gluteal crush injury

A

When a person puts too much weight on one side of their butt for too long, this can compress their SCIATIC NERVE. As a result, they loose sensation in

  1. hamstring muscles
  2. Down thigh
  3. cannot plantarflex or dorsiflex foot
89
Q

What are the cutaneous nerves of the gluteal region?

A

Cluneal nerves:

  1. Superior cluneal nerve
  2. Middle cluneal nerve
  3. Inferior cluneal nerve
90
Q

What supplies sensation to the superior 2/3 of the butt?

A
  1. Superior cluneal N.

2. Middle cluneal N.

91
Q

Where do the superior cluneal nerve roots come from?

A

L1-L3 dorsal rami

92
Q

Where do the middle cluneal nerve roots come from?

A

S1- S3 dorsal rami

93
Q

Where the inferior cluneal nerve roots come from?

A

S1-S3 VENTRAL rami

94
Q

What are the small lateral rotators?

A
  1. Superior gemellus m.
  2. Obturator internus m
  3. Inferior gemellus m
  4. Quadratus femoris m.
95
Q

What does the internal pudendal a supply blood to?

A

Perineal m and external genitilia.

NO STRCTURS IN THE BUTT.

96
Q

What is the chief extensor of the thigh?

A

GLUTEUS MAXIMUS

97
Q

Pivot shift test

A

The pivot shift test is a test done to see if the anterior cruciate ligament (ACL) is damaged.

Doc flexes the knee and if the knee “pop” backwards as the IT tract becomes a flexor, the test is +.

98
Q

If the knee strays straight, the IT tract will _____ the knee.

If the knee becomes overly bent, the IT tract becomes a _____ of the knee.

A

straighten

Flexor

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