Lower Limb: Gluteal Region and Thigh Flashcards
State the gateways to the pelvic girdle
Greater sciatic foramen
Lesser sciatic foramen
Obturator space/canal (foramen)
Retro-inguinal space
Greater sciatic foramen
Gateway between the pelvis and the gluteal region.
Lesser sciatic foramen
Gateway between the gluteal region and the perineum (place where you find external genitalia).
State the contents of the greater sciatic foramen
Sciatic nerve
Gluteal neurovascular bundle
(superior and inferior gluteal nerves + arteries etc.)
State the contents of the lesser sciatic foramen
Internal pudendal neurovascular bundle
State the contents of the obturator space (canal)
Obturator neurovascular bundle
State the contents of the retro-inguinal space
Femoral neurovascular bundle
- Femoral nerve
- Femoral artery
- Femoral vein
Describe the gluteal region (buttock)
i.e. how is it bounded
Bounded superiorly by the iliac crest and inferiorly by the gluteal fold (fold of the buttock)
What is the gluteal region made up of ?
Gluteal muscles and a thick layer of superficial fascia.
- Extensors, abductors and rotators of the hip joint
State the gluteal muscles
Gluteus maximus
Gluteus medius
Gluteus minimus
Extensors of the hip joint
Gluteus maximus
Abductors of the hip joint
Gluteus medius and minimus
What is the Gluteus Maximus innervated by ?
Inferior gluteal nerve
What are Gluteus Medius and Minimus innervated by ?
Superior gluteal nerve
KEY function of Gluteus Maximus
Prime extensor of the hip
(esp in a flexed position)
- standing up from sitting position + climbing stairs
Other function of the gluteus maximus
Externally rotates and abducts the femur
Extends and locks the knee via the iliotibial tract.
State the insertions of the gluteus maximus muscle
Deep fibres: insert on gluteal tuberosity
Superficial fibres: insert on iliotibial tract
Iliotibial tract
Thickening of the fascia lata in the thigh region.
Stabilises the lateral aspect of the knee via the gluteus maximus contraction.
Describe the location of gluteus medius and minimus
Gluteus medius lies deep to gluteus maximus
Gluteus minimus lies deep to gluteus medius
Where does gluteus medius attach ?
Between the anterior and posterior gluteal lines.
Where does gluteus minimus attach ?
Between the inferior and anterior gluteal lines.
Where does gluteus maximus attach ?
Behind the posterior gluteal line.
Tensor fascia lata and gluteus maximus attach to the iliotibial tract.
Function of the tensor fascia lata and gluteus maximus
Aids gluteus medius and minimus in hip abduction.
Innervation of tensor fascia lata
Superior gluteal nerve
Function of tensor fascia lata
Synergist, supporter, stabiliser of hip and knee movements.
Function of abductors of the hip
Keep the pelvis level when walking or standing on one leg.
Where are abductors of the hip found ?
Muscles that pass from the pelvis to the femur.
They lie laterally to the sagittal axis of the hip joint.
Test for abductors of the hip
Trendelburgh gait / test
Indicative of weakness of abductors.
Where are lateral rotators of the hip located ?
Pass from the pelvis to the femur.
Lie close to and posterior to the hip joint.
State the lateral rotators of the hip
Piriformis
Superior gemellus
Obturator internus
Inferior gemellus
Quadratus femoris
Obturator externus
Function of the lateral rotators of the hip
Stabilise the joint and laterally rotate the femur to keep the foot pointing forwards during walking.
Where do the lateral rotators of the hip insert ?
All except the quadratus femoris insert into the trochanteric fossa.
Nerve to piriformis
S1-2
Supplies the piriformis muscle
Nerve to obturator internus
L5, S1
Supplies the obturator internus and superior gemellus (and obturator externus which is pierced by the obturator nerve)
Nerve to quadratus femoris
L5, S1
Supplies the quadratus femoris and inferior gemellus
Location of the sciatic nerve
Emerges into the gluteal region, inferior to piriformis (usually)
Midway between the ischial tuberosity and greater trochanter.
What does the sciatic nerve run alongside ?
Runs alongside the posterior cutaneous nerve of the thigh.
Where can you safely inject in the gluteal region ?
EXAM TYPE Q
Intramuscular injection
- safe area for intramuscular injection is the upper, outer quadrant of the gluteal region
- away from the sciatic nerve
State the location of flexors of the hip
Pass from the pelvis to the femur.
Anterior to the transverse axis of the hip joint
State the flexors of the hip
Iliacus
Psoas major
COLLECTIVELY referred as : Iliopsoas
Sartorius
Rectus femoris
Function of Iliopsoas
The most powerful flexor of the hip
Iliopsoas
Iliacus (L2-3)
Psoas Major (L1-3)
Sartorius function
Flexor of the hip and knee joint
Rectus femoris function
Flexor of the hip and knee joint
Where do iliacus and psoas major pass ?
Pass through the retro-inguinal space into the femoral region.
- fascia of psoas divides the space into muscular and vascular compartments
- iliopsoas and femoral nerve pass through the muscular compartment
What supplies the sartorius and rectus femoris muscle ?
The femoral nerve
How is the retro-inguinal space divided into muscular and vascular compartments ?
The fascia of psoas divides the space
How are muscles of the thigh separated ?
Separated into 3 compartments by layers of deep fascia.
State the compartments of the thigh
Medial (Adductor)
Anterior (Extensor)
Posterior (Flexor)
All the compartments are surrounded by thick fascia lata
Function of the anterior compartment of the thigh
Knee extensors
Hip flexors
Function of the posterior compartment of the thigh
Knee flexors
Hip extensors
Function of the medial compartment of the thigh
Hip adductors
Nerve supplying the anterior compartment of the thigh
Femoral nerve
except iliopsoas
Nerve supplying the posterior compartment of the thigh
Sciatic nerve
Nerve supplying the medial compartment of the thigh
Obturator nerve
State the muscles of the anterior compartment of the thigh
Quadriceps femoris
Sartorius
Iliopsoas
Pectineus
How is the function of sartorius different from the other muscles in the anterior compartment of the thigh ?
Sartorius muscle FLEXES not EXTENDS the knee
Function of deep tendon reflex of the patella
Tests the femoral nerve
Spinal segments L3 and L4
What is the main extensor of the knee ?
Quadratus femoris
- knee joint stability is hugely dependent upon quadriceps
State the heads of quadratus femoris
Rectus femoris (acts of hip and knee joint)
Vastus intermedius
Vastus medialis
Vastus lateralis
How is the deep tendon reflex of the knee elicited ?
Elicited by tapping the patellar ligament
(Patellar tendon, quadriceps tendon)
State the boundaries of the femoral triangle
Inguinal ligament
Sartorius
Adductor longus
What is the femoral triangle ?
Area in the anterior thigh
- Roofs
- Boundaries
- Floor
- Contents
State the floor of the femoral triangle
Iliopsoas
Pectineus
Adductor longus
State the contents of the femoral triangle
Femoral Nerve, Artery, Vein
(lateral to medial NAVY)
Femoral nerve above iliopsoas
Femoral sheath : 3 compartments
- Artery
- Vein
- Femoral Canal: lymphatics
State the roof of the femoral triangle
Fascia lata
What is the femoral canal ?
A short and conical space between the medial wall of the femoral sheath and the femoral vein
What is the femoral sheath ?
A continuation of the abdominal transversalis fascia
What does the femoral canal contain ?
Deep inguinal lymph node
The femoral canal allows the femoral vein to expand.
Describe the femoral canal
The base of the femoral canal (opening) is the femoral ring.
The femoral ring is a weak area, common location for femoral hernia
Common location for femoral hernia
The femoral ring - opening of the femoral canal at the abdominal side
State some features of the femoral canal
Deep inguinal lymph node - cloquet node
Pectineal ligament
Lacunar ligament
Saphenous opening
State the location of the posterior muscles of the thigh
Muscles that pass from the pelvis to the lower limb.
Posterior to the transverse axis of the hip joint.
Function of the posterior compartment muscles of the thigh
Extend the thigh
Extend the hip
Flex the knee
State the muscles of the posterior compartment of the thigh
Ischiocrural (hamstring) muscles
Biceps femoris: 2 heads
Semitendinous
Semimembranosus
Location of the ischiocrural (hamstring) muscles
Extends between the ischial tuberosity and the leg.
Supply to the posterior comp of thigh
Sciatic nerve - tibial part
(except the short head of biceps femoris)
Origin and insertion of the hamstring muscles
ORIGIN: Ischial tuberosity
INSERTION of biceps femoris:
- fibular insertion
INSERTION of semitendinous and semimembranous - tibial insertion
State the hamstring muscles
Biceps femoris
Semitendinosis
Semimembranosis
What does the tibial part of the sciatic nerve innervate ?
Long head of biceps femoris
Semitendinosis
Semimembranosis
What is the short head of biceps femoris innervated by ?
The common peroneal part of the sciatic nerve.
State the muscles of the medial compartment of the thigh
Adductor magnus
Adductor longus
Adductor brevis
Gracilis
State some features of the medial compartment of the thigh
All adductors of the hip*
All originate from the pubic body/ramus and insert into the femur*
What muscle in the medial compartment of the thigh is not innervated by the obturator nerve ?
Adductor Magnus:
- has a hamstring part from ischial tuberosity, and is 1/2 innervated by the sciatic nerve
Adductor magnus
Dual nerve supply:
1/2 obturator nerve - adductor part
1/2 sciatic nerve - hamstring part
What is the pes anserinus ?
Common attachment of sartorius, gracilis and semitendinosus on the tibia.
Function of the pes anserinus
Adds significant dynamic stability to the medial side of the knee
Describe the tendons attaching to pes anserinus
Tendons pass posterior to the transverse axis of rotation of the knee
- flex the knee
Length of the adductor canal / hunters canal / SUB sartorial canal
Starts at the inferior corner of the femoral triangle
Ends at the adductor hiatus
What enters the adductor canal ?
Femoral vessels and saphenous nerve
- Saphenous nerve pierces the anteromedial wall and becomes superficial
- Femoral vessels enter popliteal fossa through adductor hiatus
Boundaries of the adductor canal
Vastus medius
(anterolaterally)
Adductor Longus and Magnus
(posteriorly)
Sartorius
(anteromedially)
