LOWER LIMB, GLUTEUS & HIP

Question 1

Describe key features of the lumbrosacral plexus.

Answer 1

Runs from spinal roots L2-S3.
Organization from Rami > Divisions > Terminal nerves
Lumbrosacral trunk connects lumbar to sacral plexuses between L4 and L5

Question 2

What are the spinal roots of the anterior compartments of the lower limb

Answer 2

Lumbar (L2-L5)

Question 3

The spinal roots of the posterior compartments of the lower limb are…

Answer 3

Lumbosacral (L5-S2)

Question 4

The rami levels of L3/L4 for myotonic innervation are involved with knee _____

Answer 4

Knee Extension
L3/L4 “Kick the door”
*Involved with Patella reflex”

Question 5

The rami levels in S1/S2 are involved with ________ of the foot.

Answer 5

Plantar Flexion

S1/S2 “Buckle my shoe”

Question 6

The dermatome level of the belly button is…

Answer 6

T10 dermatome level

Question 7

The dermatome level at the knee is…

Answer 7

L4 dermatome level

Question 8

A man came into the ED after sustaining trauma to his lower back. He states that after the injury he felt tingling of sensation spiraling from his lateral thigh to the dorsum of his foot. Which spinal nerve is impinged.

Answer 8

L5 spinal nerve

Question 9

The anterior muscles of the hip are ________ (from myotomes __to__), while the anterior department of the ankle are __________ (from myotomes __to__).

Answer 9

Hip flexors at the thigh (L2-L3),
Knee extensors (dorsiflexors; L3-L4)

Question 10

Describe the significance of the autonomous zone.

Answer 10

Unlike the upper limb (with regards to segmental innervation), if you knock out a rami for the lower limb with anesthesia, you will see Total Numbness.

Question 11

List the arteries that supply the following:

Hip; Thigh; Knee; Leg; Foot

Answer 11

Hip: Femoral artery;
Thigh: Deep femoral artery;
Knee: Popliteal artery;
Leg: Anterior and Posterior Tibial Arteries
Foot: Plantar Arches and dorsal pedis artery

Question 12

Describe the attachments and directions of the pelvic ligaments.

Answer 12

Sacrotuberous ligament: (vertical) between pubis and spinal sacrum
Sacrospinous ligament: (horizontal) between Ischial spine and spinal sacrum
Sacroiliac ligament: (diagonal) between iliac spine and sacral lateral attachments

Question 13

If an elderly person sustained a hip injury from a hard fall and claims to have broken a bone, which bone is most likely damaged?

Answer 13

Elderly are prone to femoral neck fractures from old age or from falls.

Question 14

What would someone not be able to do if his or her Superior gluteal nerve is lacerated? How is this shown if that person stands on one leg?

Answer 14

Struggle to abduct the thigh or stand on one leg, since the gluteus medius and minimus would not be innervated. This can present as a positive Trendelenberg sign where the hip is slanted towards the affected side.

Question 15

List the pelvic muscles that are medial rotators at the thigh.

Answer 15

Gluteus medius, gluteus minimus, tensor fascia latae

Question 16

List the lateral rotators of the thigh.

Answer 16

Piriformis, gemellus superior, gemellus inferior, Obturator Internus, Quadratus femoris
“P-Go-Go-Q”

Question 17

What is the hip extensor, its innervation and daily actions it assists with.

Answer 17

Gluteus maximus - inferior gluteal nerve

Walking upstairs, getting out of the chair

Question 18

Describe the types of sciatic nerve variations.

Answer 18

Piriformis Syndrome - common fibular nerve goes THROUGH the piriformis leading to pain when contracted.
Intragluteal Injection Risk - common fibular nerve is at risk after an injection because it passes ABOVE the piriformis

Question 19

Where does the sciatic nerve originate in normal human anatomy?

Answer 19

Out from the greater sciatic foramen between the sacrum and sacrospinous ligament, BELOW the piriformis.

Question 20

Describe the significance of the acetabulum.

Answer 20

This articulates with the femoral head, in which the labrum deepens the hip joint. This fuses the 3 bone components of the pelvic girdle: ilium, ischium and the pubis.

Question 21

Which hip ligaments are known to resist hip extension?

Answer 21

Iliofemoral ligament and pubofemoral ligament pull tighter during hip extension, thereby resisting this action.

Question 22

What vessel supplies blood to the hip joint and where does it originate?

Answer 22

Medial circumflex femoral artery supplies the hip joint and branches from the femoral artery.

Question 23

What are the four structures that emerge from the Femoral triangle?

Answer 23

“NAVL: going from lateral to medial”
Femoral nerve, artery, vein and lymphatic.
These structures emerge from below the inguinal ligament out of the femoral canal. The nerve is outside of the sheath

Question 24

Describe the 3 common reasons for hip dysfunction.

Answer 24

1. Hip dislocations - more common in females’ left hip (due to looser ligaments)
2. Femoral neck fractures - femoral head and trochanter can break (and are no longer at a slant as seen normally in a radiograph)
3. Osteoarthritis - articulate cartilage is worn down, osteophytes form, nerves are irritated

Question 25

What 2 nerves make up the Sciatic nerve and what spinal roots does this nerve arise from?

Answer 25

Tibial nerve (anterior division) and the Common Fibular nerve makes up the Sciatic nerve (L4-S3)

Question 26

Lymph from the lower limb drains into the _______ _______ nodes where the thigh and trunk meet.

Answer 26

Deep Inguinal nodes at the groin

Question 27

What is the main blood supply for the hip joint? What can occur if it ruptures, that commonly occurs with falls in the elderly?

Answer 27

Medial Circumflex Femoral Artery;

Avascular necrosis of the Femoral head

Question 28

If a radiologist finds an X-ray of a patient with the femur head and trochanter at the same level, what injury has that person sustained?

Answer 28

Femoral neck fracture, since normally the femur head and trochanter are at a slant.

Question 29

Define the Adductor Hiatus and what passes through it.

Answer 29

This is a space in which the femoral artery passes through to supply the posterior part of the leg. It eventually becomes the. Popliteus artery after this hiatus