Module 9 - Gluteal, Thigh, and Popliteal Flashcards
What are the muscles of the gluteal region?
- superior gemellus
- inferior gemellus
- gluteus maximus
- gluteus medius
- gluteus minimis
- obturator internus
- piriformis
- quadratus femoris
Which gluteal muscles laterally rotate the hip?
- superior gemellus
- inferior gemellus
- gluteus maximus
- obturator internus
- piriformis
- quadratus femoris
Which gluteal muscles medially rotate the hip?
- gluteus medias
- gluteus minimis
What are the OIANs for superior gemellus?
origin: external surface spine of ischium via obturator internus tendon
insert: greater trochanter
action: laterally rotates hip
nerve: sacral plexus (L5-S2)
What are the OIANs of inferior gemellus?
origin: proximal ischial tuberosity via obturator internus tendon
insert: greater trochanter
action: laterally rotate hip
nerve: sacral plexus (L4-S1)
What are the OIANs of the gluteus maximus?
origin: aponeurosis of the erector spinae, sacrum, sacrotuberous ligament and posterior gluteal line (innominate)
insert: greater trochanter, gluteal tuberosity of the femur and IT tract
action: extend and lateral rotate hip
nerve: inferior gluteal nerve (L5-S2)
What are the OIANs of gluteus medius?
origin: external iliac surface
insert: oblique ridge on the lateral aspect of the greater trochanter; gluteal aponeurosis
action: abducts and medially rotates hip; keeps the pelvis level when opposite leg is raised off ground
nerve: superior gluteal nerve (L4-S1)
What are the OIANs of the gluteus minimis?
origin: external iliac surface and margin of the greater sciatic notch
insert: anterolateral aspect of the greater trochanter
action: abducts & medially rotates hip; and keeps the pelvis level when opposite leg is
raised
nerve: superior gluteal nerve (L4-S1)
What are the OIANs of obturator internus?
origin: anterior lateral wall of the pelvis and obturator membrane
insert: medial surface of the greater trochanter
action: laterally rotates hip
nerve: nerve to obturator internus (L5-S2)
What are the OIANs of piriformis?
origin: anterolateral sacrum and posterior inferior iliac spine
insert: upper border of the greater trochanter
action: abducts and laterally rotated hip
nerve: nerve to piriformis (S1-2)
What are the OIANs of quadratus femoris?
origin: ischial tuberosity
insert: quadrate tubercle of the femur
action: laterally rotates hip
nerve: nerve to quadratus femoris (L4-S1)
What Is the organization of the fascia lata and its thickening, the iliotibial tract?
- deep fascia of the thigh
- lateral + medial intermuscular septa
- saphenous opening (great saphenous vein goes through here)
iliotibial tract
- extends from tensor fasciae latae and flutes maximums muscle to proximal lateral tibia
- long dense structure
- tight structure with bursae
What are the compartments of the thigh?
- anterior
- posterior
-medial
What separates the compartments of the thigh?
- medial (ant and medial compartments)
- lateral (ant and post compartments)
no separation between medial and posterior compartments
What are the contents general actions, innervation, and blood supply of the anterior compartment of the thigh?
- femoral n., hip flexors, knee extensors
- flex hip and extend knee
- femoral nerve innervation
- femoral artery
What are the contents general actions, innervation, and blood supply of the posterior compartment of the thigh?
- hip extensors and knee flexors
- extend thigh and flex knee
- tibial division of sciatic nerve
- femoral artery
What are the contents general actions, innervation, and blood supply of the medial compartment of the thigh?
- adductors of thigh
- adduct thigh and laterally rotate
- obturator nerve innervation
- obturator artery supply
*adductor Magnus innervated by tibial division of sciatic (hamstring part)
What are the anterior femoral muscles?
- iliopsoas (iliacus + psoas major)
- rectus femoris
- sartorius
- tensor fascia latae
- vastus medialis
- vastus lateralis
- vastus intermedius
- articularis genu
What are the OIANs of articularis genu?
origin: distal anterior shaft of femur
insert: proximal portion of synovial membrane of knee joint
action: pulls articular capsule proximally
nerve: femoral nerve (L2-4)
may blend with vests intermedius
What are the OIANs of vastus medialis?
origin: intertrochanteric line, spiral line, linea aspera and medial supracondylar line
insert: base and medial border of patella
action: extends leg
nerve: femoral nerve (L2-4)
What are the OIANs of vastus lateralis?
origin: intertrochanteric line, greater trochanter, gluteal tuberosity, and Lina aspera
insert: base and lateral border of patella
action: extends knee
nerve: femoral nerve (L2-4)
What are the OIANs of vastus intermedius?
origin: anterior aspect of proximal 2/3 of femoral shaft
insert: lateral border of patella
action: extends knee
nerve: femoral nerve (L2-L4)
What are the OIANs of tensor fascia latae?
origin: anterior iliac spine and external lip iliac crest
insert: iliotibial tract
action: abducts, flexes, and medially rotates hip and assists in knee extension
nerve: superior gluteal nerve (L4-S1)
What are the OIANs of sartorius?
origin: anterior iliac spine
insert: medial aspect of proximal tibia
action: flexes, abducts, and laterally rotates hip, flexes and assists in medial rotation of knee
nerve: femoral nerve (L2-3)
What are the OIANs of rectus femoris?
origin: anterior iliac spine and groove superior to acetabulum
insert: base of patella
action: flex hip and extend knee
nerve: femoral nerve (L2-4)
What are the OIANs of iliacus?
origin: iliac fossa, iliac crest, sacral ala, and sacroilliac ligaments
insert: lesser trochanter of femur
action: flexes and stabilizes the hip joint
nerve: femoral nerve (L2-4)
What are the OIANs of psoas major?
origin: anterior transverse processes, vertebral bodies and discs (T12-L5)
insert: lesser trochanter of femur
action: flexes and stabilizes hip joint
nerve: ventral rami L1-L4 (lumbar plexus)
What is the spinal level innervation of iliopsoas?
L1-4
What are the medial femoral muscles?
- adductor brevis
- adductor longus
- adductor magnus
- gracilis
- pectineus
- obturator externus
What are the OIANs of obturator externus?
origin: rami of the pubis and ischium; external obturator membrane
insert: trochanteric fossa
action: laterally rotates hip
nerve: obturator nerve (L3-4)
What are the OIANs of pectineus?
origin: superior pubic ramus
insert: femur between the lesser trochanter and linea aspera (pectineal line)
action: adducts and flexes hip
nerve: femoral and obturator nerve (L2-4)
What are the OIANs of gracilis?
origin: body of the pubis and inferior pubic ramus
insert: medial surface of tibia, distal to condyle, proximal to insertion of semitendinosus, lateral to insertion of satorius
action: flexes and medially rotates knee, and adducts hip
nerve: obturator nerve (L2-4)
What are the OIANs of adductor Magnus?
origin: inferior pubic ramus, ischial ramus, and tuberosity
insert: gluteal tuberosity, line aspera (adductor part) & medial supracondylar ridge and adductor tubercle of femur (hamstring part)
action: adducts and flexes (adductor part) & extends (hamstring part) hip
nerve: obturator nerve (adductor part L2-4) and tibial division of sciatic nerve (hamstring part L4-S1)
What are the OIANs of adductor longus?
origin: pubic crest
insert: medial lip linea aspera
action: adducts, medially rotates, and flexes hip
nerve: obturator nerve (L2-4)
What are the OIANs of adductor brevis?
origin: inferior pubic ramus
insert: distal 2/3 pectineal line and medial lip linea aspera
action: adducts and flexes hip
nerve: obturator nerve (L2-4)
What are the posterior femoral muscles?
- biceps femoris
- semimembranosus
- semitendinosus
What are the OIANs of semitendinosus?
origin: ischial tuberosity
insert: proximal, medial tibia
action: extends hip & flexes and medially rotates knee
nerve: tibial division of sciatic nerve (L4-S2)
What are the OIANs of semimembranosus?
origin: ischial tuberosity
insert: posterior aspect of the medial tibial condyle
action: extend hip & flexes and medially rotates knee
nerve: tibial division of sciatic nerve (L4-S2)
What are the OIANs of biceps femoris?
origin: ischial tuberosity and sacrotuberous ligament (long head); lateral lip of linea aspera and lateral supracondylar line (short head)
insert: lateral side of fibular head
action: flexes and laterally rotates the knee (both) and extends hip (long head only)
nerve: tibial division of sciatic (long head L5- S3) and fibular division of sciatic (short head L5-S2)
What are the boundaries of the femoral triangle?
- inguinal ligament
- adductor longus muscle
- sartorius muscle
floor
- iliopsoas
- pectineus
What are the contents of the femoral triangle
- femoral nerve, artery, and vein
What is the arrangement of the femoral artery, nerve, and vein?
lateral > medial
- nerve > artery > vein
NAV
What are the boundaries of the greater sciatic formina?
- anterior sacroiliac lig
- sacrotuberous lig
- sacrospinous lig
-greater sciatic notch
What are the contents of the greater sciatic foramina?
- piriformis muscle
- posterior femoral cutaneous nerve
- superior gluteal vessels/nerve
- inferior gluteal vessels/nerve
- internal pudendal vessels
- pudendal nerve
What are the boundaries of the lesser sciatic foramina?
- spine of ischium
- sacrotuberous lig
- tuberosity of ischium
What are the contents of the lesser sciatic foramina?
- obturator internus
- internal pudendal vessels
- pudendal nerve
What is a Trendelenburg gait and what structures are impairs in this condition?
- abnormal gait where hip of leg lifted off the ground drops significantly due to weakness of opposite hip abductor muscles
- affects superior gluteal nerve (L4-S1)
- insufficient gluteus medias and minimis activation
What are the important dermatome points of the LE?
- 1st toe = L4
- 5th toe = S1
- from top to bottom thigh = L1 > L2 > L3
- medial shin = L4
- lateral shin = L5
- plantar and dorsal foot = L5
- medial calf = S2
- lateral calf = S1
What is the path taken by the femoral nerve?
- saphenous branch descends through femoral triangle enters adductor canal, posterior (deep) to inguinal ligament
What is the path taken by the obturator nerve?
- emerges inferior to superior pubic ramus
- anterior and posterior branch
- relation to adduction brevis
What is the path taken by the sciatic nerve?
between greater trochanter and ischial tuberosity
- splits into common fibular and tibial
- biceps femoris SH = fibular division
- biceps femoris LH = tibial division
What is the path taken by the common fibular nerve?
- originates in sciatic nerve, courses along posterolateral aspect of leg deep to long head of biceps femoris and passes behind proximal fibular head
What is the path of the tibial nerve path?
- originates from sciatic nerve, travels through the posterior compartment of leg, descending between the heads of gratrocnemius
What is the path of lymphatic drainage of the lower extremity?
superficial inguinal and popliteal > deep inguinal > external iliac > ext iliac and int iliac > common iliac > R or L lumbar trunks > cisterna chyli > thoracic duct > internal jugular vein
What is the level of cisterna chyli?
- L2 vertebrae
What does the popliteal lymph node drain?
- drain knee and deep tissues of leg and foot
What does the deep inguinal lymph node drain?
- drain deep tissues of the thigh, popliteal nodes, and superficial inguinal nodes
What does the superficial inguinal lymph node drain?
- drain superficial structures inferior to umbilicus except for the anus and glans of the clitoris or penis
What do the right and left lumbar trunks drain?
- drain lateral aortic lymph nodes, carrying all lymphatic drainage from lower extremity
What vessels supply blood to the head and neck of the femur and how does this change with age?
- children = obturator artery
- adults = medial circumflex artery
What happens to the femur head and neck supply if there is a dislocation early in life?
- interrupt acetabular br of the obturator artery
- if later re-injured, avascular necrosis can develop
What is the femoral sheath and its contents?
- continuation of the plaices and transversalis fascia inferior to the inguinal ligament
- contains femoral nerve, artery, and vein
What are the locations you take femoral pulse?
- below inguinal ligament , midway between pubic symphysis and anterior superior iliac spine
What are the primary motions that occur at the knee?
- flexion/extension
rotation of tibia one femur during extension/flexion
What are the primary motions that occur at the hip?
- flexion/extension
- abduction/adduction
- circumduction
- rotation
What are the ligaments of the pelvic girdle?
- sacrotuberous
- sacrospinous
- fibrous joint capsule
- iliofemoral
- pubofemoral
- ischiofemoral
- ligamentum teres (head of femur)
- transverse acetabular
What are the attachments of the transverse acetabular ligament?
- interconnects margins of acetabular notch
What are the attachments of the ligamentum teres?
- fovea of femoral head to acetabular notch
What are the attachments of the ischiofemoral ligament?
- ischium posterior to acetabulum to the greater trochanter and iliofemoral ligament
What are the attachments and function of the pubofemoral ligament?
- from iliopubic eminence and superior pubic ramus to fibrous capsule
- limits femoral abduction
What are the attachments and function of the iliofemoral ligament?
- anterior iliac spine to the intertrochanteric line of the femur
- limit extension of thigh at hip
What are the attachments of the fibrous joint capsule of the hip?
- margin of the acetabulum to the neck, intertrochanteric line, and intertrochanteric crest of the femur
What are the attachments of the sacrospinous ligament?
- ischial spine to lateral margin of sacrum
What are the attachments of the sacrotuberous ligament?
- posterior iliac spine and lateral margin of the sacrum to the ischial tuberosity
What are the ligaments of the knee?
- fibrous capsule of the knee
- tibial (medial) collateral
- fibular (lateral) collateral
- anterior cruciate
- posterior cruciate
- patellar ligament
What are the attachments of the fibrous capsule of the knee?
- margins of the femoral condyles to the margins of the tibial condyles
What are the attachments and function of the tibial (medial) collateral ligament?
- medial epicodyle of the femur to the medial condyle and shaft of the tibia
- prevent abduction of tibia (genu valgus)
What are the attachments and functions of the fibular (lateral) collateral ligament?
- lateral epicondyle of the femur to the head of the fibula
- prevent adduction of tibia (genu varus)
What are the attachments and function of the anterior cruciate ligament?
- medial part of the anterior intercondylar area of the tibia to the posterior part of the medial surface of the lateral condyle of the femur
- prevents posterior displacement of the femur on the tibia and hyperextension of the knee
What are the attachments and functions of the posterior cruciate ligament?
- posterior intercondylar area of the tibia to the lateral surface of the medial condyle of the femur
- prevents anterior displacement of the femur on tibia
What are the attachments and function of the patellar ligament?
- apex of the patella to the tibial tuberosity
- resists knee flexion
What are the capsular ligaments of the hip?
- iliofemoral (strong enough to hold entire body weight
- pubofemoral (anterior)
- ischiofemoral (posterior)
- all will be taught in extension/limit extension
What are the capsular ligaments of the knee?
- MCL/TCL
- LCL/FCL
What are the joints of the pelvic girdle and hip?
- sacroiliac
- pubic symphysis
- hip
What is the synovial joint classification of the sacroiliac joint?
- plane
What is the synovial classification of the hip joint?
- ball and socket
What are the joints of the knee?
- tibiofemoral
- patellofemoral
- proximal tibiofibular
What is the synovial classification of the tibiofemorl joint?
- bi condylar
What is the synovial classification of the proximal tibiofibular joint?
- plane
What are the identifying features of the medial and lateral menisci?
medial
- larger
- C shape
- attached to MCL
lateral
- smaller
- O shape
What are the injuries of the meniscus?
- bucket handle
- radial tear
What are the strictly sensory branches of the lumbar plexus?
- femoral (L1-2)
- lateral cutaneous nerve of the thigh (L2-3)
What nerves belong to the anterior division of the sacral plexus?
- branches to levator ani
- pudendal nerve
- posterior cutaneous nerve of the thigh
- tibial division/tibial nerve of sciatic
What nerves belong to the posterior division of the sacral plexus?
- superior gluteal
- inferior gluteal
- nerve to piriformis
- perforating cutaneous
- fibular division/ common fibular nerve of sciatic
What is the most common mechanism of injury for hip dislocation and what structure is most affected?
- motor vehicle accident
- injure sciatic nerve
What are the weak points of the pelvis?
- weakest: between pubis and ischium
- superior pubic ramus
- inferior pubic ramus
What is a double ring and single ring fracture?
double
- between pubis and ischium
- superior pubic ramus fracture
single
- inferior pubic ramus fracture
What is normal angle of inclination and what are the indications of coxa vara and valgum?
- 125 deg
- coxa vara = <125 deg inclination, leads to genu valgum
- coxa valgum = >125 deg inclination, leads to genus varam
what is the normal angle of torsion?
- 8 to 15 deg
What is retrovesion and anterversion?
- anterversion = pigeon toed
- retroversion = duck feet
What are the boundaries of the popliteal fossa?
- popliteal surface of femur
- joint capsule of knee
- popliteus muscle and its fascia
What are the contents of the popliteal fossa?
superficial to deep
- tibial nerve
- popliteal vein
- popliteal artery
What muscles offer knee support?
- sartorius
- gracilis
- semitendinosus
(goose’s foot)
What are the boundaries of the gluteal region?
- inferior = gluteal fold
- lateral = line joining greater trochanter and ASIS
- superior = iliac crest
- medial = midline of body
What is the subpubic angle of men and women?
- men = 50-80 deg
- women = 90 deg (iliac flare)
What are the bones of the pelvic girdle?
- inominate (pubis, ilium, ischium)
- sacrum
- coccyx
What is the stage of fusion for the ischiopubic ramus?
- starts to fuse @ 7-8 yrs old
- fully fuses @ 15-25 yrs old
What is the function of quadratus lumborum branch of the lumbar plexus?
- sensory, postganlionic symp, and motor innervation of quadratus lumborum muscle
What is the function of the psoas branch of the lumbar plexus?
- sensory, postganlionic symp, and motor innervation of the psoas muscle
What are the functions of the lateral cutaneous nerve?
L2-3
- sensory and postganglionic sympathetic innervation of the skin overlying the lateral aspect of the thigh
What are the functions of the saphenous nerve branch of the femoral nerve?
L2-4
- sensory and postganlionic sympathetic innervation of the skin overlying the medial aspect of the leg
What are the functions of the muscular branches of the femoral nerve?
L2-4
- sensory, postganlionic sympathetic, and motor innervation of the iliacus, pectineus, sartorius, rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius muscles
What are the functions of the obturator nerve?
L2-4
- sensory, postganglionic symp, and motor innervation of the gracilis, adductor brevis, adductor longus, adductor Magnus, and obturator externus muscles
What are the functions of the nerve to piriformis branch of the sacral plexus?
S1-2
- sensory, postganlionic symp, and motor innervation of the piriformis muscle
What are the functions of the nerve to quadratus femoris branch of the sacral plexus?
L4-5, S1
- sensory, postganglionic symp, and motor innervation of the quadratus femoris and inferior gemellus muscles
What are the functions of the nerve to obturator internus branch of the sacral plexus?
L5,S1-2
- sensory, postganglionic symp, and motor innervation of the obturator internus and superior gemellus muscles
What are the sensory branches of the sacral plexus?
- perforating cutaneous and posterior cutaneous nerve of the thigh
What is the function of the perforating cutaneous nerve?
S2-3
- sensory, postganglionic symp innervation of the medial part of buttock
What are the function of the posterior cutaneous nerve of the thigh?
S1-3
- sensory, postganglionic symp innervation of buttock and uppermost medial and posterior surfaces of thigh
What are the functions of the superior gluteal nerve?
L4-5, S1
- sensory, postganglionic symp, and motor innervation of the gluteus medius, gluteus minimus, and tensor fasciae latae muscles
What are the functions of the inferior gluteal nerve?
L5, S1-2
- sensory, postganglionic symp, and motor innervation of the gluteus maximus muscle
What are the functions of the musclar branches of the tibial division of the sciatic nerve?
- sensory, postganglionic sympathetic and motor innervation of semimembranosus, semitendinosus, biceps femoris (LH) and adductor magnus muscles
What is the function of the sural nerve branch of the tibial nerve?
- sensory and postganglionic symp innervation of skin overlying lateral aspect of leg and foot
What are the functions of the muscular branches of the tibial nerve?
- sensory, postganglionic symp, and motor innervation of the gastrocnemius, soleus, planteris, popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles
What are the functions of the medial plantar nerve branch of the tibial nerve?
- sensory, postganglionic symp, and motor innervation of the medial muscles of the planter surface of the foot
What are the functions of the lateral plantar nerve branch of the tibial nerve?
- sensory, postganglionic symp, and motor innervation of the lateral muscles of the plantar surface of the foot
What are the functions of the muscular branches of the fibular division of the sciatic nerve?
- sensory, postganlionic symp, and motor innervation of the biceps femoris short head
What are the functions of the lateral sural nerve branch of the common fibular nerve?
- sensory and postganlionic symp innervation of the skin overlying lateral aspect of leg
What are the functions of the deep fibular nerve?
- sensory, postganglionic symp, and motor innervation of the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and fibulas tertius muscles
What are the functions of the superficial fibular nerve branch of the common fibular nerve?
- sensory, postganglionic symp, and motor innervation of the fibularis longus and brevis muscles
