Muscles Of The Gluteal Region And Thigh And Neurovascular Supply Of The Thigh Flashcards
1
Q
2 groups of muscles in gluteal region
A
Superficial
Deep
2
Q
Superficial gluteal muscles
A
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia latae
3
Q
Number of superficial gluteal muscles
A
4
4
Q
Proximal Attachments of gluteus maximus
A
Most posterior parts of the posterior surface of the ilium
Sacrotuberous ligament
Sacrum
5
Q
Distal attachments of the gluteus maximus
A
Iliotibial band
Gluteal tuberosity
6
Q
Function of gluteal maximus
A
Extensor of the hip
- Important for standing from a sitting position
External rotator of the hip
Stabilises knee joint- as inserts into Iliotibial tract
7
Q
Attachments of the gluteus medius and gluteus minimus
A
Posterior ilium
Greater trochanter
8
Q
Function of gluteus medius and gluteus minimus
A
Abduction of hip
Internal rotation of hip
Important role in normal gait- contraction and hold the pelvis level when walking
9
Q
Attachments of the tensor fascia latae
A
ASIS
Iliotibial band
10
Q
Function of tensor fascia latae
A
Tenses the fascia lata and Iliotibial band- stabilising the knee when extended
Weak hip flexor
11
Q
Fascia lata
A
A thick fascia that envelopes the muscles of the thigh from the iliac crest proximally to the tibia distally
12
Q
Which nerves innervate the superficial gluteal muscles
A
Gluteal nerves which leave the sacral plexus via the greater sciatic foramen
13
Q
Which nerve innervates the gluteus maximus
A
Inferior gluteal nerve
14
Q
Which nerve innervates the gluteus medius, gluteus minimus and tensor fascia latae
A
Superior gluteal nerve
15
Q
Function of deep gluteal muscles
A
Stabilise and laterally rotate the hip
16
Q
Number of deep gluteal muscles
A
5
17
Q
Deep gluteal muscles
A
Piriformis
Superior and inferior gemelli
Obturator internus
Quadratus femoris
18
Q
What do all deep gluteal muscles insert into or close to
A
Greater trochanetr
19
Q
Path of piriformis muscle
A
Attaches to anterior surface of sacrum
Passes through greater sciatic foramen
Inserts on greater trochanter
20
Q
Over which muscle do the nerves of the sacral plexus pass
A
Piriformis
21
Q
Where does the sciatic nerve emerge
A
Below inferior border of Piriformis in gluteal region
22
Q
What do the superior and inferior gemelli and quadratus femoris arise from
A
Ischium
23
Q
What does the obturator internus arise from
A
Obturator membrane
24
Q
What does the tendon of the obturator internus pass through
A
Lesser sciatic foramen
25
Number of muscles in anterior thigh
7
26
What are the muscles of the anterior thigh innervated by
Femoral nerve
27
Which spinal nerves are the femoral nerve derived from
L2-L4
28
Muscles of the anterior thigh
Quadriceps femoris- 4 muscles
Sartorius
Iliopsoas
Pectineus
29
Function of quadriceps femoris
Primary Extensor of the knee
30
Muscles of quadriceps femoris
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
31
Quadriceps tendon
Convergence of all 4 quadriceps femoris muscles
Runs over patella to insert into the tibial tube rosary via the patellar ligament
32
Rectus femoris
Lies in midline of anterior thigh
Attaches to AIIS
33
Function of rectus femoris
Flexion of hip
Extension of knee
34
Vastus lateralis
Lies lateral to rectus femoris
Attaches to linea aspera on posterior aspect of femoral shaft
35
Vastus medialis
Lies medial to rectus femoris
Attaches to linea aspera
36
Vastus intermedius
Lies deep to rectus femoris
Attaches to anterior aspect of femoral shaft
37
Sartorius location
Superficially in anterior thigh
Attaches to ASID and twists across thigh to insert on medial aspect of proximal tibia
38
Function of sartorius muscle
Flexion and external rotation of hip joint
Flexion of knee
39
Iliopsoas location
Proximal in anterior thigh
Psoas major and iliacus converge via a common tendon onto the lesser trochanter of the femur
40
Which 2 muscles form the ilipsoas
Psoas major
Iliacus
41
Function of ilipsoas
Primary Flexor of hip joint
42
What innervated the psoas major
Branched of L1-L3 spinal nerves
43
What innervates the iliacus muscle
Femoral nerve
44
What is the primary flexor of the hip joint
Ilipsoas
45
Pectineus location
In proximal anterior thigh medial to ilipsoas
Attaches proximally to superior pubic ramus and distally in femur (just inferior to lesser trochanter)
46
Function of pectineus
Flexes and adducts the hip joint
47
Number of muscles in the medial thigh
5
48
Which nerve innervates the muscles of the medial thigh
Obturator nerve
49
Which spinal nerves form the obturator nerve
L2-L4
50
Primary action of the medial thigh muscles
Adductors of the hip
51
Muscles of the medial thigh
Adductor brevis
Adductor longus
Adductor Magnus
Gracilis
Obturator externus
52
Which 2 muscles does the Obturator nerve lie between
Adductor brevis and adductor longus
53
Attachments of the adductor brevis and adductor longus
Pubic bone
Linea aspera
54
2 parts of adductor Magnus
Adductor part
Hamstring part
55
Adductor part of adductor Magnus
Attaches to inferior pubic ramus and linea aspera
Acts as an adductor
Innervated by Obturator nerve
56
Hamstring part of adductor Magnus
Attaches to ischia’s tuberosity and adductor tubercle
Acts as an extensor of the hip
57
Hamstring part of adductor Magnus function
Extensor of hip
58
Hamstring part of adductor Magnus innervation
Tibial part of sciatic nerve
59
Adductor hiatus
Gap formed between the distal attachments of the 2 parts of the adductor magnus
60
What travels through the adductor hiatus
Femoral artery and vein to enter posterior thigh
61
Gracilis location
Most medial muscle
Attaches to pubic bone and medial aspect of tibia
62
Gracilis function
Weak adductor and flexor of hip
Weak flexor of knee
63
Obturator externus location
Attached to external surface of Obturator membrane and inserts in femur near greater trochanter
64
Function of Obturator externus
Stabilises and laterally rotates the hip
65
Number of muscles in posterior thigh
4
66
Muscles in posterior thigh
Semimembranosus
Semitendinosus
Biceps femoris
Hamstring part of adductor magnus
67
Which muscles form the hamstrings
Semimembranosus
Semitendinosus
Long head of biceps femoris
68
What do the hamstrings attach to
Ischial tuberosity proximally
69
Function of the hamstrings muscles
Extend the hip
Flex the knee
70
What innervates the hamstrings muscles
Tibial part of the sciatic nerve
71
What does the Semimembranosus and Semitendinosus insert into
Medial aspect of proximal tibia
72
What does the long head of the biceps femoris insert into
Forms a common tendon with the short head and inserts onto head of the fibula
73
What does short head of the biceps femoris arise from
Linea aspera
74
What innervates the short head of biceps femoris
Common fibular part of sciatic nerve
75
Function of short head of biceps femoris
Flexes the knee
76
What does the hamstring part of adductor magnus arise from
Ischial tuberosity
77
What does the hamstring part of the adductor magnus insert onto
Adductor tubercle of the femur
78
Function of the hamstring part of the adductor magnus
Extends the hip
79
Biceps femoris
Short head and long head
80
Femoral triangle
Region of the proximal anterior thigh
81
Lateral border of the femoral triangle
Medial border of the sartorius
82
Medial border of the femoral triangle border of the femoral triangle
Lateral border of adductor longus
83
Superior border of the femoral triangle
Inguinal ligament
84
Apex of the femoral triangle
Distal
Where sartorius and adductor longus meet
85
Floor of the femoral triangle
Ilipsoas laterally
Pectineus medially
86
Contents of the femoral triangle
Femoral artery
Femoral vein
Femoral nerve
Lymknatics
87
Tributary into the femoral vein
Superficial vein- great saphenous vein
88
Location of femoral nerve
Travels deep to the inguinal ligament to enter the anterior thigh
89
Order of contents of femoral triangle from lateral to medial
NAVaL
Nerve
Artery
vein
Lymphatics
90
What are the superior and inferior gluteal arteries branches of
Internal iliac artery
91
What is the femoral artery a branch of
External iliac artery
92
What is the Obturator artery a branch of
Internal iliac artery
93
Branches of the femoral artery
Profunda femoris
Popliteal artery
94
What does the femoral artery become
Popliteal artery
95
Path of femoral artery
It travels deep to the inguinal ligament to enter the proximal anterior thigh. It is located relatively superficially here and can be palpated. It gives off a large branch called the profunda femoris (deep artery of the thigh) which travels deep into the thigh and supplies it. The femoral artery continues distally, traverses the adductor hiatus, and enters the distal part of the posterior thigh where it becomes the popliteal artery.
96
Path of Obturator artery
It travels through the obturator canal into the medial compartment of the thigh. It anastomoses with branches from the femoral artery.
97
Which 2 arteries of the thigh anastomose
Femoral and obturator
98
Which arteries supply the hamstring muscles
3/4 perforating arteries that arise from the profunda femoris
99
Path of perforating arteries
travel through small apertures in the adductor magnus to reach the posterior compartment.
100
Veins of the thigh
Superior and inferior gluteal veins
Popliteal vein—> femoral vein
Great saphenous vein
Obturator vein
101
Which veins drain into the internal iliac vein
Obturator
Superior and inferior gluteal
102
Path of femoral vein
Medial to femoral artery in proximal thigh
103
How does the popliteal vein enter the anterior thigh
Via the adductor hiatus
104
What does the femoral vein receive blood from in the femoral triangle
Great saphenous vein
105
Which vein becomes the external iliac vein
Femoral vein after travelling under the inguinal ligament
106
Which nerve innervates the skin over the leg
Saphenous nerve
107
What is the saphenous nerve a branch of
Femoral nerve
108
Obturator nerve
travels along the lateral wall of the pelvis and exits through the obturator canal. It emerges onto the superficial surface of adductor brevis and gives rise to branches that innervate the medial compartment muscles and skin over the medial thigh.
109
Sciatic nerve
leaves the pelvis via the greater sciatic foramen and enters the gluteal region inferior to the lower border of piriformis. The nerve is really composed of two separate nerves bound together – the tibial nerve and the common fibular nerve.
110
Which nerves form the sciatic nerve
Tibial nerve
Common fibular nerve
111
Tibial nerve innervates
Muscles of posterior thigh and posterior leg
112
Common fibular nerve innervates
Muscles of anterior and lateral leg
113
Which spinal nerves form the sciatic nerve
L4-S3
114
Neurovascular access
The femoral artery can be accessed in the femoral triangle. This is very commonly undertaken for angiography. The femoral vein is medial to the femoral artery. Using knowledge of anatomy and surface landmarks, in emergency situations, it can be easily accessed for blood samples if they cannot be obtained from peripheral veins.
115
Fascia iliaca compartment block
This is a commonly performed procedure in the emergency department where a relatively large volume (around 30-40ml) of local anaesthetic is injected, usually under ultrasound guidance, just underneath the fascia of the iliacus muscle near the femoral triangle. In this ‘compartment’, there are several nerves that carry pain sensation from the around the neck of the femur, including the femoral and obturator nerves, so it is performed to provide analgesia (pain relief) to patients that have sustained a neck of femur fracture. Care must be taken not to accidentally inject the anaesthetic into an artery or vein.
116
Femoral hernia
Similar to an inguinal hernia, this is an abnormal protrusion of intestine into the upper anterior thigh. It is more common in females. The intestine passes deep to the inguinal ligament and causes a lump to appear just distal to the inguinal region. Strangulation of the herniated intestine leads to ischaemia and infarction of the tissue.
117
Obturator nerve irritation
Along its course on the lateral wall of the pelvis, the obturator nerve runs close to the ovary. Ovarian pathology, such as a cyst, may irritate the nerve. This typically results in sensory abnormalities (tingling, itching or pain) in the medial thigh.
118
Gluteal IM injection
Gluteus maximus is a common site for intramuscular injection, but the sciatic nerve must be avoided. Given the position of the nerve deep to the gluteal muscles, the only safe place to give an injection is into the upper outer quadrant of the buttock to safely avoid the sciatic nerve.
119
Sciatica
This term is in common use and describes pain that is felt in the posterior thigh and leg due to compression of nerve roots that contribute to the sciatic nerve (L4 - S3). Most commonly it is the result of a prolapsed (‘slipped’) intervertebral disc between L5 and S1.
120
1. Which muscles are the primary abductors of the hip joint? Explain why abduction is important for normal gait.
Gluteus medius and gluteus minimus
Abductors contract to hold pelvis level and prevent tilt
121
2. Which muscles attach to the ischial tuberosity?
Semimembranosus
Semitendinosus
Long head of biceps femoris
Hamstring part of adductor magnus
122
3. Which arteries supply the gluteal region? What larger vessel do they arise from?
Superior and inferior gluteal arteries
- internal iliac
123
4. Which vessel supplies the posterior compartment of the thigh?
Perforating arteries that arise from the profunda femoris
124
5. What is the surface marking of the femoral artery?
Just below the inguinal ligament at the point halfway between the pubic tubercle and ASIS
125
6. How do the femoral artery, vein and nerve lie relative to each other in the femoral triangle?
NAV lateral to medial
126
7. Which compartment and muscles are supplied by the femoral nerve? What is the general action of this muscle group?
Anterior - quadriceps femoris, sartorius, iliopsoas and pectineus
-primary flexors of hip and extensors of knee
127
8. Which regions of skin in the lower limb are innervated by the femoral nerve?
Anterior thigh and anteromedial leg (via saphenous nerve)
128
10. What forms the adductor hiatus and what passes through it?
Aperture formed between the attachments of the 2 parts of the adductor magnus to femur
-femoral artery and vein
129
9. Describe the course of the obturator nerve.
o The nerve is composed of fibres from the L2-L4 spinal nerves.
o It descends into the pelvis and courses along the lateral wall of the pelvis with the obturator artery and vein.
o It travels through the obturator foramen.
o It travels between adductor brevis and longus. It gives rise to branches that innervate the medial thigh muscles and the skin of the medial thigh.
130
What artery supplies the posterior thigh compartment
Profunda femoris (branch of femoral)
131
What artery supplies the medial thigh compartment
Obturator
132
What artery supplies the anterior thigh compartment
Femoral
133
What artery supplies the gluteal compartment
Superior and inferior gluteal (branch of internal iliac)
134
Primary hip flexors
Iliacus
Psoas major
135
Which muscles insert into lesser trochanter of femur
Iliacus
Psoas major
