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ACEM Primary Written > Musculoskeletal: Anatomy - Gluteal and posterior thigh regions > Flashcards

Musculoskeletal: Anatomy - Gluteal and posterior thigh regions Flashcards

1
Q

Describe the gluteal ligaments

A

Posterior sacroiliac ligament (continuous inferiorly with sacrotuberous ligament)
Posterior sacrococcygeal ligaments
Sacrotuberous ligament
Sacrospinous ligament

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2
Q

How are the greater and lesser sciatic foramina formed and what is the significance of each?

A

Sacrotuberous ligament extends across sciatic notch, converting it into a foramen that is subdivided by the sacrospinous ligament and ischial spine into the greater and lesser sciatic foramen
Greater sciatic: structures travelling to and from pelvis
Lesser sciatic: structures travelling to and from perineum

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3
Q

Which muscle fills most of the greater sciatic foramen?

A

Piriformis

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4
Q

Four muscles of the superficial layer of the gluteal region

A

Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia latae

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5
Q

Five muscles of the deep layer of the gluteal region

A

Obturator internus
Piriformis
Superior gemellus
Inferior gemellus
Quadratus femoris

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6
Q

Describe the proximal attachment and actions of the superficial gluteal muscles generally

A

Proximal attachments to posterolateral (external) surface and margins of ala of ilium
Mainly extend, abduct and medially rotate the hip

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7
Q

Describe the distal attachment and actions of the deep gluteal muscles generally

A

Distal attachments to intertrochanteric crest
Lateral rotators and stabilise femoral head in acetabulum

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8
Q

Six lateral rotators of the thigh

A

Obturator externus (anterior compartment)
Obturator internus
Piriformis
Superior gemellus
Inferior gemellus
Quadratus femoris

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9
Q

Which three muscles form the triceps coxae?

A

Superior and inferior gemelli, and obturator internus

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10
Q

Proximal and distal attachments, innervation, and main actions of gluteus maximus

A

Proximal: ilium posterior to posterior gluteal line, dorsal sacrum and coccyx, sacrotuberous ligament
Distal: gluteal tuberosity, iliotibial tract
Innervation: inferior gluteal n. (L5, S1-2)
Actions: hip extension, assists in lateral rotation

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11
Q

Proximal and distal attachments, innervation, and main actions of gluteus medius

A

Proximal: ilium between anterior and posterior gluteal lines
Distal: lateral greater trochanter
Innervation: superior gluteal n. (L5, S1)
Actions: hip abduction and medial rotation

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12
Q

Proximal and distal attachments, innervation, and main actions of gluteus minimus

A

Proximal: ilium between anterior and inferior gluteal lines
Distal: anterior greater trochanter
Innervation: superior gluteal n. (L5, S1)
Actions: hip abduction and medial rotation

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13
Q

Proximal and distal attachments, innervation, and main actions of obturator internus

A

Proximal: pelvic surface of obturator membrane and surrounding bones
Distal: medial greater trochanter (trochanteric fossa)
Innervation: nerve to obturator internus (L5, S1)
Actions: abduction of flexed thigh and lateral rotation of extended thigh, steadies femoral head in acetabulum

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14
Q

Proximal and distal attachments, innervation, and main actions of superior gemellus

A

Proximal: ischial spine
Distal: medial greater trochanter (trochanteric fossa)
Innervation: nerve to obturator internus (L5, S1)
Actions: abduction of flexed thigh and lateral rotation of extended thigh, steadies femoral head in acetabulum

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15
Q

Proximal and distal attachments, innervation, and main actions of inferior gemellus

A

Proximal: ischial tuberosity
Distal: medial greater trochanter (trochanteric fossa)
Innervation: nerve to quadratus femoris (L5, S1)
Actions: abduction of flexed thigh and lateral rotation of extended thigh, steadies femoral head in acetabulum

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16
Q

Proximal and distal attachments, innervation, and main actions of piriformis

A

Proximal: anterior sacrum and sacrotuberous ligament
Distal: superior greater trochanter
Innervation: anterior rami S1-2
Actions: abduction of flexed thigh and lateral rotation of extended thigh, steadies femoral head in acetabulum

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17
Q

Proximal and distal attachments, innervation, and main actions of quadratus femoris

A

Proximal: lateral ischial tuberosity
Distal: quadratus tubercle on intertrochanteric crest
Innervation: nerve to quadratus femoris (L5, S1)
Actions: lateral rotation of thigh, steadies femoral head in acetabulum

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18
Q

Proximal and distal attachments, innervation, and main actions of tensor fascia latae

A

Proximal: ASIS, anterior iliac crest
Distal: iliotibial tract to lateral tibial cond0yle
Innervation: superior gluteal n. (L5, S1)
Actions: hip abduction and medial rotation

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19
Q

Three bursae associated with gluteus maximus

A

Trochanteric bursa: separates from greater trochanter (largest, present at birth)
Ischial bursa: separates from ischial tuberosity
Gluteofemoral bursa: separates iliotibial tract from vastus lateralis

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20
Q

Describe the role of piriformis as a landmark in the gluteal region

A

Superior gluteal vessels and nerves emerge superior to it
Inferior gluteal vessels and nerves emerge inferior to it

21
Q

Four posterior thigh muscles. Which of these are the hamstring muscles?

A

Semitendinosus*
Semimembranosus*
Biceps femoris: long head*
Biceps femoris: short head

  • Hamstring muscles
22
Q

What are the common features of the hamstring muscles?

A

Proximal attachment to ischial tuberosity
Distal attachment to bones of leg
Innervation by tibial division of sciatic nerve

23
Q

Proximal and distal attachments, innervation, and main actions of semitendinosus

A

Proximal: ischial tuberosity
Distal: superomedial tibia via pes anserinus
Innervation: tibial division of sciatic n. (L5, S1-2)
Action: hip extension, knee flexion (and medial rotation of leg when knee is flexed)

24
Q

Proximal and distal attachments, innervation, and main actions of semimembranosus

A

Proximal: ischial tuberosity
Distal: posterior part of medial tibial condyle, reflected attachment forms oblique popliteal ligament (to lateral femoral condyle)
Innervation: tibial division of sciatic n. (L5, S1-2)
Action: hip extension, knee flexion (and medial rotation of leg when knee is flexed)

25
Q

Proximal and distal attachments, innervation, and main actions of biceps femoris

A

Proximal: long head to ischial tuberosity, short head to linea aspera and lateral supracondylar line of femur
Distal: lateral head of fibula (tendon split by lateral collateral ligament)
Innervation: long head by tibial division of sciatic n. (L5, S1-2), short head by common fibular division of sciatic n. (L5, S1-2)
Action: hip extension, knee flexion (and lateral rotation of leg when knee is flexed)

26
Q

The tendon of which muscle is reflected to form the oblique popliteal ligament?

A

Semimembranosus

27
Q

Three superficial gluteal nerves

A

Superior clunial
Middle clunial
Inferior clunial

28
Q

Seven deep gluteal nerves

A

Sciatic nerve
Posterior cutaneous nerve of thigh
Superior gluteal
Inferior gluteal
Nerve to quadratus femoris
Pudendal
Nerve to obturator internus

29
Q

Origin, course and distribution of superior clunial nerve

A

Origin: lateral cutaneous branches of posterior rami L1-3
Course: inferolateral across iliac crest
Distribution: skin of superior buttocks to tubercle of iliac crest

30
Q

Origin, course and distribution of middle clunial nerve

A

Origin: lateral cutaneous branches of posterior rami S1-3
Course: exits posterior sacral foramina laterally
Distribution: skin over sacrum and adjacent buttocks

31
Q

Origin, course and distribution of inferior clunial nerve

A

Origin: posterior cutaneous nerve of thigh
Course: ascends superiorly from inferior border of gluteus maximus
Distribution: inferior half of buttocks to greater trochanter

32
Q

Origin, course and distribution of sciatic nerve

A

Origin: sacral plexus (L4-S3)
Course: enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximus, descends in posterior thigh deep to biceps femoris, bifurcates into tibial and common fibular nerves at apex of popliteal fossa
Distribution: all muscles of posterior thigh compartment (tibial division to all except short head of biceps femoris which is supplied by common fibular)

33
Q

Origin, course and distribution of superior gluteal nerve

A

Origin: sacral plexus (L4-S1)
Course: enters gluteal region via greater sciatic foramen superior to piriformis, courses laterally between gluteus medius and minimus to tensor fascia latae
Distribution: gluteus medius, gluteus minimus, tensor fascia latae

34
Q

Origin, course and distribution of inferior gluteal nerve

A

Origin: sacral plexus (L5-S2)
Course: enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximum
Distribution: gluteus maximus

35
Q

Origin, course and distribution of nerve to obturator internus

A

Origin: sacral plexus (L5-S2)
Course: exits pelvis via greater sciatic foramen inferior to piriformis, descends posterior to sacrospinous ligament, enters perineum through lesser sciatic foramen
Distribution: superior gemellus and obturator internus

36
Q

Origin, course and distribution of nerve to quadratus femoris

A

Origin: sacral plexus (L4-S1)
Course: enters gluteal region via greater sciatic foramen inferior to piriformis, deep (anterior) to sciatic nerve
Distribution: hip joint, inferior gemellus, and quadratus femoris

37
Q

Origin, course and distribution of posterior cutaneous nerve of thigh

A

Origin: sacral plexus (S1-3)
Course: enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximus, descends in posterior thigh deep to fascia lata
Distribution: skin of inferior half of buttocks (via inferior clunial nerves), skin over posterior thigh and popliteal fossa, skin of lateral perineum and upper medial thigh (via perineal branch)

38
Q

Origin, course and distribution of pudendal nerve

A

Origin: sacral plexus (S2-4)
Course: exits pelvis via greater sciatic foramen inferior to piriformis, descends posterior to sacrospinous ligament, enters perineum through lesser sciatic foramen
Distribution: principal nerve to perineum

39
Q

Four arteries of gluteal and posterior thigh region

A

Superior gluteal
Inferior gluteal
Internal pudendal
Perforating

40
Q

Course and distribution of superior gluteal artery

A

Course: enters gluteal region through greater sciatic foramen superior to piriformis, divides into superficial and deep branches, anastamoses with inferior gluteal and medial circumflex femoral arteries
Distribution: superficial branch to gluteus maximus, deep branch to gluteus medius and minimus, and tensor fascia latae

41
Q

Course and distribution of inferior gluteal artery

A

Course: enters gluteal region through greater sciatic foramen inferior to piriformis, descends medial to sciatic nerve, anastamoses with superior gluteal artery and as part of cruciate anastamosis
Distribution: supplies gluteus maximus, obturator internus, quadratus femoris, and superior part of hamstrings

42
Q

Course and distribution of perforating arteries

A

Course: enters posterior compartment by perforating aponeurotic attachment of adductor magnus and medial intermuscular septum, provides muscular branches to hamstrings then continues to anterior compartment of thigh by piercing lateral intermuscular septum
Distribution: majority of hamstrings, vastus lateralis

43
Q

Course and distribution of internal pudendal artery

A

Course: enters gluteal region via greater sciatic foramen, descends posterior to ischial spine, enters perineum through lesser sciatic foramen
Distribution: external genitalia and perineal muscles

44
Q

Contents of the greater sciatic foramen (supra- and infra-piriform)

A

Suprapiriform foramen:
Superior gluteal artery and vein
Superior gluteal nerve

Infrapiriform foramen:
NIP SNIP
Nerve to obturator internus
Inferior gluteal artery, vein and nerve
Pudendal nerve

Sciatic nerve
Nerve to quadratus femoris
Internal pudendal artery and vein
Posterior cutaneous nerve of thigh

45
Q

Contents of the lesser sciatic foramen

A

PINTO:
Pudendal nerve
Internal pudendal artery and vein
Nerve to obturator internus
Tendon Of obturator internus

46
Q

Arteries involved in cruciate anastamosis of thigh

A
  1. First perforating artery of profunda femoris
  2. Medial circumflex femoral artery
  3. Lateral circumflex femoral artery
  4. Inferior gluteal artery
47
Q

From which major artery do the arteries of the gluteal and posterior thigh regions originate?

A

Internal iliac

48
Q

From which four arteries does the posterior compartment of the thigh receive its blood supply?

A
  1. Inferior gluteal
  2. Medial circumflex femoral
  3. Perforating
  4. Popliteal

ACEM Primary Written (150 decks)

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