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Limbs > Musculoskeletal system of the hips and thigh > Flashcards

Musculoskeletal system of the hips and thigh Flashcards

1
Q

Where are the 3 openings in the pelvis

What are the main ligaments that form these openings

A

Greater and lesser sciatic notch
Obturator foramen

Sacrotuberous ligament
Sacrospinous ligament

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2
Q

Describe the main features found on the pelvis regarding the attachments of the gluteus max, med and min
Describe other key structures on the pelvis

A

Gluteus max post to post gluteal line
Gluteus medius between post and ant gluteal line
Gluteus minimus ant to ant gluteal line
All 3 muscles attach to the ilium

ASIS, AIIS, pubic tubercle
Obturator foramen covered by obturator membrane

Greater sciatic notch, ischial spine, lesser sciatic notch, ischial tuberosity under the PIIS

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3
Q

Describe the functions of the gluteus muscles in relation to the mechanical axis

A

Post to mechanical axis
-Max, med and min => lat rot and hip ext

Ant to mechanical axis
-Med and min => med rot and hip flex

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4
Q

Which 2 muscles are the main hip extensors

A

Gluteus max

Tensor fascia lata

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5
Q

Where does the gluteus maximus attach
innervation?
Function?

A

Sacrotuberous ligament, gluteal tuberosity, ilium, iliotibial tract

Inf gluteal nerve L5-S2

Thigh ext, lat rot, running and climbing against gravity

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6
Q

Where does the tensor fascia lata attach
Innervation?
Function?

A

ASIS, ant of iliotibial tract

Sup gluteal nerve L4-S1

Counters gluteus max

  • lat rot
  • abduction
  • med rot

Sustains tension of iliotibial tract

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7
Q

What happens when you get pain at the side of your knee

A

Friction between iliotibial band and lateral epicondyle of femur

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8
Q

What 2 muscles are the main hip abductors and medial rotators
What are their attachments
What are they innervated by
What other functions do they have

A

Gluteus medius
Gluteus minimus

Sup gluteal nerve L4-S1

Attach to ilium and greater trochanter

Abduct hip, stabilises pelvis so we don’t fall when on 1 leg

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9
Q

What is Trendelburg’s sign

A

Damage to L4-5 => weak gluteus med and min => Can’t stabilise hip

Tilts hip to side before lifting legs for stability => wasting of muscles

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10
Q

What 5 muscles are the main hip lateral rotators
What are their attachments
What are they innervated by

A 
Piriformis
Superior gemellus
Inferior gemellus
Quadratus femoris
Obturator internus

Piriformis attaches to ant sacrum, greater trochanter
All except quadratus femoris attach to greater trochanter

Quadratus femoris attaches to quadrate tubercle at base of greater trochanter and intertrochanteric crest

All have a different nerve supply

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11
Q

Describe the nerves that emerge from the superior piriformis foramen of greater sciatic notch
What are their innervations and their function

A

Superior gluteal nerve L4-S1

Motor, no cutaneous

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12
Q

Describe the nerves that emerge from the inferior piriformis foramen of greater sciatic notch
What are their innervations and their function

A

Inferior gluteal nerve L5-S2
Motor, no cutaneous

Sciatic nerve L4-S3
Innervates post thigh and hamstrings, no sensory

Post cutaneous thigh S1-3
Post thigh and leg compartment, cutaneous for perineum

Pudendal S2-4 => inf rectal
Ext genitalia, anal canal, cutaneous for perineum

Perforating cutaneous S2-3 (perforates through sacrotuberous ligament
Post thigh and leg

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13
Q

Describe the arteries that emerge from the superior piriformis foramen of the greater sciatic notch

What artery do they come from
What do they supply

A

Superior gluteal from post div of int iliac

Gluteus max, med, min
Tensor fascia lata
Piriformis
Hip joint

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14
Q

Describe the arteries that emerge from the inferior piriformis foramen of the greater sciatic notch

What artery do they come from
What do they supply

A

Inferior gluteal from ant div of int iliac

Gluteus max
Piriformis
Obturator internus
Both gemellus
Quadratus femoris

Internal pudendal from ant div of int iliac

Rectum
Perineum
Genitalia

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15
Q

Describe the importance of knowing the surface anatomy of the gluteal region
How would you avoid damage and pain here with injections
What are the consequences

A

Sciatic nerve comes behind piriformis at sacrum

Avoid IM injections into the sciatic nerve

Place fingers on ASIS and iliac tubercle, inject in between

Damage to the sciatic nerve => pain radiates down leg => paralysis

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16
Q

What are the 3 compartments in the thigh
What nerves supply them
What is their main function

A

Anterior

  • Femoral L2-4
  • Extend knee

Medial

  • Obturator L2-4
  • Adductor

Posterior

  • Tibial branch of sciatic
  • Flex knee
17
Q

What are the 3 main neuromuscular structures in the thigh

A

Anterior
-Femoral nerves and vessels

Medial
-Obturator nerves and vessels

Posterior
-Sciatic nerve

18
Q

What are the 3 openings from the abdomen and pelvis

A

Anterior
-Femoral

Medial
-Obturator canal

Posterior
-Greater sciatic foramen

19
Q

Name the main muscles of the anterior thigh compartment (leg extensors)

A 
Psoas major
Iliac
Pectineus
Sartorius
Vastus medialis
Vastus lateralis
Rectus femoris (vastus intermediairs underneath)
20
Q

What are the attachments and innervations of

  • Psoas major
  • Iliacus
  • Vastus lateralis
  • Vastus medialis
  • Rectus femoris
  • Pectineus
  • Sartorius
A

Psoas major

  • L1-3
  • Lumbar vertebrae and lesser trochanter

Iliacus

  • Femoral nerve L2-4
  • Iliac fossa and lesser trochanter

Vastus lateralis

  • Femoral nerve
  • Greater trochanter and lateral of linea aspera => quadriceps tendon

Vastus medialis

  • Femoral nerve
  • Intertrochanteric line and medial of linea aspera => quadriceps tendon

Rectus femoris

  • Femoral nerve
  • Ilium superior to acetabulum and patella => quadriceps tendon

Pectineus

  • Femoral nerve
  • Pectineal line ant => post

Sartorius

  • Femoral nerve
  • ASIS => superior medial surface of tibia
21
Q

What are the 6 main muscles of the medial thigh compartment (hip adductors)

A 
Obturator externus
Pectineus 
Adductor brevis
Adductor longs
Adductus magnus
Gracilis
22
Q

What are the attachments and innervations of

  • Obturator externus
  • Pectineus
  • Adductor brevis
  • Adductor longus
  • Adductor magnus
  • Gracilis
A

Obturator externus

  • Obturator nerve L2-4
  • Ext obturator membrane => post of greater trochanter

Pectineus

  • Femoral nerve L2-4
  • Pectineal line ant => post

Adductor brevis

  • Obturator nerve L2-4
  • Inf pubic rami => linea aspera

Adductor longus

  • Obturator nerve
  • Pubis => linea aspera

Adductor magnus

  • Obturator nerve
  • Inf pubic rami and ischial rami => linea aspera

Gracilis

  • Obturator nerve
  • Inf pubic ramus and pubis => medial surface of tibia
23
Q

Name the 4 main muscles in the posterior thigh compartment (hip extensors and knee flexors)

A

Semitendinosus
Semimembranosus
Biceps femoris (LH)
Biceps femoris (SH)

24
Q

What are the attachments and innervations of

  • Semitendinosus
  • Semimembranosus
  • Biceps femoris (LH)
  • Biceps femoris (SH)
A

Semitendinosus

  • Tibial nerve L4-S3
  • Ischial tuberosity => medial surface of tibia

Semimembranosus

  • Tibial nerve L4-S3
  • Ischial tuberosity => medial tibial condyle

Biceps femoris (LH)

  • Tibial nerve
  • Ischial tuberosity => fibula head

Biceps femoris (SH)

  • Common fibula
  • Post of linea aspera => fibular head

SH is posterior to LH, lateral
Semitendinosus posterior to semimembranosus, medial

25
Q

What muscles make up the quadriceps in the anterior compartment

A

Vastus lateralis
Vastus medialis
Vastus intermedialis
Rectus femoris

26
Q

What 4 muscles allow for medial rotation of the knee

A

Semimembranosus
Semitendinosus

Gracilis

Sartorius

Popliteus

27
Q

What muscle allows for lateral rotation of the knee

A

Biceps femoris

28
Q

What 4 muscles allow for extension of the knee

A

Rectus femoris

Vasti muscles

29
Q

What 7 muscles allow for flexion of the knee

A

Semimembranosus
Semitendinosus
Biceps femoris

Gracilis

Sartorius

Popliteus
Gastrocnemius

30
Q

Describe the

  • Superior border
  • Lateral border
  • Medial border
  • Roof
  • Base of the femoral triangle
A 
Superior, inguinal ligament
Lateral, medial border of the sartorius
Medial, medial border of adductor longus
Roof, fascia lata
Base, pectineus, iliopsoas, adductor longus
31
Q

What muscle does the femoral canal pass under

What passes through the femoral hiatus

A

Continues under sartorius

Femoral artery, vein leave via hiatus => popliteus

32
Q

Describe the contents of the femoral triangle
Describe the wrappings of the femoral triangle

What is the significance of the location of the femoral artery
How does the saphenous vein relate to the femoral triangle

A

From lateral => medial
Femoral nerve => femoral artery => femoral vein => inguinal lymph

Femoral nerve, only one not wrapped up in a femoral sheath

Femoral artery, midinguinal point between ASIS and pubic symphysis

Saphenous vein leaves femoral vein medially

33
Q

Describe the formation of femoral hernias

A

Can form via lymphatic femoral sheath

Abnormal protrusion of peritoneum and guts through femoral triangle

34
Q

What are the 5 muscles that make up the popliteal fossa

What are their attachments

A

Semimembranosus (medial sup to popliteal fossa)
-Ischial tuberosity => medial condyle of tibia

Semitendinosus (medial sup to popliteal fossa)
-Ischial tuberosity => tibial tuberosity

Biceps femoris (lateral sup to popliteal fossa)
-Ischial tuberosity (LH), post linea aspera (SH) => fibula head

Plantaris (lateral inf to popliteal fossa)
-Lateral supracondylar line of femur => calcineal tendon

Gastrocnemius (medial inf to popliteal fossa)
-Lateral medial femoral condyle => calcineus

35
Q

What are the layers of the vessels in the popliteal fossa from superficial => deep

What forms the roof and wall of the popliteal fossa

A

Nerves (common fibular and tibial)
Popliteal vein
Popliteal artery
Bone

Roof, popliteal fascia
Wall, post thigh comp and post femur

36
Q

Describe the lymph nodes around the popliteal fossa

Describe their drainage

A

Nodes around the popliteal vessels

Drain => deep inguinal lymph nodes

37
Q

What could cause swelling around the popliteal fossa

A

Neuromas
Vein thrombus (don’t dislodge it!)
Popliteal artery aneurysm (pulsatile)
Node swelling

Limbs (15 decks)

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