Post Thigh, Gluteal region, & Popliteal fossa Flashcards
What is the superior boundary of the gluteal region?
iliac crest
What is the medial boundary of the gluteal region?
Sacrum and coccyx
What is the inferior border of the gluteal region?
Sacrotuberous ligament and ischial tubersity
What is the lateral border of the gluteal region?
greater trochanter
What is the primary cutaneous innervation of the gluteal region?
Clunials
What does the superior clunial supply? origin?
dorsal rami L1-L3, supplies skin over superior buttocks
What does the middle clunial supply? origin?
dorsal rami S1-S3, supplies skin over sacrum and adj. areas of buttocks
What does the inferior clunial supply? origin?
posterior femoral cutaneous nerve, supplies skin of inferior 1/2 of buttocks
What other nerves have branches in the gluteal region?
Subcostal, iliohypogastric, and lateral femoreal cutaneous nerve
What are the muscles of the gluteal region?
Gluteus maximus, minimus, medius, obturator internus, quadratus femoris, piriformis, Gemelli
What are the primary movements of the muscles in the gluteal region?
Abduction and Lateral Rotation
What is the primary innervation of the muscles of the gluteal region?
Superior and inferior gluteal nerves and smaller branches of LS plexus
What are the ligaments of the gluteal region?
Sacrotuberous and sacrospinous
What structures does the sacrotuberous ligament connect?
PIIS, sacrum, and coccyx to ischial tuberosity
What structures does the sacrospinous ligament connect?
sacrum and coccyx to ishcial spine
What structures are formed the sacrotuberous and sacrospinous ligaments?
Greater and lesser foramina
What is the course and where does the superior gluteal nerve supply?
pass through GSF superior to piriformis to innervate gluteus medius and minimus and TFL
What does the gluteal vessels supply?
Superficial - gluteus max deep - gluteus med and min, and TFL
What is the course and where does the inferior gluteal nerve supply?
exit GSF inferior to piriformis and enters the deep surface of gluteus maximus to supply it
What does the gluteal vessels supply?
Gluteus max, Obturator internus, Quadratus femoris, and superior hamstrings
What is the course and where does the inferior sciatic nerve supply?
passes through GSF inferior to piriformis, descends posterior to obturator internus, gemelli, and quadratus femoris to enter the thigh to supply them as well as all the leg and foot muscles and most of its skin
What is the nerve the runs medial to the sciatic nerve and supplies cutaneous information to the posterior thigh?
Posterior femoral cutaneous nerve
In the normal population, the sciatic nerve passes under what structure?
Piriformis muscle
In 12% of the population, what happens to the course of the sciatic nerve?
Passes through the piriformis
In ~0.5% of the population, what happens to the course of the sciatic nerve?
Passes over the piriformis
What is the largest and heaviest muscle in the body?
Gluteus maximus
What structure(s) separate the gluteus maximus for adjacent structures to reduce friction and allow for free movement?
Gluteal bursae
Where are the three usual bursae and describe what the separate?
Trochanteric (separate sup. fibers of Gluteus max from GT)
Ischial (inf part of gluteus max from ischial tuberosity - is often missing)
Glutofemoral (IT tract from sup part of prox attachment of vastus lateralis)
Describe how to test the gluteus medius and minimus.
Sidelying with the test limb uppermost and the lowermost limb flexed at the knee. Abduct the top thigh w/o flexion or rotation, and can be palpable inferior to iliac crest, post to TFL
What structure does the piriformis pass through to reach the greater trochanter?
GSF
What is the name of the tricipital muscle created by the Obturator internus and the two gemelli?
Triceps coxae
Where is the triceps coxae positioned?
the gap between the piriformis and quad fem
What is the course and distribution of the nerve to quadratus femoris?
leaves pelvis anterior to sciatic nerve and Obturator internus, passes over the posterior surface of the hip joint to supply it and innervate the quad fem and gemellus inf
What nerve supplies the skin of the perineum via its perineal branch, skin of inf buttocks via posterior branches, and skin of post thigh and prox leg via inferior branches?
Posterior cutaneous nerve of thigh
What nerve is the most medial to exit the pelvis through the GSF, descend inferior to piriformis, posterolateral to the sacrospinous ligament, and enter the perineum via LSF to supply this region?
Pudendal n.
What nerve arises from anterior divisions of the anterior rami of L5-S2, parallels the pudendal nerve, passes around the ischial spine to supply the superior gemllus and Obturator internus (after entering the perineum via GSF)?
Nerve to obturator internus
Before birth, what is the major artery of the posterior compartment?
Inferior gluteal a.
What artery enters the gluteal region through the GSF inferior to piriformis, crosses the ischial spine, and enters the perineum through the LSF to supply the skin, external genitalia, and muscles of the perineum?
Internal pudendal a.
Four smaller _ arteries branch off the _ _ artery to supply the majority of the hamstrings vastus lateralis.
Perforating, profunda femoris
Describe the course of the perforating arteries.
Enter near ADD Mag and intermuscular septum - post compartment - give rise to muscular branches to hamstrings, anterior compartment - pierce the lateral intermuscular septum to supply the hamstrings and continues to supply the VL
What is the palpable part of the intergluteal cleft?
Coccyx
The position of the PSIS can be located at the bottom of the back dimples how many centimeters from the midline?
3.75
How can the gluteus maximus be felt?
By contracting when straightening up from bending over, an imaginary line from coccyx to ischial tuberosity, or PSIS to the point just superior of the greater trochanter
What is the skin crease inferior to the gluteal fold that delinates the buttocks from the posterior thigh?
Gluteal sulcus
When can you palpate the ischial tuberosity?
when thigh is flexed b/c gluteus max slips off tuberosity, which is then subcutaneous, feel it as you bend to sit
The superior gluteus medius can be palpated between the max and iliac crest in what standing position?
all weight on an ipsilateral limb
A line joining the back dimple formed by the PSIS and greater trochanter marks what?
superior pirifiormis
What is the nerve that can be palpated at the midpoint between the greater trochanter and ischial tuberosity that stretches as thigh is flexed, knee is extended?
Sciatic nerve
How can you observe the T band?
on lat thigh as it passes to the lateral tibial condyle when sitting down w/ lower limb extended, raise heel off the floor - can feel the ant border passing just posterior to lateral patella
What tendons can be observed and palpated at the popliteal fossa?
Hamstring tendons
Trochanteric bursitis occurs from what type of actions?
Repetitive (climbing stairs, running steep incline on treadmill)
What is trochanteric bursitis characterized as and what muscle does it involve?
point tenderness over GT radiating along IT band, Gluteus max
What occurs from excessive friction between the ischial bursae and tuberosities?
Ischial bursitis
Where can an injection for a sciatic nerve anesthetic block be injected?
A few cms inferior to midpoint of PSIS and superior GT
What occurs due to a complete section of the sciatic nerve?
extension and flexion of the hip is impaired, rendering the leg useless, also lose all foot movement
Where are the safe zones for intragluteal injections?
superolateral quadrant of buttocks, superior to line extending from PSIS to GT, and anterolateral thigh
Injury to what nerve results in a disabled gluteus medius, characterized by a limp to compensate for weakened thigh abduction?
Superior Gluteal n.
What test is positive when injury to the superior gluteal nerve results in motor loss?
Trendelenburg
What is the primary cutaneous innervation of the posterior thigh and over popliteal fossa? origin?
Posterior femoral cutaneous ventral primary rami (S1-S3)
The posterior thigh primarily results in what type of movements?
Leg flexion, thigh extension
What nerve innervates the posterior thigh?
Sciatic nerve
What are the “hamstring” muscles of the posterior thigh?
biceps femoris, semitendonosus, semimembranosus
What are the three divisions of the semimembranosus?
- direct attachment to posterior medial condyle
- blends with popliteal fossa
- Refelcted part that reinforces the intercondylar part of joint capsle of knee as the oblique popliteal ligament
what is the diamond shaped hollow on the posterior surface of knee?
Popliteal fossa
What is the superolateral boundary of the PF?
Biceps Fem
What is the superomedial boundary of the PF?
semiTend and semiMemb
What is the inferolateral boundary of the PF?
Lateral gastroc head
What is the inferomedial boundary of the PF?
Medial gastroc head
What is the roof of the PF?
Fascia lata
What is the Floor of the PF?
popliteal surface of femur, capsule, and obliguq popliteal ligament
What nerve travels right down the medial of the PF?
Tibial n.
What nerve skirts aling the lateral border of the PF?
Common peroneal (fibular)
What are the contents of the PF?
tibial n, common peroneal n, origins of sural n, popliteal vessels
The popliteal artery is a continuation of what artery?
Femoral a.
What structure does the popliteal artery pass through then divides at inferior borders?
Adductor hiatus of the PF
What are the two divisions of the popliteal artery?
Anterior tibial and posterior tibial
The anterior tibial supplies the anterior leg, while the posterior tibial supplies the posterior leg, but the post. tibial also gives rise to what artery to help supply the post and lateral leg?
Peroneal
The popliteal artery has four additional arteries that surround the knee. What are they?
Genicular anastomoses - superior medial and lateral and inferior medial and lateral
What are the two nerves that create the sciatic nerve?
Tibial and common peroneal
After passing over the posterior head of fibula, the common peroneal nerve splits into what two nerves to supply what?
superficial preoneal n - lateral leg, deep peroneal n - anterior leg
What muscles make up the pes anserinus?
SGT - sartorius, gracilis, semitendinosus
