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Posterior Leg Flashcards

1
Q

gluteal region: boundaries

A

-superior- iliac crest
-medial- natal cleft (cleft between buttocks -> aka intergluteal cleft)
-inferior- gluteal sulcus (crease inferior to gluteal fold
-gluteal fold is formed by inferior border of gluteus maximus muscle

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2
Q

gluteal fascia

A

-superficial fascia- fatty and continuous with abdomen and thigh
-deep fascia- gluteal fascia that is continuous inferiorly with fascia latae
-splits to enclose gluteus maximus and covers the superficial surface of gluteus medius

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3
Q

sacrotuberous and sacrospinous ligaments

A

-sacrum to hip bones
-sacrotuberous- passes from sacrum to ischial tuberosity
-sacrospinous- projects from sacrum to ischial spine
-greater sciatic foramen
-lesser sciatic foramen

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4
Q

gluteal region muscles

A

-gluteus maximus- most powerful extensor
-gluteus medius
-gluteus minimus
-tensor fascia latae

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5
Q

gluteus maximus

A

-innervation- inferior gluteal nerve
-supply- superior and inferior gluteal arteries
-extends the thigh (hip extensor) from flexed position (as opposed to standing)
-climbing stairs, rising from sitting
-walking, heel strike
-gluteus maximus slows forward motion of trunk by arresting flexion of hip
-weak gluteus maximus- lurch trunk backward to interrupt forward motion during heal strike -> compensates for lack of hip extension
-laterally rotates thigh

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6
Q

gluteus medius, minimus, and tensor fascia latae

A

-hip abductors -> prevents pelvic from dropping or sagging on contralateral side
-innervation- superior gluteal nerve
-supply- superior gluteal artery
-gluteus medius and minimus- abduct and medially rotate thigh (less important), steadies pelvis on leg when opposite leg is raised
-tensor fascia latae- flex, abduct, and medially rotate thigh -> stabilize the extended knee

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7
Q

trendelenburg gait

A

-weakness of hip abductors (gluteus medius, minimus, and tensor fasciae latae)
-compensated gait- pt leans towards weak side to compensate for weakness
-uncompensated gait- pelvis sags on contralateral side of weakness
-trendelenberg test- standing on both feet equally -> stable
-if you lift one foot and pelvis sags to upsupported side -> +
-+ test -> functional impairment often due to superior gluteal nerve lesion or fracture of femur
-L4-S3 region
-can be caused by improper gluteal injection damaging sciatic n
-can cause foot slap (but for other reasons)

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8
Q

lateral/external rotators

A

-collaboratively rotate thigh
-dynamically stabilize the hip joint
-work with medial rotators of hip to hold head of femur in the acetabulum
-landmarks orthopedic surgery on hip joint
-superior to inferior:
-piriformis
-superior gemellus
-obturator internus
-inferior gemellus
-quadratus femoris
-obturator internus, inferior gemellus, and quadratus femoris- sometimes called tricpes coxae bc tendons are merged

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9
Q

cutaneous innervation of gluteal region

A

-provided by superior, middle, and inferior cluneal (clunial) nerves
-superior and medial- branches of dorsal primary rami
-inferior- posterior cutaneous nerveof thigh
-posterior femoral nerve also supplies part of perineum and majority of posterior thigh

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10
Q

gluteal region: motor innervation

A

-gluteal muscles- superior gluteal nerve (gluteus medius and minimus) and inferior gluteal nerve (gluteus maximus)
-lateral hip rotators- direct branches from sacral plexus
-pudendal nerve travels towards perineum and sciatic nerve innervates structures in posterior thigh and leg -> these pass through gluteal region but dont innervate anything in it

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11
Q

gluteal region: blood supply

A

-superior and inferior gluteal arteries -> branches of internal iliac artery
-superior gluteal artery exits through greater sciatic foramen superior to piriformis
-superior gluteal artery supplies more superior gluteal muscles -> 3 gluteal muscles and tensor fasciae latae
-inferior gluteal artery- exits greater sciatic foramen inferior to piriformis
-inferior supplies gluteus maximus and lateral rotators
-also supplies superior portions of muscles in posterior compartment of thigh
-internal pudendal artery- exits greater sciatic foramen inferior to piriformis and goes around ischial spine and passes through lesser sciatic foramen to perineal region

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12
Q

gluteal intramuscular injections

A

-commonly done to administer drugs
-numerous neurovascular structures lying deep to gluteus maximus -> only inject in “safe area”
-safe area- between posterior superior iliac spine and superior aspect of greater trochanter (of femur)
-inferior to this line -> sciatic nerve could be damaged (especially if pt has sciatic anomaly)

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13
Q

greater and lesser sciatic foramina

A

-greater sciatic foramen:
-piriformis- landmark in gluteal region due to its location in greater sciatic foramen
-structures pass through greater sciatic foramen -> exiting superior or inferior to piriformis
-superior to piriformis -> superior gluteal artery vein and nerve
-inferior to piriformis- inferior gluteal artery, vein, and nerve, sciatic nerve, posterior femoral cutaneous nerve
-lesser sciatic foramen- obturator internus muscle
-internal pudendal artery and nerve exit via greater sciatic foramen and re-enter via lesser sciatic foramen

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14
Q

muscles of posterior compartment of thigh

A

-semitendinosus and semimembranosus- tibial nerve (from sciatic)
-bicep femoris- long head- tibial n; short head- common fibular n
-ALL- deep femoral artery and inferior gluteal artery
-ALL- extend thigh at hip, flexes leg at knee
-ALL- sciatic nerve

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15
Q

hamstring muscles

A

-origin on ischial tuberosity
-cross hip and knee joint
-innervated by tibial nerve
-true- semitendinosus, semimembranosus, and long head of biceps femoris
-portion of adductor magnus that takes origin from ischial tuberosity-> hamstring position of muscle (innervated by tibial nerve)
-not a true hamstring bc it doesnt cross the knee joint
-short head of bicep femoris is NOT a hamstring bc it doesnt cross hip joint and is innervated by common fibular nerve

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16
Q

pes anserinus

A

-goose foot
-conjoined tendons of 3 muscles that insert on medial aspect of proximal tibia
-anterior to posterior:
-sartorius
-gracilis
-semitendinosus
-help to stabilize medial knee joint
-SarGent Muscles

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17
Q

posterior thigh cutaneous innervation

A

-sensory innervation- posterior femoral cutaneous nerve

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18
Q

posterior thigh motor innervation

A

-sciatic nerve (branch of sacral plexus (ventral primary rami L4-S3)
-sciatic nerve is composed of 2 nerves bundled together in 1 connective tissue sheath
-posterior thigh- tibial nerve innervates hamstring muscles (semitendinous, semimembranosus, and long head biceps femoris)
-common fibular/common peroneal nerve innervates short head of biceps femoris

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19
Q

sciatic nerve

A

-from greater sciatic foramen inferior to piriformis
-splits into two divisions-> tibial and common fibular -> superior to popliteal fossa
-can emerge separately through greater sciatic foramen -> variation in way they exit
-sometimes -> sciatic nerve splits more superiorly -> common fibular nerves can pass or THROUGH or OVER piriformis

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20
Q

sciatica

A

-sciatic neuritis
-MC forms of radiculopathy
-symptoms that result from general compression/irritation of 1 or more nerve roots that give rise to sciatic nerve (L4-S3)
-pain (sometimes severe) in lower back, buttocks and/or various parts of leg and foot
-numbness, muscular weakness, pins and needles, tingling, difficulty moving or controlling leg
-unilateral
-causes- compression of L4-S1 nerves by disc herniation, spondylolisthesis, disc degeneration
-pseudo-sciatica- similar symptoms caused by compression usually of muscular origin (more peripheral sciatic nerve)

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21
Q

posterior thigh blood supply

A

-perforating branches of deep femoral artery and inferior gluteal artery

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22
Q

hip joint osteology

A

-hip joint is ball and socket synovial joint between head of femur and acetabulum of hip bone
-comprised of femur head, fovea, neck
-fovea- depression of femoral head where ligamentum teres attaches
-2 elevated areas- form transition points of neck and shaft of femur ->
-intertrochanteric line- anterior attachment site of fibrous capsule
-intertrochanteric crest- posterior attachment site to fibrous capsule

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23
Q

trochanteric bursa

A

-bursa is connective tissue sac lined by synovial membrane
-may be extension of joint cavity or completely independent
-found where ever friction may impinge on free movement of structures
-bursa that completely surround tendons -> tendon sheaths
-tendonitis/bursitis
-ischial and trochanteric bursae may become inflamed with excess friction between bursa and underlying bone

24
Q

ischial bursitis

A

-result of prolonged injury or sitting on hard surface or in same position for extended period of time

25
trochanteric bursitis
-more common in women -product of overuse -runners and ballet dancers are particularly susceptible to trochanteric bursitis
26
pelvic bone (os coxa, coxal bone, inominate bone)
-acetabulum- boney ring around head of femur -> stability and prevents dislocation -lunate surface- inner surface of acetabulum- covered with articular cartilage -acetabular fossa- round area contained by lunate surface -> fat and pelvic attachment site for ligament of femoral head -acetabular notch- inferior to acetabular fossa -> open gas that transmits neurovasculature into joint -transverse acetabular ligament- spans the acetabular notch
27
hip joint: joint capsule and ligament
-fibrous capsule of hip joint attaches proximally to acetabulum and transverse acetabular ligament, distally to the intertrochanteric line and neck of femur -strong enough to provide stability to joint but loose enough to allow free range of movement -ligaments: -iliofemoral ligament (Y ligament)- reinforces capsule anteriorly, prevents hyperextension of femur while standing -pubofemoral ligament- strengthens capsule anterior and inferiorly, prevents abduction of femur -ischiofemoral ligament- reinforces capsule posteriorly, prevents excessive medial rotation and hyperextension
28
development dysplasia
-MC orthopedic disorder in newborns -poorly develop acetabulum- shallow or ligaments are stretched -dx- PE/palpation of hip -DDH (development dysplasia of hip) -spectrum of deformities involving growing hip that results in varying displacement of proximal femur from acetabulum -dislocated- most severe cases of DDH -> head of femur completely out of socket -dislocatable- head of femur lies within acetabulum -> can be easily pushed out of socket during physical exam -subluxable- mild DDH -> head of femur simply loose in socket -> during PE bone can be moved within socket but not dislocated -tx- harness or brace early on -no tx- past 2 -> pain, waddeling, demformities -no tx at all- osteoarthritis
29
osteoarthritis of hip
-cartilage gradually wear away over time -becomes frayed and rough -protective joint space between bones decreases which can be on AP radiographs of hip joint -result in bone rubbing on bone -to compensate for lost cartilage bones may grow outwards -> bone spurs (osteophytes) -slow process, pain worsens overtime -joint space narrowing, sclerosis, osteophytes, chondral cysts
30
intracapsular structures of hip joint
-hyaline cartilage- covers lunate surface and femoral head -transverse acetabular ligament- spans acetabular notch converting it to a foramen -ligament of head of femur- weak that attaches to fovea of femoral head, acetabular notch, and transverse acetabular ligament -acetabular labrum- increase depth of acetabulum -ligament of head of femur usually transmits artery of femoral head (branch of obturator artery) -artery has a minor role in supplying blood to femoral head prior to closure of growth plate of femoral head
31
hip fractures
-fractures of proximal femur are generally characterized as intracapsular or extracapsular depending on whether they occur within or outside fibrous capsule of joint -intracapsular fracture have high incidence of subsequent avascular necrosis due to disruption of medial circumflex artery -intertrochanteric fracture- extracapsular -> from greater to lesser trochanter -sub-capital hip fracture- (MC intracapsular)- step-off in cortex superiorly and abnormal overlapping of femoral head and neck
32
hip joint blood supply
-medial** and lateral femoral circumflex arteries -medial is though to be most important bc it supplies head and neck of femur -these arteries send out retinacular branches that parallel femoral neck and run under synovial membrane -small contribution from obturator artery -> acetabular branch passes into acetabular fossa through acetabular foramen -acetabular branch supplies acetabulum and send a small branch to supply head of femur through ligament of head -intracapsular fracture- high incidence of subsequent avascular necrosis due to disruption of medial circumflex artery -artery to head of femur (branch of obturator) is inconsistent and does not supply enough blood to femoral head to prevent avascular necrosis
33
sciatic nerve branches
-splits into 2 divisions superior to popliteal fossa -> tibial nerve and common fibular nerve -tibial nerve- travels in popliteal fossa superficial to popliteal artery and vein -> gives off medial sural cutaneous nerve -> branches to popliteus muscle within fossa -> enters posterior compartment of leg -common fibular nerve- travels along medial border of bicep femoris -> leaves popliteal fossa by traveling around neck of fibula -> gives of 2 branches within popliteal fossa -> lateral sural cutaneous nerve and fibular (sural) communicating branch -communicating branch occasionally arises from lateral sural cutaneous rather than common fibular directly -medial sural, lateral sural, and sural communicating -> sural cutaneous nerves *
34
popliteal fossa boundaries
-fat filled -when extended- triangular -superior medial- semimembranosus muscle -superior lateral- bicep femoris -inferior medial- medial head of gastrocnemius -inferior lateral border- lateral head of gastrocnemius -floor- fascia of popliteus muscle, capsule of knee joint, and popliteal surface of femur
35
neurovasculature in popliteal fossa
-popliteal artery and vein -tibial nerve -common fibular nerve -small saphenous vein joins the popliteal vein in the popliteal fossa -nerves are the two branches of sciatic (which split just superiorly)
36
popliteal artery
-continuation of femoral artery after passes through adductor hiatus -within popliteal fossa -> gives off genicular arteries that supply knee joint -popliteal artery travels inferiorly into leg -> divides into following 2 branches at inferior border of popliteus muscle: -anterior tibial artery -posterior tibial artery
37
aneurysms of popliteal artery
-popliteal aneurysm -kinks -collateral routes of blood flow ensure blood flow regarless of changing of position- anastomoses -popliteal collateral circulation is via superior and inferior lateral and superior and inferior medial geniculate branches of popliteal artery -MC occurring in peripheral circulation -edema and pain in popliteal fossa
38
popliteal vein and small saphenous vein
-popliteal vein travels with popliteal artery -more posterior than artery -receives blood from small saphenous vein -small saphenous vein originates on lateral side of foot where it collects blood from dorsal venous arch -first courses inferior to lateral malleolus and then turns superiorly to pass posterior to lateral malleolus -receives venous blood from posterior leg as it ascends to popliteal fossa -after receiving blood from small saphenous vein -> popliteal vein travels through adductor hiatus to become femoral vein
39
small saphenous vein
-accompanied by the sural nerve in the posterior leg and lateral ankle
40
popliteal cyst- bakers cyst
-outpouchings of knee joints synovial membrane -typically occur in medial aspect of popliteal fossa between medial head of gastrocnemius and semimembranosus tendon -sometimes- no pain -edema -rupture of cyst- fluid into posterior leg -> pain and swelling -knee pain -stiffness and inability to fully flex -worsening symptoms while standing and increased activity
41
superficial posterior compartment of leg
-gastrocnemius- plantar flexes foot, flexes leg -soleus- plantar flexes foot -plantaris- weakly plantar flexes foot, flexes leg -innervated by tibial nerve -supply- posterior tibial artery
42
plantaris muscle
-largely insignificant -tendon is often used to replace damaged tendons in forearm and hand -long, thin tendon of plantaris either joins calcaneal tendon or inserts independently on calcaneal tuberosity in position medial to calcaneal tendon
43
gastrocnemius
-two heads have separate origins on distal femur but distally unite -approx halfway down leg -> the muscle ends in a flat tendon that receives distal attachment on soleus muscle -common tendon becomes more rounded and continues inferiorly as calcaneal (achilles) tendon -bc soleus and gastrocnemius have common insertion and similar function -> they collectively referred to as triceps surae (3 headed calf muscle)
44
deep posterior compartment of leg
-popliteus- weak knee flexion, unlocks knee by rotating femur 5 degrees on fixed tibia -flexor digitorum- flexion lateral 4 toes, plantar flexion foot -tibialis posterior- plantar flexion and foot inversion -flexor hallucis longus- flexion great toe, plantar flexion foot -innervation- tibial nerve -popliteus- popliteal artery -flexor digitorum, tibialis posterior, flexor hallucis longus- posterior tibial artery
45
posterior compartment of leg arterial supply
-popliteal, posterior tibial, and fibular artery -popliteal- divides into 2 terminal branches -> anterior and posterior tibial arteries at inferior border of popliteus muscle -posterior tibial artery- main supply to posterior compartment of leg and foot -> travels deep to tendinous arch of soleus and gives off its only major branch in leg -> fibular artery -fibular a- travels inferiorly deep to felxor hallucis longus muscle -> supplies muscles in posterior and lateral compartments of leg
46
flexor retinaculum
-at ankle- crural fascia of leg forms retinacula that holds in place tendons of leg muscles that traverse ankle -total of 5 retinacula at ankle -flexor retinaculum- located on medial aspect of ankle between medial malleolus and calcaneus -flexor retinaculum binds down tendons of legs deep group of muscles
47
tarsal tunnel and contents
-fibro-osseous space located posterior and inferior to medial malleolus of tibia -boundaries include: -roof formed by flexor retinaculum- prevent medial displacement of tunnel contents -floor formed by osseous structures -> distal tibia, talus, calcaneus -sometimes adductor halucis is included in inferior osseous floor -> then typically inferior floor becomes medially -tarsal tunnel anterior to posterior: -tibialis posterior -flexor digitorum longus -posterior tibial artery -posterior tibial vein -tibial nerve -flexor hallucis longus - travels through fibro-osseous tunnel deep to susteniculum tali -Tom, Dick, and A, Very, Nervous, Harry
48
cutaneous innervation of posterior leg
-posterior femoral cutaneous nerve- small proximal portion -saphenous nerve- courses with great saphenous vein -> innervates medial leg, medial malleolus, medial side of foot -sural nerves- innervates posterolateral leg, lateral malleolus, and lateral side of foot -medial sural cutaneous nerve- branch of tibial nerve- merges with fibular communicating branch to become sural branch -lateral sural cutaneous nerve is branch of common fibular nerve- innervates lateral upper calf
49
motor innervation of posterior leg
-superficial and deep -tibial nerve -tibial nerve exits popliteal fossa by passing through tendinous arch of soleus muscle -travels inferiorly through posterior leg alongside posterior tibial vessels (between superficial and deep groups of muscles) -courses through tarsal tunnel to enter foot
50
flexion of hip
-iliopsoas -rectus femoris -sartorius -tensor fasciae latae -adductor longus and brevis -adductor magnus -pectineus
51
extension
-gluteus maximus -semitendinosus -semimembranosus -biceps femoris (long head) -adductor magnus (hamstring portion)
52
abduction
-gluteus medius and minimus (lesser gluteals) -tensor fasciae latae
53
adduction
-longus, brevis, magnus -gracilis -pectineus -obturator externus
54
lateral rotation
-sartorius -gluteus maximus -obturator externus -piriformis -obturator internus -superior gemellus -inferior gemellus -quadratus femoris
55
medial rotation
-tensor fasciae latae -gluteus medius and minimus
56
hip dislocation
-adducted and medially rotated, a little bit shorter -deceleration -posterior dislocation of hip in MVA -medial circumflex, sciatic n, -shearing and tearing of ligaments

Anatomy (34 decks)

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