Quiz 3- Lec 17-19 Flashcards
important osteology and ligaments
osteology of femur: proximal end
identify: greater trochanter and gluteal tuberosity
important ligaments in the gluteal region
- sacrospinous ligament
- sacrotuberous ligament
2 important foramina of gluteal region
(formed by notches and ligaments)
- greater sciatic foramen
- lesser sciatic foramen
major structures that leave the pelvis through:
greater sciatic foramen to enter the gluteal region
- superior and inferior gluteal artery, nerve, vein
- piriformis m
- pudendals (internal pudendal artery & vein, and pudendal nerve)
- sciatic nerve
- posterior femoral cutaneous
- nerve to obturator internus
- nerve to quadratus femoris
major structures that leave the gluteal region through:
lesser sciatic foramen to enter the perineum
- pudendals (pudendal nerve, internal pudendal vein & artery)
- nerve to obturator internus
structures that enter gluteal region thru
lesser sciatic foramen
obturator internus tendon
muscles of gluteal region
- GLUTES
- maximus
- medius
- minimus
- tensor fasciae latae
- piriformis
- superior gemellus
- obturator internus
- inferior gemellus
- quadratus femoris
- obturator externus
tensor fasciae latae:
origin, insertion
- o:
- anterior 1/4 of lateral lip of iliac crest lateral side of ASIS &
- interspinous fossa fascia lata & gluteal fascia
- ins: travels b/w 2 layers of fascia lata to insert on IT band (tract)
tensor fasciae latae:
act, inn
- action: abduction, medial rotation, & flexion of hip; assists w/ knee extension; helps to tense fascia lata
- inn: superior gluteal nerve (L4)
gluteus maximus:
origin, insertion
- origin
- ilium posterior to posterior gluteal line
- sacrotuberous ligament
- dorsal surface of distal 2 sacral segments and coccyx
- [aponeurosis of erector spinae, dorsal sacroiliac lig & fascia lata]
- ins
- superior and superficial fibers insert into IT tract
- deep fibers insert into gluteal tuberosity
gluteus maximus:
action, innervation
- action: power extension of hip, raise trunk from flexed position, superior fibers abduct hip, other fibers adduct hip; lateral rotation of hip, tenses fascia lata
- inn: inferior gluteal nerve
gluteus medius:
origin, insertion
- origin:
- ilium between posterior and anterior gluteal lines
- gluteal fascia
- ins
- diagonal ridge of lateral surface of greater trochanter
gluteus medius:
action, innervation
- actions:
- abduction of hip (stabilizes pelvis)
- anterior fibers flex & medially rotate hip
- posterior fibers extend & laterally rotate hip
- innervation: superior gluteal nerve
gluteus minimus:
origin, insertion
- o: ilium between anterior and inferior gluteal lines
- ins: depression on anterior side of greater trochanter
gluteus minimus:
actions, innervation
- actions:
- abduction of hip (also stabilizes pelvis)
- flex and medially rotate hip
- inn: superior gluteal nerve
CC: lurch gait is a symptom of lesion of which nerve?
inferior gluteal nerve
(characterized by posterior leaning of the trunk at heel strike in order to keep hip extended during stance phase.)
combined actions of gluteus medius and minimus….
prevents pelvic tilt/drop on the contralateral side
CC: Trendelenburg gait and sign is a symptom of lesion of which nerve?
lesion of superior gluteal nerve
(When standing on the right leg, if the left hip drops, it’s a positive right Trendelenburg sign (the contralateral side drops because the ipsilateral hip abductors do not stabilize the pelvis to prevent the droop)
piriformis
origin, insertion
- o:
- pelvic surface of sacrum (lateral parts of S2 - S4 segments)
- [ventral sacroiliac & sacrotuberous ligaments]
- ins:
- “tip” of greater trochanter
piriformis:
actions, innervation
- actions:
- laterally rotate hip
- abductor of thigh w/ hip flexed
- innervation: twigs from ventral rami (S1 & S2), nerve to piriformis in pelvis
obturator iNTERNUS & superior & inferior gemelli
origin & insertion
- origin
- Obturator internus: bony internal margin of obturator foramen and obturator membrane
- Superior gemellus: external surface of ischial spine
- Inferior gemellus: superior edge of ischial tuerosity, next to obturator notch
- insertion: all 3 thru combined tendon into medial side of greater trochanter, anterosuperior to trochanteric fossa
obturator INTERNUS, & superior/inferior gemelli
actions, innervation
- actions: all 3 laterally rotate hip and abduct the thigh with hip flexed
- inn:
- Obturator internus & superior gemellus: nerve to obturator internus
- Inferior gemellus (and quadratus femoris): nerve to quadratus femoris
quadratus femoris:
origin, insertion
o: lateral side of ischial tuberosity and from part of body of ischium
ins: quadrate tubercle and bone inferior to it
quadratus femoris:
action, innervation
action: laterally rotates hip; weak adductor
inn: nerve to quadratus femoris (also inn. inferior gemellus)
which muscles in gluteal region are supplied by:
superior gluteal artery
- G. max (superficial branch)
- G. med
- G. min (deep branch)
which muscles in gluteal region are supplied by:
inferior gluteal artery
- G. max and
- to most short lateral rotators (and to “hamstrings”) & ischiadic branch to the sciatic nerve
cruciate anastomosis:
define and included arteries
- “cross-like” configuration of arteries in upper posterior thigh near the lesser trochanter
- includes:
- Branch from inferior gluteal
- 1st perforating/ascending branch
- Medial circumflex (transverse br.)
- Lateral circumflex (transverse br.)
variation in sciatic nerve (tibial & common fibular/peroneal)
an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve as it passes under or through the piriformis muscle
normal relationship between sciatic nerve and piriformis
normally, sciatic nerve is inferior/deep to piriformis
abnormal variation of fibular nerve could include:
- piercing piriformis
- superior/superficial to piriformis
how to reproduce piriformis syndrome?
which group is often affected?
- reproduce with FAIR maneuver (flexion, adduction & internal rotation - stretches piriformis).
- rowers and rock climbers often develop symptoms
cc: sciatica
(NOT A DIAGNOSIS)
- compression of sciatic nerve or roots producing radicular pain – reproduced by straight leg raise w/30-70° passive hip flexion (Lasegue’s sign)
Cutaneous nerves (list)
- inferior cluneal nerves
- posterior cutaneous nerve of the thigh
- superior cluneal
- middle cluneal
cluneal nerves and assoc. rami
- Superior (dorsal rami L1-L3
- Middle (dorsal rami S1-S3)
- Inferior (ventral rami S1-S3 from posterior cut. nerve of thigh)
rami assoc. w/ posterior cutaneous nerve of the thigh
- (ventral rami of S1-3)
- Dorsal division fibers from S1 & S2 &
- ventral division fibers from S2 & S3
S1 fibers go to posterior leg
what is the preferred location for an
intramuscular injection?
- Superolateral quadrant or
- above a line that connects the PSIS and superior margin of the greater trochanter
again, where is the preferred site for intragluteal injections to avoid sciatic nerve?
between tubercle of iliac crest & anterior superior iliac spine
lymphatics of the gluteal/lower limb?
- superficial inguinal nodes –> drain into external iliac nodes
- deep inguinal nodes (in femoral ring and canal)
- external iliac nodes
- popliteal nodes
superficial inguinal nodes
receive lymph from:
- lower limb
- perineum
- gluteal region
- lower abdominal wall
popliteal nodes drain into:
deep inguinal nodes, along deep veins
2 bursae in gluteal region?
- ischial bursa
- trochanteric bursa
ischial bursa is found where?
between gluteus max & ischial tuberosity
trochanteric bursa is found where?
between gluteus max & lateral surface of greater trochanter
standing
goal of standing
maintaining equilibrium
what force exerts rotatory movements at major joints of lower limb?
gravity
what rotary movement at hip?
what offsets this?
- tendency is toward hyperextension
- opposed by iliofemoral and ischiofemoral
what rotary force at the knee?
what offsets this?
- tendency is toward hyperextension at knee
- opposed by gastrocnemius muscles
what rotary force at the ankle?
what offsets this?
- tendency is dorsiflexion at the ankle
- to oppose this, plantar flexors are active
the driving action opposes which force?
ground reaction force
which muscles are involved in:
heel strike of stance phase
- Hip:
- gluteus maximus & hamstrings contract to resist hip flexion (prevent trunk from going into flexion on thigh)
- Knee:
- quadriceps femoris group contract to prevent knee from flexing
what muscles are involved in:
midstance
- Hip:
- gluteus medius/minimus contract to prevent opposite side of the pelvis from sagging/drop (maintain pelvic balance…keep pelvis level)
- Knee:
- (toe off on opposite side) and previous quadriceps femoris contraction (from heel strike) brings trunk forward causing knee extension
which muscles are involved in:
toe off
- Hip:
- anteriorly arising adductors and iliopsoas contract to resist hip extension (prevent trunk from lagging behind) and initiate high swing
- Knee:
- quadriceps femoris shows small contraction to support knee and initiate leg swing
describe:
acceleration of swing phase
acceleration is generated by plantar flexors in toe off and flexing adductors, iliopsoas & quadriceps femoris to bring limb forward to prepare for next heel strike
describe:
midswing phase of swing phase
swinging limb is beneath body and is shortened (hip & knee flexion and ankle dorsiflexion) to clear ground
describe:
deceleration of swing phase
acceleration (forward motion of limb) is reduced by hamstring contractions at hip and knee to ready the foot for heel strike & quadriceps femoris contract to prepare the knee for heel strike
list the segments of the traditional
stance phase of gait cycle
- initial contact
- foot flat
- midstance
- heel off
- toe off
list the segments of the traditional
swing phase of gait cycle
- acceleration
- midswing
- deceleration
