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2b_Y1 - LEA-Exam 1 > Quiz 3- Lec 17-19 > Flashcards

Quiz 3- Lec 17-19 Flashcards

1
Q

important osteology and ligaments

A
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2
Q

osteology of femur: proximal end

identify: greater trochanter and gluteal tuberosity

A
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3
Q

important ligaments in the gluteal region

A
  • sacrospinous ligament
  • sacrotuberous ligament
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4
Q

2 important foramina of gluteal region

(formed by notches and ligaments)

A
  • greater sciatic foramen
  • lesser sciatic foramen
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5
Q

major structures that leave the pelvis through:

greater sciatic foramen to enter the gluteal region

A
  1. superior and inferior gluteal artery, nerve, vein
  2. piriformis m
  3. pudendals (internal pudendal artery & vein, and pudendal nerve)
  4. sciatic nerve
  5. posterior femoral cutaneous
  6. nerve to obturator internus
  7. nerve to quadratus femoris
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6
Q

major structures that leave the gluteal region through:

lesser sciatic foramen to enter the perineum

A
  1. pudendals (pudendal nerve, internal pudendal vein & artery)
  2. nerve to obturator internus
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7
Q

structures that enter gluteal region thru

lesser sciatic foramen

A

obturator internus tendon

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8
Q

muscles of gluteal region

A
  1. GLUTES
    • maximus
    • medius
    • minimus
  2. tensor fasciae latae
  3. piriformis
  4. superior gemellus
  5. obturator internus
  6. inferior gemellus
  7. quadratus femoris
  8. obturator externus
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9
Q

tensor fasciae latae:

origin, insertion

A
  • 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)
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10
Q

tensor fasciae latae:

act, inn

A
  • action: abduction, medial rotation, & flexion of hip; assists w/ knee extension; helps to tense fascia lata
  • inn: superior gluteal nerve (L4)
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11
Q

gluteus maximus:

origin, insertion

A
  • 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
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12
Q

gluteus maximus:

action, innervation

A
  • 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
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13
Q

gluteus medius:

origin, insertion

A
  • origin:
    • ilium between posterior and anterior gluteal lines
    • gluteal fascia
  • ins
    • diagonal ridge of lateral surface of greater trochanter
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14
Q

gluteus medius:

action, innervation

A
  • actions:
    • abduction of hip (stabilizes pelvis)
    • anterior fibers flex & medially rotate hip
    • posterior fibers extend & laterally rotate hip
  • innervation: superior gluteal nerve
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15
Q

gluteus minimus:

origin, insertion

A
  • o: ilium between anterior and inferior gluteal lines
  • ins: depression on anterior side of greater trochanter
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16
Q

gluteus minimus:

actions, innervation

A
  • actions:
    • abduction of hip (also stabilizes pelvis)
    • flex and medially rotate hip
  • inn: superior gluteal nerve
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17
Q

CC: lurch gait is a symptom of lesion of which nerve?

A

inferior gluteal nerve

(characterized by posterior leaning of the trunk at heel strike in order to keep hip extended during stance phase.)

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18
Q

combined actions of gluteus medius and minimus….

A

prevents pelvic tilt/drop on the contralateral side

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19
Q

CC: Trendelenburg gait and sign is a symptom of lesion of which nerve?

A

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)

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20
Q

piriformis

origin, insertion

A
  • o:
    • pelvic surface of sacrum (lateral parts of S2 - S4 segments)
    • [ventral sacroiliac & sacrotuberous ligaments]
  • ins:
    • “tip” of greater trochanter
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21
Q

piriformis:

actions, innervation

A
  • actions:
    • laterally rotate hip
    • abductor of thigh w/ hip flexed
  • innervation: twigs from ventral rami (S1 & S2), nerve to piriformis in pelvis
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22
Q

obturator iNTERNUS & superior & inferior gemelli

origin & insertion

A
  • 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
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23
Q

obturator INTERNUS, & superior/inferior gemelli

actions, innervation

A
  • 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
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24
Q

quadratus femoris:

origin, insertion

A

o: lateral side of ischial tuberosity and from part of body of ischium
ins: quadrate tubercle and bone inferior to it

25
Q

quadratus femoris:

action, innervation

A

action: laterally rotates hip; weak adductor
inn: nerve to quadratus femoris (also inn. inferior gemellus)

26
Q

which muscles in gluteal region are supplied by:

superior gluteal artery

A
  • G. max (superficial branch)
  • G. med
  • G. min (deep branch)
27
Q

which muscles in gluteal region are supplied by:

inferior gluteal artery

A
  • G. max and
  • to most short lateral rotators (and to “hamstrings”) & ischiadic branch to the sciatic nerve
28
Q

cruciate anastomosis:

define and included arteries

A
  • “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.)
29
Q

variation in sciatic nerve (tibial & common fibular/peroneal)

A

an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve as it passes under or through the piriformis muscle

30
Q

normal relationship between sciatic nerve and piriformis

A

normally, sciatic nerve is inferior/deep to piriformis

31
Q

abnormal variation of fibular nerve could include:

A
  1. piercing piriformis
  2. superior/superficial to piriformis
32
Q

how to reproduce piriformis syndrome?

which group is often affected?

A
  • reproduce with FAIR maneuver (flexion, adduction & internal rotation - stretches piriformis).
  • rowers and rock climbers often develop symptoms
33
Q

cc: sciatica

(NOT A DIAGNOSIS)

A
  • compression of sciatic nerve or roots producing radicular pain – reproduced by straight leg raise w/30-70° passive hip flexion (Lasegue’s sign)
34
Q

Cutaneous nerves (list)

A
  1. inferior cluneal nerves
  2. posterior cutaneous nerve of the thigh
  3. superior cluneal
  4. middle cluneal
35
Q

cluneal nerves and assoc. rami

A
  1. Superior (dorsal rami L1-L3
  2. Middle (dorsal rami S1-S3)
  3. Inferior (ventral rami S1-S3 from posterior cut. nerve of thigh)
36
Q

rami assoc. w/ posterior cutaneous nerve of the thigh

A
  • (ventral rami of S1-3)
  • Dorsal division fibers from S1 & S2 &
  • ventral division fibers from S2 & S3

S1 fibers go to posterior leg

37
Q

what is the preferred location for an

intramuscular injection?

A
  • Superolateral quadrant or
  • above a line that connects the PSIS and superior margin of the greater trochanter
38
Q

again, where is the preferred site for intragluteal injections to avoid sciatic nerve?

A

between tubercle of iliac crest & anterior superior iliac spine

39
Q

lymphatics of the gluteal/lower limb?

A
  1. superficial inguinal nodes –> drain into external iliac nodes
  2. deep inguinal nodes (in femoral ring and canal)
  3. external iliac nodes
  4. popliteal nodes
40
Q

superficial inguinal nodes

receive lymph from:

A
  • lower limb
  • perineum
  • gluteal region
  • lower abdominal wall
41
Q

popliteal nodes drain into:

A

deep inguinal nodes, along deep veins

42
Q

2 bursae in gluteal region?

A
  1. ischial bursa
  2. trochanteric bursa
43
Q

ischial bursa is found where?

A

between gluteus max & ischial tuberosity

44
Q

trochanteric bursa is found where?

A

between gluteus max & lateral surface of greater trochanter

45
Q

standing

goal of standing

A

maintaining equilibrium

46
Q

what force exerts rotatory movements at major joints of lower limb?

A

gravity

47
Q

what rotary movement at hip?

what offsets this?

A
  • tendency is toward hyperextension
  • opposed by iliofemoral and ischiofemoral
48
Q

what rotary force at the knee?

what offsets this?

A
  • tendency is toward hyperextension at knee
  • opposed by gastrocnemius muscles
49
Q

what rotary force at the ankle?

what offsets this?

A
  • tendency is dorsiflexion at the ankle
  • to oppose this, plantar flexors are active
50
Q

the driving action opposes which force?

A

ground reaction force

51
Q

which muscles are involved in:

heel strike of stance phase

A
  • 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
52
Q

what muscles are involved in:

midstance

A
  • 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
53
Q

which muscles are involved in:

toe off

A
  • 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
54
Q

describe:

acceleration of swing phase

A

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

55
Q

describe:

midswing phase of swing phase

A

swinging limb is beneath body and is shortened (hip & knee flexion and ankle dorsiflexion) to clear ground

56
Q

describe:

deceleration of swing phase

A

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

57
Q

list the segments of the traditional

stance phase of gait cycle

A
  1. initial contact
  2. foot flat
  3. midstance
  4. heel off
  5. toe off
58
Q

list the segments of the traditional

swing phase of gait cycle

A
  • acceleration
  • midswing
  • deceleration

2b_Y1 - LEA-Exam 1 (9 decks)

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