Quiz 4: Lectures 12-14 Flashcards
Which of the following nerves does not originate from the sacral plexus?
Obturator nerve
Which nerves run below the piriformis in the greater sciatic foramen?
Sciatic nerve, inferior gluteal nerve, pudendal nerve
The femoral nerve originates from which nerve roots?
L2-L4
Which of the following ligaments restrict hip extension?
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
All of them restrict hip extension
Which of the following arteries do not supply blood to the femoral head or neck?
- acetabular branch of the obturator artery
- perforating branches of the deep femoral artery
- lateral circumflex femoral artery
- medial circumflex femoral artery
Perforating branches of the deep femoral artery
The distal attachment of the glute med is the…?
Greater trochanter
Which of the following is not an action of the TFL?
- hip flexion
- hip abduction
- hip external rotation
- hip internal rotation
Hip external rotation
Where does the femoral nerve originate?
L2-L4 nerve roots of lumbar plexus
Which nerve provides motor innervation to the anterior compartment of the thigh?
Femoral nerve
What are the 6 major nerves of the lumbar plexus?
- iliohypogastric
- ilioinguinal
- genitofemoral
- lateral femoral cutaneous
- obturator
- femoral
Where does the iliohypogastric nerve originate in the lumbar plexus?
L1
Where does the ilioinguinal nerve originate in the lumbar plexus?
L1
Where does the genitofemoral nerve originate in the lumbar plexus?
L1-L2
Where does the lateral femoral cutaneous nerve originate in the lumbar plexus?
L2-L3
Where does the obturator nerve originate in the lumbar plexus?
L2-L4
Where does the femoral nerve originate in the lumbar plexus?
L2-L4
The iliohypogastric nerve provides motor innervation to which deep muscles?
Internal Oblique and Transverse Abdominis
Where does the iliohypogastric provide sensory innervation to?
Abdominal skin above the pubis and upper lateral thigh
Which muscles attach to the thoracolumbar fascia?
Internal oblique and transverse abdominis
The ilioinguinal nerve provides motor innervation to which deep muscles?
Internal oblique and transverse abdominis
Where does the ilioinguinal nerve provide sensory innervation to?
Upper medial thigh
T or F? The genitofemoral nerve provides sensory and motor innervation?
True
The femoral branch of the genitofemoral nerve provides sensory innervation to where?
Upper anterior thigh
The genital branch of the genitofemoral nerve provides motor innervation to _______________ and sensory innervation to _____________ and ______________
- cremaster muscle
- scrotum and mons pubis
The lateral femoral cutaneous nerve provides sensory innervation to…
Lateral thigh
T or F? The femoral nerve is the largest branch of the lumbar plexus?
True
The femoral nerve provides motor innervation to where?
anterior compartment of the thigh (hip flexors and knee extensors)
The obturator nerve provides motor innervation to where?
Medial compartment (hip adductors)
The femoral nerve provides sensory innervation to where?
anterior thigh and medial leg
The obturator nerve provides sensory innervation to where?
Medial lower thigh
Which nerve goes through the psoas major?
Genitofemoral nerve
What are the 4 primary nerves of the sacral plexus?
Superior gluteal nerve, inferior gluteal nerve, posterior femoral cutaneous nerve, pudendal nerve
Which sacral plexus nerve originates from L4-S1?
Superior gluteal nerve
Which sacral plexus nerve originates from L5-S2?
Inferior gluteal nerve
Which sacral plexus nerve originates from S1-S3?
posterior femoral cutaneous nerve
Which sacral plexus nerve originates from S2-S4?
Pudendal nerve
The superior gluteal nerve provides motor innervation to the?
Glute med, glute min, and TFL
The posterior femoral cutaneous nerve provides sensory innervation to the?
back and medial side of the thigh, popliteal fossa, and the upper part of the back of the leg
The inferior gluteal nerve provides motor innervation to the?
Glute max
Which nerve provides sensory and motor innervation to the perineum region?
Pudendal
Which nerve loops around the sacrospinous ligament and passes through both the greater and lesser sciatic foramen?
Pudendal nerve
The sciatic nerve branches off into which two nerves?
Tibial nerve (medial) and fibular/peroneal nerve (lateral)
The sciatic nerve provides motor innervation to the?
- posterior compartment of thigh (hamstrings)
Which nerve innervates the tibialis anterior?
deep peroneal nerve
Which nerve innervates the peroneus longus?
superficial peroneal nerve
Which nerve innervates the tibialis posterior?
tibial nerve
The sciatic nerve provides sensory innervation to the?
Foot and the lateral side of leg
Which nerve provides sensory innervation to the medial lower leg?
Saphenous nerve
What are the 6 hip external rotators?
(PGOGOQ)
- Piriformis
- Superior Gemellus
- Obturator Internus
- Inferior Gemellus
- Obturator Externus
- Quadratus Femoris
T or F? All of the sacral plexus nerves go through the greater sciatic foramen
True
What is the only sacral plexus nerve that goes superior to the piriformis?
superior gluteal nerve
Which nerve provides sensory innervation to the glutes?
Cluneal nerves (superior, medial, inferior)
- The internal iliac artery goes to the…
- The external iliac artery goes to the…
- pelvis
- down the lower extremity
The external iliac artery turns into the __________ artery after it passes the inguinal ligament
femoral
The femoral artery becomes the ___________ artery at the knee
Popliteal artery
The popliteal artery becomes the __________________________ artery to supply the leg
anterior/posterior tibial artery and peroneal artery
What are the three major branches of the internal iliac artery that supply the hip and gluteal region?
- Obturator artery (supplies hip region)
- Superior gluteal artery (supplies the gluteal region)
- Inferior gluteal artery (supplies the gluteal region)
Patients who have meralgia paresthetica feel tingling, numbness, and burning pain on the outer side of the thigh. This disease is caused by entrapment of a nerve. Which nerve would this most likely be?
Lateral femoral cutaneous
Stretching is often used to treat meralgia paresthetica. Which muscle should you most likely stretch?
Psoas Major
Stretching is often used to treat meralgia paresthetica. Which muscle should you most likely stretch?
Psoas Major
Name the layers of a synovial joint from outer to inner
Capsule, synovial membrane, synovial fluid, articular cartilage (lines the head of bones)
Where does the rectus femoris originate?
AIIS
Which structures attach to the ASIS?
Inguinal ligament, sartorius, (TFL maybe?)
Which structure divides the greater and lesser sciatic foramen?
Sacrospinous ligament
T or F? All of the adductor muscles attach to the superior and/or inferior pubic ramus
True
Where are the 2 pectineal lines?
Femur and superior pubic ramus
Which ligament attaches the fovea of the femoral head to the acetabulum
Ligamentum teres
Describe the acetabular labrum
- stabilizes the hip joint
- deepens acetabulum by 30%
- creates negative intra-articular pressure
- poor vasculature (will not heal well if damaged)
Which structures pass through the greater sciatic foramen?
Gluteal vessels/nerves, sciatic nerve, pudendal nerve
Which structures pass through the lesser sciatic foramen?
Pudendal nerve
Which structure passes through the obturator canal?
Obturator nerve
All of the sacral plexus nerves go through which structure?
Greater sciatic foramen
What is the strongest, and 2nd strongest bone in the body?
Femur, tibia
Which muscles attach to the greater trochanter?
- glute min (anterior trochanter)
- glute med (lateral trochanter)
- piriformis (superior trochanter)
- obturator internus (medial/posterior)
- superior and inferior gamelli
What is the function of the intertrochanteric line?
Provide attachment to iliofemoral ligament
Which muscle inserts on the lesser trochanter?
Iliopsoas
What is the pectineal line? Which muscles attach to it?
Base of the lesser trochanter
Pectineus
Wich muscles attach to the linea aspera?
Adductor longus, brevis, and magnus
Where is the gluteal tuberosity?
At the base of the greater trochanter
What is the gluteal tuberosity? Which muscle attaches to it?
Lateral lip of linea aspera / base of greater trochanter
Gluteus Maximus
Which muscle inserts on the intertrochanteric crest and quadrate tubercle?
Quadratus femoris
What is the angle of inclination?
The angle between the axis of femoral head/neck and the long axis of femur
Frontal plane angle: 125 degrees
If the angle of inclination is greater than 125 degrees, it is referred to as…
Coxa valga
If the angle of inclination is less than 125 degrees, it is referred to as…
Coxa vara
What is the femoral anteversion angle? What is a normal angle?
An angle between the femoral head/neck and a horizontal line in the transverse plane
15 degrees
What type of capsule is the hip capsule?
Fibrous capsule
- synovial lining
Where does the hip capsule attach?
Proximal attachment: acetabulum
Distal anterior: intertrochanteric line
Distal posterior: intertrochanteric crest
Which of the 4 hip ligaments connects the fovea of the femur to the acetabulum, and carries a branch of the obturator artery?
ligamentum teres
Explain the iliofemoral ligament
- known as the “Y” ligament
- proximally attaches to AIIS, distally attaches to intertrochanteric line
- resists extension and external rotation
- STRONGEST LIGAMENT IN THE BODY
Explain the pubofemoral ligament
- Proximally attaches to superior pubic ramus, dismally attaches to intertrochanteric line
- resists extension/abduction
- distally blends with iliofemoral ligament and joint capsule
Explain the ischiofemoral ligament
- located on the posterior part of the hip joint
- proximally attaches to ischium
- distally attaches to the intertrochanteric line
- resists internal rotation and extension
Which 3 arteries supply blood to the hip joint?
- medial circumflex femoral artery
- lateral circumflex femoral artery
- acetabular branch of obturator artery
What are the two main branches off the external iliac artery?
- profunda femoris artery
- femoral artery
What is another term for profunda femoris artery?
Deep femoral artery
Which nerves provide sensation to the glutes
- Superior cluneal nerves (L1-L3)
- Lateral cluneal nerves (L1)
- Medial cluneal nerves (S1-S3)
- Inferior cluneal nerves (via posterior femoral cutaneous nerve)
Which nerve comes off T12?
Subcostal nerve
Which nerves come off of the lumbar plexus?
I, I Get Lunch On Fridays
- Iliohypogastric (L1)
- Ilioinguinal (L1)
- Genitofemoral (L1, L2)
- Lateral femoral cutaneous nerve (L2,L3)
- Femoral nerve (L2, L3, L4)
- Obturator nerve (L2, L3, L4)
T or F? The majority of the nerve innervation to the gluteal region comes from the lumbar plexus
False, sacral plexus
Which nerve inner area the glute med, glute min, and TFL?
Superior gluteal nerve
Which nerve supplies the glute max?
Inferior gluteal nerve
Which nerves innervate the small external rotators? What is the one exception?
Sacral plexus nerves
Exception: obturator nerve innervates the obturator externus
Which vessels supply/drain the deep glute muscles (min and med), and superficial glute muscles (glute max)?
Superior gluteal artery/vein
Which vessels supply/drain the glute max and external rotators (except obturator externus and quadratics femoris)
Inferior gluteal artery/vein
Which artery supplies the obturator externus?
Obturator artery
Which artery supplies the quadratic femoris?
Medial circumflex artery
What is the strongest ligament in the body?
Iliofemoral ligament
What is the origin and insertion of the glute max? Action? Innervation? Blood supply?
Origin: posterior ilium, sacrum, sacrotuberous ligament
Insertion: gluteal tuberosity and iliotibial tract (IT band)
Action: hip extension and external rotation
Innervation: inferior gluteal nerve (L5-S2)
Blood supply: superior and inferior gluteal arteries
Where does the IT band originate and insert?
Origin: Iliac crest
Insertion: Gerdy’s tubercle
What is “snapping hip”
A snap in the hip whenever it goes into flexion and/or extension
Although the IT band doesn’t stretch, how could you lengthen it and treat IT band syndrome?
Stretch the muscles attached to it (glute max and TFL)
Where does the TFL originate and insert? Action? Innervation? Blood supply?
Origin: ASIS
Insertion: IT band (iliotibial tract)
Action: hip abduction, flexion, and internal rotation
Innervation: superior gluteal nerve (L4-S1)
Blood supply: superior gluteal artery, lateral circumflex femoral artery
Where does the glute med originate and insert? Action? Innervation? Blood supply?
Origin: between anterior and posterior gluteal lines
Insertion: greater trochanter (lateral)
Action: abduction, internal rotation, external rotation
Innervation: superior gluteal nerve (L4-S1)
Blood supply: superior gluteal artery
Where does the glute min originate and insert? Action? Innervation? Blood supply?
Origin: between anterior and posterior gluteal lines
Insertion: greater trochanter (anterior)
Action: abduction, internal rotation, external rotation
Innervation: superior gluteal nerve (L4-S1)
Blood supply: superior gluteal artery
What is trendelenburg?
When hip drop occurs contralateral to the affected glute med
Where does the piriformis originate and insert? Action? Innervation? Blood supply?
Origin: anterior-lateral surface of sacrum
Insertion: greater trochanter
Action: hip external rotation
Innervation: nerve to piriformis (S1-S2)
Blood supply: inferior and superior gluteal artery
What is the origin and insertion of the gemellus superior?
Origin: ischial spine
Insertion: greater trochanter
Action: hip external rotation
Innervation: nerve to obturator internus (L5-S2)
Blood supply: inferior gluteal artery
Where does the obturator internus originate and insert? Action? Innervation? Blood supply?
Origin: obturator membrane
Insertion: greater trochanter
Action: hip external rotation
Innervation: nerve to obturator internus (L5-S2)
Blood supply: inferior gluteal artery
Where does the gemellus inferior originate and insert? Action? Innervation? Blood supply?
Origin: ischial tuberosity
Insertion: greater trochanter
Action: hip external rotation
Innervation: nerve to quadratus femoris (L4-S1)
Blood supply: inferior gluteal artery
Where does the quadratus femoris originate and insert? Action? Innervation? Blood supply?
Origin: ischial tuberosity (lateral edge)
Insertion: intertrochanteric crest
Action: hip external rotation
Innervation: nerve to quadratus femoris (L4-S1)
Blood supply: medial circumflex femoral artery
Where does the obturator externus originate and insert? Action? Innervation? Blood supply?
Origin: obturator membrane
Insertion: trochanteric fossa of femur
Action: hip external rotation
Innervation: obturator nerve (L2-L4)
Blood supply: obturator artery
Where does the superior cluneal nerve come from?
Dorsal rami of L1-L3
Where does the medial cluneal nerve come from?
Dorsal rami of S1-S3
Where does the inferior cluneal nerve come from?
Posterior femoral cutaneous nerve (S1-S3)
Where is a safe place to perform a gluteal injection?
Superior lateral glute
What are the dermatomes in the gluteal region like?
- Primarily S2 and S1 dermatome
- looks like a dart board
- S5 is innermost layer, S1 is outermost
Which muscle attaches to the AIIS?
Rectus femoris
Which muscle attaches to the ASIS?
Sartorius, inguinal ligament
Which structures go through the greater sciatic foramen?
- piriformis
- sciatic nerve
- inferior gluteal nerve
- posterior cutaneous nerve
- internal pudendal artery
- superior gluteal nerve
- inferior gluteal artery
Which structures go through the lesser sciatic foramen?
- internal pudendal artery/vein
- pudendal nerve
- nerve to obturator internus
What are the proximal and distal attachments of the femoral capsule?
Proximal: acetabulum
Distal: lesser trochanter of line and crest
Which artery supplies the obturator externus?
Obturator artery
Which artery supplies the quadratus femoris?
Medial circumflex artery
The lumbar and sacral plexus divide at which vertebral level?
L4
❗️How to distinguish between posterior and anterior femur?
Intertrochanteric line is anterior
Intertrochanteric crest and linea aspera are posterior
❗️How to distinguish between posterior and anterior femur?
Intertrochanteric line is anterior
Intertrochanteric crest and linea aspera are posterior
