Review Flashcards
1
Q
Gluteus maximus. Innervation
A
- Innervation: inferior gluteal (L5-S2)
2
Q
Gluteus medius. Innervation
A
- Innervation: superior gluteal (L4-S1)
3
Q
Gluteus minimus. Innervation
A
- Innervation: sup gluteal (L4-S1)
4
Q
What is a positive Trendelenburg sign? What does this indicate?
A
- During the stance phase, the opposite abductor muscles (gluteus medius and minimis) normally serve to prevent the pelvis from tilting down, both hips should be maintained at the same level.
- Positive sign = weak abductor muscles of the hip supplied by the superior gluteal nerve or damage to the nerve
- These individuals have waddling/hip steppage or swing out gait
5
Q
Piriformis. Innervation
A
- Innervation: S1, S2 (mnemonic = Piriformiss, 2 esses: S1, S2)
6
Q
Obturator internus. Innervation
A
- Innervation: obturator internus nerve (L5, S1, S2)
7
Q
Superior gemellus. Innervation
A
- Innervation: obturator internus nerve (L5, S1, S2)
8
Q
Inferior gemellus. Innervation
A
- Innervation: nerve to quadratus femoris (L4-S1)
9
Q
Quadratus femoris. Innervation
A
- Innervation: nerve to quadratus femoris (L4-S1)
10
Q
What nerves form the sacral plexus?
A
- L4/5 (from lumbosacral trunk) and S1-S4 (via sacral foramina)
11
Q
True/False. The nerves of the sacral plexus supply the gluteal region, anterior/posterior thigh, entire leg and entire foot.
A
- False. Does not supply the anterior thigh
12
Q
Posterior division sacral plexus nerves
A
- Common peroneal (L4-5, S1-2)* part of sciatic
- Superior gluteal (L4-S1)
- Inferior gluteal (L5-S2)
- Posterior femoral cutaneous, partly (S1-S3)
- Nerve to piriformis (S1, S2)
13
Q
Anterior division sacral plexus nerves
A
- Tibial nerve (L4-5, S1-3)* part of sciatic
- Nerve to obturator internus (L5-S2)
- Nerve to quadratus femoris (L4-S1)
- Pudendal nerve (S2-4)
- Nerve to levator ani
14
Q
Sciatic nerve is composed of what nerves? From what spinal levels?
A
- Tibial (anterior division) – L4-S3
- Common peroneal (posterior division) – L4-S2
15
Q
65 yo female comes into your office with paralysis of her gluteal muscles. Do you suspect sciatic nerve involvement?
A
- No. Injury to sciatic nerve does not affect muscles in the gluteal region. Innervation to those muscles are prior to formation of the sciatic nerve in the sacral plexus
16
Q
Name of nerve that exit the pelvis above the piriformis muscle. Below?
A
- Above = superior gluteal through greater sciatic foramen
- Below = all other branches of sacral plexus
17
Q
What muscles are affected with injury to the superior gluteal nerve?
A
- Gluteus medius and minimus
18
Q
What muscles are affected with injury to the inferior gluteal nerve?
A
- Gluteus maximus
19
Q
Nerves that innervate the cutaneous gluteal region. From which rami does each originate?
A
- Superior cluneal (dorsal rami)
- Medial cluneal (dorsal rami)
- Inferior cluneal (ventral rami)
20
Q
Nerve supply to cutaneous proximal medial thigh
A
- Genital branches of genitofemoral (L1, L2) and ilioinguinal nerves (L1)
21
Q
Nerve supply to cutaneous femoral triangle/proximal anterior thigh
A
- Femoral branch of genitofemoral (L1, L2)
22
Q
Nerve supply to cutaneous medial thigh
A
- Medial cutaneous branch of femoral (L2-4)
23
Q
Nerve supply to anterior distal thigh
A
- Intermediate cutaneous branch of femoral (L2-4)
24
Q
Nerve supply to lateral thigh
A
- Lateral femoral cutaneous nerve (L2, L3)
25
Nerve supply to posterior thigh
- Posterior femoral cutaneous nerve (S1-3)
26
Nerve supply to popliteal region
- Posterior femoral cutaneous nerve (S1-3)
27
What are the muscle compartments of the thigh? What are the muscles contained in each? What nerve supplies each compartment?
1.) Medial = adductor compartment
a.) innervation = obturator nerve (this nerve has two divisions, anterior and posterior, which are anterior and posterior in reference to adductor brevis)
b.) pectineus#, adductor longus, adductor brevis, adductor magnus*, gracilis, obturator externus
# also innervated femoral nerve
* hamstring part is innervated by tibial nerve, not obturator nerve
2. ) Anterior = hip flexor, knee extensor compartment
a. ) innervation = femoral nerve
b. ) sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius, articularis genu, psoas major, iliacus, tensor fascial latae
3.) Posterior = hip extensor, knee flexor compartment
a.) innervation = tibial nerve
b.) biceps femoris~, semitendinosus, semimembranosus
~ short head innervated by common peroneal nerve, not tibial nerve
28
What nerve supplies skin on the medial side of the leg?
- Saphenous nerve (L3, 4), branch off femoral
29
Branches of the common peroneal nerves
- Lateral sural cutaneous nerve, branch off this = sural communicating nerve, which joins with medial sural cutaneous nerve (from tibial)
- Superficial peroneal nerve
- Deep peroneal nerve
30
What nerve supplies skin of the anterolateral leg and dorsum of the foot?
- Superficial peroneal nerve (branch off common peroneal, which is part of sciatic off of sacral plexus)
31
Branches of the tibial nerve in leg
- Medial sural cutaneous nerve
32
What forms the sural nerve?
- Junction of medial sural and communicating sural cutaneous nerve
33
3 compartments of the leg? Muscles of each compartment? Nerves?
1. ) Anterior compartment:
- Muscles: tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius
- Nerve: deep peroneal nerve
2. ) Lateral compartment:
- Muscles: peroneus longus, peroneus brevis
- Nerve: superficial peroneal nerve
3. ) Posterior compartment:
- Muscles: gastrocnemius + soleus = triceps surae, plantaris, popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
- Nerve: tibial nerve (L4-S3)
34
Injury to the common peroneal (fibular) nerve causes what paralysis?
- Paralysis to anterior and lateral compartment muscles
- Anterior is supplied by deep peroneal (fibular) nerve
- Lateral is supplied by superficial peroneal (fibular) nerve
35
What nerve supplies the cutaneous medial side of the foot as far as the 1st metatarsal?
- Saphenous nerve (branch of femoral)
36
What nerve supplies the cutaneous lateral side of the foot to the 5th toe?
- Lateral dorsal cutaneous nerve (continuation of sural nerve from common peroneal)
37
What nerve supplies the cutaneous middle part of the dorsum of the foot?
- Superficial peroneal nerve branches = medial / intermediate dorsal cutaneous nerves
38
What nerve supplies the skin between the 1st and 2nd toes?
- Deep peroneal nerve (from common peroneal)
39
What nerve innervates the cutaneous heel area?
- Medial calcaneal (of tibial nerve) for the majority of the heel
- Lateral aspect = lateral dorsal cutaneous (from sural from common peroneal)
40
What nerve supplies the medial 3.5 digits on the plantar surface of the foot?
- Medial plantar nerve (of tibial nerve) is larger than lateral
41
What nerve supplies the lateral 1.5 digits on the plantar surface of the foot?
- Lateral plantar nerve (of tibial nerve)
42
What nerve supplies the medial side of foot (including arch) of the foot?
- Saphenous nerve (from femoral)
43
Innervation of the plantar foot muscles
- Medial plantar nerve innervates: mnemonic = LAFF = 1st Lumbrical, Abductor hallucis, Flexor digitorum brevis, Flexor hallucis brevis
- Lateral plantar nerve innervates all other plantar foot muscles
44
What forms the arches of the foot? Function?
- Tarsal and metatarsal bones
| - Weight bearing, resilience, shock absorption, propelling limb in walking
45
Arches of foot – what bones does each consist of?
- Medial longitudinal arch: calcaneus, talus, navicular, three cuneiforms and three medial metatarsals
- Lateral longitudinal arch: calcaneus, cuboid, two lateral metatarsals
- Transverse arch: cuboid, three cuneiforms, bases of all metatarsals
46
Medial longitudinal arch. Bones? Ligaments?
- Bones: calcaneus, talus, navicular, three cuneiforms, three medial metatarsals
- Ligament: calcaneonavicular ligament (aka spring ligament), plantar aponeurosis
47
Lateral longitudinal arch. Bones? Ligaments?
- Bones: calcaneus, cuboid, lateral two metatarsals
| - Ligament: long plantar ligament, short plantar ligament (aka calcanavicular), plantar aponeurosis
48
Transverse arch. Bones?
- Bones: cuboid, three cuneiforms, bases of all metatarsals
49
Joints of the foot. Bones that make up the joint? What type of joint is each? Motion?
1. ) Ankle, aka talocrural joint:
- Bones: trochlea of talus, tibia, fibula
- Joint type: hinge (ginglymus) type of synovial
2. ) Subtalar joint, aka talocalcaneal joint:
- Bones: talus, calcaneus
- Joint type: plane type of synovial
- Motion: inversion, eversion
3. ) Transverse tarsal joints: Motion here = inversion and eversion
a. ) talocalcaneonavicular:
- Bones: talus, calcaneus, navicular
- Joint type: ball and socket
b. ) calcaneocuboid:
- Bones: calcaneus, cuboid
- Joint type: plane
4. ) Tarsometatarsal joints:
- Bones: tarsals and metatarsals
- Joint type: plane type of synovial
- Motion: gliding
5. ) Intermetarsal joints:
- Bones: between bases of metatarsals
- Joint type: plane type of synovial
- Motion: slight gliding between bases
6. ) Metatarsal phalangeal (MP) joints:
- Bones: heads of metatarsals and bases of proximal phalanges
- Joint type: condyloid type of synovial
- Motion: flexion, extension, abduction, adduction and rotation
7. ) Interphalangeal (IP) joints – proximal (PIP) and distal (DIP):
- Bones: between phalanges
- Joint type: hinge type of synovial
- Motion: flexion and extension
50
Talocrural joint (ankle joint). Bones of the joint, joint type, ligaments, actions?
- Bones: trochlea of talus, tibia, fibula
- Joint type: hinge (ginglymus) type of synovial
- Ligaments:
a. ) Articular capsule: surrounds joint cavity, surrounded by
b. ) Deltoid ligament: medial side of joint with 4 bands (very strong): anterior tibiotalar, posterior tibiotalar, tibionavicular, tibiocalcaneal
c. ) Lateral ligament: lateral side of joint with 3 bands (weaker than deltoid): anterior talofibular, posterior talofibular, calcaneofibular
- Actions: dorsiflexion (stable in this position), plantar flexion (unstable)
51
Ankle sprains are usually the result of what excessive motion at the joint?
- Inversion, damaging lateral ligaments, which are weaker than the medial deltoid ligaments
52
What is a Potts fracture?
- Foot is forcefully everted, result is fracture of medial and lateral malleoli (or more proximal fibula)
53
What type of joint is the hip joint?
- Ball and socket type synovial joint
54
What is the name of the surface of the acetabulum that forms the joint with the head of the femur?
- Lunate surface surrounds the acetabular fossa
55
What is the acetabular notch?
- inferomedial aspect of the acetabulum
56
Blood supply to the hip joint?
- Obturator
- Retinacular arteries from the medial and lateral circumflex femoral
- Inferior and superior gluteal arteries
- 1st perforating artery
57
What type of fracture leads to necrosis of the head of the femure?
- Subcapital (area of neck immediately adjacent to head) fracture as it breaks vessels to the head
- Basal fracture (area at base of neck) usually doesn’t lead to necrosis of head
58
Nerves to hip joint?
- Femoral, obturator, superior/inferior gluteal, sciatic
59
What are the ligaments of the hip joint? Location of each?
- Articular capsule: surrounds joint and blends with other ligaments
- Iliofemoral (iliotrochanteric) ligament: anterior of joint, attached to AIIS and intertrochanteric line
- Pubofemoral (pubocapsular) ligament: superior ramus of pubis and obturator crest and blends with iliofemoral ligament
- Ischiofemoral (ischiocapsular) ligament: body of ischium below and behind acetabulu and attach to femoral neck below greater trochanter
- Ligament capitis femoris: fovea capitis to transverse ligament
- Acetabular labrum: fibrocartilaginous rim attached to margin of acetabulum
- Transverse acetabular ligament: acetabular labrum continuation across acetabular notch
60
Function of iliofemoral ligament?
- Checks hyperextension and external rotation, helps maintain erect posture
61
Function of pubofemoral ligament?
- Checks hyperextension, external rotation and abduction
62
Function of ischiofemoral ligament?
- Checks hyperextension, internal rotation
63
Function of ligament capitis femoris?
- Tenses when flexed thigh is adducted
64
What is the largest strongest and widest ligament of the hip joint?
- Iliofemoral ligament
65
What type of joint is the knee joint?
- Between tibia and femur = synovial hinge joint, better described as condyloid given its rotatory motion
- Patella and femur = plane gliding synovial joint
66
Nerve supply to the knee joint?
- Femoral, obturator, common peroneal and tibial
67
Blood supply to the knee joint?
- Genicular arteries from the femoral artery anastomose
68
Which genicular artery penetrates through the joint capsule to supply the intercondylar structures of the knee joint?
- Middle genicular artery (from femoral artery)
69
Ligament of the knee joint? Location of each?
- Articular capsule: attached to margins of articular surfaces, incomplete where replaced by tendons
- Quadriceps tendon: encloses patella
- Patellar ligament: patella to tuberosity of tibia
- Tibial (medial) collateral ligament: medial epicondyle of femure to medial surface of tibial, attached to medial meniscus
- Fibular (lateral) collateral ligament: lateral epicondyle of femure to head of fibula, no attached to lateral meniscus
- Oblique popliteal ligament: it is an expansion of tendon of semimembranosus muscle, fibers from medial condyle of tibia to lateral condyle of femur
- Arcuate popliteal ligament: intercondylar area of tibia to fibular head
- Coronary ligament: fibers surrounding capsule attached to menisci
- Intra-articular ligaments: transverse, ant/post meniscofemoral, cruciate ligaments (ACL, PCL)
70
Describe location of the intra-articular ligaments of the knee.
1. ) Transverse ligament: connect menisci anteriorly
2. ) Ant/posterior meniscofemoral ligament: obliquely from lateral menisci to medial femoral condyle
3. ) Cruciate ligaments
a. ACL: anterior interchondral fossa to lateral condyle of femur
b. PCL: posterior interchondral fossa to medial condyle of femur
71
Function of tibial (medial) collateral ligament? Fibular (lateral) collateral ligament?
- Become tight during extension and stabilize the knee joint
72
Function of cruciate ligaments of knee joint?
- ACL: stops hyperextension of the knee
| - PCL: stops hyperflexion of the knee
73
Which of the cruciate ligaments of the knee joint are stronger?
- PCL is shorter and stronger than the ACL
74
Function of the menisci of the knee joint?
- Deepen the articular surfaces
75
What ligament of the knee joint attaches the menisci to the capsule?
- Coronary ligament
76
To what bone are the menisci of the knee joint attached?
- Tibial condyles
77
What is a Baker’s cyst?
- Where synovial fluid escapes from the knee joint into the popliteal fossa
78
What is the unhappy triad? Describe the mechanism of this injury?
- Injury to knee involving MCL, medial meniscus and ACL
| - Knee is hit on the lateral aspect
79
Clinical examinations to test for ACL and PCL tears?
- ACL tear: anterior drawer test
| - PCL tear: posterior drawer test
80
Name accidents that can cause ACL and PCL tears?
- ACL: skiing
| - PCL: car accident
81
What is genu varum?
- Decreased Q-angle = Bow leg
82
What is genu valgum?
- Increased Q-angle = Knock knee
