TBL 8 - Gluteal Region, Posterior Thigh, Popliteal Fossa, Posterior Leg, Ankle and Foot

Question 1

Describe the sacral hiatus and whats inside

Answer 1

inverted U that opens into the sacral canal (part of vertebral canal). Sacral cornea project inferiorly at the corners of the hiatus. The sacral nerve roots of the caudal equina are inside

Question 2

How is caudal epidural anesthesia performed and which spinal nerves are typically affected?

Answer 2

It is injected through the sacral hiatus into the fat of the sacral canal around the proximal portions of the sacral nerves. It affects the S2-Co1 nerves

Question 3

What holds the sacrum and hip bones together

Answer 3

The anterior and posterior sacroiliac ligaments

Question 4

What creates the greater and lesser sciatic foramina

Answer 4

The sacrotuberous ligament connected to the ischial tuberosity and sacrospinous ligament connected to the ischial spine

Question 5

Gluteus maximus

Answer 5

superoposterior ilium and posterior sacrum to the iliotibial tract
Extensor of thigh from flexed position

Question 6

What does the inferior gluteal nerve innervate

Answer 6

the gluteus maximus

Question 7

Gluteus Medius and minimus

Answer 7

Just deep to the maximus, external surface of ilium to the greater trochanter of the femur
Abduct and medially rotate the thigh

Question 8

What does the superior gluteal nerve innervate

Answer 8

The gluteus medius and minimus

Question 9

What are the main lesions that cause a positive Trendelenburg test?

Answer 9

Lesions to the superior gluteal nerve as the Trendelenburg suggest a problem in the gluteus medius

Question 10

Where is the safe area for intragluteal injections?

Answer 10

Superolateral quadrant of buttocks or superior to line from PSIS to the superior border of the greater trochanter

Question 11

Tensor Fasciae Lata

Answer 11

ASIS to iliotibial tract. Helps flex thigh

Question 12

Paralysis of which muscle activates hypertrophy of the tensor fascia lata?

Answer 12

Iliopsoas. The tensor fasciae lata tries to compensate for the iliopsoas

Question 13

Piriformis

Answer 13

Anterior surface of the sacrum to the greater trochanter of the femur occupying the greater sciatic foramen

Question 14

Quadratus femoris

Answer 14

Ischial tuberosity to the intertrochanteric surface of femur

Question 15

What muscles laterally rotate the thigh

Answer 15

Piriformis and quadratus femoris

Question 16

What muscles attach to the ischial tuberosity

Answer 16

Quadratus femoris, semitendinosus, semimembranosus, long head of the biceps femoris, and the hamstring portion of the adductor magnus

Question 17

Short head of biceps femoris and distal for both heads

Answer 17

Attaches to the linea aspera to the common distal attachment of head of fibula

Question 18

Distal attachment for semitendinosus and semimembranosus

Answer 18

superior tibia

Question 19

What does the tibial division of the sciatic nerve innervate?

Answer 19

The semitendinosus and semimembranosus, and long head of the biceps femoris

Question 20

What does the common fibular division of the sciatic nerve innervate

Answer 20

Short head of biceps femoris

Question 21

Pes Anserinus

Answer 21

On the superomedial tibia - semitendinosus, sartorial, and gracilis and they are separated from tibia by the anserine bursa, bursitis of which causes medial knee pain

Question 22

Why are both heads of the biceps femoris not always paralyzed after nerve injury in the posterior thigh?

Answer 22

Different nerves. Long head = tibial division of sciatic. Short head = common fibular division

Question 23

Why does complete section of the sciatic nerve, although uncommon, cause loss of ipsilateral lower limb function?

Answer 23

Its divisions innervate most, if not all of the lower limb. Happens if hypertrophy occurs in the piriformis or some trauma to the gluteal region

Question 24

What supplies the hamstring muscles

Answer 24

Deep artery of the thigh

Question 25

What supplies the gluteal region

Answer 25

The gluteal arteries

Question 26

Describe the course of the tibial nerve, popliteal artery/vein, and common fibular nerve through the popliteal fossa

Answer 26

Tibial nerve and popliteal artery/vein through the center and common fibular around the lateral border

Question 27

Name the borders of the popliteal fossa

Answer 27

Superomedial - Semimembranosus Superolateral - biceps femoris Inferomedial - medial head of gastrocnemius Inferolateral - gastrocnemius

Question 28

Popliteus muscle

Answer 28

Lateral condyle of femur to superoposteriar tibia, separates the LCL and lateral meniscus and forms floor of popliteal fossa

Question 29

What muscles unlocks knee and how?

Answer 29

Popliteus by rotating femur 5 degrees laterally

Question 30

What arteries anastomose around the knee for collateral circulation and whats the importance

Answer 30

Branches of the popliteal, the anterior tibial, and femoral arteries. Importance is to make sure that if the vessels are occluded or the knee is flexed for too long, blood still gets to where it needs to go

Question 31

What artery supplies the fibulas longus and braves and other muscles on the lateral side of posterior leg

Answer 31

fibular artery

Question 32

What artery supplies posterior of leg

Answer 32

Posterior tibial artery

Question 33

Why can palpation of the popliteal arterial pulse be difficult and what can cause its weakening or absence?

Answer 33

Artery is deep. Weakening is a sign of femoral artery obstruction

Question 34

Where is the posterior tibial pulse palpated and why is its absence in people over 60 related to intermittent claudication?

Answer 34

Between the medial malleolus and medial border of calcaneal tendon. Sign of occlusive peripheral artery disease in people older than 60. Intermittent claudication (leg pain and cramps) is a result of ischemia of the leg muscles

Question 35

Gastrocnemius

Answer 35

Distal end of femur to calcaneal tendon to calcaneal tuberosity

Question 36

Soleus

Answer 36

Fibula and tibia to calcaneal tendon which goes to the calcaneal tuberosity

Question 37

Plantaris

Answer 37

long tendon joins the calcaneal tendon. Used for grafting without any compromise of plantarflexion

Question 38

What muscles plantar flex foot?

Answer 38

Gastrocnemius and soleus along with plantaris

Question 39

Why does rupture of the calcaneal tendon cause the most severe acute problem of the leg?

Answer 39

Cannot plantar flex against resistance so there is excessive dorsiflexion. Walking is difficult

Question 40

What does the tibial nerve innervate

Answer 40

Superficial and deep muscles of the posterior leg

Question 41

Tom, dick, harry flexors

Answer 41

Tibialis posterior, flexor digitorum longus, and flexor hallucis longus all go around the medial malleolus of the tibia.

Question 42

Ankle joint

Answer 42

superior aspect of talus with eh tibial medial malleolus and fibular lateral malleolus

Question 43

Ligaments of the ankle joint

Answer 43

Anterior talofibular, posterior talofibular, and calcaneofilbular ligaments are the lateral side. The medial side is the deltoid or strong medial ligament (much stronger than lateral)

Question 44

Why is a Pott fracture-dislocation of the ankle erroneously called a trimalleolar fracture?

Answer 44

Foot is forcibly everted, the medial ligament is torn causing the medial malleolus to be torn off, talus moves laterally shearing off the lateral malleolus or distal fibula causing the tibia to go anteriorly and shear off the distal tibia

Question 45

What joint does inversion and eversion go across?

Answer 45

The subtalar joint, part of the the talocalcaneonavicular joint

Question 46

Why are comminuted fractures of the calcaneus usually disabling?

Answer 46

Disrupts the subtalar joint where the talus articulates with the calcaneus

Question 47

Purpose of the arches of the foot.

Answer 47

Springboards to help the FHL propel the foot off the ground

Question 48

What provides support for the medial longitudinal arch

Answer 48

Plantar calcaneonavicular ligament (spring ligament) and plantar aponeurosis provides passive support along with tendons of tibias posterior and flexor digitorum longus that provide active support

Question 49

What causes acquired flatfeet and how do they differ from rigid flatfeet?

Answer 49

Acquired is from dysfunction of the tibias posterior due to trauma, degeneration with age, or nerve damage. Rigid is from bone deformity from childhood

Question 50

When is pain from this inflammatory condition, plantar fasciitis, most severe, when does it dissipate, and how is it exacerbated?

Answer 50

Severe after sitting. Dissipates from 5-10 min of activity and is exacerbated by dorsiflexion of the ankle or weight-bearing. Passive extension of the toe causes problems

Question 51

What nerve supplies the plantar surface of foot

Answer 51

The tibial branches posterior to the medial malleolus into medial and lateral plantar nerves

Question 52

What innervates the dorsum of the foot and the lateral side of ankle

Answer 52

Superficial fibular nerve

Question 53

What innervates skin between 1st and 2nd toes

Answer 53

Deep fibular nerve

Question 54

What innervates the lateral side of foot and where does it come from

Answer 54

The sural nerve formed by the branches of the tibial and common fibular nerves

Question 55

Why can injury of the sciatic nerve in the gluteal region cause loss of sensation from the foot?

Answer 55

The sciatic nerve innervates the foot

Question 56

Describe the course of the posterior tibial artery and what it becomes

Answer 56

Posterior to medial malleolus and bifurcates into the medial and lateral plantar arteries