Tutorial #2 Flashcards
What is the origin of the super gluteal neurovascular bundle?
L4-S1 (All gluteal region nerves arise from lumbrosacral plexus)
Emerges superior to piriformis muscle (all others emerge inferior to piriformis muscle)
What is the function of the superior gluteal neurovasculat bundle?
Motor to gluteus minimus and medius muscles
Trendenlenburg sign
Where would you find the superior gluteal neurovascular bundle?
Between gluteus minimus and gluteus medius muscles
A lesion of the superior gluteal neurovascular bundle would produce:
Weakness of Abducting the thigh at the hip
Would cause Trendelenberg sign – sagging of muscles of unaffected side of butt/pelvis
Muscles unable to provide necessary stability while walking
What are the landmarks of the deep branch of the femoral artery?
Branches around the lower trochanter and heads deeper/posteriorly
Runs down thigh (closer to femur than femoral artery)
Runs between pectineus and adductor longus muscles
The artery does not leave the thigh region
What branches of the deep femoral artery supply the hip?
Medial and lateral femoral circumflex
What region of the thigh is supplied by the deep branches of the femoral artery (perforating)?
Medial and posterior thigh
What are the landmarks for the adductor brevis muscle?
Runs from the sides of the pubic symphysis to the area of femur just below lesser trochanter
Found under the adductor longus muscles
What other muscles share the same function as adductor brevis?
Stabilize pelvis when standing and femur when sitting with knee bent Adductor longus (on top of brevis) Adductor magnus (below brevis, very large)
A lesion to the adductor muscles would result in:
Obturator nerve innervates adductors
“Waddling gait”
—Wide gait that is aligned with the shoulders instead of the normal alignment with the pelvis
What are the landmarks of the sartorius muscle?
Runs from the ASIS in the pelvis to the Pes Anserine on the medial part of the tibia; in anterior compartment
Longest muscle in human body and is an outermost long, thin muscle
Upper part forms lateral border of the femoral triangle
What are the primary functions of the sartorius muscle?
Flex knee
Weakly flexes, abducts and laterally rotates hip
What is the nervous innervation to sartorius muscle?
Anterior/Superficial branch of femoral nerve
Sensory and motor to Sartorius
Would a strong vargas or valgus force compromise the integrity of the MCL?
Valgus Force
Abducting force of limb against a stationary thigh (knocking knee in with fore coming from a lateral direction)
What are the landmarks of the MCL?
From medial epicondyle of the femur to the medial condyle of the tibia (medial side of the knee)
What are the potential consequences of an MCL injury?
MCL is directly connected to medial meniscus, so a medial meniscus tear is common
Tendon of the Obturator Internus Muscle
Landmarks?
From anterior ischium/rim of pubis to greater trochanter region
Tendon of the Obturator Internus Muscle
Primary action?
Primary action:
Lateral rotation of femur with hip flexion
Steady femoral head in acetabulum
Tendon of the Obturator Internus Muscle
What other muscles do the same action?
Primary action:
Lateral rotation of femur with hip flexion
Steady femoral head in acetabulum
Three other muscles with same action:
Superior gamellus muscle
Inferior gamillus muscle
Quadratus femorus
What are the landmarks of the deep branch of the common fibular nerve?
Passes deep to the extensor digitorum longus
Winds around fibula
A lesion of the common fibular nerve would result in:
Foot drop
Loss of sensation to dorsum of foot
Walk with slapping of foot on the ground and difficulty “heel walking”
Typically occurs with trauma to the neck of the fibula, as it winds around it
What artery accompanies the common fibular nerve?
Anterior tibial artery
What are the landmarks of the tendon of the flexor hallicus longus?
Muscle runs down lateral leg, and tendon can be seen curving around medial portion of ankle to run down to end of hallux (big toe)
“Tom, Dick, and HARRY”
What artery lies immediately deep to the flexor hallicus longus and what does it supply?
Peroneal (fibular) artery (peroneal branch of posterior tibial artery)
Blood supply to lateral compartment of the leg
Name two other muscles in the deep portion of the posterior compartment of the leg besides flexor hallicus longus and what nerve supplies them?
Innervation:
Tibial Nerve
Flexor digitorum longus
Tibialis posterior
What are the landmarks of tibialis anterior muscle?
Origin: lateral condyle and proximal half of lateral surface of tibia
Passes anterior to medial malleolus and inserts onto the inferior surface of the 1st cuneiform bone and 1st metatarsal
Primary action of tibialis anterior on the foot and what muscle is a synergist?
Inversion of ankle and supination of foot
Tibialis posterior
Primary action of tibialis anterior muscle on ankle and what muscles are synergists?
Dorsiflexion at ankle
Extensor hallucus longus
Extensor digitorum longus
What are the landmarks of the IT band?
Formed by tendinous insertion of gluteus maximus and tensor fascia lata onto lateral tibial condyle
What is the function of the IT band?
tabilizes lateral aspect of knee by keeping the femur from moving on the tibia when the knee is flexed
What muscle lies at the IT band’s superior extent and what is its action?
Tensor fascia lata
ABducts and stabilizes the hip
Assists with initiation of hip flexion
What is the landmark of the quadriceps tendon?
Combined Tendon of 4 muscles superior to the patella (and encases patella)
Name action of muscles who’s fibers terminate as the quadriceps tendon:
All work together to extend the knee
Rectus Femoris
Vastus Medialis
Vastus Intermedius
Vastus Lateralis
What is the relationship of the quadriceps tendon to the patella?
Encases patella, then continues on to form the patellar ligament to insert on the tibia for knee extension
What are the landmarks of the dorsalis pedis artery?
Runs superficially down middle of top of foot towards area between the first and second toes
The dorsalis pedis artery is the termination of what artery?
Anterior tibial artery
What is the clinical significance of the dorsalis pedis artery?
You can take pedal pulse from it to check for cardiovascular problems/mismatch
Runs over talus, navicular, and intermediate cuneiform bones
What are the landmarks of the common fibular nerve?
Split of the sciatic nerve (other branch of sciatic n. is tibial nerve) superior to knee on lateral leg
What are the cutaneous termini of the two major branches of the common fibular nerve?
Common fibular branches into superficial and deep fibular nerves
Cutaneous branches are:
Articular Cutaneous Nerve
Sural Cutaneous Nerve
What are the landmarks of the popliteus muscle?
Deep to hamstrings, posteriorly
Runs diagonally across the back of the knee, laterally, from the femur to the medial tibia
How does the popliteus unlock the knee?
Causes a slight rotation of the femur laterally on the tibia (in the weight bearing position), which is required in unlocking the knee
What is the nerve supply to the popliteus muscle?
Tibial nerve
What is the landmark for the tendo calcaneus?
Back of leg at ankle
What two muscles contribute to the tendo calcaneus?
Two heads of gastrocnemius muscle (lateral and medial)
Soleus muscle
(through this tendon, the triceps surae attach to the back of the calcaneus)
What functional deficit would occur following rupture of the Achilles tendon?
Sharp pain in back of ankle or lower leg that will affect ability to walk, especially uphill or up stairs and difficulty rising up on the toes
What are the landmarks of the ACL?
Between (anterior) tibia and crosses anteriorly to PCL to attach to (posterior) femur
What functional deficit would occur following rupture of ACL?
Functions to resist anterior movement of the tibia on the femur Pain and swelling in the knee Loss of range of motion Tenderness along the joint line Discomfort while walking
How would you test for an injury to the ACL?
Lachman test: Flex knee at 20-30 degrees with pt supine, pull forward on tibia while holding femur in place – assess amt of forward motion
What are the landmarks of the iliofemoral ligament?
Anteriorly connects the ilium to the femur
Strongest and most important extrascapular ligament, covering the anterior and inferior aspects of the joint
What is the function of the iliofemoral ligament?
Prevents hyperextension of the hip
How does the iliofemoral ligament facilitate standing for long periods of time?
It helps lock the hip joint
It prevents hyperextension of the joint, preventing movement of the femur past a vertical line, locking it into place
What are the landmarks for the lateral ligament of the ankle?
Set of 3 ligaments on the lateral ankle from the lateral malleolus of the radius to the talus or calcaneus – they resist inversion (supination) of the foot
What portion of the lateral ligament of the ankle is usually torn as a result of inversion injury?
Usually get a foot inversion ankle sprain because the lateral ligament is weaker than the medial deltoid
Calcaneofibular portion
What may be the consequences of a young patient if the portion of the lateral ligament of the ankle that attaches to the fibula is torn?
If the calcaneofibular ligament is involved, the distal portion of the lateral malleolus is often avulsed
This injury can damage the growth plate of the fibula, in a young individual, and disrupt the course of the tendons of the fibularis muscles
What are the landmarks of the spring ligament?
Located on the bottom of the foot and connects the navicular bone’s plantar surface with the calcaneus’s sustentaculum
What is the function of the spring ligament?
Supports the medial longitudinal arch
If the spring ligament is lax, what clinical symptom/consequence may result?
Flat feet (pes planus) In this situation, the head of the talus moves inferiorly and the medial longitudinal arch is flattened, while the metatarsals and phalanges are noticibly deviated laterally Pain due to excessive strain and pressure on the muscles and bones in the foot because of inappropriate weight transfer while walking
What are the landmarks of the fibularis longus muscle?
Muscle in the lateral compartment of leg and tendon wraps around the lateral (malleolus) ankle and crosses bottom of foot to attach at lateral side of the base of the first metatarsal of big toe
What is the major action of the fibularis longus muscle?
Eversion/Pronation and plantarflexion of the foot
What function does the tendon of the fibularis longus serve on the plantar surface of the foot?
Helps steady the leg upon the foot, especially when standing on one leg where there is a tendency of the leg to move medially – fibularis longus overcomes this tendency by drawing on the lateral side of the leg
