Week 4 Flashcards
Where does the gluteus maximus originate & insert?
It’s innervated by the inferior gluteal artery & nerve
- Posterior gluteal line - origin
- Gluteal tuberosity - insertion
Where do you want to give gluteal injections?
Superolateral quadrant
What innervates the tensor fascia lata?
What is the function of the tensor fascia lata?
Superior gluteal nerve
-It flexes the thigh & stabilizes the knee in extension
What causes gluteal gait/lurch? (limited hip extension on affected side that is compensated for with hyperextension of trunk
Paralysis of the gluteus maximus due to damage of inferior gluteal nerve (L5-S2)
What causes Iliotibial band syndrome (ITBS)?
Running/exercise - usually very athletic people - caused by friction
What are the functions of the Gluteus medius & minimus? What happens when the superior gluteal nerve is damaged?
They abduct the thigh & steady the pelvis
- The hip will fall to the opposite side
- Trendelenberg sign & gait/gluteus medius limp (have patients stand on one leg & switch - if hip falls that leg is damaged)
What is the function of the piriformis? Where does the piriformis originate and insert?
It is the strongest lateral hip rotator!
Origin - sacrum
Insertion - greater trochanter of the femur
What innervates the piriformis?
Nerve to the piriformis!
What are the four lateral rotators?
Superior Gemellus, Obturator internis (can usually only see the tendon), Inferior Gemellus, Obturator externis, Quadratus femoris
-Superior and Inferior Gemellus insert on greater trochanter
Where does the neurovasculature enter the pelvis?
Through the greater sciatic foramen!
What is the function of the posterior compartment of the thigh?
Hip extensor & knee flexors
What innervates the posterior compartment of the thigh?
Tibial nerve (common fibular for short head of biceps)
What is the function innervation of the medial compartment of the thigh?
Obturator Nerve - Thigh adductors
What is the function and innervation of the anterior compartment?
Femoral Nerve - hip flexors, knee extensors
What is a hamstring tear? How is it caused?
It is a tear of a muscle from the back of the leg - can be from avulsed ischial tuberosity
-Usually occurs in athletes who run and/or kick hard!
What supplies the posterior compartment of the thigh (blood)?
Perforating branches of the deep femoral artery
What originates on the ischial tuberosity?
Semimembranosus, Semitendinosus, Biceps femoris - the hamstrings
Where does the popliteus tendon attach?
Lateral femoral condyle. It does through/under the lateral/fibular collateral ligament, next to the lateral meniscus.
What type of joint is the interosseous membrane?
Syndesmosis joint - fibrous joint - unites tibia & fibula
Since the tibia articulates with the femur and bears the weight, what is the function of the fibula?
It is an attachment for muscles primarily & also for stability of the ankle joint.
Where does the small saphenous vein originate?
The popliteal vein!
What are vericose veins? How to treat?
Spider veins are a milder form. They are when valves of the vein become incompetent and the blood pools superficially.
Treatment: exercising calf muscle (it pumps the blood), contracting the calf muscles, wearing compression stockings/TED stockings
How do you still get blood to the knee while bypassing the femoral artery?
Through the lateral circumflex femoral - it goes into a system of genicular anastomosis - this also helps deliver blood when the knee has been bent for an extended period of time
What is a baker’s cyst and what causes it?
It is a swelling of fluid from the knee joint (synovial cavity). It can be caused by osteoarthritis & many other forms of arthritis.
-It results from chronic irritation and inflammation of the knee joint that increases fluid in the joint capsule
What is a popliteal aneurysm?
It usually occurs in older men, the popliteal artery is distended and it rarely has symptoms. It usually doesn’t rupture but if a blood clot happens it can cut off blood flow to the foot and cause amputation. You can put a sleeve on it to fix the rupture.
What are the compartments of the lower leg?
Lateral, anterior, posterior
What muscles Plantarflex the foot at the ankle?
Muscles of the posterior compartment
Where does the gastrocnemius originate?
Medial & lateral condyles of the femur
What is tennis leg?
Rupture of the medial head of the gastrocnemius. It usually occurs in poorly conditioned people over 40. It is caused by sudden, abrupt changes in direction to bring about a tear in the calf muscle.
Where does the Soleus originate & what is its function?
It does most of the plantarflexion. It originates on the soleal line of the tibia, fibula and interosseus membrane.
What is tendonitis?
Infalmmation of a tendon, most common is Achilles/Calcaneous. It occurs as a result of repetitive activities. Tendon rupture occurs in poorly conditioned people with tendonitis.
What nerve root does the tibial nerve come from?
S1 & S2 - it causes the achilles tendon reflex.
What is the function of the popliteus?
It rotates the femur on the fixed tibia about 5 deg to unlock it when knee is fully extended.
What is the order of the muscles in the deep compartment of the posterior leg?
Medial to lateral: Dick, tom, harry (down to hug)
Flexor digitorum longus, Posterior tibialis, Flexor hallicus longus
What is the function of the flexor digitorum longus?
It plantarflexes the ankle joint & flexes the lateral 4 toes
What is the function of the tibialis posterior?
It plantarflexes the foot & inverts the foot
What does the fibular artery supply?
The lateral compartment of the leg
Lambert-Eaton Syndrome:
Autoimmune disease, specific type of VG Ca+ channels are attacked –> thus patients have decrease in Ca2+ triggered NT release –> Shows as muscle weakness where if you repetitively stimulate, the weakness will go away - weakness improves with repeated contraction
Myasthenia gravis
-Autoimmune disease - antibodies against Nicotinic-ACh receptor –> causes rapid muscle fatigue
What do pesticides & tear gases cause?
SLUDGE
What activates AMPA and NMDA?
Glutamine
What is a nicotinic (ACh) receptor?
- 2 ACh molecules bind to active sites & cause the channel to open
- Non selective Cation channel
What is a GABA channel?
Releases GABA, Cl- ion & causes IPSP (Inhibitory post-synaptic potential)
How to treat pesticide?
Put in an anticholinesterase (neostigmine, pyridostigmin, edrophonium)
What is Melarsoprol and what is it used to treat?
“Arsenic in antifreeze” - used to treat African sleeping sickness that has crossed the blood-brain barrier buct 5-10% of people who take it get reactive encephalopathy & half die
What are the symptoms of Onchoceriasis?
(River blindness)
-Hyperpigmented skin, SEVERE itching, eye lesions, skin lesions, Keratitis (inflam. of cornea), blindness, opaque eyes, thin skin, nodules under the skin filled with parasites
What does Ivermectin do?
- Used for Onchoceriasis
- Orally administered
- Prevents blindness (but can’t reverse it), long term skin damage & transmission
What causes Babesiosis?
Ixodes scapularis -Endemic in rural US -Transferred by Deer Tick -Fever, chills, malaise, night sweats, loose of appetite, no rash Treatment: Atovaquone
What causes Leishmaniasis?
- Leishmanie (protozoan), Sand fly, Causes ulcerative skin lesions
- Can get visceral if you have HIV
- Liposomal Amphoteracin B is used to treat visceral version
Where do people usually get Tocoplasma gondii (Toxoplasmosis)?
CATS - 25% of US infected. It can also come from unwashed produce and uncooked meat.
- Usually asymtomatic or flu-like symptoms
- Can cause focal brain disorder or Ocular Toxoplasmosis
- “Headlight in fog” lesion with scars in one eye
When do we treat Toxoplasmosis?
In pregnant woman (so it doesn’t pass to baby) - Spiramycin
Immunocompromised - Sulfadiazine & Pyrimethamine
