Week 4 - Ach Flashcards
What dermatomes correspond with the lower limb buds?
L2-S2
What are the three ligaments of the pelvis that resist the outward thrust of the sacrum?
- Posterior sacroiliac ligament
- Sacrospinous ligament
- Sacrotuberous ligament
The sacrospinous ligament converts what notches into what foramina?
Greater sciatic notch –> Greater Sciatic Foramen
Lesser Sciatic Notch –> Lesser Sciatic Foramen
What is the Ishioanal fossa?
Where is it located?
Triangle formed from connecting lines of the Left ischial tuberosity, Right ischial tuberosity, and Coccyx.
Surrounds the anus (near Pudendal vessals/nerves).
Where does the Gluteus Maximus orginate? Terminate?
Originates: posterior Ilium/dorsal surface of sacrum and coccyx
Terminates: Iliotibial tract (IT band)
Where are most gluteal IM injections given?
Superolateral Quadrant
- above gluteus maximus
- into Gluteal Aponeurosis/gluteous medius
What nerve innervates the Gluteous Maximus?
Inferior gluteal nerve
What happens with damage/lesion of inferior gluteal nerve (L5-S2)?
Paralysis of Gluteus Maximus
“Gluteal Gait” or “Gluteal Lurch”
-compensate with hyperextension of the trunk
Where are two potential irriations with Iliotibial Band Syndrome?
Greater Trochanter of humerus
OR
Lateral condyle of the knee
What are the two bursae of the Gluteal Region?
What is their function?
- Trochanteric Bursa
- Ischial Bursa
- Helps spread out the weight of your body when sitting.
What happens in trochanteric bursitis?
- inflammation of the trochanteric bursa
- friction bursitis
- results from repetitive movements of the superior tendinous fibers of the gluteus maximus back and forth over the bursae
- point tenderness over greater trochanter, radiation of pain along IT band
What happens in Ischial Bursitis?
- “Weaver’s bottom”
- repetitive hip extension while sitting
- localized pain over the bursa, worse with movement of gluteus maximus
What happens with damage/injury to the Superior Gluteal Nerve?
- “Gluteus Medius Limp” or “Trendelenberg gait”
- Causes hip to fall to contralateral side when walking
- Positive Trendelenburg’s sign
In a patient with left-sided gluteus medius paralysis, which side would dip when standing on the left leg?
Right pelvis dips
What five muscles are the lateral hip rotators?
- Piriformis
- Superior Gemellus
- Obturator Internus
- Inferior Gemellus
- Quadratus Femoris
What causes sciatica?
Herniated L4 disc that compresses and compromises the L5 or S1 component of the sciatic nerve.
OR
Spasm of the Piriformis muscle.
What can a posterior dislocation of the hip joint injury?
Sciatic Nerve
What does the Pudendal nerve supply?
Structures in the perineum.
What structures does the Posterior Femoral Cutaneous Nerve supply?
Skin of lower buttock
and
skin of posterior compartment of the thigh.
What landmark do you feel for when performing a Pudendal nerve block?
Ischial Spine
(S2-S4 dermatomes)
What nerve enters the Lesser Sciatic Foramen to go to the perineum?
Pudendal Nerve
What nerves leave the pelvis through the Greater Sciatic Foramen?
Sacral Plexus (L4-S4)
(includes Sciatic nerve, Superior/Inferior Gluteal Nerve, Posterior Cutaneous Nerve, and Pudendal Nerve)
What is the only nerve of the gluteal region that emerges superior to the Piriformis?
Superior Gluteal Nerve
What blood vessel supplies the muscles of the gluteal region?
Branches of the Internal Iliac Artery
What dermatomes are associated with the posterior thigh?
L5-S4
L5: lateral thigh and dorsum of foot
S3/S4: Anal region
What two nerves supply the Poterior compartment of the thigh?
Tibal Nerve & Fibular Nerve
What is the only muscle of the posterior compartment of the thigh supplied by the Fibular nerve?
Short head of the Biceps Femoris
(Common Fibular Portion of the Sciatic Nerve)
What muscles is more medial: Semitendonous or Semimembranous?
Semimembranous
What blood vessel supplies the posterior thigh?
perforating branches of the
Deep Femoral Artery and Vein
What is a “hip pointer”?
- Medical term: avulsion fracture
- Contusion of the iliac crest (anterior part)
- common in collision sports
What is a “charley horse”?
- Cramping of an individual thigh muscle because of tearing of muscle fibers or contusion and rupture of blood vessels
- form hematoma
- localized pain and/or muscle stiffness
What are common hamstring injuries?
- Hamstring strain:
- avulsion/tear of part of the proximal tendinous attachments of the hamstrings to the ischial tuberosity
- Hamstring Tear:
- complete avusion/tear of hamstring tendon at ischial tuberosity
- due to forcible flexion/not warming up before exercise
- fall to the ground writhing in pain
What are the boundaries of the popliteal fossa?
Biceps femoris (laterally), Semitendinosus/membranosus (medially), both heads of Gastrocnemius (inferiorly)
What are the 5 principal contents of the popliteal fossa?
Popliteal Artery/Vein, Small saphenous vein, Tibial Nerve, & Common fibular nerve
When does the Femoral Artery become the Popliteal Artery?
after it passes through the Adductor Hiatus muscle
What does the Sural nerve innervate?
posterior cutaneous layer of leg/heel
What are the compartments of the leg?
- Anterior
- Lateral
- Posterior
- Superficial
- Deep
What are the five septa/fascia/membranes that separate the leg into compartments?
- Deep crural fascia
- surrounds musculature
- continuous with fasciae latae
- Anterior intermuscular septum
- separates anterior from lateral compartments
- Posterior intermuscular septum
- separates lateral from posterior compartments
- Interosseous membrane
- separates anterior from posterior compartments
- Transverse intermuscular septum
- separates superficial from deep posterior compartments
What muscles are located in the superficial posterior compartment?
- Gastrocnemius
- Soleus
- Plantaris
***All innervated by the Tibial Nerve!
What muscles are located in the deep posterior compartment?
- Popliteus
- Flexor digitorum longus
- Tibialis posterior
- Flexor hallucis longus
***All innervated by the Tibial nerve!
What is the most severe acute muscular problem of the leg?
Ruptured calcaneal tendon
Who usually sustains a rupture of the calcaneal tendon?
Poorly conditioned people with a history of calcaneal tendinitis.
What causes varicose veins?
Veins become dilated, so that the cusps of their valves do not close.
Valves become incompetent due to dilation or rotation and no longer function properly.
How do you manage varicose veins?
Compression socks & exercise
What forms a Baker’s cyst?
Increased synovial fluid in the knee joint pushes out posteriorly into the popliteal fossa.
Pain due to a Popliteal Aneurysm is felt where?
- Pain in the popliteal fossa
- Referred pain to the skin overlying the medial aspect of the calf, ankle, or foot
- due to compression of the tibial nerve
What area of the gastrocnemius muscle is commonly injured?
Strain/Rupture of the Medial head
- partial tearing at or near its musculotendinous junction
- usually patients >40 years old
a. k.a. Tennis leg
What muscle in the posterior leg is often harvested for tendon?
Plantaris
(“freshman nerve”)
What nerve/nerve roots does the Calcaneal Tendon Reflex (ankle jerk) test?
S1 & S2 nerve roots
Tibial nerve
