32 - Gluteal Reegion + Posterior Thigh

Question 1

What are the 3 bony ridges on the posterior aspect of ilium ?

Answer 1

superior, middle, inferior gluteal lines

Question 2

What forms the greater and lesser sciatic foramen?

Answer 2

greater :
- greater sciatic notch
- sacrospinous ligament (inferiorly)

lesser:
- sacrospinous ligament (superiorly)
- lesser sciatic notch
- sacrotuberous ligament (inferiorly)

Question 3

Sacrospinoud ligament
- description
- attachment
- deep/superficial?

Answer 3

Ligament formed from attachment between sacrum and ischial spine (superior to ischial tuberosity)

deep to sacrotuberous ligament

between greater and lesser sciatic foramen

Question 4

Sacrotuberous ligament
- description
- attachment
- deep/superficial?

Answer 4

attachment between sacrum and ischial tuberosity

inferior to lesser sciatic foramen

superficial to sacrospinous ligament

Question 5

What attaches onto the ischial spineL

Answer 5

sacropinous ligament

Question 6

What attaches onto the ischial tuberosity?

Answer 6

sacrotuberous ligament
muscles of posterior thigh (origin) except for short head of biceps femoris (linea aspera)

Question 7

Gluteal tuberosity
- description
- location
- muscles

Answer 7

extension of the linea aspera superiorly and laterally

just inferior trochanters - posterior femur

gluteus maximus attaches here

Question 8

How many groups of gluteal muscles are there?
What are they?

Answer 8

2:
- superficial
- deep

Question 9

Superficial gluteal muscles
- number
- names
- innervation

Answer 9

4:
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fascia latae

all innervated by inferior gluteal, apart from gluteus maximus

Question 10

How many superficial gluteal muscles are there?

Answer 10

4

Question 11

Gluteals maximum
- location
- attachments
- movement of hip
- innervation

Answer 11

most superficial of gluteal muscles

origin - multiple sites on pelvis
- posterior aspect of posterior ilium
- sacrum
- sacrotuberous ligament

insert - some fibres onto gluteal tuberosity, some into iliotibial band

movements - extend, laterla rotation

N - inferior gluteal nerve

stabilises knee joint

Question 12

Where does gluteal muscle originate from?

Answer 12

• posterior aspect of posterior ilium
• saccrum
• sacrotuberous ligament

Question 13

Where does gluteal muscle insert onto?

Answer 13

• iliotibial band
• gluteal tuberosity

Question 14

Gluteus medius
- location
- attachment
- movement
- innervation

Answer 14

• deep to gluteus maximus
• origin - anterior aspect of posterior ilium
• insert - greater trochanter

M - medially rotates and abducts hip
N - superior gluteal nerve

Question 15

Gluteus minimus
- description
- location
- attachment
- movement of hip
- innervation

Answer 15

• deep to gluteus medius
• origin - anterior aspect of posterior ilium
• insert - greater trochanter

M - medially rotates and abducts hip
N - superior gluteal nerve

(same as gluteus medius)

Question 16

What role to gluteus medius and minimus play in normal gait?

Answer 16

contract when standing on one leg - ensures pelvis doesnt tilt towards contralateral leg
prevents limp

Question 17

How is gait affected if gluteus medius / minimus are weak / paralysed?

Answer 17

if muscles weakened on stnading leg, pelvis will tilt towards elevated leg (contralateral leg) when walking -> limp

Question 18

Tensor fascia latae
- description
- location
- attachments
- movement
- innervation

Answer 18

anterior + lateral to gluteus maximus
tenses the fascia lata

O - ASIS
I - iliotibial band

M - flexes hip, stabilises extended knee (not prime mover)
N - superior gluteal

Question 19

How are the superficial gluteal muscles innervated?

Answer 19

superior gluteal nerve
- gluteus medius / minimus
- TFL

inferior gluteal
- gluteus maximus

Question 20

Where do gluteal nerves originate from?

Answer 20

sacral plexus

Question 21

Who’s foramina do the gluteal nerves pass in the pelvis?

Answer 21

greater sciatic

Question 22

Iliotibial band
- description
- muscles
- insertion
- layers

Answer 22

located on lateral thigh

• stabilises knee
• fibres from gluteus maximus and TFL

I - lateral proximal tibia (Gerdy’s tubercle)

3 layers :
- superficial
- intermediate
- deep

Question 23

What does the linea aspera give rise to proximally and distally?

Answer 23

proximally
- pectineal line (medial)
- gluteal tuberosity (lateral)

distally
- medial supracondylar line
- lateral supracondylar line

Question 24

What does the gluteal line arise from?

Answer 24

linea aspera

Question 25

Deep gluteal muscles
- number
- names
- innervation
- origin
- inserts
- movements

Answer 25

5:
- piriformis
- gemellis superior
- obturator internus
- gemellis inferior
- quadratus femoris

O:
- all - ischium
- piriformis - anterior sacrum
- obturator internus - obturator membrane

I - onto / near greater tochanter

M - laterally rotate + stabilise hip

N -

Question 26

Where do the deep gluteal muscles originate from?

Answer 26

piriformis - anterior sacrum
obturator internus - obturator membrane

rest - ischium

Question 27

Where do the deep gluteal muscles insert onto?

Answer 27

onto / near greater trochanter

Question 28

Why is piriformis a key landmark?

Answer 28

passes though greater sciatic foramen
- sacral plaxus lies on its internal surface
- sciatic nerve emerges inferior to it
- gluteal arteries originate superior / inferior to it

Question 29

Which deep gluteal muscles pass through the greater and lesser sciatic foramen?.

Answer 29

greater - piriformis
lesser - tendon of obturator internus

Question 30

Piriformis
- attachments
- pathway

Answer 30

O - anterior sacrum
I - greater trochanter
passes through greater sciatic foramen

Question 31

Which nerve emerges from the inferior border of piriformis?

Answer 31

sciatic nerve

Question 32

What does the sciatic nerve divide into?

Answer 32

tibial (medial)
common peroneal (lateral)

Question 33

Posterior compartment of thigh
- number
- names

Answer 33

4:
- semimembranosus
- semitendonosus
- biceps femoris (short and long head)
- adductor magnus (hamstring part)

Question 34

Which muscles make up the hamstring group? Which joints do they span?
- attachment
- innervation
- movement of hip, knee

Answer 34

• semimebranosus
• semitendonosus
• biceps femoris (long)

span hip and knee
O - ischial tuberosity
I - medial tibia (long head onto fibula head)

N - tibial nerve
M:
- flex knee
- extend hip

Question 35

Biceps femoris (long head)
- attachments
- innervation
- movements

Answer 35

O - ischial tuberosity
I - fibula head

N - tibial nerve
M - extend hip, flex knee

Question 36

Biceps femoris (short head)
- description
- attachments
- innervation
- movements

Answer 36

O - linea aspera
I - fibula head (forms common tendon with long head)

N - common peroneal
M - flex knee

Question 37

Which muscles of the hamstring group insert onto medial tibia?

Answer 37

semimembranosus
semitendonosus

Question 38

Which muscles of hamstring groups insert onto head of fibula?

Answer 38

biceps femoris (long)

Question 39

Adductor Magnus (hamstring)
- attachments
- innervation
- movement
- thigh compartment

Answer 39

O - ischial tuberosity
I - adducotr tuberosity (femur)

N - tibial
M - extension of hip
C - posterior thigh

Question 40

Adductor Magnus (adductor)
- attachments
- innervation
- movement
- thigh compartment

Answer 40

O - inferior pubic ramus
I - linea aspera

N - obturator
M - adduction of hip
C - medial

Question 41

Which artery supplies gluteal muscles?
Branch of?

Answer 41

superior and inferior gluteal
internal iliac

Question 42

Which artery supplies posterior thigh?
Branch of?

Answer 42

perofrating branches of profunda femoris
femoral artery

Question 43

How do perforating arteries of profunda femoris reach posterior compartment?

Answer 43

penetrate through gaps in adductor magnus (adducotr part)

Question 44

Which artery supplies lower posterior thigh?

Answer 44

popliteal artery

Question 45

Sciatic nerve roots?

Answer 45

L4 - S3

Question 46

Sciatic nerve
- roots
- pathways

Answer 46

L4 - S3
branches off sacral plexus
passes thorugh greter sciatic foramen along inferior border of piriformis

Question 47

What does tibial nerve innervate?

Answer 47

posterior thigh (apart from short head of biceps femoris)
posteiror leg

Question 48

What does common peroneal need innervate?

Answer 48

anterior + lateral leg

Question 49

Popliteal fossa
- description
- boundaries
- contents

Answer 49

diamond shaped fossa on posterior aspect of knee

Superior
- medial - semimebranosus + semitendonosus
- lateral - biceps femoris

Inferior
- gastrocnemius heads

Contains:
- popliteal artery
- popliteal vein
- tibial nerve
- common peroneal nerve

Question 50

Where and how can the popliteal artery be palpated?

Answer 50

in the popliteal fossa
easiest when the knee is completely flexed

Question 51

Branching from eternal iliac artery to fibular artery

Answer 51

external iliac -> femoral -> popliteal artery -> posterior tibial -> fibular artery

Question 52

how does the popliteal artery divide?

Answer 52

popliteal artery -> anterior + posterior tibial
posterior tibial -> fibular / peroneal artery

Question 53

common peroneal nerve
- pathway
- brnaches
- innervation

Question 54

gluteal IM injection
- muscle
- where
- why?

Question 55

sciatica
- description
- common cause

Question 56

popliteal anuerysm
- what happens
- consequences