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Semester 2 Year 1 > Gluteal Region and Thigh > Flashcards

Gluteal Region and Thigh Flashcards

1
Q

What are the four main neuromuscular bundles that pass through the thigh?

A

Sciatic Nerve and Gluteal Neurovascular Bundle

Internal Pudendal Neurovascular Bundle

Obturator Neurovascular Bundle

Femoral Neurovascular Bundle

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2
Q

Describe the gluteal region (buttock)

A

 Bounded superiorly by the iliac crest and inferiorly by the fold of the buttock.

 Largely made up of the gluteal muscles and a thick layer of superficial fascia.
• Extensors of the hip joint (gluteus maximus)
• Abductors of the hip joint (gluteus medius and minimus)
• Rotators of the hip joint

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3
Q

What are the gluteal muscles?

A

 Gluteus maximus, medius and minimus

 External rotators of the thigh

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4
Q

Describe the gluteus maximus

A

 Gluteus maximus is the prime extensor of the hip
− while standing up from sitting position and climbing stairs
− Externally rotates, abducts (can it also adduct?) the femur
− Deep fibres insert on gluteal tuberosity; Superficial fibres insert on iliotibial tract
− Extends and locks the knee via iliotibial tract

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5
Q

Describe the gluteus medius and minimus

A

 Gluteus medius lying deep to gluteus maximus, and gluteus minimus lying deep to gluteus medius are the abductors of the thigh
 Tensor fascia latae and Gluteus maximus, which attach to the iliotibial tract, also aids gluteus medius and minimus in hip abduction

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6
Q

Describe the abductors of the thigh

A

 Muscles that pass from the pelvis to the femur, lying lateral to the sagittal axis of the hip joint will abduct it
 Abductors, with contralateral adductors keep the pelvis level when walking or standing on one leg

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7
Q

What are the lateral rotators of the thigh?

A

The piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris and obturator externus

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8
Q

Describe the lateral rotators of the thigh?

A

 A group of muscles that pass from the pelvis to the femur, lying close to and posterior to the hip joint
 They stabilise the joint and laterally rotate the femur to keep the foot pointing forwards during walking
 Piriformis is supplied by S1-S2; Superior gemellus and obturator internus by obturator internus nerve; inferior gemellus and quadratus femoris by nerve to quadratus femoris;

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9
Q

What is the origin and insertion of the gluteus maximus?

A

Origin
Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; and sacrotuberous ligament

Insertion
Iliotibial tract and gluteal tuberosity

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10
Q

What is the origin and insertion of the gluteus medius?

A

Origin
External surface of ilium between anterior and posterior gluteal lines

Insertion
Greater trochanter of femur

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11
Q

What is the origin and insertion of the gluteus minimus?

A

Origin
External surface of ilium between anterior and inferior gluteal lines

Insertion
Greater trochanter of femur

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12
Q

What is the origin and insertion of the tensor fascia latae?

A

Origin
Anterior superior iliac spine; anterior part of iliac crest

Insertion
Lateral condyle of tibia via Iliotibial tract

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13
Q

What are the inevitable rules and exceptions of the gluteal muscles?

A

 All gluteal muscles are supplied by the superior gluteal nerve except gluteus maximus (inferior gluteal nerve)
 All abductors of one side keep pelvis level when limb of the same side is weight bearing

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14
Q

What is the course of the sciatic nerve within the gluteal region?

A

Sciatic nerve emerges into the gluteal region inferior to piriformis

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15
Q

Where would one perform a intragluteal injection?

A

 Midway between ischial tuberosity and greater trochanter

 Safe area for intramuscular injections is the upper, outer quadrant

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16
Q

What are the flexors of the thigh?

A

Iliacus and Psoas major

Sartorius and Rectus femoris

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17
Q

Describe the flexors of the thigh

A

Muscles that pass from the pelvis to the femur, anterior to the transverse axis of the hip joint will flex the thigh

Sartorius and Rectus femoris flex the hip but they act on the knee joint as well

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18
Q

Where do iliacus and psoas major pass?

A

 Iliacus and psoas major pass through the retro-inguinal space into the femoral region

  • The fascia of psoas divide the space into muscular and vascular compartments
  • Iliopsoas and femoral nerve pass through the muscular compartment
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19
Q

What is the origin and insertion of the iliacus?

A

Origin
Iliac fossa

Insertion
Lesser trochanter of femur

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20
Q

What is the origin and insertion of psoas major?

A

Origin
Posterior abdominal wall (lumbar transverse processes, intervertebral discs, and adjacent bodies from T12 to L5 and tendinous arches between these points)

Insertion
Lesser trochanter of femur

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21
Q

What is the origin and insertion of rectus femoris?

A

Origin
Straight head: AIIS
Reflected head: ilium just superior to the acetabulum

Insertion
Base of patella via common Quadriceps femoris tendon

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22
Q

What is the origin and insertion of sartorius?

A

Origin
Anterior superior iliac spine (ASIS)

Insertion
Medial surface of medial tibial condyle (pes anserinus)

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23
Q

What is the origin and insertion of pectineus?

A

Origin
Superior ramus of pubis

Insertion
Pectineal line of femur

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24
Q

What is the origin and insertion of the tensor fascia latae?

A

Idk go look it up

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25
Q

What are the anatomical rules and exceptions of the flexors of the thigh?

A

All supplied by the femoral nerve except psoas major (L1-L3) and tensor fascia lata (superior gluteal)

26
Q

What are the compartments of the thigh?

A

Anterior compartment
Posterior compartment
Medial compartment

27
Q

How are the compartments of the thigh divided by function?

A

These are medial (adductor), anterior (extensor), and posterior (flexor) compartments

28
Q

What separates the compartments of the thigh?

A

Muscles in the thigh are separated into three compartments by layers of fascia

29
Q

Discuss the posterior compartment of the thigh

A

 Muscles that pass from the pelvis to the lower limb, posterior to the transverse axis of the hip joint will extend the thigh

 Hamstring muscles extend between the ischial tuberosity and the leg
- They span 2 joints

 Biceps femoris, semitendinosus and semimembranosus

  • They extend the hip but also flex the leg
  • They extend the body if the thigh is fixed
30
Q

What are the hamstrings

A

Biceps femoris (long and short head)

Semitendinosus

Semimembranosus

31
Q

What is the origin and insertion of the biceps femoris?

A

Origin
Ischial tuberosity and lateral lip of linea aspera

Insertion
Head of fibula

32
Q

What is the origin and insertion of semitendinosus?

A

Origin
Ischial tuberosity

Insertion
Medial surface of medial tibial condyle (pes anserinus)

33
Q

What is the origin and insertion of semimembranosus?

A

Origin
Ischial tuberosity

Insertion
Medial condyle of tibia; reflected attachment forms oblique popliteal ligament

34
Q

What are the anatomical rules and exceptions of the extensors of the thigh?

A

 All hamstrings are supplied by the sciatic nerve (All hamstrings except the short head of the biceps femoris are supplied by the tibial nerve component)
 All hamstrings except the short head of the biceps femoris originate from the ischial tuberosity
 All hamstrings except the short head of the biceps femoris cross, therefore, act on both the hip and knee joints

35
Q

What muscles are found in the medial compartment of the thigh?

A

Adductor magnus

Adductor longus

Adductor brevis

Gracilis

36
Q

Where does the sciatic nerve lie in the medial compartment of the thigh?

A

The sciatic nerve descends between the adductor magnus and biceps femoris

37
Q

What is the origin and insertion of adductor longus?

A

Origin
Body of pubis inferior to pubic crest

Insertion
Middle third of linea aspera of femur

38
Q

What is the origin and insertion of adductor brevis?

A

Origin
Body and inferior ramus of pubis

Insertion
Proximal part of linea aspera of femur

39
Q

What is the origin and insertion of adductor magnus?

A

Origin
Adductor part: ischiopubic ramus Hamstring part: ischial tuberosity

Insertion
Linea aspera, medial supracondylar line, adductor tubercle of femur

40
Q

What is the origin and insertion of gracilis?

A

Origin
Body and inferior ramus of pubis

Insertion
Medial surface of medial tibial condyle (pes anserinus)

41
Q

What is the origin and insertion of obturator externus?

A

Origin
Margins of obturator foramen and external surface of obturator membrane

Insertion
Trochanteric fossa of femur

42
Q

What are the anatomical rules and exception of the adductors of the thigh?

A

 All originate from pubis or ischiopubic ramus except hamstring part of adductor magnus

 All attach to the femur except gracilis (medial condyle of tibia)

 All supplied by the obturator nerve except Pectineus (femoral nerve) and adductor magnus (both tibial and obturator nerves)

43
Q

Describe the anterior compartment of the thigh

A

 Muscles in this compartment either flex the hip or extend the knee joint
• Quadriceps femoris
• Sartorius (flexes NOT extends the knee) • Iliopsoas
• Pectineus
 Supplied by the femoral nerve except iliopsoas

44
Q

What are the muscles of the anterior compartment of the thigh?

A
  • Quadriceps femoris
  • Sartorius (flexes NOT extends the knee)
  • Iliopsoas
  • Pectineus
45
Q

Describe the extensors of the knee

A

Quadriceps femoris is the main extensor of the knee joint
• Rectus femoris (acts on both hip and knee joints)
• Rectus intermedius
• Vastus medialis
• Vastus lateralis

− Knee joint stability is hugely dependent upon quadriceps

46
Q

What are the extensors of the knee?

A

Quadriceps femoris is main extensor of the knee joint
• Rectus femoris (acts on both hip and knee joints)
• Rectus intermedius
• Vastus medialis
• Vastus lateralis

47
Q

What is the origin and insertion of quadriceps femoris?

A

Origin
Rectus femoris: Anterior inferior iliac spine and ilium superior to acetabulum
Vastus lateralis: Greater trochanter and lateral lip of linea aspera
Vastus medialis: Intertrochanteric line and medial lip of linea aspera
Vastus intermedius: Anterior and lateral surfaces of shaft of femur

Insertion
Base of patella
Tibial tuberosity via patellar ligament Patella and tibia via Medial and lateral patellar retinacula

48
Q

What are the anatomical rules and exceptions of the extensors of the knee?

A

Quadriceps femoris is supplied by the femoral nerve

49
Q

What is the pes anserinus?

A

 Common attachment of sartorius, gracilis and semitendinosus on tibia
 Attaches posterior to the transverse axis of rotation of the knee
− Flex the knee
 Adds significant dynamic stability to the medial side of the knee

50
Q

What is the knee reflex?

A

 Deep tendon reflex
 Elicited by tapping the patellar ligament [patellar tendon, quadriceps tendon]
 Tests the Femoral Nerve
 Spinal Segments L3 and L4

51
Q

What results may one get from the knee reflex?

A
  • Absent
  • Trace (Diminished)
  • Normal
  • Brisk
  • Hyperactive
  • ? Clonus
52
Q

Describe the femoral triangle

A

Bounded by the inguinal ligament (base), the sartorius muscle laterally, and the adductor longus muscle medially.
Iliopsoas Pectineus

Floor: pectineus (medially) and the iliopsoas (laterally).

Roof: fascia lata, subcutaneous tissue and skin.
− The femoral sheath encloses the femoral artery and vein BUT NOT the nerve.

Contains femoral vessels and branches of the femoral nerve, opening of the great saphenous vein and deep inguinal lymph nodes

53
Q

What is the clinical significance of the femoral triangle in cases of physical trauma?

A

Artery at risk in groin lacerations

54
Q

Describe the femoral canal

A

 Is a short and conical space between the medial wall of the femoral sheath and the femoral vein
− Femoral sheath is the continuation of the abdominal transversalis fascia
Deep inguinal lymph node
Contains deep inguinal lymph node.
Allows the femoral vein to expand
 The base of the canal (opening) is the femoral ring
Femoral ring is a weak areafemoral hernia

55
Q

What key structures of the femoral canal should you go over?

A

Deep inguinal lymph node (Cloquet node)

Pectineal ligament

Lacunar ligament

Saphenous opening

56
Q

What is the femoral ring?

A

Is the opening of the femoral canal at the abdominal side

57
Q

What forms the boundaries of the femoral ring?

A
  • Anteriorly by the medial part of the inguinal ligament
  • Medially by the lacunar ligament
  • Laterally by the septum between the femoral canal and vein
  • Posteriorly by Pectineus muscle and fascia (superior ramus of the pubis)
58
Q

What is the femoral ring a common site for?

A

Femoral hernias

59
Q

Describe femoral hernias

A

 In femoral hernia, there is a protrusion of abdominal viscera through the
femoral ring and into the femoral canal.
 If left untreated, the abdominal viscera (commonly parts of the small
intestine) can undergo necrosis, especially as a result of strangulation of the tissue due to the surrounding femoral ring and lacunar ligament boundary

60
Q

What are some other names for the adductor canal?

A

Hunter’s or Subsartorial canal

61
Q

Describe the adductor canal

A

 Starts at the inferior corner of the
femoral triangle
 Ends at adductor hiatus
– On adductor magnus
 Femoral vessels and saphenus nerve* enter
– Saphenus nerve pierces anteromedial wall and becomes superficial
– Femoral vessels exit through adductor hiatus

62
Q

What forms the boundaries of the adductor canal?

A 
– vastus medialis
(anterolaterally)
– adductor longus and
adductor magnus (posteriorly)
– sartorius (anteromedially)

Semester 2 Year 1 (82 decks)

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