ANA 211 Lower Limb Osteology and Gluteal Region

Question 1

What are the types of bones

Answer 1

Flat
Long
Irregular
Short
Sesamoid

Question 2

Function of flat bones and examples

Answer 2

1. They shield and protect organs
2. They can provide large areas of attachment for muscles

Eg. Scapula, sternum, ribs, cranial bones

Question 3

Function and examples of long bones

Answer 3

1.Supports weight
2. Facilitates movements

Eg. Humerus, femur, tibia, fibula, ulna, radius, metacarpal, metatarsal and phalanges

Question 4

Function of lower limb bones?

Answer 4

Locomotion
Carry the weight of the entire erect body
Support
Points for muscular attachments

Question 5

Components of the lower limb bones

Answer 5

1.Hip (Pectoral girdle)
Ilium
Ischium
Pubis
Acetabulum

2.Thigh
Femur

3.Knee
Patella
Leg
Tibia (medial)
Fibula (lateral)

4.Foot
Tarsals (7)
Metatarsals (5)
Phalanges (14)

Question 6

What are the bones of the hip?

Answer 6

Ilium
Ischium
Pubis
Acetabulum

Question 7

How many phalanges, metatarsals and tarsals do we have?

Answer 7

phalanges, (14)
metatarsals (5)
tarsals (7)

Question 8

What is the epiphyseal plate?

Answer 8

Line of hyaline cartilage between epiphysis and diaphysis where the developing bone lengthens
Responsible for:
The proliferation of the cartilage cells responsible for the length of the developing bone
It disappears when growth in bone length stops

Question 9

Where is the red bone marrow located in a long bone?

Answer 9

The epiphysis

Question 10

The medullary/marrow cavity is filled with _

Answer 10

Yellow bone marrow

Question 11

Yellow bone marrow makes white blood cells TRUE/FALSE

Answer 11

FALSE the yellow bone marrow stores fats and nutrients for the bone

Question 12

Where are red and white blood cells produced?

Answer 12

Both are produced in the red bone marrow

Question 13

What age does yellow bone marrow develop in humans?

Answer 13

7/8 years

Question 14

Which bone-type functions in strengthening the bone?

Answer 14

Compact bone (dense and closely packed cell material)

Question 15

What are the types of bone structures in a long bone?

Answer 15

Spongy bone
Compact bone

Question 16

What is the function of the spongy bone?

Answer 16

To house the red bone marrow
to make the bones light, for ease of movement

Question 17

Purpose of the arteries in the bone?

Answer 17

To deliver nutrients and transport new blood cells throughout the body

Question 18

Function of the periosteum

Answer 18

Consists of a layer of osteoblasts for bone material to grow and heal if broken

Question 19

What is the metaphysis?

Answer 19

Part of the diaphysis adjacent to the epiphyseal plate

The most active site of bone formation in the developing bone

Highly vascularized

Question 20

List and explain the types of epiphysis

Answer 20

1. Pressure Epiphysis
   Found at the ends of long bones
   Articular in nature
   Takes part in the transmission of weight
2. Traction Epiphysis
   Produced due to the pull of the muscle and therefore provides attachment to the muscle(s)
   Non-articular in nature
   Does not take part in the transmission of weight
3. Atavistic Epiphysis
   An independent bone in lower animals, but part of another bone in humans
4. Aberrant Epiphysis
   Not present in everybody

Question 21

Examples of the different types of epiphyses

Answer 21

Pressure e.g. head of femur, humerus, the lower end of the radius
Traction e.g. greater and lesser tubercles of the humerus, greater and lesser trochanters of the femur, and the mastoid process of the temporal bone.
Atavistic e.g. Coracoid process of scapula, posterior tubercle of talus
Aberrant: e.g. epiphysis at the head of first metacarpal and base of other metacarpals

Question 22

Flat bones such as the cranial bones and clavicle are developed by which form of ossification?

Answer 22

Intramembranous ossification

Question 23

Long bones such as the humerus and femur are developed by which form of ossification?

Answer 23

Endochondral ossification

Question 24

Types of joint functions

Answer 24

1. Synarthrosis: no movement
2. Amphiarthrosis: little movement
3. Diarthrosis: full movement

Question 25

Examples of synarthrosis joints

Answer 25

Skull sutures Articulations of bony sockets Teeth in facial skeleton bone

Question 26

Example of amphiarthrosis joints

Answer 26

Distal joint between the tibia and the fibula Pubic symphysis

Question 27

Example of diarthrosis joints

Answer 27

Elbow, shoulder, ankle

Question 28

Types of joints according to structure

Answer 28

Fibrous joint Cartilaginous joint Synovial joint

Question 29

Why are most fibrous joints immovable

Answer 29

They have no joint cavity and are connected via fibrous connective tissues (synarthroses)

Question 30

Types of fibrous joints

Answer 30

1.SUTURES are nonmoving joints that connect bones of the skull. These joints have serrated edges that lock together with fibers of connective tissue. 2.The fibrous articulations between the teeth and the mandible or maxilla are called GOMPHOSES and are also immovable. 3.A SYNDESMOSIS is a joint in which a ligament connects two bones, allowing for a little movement (amphiarthroses). The distal joint between the tibia and fibula is an example of a syndesmosis.

Question 31

Types of cartilaginous joints

Answer 31

(1) A SYNCHRONDOSIS is an immovable cartilaginous joint. One example is the joint between the first pair of ribs and the sternum. (2) A SYMPHYSIS consists of a compressible fibrocartilaginous pad that connects two bones. This type of joint allows for some movement. The hip bones, connected by the pubic symphysis, and the vertebrae, connected by intervertebral discs, are two examples of symphyses.

Question 32

Types of synovial joints

Answer 32

(1) Gliding joints move against each other on a single plane. E.gs. intervertebral joints and the bones of the wrists and ankles. (2) Hinge joints move on just one axis. These joints allow for flexion and extension. E.gs. the elbow and finger joints. (3) A pivot joint provides rotation. At the top of the spine, the atlas and axis form a pivot joint that allows for rotation of the head. (4) A condyloid joint allows for circular motion, flexion, and extension. The wrist joint between the radius and the carpal bones is an example of a condyloid joint. (5) A saddle joint allows for flexion, extension, and other movements, but no rotation. In the hand, the thumb’s saddle joint (between the first metacarpal and the trapezium) lets the thumb cross over the palm, making it opposable. (6) The ball-and-socket joint is a freely moving joint that can rotate on any axis. The hip and shoulder joints are examples of ball and socket joints.

Question 33

What is an ossification center and what are the types of ossification?

Answer 33

A point where ossification starts 1.Primary 2. Secondary

Question 34

Which joint in the thumb allows for opposition?

Answer 34

condyloid joint

Question 35

Synchrondoses is a _ cartilaginous joint

Answer 35

Primary

Question 36

What is the fibrous joint found in the skull?

Answer 36

suture

Question 37

What is the fibrous joint found between the ulna and radius?

Answer 37

syndesmosis

Question 38

What are the fibrous articulations between the teeth and the mandible or maxilla?

Answer 38

gomphosis

Question 39

What kind of joint can be found between the epiphysis and diaphysis of long bones?

Answer 39

a cartilaginous joint

Question 40

Name the secondary cartilaginous joint

Answer 40

Symphysis

Question 41

What is the joint between the first pair of ribs and the sternum?

Answer 41

synchondrosis

Question 42

What cartilaginous joint is located at the pubis symphyses?

Answer 42

Symphysis/ symphyses

Question 43

Syndesmosis possesses which type of joint mobility?

Answer 43

Amphiarthrosis

Question 44

Gomphosis and Synchondrosis possess which type of joint mobility?

Answer 44

Synarthrosis

Question 45

The gluteal region is between

Answer 45

The iliac crest and gluteal fold

Question 46

What is the line dividing the buttock

Answer 46

nata (intergluteal) cleft

Question 47

What is the clinical relevance of the superficial fascia?

Answer 47

intramuscular drug delivery

Question 48

Functions of the Superficial Fascia

Answer 48

Gives the characteristic convexity to the buttock Forms a thick cushion over the ischial tuberosity

Question 49

What are the muscles of the lower limb?

Answer 49

Gluteus maximus Gluteus medius gluteus minimus tensor fascia lata piriformis superior gemellus Inferior gemellus obturator internus quadratus femoris

Question 50

What is the largest muscle in the body?

Answer 50

Gluteus Maximus

Question 51

Where are the points of origin of the Gluteus Maximus?

Answer 51

Posterior surface of the sacrum and coccyx Lumbar fascia Outer Ilium posterior to the gluteal line Sacrotuberous ligament

Question 52

What is the point of insertion for the Gluetus Maximus?

Answer 52

Most of the muscle (3/4th) inserted into the iliotibial tract Deeper fibers inserted into the gluteal tuberosity

Question 53

What is the nerve supply of the Gluteus Maximus?

Answer 53

Inferior gluteal nerve (L5, S1 & 2)

Question 54

What are the actions of the gluteus Maximus?

Answer 54

Extends and laterally rotates hip joint extends the knee joint through iliotibial tract Gives simultaneous stability to the hip and knee joints through the iliotibial tract

Question 55

What is the chief anti gravity muscle of the hip?

Answer 55

Gluteus Maximus

Question 56

What makes up the inferior gluteal nerve?

Answer 56

L5, S1 and 2

Question 57

What makes up the superior gluteal nerve?

Answer 57

L4, 5 and S1

Question 58

What can be the result of damage to the superior gluteal nerve?

Answer 58

Damage to the superior gluteal nerve results in paralysis of the gluteus medius muscle resulting in a characteristic gait on walking and standing known as the Trendelenburg

Question 59

What is the origin of the gluteus medius?

Answer 59

Outer surface of the ilium between the anterior and posterior gluteal lines

Question 60

Which gluteal muscle, extends from the pelvis to the gluteal tuberosity of femur?

Answer 60

Gluteus maximus

Question 61

What is the blood supply of the gluteus maximus?

Answer 61

Inferior gluteal and superior gluteal arteries

Question 62

Which gluteal muscle extends from the ilium to the proximal femur?

Answer 62

Gluteus medius

Question 63

What is the insertion of the gluteus medius?

Answer 63

Lateral surface of the greater trochanter of the femur

Question 64

Action of gluteus medius?

Answer 64

Hip joint: Thigh abduction, thigh medial rotation Stabilizing the pelvis whilst walking Connects pelvis to femur by crossing over the acetabulofemoral joint (aka hip joint)

Question 65

What is the blood supply of the gluteus medius?

Answer 65

Deep branch of superior gluteal artery, trochanteric anastomosis

Question 66

What is the innervation of the gluteus medius?

Answer 66

Superior gluteal nerve L4,L5 and S1

Question 67

Which gluteal muscle spans from the gluteal surface of the ilium to the proximal end of the femur

Answer 67

Gluteus minimus

Question 68

What is the origin of the gluteus minimus?

Answer 68

Outer surface of ilium between the anterior and interior gluteal lines

Question 69

What is the insertion of the gluteus minimus?

Answer 69

Anterior aspect of greater trochanter of femur

Question 70

What is the innervation of the gluteus minimus?

Answer 70

Superior gluteal nerve: L4,L5 and S1

Question 71

What is the action of the gluteus minimus?

Answer 71

Thigh abduction, thigh medial rotation Stabilizing the pelvis whilst walking

Question 72

The hip joint is also known as the

Answer 72

acetabulofemoral joint

Question 73

What is the origin of the Tensor Fascia Lata?

Answer 73

Outer edge of iliac crest between anterior superior iliac spine & iliac tubercle

Question 74

What is the insertion of the Tensor Fascia lata?

Answer 74

The iliotibial tract

Question 75

Nerve supply of tensor fascia lata?

Answer 75

Superior gluteal nerve (L4,5, S1)

Question 76

Action of tensor fascia lata?

Answer 76

Maintains the knee in extended position

Question 77

One of the important landmarks in the gluteal region is _

Answer 77

Piriformis

Question 78

Origin of the piriformis

Answer 78

Anterior surface of S2,3,4 vertebrae of the sacrum

Question 79

Insertion of piriformis

Answer 79

Upper border of greater trochanter

Question 80

Nerve supply of piriformis

Answer 80

Anterior rami of S1,2

Question 81

Action of piriformis

Answer 81

Lateral rotator of thigh Assists in stabilizing hip joint especially in abduction

Question 82

What is the landmark between the gluteus maximus and tensor fascia lata?

Answer 82

Iliotibial tract

Question 83

Origin of the obturator internus

Answer 83

Inner surface of obturator membrane and adjacent bone

Question 84

Insertion of the obturator internus

Answer 84

Upper border of greater trochanter along with gemelli

Question 85

Nerve supply to obturator internus

Answer 85

Nerve to obturator internus (L4,S1)

Question 86

Action of obturator internus

Answer 86

Lateral rotator of thigh

Question 87

Origin of superior and inferior Gemelli

Answer 87

Superior from ischial spine Inferior from ischial tuberosity

Question 88

Insertion of the superior and inferior gemelli

Answer 88

Upper border of greater trochanter

Question 89

Nerve supply of the gemelli?

Answer 89

Superior from nerve to obturator internus (L4, S1) Inferior from nerve to quadratus femoris (L4, S1)

Question 90

Action of gemelli

Answer 90

Lateral rotators of thigh

Question 91

Origin of the quadratus femoris

Answer 91

Lateral border of ischial tuberosity

Question 92

Insertion of the quadratus femoris

Answer 92

Quadrate tubercle of femur

Question 93

Insertion of the quadratus femoris

Answer 93

Quadrate tubercle, intertrochanteric crest of femur

Question 94

Nerve supply of quadratus femoris

Answer 94

Nerve to quadratus femoris (L4,S1)

Question 95

Action of quadratus femoris

Answer 95

Lateral rotator of thigh

Question 96

Problems that could lead to a positive trendelenburg test

Answer 96

Fracture neck of femur Dislocation of hip joint Coxa Vara Nonfunctioning gluteus medius and minimus due to: Neurological damage (L4 – 5 disc herniation) Any disease affecting muscles (myopathy)

Question 97

How does arthritis occurs

Answer 97

Inflammation of one or more joints, causing pain and stiffness that can worsen with age. It occurs when the synovial fluid begins to dry up leading to more friction between bones

Question 98

What are the nerves of the gluteal region?

Answer 98

Sciatic posterior cutaneous nerve of the thigh superior gluteal inferior gluteal nerve to quadratus femoris pudendal nerve nerve to obturator internus

Question 99

What converts the the sciatic notch of the hip bone into a greater and lesser foramina?

Answer 99

Sacrotuberous and sacrospinous ligament

Question 100

Use of the greatest sciatic foramen And division

Answer 100

The greater sciatic foreman forms a passageway through which structures entering and leaving the pelvis passes e.g. sciatic nerve It can be divided into **Suprapiriform foramen** superior gluteal vessels superior gluteal nerve **Infrapiriform foramen** inferior gluteal vessels internal pudendal vessels nerves of the sacral plexus inferior gluteal nerve pudendal nerve sciatic nerve posterior femoral cutaneous nerve nerve to obturator internus nerve to quadratus femoris

Question 101

Use of the lesser sciatic foramen

Answer 101

The lesser sciatic foramen serves as a passageway for structures entering and leaving the perineum eg. pudendal nerve

Question 102

The cluneal nerves innervates…?

Answer 102

The skin of the gluteal region Specifically the e skin over the iliac crest, between the posterior superior iliac spines and I’ve ever iliac tubercle Consequently these nerves are vulnerable to injury when bone is taken from the ilium for grafting

Question 103

Describe the superior cluneal nerves

Answer 103

The superior cluneal nerves are the lateral cutaneous branches of the dorsal rami of L1-L3 They supply the skin of the gluteal region as far as the greater trochanter

Question 104

Describe the medial cluneal nerves

Answer 104

The medial cluneal nerves are the lateral cutaneous branches of the dorsal rami of S1-S3 Supplies the skin and subcutaneous tissue over the sacrum and the adjacent area of the buttock

Question 105

Describe the inferior cluneal nerves

Answer 105

The inferior cluneal nerves are gluteal branches of the posterior cutaneous nerve of the thigh, a derivative of the sacral plexus (ventral rami S1-S3) These nerves curl around the inferior border of the gluteus maximus supplies the inferior half of the buttock

Question 106

Describe the perforating cutaneous nerve

Answer 106

The perforating cutaneous nerve (S2 and S3) passes through the sacrotuberous ligaments and the inferior part of the gluteus maximus

Question 107

What are the deep gluteal nerves?

Answer 107

Entering the Gluteal region from the pelvis through the greater sciatic foramen: Superior gluteal nerve inferior gluteal nerve sciatic nerve pudendal nerve nerve to the quadratus femoris nerve to the obturator internus posterior cuntaneous nerve of the thigh Entering the Gluteal region by passing through the sacrotuberous ligament: The perforating cutaneous nerve

Question 108

Nerves derived from the sacral plexus

Answer 108

superior and infeior gluteal nerves sciatic nerve posterior femoral cutaneous pudendal

Question 109

Arteries of the gluteal region

Answer 109

Superior and inferior gluteal arteries enter the gluteal region from the pelvic cavity through the greater sciatic foramen. They supply structures in the gluteal region and posterior thigh and have important collateral anastomoses with branches of the femoral artery.

Question 110

Discuss the superior gluteal artery

Answer 110

Originates from the posterior trunk of the internal iliac artery in the pelvic cavity. It leaves the pelvic cavity with the superior gluteal nerve through the greater sciatic foramen **above** the piriformis muscle. In the gluteal region, it divides into a superficial branch and a deep branch: the superficial branch supplies the gluteus maximus the deep branch supplies the gluteus medius and minimus muscles. It also contributes to the supply of the hip joint. Branches of the artery also anastomose with the lateral and medial femoral circumflex arteries from the deep femoral artery in the thigh, and with the inferior gluteal artery.

Question 111

Discuss the inferior gluteal artery

Answer 111

Originates from the anterior trunk of the internal iliac artery in the pelvic cavity. It leaves the pelvic cavity with the inferior gluteal nerve through the greater sciatic foramen **inferior** to the piriformis muscle. The inferior gluteal artery descends through the gluteal region and into the posterior thigh and anastomoses with perforating branches of the femoral artery. It also supplies a branch to the sciatic nerve.

Question 112

Arterial supply to femoral head

Answer 112

Medial & lateral femoral circumflex arteries Superior and inferior gluteal arteries Post. obdurator artery via artery of femoral ligament

Question 113

Trendelenberg test

Answer 113

To assesses whether the hip abductors (particularly gluteus medius) are functioning normally Observe patient from behind, ask him/her to stand on one foot and then the other Negative test: Pelvis ‘tilts up’ on contralateral side Positive test: Pelvis ‘sags’ on contralateral side

Question 114

Problems that could lead to a positive Trendelenburg test:

Answer 114

Fracture neck of femur Dislocation of hip joint Coxa Vara Nonfunctioning gluteus medius and minimus due to: Neurological damage (L4 – 5 disc herniation) Any disease affecting muscles (myopathy)

Question 115

Clinical significance of an intramusular injection

Answer 115

Intramuscular injection enables a large amount of a drug to be introduced at once but absorbed gradually. This procedure must be carried out without injuring neurovascular structures. A typical site for an intramuscular injection is the gluteal region, the upper lateral quadrant of the gluteal region being the safest region The sciatic nerve passes through this region and needs to be avoided. A needle placed in this region enters the gluteus medius anterosuperior to the margin of the gluteus maximus.