B6.028 Gluteal Region, Posterior Thigh, Anterior Thigh, Femoral Triangle, and Medial Thigh

Question 1

thigh

Answer 1

from hip joint to knee joint

Question 2

leg

Answer 2

from knee joint down

Question 3

3 palpable landmarks in gluteal region

Answer 3

posterior superior iliac spine (possible dimple)
greater trochanter of the femur
ischial tuberosity

Question 4

purpose of gluteal and posterior thigh muscles

Answer 4

act at the hip and knee joints

many powerful anti-gravity muscles

Question 5

which two portions of the pelvis are aligned anatomically

Answer 5

anterior superior iliac spine
pubic tubercle
(forward facing mickey mouse ears)

Question 6

which 3 ligaments act as anchors for large gluteal muscles

Answer 6

sacrospinous ligament
sacrotuberous ligament
sacroiliac ligament

Question 7

deep fascia of the thigh

Answer 7

“fascia lata”
wraps around entire thigh region
lateral aspect thickens to form “iliotibial tract”
continuous with deep fascia of the leg

Question 8

iliotibial tract

Answer 8

connects the gluteus maximus to the lateral leg (tibia)

Question 9

4 superficial gluteal muscles

Answer 9

gluteus maximum
gluteus medius
gluteus minimum
tensor fascia latae

Question 10

major function of gluteus muscles

Answer 10

resist gravity during the gait and posture

Question 11

largest skeletal muscle

Answer 11

gluteus maximum

can be up to 4 lb

Question 12

function of iliotibial track

Answer 12

dramatically increases the length of the lever arm used by gluteus maximum

Question 13

function of bursas in the hip joint

Answer 13

minimize excessive shearing during extreme jumping, walking/running, or climbing

Question 14

trochanteric bursa

Answer 14

between gluteus maximus and greater trochanter

Question 15

ischial bursa

Answer 15

between ischial tuberosity and skin when sitting

Question 16

gluteofemoral bursa

Answer 16

between iliotibial track and vastus lateralis

Question 17

function of piriformis muscle

Answer 17

does not have an important function

useful anatomical marker that divides superior vs inferior gluteal regions

Question 18

important vessels/nerves that exit the pelvis above the piriformis

Answer 18

superior gluteal nerve, artery and vein

Question 19

important vessels/nerves that exit the pelvis below the piriformis

Answer 19

inferior gluteal nerve, artery, and vein

sciatic nerve

Question 20

major branches of internal iliac artery

Answer 20

superior gluteal

inferior gluteal

Question 21

what is the sciatic nerve composed of

Answer 21

2 separate nerves: tibial and common fibular

do not exchange fibers

Question 22

major nerves to the gluteal region

Answer 22

superior gluteal
inferior gluteal
sciatic
posterior femoral cutaneous

Question 23

result of injuries to superior gluteal nerve

Answer 23

waddling or hip drop gait

pelvis cannot be maintained in a level position

Question 24

sciatica

Answer 24

irritation and inflammation of sciatic nerve due to chronic pressure

Question 25

causes of sciatic nerve damage

Answer 25

thick wallets, prolonged sitting on rigid surfaces | unsafe intramuscular injection into inferior gluteal quadrants

Question 26

how to do an anesthetic block of the sciatic nerve

Answer 26

inject anesthetics a few centimeters inferior to the midpoint of the line joining the posterior superior iliac spine and the superior greater trochanter

Question 27

3 posterior thigh muscles (hamstrings)

Answer 27

semitendinosus semimembranosus biceps femoris

Question 28

general parameters of hamstring muscles

Answer 28

originate from ischial tuberosity (pelvis) cross 2 joints - hip and knee - to attach to leg bone extend the thigh at the hip joint (extend the trunk) and flex the knee, but not both simultaneously innervated by tibial nerve **short head of biceps femoris is an exception to these**

Question 29

common hamstring injuries

Answer 29

hamstring strain or avulsion of ischial tuberosity

Question 30

why cant you extend a fully flexed hip and flex a knee at the same time

Answer 30

hamstring tendons are unusually long, but the muscle fiber bundles are too short to accomplish both actions simultaneously (not enough muscle contraction length)

Question 31

describe the arteries to the posterior thigh

Answer 31

external iliac > femoral > profundal femoris (deep femoral) > medial and lateral circumflex femoral arteries extensive anastomosis around hip

Question 32

what is unusual about the blood supply to the posterior thigh

Answer 32

no big, main artery | supplied by tributaries from anterior thigh arteries

Question 33

anastomoses between internal and external iliac crests

Answer 33

branches of inferior gluteal (internal iliac) join deep femoral branches (external iliac) arteries that contribute to femoral anastomosis also comprise a potential "bypass" should a blockage occur in the femoral artery

Question 34

which nerves of the gluteal region are from the posterior rami

Answer 34

superior cluneal | middle cluneal

Question 35

which nerves of the gluteal region are from the anterior rami

Answer 35

inferior cluneal (posterior femoral cutaneous)

Question 36

nerves of the sacral plexus

Answer 36

nerves: superior gluteal, inferior gluteal, posterior femoral cutaneous branches: piriformis, obturator, quadratus femoris

Question 37

anatomy of great saphenous vein

Answer 37

``` originates from dorsum of foot passes anterior to the medial malleolus runs behind the medial side of knee joint remains medial on the distal thigh ascends to the saphenous opening dives deep to join the femoral ```

Question 38

anatomy of small saphenous vein

Answer 38

originates from lateral foot/sole passes posterior to lateral malleolus runs on posterior surface of calf drains into popliteal vein

Question 39

what is the saphenous opening

Answer 39

defect in the upper anterior thigh fascia

Question 40

crural fascia

Answer 40

deep fascia of the leg

Question 41

where is the femoral nerve

Answer 41

passes behind inguinal ligament at the midpoint

Question 42

branches of the femoral nerve

Answer 42

muscular: to anterior thigh muscles branches to hip and knee joints all terminal branches form within the femoral triangle

Question 43

saphenous nerve

Answer 43

only femoral nerve branch which travels below the knee joint | serves the skin of the medial leg and foot

Question 44

femoral cutaneous branches

Answer 44

anterior femoral cutaneous (medial anterior thigh) | saphenous (medial leg and heel)

Question 45

superficial cutaneous branches of the femoral artery

Answer 45

superficial epigastric inferior epigastric superficial circumflex iliac external pudendal (superficial and deep)

Question 46

femoral artery tributaries to muscle

Answer 46

deep femoral > medial femoral and lateral femoral circumflex > 3 perforating arteries

Question 47

blood supply to the head of the femur and hip joint

Answer 47

medial circumflex femoral- posterior retinacular arteries lateral circumflex femoral-anterior retinacular arteries these two branches anastomose with inferior gluteal artery and 1st perforating branch of the deep femoral

Question 48

fracture of the femoral neck

Answer 48

endangers retinacular arteries of the femoral neck

Question 49

4 bursae at the insertion of the quadriceps femoris

Answer 49

prepatellar (subcutaneous) suprapatellar (sebtendinous) subcutaneous infrapatellar deep infrapatellar

Question 50

which bursa communicates with the joint cavity

Answer 50

suprapatellar most common site of quadriceps tendon bursitis important in infections

Question 51

how might the psoas muscle be infected

Answer 51

a retroperitoneal pyogenic infection can arise from lung or vertebral column due to TB or enteritis (Crohns), infiltrating the investing fascia of the psoas

Question 52

pus accumulation in the psoas

Answer 52

pus accumulation in the thoracic portion may infiltrate through muscle into the inguinal region and then into the hip joint synovial space via communicating bursae

Question 53

differential of edema in the inguinal region

Answer 53

``` psoas abscess inguinal hernia femoral hernia inguinal lymph node enlargement local dilation of the great saphenous vein ```

Question 54

poor or unequal quad function

Answer 54

can cause arthritis or trauma to the knee joint, abnormal patella wear, resulting in loss of knee joint stability and function

Question 55

chondromalacia patellae

Answer 55

runners knee deterioration of the patellar articular cartilage due to excessive wear observed in young and old can be caused by repeated misaligned quad contractions or by excessive rising from a squatting position under heavy loads

Question 56

patellar fractures

Answer 56

caused by direct blows such as front end auto collisions

Question 57

abnormal ossification of the patella

Answer 57

multiple ossification centers may be bipartite or tripartite sometimes mistaken as fractures

Question 58

what is the femoral triangle

Answer 58

triangular compartment inferior to the inguinal ligament in the superficial space

Question 59

boundaries of the femoral triangle

Answer 59

inguinal ligament sartorius adductor longus

Question 60

contents of femoral triangle

Answer 60

iliopsoas muscle femoral nerve femoral sheath (femoral artery, vein, and canal)

Question 61

roof/anterior wall of the femoral triangle

Answer 61

fascia lata has an opening just below the inguinal ligament called the saphenous opening

Question 62

saphenous opening/hiatus

Answer 62

size of a quarter | covered by delicate perforated CT layer called the cribriform fascia

Question 63

what is the femoral canal

Answer 63

cone shaped potential space that extends to the saphenous opening typically contains fat, loose CT, and lymph nodes

Question 64

clinical importance of femoral canal

Answer 64

potential passageway for femoral hernia

Question 65

femoral triangle from lateral to medial

Answer 65

``` nerve artery vein canal lacunar ligament ```

Question 66

clinical considerations for the femoral triangle

Answer 66

palpate femoral artery compress femoral artery against superior ramus of pubic bone place catheter into femoral artery for left cardiac angiography place catheter into femoral vein for right cardiac angiography femoral venipuncture site for fluid infusion

Question 67

femoral hernia

Answer 67

``` more frequent in females deep to inguinal ligament, soft subcutaneous lump never enters scrotum distinct from inguinal hernia can lead to strangulated intestine ```

Question 68

obturator artery

Answer 68

provides blood supply to medial adductor muscle group from internal iliac anastomose with circumflexes from deep femoral for collateral circulation

Question 69

anastomoses between internal and external iliac

Answer 69

1. inferior gluteal and circumflex femoral arteries 2. obturator and deep femoral artery twigs 3. internal pudendal and external pudendal

Question 70

obturator nerve

Answer 70

from L2-L4 exits pelvic cavity at the obturator foramen splits into 2 branches: superficial- runs between adductor longus and brevis deep- runs posterior to adductor brevis

Question 71

pulled groin

Answer 71

strain and possible tearing of the proximal attachments of the adductor muscle groups usually occurs in sports requiring quick acceleration from a rest position

Question 72

cause of pes anserinus bursitis

Answer 72

3 thin, strap like muscles all insert at the upper part of the medial surface of the tibia due to close proximity of these muscles tendons to the knee joint capsule, there is an intervening bursa to reduce friction during gait

Question 73

symptoms of pes anserius bursitis

Answer 73

pain and tenderness on the inside of the knee, 5-7 cm below the joint runners susceptible

Question 74

common clinical problems affecting gluteal and thigh regions

Answer 74

``` deep and superficial VT pelvic and hip fractures muscle strain injuries hip, gluteal, and back pain OA and RA of the hip bursitis at gluteal and trochanteric friction points ```