Flashcards in Block 3 Deck (217):
The greater sciatic foramen is divided by?
What is contained within the greater sciatic foramen above the piriformis?
superior gluteal nerve, artery, vein
What is contained within the greater sciatic foramen below the piriformis muscle?
sciatic n, inferior gluetal n/a/v, pudenal n, internal pudendal a/v, posterior femoral cutaneous n
What is contained within the lesser sciatic foramen?
obturatur internus muscle tendon, pudendal n and internal pudendal vessels
What passes through the obturator canal?
obturator nerve and vessels
What passes between the inguinal ligament and pelvic bone?
psoas major, iliacus, pectineus muscles, femoral A/V/N, lymphatics, femoral branch of genitofemoral, lateral cutaneous n of thigh
The greater and lesser sciatic foramen is created by?
the sacrospinous and sacrotuberous ligaments
Nerve supply to the lower limb arises from which primary rami?
Femoral nerve provides cutaneous innervation to?
entirety of anterior medial leg and posterior medial calf
Obturator nerve provides cutaneous innervation to?
small portion of mid-medial thigh (posterior and anterior)
The sympathetics follow which GENERAL path (spinal nerves involved are inferior to IML)?
Descend and then synapse
At the level of the lumbar spine, which is greater: intervertebral foramen height or the height of lumbar IVD?
intervertebral foramen height
Lumber spinal nerve exiting at the level of a herniated disk will pass where in relation to the herniation?
Herniation will affect the roots of the?
Lower spinal nerve
At a L3-L4 herniation, where will the radiculopathy occur?
Lower limb radicular syndrome: L4. Sensory loss?
Lower limb radicular syndrome: L4. Motor weakness?
Patellar tendon reflex
Lower limb radicular syndrome: L5. Sensory loss?
Dorsum of foot
Lower limb radicular syndrome: L6. Sensory loss?
Lower limb radicular syndrome: L6. Motor weakness?
Achilles Tendon Reflex
Dermatomes of the lumbar plexus take care of?
the anterior aspect of the lower limb
The posterior aspect of the lower limb is mostly taken care of by dermatomes relating to?
the proximal sacral plexus (S1, S2)
The distal portions of the sacral plexus have dermatomes relating to?
the perineum (S2,3,4)
Each joint movement consists of how many consecutive spinal nerves?
Myotomes responsible for flexion of the hip?
Myotomes responsible for extension of the hip?
Myotomes responsible for extension of the knee?
Myotomes responsible for flexion of the knee?
Anterior compartment is associated with which bone?
Anterior compartment is associated with which nerve?
Femoral n levels?
The anterior compartment is responsible for which movements?
Mainly knee extension, hip flexion
The medial compartment is associated with which bone?
The medial compartment is associated with which nerve?
Obtruator n levels?
The medial compartment is associated with which movement?
The posterior compartment is associated with which bone?
The posterior compartment is associated with which nerve?
Tibial n levels:
The posterior compartment is associated with which movements?
hip extension, knee flexion
The femoral n is associated with which movements?
mainly knee extension, hip flexion
The obturator n is associated with which movements?
The tibial n is associated with which movement?
hip extension, knee flexion
Muscles of the anterior compartment?
Iliopsoas, quadriceps femoris, sartorius, pectineus
What are the three muscles of Quadriceps Femoris?
rectus femoris, vastus medialis, vastus lateralis
Which muscle is the chief hip flexor?
Which muscle is the great extensor of the knee?
Which two muscles of the anterior compartment act on both joints?
rectus femoris and sartorius
Which muscle in the anterior compartment is weak and can't do its job on its own?
Why is pectineus unique?
Despite being innervated by femoral it adducts
What are the three actions of pectineus?
adduction, hip flexion, assists in medial rotation at the hip joint
Innervation of pectineus?
Femoral n (90% of the time), but could be obturator n.
Where does pectineus originate from?
superior ramus of pubis
Why is pectineus sometimes innervated by obturator n?
It crosses from anterior to medial compartment
What general actions are associated with quadriceps femoris?
kicking a ball, rising from sitting/squatting, climbing stairs, acceleration (long jump)
What reflex can you use to test the femoral n?
Knee (jerk) reflex/ patellar tendon reflex
Muscles of the medial compartment:
gracilis, adductor longus, adductor brevis, adductor magnus, obturator externus
What are the two parts of the adductor magnus?
adductor part, hamstring part
The hamstring part of the adductor magnus performs which action?
extension of hip
Which muscle in the medial compartment is not strong and can't do its job by itself?
Which medial compartment muscle has dual innervation?
The adductor portion of adductor magnus is innervated by?
The hamstring part of adductor magnus is innervated by?
The obturator nerve splits into?
Posterior and anterior branch
The posterior branch of the obturator nerve is located posterior to?
Obturator externus performs which movement?
The adductor portion of adductor magnus attaches?
inferior ischiopubic ramus
The hamstring portion of adductor magnus attaches?
Superior boundary of the femoral triangle:
Medial boundary of the femoral triangle:
Lateral boundary of the femoral triangle:
Apex boundary of the femoral triangle:
sartorius + Adductor longus
Floor of the femoral triangle:
Iliopsoas + pectineus
Roof of the femoral triangle:
Fascia lata, cribiform fascia, subcutaneous tissue and skin
What is the femoral sheath?
Engrossment between the fascia of transversalis and iliopsoas
What are the three compartments of the femoral sheath?
lateral, intermediate, medial
What is housed in the lateral compartment of the femoral sheath?
What is housed in the intermediate compartment of the femoral sheath?
femoral v and proximal tributaries, great saphenous v, deep v of thigh
What is housed in the medial compartment of the femoral sheath?
femoral canal, femoral ring, fat, deep inguinal lymph nodes
What key player is not housed in the femoral sheath?
The entrance to the femoral canal is the?
The femoral ring is an extension of?
the inguinal ligament
Femoral hernias are more common in which gender?
The mass of the femoral hernia is located?
on the anterior thigh at the femoral triangle, lateral and inferior to pubic tubercle
Where in the femoral triangle is a femoral hernia located?
deep to inguinal canal via femoral ring, saphenous opening
The femoral triangle is important for what procedures?
Central access and coronary angioplasty
When you hear "circumflex" you should think of?
Supplying a joint
The descending branch of the lateral circumflex femoral anastomoses with?
superior lateral genicular artery
The medial CFA is associated with what bone?
Neck and head of the femur
The medial CFA could be impacted by this injury?
neck fracture and/or hip dislocation
The lateral CFA is associated with?
mm. lateral aspect of the thigh
Is it common to see the lateral CFA impacted by injury?
What are the three branches of the lateral CFA?
ascending, descending, transverse
What are the four "cruciate anastomosis" of the posterior thigh
Medial circumflex femoral, lateral circumflex femoral, inferior gluteal, 1st perforating
What are the two branches of the obturator a?
The anterior branch of the obturator a supplies what muscles?
pectineus, adductors of the thigh, gracilis, obturator externus
Posterior branch of the obturator a supplies what?
head of femur, mm. ischial tuberosity
Is the fibula part of the knee?
Is the knee mechanically strong or weak?
What are the crucial muscles of the knee?
Quadriceps femoris (vastus medialis and vastus lateralis)
What's a bursa?
fluid sacs and synovial pockets that surround and sometimes communicate with the joint cavity
Suprapatellar bursa location
between the anterior surface of the lower part of the femur and deep surface of the quadriceps femoris
What does the suprapatellar bursa allow for?
movement of the quadriceps tendon over the distal end of the femur
What is the pes anserinus?
conjoined tendons of three muscles that insert onto the anteromedial (front and inside) surface of the proximal extremity of the tibia.
What are the muscles that have tendons conjoin at the pes anserinus?
gracilis, sartorius, semitendinosus
How does the pes anserinus related to ACL tear?
Semitendiosus can be used for ACL tear
What are the two components of the joint capsule?
fibrous layer and synovial membrane
Which layer (fibrous or synovial) is deepest?
Where does the synovial membrane not cover?
the central aspect of the joint (so the anterior and posterior cruciate ligament)
Two categories of knee ligaments:
patellar, fibular collateral, tibial collateral, oblique popliteal, arcuate popliteal
cruciate, menisci, tendon of popliteus
Where does the fibular collateral ligament attach?
lateral epicondyle of femur to head of fibula
What does the fibular collateral ligament split?
biceps femoris tendon
Which is stronger fibular collateral ligament or tibial collateral ligament?
Fibular collateral ligament
Where does the tibular collateral ligament attach?
medial epicondyle to tibia medial condyle
Which is more likely to be damaged fibular collateral ligament or tibial collateral ligament?
tibial collateral ligament
The tibial collateral ligament attaches to femur medial epicondyle and tibia medial condyle, but also where?
The tibial collateral ligament is often injured with?
Deep to the fibular collateral ligament, you can find?
the tendon of the popliteus
What two extracapsular ligaments strengthen the capsule posteriorly?
Oblique popliteal ligament and acruate popliteal ligament
What acronym can be used to remember ACL attachments?
What are the attachments of the ACL:
anterior tibia, posteriorly & externally (laterally) to femur lateral condyle
What are the actions of the ACL?
prevents posterior displacement of femur on tibia, prevents hyperextension of knee
What is notable about the ACL?
Weak and poor blood supply
Is the ACL slack or flexed when knee is flexed?
Is the ACL slack or flexed when knee is extended?
When knee is flexed 90 degrees, what cannot be pulled anterior?
What is the acronym to remember PCL?
posterior tibia, anteriorly and internally (medially) to femur medial condyle
Which is stronger: ACL or PCL?
What are the actions of the PCL?
prevents anterior displacement of femur on tibia, prevents hyperflexion of knee
Is the PCL slack or flexed when knee is flexed?
What is the main ligament stabilizer of femur in a weight-bearing flexed knee position (walking down hill)?
What shape is the medial meniscus?
The medial meniscus is associated with which ligament?
tibial collateral ligament
What shape is the lateral meniscus?
almost circular but smaller
Which meniscus is freely moveable?
Is the medial or lateral meniscus more likely to be injured?
The posterior meniscofemoral ligament joins?
Lateral meniscus to PCL
Where does the posterior meniscofemoral ligament attach?
arises from the posterior horn of the lateral meniscus and passes to attach to the lateral aspect of the medial femoral condyle
What ligaments are involved in the Unhappy Triad
It involves full or partial tears of the Anterior Cruciate Ligament, the Medial Collateral Ligament and a tear of the Medial Meniscus.
Unhappy triad is common in which sports?
football and basketball
Anterior knee innervation?
Posterior knee innervation?
Lateral knee innervation?
common fibular n
Medial knee innervation?
obturator and saphenous nn
What are the genicular anastomosis?
superior lateral genicular a, superior medial genicular a, middle genicular a, inferior lateral genicular a, inferior medial genicular (others: descending genicular a, desc branch of lateral femoral circumflex, anterior tibial recurrent)
What rami do the cluneal nerves arise from?
Superior, lateral, and medial arise from dorsal rami. Inferior cluneal nn arises from ventral rami.
The cluneal nerves are terminal branches of?
posterior femoral cutaneous nerve of the thigh
Medial rotates are located anteriorly or posteriorly?
Lateral rotators are located anteriorly or posteriorly?
Which is weaker medial or lateral rotators?
Medial are weaker
Stronger ligaments are associated with medial or lateral rotators?
medial rotators (anterior)
Name the hip joint ligaments:
Iliofemoral ligament, pubofemoral ligament, Ischiofemoral ligament, ligament of the head of the femur
What is the shape of the Iliofemoral ligament?
Which is the strongest hip joint ligament?
Where does the Iliofemoral ligament attach?
Anterior inferior iliac spine, acetabular rim to intertroachanteric line
Iliofemoral ligament limits?
hyperextension and lateral rotation
What is the second strongest hip joint ligament?
Pubofemoral ligament limits?
tightens extension and abduction at the hip joint
Which is the weakest hip joint ligament?
Where does the ischiofemoral ligament attach?
postero-inferior acetabular margin to femoral neck/greater trochanter
Ischiofemoral ligament limits?
extension and medial rotation
What is the job of the ligament of the head of the femur?
Houses the ligament of head of the femur, not much for stability
Where does the pubofemoral ligament attach?
obturator crest and the superior ramus of the pubis; below, it blends with the capsule and a ligament
What are the medial rotators of the thigh?
tensor fasciae latae, gluetus minimus, gluteus medius
What are the lateral rotators of the thigh?
quadratus femoris, gluteus maximus, piriformis, superior and inferior gemelli, obturator internus, obturator externus
The medial rotators of the thigh are innervated by?
Superior gluteal n
Functions of gluteus maximus:
powerful extensor, lateral rotator of thigh
What arteries supply gluetus maximus?
Superior and inferior gluteal arteries
The gluteus maximus is innervated by?
the inferior gluteal n.
Gluteus maximus is utilized in what common motion?
Bring your body up from sitting position
Actions of gluetus medius and minimus:
abduct thigh, medial rotation of thigh, keeps contralateral side of the pelvis from sagging to the unsupported side
Gluteus medius and minimus are innervated by?
Superior gluteal n.
What muscle is the chief flexor of the hip?
Actions of tensor fascia lata?
abduction & medial rotation + stabilizes extended knee + hip flexor
Tensor fascia lata is innervated by?
superior gluteal n.
Tensor fascia lata is supplied by?
Superior gluteal a
Injuries to the inferior gluteal n can occur from?
Inappropriately administering injections
Where is the safe space for gluteal injections?
Upper lateral quadrant
What will happen if you have an injury to the inferior gluteal n? (daily action)
Challenge to stand up and climb stairs
Injury to inferior gluteal n will result in what actions being limited?
Extension at the hip, lateral rotation at the hip
A superior gluteal n injury would impact what muscles?
gluteus medius, minimis, and tensor fascia lata
Superior gluteal n injury would result in what actions?
severely impaired medial rotation of thigh , weak abduction of thigh , pelvis sag to opposite side of lesion
Positive Trendelenburg Gait is caused by an injury to
Superior gluteal n
Pelvis sags on the (same/opposite) side of lesion?
positive trendelenburg gait indicates what type of gait:
limb too long, "waddle or gluteal gait" (swing forward), use high "steppage gait" (lift foot higher and move forward), "lateral swing out" (swing foot outward without foot drop), pt will lean to side that is not sinking (side with nerve injury)
What are the superficial gluteal muscles?
tensor fasciae latae, gluteus minmus, gluteus medius, gluteus maximus
What are the deep gluteal muscles?
obturator internus, superior and inferior gemelli, piriformis, quadratus femoris
Actions of piriformis and obturator internus:
When thigh is extended, lateral rotator. When thigh is flexed, abduct. Stabilize hip joint (femoral head)
Innervation of piriformis:
anterior rami of S1-S2
Innervation of obturator internus
Obturator internus n (L5-S1)
Actions of the gemelli muscles
stabilizes hip joint (femoral head), assists & reinforces Obturator Internus, when thigh is extended it acts as a lateral rotator, when thigh is flexed, it abducts.
The superior gemelli m is innervated by?
The n to obturator internus
The inferior gemlli m is innervated by?
the n to quadratus femoris
Action of quadratus femoris?
Strong lateral rotator
Quadratus femoris is innervated by?
quadratus femoris n
Piriformis syndrome is caused by:
overuse of gluetal mm or buttock trauma
Piriformis syndrome results in
hypertrophy and muscle spasms
Piriformis is more prevalent in which gender?
What pierces through the piriformis in 12-15% of the population?
Why do muscle spasms occur in piriformis syndrome?
muscle gets big, constriction in the space
What are the hip extensors?
gluteus maximus, biceps femoris, semitendinosus, semimembranosus, adductor magnus (hamstring)
What are the hip flexors? Posterior thigh
tensor fasciae latae
What are the hamstring muscles?
semimembranosus, semitendinosus and biceps femoris
Which hamstring muscles are innervated by tibial n. ?
semimembranosus, semitendinosus, becieps femoris (long head)
Which hamstring muscles are innervated by common peroneal portion of sciatic nerve (both L5, S1)?
biceps femoris (short head)
Hamstring injuries are common in what sport?
Hurdles (forced hip flexion with forced knee extension)
Where do hamstrings tend to detach in injury?
proximal attachment at ischial tuberosity
Sensory innervation of tibial division
skin on posterior aspect of leg, lateral ankle and foot, skin sole
Superolateral boundary of the popliteal fossa
Superomedial boundary of the popliteal fossa
Inferolateral and inferomedial boundary of the popliteal fossa
gastrocnemius (lateral and medial heads)
Posterior (roof) boundary of the popliteal fossa
skin and fascia
Anterior (floor) boundary of the popliteal fossa
popliteal surface femur, oblique popliteal ligament, popliteal fascia