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Flashcards in Block 3 Deck (217):
1

The greater sciatic foramen is divided by?

Piriformis muscle

2

What is contained within the greater sciatic foramen above the piriformis?

superior gluteal nerve, artery, vein

3

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

4

What is contained within the lesser sciatic foramen?

obturatur internus muscle tendon, pudendal n and internal pudendal vessels

5

What passes through the obturator canal?

obturator nerve and vessels

6

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

7

The greater and lesser sciatic foramen is created by?

the sacrospinous and sacrotuberous ligaments

8

Nerve supply to the lower limb arises from which primary rami?

Ventral

9

Femoral nerve provides cutaneous innervation to?

entirety of anterior medial leg and posterior medial calf

10

Obturator nerve provides cutaneous innervation to?

small portion of mid-medial thigh (posterior and anterior)

11

The sympathetics follow which GENERAL path (spinal nerves involved are inferior to IML)?

Descend and then synapse

12

At the level of the lumbar spine, which is greater: intervertebral foramen height or the height of lumbar IVD?

intervertebral foramen height

13

Lumber spinal nerve exiting at the level of a herniated disk will pass where in relation to the herniation?

Safely above

14

Herniation will affect the roots of the?

Lower spinal nerve

15

At a L3-L4 herniation, where will the radiculopathy occur?

L4

16

Lower limb radicular syndrome: L4. Sensory loss?

Medial ankle

17

Lower limb radicular syndrome: L4. Motor weakness?

Patellar tendon reflex

18

Lower limb radicular syndrome: L5. Sensory loss?

Dorsum of foot

19

Lower limb radicular syndrome: L6. Sensory loss?

Lateral ankle

20

Lower limb radicular syndrome: L6. Motor weakness?

Achilles Tendon Reflex

21

Dermatomes of the lumbar plexus take care of?

the anterior aspect of the lower limb

22

The posterior aspect of the lower limb is mostly taken care of by dermatomes relating to?

the proximal sacral plexus (S1, S2)

23

The distal portions of the sacral plexus have dermatomes relating to?

the perineum (S2,3,4)

24

Each joint movement consists of how many consecutive spinal nerves?

4

25

Myotomes responsible for flexion of the hip?

L2,3

26

Myotomes responsible for extension of the hip?

L4,5

27

Myotomes responsible for extension of the knee?

L3,4

28

Myotomes responsible for flexion of the knee?

L5,S1

29

Anterior compartment is associated with which bone?

Ilium

30

Anterior compartment is associated with which nerve?

Femoral n

31

Femoral n levels?

L2-L4

32

The anterior compartment is responsible for which movements?

Mainly knee extension, hip flexion

33

The medial compartment is associated with which bone?

Pubis

34

The medial compartment is associated with which nerve?

Obturator n.

35

Obtruator n levels?

L2-L4

36

The medial compartment is associated with which movement?

hip adduction

37

The posterior compartment is associated with which bone?

Ischium

38

The posterior compartment is associated with which nerve?

Tibial

39

Tibial n levels:

L4-S3

40

The posterior compartment is associated with which movements?

hip extension, knee flexion

41

The femoral n is associated with which movements?

mainly knee extension, hip flexion

42

The obturator n is associated with which movements?

hip adduction

43

The tibial n is associated with which movement?

hip extension, knee flexion

44

Muscles of the anterior compartment?

Iliopsoas, quadriceps femoris, sartorius, pectineus

45

What are the three muscles of Quadriceps Femoris?

rectus femoris, vastus medialis, vastus lateralis

46

Which muscle is the chief hip flexor?

Iliopsoas

47

Which muscle is the great extensor of the knee?

Quadriceps femoris

48

Which two muscles of the anterior compartment act on both joints?

rectus femoris and sartorius

49

Which muscle in the anterior compartment is weak and can't do its job on its own?

Sartorius

50

Why is pectineus unique?

Despite being innervated by femoral it adducts

51

What are the three actions of pectineus?

adduction, hip flexion, assists in medial rotation at the hip joint

52

Innervation of pectineus?

Femoral n (90% of the time), but could be obturator n.

53

Where does pectineus originate from?

superior ramus of pubis

54

Why is pectineus sometimes innervated by obturator n?

It crosses from anterior to medial compartment

55

What general actions are associated with quadriceps femoris?

kicking a ball, rising from sitting/squatting, climbing stairs, acceleration (long jump)

56

What reflex can you use to test the femoral n?

Knee (jerk) reflex/ patellar tendon reflex

57

Muscles of the medial compartment:

gracilis, adductor longus, adductor brevis, adductor magnus, obturator externus

58

What are the two parts of the adductor magnus?

adductor part, hamstring part

59

The hamstring part of the adductor magnus performs which action?

extension of hip

60

Which muscle in the medial compartment is not strong and can't do its job by itself?

gracilis

61

Which medial compartment muscle has dual innervation?

adductor magnus

62

The adductor portion of adductor magnus is innervated by?

obturator n

63

The hamstring part of adductor magnus is innervated by?

tibial n

64

The obturator nerve splits into?

Posterior and anterior branch

65

The posterior branch of the obturator nerve is located posterior to?

Adductor brevis

66

Obturator externus performs which movement?

lateral rotation

67

The adductor portion of adductor magnus attaches?

inferior ischiopubic ramus

68

The hamstring portion of adductor magnus attaches?

Ischial tuberosity

69

Superior boundary of the femoral triangle:

inguinal ligament

70

Medial boundary of the femoral triangle:

adductor longus

71

Lateral boundary of the femoral triangle:

sartorius

72

Apex boundary of the femoral triangle:

sartorius + Adductor longus

73

Floor of the femoral triangle:

Iliopsoas + pectineus

74

Roof of the femoral triangle:

Fascia lata, cribiform fascia, subcutaneous tissue and skin

75

What is the femoral sheath?

Engrossment between the fascia of transversalis and iliopsoas

76

What are the three compartments of the femoral sheath?

lateral, intermediate, medial

77

What is housed in the lateral compartment of the femoral sheath?

femoral a

78

What is housed in the intermediate compartment of the femoral sheath?

femoral v and proximal tributaries, great saphenous v, deep v of thigh

79

What is housed in the medial compartment of the femoral sheath?

femoral canal, femoral ring, fat, deep inguinal lymph nodes

80

What key player is not housed in the femoral sheath?

Femoral n.

81

The entrance to the femoral canal is the?

Femoral ring

82

The femoral ring is an extension of?

the inguinal ligament

83

Femoral hernias are more common in which gender?

Females

84

The mass of the femoral hernia is located?

on the anterior thigh at the femoral triangle, lateral and inferior to pubic tubercle

85

Where in the femoral triangle is a femoral hernia located?

deep to inguinal canal via femoral ring, saphenous opening

86

The femoral triangle is important for what procedures?

Central access and coronary angioplasty

87

When you hear "circumflex" you should think of?

Supplying a joint

88

The descending branch of the lateral circumflex femoral anastomoses with?

superior lateral genicular artery

89

The medial CFA is associated with what bone?

Neck and head of the femur

90

The medial CFA could be impacted by this injury?

neck fracture and/or hip dislocation

91

The lateral CFA is associated with?

mm. lateral aspect of the thigh

92

Is it common to see the lateral CFA impacted by injury?

Not really

93

What are the three branches of the lateral CFA?

ascending, descending, transverse

94

What are the four "cruciate anastomosis" of the posterior thigh

Medial circumflex femoral, lateral circumflex femoral, inferior gluteal, 1st perforating

95

What are the two branches of the obturator a?

Posterior, Anterior

96

The anterior branch of the obturator a supplies what muscles?

pectineus, adductors of the thigh, gracilis, obturator externus

97

Posterior branch of the obturator a supplies what?

head of femur, mm. ischial tuberosity

98

Is the fibula part of the knee?

No

99

Is the knee mechanically strong or weak?

Weak

100

What are the crucial muscles of the knee?

Quadriceps femoris (vastus medialis and vastus lateralis)

101

What's a bursa?

fluid sacs and synovial pockets that surround and sometimes communicate with the joint cavity

102

Suprapatellar bursa location

between the anterior surface of the lower part of the femur and deep surface of the quadriceps femoris

103

What does the suprapatellar bursa allow for?

movement of the quadriceps tendon over the distal end of the femur

104

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.

105

What are the muscles that have tendons conjoin at the pes anserinus?

gracilis, sartorius, semitendinosus

106

How does the pes anserinus related to ACL tear?

Semitendiosus can be used for ACL tear

107

What are the two components of the joint capsule?

fibrous layer and synovial membrane

108

Which layer (fibrous or synovial) is deepest?

Synovial

109

Where does the synovial membrane not cover?

the central aspect of the joint (so the anterior and posterior cruciate ligament)

110

Two categories of knee ligaments:

extracapsular, intracapsular

111

Extracapsular ligaments:

patellar, fibular collateral, tibial collateral, oblique popliteal, arcuate popliteal

112

Intracapsular ligaments:

cruciate, menisci, tendon of popliteus

113

Where does the fibular collateral ligament attach?

lateral epicondyle of femur to head of fibula

114

What does the fibular collateral ligament split?

biceps femoris tendon

115

Which is stronger fibular collateral ligament or tibial collateral ligament?

Fibular collateral ligament

116

Where does the tibular collateral ligament attach?

medial epicondyle to tibia medial condyle

117

Which is more likely to be damaged fibular collateral ligament or tibial collateral ligament?

tibial collateral ligament

118

The tibial collateral ligament attaches to femur medial epicondyle and tibia medial condyle, but also where?

medial meniscus

119

The tibial collateral ligament is often injured with?

medial meniscus

120

Deep to the fibular collateral ligament, you can find?

the tendon of the popliteus

121

What two extracapsular ligaments strengthen the capsule posteriorly?

Oblique popliteal ligament and acruate popliteal ligament

122

What acronym can be used to remember ACL attachments?

APEX

123

What are the attachments of the ACL:

anterior tibia, posteriorly & externally (laterally) to femur lateral condyle

124

What are the actions of the ACL?

prevents posterior displacement of femur on tibia, prevents hyperextension of knee

125

What is notable about the ACL?

Weak and poor blood supply

126

Is the ACL slack or flexed when knee is flexed?

Slack

127

Is the ACL slack or flexed when knee is extended?

flexed

128

When knee is flexed 90 degrees, what cannot be pulled anterior?

Tibia

129

What is the acronym to remember PCL?

PAIN

130

PAIN

posterior tibia, anteriorly and internally (medially) to femur medial condyle

131

Which is stronger: ACL or PCL?

PCL

132

What are the actions of the PCL?

prevents anterior displacement of femur on tibia, prevents hyperflexion of knee

133

Is the PCL slack or flexed when knee is flexed?

Flexed

134

What is the main ligament stabilizer of femur in a weight-bearing flexed knee position (walking down hill)?

PCL

135

What shape is the medial meniscus?

C-shaped

136

The medial meniscus is associated with which ligament?

tibial collateral ligament

137

What shape is the lateral meniscus?

almost circular but smaller

138

Which meniscus is freely moveable?

Lateral meniscus

139

Is the medial or lateral meniscus more likely to be injured?

Medial meniscus

140

The posterior meniscofemoral ligament joins?

Lateral meniscus to PCL

141

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

142

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.

143

Unhappy triad is common in which sports?

football and basketball

144

Anterior knee innervation?

femoral

145

Posterior knee innervation?

tibial

146

Lateral knee innervation?

common fibular n

147

Medial knee innervation?

obturator and saphenous nn

148

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)

149

What rami do the cluneal nerves arise from?

Superior, lateral, and medial arise from dorsal rami. Inferior cluneal nn arises from ventral rami.

150

The cluneal nerves are terminal branches of?

posterior femoral cutaneous nerve of the thigh

151

Medial rotates are located anteriorly or posteriorly?

Anteriorly

152

Lateral rotators are located anteriorly or posteriorly?

Posteriorly

153

Which is weaker medial or lateral rotators?

Medial are weaker

154

Stronger ligaments are associated with medial or lateral rotators?

medial rotators (anterior)

155

Name the hip joint ligaments:

Iliofemoral ligament, pubofemoral ligament, Ischiofemoral ligament, ligament of the head of the femur

156

What is the shape of the Iliofemoral ligament?

Y-Shaped

157

Which is the strongest hip joint ligament?

Iliofemoral

158

Where does the Iliofemoral ligament attach?

Anterior inferior iliac spine, acetabular rim to intertroachanteric line

159

Iliofemoral ligament limits?

hyperextension and lateral rotation

160

What is the second strongest hip joint ligament?

Pubofemoral ligament

161

Pubofemoral ligament limits?

tightens extension and abduction at the hip joint

162

Which is the weakest hip joint ligament?

Ischiofemoral ligament

163

Where does the ischiofemoral ligament attach?

postero-inferior acetabular margin to femoral neck/greater trochanter

164

Ischiofemoral ligament limits?

extension and medial rotation

165

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

166

Where does the pubofemoral ligament attach?

obturator crest and the superior ramus of the pubis; below, it blends with the capsule and a ligament

167

What are the medial rotators of the thigh?

tensor fasciae latae, gluetus minimus, gluteus medius

168

What are the lateral rotators of the thigh?

quadratus femoris, gluteus maximus, piriformis, superior and inferior gemelli, obturator internus, obturator externus

169

The medial rotators of the thigh are innervated by?

Superior gluteal n

170

Functions of gluteus maximus:

powerful extensor, lateral rotator of thigh

171

What arteries supply gluetus maximus?

Superior and inferior gluteal arteries

172

The gluteus maximus is innervated by?

the inferior gluteal n.

173

Gluteus maximus is utilized in what common motion?

Bring your body up from sitting position

174

Actions of gluetus medius and minimus:

abduct thigh, medial rotation of thigh, keeps contralateral side of the pelvis from sagging to the unsupported side

175

Gluteus medius and minimus are innervated by?

Superior gluteal n.

176

What muscle is the chief flexor of the hip?

Iliopsoas

177

Actions of tensor fascia lata?

abduction & medial rotation + stabilizes extended knee + hip flexor

178

Tensor fascia lata is innervated by?

superior gluteal n.

179

Tensor fascia lata is supplied by?

Superior gluteal a

180

Injuries to the inferior gluteal n can occur from?

Inappropriately administering injections

181

Where is the safe space for gluteal injections?

Upper lateral quadrant

182

What will happen if you have an injury to the inferior gluteal n? (daily action)

Challenge to stand up and climb stairs

183

Injury to inferior gluteal n will result in what actions being limited?

Extension at the hip, lateral rotation at the hip

184

A superior gluteal n injury would impact what muscles?

gluteus medius, minimis, and tensor fascia lata

185

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

186

Positive Trendelenburg Gait is caused by an injury to

Superior gluteal n

187

Pelvis sags on the (same/opposite) side of lesion?

opposite

188

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)

189

What are the superficial gluteal muscles?

tensor fasciae latae, gluteus minmus, gluteus medius, gluteus maximus

190

What are the deep gluteal muscles?

obturator internus, superior and inferior gemelli, piriformis, quadratus femoris

191

Actions of piriformis and obturator internus:

When thigh is extended, lateral rotator. When thigh is flexed, abduct. Stabilize hip joint (femoral head)

192

Innervation of piriformis:

anterior rami of S1-S2

193

Innervation of obturator internus

Obturator internus n (L5-S1)

194

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.

195

The superior gemelli m is innervated by?

The n to obturator internus

196

The inferior gemlli m is innervated by?

the n to quadratus femoris

197

Action of quadratus femoris?

Strong lateral rotator

198

Quadratus femoris is innervated by?

quadratus femoris n

199

Piriformis syndrome is caused by:

overuse of gluetal mm or buttock trauma

200

Piriformis syndrome results in

hypertrophy and muscle spasms

201

Piriformis is more prevalent in which gender?

Females

202

What pierces through the piriformis in 12-15% of the population?

sciatic n.

203

Why do muscle spasms occur in piriformis syndrome?

muscle gets big, constriction in the space

204

What are the hip extensors?

gluteus maximus, biceps femoris, semitendinosus, semimembranosus, adductor magnus (hamstring)

205

What are the hip flexors? Posterior thigh

tensor fasciae latae

206

What are the hamstring muscles?

semimembranosus, semitendinosus and biceps femoris

207

Which hamstring muscles are innervated by tibial n. ?

semimembranosus, semitendinosus, becieps femoris (long head)

208

Which hamstring muscles are innervated by common peroneal portion of sciatic nerve (both L5, S1)?

biceps femoris (short head)

209

Hamstring injuries are common in what sport?

Hurdles (forced hip flexion with forced knee extension)

210

Where do hamstrings tend to detach in injury?

proximal attachment at ischial tuberosity

211

Sensory innervation of tibial division

skin on posterior aspect of leg, lateral ankle and foot, skin sole

212

Superolateral boundary of the popliteal fossa

biceps femoris

213

Superomedial boundary of the popliteal fossa

semimembranosus

214

Inferolateral and inferomedial boundary of the popliteal fossa

gastrocnemius (lateral and medial heads)

215

Posterior (roof) boundary of the popliteal fossa

skin and fascia

216

Anterior (floor) boundary of the popliteal fossa

popliteal surface femur, oblique popliteal ligament, popliteal fascia

217

Contents of popliteal fossa

small saphenous v, popliteal a/v, tibial and common fibular nn, posterior cuteaneous n of the thigh, popliteal LN and lymphatic v