Final: Lecture 19

Question 0

Hip relevant palpable features

Answer 0

•Greater sciatic notch, ischial spine, lesser sciatic notch, ischial tuberosity, articular (lunate) surface, acetabular fossa, acetabular notch, obturator foramen, auricular surface

Question 1

Hip muscle attachment sites

Answer 1

•Anterior gluteal line, posterior gluteal line, inferior gluteal line

Question 2

Hip palpable feature

Answer 2

•Iliac crest

Question 3

Sacrum muscle attachment, relevant impalpable, and palpable features

Answer 3

• Muscle: lateral sacral crest
• Impalpable: auricular surface, posterior sacral foramina, lumbosacral articular surface, sacral part of pelvic brim, anterior sacral foramina
• Palpable: median sacral crest

Question 4

Femur muscle attachment sites

Answer 4

•Greater trochanter, trochanteric fossa, intertrochanteric crest, greater trochanter, quadrate tubercle, gluteal tuberosity

Question 5

Structures exiting the Greater Sciatic Foramen

Answer 5

• Gluteal neurovascular bundles
• Piriformis m.
• Sciatic nerve
• Posterior Femoral cutaneous n
• Pudendal n and internal pudendal n
• Obturator internus/superior gemellus nerve

Question 6

Structures entering the Lesser Sciatic Forament

Answer 6

• Pudendal n and internal pudendal artery

* Obturator internus/superior gemellus nerve

Question 7

T/F the Obturator internus enters the Lesser Sciatic Foramen

Answer 7

•False, exits

Question 8

Superior gluteal nerve

Answer 8

• Leaves pelvis uperior to piriformis with superior gluteal artery
• Runs between gluteus medius and minimus
• **Supplies gluteus medius, minimus, and tensor fascia latae

Question 9

Inferior gluteal nerve

Answer 9

• Leaves pelvis inferior to piriformis with inferior gluteal artery
• **supplies gluteus maximus

Question 10

Sciatic nerve

Answer 10

• Leaves pelvis inferior to piriformis
• Runs inferiorly deep to gluteus maximus
• Usually divides about halfway down thigh into tibial and common fibular nerves
• L4-S3, doesn’t supply any gluteal structures

Question 11

Pudendal Nerve

Answer 11

• Anterior divisions of S2-S4 ventral rami
• S2, 3, 4 keeps your penis off the floor
• Most medial structure exiting greater sciatic foramen
• Reenters pelvis via lesser sciatic foramen to supply perineal structures

Question 12

Superior Gluteal Artery

Answer 12

• Largest internal iliac artery branch
• Superficial branch: gluteus maximus
• Deep branch: gluteus medius, minimus, and tensor fascia lata

Question 13

Inferior Gluteal Artery

Answer 13

• Supplies: Maximus, small lateral rotators, superior hamstrings
• Participates in cruciate anastomosis of thigh

Question 14

Internal Pudendal Artery

Answer 14

• Reenters pelvis via lesser sciatic foramen
• Supplies perineal muscles of ext genitalia
• Does not supply any gluteal structures

Question 15

Gluteus Maximus

Answer 15

• Chief extensor of thigh and lateral rotation
• Slight extension of leg when working with TFL, through IT band
• Innervation: Inferior gluteal (L5-S1)
• Attach at posterior gluteal line

Question 16

Gluteus Medius and Minimus

Answer 16

• Medius over minimus
• Thigh abduction and medial rotation
• Innervation: superior gluteal (L5-S1)

Question 17

Tensor Fascia Lata

Answer 17

• Innervation: superior gluteal

* Function: abducts, medially rotates, and flexes thigh, slight extension of knee along with maximus

Question 18

Iliotibial track of TFL

Answer 18

• Runs from iliac tubercle to tubercle (Gerdy’s) on lateral tibial condyle
• Reinforced by tendinous fibers from TFL and maximus
• Functions: assists in decelerating adduction of thigh (abduction), laterally stabilizes knee, Extends leg, compensate for quads paralysis, pulls patella laterally, antagonist of vastus medialis, and synergist with flexing vastus lateralis
• Stretch to treat chondromalacia patella

Question 19

What is it called when a patient has a superior gluteal nerve injury and loses steadying action of gluteus medius and minimus?

Answer 19

• Gluteal gait or limp, Positive Trendelenburg’s sign

* Will lean away from side that doesn’t work

Question 20

Piriformis

Answer 20

• lies deep to maximus
• medial to medius
• Demarcates gluteal blood vessels and nerves

Question 21

Obturator Externus

Answer 21

• Deep to pectineus
• Attachments: external margins of obturator foramen, trochanteric fossa
• Innervation: Obturator nerve (L3, L4)

Question 22

Which of the small lateral rotators is least effective when the thigh is flexed?

Answer 22

•quadratus femoris

Question 23

Posterior Thigh Muscles

Answer 23

• Hamstrings
• Common proximal attachment: ischial tuberosity, except short head of biceps femoris
• Common Innervation: tibial division of sciatic nerve, except short head (common fibular portion)
• Functions: thigh extension, except short head, leg flexion (all four)

Question 24

Semitendinosus

Answer 24

* long, cordlike tendon that begins 2/3 of the way down the thigh * Function: extend thigh, flex leg (med rotate) * Innervation: tibial division of sciatic nerve * Attachments: ischial tuberosity, medial surface of superior aspect of tibia

Question 25

Biceps Femoris

Answer 25

* Long head: flex leg, extend thigh, tibial division of sciatic, attach ischial tuberosity * Short head: only flexed leg, common fibular branch of sciatic, attach distal lateral lip of linea aspera * common insertion on the head of the fibula

Question 26

Adductor Magnus

Answer 26

* Attaches proximally at ischial tuberosity and distally to the adductor tubercle of the medial epicondyle of femur * Function: extend thigh * Innervation: tibial division of sciatic

Question 27

The diamond-shaped region posterior to the knee is call the ______ _______.

Answer 27

•Popliteal fossa

Question 28

Popliteal Fossa boundaries

Answer 28

* superomedially: semitendinosus and semimembranosus * Superolaterally: biceps femoris * Inferolaterally: lateral head gastrocnemius * Inferomedailly: medial head gastrocnemius

Question 29

Popliteal fossa contents (superficial to deep)

Answer 29

* Nerves * Popliteal vein, lymph nodes and branches * popliteal artery and branches

Question 30

What view terminates the popliteal vein?

Answer 30

•Small saphenous vein

Question 31

What nerve winds around the head and neck of the fibula and is susceptible to injury?

Answer 31

•Common Fibular (Peroneal) nerve