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anatomy > Gluteal and Thigh > Flashcards

Gluteal and Thigh Flashcards

1
Q

Femoral Triangle

A 
Borders:
1. Inguinal Ligament
2. Sartorius
3. Adductor Longus
Floor: psoas major, pectineus
Contents: femoral artery/vein and their branches, great saphenous vein, femoral nerve
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2
Q

Adductor Canal

A
  • Borders: medially adductor longus, laterally vastus medialis, roof: sartorius
  • Contents: femoral artery/vein, saphenous nerve (branch of femoral nerve), nerve to vastus medialis
  • thickening of fascia holds all these contents together on medial leg above knee
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3
Q

Creation of Greater Sciatic Foramen

A
  • Sacrospinous ligament attaches ischial spine to sacrum/coccyx to divide greater sciatic notch and lesser sciatic notch
  • Sacrotuberous ligament connects ischial tuberosity to ilium/sacrum/coccyx and turns notches into foramen
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4
Q

interosseous membrane

A

-connect tibia and fibula bones

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5
Q

interosseous border

A
  • receives more of weight bearing in the tibia

- made of fibers

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6
Q

patella

A
  • anterior side is convex
  • posterior side has 2 concave facets which articulate with femoral condyles
  • base is superior and apex is inferior, upside down triangle
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7
Q

intergluteal cleft

A
  • groove that separates buttocks from each other, buttcrack

- coccyx runs at superior border

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8
Q

gluteal fold

A
  • marks inferior aspect of gluteals and beginning of thigh
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9
Q

OINA: Gluteus maximus

A
  • O: dorsal surface of sacrum and coccyx, sacrotuberous ligament, ilium posterior to posterior gluteal line
  • I: (2 distal attachments) iliotibial tract which inserts into lateral condyle of tibia (most, superficial), some fibers (part, deep) on gluteal tuberosity by way of lateral intermuscular septum
  • N: inferior gluteal nerve (L5, S1, S2)
  • A: hip extension, external rotation, steadies thigh, helps sit to stand, posterior pelvic tilt (relative hip ext), help walk uphill/stairs
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10
Q

OINA: Gluteus medius

A
  • O: between anterior and posterior gluteal line on ilium
  • I: lateral surface of greater trochanter
  • N: superior gluteal nerve (L5, S1)
  • A: hip abduction, internal rotation (because where it attaches on greater trochanter), HUGE in gait, keep pelvis level when ipsilateral limb is weight bearing and opposite limb being advanced
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11
Q

open chain vs closed chain

A
  • open: distal part of limb is moving in space

- closed: in contact or stable with ground/surface

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12
Q

OINA: Gluteus minimus

A
  • O: between anterior and inferior gluteal line of ilium
  • I: anterior surface of greater trochanter
  • N: superior gluteal nerve (L5, S1)
  • A: hip abduction, internal rotation
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13
Q

Exercises to Strengthen Glut Med

A

exercise- clam shells with fire hydrant so you get more abd instead of ER (glut max), isometric hold is better neural connection, functional exercise: side lunge, monster walks (hinging), marching, sidelying hip abd (cue bend bottom knee and angle foot down at diagnol)

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14
Q

OINA: Tensor Fascia Latae

A
  • O: anterior aspect of iliac crest, ASIS
  • I: iliotibial tract to gerdy’s tubercle on lateral tibial condyle
  • N: superior gluteal nerve (L5, S1)
  • A: hip abduction, internal rotation, hip flexion because it sits anteriorly
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15
Q

“P- GO- GO-Q”

A

-superior to inferior: piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, quadratus femoris

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16
Q

OINA: Piriformis

A
  • O: anterior surface of sacrum, sacrotuberous ligament (S2-S4)
  • I: superior surface of greater trochanter
  • N: N to piriformis S1,S2 (composed of anterior rami S1,2)
  • A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum, if 90 degrees hip flex then acts as internal rotator
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17
Q

Sciatic Nerve

A
  • exits inferior to piriformis normally

- can also exit above, to the side, or through piriformis variable

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18
Q

triceps coxae

A
  • made of superior gemellus, obturator internus, and inferior gemellus
  • these work as a unit altogether even though they are separate
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19
Q

OINA: Gemellus Superior

A
  • O: ischial spine
  • I: (medial surface of greater trochanter) intertrochanteric fossa
  • N: nerve to obturator internus (L5,S1)
  • A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum
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20
Q

OINA: Gemellus Inferior

A
  • O: ischial tuberosity (superior)
  • I: (medial surface of greater trochanter) intertrochanteric fossa
  • N: nerve to quadratus femoris (L5,S1)
  • A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum
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21
Q

OINA: Obturator Internus

A
  • O: internal pelvic surface of obturator membrane and surrounding bones
  • I: (medial surface of greater trochanter) intertrochanteric fossa
  • N: nerve to obturator internus (L5,S1)
  • A: external rotation extended hip, abduct flex hip, steadies femoral head in acetabulum, dancing
  • SPECIAL: start on inside of pelvis and exits lesser sciatic foramen making 90 degree turn, sits in pelvis but it is a hip muscle
  • deeper muscles have to work harder after sitting all day because glutes are lengthened and create symptoms
22
Q

OINA: Quadratus Femoris

A
  • O: lateral border of ischial tuberosity
  • I: quadrate tubercle of intertrochanteric crest and area inferior to it
  • N: nerve to quadratus femoris (L5,S1)
  • A: laterally rotates thigh, steadies femoral head in acetabulum
23
Q

OINA: Obturator Externus

A
  • found underneath quadratus femoris
  • O: margins of obturator foramen and membrane
  • I: trochanteric fossa
  • N: obturator nerve (L3,4)
  • A: lateral rotates thigh and steadies femoral head in acetabulum
24
Q

Bursae

A
  • minimize friction and allow greatest ease of movement
  • fluid filled sacs lined with synovial membranes
  • located in areas of high fricition
25
Q

Gluteofemoral Bursae

A

-separates iliotibial tract from superior part of proximal attachment of vastus lateralis

26
Q

Ischial Bursae

A
  • separates inferior part of glute max from ischial tuberosity
  • can be bothered during sitting, rowing, cycling possibly
27
Q

Trochanteric Bursae

A
  • separates superior fibers of glute max from greater trochanter
  • weak glut meds and rubbing of IT band walking uphill can irritate this
  • plunging good for blood flow at bursae because it is inflamed so you don’t want to put pressure on it
28
Q

Fascia Lata

A
  • surrounds entire thigh
  • IT band is continuous with fasia lata but just thicker on the lateral side of leg
  • can’t change length of IT band
  • work on parts anterior and posterior to IT band to relieve symptoms, but you are actually working on fascia of IT band
29
Q

Intermuscular Septums and Compartments

A
  • Lateral femoral intermuscular septum: separates antreior and posterior compartments of thigh, strongest
  • Posteromedial FIS: separates posterior and medial compartments
  • Anteromedial FIS: separates anterior and medial compartments
  • Compartments: Anterior(quad and hip flexors), medial (adductors), and posterior (hamstrings)
30
Q

OINA: Sartorius

A
  • O: ASIS and superior part of notch inferior to it
  • I: superior part of medial tibia via pes anserine
  • N: Femoral nerve (L2,L3)
  • A: Hip flexion, abd, ER, weak knee flex, IR the leg with knee flexed, FABER
  • longest muscle in body so mainly a synergist
31
Q

OINA: Rectus Femoris

A
  • O: AIIS and ilium superior to acetabulum
  • I: base of patella via quad tendon/tibial tuberosity via patellar lig
  • N: femoral nerve (L2,L3,L4)
  • A: knee ext, hip flex
32
Q

OINA: Vastus Medialis

A
  • O: intertrochanteric line and medial lip of linea aspera
  • I: via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
  • N: femoral nerve (L2,L3,L4)
  • A: Knee ext
33
Q

OINA: Vastus Lateralis

A
  • O: greater trochanter, and lateral lip of linea aspera
  • I:via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
  • N: femoral nerve (L2,L3,L4)
  • A: knee ext
  • largest of quads
34
Q

OINA: Vastus Intermedius

A
  • O: anterior and lateral surface of shaft of femur
  • I:via common tendinous (quad tendon) and I attach to base of patella, indirectly via patellar lig to tibial tuberosity
  • N: femoral nerve (L2,L3,L4)
  • A: knee ext
35
Q

OINA: Pectineus

A
  • O: superior ramus of pubis
  • I: pectineal line of femur, just inferior to lesser trochanter
  • N: Femoral n. (L2,3), may receive branch from obturator nerve, shares same nerve root level as gracilis
  • A: Hip flex, add, assists in med rotation of thigh
  • seen as a transitional muscle between anterior and medial compartments
36
Q

Layers of Medial Thigh

A
  • Superficial Layer: pectineus and adductor longus
  • Intermediate Layer: adductor brevis lies deep to adductor longus and pectineus
  • Adductor magnus separates hamstrings and adductors
  • Adductors contribute to hip flexion from full extension and hip extension from fully flexed position when running or against resistance
37
Q

OINA: Adductor Longus

A
  • O: body of pubis inferior to pubic crest
  • I: middle 1/3 of linea aspera
  • N: obturator nerve (L2,L3,L4)
  • A: hip add
38
Q

OINA: Adductor Brevis

A
  • O: body of inferior pubic ramus
  • I: pectineal line and proximal part of linea aspera
  • N: obturator nerve (L2,L3,L4)
  • A: hip add, some flex of hip
39
Q

OINA: Adductor Magnus

A

-adductor and hamstring
-O: adductor- inferior ramus of pubis and ramus of ischium
hamstring: ischial tuberosity
-I: adductor- gluteal tuberosity, linea aspera, and medail supracondylar line
hamstring- adductor tubercle
-N: adductor- obturator nerve (L2,L3,L4)
hamstring- tibial branch of sciatic nerve (L4)
-A: adductor- add of hip, hip flex
hamstring- hips ext, add

40
Q

OINA: Gracilis

A
  • O: body of inferior ramus of pubis
  • I: medial aspect of anterior tibia via pes anserine
  • N: obturator nerve L2,L3
  • A: hip adduction, weak flex and IR
41
Q

pes anserine

A
  • muscles that attach here: say grace before tea
    1. sartorius
    2. gracilis
    3. semitendinosus
  • provide medial support to extended knee
42
Q

OINA: Semimembranosus

A
  • O: ischial tuberosity
  • I: posterior aspect of medial tibial condyle
  • N: tibial divison of sciatic nerve (L5,S1,S2)
  • A: hip ext, knee flex, IR of knee with knee flex
  • Has 3 distal attachment parts:
    1. posterior aspect of medial tibial condyle
    2. blends with popliteal fascia
    3. attaches to oblique popliteal ligament to reinforce posterior joint capsule at intercondylar part
43
Q

OINA: Semitendinosus

A
  • O: ischial tuberosity
  • I: medial surface of superior part of tibia
  • N: tibial divison of sciatic nerve (L5, S1,S2)
  • A: hip ext, knee flex, IR of knee with knee flexed
  • becomes tendon early on in thigh
44
Q

OINA: Biceps Femoris Long Head

A
  • O: ischial tuberosity
  • I: lateral side of fibular head
  • N: tibial division of sciatic nerve (L5, S1,S2)
  • A: hip ext, knee flex, ER of knee with knee flexed
45
Q

OINA: Biceps Femoris Short Head

A
  • O: linea aspera and lateral supracondylar line of femur
  • I: lateral side of fibular head, tendon is split by fibular collateral lig of knee
  • N: common fibular branch of sciatic n (L5,L1,L2)
  • A: accelerating mass during first step of gait
46
Q

Neural Tension Testing

A
  • creates tension in structures to duplicate pain
  • work on soft tissue around nerves so you don’t inflame nerve more but actually make it easier to glide in muscles
  • Sciatic Nerve: ankle dorsiflexion, knee ext, hip flex, trunk flex, SLUMP
  • femoral nerve: hip ext, knee, flex, dorsiflexion of ankle, trunk ext
  • obturator nerve: hip abd, IR hip, knee flex, dorsiflex of ankle
47
Q

Cluneal Nerve

A
  • superficial nerves that supply skin in gluteal region
48
Q

Superior cluneal nerve

A
  • post Rami L1, L2, L3
  • passes inferiorly along iliac crest
  • sensory to superior buttock as far as tubercle of iliac crest
49
Q

Middle cluneal nerve

A
  • post Rami S1,2,3
  • exit via sacral foramen and supply gluteal region just laterally
  • sensory to skin covering sacrum adjacent to buttocks
50
Q

Inferior cluneal nerve

A
  • ant rami S2,3 via branches from posterior cutaneous femoral nerve of thigh
  • come from inferior border of gluteus maximus and ascend vertically
  • sensory to inferior half of buttocks as far laterally as greater trochanter
51
Q

Peripheral Cutaneous Distribution vs Dermatomes

A
  • myotomes: primary spinal neurosegments that create motor activation, voluntary control
  • dermatomes: focus on A/B map slide 37, nerve root, plexuses from APR/PPR
  • Peripheral Cutaneous: what is formed from branches, more of nerve itself, sensory function
  • focus on ASIA
52
Q

Lesion to L4 nerve root vs femoral root

A

L4 nerve root
- weak knee ext, ankle dorsiflex, hip ext
-impaired sensation along anterior and medial aspect of lower leg
-not as sever symptoms because of dermatome overlap and distance between nerve and muscle
Femoral nerve root damage
-paralysis of knee ext, only nerve applying muscle to extend knee
-altered sensation along anterior surface of thigh, minus lateral portion from lateral femoral cutaneous nerve

anatomy (8 decks)

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