LE Notes Flashcards
(253 cards)
1
Q
The kidney is [periotneal/retroperitoneal]. It is situated partly agains the __ and partly agains the __ and is surrounded by ___.
A
The kidney is RETROPERITONEAL. It is situated partly against the DIAPHRAGM and partly against the POSTERIOR BODY WALL MUSCLES. It is surrounded by FAT, CONNECTIVE TISSUE, and RENAL FASCIA.
2
Q
The kidney does/does not move with respiration. Why?
A
DOES move with respiration because it sits partly against diaphragm.
3
Q
Which kidney sits higher in the abdomen? At what levels do both sit?
A
LEFT kidney (ribs 11 & 12) is higher than right kidney (rib 12)
4
Q
The abdominal aorta begins at the ___ [opening for aorta in diaphragm] and ends at ___ vertebral level where it biforcates into ___. In the abdomen, branches include the ___, ___ (L_), ___ (L_), ___, ____, and ___.
A
Abdominal aorta begins at the AORTIC HIATUS of diaphragm and ends at L4. Biforcates into 2 COMMON ILIAC AA. Abdominal branches: Celiac trunk, Superior Mesenteric a. (L1), Inferior Mesenteric a. (L3), Renal a., Suprarenal a., Gonadal a. (Testicular a. in males, Ovarian a. in females)
5
Q
Aortic aneurysms occur because of 2 reasons… They often present as ___. They [can/cannot] be repaired, but a ruptured aneurysm has [high/low] mortality rate, about __-__%.
A
Congenital or acquired weakness in arterial wall. Often present as pulsating back pain. CAN be repaired, but ruptured aneurysm has HIGH mortality rate (50-70%)
6
Q
The kidneys are supplied by the ___ arteries which come off of the __ around the level of the ___. About ___% may have ___ aa. (extras) that enter the hilus or somewhere else on the kidney.
A
Kidneys are supplied by the RENAL arteries. Left and Right renal arteries come off of the AORTA around the level of the SUPERIOR MESENTERIC A. (L1). About 30% have ABERRANT AA. that enter the hilus or somewhere else on kidney
7
Q
Venous drainage of the kidneys goes to the ___ via ___ vv. The IVC runs [ant/post] to the Right renal artery.
A
Venous drainage: L and R renal veins dump into IVC. IVC runs ANTERIOR to R renal a.
8
Q
The kidney consists of the outer part called the ___, the ____ (the rest of the kidney), and a system of ducts.
A
Outer part = cortex.
Rest of kidney minus cortex = Medulla
9
Q
The pyramids are found in what part of the kidney? What do they do? How many are in each kidney? What are papillae?
A
Pyramids are found in the MEDULLA of the kidney. There are about ~10ish pyramids per kidney and they are part of the filtering system. Each pyramid comes to a tip called the PAPILLAE. There, it starts to drain the urine into the duct system of the kidney
10
Q
Describe the duct system of the kidney beginning at the pyramids.
A
Each pyramid comes to a tip called the PAPILLAE. Each papillae has a MINOR CALYX associated with it, which is the first part of the duct system. Minor calicies empty into ~3 MAJOR CALICIES which drain into the RENAL PELVIS which drains into the URETER.
11
Q
The gonadal vessels from [ant/post] to the ureter
A
Gonadal vessels cross ANTERIOR to ureter.
12
Q
The ureters run downward and [laterally/medially] [anterior/posterior] to the psoas major. They are crossed [anteriorly/posteriorly] by the gonadal vessels. Better stated, from anterior to posterior you see ___.
A
Ureters run downward and MEDIALLY, ANTERIOR to psoas major. Ureters are crossed ANTERIORLY by gonadal vessels. Ant to post: Gonadal vessels, Ureter, psoas major
13
Q
Describe hydronephrosis.
A
Hydronephrosis: may occur in pregnancy. Distention of kidney due to enlargement of OVARIAN A. which compresses the URETER.
14
Q
The ureter runs [ant/post] to the sacroiliac joint. It is a duct made of __.
A
ANTERIOR to sacroiliac joint. Duct made of SMOOTH MUSCLE
15
Q
The suprarenal glands are [peritoneal/retroperitoneal]. The right adrenal is __ shaped, and the left adrenal is __ shaped. Their function is only [endocrine/exocrine]. Describe that function.
A
Suprarenal glands are RETROPERITONEAL. Right = TRIANGULAR shaped. Left = HALF MOON shaped.
Function: ONLY ENDOCRINE. Cortex secretes CORTICOSTEROID (normally part of stress response). Medulla secretes EPINEPHRINE (nervous/excited chemical!)
16
Q
The __ is the muscle important in hip hiking.
A
Quadratus lumborum
17
Q
The ___ overlaps quadratus lumborum anteriorly. It sits [lateral/medial] to QL.
A
The PSOAS MAJOR overlaps QL anteriorly and sits MEDIALLY to QL
18
Q
The __ and __ join. Together, they’re referred to as the Iliopsoas and act in ___.
A
Psoas major and Iliacus joint = Iliopsoas. STRONG HIP FLEXORS
19
Q
The psoas minor is found in ___%. It does/does not contribute to the iliopsoas.
A
Psoas minor = <50%. DOES NOT contribute to iliopsoas. Has some action to posteriorly tilt pelvis, but not very functionally important
20
Q
Psoas major can [increase/decrease] lumbar lordosis. Why? Similarly, it can cause [tight/loose] hip flexors. Why?
A
Psoas major can INCREASE lumbar lordosis by pulling on its origin on the lumbar spine. Also can cause TIGHT hip flexors via its attachment to the lesser trochanter
21
Q
There are areas of thickened fascia over the ___, ___, ___, and ___. These areas of fascia are continuous with the ___.
A
Quadratus lumborum, psoas, diaphragm, and iliacus. These are continuous with the TRANSVERSALIS FASCIA.
22
Q
The diaphragm is __ shaped when relaxed and during expiration. It takes its origin from the right and left ___, as well as thickened fascia over the ___, ___, and ___. The diaphragm fibers arch up and insert on the ___.
A
Diaphragm is DOME shaped when relaxed and during expiration. Originates from RIGHT CRUS, LEFT CRUS, and thickened fascia over the QUADRATUS LUMBORUM (Lateral arcuate ligament), PSOAS (Medial Arcuate ligament), and Aorta (Median Arcuate Ligament). Fibers insert on CENTRAL TENDON
23
Q
3 apertures in the diaphragm. Name them and give the vertebral level at which they are found.
A
- Vena Caval Aperature (highest, sits at T8. Goes THROUGH CENTRAL TENDON)
- Esophageal Aperature (T10. Right crus of diaphragm loops around esophagus and strengthens the sphincter)
- Aortic Aperature (lowest, most posterior [right against vertebral bodies], at T12)
24
Q
The lumbrosacral plexus forms within the substance of the __ muscle from the [dorsal/ventral] rami of ___-____, plus some communication from ___.
A
Lumbrosacral plexus: forms within substance of PSOAS muscle.
From VENTRAL rami of L1-L4 plus some T12 (subcostal n.)
25
L_ joins __ to form the lumbrosacral trunk. This joins the sacral plexus (S_,_,_) to form the ____. What does that innervate?
L4 joins L5 to form lumbrosacral trunk. This joins sacral plexus (S1,2,3) to form LUMBROSACAL PLEXUS. This innervates some lower trunk but mostly lower ribs
26
The subcostal N. comes from ___ and runs under the ___.
Subcostal n. = from T12, runs under 12th rib
27
Branches from L1 appear [medial/lateral] to psoas and run ant/post to QL.
Branches from L1 appear LATERAL to psoas and run across ANTERIOR to QL.
28
The iliohypogastric n. ([upper/lower] branch of L___) appears on the [med/lat[ border of the psoas [ant/post] to the quadratus lumborum. It becomes cutaneous lower down and innervates the ___. It supplies the ___ muscles.
Iliohypogastric n. is the UPPER branch from L1. Appears on LATERAL border of psoas ANTERIOR to QL. Cutaneous: middle groin. Motor: Abdominal muscles
29
Ilioinguinal N. ([upper/lower] branch of L___). May come off together with ___ n. It exits at the [med/lat] border of the psoas and goes through the ___. It provides cutaneous innervation to the ___ as well as the ___.
Ilioinguinal n. (LOWER branch from L1). May come off together with iliohypogastric n. Exits at LATERAL border of psoas and goes through the SUPERFICIAL INGUINAL RING. It provides cutaneous innervation to the PUBIC REGION, ANTERIOR SCROTUM or LABIA MAJORA. Also gives cutaneous innervation to UPPER MEDIAL THIGH
30
The genitofemoral n. (L___) pierces and lies on the ANTERIOR surface of the ___. It has 2 parts: ___ and ___. The first part runs more [medially/laterally], leaves the abdomen through the ___, joins the contents of the ___, and supplies the ___. The second part runs more [medially/laterally], goes under the ___ and supplies the ___.
Genitofemoral n. (L1, 2). Pierces and lies on anterior surface of PSOAS MAJOR. 2 Parts:
(A) Genital branch - more medially, leaves abdomen through DEEP RING and joins contents of SPERMATIC CORD. It supplies the CREMASTER M. and SKIN OF SCROTUM or LABIA MAJORA.
(B) Femoral branch - more lateral, goes UNDER INGUINAL LIGAMENT, and provides cutaneous innervation to ANTERIOR THIGH
31
The lateral femoral cutaneous n. (L___) emerges [medial/lateral] to the psoas. It runs across the ___ muscle, a little lower than what other nn? It emerges below the lateral portion of the ___ and crosses over/under the ligament. It innervates ___ and provides ONLY cutaneous/motor innervation.
Lateral Femoral Cutaneous N. (L2,3)
-Emerges LATERAL to psoas, runs across ILIACUS muscle lower than the ilioinguinal or iliohypogastric nn. Emerges below lateral portion of INGUINAL LIGAMENT (Crosses under ligament). It provides ONLY CUTANEOUS innervation and innervates the skin of the LATERAL THIGH down to the knee
32
The femoral n. (L___) passes [medial/lat] to psoas and runs in the groove between the ___. It crosses under the ___. It provides motor innervation to the ___ and cutaneous innervation to the ___.
Femoral n. (L2,3,4) runs passes LATERAL to psoas and runs in groove between PSOAS AND ILIACUS. It crosses under INGUINAL LIGAMENT. Motor: Muscles of anterior thigh (quads), Cutaneous: Ant/medial thigh and medial leg (mediocutaneous n. of the leg) to the ankle
33
The obturator n. (L___) runs [medial/lat] to psoas along the ____. It exits the ___ foramen through the ___ canal in the upper part of the ____. It provides motor innervation to the __ and cutaneous innervation to the ___.
Obturator N. (L2,3,4): runs MEDIAL to psoas along the LATERAL PELVIC WALL. It exits the OBTURATOR FORAMEN through the OBTURATOR CANAL in the upper part of the OBTURATOR MEMBRANE. Motor: Adductor muscles on medial thigh, Cutaneous: Skin of medial thigh
34
Lumbrosaocral trunk (L___) runs [lat/medial] to psoas and runs into the ___. It contributes to and combines with the ___ in the pelvis. It runs [sup/deep] to the obturator n.
Lumbrosacral trunk (L4,5) runs MEDIAL to psoas and runs into PELVIS. Combines with SACRAL PLEXUS in pelvis, and runs DEEP to Obturator n.
35
The sciatic n. (give nerve levels) is made of 2 components: (1) ___ n. (L__, S__) which innervates the ___; (2) ____ n. (L__, S__) which innervates the ___.
Sciatic n. (L4,5,S1,2,3) has 2 compnents:
(1) Tibial N. (L4,5,S,1,2,3) - supplies posterior leg, posterior thigh
(2) Common peroneal (fibular) (L4,5,S1,2) - supplies lateral and anterior leg
36
The common peroneal n. is a branch of ___. It further divides into the ___ and ___.
Common peroneal (fibular) (L4,5,S1,2) is a component of the SCIATIC N.. It further divides into
- SUPERFICIAL PERONEAL (FIBULAR) (L5, S1,2)
- DEEP PERONEAL (FIBULAR) (L4,5,S1)
37
Give the nerve roots that contribute to the superior gluteal n. and the inferior gluteal n.
Superior gluteal n - L4,5, S1
| Inferior gluteal n. - L5, S1,2
38
The pudendal n. provides sensation in the ___.
Pudendal n. - sensation in perineum, genitals, urogenital triangle
39
Small branches of the lumbrosacral plexus are sent to the __, __, and ___.
Piriformis, obturator internus, levator ani
40
Pelvic organs are draped with ___ which causes the formation of ___ and ____.
Pelvic organs are draped with PERITONEUM (dips between organs, but doesn't actually suspend them); forms POUCHES and "LIGAMENTS"
41
___ is the space between the bladder and rectum in males.
Rectovesical pouch
42
___ is the space between the rectum and the uterus in females.
Rectouterine pouch
43
___ is the space between the bladder and uterus in females.
Vesicouterine pouch
44
The broad ligament consists of __ (#) layers of peritoneum that fuse together after draping over the ___. Within the broad ligament are the ____ and ___ situated in the ___ and ___ respectively.
Broad ligament = 2 layers of peritoneum that fuse after draping uterus. The ROUND LIGAMENT is in the ANTERIOR LAMINA and the PROPER LIGAMENT of the OVARY is in the POSTERIOR LAMINA.
45
The round ligament runs along the ___, through the ___ to the ___. It is in the ____.
Round ligament = runs along PELVIC RIM through DEEP RING to LABIA MAJORA. Runs in ANTERIOR LAMINA of broad ligament
46
The "Proper" Ligament of the Ovary runs between the ___ and ___ in the ____. It stabilizes the relative to the ___.
Proper ligament of the ovary stabilizes (and runs between) the ovary relative to the uterus
47
The bladder is located posterior to the ___. It rests on ___ in females and ___ in males. It is made of interlacing ___, called ___.
Bladder is post. to PUBIC SYMPHYSIS. Rests on PELVIC DIAPHRAGM (Pelvic floor) in female. Rests on PROSTATE in male. Made of interlacing SMOOTH MUSCLE called DETRUSOR MUSCLE
48
Describe the openings to the bladder
Ureters - 2 in the base (back side of bladder)
| Urethra - one opening from the neck of the bladder (goes through pelvic floor and through prostate in men)
49
Describe the sphincters in the bladder. Where are they and how are they innervated?
Internal urethral sphincter (Smooth muscle, PARASYMPATHETIC)
| External urethral sphincter (Skeletal muscle, VOLUNTARY)
50
During urination (AKA ___), [parasympathetic/sympathetic] innervation contracts the ___ muscle in the bladder and relaxes the [internal/external] sphincter. Additionally, we [voluntarily/involuntarily] relax the [internal/external sphincter]
Urination = MICTURITION
PARASYMPATHETICS contract DETRUSOR muscle to relax INTERNAL SPHINCTER
Voluntary relaxation of EXTERNAL sphincter
51
The ureters pass [ant/post] to the bifurcation of the common iliac aa. They pass [ant/post] to the sacroiliac joint and taper [medially/laterally] as they insert into the ___.
Ureters pass ANTERIOR to bifurcation of common iliac aa. and ANTERIOR to sacroiliac joint before they taper medially and end in the BASE OF THE BLADDER.
52
List the main features of the male pelvis contents.
Prostate gland, Seminal vesical, urethra
53
The prostate gland is situated between the __ and __. It makes secretions that add to the ___. It contains a large amount of ___ and ___. Prostatic tissue usually forms the wall of the ___.
Prostate gland: Between BLADDER and UROGENITAL DIAPHRAGM. Makes secretions that add to EJACULATE. Contains large amount of SMOOTH MUSCLE and DUCTS. Prostatic tissue usually forms wall of the PROSTATIC URETHRA (part that passes through prostate gland)
54
Describe the problems to the bladder/urethra caused by Prostatic hypertrophy.
It compresses the urethra, and urine backs up into the bladder. This stretches the bladder and its muscles so that they are no longer efficient. Men need to urinate often because they are not fully emptying their bladder each time.
55
The seminal vesical lies against the ___ (border side) bladder. Its secretions add to the ___. The duct of the seminal vesicle joins the ___ to form the ___ which empties into the ___.
The seminal vesical lies against the POSTERIOR-LATERAL BLADDER. Its secretions add ot the ejaculate. The duct of the seminal vesicle joins the VAS DEFERENS to form the COMMON EJACULATORY DUCT which empties into the PROSTATIC URETHRA
56
In men, the urethra consists of three parts. Name them and describe where they pass.
PROSTATIC (through prostate)
MEMBRANOUS (passes through pelvic floor muscles; very short; sphincters act on urethra here)
PENILE (travels through penis to outside world)
57
Describe the contents of the female pelvis.
Ovary, Uterine tube (AKA oviduct, Fallopian tube), Uterus, Broad Ligament, Vagina, Rectum
58
The ovary is __-shaped and ~__cm long. It is suspended from the ___ of the broad ligament by ___. It is attached to the lateral pelvic wall by the ___. It is attached at its medial end to the uterus by the ___.
The ovary is ALMOND-shaped and ~3 long. It is suspended from the POSTERIOR LAMINA of the broad ligament by MESOVARIUM. It is attached to the lateral pelvic wall by the SUSPENSORY LIGAMENT OF THE OVARY. It is attached at its medial end to the uterus by the PROPER OVARIAN LIGAMENT (in the broad ligament).
59
The ovarian vessels, artery, and vein are covered in fascia, and together they make up the ___.
Ovarian vessels, artery, and vein covered in fascia an dmake up the SUSPENSORY LIGAMENT OF THE OVARY
60
The uterine tube is AKA ___ or ___. It extends from the __ to the ___ and connects the ___cavity with the ___ cavity. It is about __ cm long and is draped in peritoneum called ___.
Uterine tube AKA oviduct, fallopian tube. Extends from UTERUS to OVARY and connects UTERINE CAVITY with PERITONEAL CAVITY. About 10cm long, draped in peritoneum called MESOSALPINX (part of broad ligament)
61
Describe the 4 parts of the uterine tube
(1) Infindibulum - has fimbrae [finger-like projections] to sweep ovulated egg into tube, trumpet-like opening
(2) Ampulla - wide, thin walled, egg is usually fertilized here
(3) Isthmus - narrow, near uterus
(4) Uterine portion - passes through uterine wall (where it implants)
62
The uterus is __-shaped and sits behind the ___, anterior to the ___. It is about __cm long and __cm wide. It has 3 parts: __, __, and __.
Uterus is PEAR-SHAPED and sits behind BLADDER, anterior to the RECTUM. 8cm long, 5cm wide. Parts: (1) Fundus (above uterine tubes), (2) Body [or corpus], (3) Cervix - narrow inferior part that protrudes into vagina
63
The ___ is the actual opening of the uterus into the vagina, while the ___ is the narrow inferior part of the uterus that protrudes into the vagina.
The EXTERNAL OS is the actual opening of the uterus into the vagina, while the CERVIX is the narrow inferior part of the uterus that protrudes into the vagina.
64
The uterus is oriented in situ so that it slants [forward/backward]. This is called ___ and is generally about __degrees from vertical, leaving the [ant/post] surface of the uterus to be completely covered by peritoneum.
The uterus is oriented in situ so that it slants FORWARD. This is called ANTEFLEXION and is generally about 45 from vertical, leaving the POSTERIOR surface of the uterus to be completely covered by peritoneum.
65
Name & describe the 3 parts of the broad ligament
Mesovarium - suspends ovary from posterior lamina
Mesosalpinx - surrounds uterine tube
Mesometrium - main part of broad ligament next to uterus
66
The vagina is about __cm long. It has ___ which are recesses around the cervix at the upper end of the vagina. The posterior ___ is covered with peritoneum and is adjacent to the ___ pouch.
Vagina = 10 cm long. Recesses around cervix = fornices. Posterior FORNIX is covered with PERITONEUM, and is adjacent to the RECTOUTERINE POUCH
67
The rectum begins at ___ (vertebral level) and is continuous with the ___. It turns __ degrees as it passes through the ___. This helps with ___ and reduces direct pressure of fecal matter on ___. The rectum does/does not have tenae coli. The rectum features one longitudinal coat of ___.
The rectum begins at S3 (vertebral level) and is continuous with the ANAL CANAL. It turns 90 degrees as it passes through the PELVIC DIAPHRAGM. This helps with CONTINENCE and reduces direct pressure of fecal matter on ANAL SPHINCTERS. The rectum DOES NOT have tenae coli. The rectum features one longitudinal coat of SMOOTH MUSCLE.
68
The pelvic outlet is the lower opening of the __. It is bounded by the __ and ___ (posteriorly), ___, and ___. It is closed by a muscular sheet known as the ___
Pelvic outlet = lower opening of PELVIS. Bounded by SACRUM & COCCYX (posteriorly), ISCHIAL TUBEROSITIES, PUBIC SYMPHYSIS (and inferior pubic ramus as you go anteriorly)
It is closed by a muscular sheet = PELVIC DIAPHRAGM
69
The pelvic diaphragm is a muscular sheet that forms a sling/hammock and controls the ___ and supports __. The __, __,and __ pass through the pelvic diaphragm, and the pelvic diaphragm acts as sphincters for these. Most important muscle of pelvic diaphragm is __.
Pelvic diapghram controls PELVIC OUTLET and supports PELVIC ORIGINS. URETHRA, VAGINA, and RECTUM all pass through. Most important = LEVATOR ANI
70
Describe the named subportions of th elevator ani.
Pubococcygeus (looks like a V anteriorly); a part of this = puborectalis= sphincter and support for rectum
Iliococcygeus (from fascia over obturator internus = tendinous arch)
Coccygeus (most posterior, AKA ischiococcygeus)
71
The internal iliac a. branches from the __ anterior to the sacroiliac joint. It gives off branches of internal iliac supply to the pelvic organs and 3 branches to the lower limb. Describe these 3 branches and where they exit the pelvis.
Internal iliac a. branches from COMMON ILIAC A.
3 branches go to lower limb:
(1) Superior gluteal a. [exits pelvis through greater sciatic foramen above piriformis]
(2) Inferior gluteal a. [leaves pelvis through greater sciatic foramen below piriformis]
(3) Obturator a. [runs forward with obturator n., exits through obturator canal]
72
The sacral plexus is part of the ___. It is comprised of [dorsal/ventral] primary rami of ____ and ___ (spinal cord levels). It arises from the anterior surface of the ___ and lies on the ant/post surface of the ___ muscle. Many of its branches leave through the ___.
Sacral plexus = part of LUMBROSACRAL PLEXUS. It is comprised of VENTRAL PRIMARY RAMI of L4 and L5 (lumbrosacral trunk) and S1-4. It arises from the anterior surface of SACRUM and lies on ANTERIOR surface of PIRIFORMIS muscle. Branches leave through greater sciatic foramen
73
Describe the path of the greater (great) saphenous vein (hit the origin, relationship to structures at ankle and knee, and what it empties into)
- Originates in medial border of dorsum of foot
- Runs ANTERIOR to medial malleolus
- Runs POSTERIOR to medial border of patella (runs behind the knee)
- Empties into FEMORAL V. in the groin through a defect in the deep fascia called the SAPHENOUS HIATUS
74
Describe the path of the Lesser (small) saphenous vein (hit the origin, relationship to structures at ankle, and what it empties into)
- From Lateral side of the dorsum of the foot
- Runs POSTERIOR to lateral malleolus (and up the back of the leg)
- Empties into Popliteal v.
75
The deep fascia of the leg is AKA ___. It attaches to ____ and divides the LE into compartments via the ___. The deep fascia is thickened laterally called the ___. This thickening acts as a "tendon" for the ___ and ___ muscles. The Deep fascia forms the ___ which helps to stabilize the patella as well as the ___ which support the ankle tendons.
The deep fascia of the leg is AKA FASCIA LATA (in the thigh). It attaches to ALL SUPERFICIAL BONY PROMINENCES and divides the LE into compartments via the INTERMUSCULAR SEPTA. The deep fascia is thickened laterally called the ILIOTIBIAL BAND. This thickening acts as a "tendon" for the TENSOR FASCIA LATA and GLUTEUS MAXIMUS muscles. The deep fascia forms the PATELLA RETINACULUM which helps to stabilize the patella as well as the the ANKLE RETINACULA which support the ankle tendons.
76
Name the spinal cord levels contributing to the following nerves:
- Iliohypogastric
- Genitofemoral
- Ilioinguinal
- Lateral (femoral) cutaneous n. of the thigh
- Iliohypogastric (L1)
- Genitofemoral (L1,2)
- Ilioinguinal (L1)
- Lateral (femoral) cutaneous n. of the thigh (L2,3)
77
Which nerve innervates the skin between the great and 2nd toes?
Deep Peroneal (Fibular) n.
78
Which nerve innervates the dorsum of the foot?
Superficial Peroneal (Fibular) N.
79
Which nerve innervates the sole of the foot?
Medial and lateral plantar nn. (terminal branches of tibial n.)
80
L1 dermatome
Uppermost thigh, groin
81
L2 dermatome
Midthigh
82
L3 dermatome
Thigh to medial knee
83
L4 dermatome
Medial leg
84
L5 dermatome
Lateral leg, dorsum of foot
85
S1 dermatome
Lateral foot, posterior leg
86
S2 dermatome
Posterior thigh
87
S3-C3 Dermatomes
Buttocks to anus
88
L1, 2 Myotome
Hip flexion
89
L3, 4 Myotome
Quads (knee extension), Adduction
90
L4, 5 Myotome
Dorsiflexion, Inversion
91
L5 Myotome
Abduction, Great toe Extension
92
L5, S1 Myotome
Hamstrings (knee flexion), Eversion
93
S1, 2 Myotome
Glutes (hip extension), Plantar flexion
94
Nerves innervating the anterior, medial, and posterior compartments of the thigh.
```
Anterior = Femoral n.
Medial = Obturator n.
Posterior = Tibial portion of sciatic n.
```
95
Nerves innervating anterior, lateral, and posterior compartments of the leg.
```
Anterior = Deep peroneal (fibular) n.
Lateral = superifical peroneal (fibular) n.
Posterior = Tibial n.
```
96
Nerves innervating dorsal and plantar foot
Dorsum = Deep peroneal (fibular) n.
| Plantar - Medial and lateral plantar nn. (terminal branches of tibial n.)
97
Describe the borders of the femoral triangle (superior, lateral, medial, and floor)
Superior: Inguinal ligament
Lateral: Sartorius
Medial: Adductor longus
Floor: Iliopsoas, pectineus
98
Describe the contents of the femoral triangle
NAVEL (lateral to medial)
| Femoral N., Femoral A., Femoral V., Femoral canal [Empty Space + Lymph]
99
What is enclosed in the femoral sheath?
Femoral A., femoral V, Lymph vessels/nodes
| *The Femoral Nerve is NOT contained in the femoral sheath
100
The femoral sheath is pierced by the ___ at the ___ to get access to the femoral vein.
Femoral sheath pierced by SAPHENOUS V. at SAPHENOUS HIATUS to access femoral vein
101
The femoral sheath is a ___-shaped, downward prolongation of __.
Funnel-shaped downward prolongation of FASCIA
102
The femoral sheath has 3 compartments. Describe each and its contents.
Lateral compartment: femoral a.
Middle compartment: femoral v.
Medial (smallest): femoral canal.
*Medial contains CT, lymph vessels, and nodes. Transmits efferent channels to external and internal iliac nodes. Acts as dead space for vein so vein can expand with LE activity.
103
The adductor canal is AKA __. It is a narrow ___ that begins at the ___ of the femoral triangle. It ends at the ___ and contains ___ en route to the ____. It lies [sup/deep] to the sartorius and runs in a groove between the __ and __ muscles.
Adductor canal = Hunter's Canal
- Narrow FASCIAL TUNNEL beins at APEX of FEMORAL TRIANGLE and ends at ADDUCTOR HIATUS. Contains FEMORAL VESSELS on their way to the POPLITEAL FOSSA. Lies DEEP to sartorius in the groove between ADDUCTOR LONGUS and VASTUS MEDIALIS
104
The obturator a. is a branch of the ___ a. It supplies the area of the ___, ___, and ___.
Obturator a. is branch of INTERNAL ILIAC A. It supplies area of OBTURATOR FORAMEN, ACETABULUM, & HEAD OF FEMUR
105
The femoral a. is a continuation of the ___ after it passes under the __. Its major branches include the ___ before it changes its name to the ___ a. at the ___ of the muscle.
Femoral a. = continuation of EXTERNAL ILIAC A. after passes under INGUINAL LIGAMENT. Its major branches are the PROFUNDA FEMORIS A. (branches to medial and lateral femoral circumflex aa. to supply neck of femur, as well as 4 perforating branches into posterior compartment). Changes name to POPLITEAL A. at the TENDINOUS HIATUS of ADDUCTOR MAGNUS
106
The profunda femoris a. is a branch of the ___ a. It gives rise to the ___ and ____. It also gives off four perforating branches. These are sent to the ____ compartment by perforating the ___ muscle close to its insertion on the ___ to supply the [ant/post] thigh.
The profunda femoris a. is a branch of the FEMORAL A. It gives rise to the MEDIAL FEMORAL CIRCUMFLEX A and LATERAL FEMORAL CIRCUMFLEX A. It also gives off four perforating branches. These are sent to the POSTERIOR compartment by perforating the ADDUCTOR MAGNUS muscle close to its insertion on the LINEA ASPERA to supply the POSTERIOR thigh.
107
Which quadriceps muscle originates from the anterior surface of the femur?
Vastus intermedius
108
The pectineus muscle is in the __ compartment. Its innervation is from the ___ n. and its action is to ___.
Pectineus = anterior compartment, DUAL innervation from Femoral N. and Obturator N. Flexes hip AND Adducts the thigh
109
The tensor fascia lata is innervated by the ___. Its origin on the ___ is shared with what other muscle?
TFL innervated by SUPERIOR GLUTEAL N. It has a shared origin with the SARTORIUS on the ASIS and it also originates on the iliac crest
110
Of the anterior thigh muscles, which are 2 joint muscles? Which cross only 1 joint?
2 joint: Sartorius, Rectus femoris
| 1 joint: Vastus lateralis, vastus medialis, vastus intermedius, Pectineus
111
The quadriceps muscles converge and insert on the ___. As a group, they act to do __.
Quads insert on QUADRICEPS FEMORIS TENDON. Act to do knee EXTENSION. Note: below the patella is the patellar ligament (patella --> tibial tuberosity)
112
Name the muscles that comprise the adductor group of the thigh.
Adductor longus, adductor brevis, Obturator Externus, Gracillis, Adductor Magnus
113
Which is the only muscle of the adductor group to cross the knee (and is therefore a 2 joint muscle)?
Gracillis
114
Which muscle of the adductor group is dually innervated? Describe its innervation.
Adductor Magnus is dually innervated. Fibers from pubis innervated by OBTURATOR N., fibers from Ischium (hamstring portion) innervated by TIBIAL N.
115
Which muscle of the anterior compartment of the thigh is dually innervated? Describe its innervation.
Pectineus - femoral n. and obturator n.
116
The opening at the distal attachment of the adductor magnus is called the ___.
ADDUCTOR HIATUS
117
What is the pes anserinus? Where is it?
Pes anserinus = "Foot of the Goose" ...common insertion point for the SARTORIUS, GRACILLIS, and SEMITENDINOSUS tendons on the upper, medial tibia
118
What is the Thomas test?
Test for tight hip flexors (iliopsoas). Lie supine, pull knees to chest, hold behind one knee and put opposite leg down straight. Normal: hamstring touches table. Bend the "down" leg: if that leg goes up (at the thigh) with knee flexion, indicates tightness of rectus femoris in addition to hip flexors
119
What is the gluteal fold?
Gluteal fold = skin crease over hip joint
120
The ___ ligament runs from the anterior surface of the sacrum to the ischial spine. This ligament closes off the ___ notch to form the ___ foramen.
SACROSPINOUS ligament: anterior sacrum --> ischial spine. Sacrospinous ligament closes off GREATER SCIATIC NOTCH to form the GREATER SCIATIC FORAMEN
121
The ___ ligament runs from the lateral surface of the sacrum to the ischial tuberosity. This ligament closes off the ___ notch to form the ___ foramen.
SACROTUBEROUS ligament: lateral sacrum to ischial tuberosity. Sacrotuberous ligament closes off the LESSER SCIATIC NOTCH to form the LESSER SCIATIC FORAMEN
122
The large bursa between the tendon of the gluteus maximus and the greater trochanter is called the __.
Trochanteric bursa
123
A __ exits between the top of the gluteus maximus and the gluteus minimus.
A fascial plane separates the superior portion of the glut max from the glut med
124
What runs superior to the piriformis? What runs inferior to the piriformis?
SUPERIOR to piriformis: Superior gluteal n. and a.
INFERIOR to piriformis: Inferior gluteal n. and a., Posterior femoral cutaneous n., sciatic n.
125
What passes through the lesser sciatic foramen?
Obturator internus
126
Describe the orientation of the superior and inferior gemelli in relation to the obturator internus.
Superior gemellus is SUPERIOR to obturator internus, and Inferior gemellus is INFERIOR to obturator internus
127
The superior and inferior gluteal aa. are branches from the ___ artery. They both exit the pelvis via the ___ foramen: the ___ exits above the ___ muscle, and the ___ exits below the __ muscle.
Superior and inferior gluteal aa. = branches of INTERNAL ILIAC A. Both exit via the GREATER SCIATIC FORAMEN: superior goes out above PIRIFORMIS and inferior goes out below piriformis
128
The posterior femoral cutaneous n. of the thigh runs [above/below] piriformis and runs [superifical/deep] to deep fascia. It supplies the cutaneous innervation to the ___.
Posterior femoral cutaneous n. of thigh runs BELOW piriformis, DEEP to deep fascia. Supplies cutaneous innervation to POSTERIOR THIGH
129
The sciatic n. is usually [above/below] piriformis. It splits into 2 parts: ___ and ___.
Sciatic n. is usually BELOW piriformis. It splits into the TIBIAL N. and COMMON PERONEAL N. generally at the level of the popliteal fossa
130
The superior gluteal n. exits the pelvis via the ___. It appears [above/below] piriformis and innervates the ___, ___, and ___ muscles.
Superior gluteal n. exits pelvis via the GREATER SCIATIC FORAMEN. It appears ABOVE the piriformis and innervates the GLUTEUS MEDIUS, GLUTEUS MINIMUS, AND TENSOR FASCIA LATA
131
The inferior gluteal n. exits the pelvis via the ___. It appears [above/below] piriformis and innervates the ___ muscle(s).
Inferior gluteal n. exits pelvis via GREATER SCIATIC FORAMEN. Appears BELOW piriformis and innervates ONLY the GLUTEUS MAXIMUS
132
The posterior compartment of the thigh is innervated by the __ n.
TIBIAL n.
133
The biceps femoris has DUAL innervation: the __ head is innervated by the ___ n., and the ___ head is innervated by the ___ n.
Long head = tibial part of sciatic n., Short head = common peroneal part of sciatic n.
134
The pes anserinus is formed by the insertion of the ___, ___ and ___ into the ____. All three muscles do ____, but each has a secondary action as well. Name them
Pes anserinus formed by insertion of SARTORIUS, GRACILLIS, and SEMITENDINOSUS into medial, upper tibia. All do KNEE FLEXION, but individually:
Sartorius - flex, ER hip
Gracillis - mostly abduction of hip
Semitendinosus - Extend hip
135
____ exist between tendons and the tibial collateral ligament in the Pes anserinus.
Anserine bursa exists between tendons and tibial collateral ligament
136
The semimembranosus lies ___ in the hamstring group. It is ___ to the semitendinosus.
Semimembranosus = medial. Lies anterior and deep to semitendinosus
137
The sciatic n. diverges into _ (#) branches close to the upper end of the ___. Describe the course of the branches.
Sciatic n --> 2 branches:
(1) Common peroneal: goes LATERAL under cover of BICEPS FEMORIS, around neck of fibula, then divides into SUPERIFICAL PERONEAL and DEEP PERONEAL
(2) TIbial N. goes straight down in post. compartment
138
The popliteal fossa is __-shaped, located ____, and filled with ___ which serves to protect its contents.
Popliteal fossa = diamond-shaped, behind the knee, filled with FAT
139
Describe the floor of the popliteal fossa
Floor = femur, joint capsule, popliteus muscle
140
Describe the boundaries of the popliteus muscle
Superior lateral: biceps femoris
Superior medial: Semimembranosus, semitendinosus
Inferior medial: Medial head of gastrocnemius
Inferior lateral: lateral head of gastrocnemius and plantaris
141
Describe the contents of the popliteal fossa
Fat, lymph nodes, tibial n, common fibular n, popliteal vessels.
142
Describe the relationship between the vessels in the most inferior part of the popliteal fossa
Nerve is most posterior, then Popliteal vein, then Popliteal artery is most anterior
143
The popliteal a. is a continuation of the __ a. after it passes through the ___. The popliteal a. ends by dividing into the ___ and ___ aa.
Popliteal a. is a continuation of FEMORAL A. after it passes through ADDUCTOR HIATUS. Popliteal a. ends by dividing into POSTERIOR TIBIAL A. and ANTERIOR TIBIAL A.
144
Several branches of the ___ a supply the knee joint
Several branches of the POPLITEAL A. supply the knee joint
145
The knee joint is between the ___, ___, and ___. The knee joint does NOT involve the ___.
The knee joint is between the MEDIAL AND LATERAL FEMORAL CONDYLES, TIBIAL PLATEAU, and PATELLA. The knee joint does NOT involve the FIBULA
146
The clinical name for the knee joint is the ___. It is a ___ joint with __ (#) degrees of freedom involving __/__ and ____.
Knee joint = Tibiofemoral joint
CONDYLOID joint with 2 degrees of freedom: Flex/extend and ROTATION
147
In terminal knee extension (last ~10 degrees), the tibia rotates [internally/externally] on the femur. Why does this occur?
Tibia rotates EXTERNALLY on the femur because one condyle is longer than the other. This occurs because the medial femoral condyle is longer than the lateral femoral condyle
148
The [femoral/tibial] articular surface is twice as large/long as the [femoral/tibial] surface.
The FEMORAL surface is 2x as large as the TIBIAL surface!
149
When the knee goes into flexion in an open chain movement, the [tibia/femur] rolls and glides [ant/post] on the [tibia/femur], and the [tibia/femur] rotates [internally/externally]. When the knee goes into extension (open chain), the [tibia/femur] rolls and glides [ant/post] on the [tibia/femur]. During closed chain movements, what happens?
OPEN CHAIN
Flexion: TIBIA rolls/glides POSTERIORLY, rotating INTERNALLY
Extension: TIBIA rolls/glides ANTERIORLY, rotating EXTERNALLY
CLOSED CHAIN
Flexion: Femur rolls/glidles ANTERIORLY, rotating EXTERNALLY
Extension: Femur rolls/glides POSTERIORLY, rotating INTERNALLY
150
The joint capsule consists of 2 layers __ and ___
Fibrous joint capsule (outer), Synovial layer of joint capsule (inner)
151
The fibrous joint capsule in the knee is attached above the ____ posteriorly, margins of ___ , ___, and ____, and the margins of the ___.
Fibrous joint capsule in knee attached above INTERCONDYLAR FOSSA posteriorly, and the margins of FEMORAL CONDYLES, PATELLA, PATELLAR LIGAMENT, and the margins of TIBIAL CONDYLES
152
The fibrous joint capsule of the knee is strengthened posteriorly by...
Posteriorly strengthened by OBLIQUE POPLITEAL LIGAMENT (expansion of semimembranosus tendon) and ARCUATE LIGAMENT
153
The fibrous joint capsule of the knee is strengthened laterally by...
Laterally strengthened by ILIOTIBIAL TRACT, PATELLAR RETINACULUM, LATERAL COLLATERAL LIGAMENT
154
The fibrous joint capsule of the knee is strengthened medially by...
Medially strengthened by PATELLAR RETINACULUM, MEDIAL COLLATERAL LIGAMENT
155
The fibrous joint capsule of the knee is strengthened anteriorly by...
Anteriorly strengthened by QUADRICEPS TENDON, PATELLA, PATELLAR LIGAMENT, and PATELLAR RETINACULUM
156
The synovial layer of the joint capsule of the knee lines a single, extensive, slightly complex cavity that is ___ -shaped. The joint capsule is continuous with the ___ bursa, bursae under each head of the ___, and ___ bursa under the popliteus muscle.
Synovial joint layer, cavity is KIDNEY shaped
Capsule is continuous with SUPRAPATELLAR BURSA, BURSAE under each head of gastroc, POPLITEAL BURSA under popliteus muscle
157
The ACL and PCL are enclosed within the ____ capsule, but not the ___ capsule
ACL and PCL are enclosed within the FIBROUS capsule, but NOT the SYNOVIAL capsule
158
What is a Baker's Cyst?
Not truly a cyst, really an inflammed bursa. With a knee injry, fluid can settle into the popliteal bursa (found under popliteus muscle)
159
Menisci are made up of ___, much like what other two structures elsewhere in the body?
Menisci = fibrocartilage, like the disc in TMJ and the intervertebral discs
160
Menisci in the knee attach to the perimeter of the ___ by ___ ligaments. The medial edge is attached/not attached. The menisci are attached at ___ to the ___ ridge. They are [thinner/thicker] at the [middle/edges]. What does this serve to do? Can you function without menisci?
Menisci attach to perimeter of TIBIAL PLATEAU by CORONARY LIGAMENTS. The medial edge of the meniscus is FREE/NOT ATTACHED. Menisci are attached at HORNS to the INTERCONDYLAR RIDGE. They are THICKER/WIDER on the PERIPHERY (EDGE). This adds contour to the articulating surface, deepens the joint, and makes it more stable. You CAN function without menisci
161
The medial meniscus of the knee is __-shaped. It is more/less firmly attached than the lateral meniscus. It is also attached to the __ ligament. Its free ends point [lat/med].
Medial meniscus is C shaped. It is MORE firmly attached than the lateral meniscus. It is also attached to the MEDIAL COLLATERAL LIGAMENT. All of this additional anchoring makes it more likely to tear than the lateral meniscus. The free ends of the meniscus point MEDIALLY
162
The lateral meniscus is __-shaped. It is larger/smaller than the medial meniscus. It is separated from the joint capsule by the __ muscle. It is/is not attached to the joint capsule. It is/is not attached to the lateral collateral ligament. Its free ends point [lat/med].
Lateral meniscus is O-shaped. It is SMALLER than medial meniscus. Separated from joint capsule by POPLITEUS muscle. It is NOT attached to the joint capsule OR to the lateral collateral ligament. Its free ends point medially. It is less likely to tear than the medial meniscus because it can move around a bit!
163
There are a lot of ligaments to think about at the knee! Name them all before we chat about them.
```
Transverse ligament
Medial (Tibial) Collateral Ligament
Lateral (Fibular) Collateral Lig.
Anterior Cruciate Lig
Posterior Cruciate Lig
Oblique Popliteal Lig
Meniscofemoral Lig
Anterolateral Lig
```
164
The transverse ligament of the knee runs between...
Runs between the menisci ANTERIORLY
165
The medial collateral (tibial collateral) ligament attaches to the __ and ___. It is __ and __ (describe thickness/shape) and acts to ____. It runs between the ___ of the femur and the __ tibia and limits ___ of the leg (genu __).
MCL attaches to MEDIAL MENISCUS and JOINT CAPSULE. It is flat and broad and runs between the MEDIAL EPICONDYLE of the femur to the MEDIAL TIBIA. It REINFORCES the capsule and limits ABDUCTION of leg (genu valgus)
166
The lateral collateral (fibular collateral) ligament is shaped like a ___. It runs from the __ of the femur to the ____. It is/is not attached to the lateral meniscus and/or joint capsule. It is palpable [superior/inferior] to the head of the fibula
The LCL is NOT broad like the MCL, but it is like a cord or pencil
It runs from LATERAL EPICONDYLE of FEMUR to the HEAD OF THE FIBULA. It is NOT attached to the lateral meniscus or joint capsule. It is palpable SUPERIOR to the HEAD OF THE FIBULA
167
The anterior cruciate ligament runs [anteriorly/posteriorly] from the ___ to the ___ tibia. It limits ___ of the [tibia/femur] on the [tibia/femur]. It attaches to the ___.
The anterior cruciate ligament runs ANTERIORLY from the LATERAL FEMORAL CONDYLE to the ANTERIOR, MEDIAL TIBIA tibia. It limits FORWARD GLIDE of the TIBIA on the FEMUR. It attaches to the SUPERIOR CONDYLAR RIDGE.
*LAMP: Lateral femoral condyle --> ACL, Medial femoral condyle --> PCL
168
The posterior cruciate ligament runs from the ___ to the ___. It limits [ant/post] glide of the [tibia/femur] on the [tibia/femur]. It attaches to the ___.
The posterior cruciate ligament runs from the MEDIAL FEMORAL CONDYLE to the POSTERIOR LATERAL TIBIA. It limits POSTERIOR glide of the TIBIA on the FEMUR. It attaches to the SUPERIOR CONDYLAR RIDGE.
*LAMP: Lateral femoral condyle --> ACL, Medial femoral condyle --> PCL
169
The oblique popliteal ligament is the tendinous expansion of the ____ tendon. It supports the capsule [ant/post] and attaches to the ___.
Oblique popliteal ligament is tendinous expansion of SEMIMEMBRANOSUS tendon. Supports the capsule posteriorly and attaches to the LATERAL FEMORAL CONDYLE
170
The meniscofemoral ligament runs from the ___ to the ___ condyle and the ___ ligament.
Meniscofemoral ligament runs from LATERAL MENISCUS to the MEDIAL FEMORAL CONDYLE and POSTERIOR CRUCIATE LIGAMENT
171
The anterolateral ligament runs from the ___ condyle and ___ meniscus to ___. It prevents ___ rotation of the tibia.
The anterolateral ligament runs from the LATERAL FEMORAL CONDYLE and the LATERAL MENISCUS to GERDY'S TUBERCLE. It preventions INTERNAL ROTATION of the tibia
172
There are 2 bursas separate from the synovial compartment in the knee. The ___ bursa is subcutaneous, and may be visible in people who work on their hands and knees. The ___ bursa is deep to the tendon of the semimembranosus.
2 bursas separate from synovial compartment of knee. The PREPATELLAR bursa is subcutaneous. The SEMIMEMBRANOSUS BURSA is deep to the tendon of the semimembranosus
173
The proximal tibiofibular joint occurs between the ___ of the fibula and tibia and the ____. It is a synovial, ___ joint (__ degrees of freedom, type of mvmt: __ ). It is supported by ___ both anteriorly and posteriorly. It is/is not part of the knee joint.
The proximal tibiofibular joint occurs between the HEAD of the FIBULA and TIBIA and the LATERAL TIBIAL CONDYLE. It is a synovial, PLANE joint ( 3 degrees of freedom, type of mvmt: GLIDING ). It is supported by LIGAMENTS both anteriorly and posteriorly. It IS NOT part of the knee joint.
174
The bones of the hip joint consist of the __ ("socket") and the ___ ("ball"). It is a __ joint with __ degrees of freedom
Bones = acetabulum & head of the femur. Synovial (ball & socket) with 3 degrees of freedom
175
The acetabulum has a rim that is defective [sup/inf]. This opening is referred to as the ___ notch and is bridged by the ___ ligament. The articular surface is ___ shaped, and ___ is only found in this area. The ___ is the central/middle part of the acetabulum and it is non-weightbearing.
The acetabulum has a rim that is defective INFERIORLY. This opening is referred to as the ACETABULAR notch and is bridged by the TRANSVERSE ACETABULAR ligament. The articular surface is HORSE-SHOE shaped, and HYALINE CARTILAGE is only found in this area. The ACETABULAR FOSSA is the central/middle part of the acetabulum and it is non-weightbearing.
176
The head of the femur articulates with the ___. It is __ (fraction) of a sphere in shape and is covered with ___ except over the roughed central area called the ___. More than __ (fraction ) of the head of the femur is contained within the acetabulum.
The head of the femur articulates with the ACETABULUM. It is 2/3 of a sphere and is covered with HYALINE CARTILAGE except over the roughed central area called the FOVEA CAPITIS. Over HALF of the head of the femur is contained within the acetabulum.
177
The neck of the femur forms a __ degree angle with the shaft. The joint capsule of the hip connects at the __ (posterior) and ___ (anterior). The greater and lesser trochanter are within/outside the joint capsule of the hip.
The neck of the femur forms a 125 DEGREE angle with the shaft. The joint capsule of the hip connects at the TROCHANTERIC LINE (posterior) and TROCHANTERIC CREST (anterior). The greater and lesser trochanter are OUTSIDE the joint capsule of the hip.
178
The articular capsule of the hip joint attaches to the __ and ___. On the femur, it attaches to the ___ of the femur anteriorly, to the ___ and ___, and posteriorly just proximal to the ___ crest.
The articular capsule of the hip joint attaches to the LABRUM and TRANSVERSE ACETABULAR LIGAMENT. On the femur, it attaches to the NECK of the femur anteriorly, to the INTERTROCHANTERIC LINE and GREATER TROCHANTER, and posteriorly just proximal to the INTERTROCHANTERIC CREST.
179
The fibrous capsule of the joint is fairly thin/thick. It is reinforced anteriorly by the ___ ligament which limits hip __. A synovial ___ lines almost the entire inner surface of the fibrous capsule.
Fibrous capsule is fairly THICK. Reinforced anteriorly by ILIOFEMORAL LIGAMENT which limits hip extension. The synovial MEMBRANE lines almost the entire inner surface of the fibrous capsule.
180
There are many ligaments at the hip joint. Name them before we discuss them.
```
Labrum
Iliofemoral Lig. ("Y" Ligament)
Pubofemoral Ligament
Ischiofemoral ligament
Ligamentum Teres
```
181
The labrum at the hip consists of ___ that attaches to the rim of the acetabulum to ___. It continues across the acetabular notch as the __ ligament.
Labrum consists of FIBROCARTILAGE that attaches to the rim of the acetabulum and DEEPENS the joint. It continues across the acetabular notch as the TRANSVERSE ACETABULAR LIGAMENT
182
Which ligament at the hip is the largest/strongest?
Iliofemoral ligament (Y ligament)
183
The Iliofemoral ligament is [ant/post] to the joint. It runs from the __, ___, and ___ to the ___ and ___. It resists ___ and reinforces the capsule. It appears as an ____.
Iliofemoral ligament is ANTERIOR to the joint. Runs from AIIS, BODY OF ILEUM, & ACETABULAR MARGIN to INTERTROCHANTERIC LINE and GREATER TROCHANTER. Resists HYPEREXTENSION. Appears as an UPSIDE DOWN "Y"
184
The pubofemoral ligament is on the [ant/post] side of the joint. It runs from the ___ and blends with the medial part of the __ ligament. It limits __.
Pubofemoral ligament on ANTERIOR side of joint. Runs from PUBIC PORTION OF ACETABULUM and blends with MEDIAL PART OF ILIOFEMORAL LIGAMENT. It limits ABDUCTION
185
The Ischiofemoral ligament runs from the ___ of the ___ on the [ant/post] side of the joint. It spirals [sup/inf]/[ant/post] to the ___ of the femur, medial to the ____. It limits __ and __.
Ischiofemoral ligament runs from ISCHIAL PORTION of ACETABULAR RIM on the POSTERIOR side of joint. It spirals SUPERIORLY/ANTERIORLY to the neck of the femur, medial to the GREATER TROCHANTER. It limits EXTENSION & INTERNAL ROTATION
186
The ligamentum teres is AKA __. It runs from the __ to the ___. It is surrounded by __. The __ artery travels in it to the ___.
The ligamentum teres is AKA the Ligament of the Head of the Femur. It runs from the ACETABULAR FOSSA to the FOVEA OF FEMUR. It is surrounded by SYNOVIAL MEMBRANE. A branch of the OBTURATOR A. travels in it to the HEAD OF THE FEMUR.
187
The nervous supply to the hip joint comes from branches of the __, __, __, and __ nn. Why is hip pain sometimes perceived in the knee?
Nervous supply to hip: branches of FEMORAL, OBTURATOR, SCIATIC, AND SUPERIOR GLUTEAL NN.
- Some nn that innervate hip are the same as those that innervate knee. When your hip/knee hurt, the brain may misinterpret where the pain is coming from. Reproduce the pain at hip during physical exam or if they truly have knee pain, you should be able to reproduce pain at knee
188
The sacroiliac joint is formed between the __ and __. The articulating surface is called the ___ surface. That surface is irregular so it adds to the joint's __.
Sacroiliac joint between SACRUM & ILIUM. Articulating surface = AURICULAR surface, irregular so it adds to stability. *Synovial joint.
189
The articular capsule at the sacroiliac joint is a strong, synovial capsule. It attaches on the edge to articulating surfaces of the __ and __.
Capsule attaches on edge to articulating surfaces of SACRUM and ILEUM
190
The sacroiliac joint is supported by 3 strong ligaments. Describe and tell where they blend.
(1) Interosseus sacroiliac ligament (blends with posterior sacroiliac ligaments)
(2) Posterior sacroiliac ligaments (blends inferiorly with sacrotuberous ligament)
(3) Anterior sacroiliac ligament (thinner, ossifies after 50 years of age)
191
Describe the movement at the sacroiliac joint.
Synovial joint: some sliding, gliding and rotation.
192
The deep fascia is continuous with the __ in the leg.
Deep fascia is continuous with the FASCIA LATA in the leg.
193
The fascia forms thickenings in the ankle called ___. Tendons pass under these, encased in ___. Describe the 3 groups of these thickenings in the ankle.
Fascial thickenings = retinacula. Tendons pass under retinaculum in SYNOVIAL TENDON SHEATHS.
(1) Extensor retinacula (2 anterior bands: superior and inferior)
(2) Peroneal retinaculua (lateral)
(3) Flexor retinaculum (medial/posterior)
194
The extensor retinacula lies __ to the ankle. It consists of 2 bands: the superior band is more ___, and the inferior band is __-shaped, [above/below] the malleoli.
Extensor retinacula lies ANTERIOR to ankle. 2 bands: superior is more HORIZONTAL, inferior is Y-shaped, BELOW THE MALELOLI
195
The peroneal retinacula lies on the __ ankle. The superior peroneal retinaculum has __ (#) compartment(s), with the tendons in a [common/separate] sheath. The inferior retinaculum has __ (#) compartment(s), with the tendons in a [common/separate] sheath.
Peroneal retinacula is LATERAL on the ankle. Superior peroneal retinacula has ONE compartment, COMMON tendon sheath. Inferior retinacula has TWO compartments, tendons in SEPARATE SHEATHS
196
The Flexor retinaculum lies ___/___ on the ankle from the ___ to the ___. It is one single band.
Flexor retinaculum lies MEDIALLY/POSTERIORLY on the ankle from the MEDIAL MALLEOLUS to the CALCANEOUS
197
The deep fascia divides the leg into compartments: __, __, and __
Anterior crural compartment, Lateral crural compartment, Posterior crural compartment (further divided into superficial and deep group via TRANSVERSE SEPTUM)
198
Name the muscles of the anterior compartment of the leg. What nerve innervates them?
Tibialis anterior
Extensor Hallucis Longus
Extensor Digitorum Longus
Peroneus Tertius
I: Deep peroneal (fibular) n.
199
Which muscle has the exact opposite action of the Tibialis Anterior?
Peroneous longus - TA and PL share their insertion!
TA: dorsiflex, inversion
PL: Plantarflex and evert
200
What type of muscle fibers doe the extensor digitorum longus have?
Bipennate
201
Which muscle appears as if it's the lower part of the Extensor Digitorum Longus?
Peroneus Tertius. BUT keep in mind that while the EDL sends tendons to the distal phalanx of each of 4 toes, the Peroneus Tertius lower fibers give off a tendon that DOESN'T go to a phalanx! Instead, it goes to the tuberosity of the 5th metatarsal
202
Dame the muscles of the dorsum of the foot. What nerve innervates them?
Extensor Hallicus Brevis
Extensor Digitorum Brevis
I: Deep peroneal n. (same as ant. compartment!)
203
Dame the muscles of the lateral compartment of the leg. What nerve innervates them?
(1) Peroneus (fibularis) Longus (more superficial)
(2) Peroneus (fibularis) Brevis (Partly covered by longus)
I: Superficial Peroneal n.
204
What muscle has the exact opposite action of the Peroneus Longus?
Tibialis anterior! They share their insertion
TA: Dorsiflex, invert
PL: Plantarflex, evert
205
List the muscles of the posterior leg. What nerve innervates them?
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Gastrocnemius
Plantaris
Soleus
Popliteus
Flexor Hallicis Longus
Tibialis Posterior
Flexor Digitorum Longus
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I: Tibial n.
206
Which muscles of the posterior leg are 2 joint muscles? What are their actions?
Gastrocnemius
Plantaris
Action of both: Knee flexion, Plantarflexion
207
What muscles insert into the tendocalcaneus?
Gastrocnemius, Plantaris (via ribbon-like tendon), Soleus
208
Which muscle of the posterior compartment is important in closed chain, e.g. postural adjustments during standing?
Soleus
209
Which muscle is responsible for "unlocking" the knee out of terminal extension (i.e. knee begins flexing). Which way does it cause the tibia to rotate (in open chain)?
Popliteus: causes tibia to rotate INTERNALLY to unlock out of the "screw home" mechanism
210
Using your hand, describe the path of the popliteus muscle.
Put heel of hand on lateral knee (lateral femoral condyle) and wrap fingers around back of knee to upper tibia - that's its path!
211
The ___ muscle is the most lateral of the deep posterior leg muscles before its tendon crosses to the opposite side to insert on the __.
Flexor hallicis longus is the most LATERAL before it crosses to insert on the DISTAL PHALANX of the GREAT TOE.
212
The ___ is often overlapped by the Flexor Hallicis Longus and the Flexor Digitorum Longus.
TIBIALIS POSTERIOR. Posterior Tib is also important in the dynamic support of the medial (longitudinal) arch of the foot
213
What muscles are the two big inverters of the foot?
Tibialis Posterior and Tibialis Anterior
214
Which muscle of the deep posterior leg originates most medial on the leg? Where does this muscle's tendon insert?
Flexor Digitorum Longus is the most MEDIAL on the leg. It has to go LATERALLY to reach the distal phalanx of the 4 lateral toes
215
From anterior to posterior (medial malleolus to calcaneus), list the tendons that pass under the flexor retinaculum.
Tom, Dick, ANd Harry
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Tibialis Posterior
Flexor Digitorum Longus
Posterior Tibial A.
Tibial N.
Flexor Hallucis Longus (slightly deep)
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216
The __ nerve (name roots) runs in the posterior compartment between the superficial and deep groups. It innervates all of the muscles of the posterior compartment.
TIBIAL N. (L4,5, S1,2,3)
217
The common peroneal n. (name roots) passes around the ___ where it divides into deep and superificial branches.
Common peroneal n. passes around the NECK OF THE FIBULA where it divides --> superficial and deep branches.
218
Describe the innervations of the superficial branch of the common peroneal n.
Superficial branch (L5, S1,2): innervates LATERAL compartment muscles plus SKIN of lateral leg and DORSUM of foot (L5, S1, 2)
219
Describe the innervations of the deep branch of the common peroneal n.
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Deep branch (L4,5, S1):
Innervates ANTERIOR compartment muscles plus PATCH OF SKIN between great toe and second toe
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220
If you lose the common peroneal n., what motor and sensory loss do you see?
Lose anterior and lateral compartments, so...
Lose: dorsiflexion (TA), Eversion (peroneus muscles), toe extension (EHL & EHB)
Weak: Inversion, plantar flexion (b/c peroneus longus)
Sensory: whole dorsum of foot, lateral leg
221
The blood supply of the leg comes from the popliteal a. which divides into the __ and __ at the ___ muscle.
Blood supply of leg comes from POPLITEAL A. which divides into ANTERIOR TIBIAL A. and POSTERIOR TIBIAL A. on POPLITEUS muscle
222
Describe the course of the anterior tibial a.
Ant. tib. a. = Enters ANTERIOR compartment by crossing ABOVE interosseous membrane. Changes name to DORSALIS PEDIS A. when it crosses ankle joint into foot
223
Describe the course of the Posterior Tibial A.
Post. Tib. A. = runs with Tibial N. Gives off PERONEAL A.
- Peroneal a. runs on LATERAL side of posterior compartment and sends branches to LATERAL compartment
- Posterior Tibial A. continues into foot BEHIND medial malleolus
224
The skin of the sole of the foot is ___. The superficial fascia in that area contains much dense __ and ___.
Skin of sole of foot is THICK, superficial fascia contains dense connective tissue and ADIPOSE. Fat pad on heel helps to cushion and absorb the shock.
225
A feature of the deep fascia on the sole of the foot is the ___. It is the central part of the deep fascia and the [strongest/weakest] and [thickest/thinnest] part of the deep fascia. It attaches posteriorly to the __ and anteriorly to the ___ by ___.
Plantar aponeurosis = central part of deep fasica, strongest/thickest. Attaches posteriorly to CALCANEUS and anteriorly to TOES by 5 BANDS
226
The first layer of muscles in the sole of the foot consists of... They are innervated by the ___ n.
Abductor hallicus, Flexor digitorum brevis, Abductor digiti minimi.
Innervation is NOT same for whole layer:
*Abd Hallicus & FDB = MEDIAL plantar n.
*Abductor Digiti Minimi = LATERAL plantar n!
227
The muscles of the first layer of the foot all originate from the ___
CALCANEUS
228
The second layer of the muscles of the sole of the foot contain __ (#) tendons and __ (#) muscles. Name them! Innervation?
2nd layer = 2 tendons, 2 muscles
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Flexor Hallicus Longus Tendon
Flexor Digitorum Longus Tendon
Quadratus plantae (insert into tendon of FDL)
Lumbricals (arise from tendons of FDL)
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Innervation:
Medial plantar n. = Quadratus Plantae, 1st lumbrical
Lateral plantar n. = Lumbricals 2-3
229
The third layer of the sole of the foot consists of 3 muscles. Name them! Innervation?
Flexor hallicus brevis, Adductor hallucis, Flexor digiti minimi brevis
Innervation:
Medial plantar n. = Flexor Hallicus Brevis
Lateral plantar n. = Adductor hallucis, Flexor Digiti Minimi Brevis
230
The adductor hallucis has 2 heads: __ and __. It acts to __.
Oblique and transverse heads. Adducts great toe
231
What is the axis for rotation in the foot?
Axis for ABD/ADDuction is the 2nd toe. Move away from the 2nd toe: digits 3,4,5 abduct away. Digit 2 can abduct in either direction!
232
What are the muscles of the 4th layer of the foot?
4th layer: Interossei + Tendons
- 3 Plantar interossei (Adduct), -4 Dorsal interossei (Abduct)
- Posterior tibialis tendon
- Peroneus longus tendon
233
The peroneus longus tendon runs in the __ layer of the sole of the foot, deep to the __.
Peroneus longus tendon runs in 4th layer, deep to LONG PLANTAR LIGAMENT
234
The __ and ___ are continuations of the tibial n.
Tibial n --> medial and lateral plantar nn.
235
The __ and __ are continuations of the posterior tibial a.
Medial and lateral plantar aa.
236
Name the joints that occur in the ankle region
Distal tibiofibular joint
Talocrural joint
Subtalar joint
Midtarsal joint
237
The distal tibiofibular joint is a ___ (joint type). It does/does not have a joint capsule. It is secured by ___ and ligaments as well as the ___.
Distal tibiofibular joint is a SYNDESMOSIS (Fibrous). It does NOT have a joint capsule. It is supported by the ANTERIOR AND POSTERIOR TIBIOFIBULAR LIGAMENTS (hold distal fibula to tibia) and INTEROSSEOUS MEMBRANE
238
The talocrural joint is AKA the ___. It is a __ joint between the ___ and ____. Its action is ___. It is supported by ligaments medially and laterally that all limit ___ at the joint.
The talocrural joint is AKA the MORTISE JOINT. It is a HINGE joint between the TROCHLEA OF THE TALUS and MEDIAL AND LATERAL MALLEOLI. Its action is DORSIFLEXION & PLANTAR FLEXION. It is supported by ligaments medially and laterally that all limit INVERSION/EVERSION at the joint.
239
List the ligaments found at the talocrural joint.
Deltoid (medial) ligament (4 parts) [anterior tibiotalar, tibonavicular, tibiocalcaneal, posterior tibiotalar]
*resist eversion
```
Lateral ligament (3 parts) [Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament]
*resist inversion
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240
The deltoid (medial) ligament runs from the ___ to the __, __, and ___. It is very [strong/weak] and acts to resist [inversion/eversion].
The deltoid (medial) ligament runs from the MEDIAL MALLEOLUS to the NAVICULAR, CALCANEUS (SUSTENTACULUM TALI), and TALUS. It is very STRONG and acts to resist EVERSION.
241
Significant eversion stress is/is not likely to tear the deltoid (medial) ligament. Describe what would happen.
Significant eversion stress is NOT likely to tear the ligament. Instead, you're likely to tear the bone (i.e. fracture the malleolus). Often, it's a TRI-MALLEOLAR FRACTURE aka POTTS FRACTURE:
(1) Medial malleolus, (2) Dome of tibia swings off and knocks off lateral malleolus, (3) Chip off of tibia
242
High ankle sprain involves separation of the ___ and possibly the ___.
High ankle sprain involves separating the SYNDESMOSIS and possibly the INTEROSSEOUS MEMBRANE
243
The anterior talofibular ligament is part of the [med/lat] ligament. It runs from the __ to the ___.
Anterior talofibular ligament is part of LATERAL ligament. Runs from HEAD OF TALUS to LATERAL MALLEOLUS
244
The posterior talofibular ligament is [superifical/deep] and runs almost vertical/horizontal]
Posterior talofibular ligament is DEEP and almost HORIZONTAL
245
The subtalar joint consists of __ (#) ____ (joint type) between the __ and ___.
Subtalar joint = 3 (sometimes 2) PLANE FACETS between the TALUS and CALCANEUS
246
The subtalar joint is supported by the ___ ligament which is [superficial/deep] to the plantar ligaments. This ligament runs from the ___ to the ___ and supports the __ and the ___.
The subtalar joint is supported by the CALCANEONAVICULAR (SPRING) ligament which is DEEP to the plantar ligaments. This ligament runs from the SUSTENTACULUM TALI to the NAVICULAR and supports the HEAD OF THE TALUS and the LONGITUDINAL ARCH.
247
Movement at the subtalar joint contributes to __ and ___ of the foot. Differentiate between these movement.s
Pronation and supination of the foot.
Supination/pronation = collapse or increase of the arch; most of this action comes from the subtalar joint
Inversion/eversion = combined movement more at the Mortise joint and involves more of the forefoot
*Inversion = adduction of the foot + supination (COMBINED!)
248
The midtarsal joint is AKA the ___. It is a functional joint comprised of the ___ and ___ joints. It runs almost ___ when looking from above.
The midtarsal joint is AKA the TRANSVERSE TARSAL JOINT. It is a functional joint comprised of the TALONAVICULAR and CALCANEOCUBOID joints. It runs almost HORIZONTAL when looking from above.
249
The long plantar ligament runs between the ___ and the ___. It is more [superficial/deep] than the short plantar ligament. It is a major support of the ___. The peroneus (fibularis) longus tendon runs [superficial/deep] to it.
The long plantar ligament runs between the CALCANEUS and the BASES OF 4 LATERAL METATARSALS. It is more SUPERFICIAL than the short plantar ligament. It is a major support of the LONGITUDINAL ARCH. The peroneus (fibularis) longus tendon runs DEEP to it.
250
The short plantar ligament runs between the __ and ___. It is superficial to the ___ ligament, but deep to the ___ ligament. It also supports the ___.
The superficial plantar ligament runs between the CALCANEUS and the CUBOID. It is SUPERFICIAL to the SPRING LIGAMENT, but DEEP to the LONG PLANTAR LIGAMENT. Also supports the longitudinal arch
251
The lateral arcuate ligament comes from thickened fascia over the ___
Lateral arcuate lig = thickened fascia over QUADRATUS LUMBORUM
252
The medial arcuate ligament comes from thickened fascia over the ___
Medial arcuate lig = thickened fascia over PSOAS
253
The Median arcuate ligament comes from thickened fascia over the ___
Median arcuate lig = thickened fascia over Aorta
