Lecture 10: Gluteal Region Flashcards
(90 cards)
1
Q
What 3 bones make up the Os Coxae?
A
Ilium
Ischium
Pubis
2
Q
What is the only nerve that exits the lesser sciatic foramen?
A
Obturator internus
3
Q
What are the 2 nerves that enter the lesser sciatic foramen?
A
Pudendal and obturator internus/superior gemellus nerve
4
Q
What artery enters the lesser sciatic foramen?
A
Internal pudendal nerve
5
Q
What does the sciatic nerve innervate in the gluteal region?
A
Nothing! It just passes through here
6
Q
What 2 classes of nerves innervate the gluteal region?
A
Cluneal and deep nerves
7
Q
What cluneal nerves innervate the gluteal region?
A
Superior, middle and inferior
8
Q
What deep nerves innervate the gluteal region?
A
Sacral plexus branches
9
Q
How do sacral plexus nerve branches leave the pelvis?
A
Through the greater sciatic foramen
10
Q
What rami supply the superior gluteal region?
A
L1-L3 dorsal rami
11
Q
What rami supply the middle gluteal region?
A
S1-S3 dorsal rami
12
Q
What rami supply the inferior gluteal region?
A
S1-S3 ventral rami -> gluteal branches of posterior femoral cutaneous nerve
13
Q
What spinal nerves make up the superior gluteal nerve?
A
L4-S1
14
Q
What spinal nerves make up the inferior gluteal nerve?
A
L5-S2
15
Q
What spinal nerves make up the nerve to piriformis?
A
S1-S2
16
Q
What spinal nerves make up the quadratus femoris and inferior gemellus?
A
L4-S1
17
Q
What spinal nerves make up the obturator internus and superior gemellus?
A
L5-S2
18
Q
What spinal nerves make up the pudendal nerve?
A
S2-S4
19
Q
What nerve is just superior to the piriformis muscle?
A
Superior gluteal nerve
20
Q
What muscles does the superior gluteal nerve innervate?
A
Gluteus medius, gluteus minimus and tensor fasciae latae
21
Q
What 2 nerves are found just inferior to the piriformis?
A
Inferior gluteal nerve and the sciatic nerve
22
Q
What muscles does the inferior gluteal nerve supply?
A
Gluteus Maximus
23
Q
What is the largest nerve in the body?
A
Sciatic nerve
24
Q
Posterior hip dislocation can cause damage to what nerve?
A
Sciatic nerve
25
Posterior hip dislocations can cause damage to the sciatic nerve, resulting in what clinical manifestations?
Paralysis of hamstrings and muscles distal to the knee. Sensory change may occur in skin over the posterolateral aspects of leg and most of foot
26
In a person with a fractured hip, which direction would you expect to see their foot rotated?
Laterally
27
In a person with a hip dislocation, which direction would you expect to see their foot rotated?
Medially
- Anterior dislocations may be more lateral, however posterior dislocations are much more common
28
What nerve in the lower limb supplies more skin than any other cutaneous nerve?
Posterior femoral cutaneous nerve
29
What nerve innervates the quadratus femoris?
The nerve to quadratus femoris and inferior gemellus nerve
30
What are the most lateral nerves in the gluteal region?
Obturator internus/superior gemellus
31
The obturator internus/superior gemellus nerve leaves the pelvis via ___________ foramen and renters the pelvis via _____________ foramen
Greater sciatic; lesser sciatic
32
What nerve is supplied by the anterior divisions of S2-S4 ventral rami?
Pudendal nerve
33
What is the most medial structure exiting the greater sciatic foramen?
Pudendal nerve
34
The pudendal nerve exits through the greater sciatic foramen and renters the pelvis via _____________ foramen to supply what structures?
Lesser sciatic; perineal structures
35
What arteries of the gluteal region are branches arising from the internal iliac artery?
Superior gluteal a
Inferior gluteal a
Internal pudendal a
36
What is the largest internal iliac artery branch?
Superior gluteal artery
37
What are the 2 branches of the superior gluteal artery?
Superficial and deep
38
What muscles are supplied by the deep branch of the superior gluteal artery?
Gluteus medius
Gluteus minimus
Tensor fascia lata
39
What muscles are supplied but the inferior gluteal artery?
Gluteus maximus
Small lateral rotators
Superior hamstrings
40
What arteries participate in the cruciate anastomosis of the thigh?
Medial circumflex femoral artery
Lateral circumflex femoral artery
First perforating artery
Inferior gluteal artery
41
Which artery in the thigh goes all the way down to the knee and is able to supply blood to the knee and is able to get enough blood to the knee to keep things alive until you fix an injured femoral artery?
Descending branch of the lateral circumflex femoral artery
42
What supplies blood to the leg if the femoral artery is occluded or severed?
Cruciate anastomosis
43
What does the internal pudendal artery supply?
Perineal muscles and external genitalia
44
What gluteal structures does the internal pudendal artery supply?
NONE
45
Where should intraglueal injections be made and why?
In the supero-lateral part of the gluteal region in order to avoid the sciatic nerve and other gluteal nerves and vessels
46
What is the chief extensor of the thigh?
Gluteus maximus
47
The gluteus maximus is the chief extensor of the thigh, but can also function to do what else?
Lateral rotation
48
What does the gait of someone with a femoral lesion?
You dont see anything in the gait because they are still able to extend their leg due to their gluteus maximus and IT band extending down to the knee. It is when they sit or stand that you see the issue
49
In a person with a femoral lesion, you dont see anything in the gait because they are still able to extend their leg due to their gluteus maximus and IT band extending down to the knee. It is when they sit or stand that you see the issue, why is this?
Problem occurs when bending past 30 degrees of flexion at the knee because the quad (where the lesion is) gives out and the leg fails
- When they try to sit, they push in on their hip to keep the leg from locking
50
What is the function of the gluteus medius and minimus?
Thigh abduction and medial rotation
- Medial rotation is particularly but he gluteus minimus
51
How are the gluteus medius and minimus unique in humans?
In any other mammal besides humans, they run straight up the back and aid in extension of the leg, but in humans they are moved out laterally and aid in abduction and medial rotation
52
During one gait cycle, what muscles are contracted during the initial heel strike?
Gluteus maximus and tibialis anterior
53
During a gait cycle, what muscles are contracted when the foot is flat and bearing weight?
Quadriceps femoris
54
During a gait cycle, what muscle is contracted midstance after the initial heel strike and flat foot loading response?
Triceps surae
55
During a gait cycle, what muscle is contracted in the weight bearing leg when initially toeing off (before knee flexes)?
Triceps surae
56
During a gait cycle, what muscles are contracted when toeing off and knee is flexed?
Rectus femoris and iliopsoas
57
During a gait cycle, what muscle is contracted during the final swing of the leg that initially started the cycle?
Hamstrings, quadriceps femoris and tibialis anterior
58
What is the clinical presentation seen in humans with deficient gluteal muscles?
Hip drop -> they fall to affected side so in their gait you will see them dropping to affected side (Duchenne's limp)
59
What is a common cause of Duchenne's limp?
Bad hip arthritis, especially when the pt has it in both hips
60
When is glutial gait/Duchenne's limp done/presented and what side do you see the limp occurring on?
Done when the patient is moving; the patient's hip drops to the affected side
61
When is a positive trendelenburg's sign seen/presented and what side of the body is it seen on?
Done when pt is not moving; the dropping of the hip occurs on the side opposite of the affected side because the muscles arent strong enough to bear the weigh
62
What is the cause of gluteal gait/Duchenne's limp and Trendelenburg's syndrome?
Superior gluteal nerve injury
63
What muscles are deficient in pts with gluteal gait/Duchenne's limp and trendelenburg?
Gluteus medius and minimus
64
What is tensor fascia lata innervated by?
Superior gluteal nerve
65
What is the function of tensor fascia lata?
- Adducts, medially rotates and flexes thigh
| - Slight extension of knee along with the gluteus maximus
66
How does the function of the IT band change depending on how the leg is flexed?
When you go into flexion past 30 degrees at the knee, the insertion point of the IT band is behind the knee and the IT band becomes a flexor
When the knee is in extension (less than 30 degrees flexion), the insertion point of the IT band is on the anterior aspect of the knee and the IT band becomes an extensor
67
What happens if the IT band becomes too tight?
It can begin to pull the patella laterally and you end up with chondromalacia of the patella
68
What do you do to cure someone with chondromalacia of the patella due to a tight IT band?
Send pt to physical therapy to strengthen the vastus medialis and stretch out IT band
- Good way to stretch IT band = crossing the legs and leaning away
69
In the gluteal region, everything down from the piriformis to the quadratus femoris has what function?
All lateral rotators -> when these muscles contract it pulls the femur rotating it laterally
- Piriformis, quadratus femoris, gemellus superior, gemellus inferior, obturator internus
70
The piriformis comes out of the greater sciatic foramen and inserts where?
Greater trochanter
71
Where does the quadratus femoris insert?
On its own tubercle called the quadrate tubercle -> all other lateral rotators of the gluteal region pretty much insert at the same spot on the medial side of the greater trochanter
72
Where do all lateral rotators of the gluteal region besides the quadratus femoris insert?
On the medial side of the greater trochanter
73
In rare cases, the sciatic nerve can be split by the piriformis muscle. If this happens, what branch runs superiorly to the muscle and what branch runs inferiorly?
Common fibular runs superiorly and tibial branch runs inferiorly
74
What is the function of the obturator internus muscle?
Uses the ischium as a pulley to laterally rotate the leg
75
The obturator internus has almost the exact same insertion site as what other muscle?
Obturator externus
- On the trochanteric fossa
76
What 3 muscles of the gluteal region are horizontally oriented?
Obturator internus
Quadratus femoris
Gemelli (all)
77
What 5 muscles of the gluteal region are vertically oriented?
Gluteus maximus, medius, minimus
Piriformis
Tensor fascia latae
78
When walking, your stance leg _________ rotates and your swing leg _________ rotates
Medially; laterally
79
What type of bursitis is very common due to the gluteus maximus sliding over the greater trochanter?
Trochanteric bursitis (inflammation of the trochanteric bursa)
80
Which of of the small lateral rotators is least effective when the thigh is flexed?
Quadriceps femoris
81
What 3 muscles form the triceps coxae?
Superior and inferior gemelli and the obturator internus m.
82
When are the abductors/medial rotators of the superficial gluteal region most active during a gait cycle?
The stance phase
83
When are the lateral rotators of the deep gluteal muscles most active during a gait cycle?
During the swing phase when they rotate the free limb (unsupported side) so that the foot remains parallel to the line of advancement
84
When are the hamstrings most active in a gait cycle?
In eccentrically contracting to decelerate hip flexion and knee exxtension during terminal swing
85
All but which vessels exit the greater sciatic foramen inferior to the piriformis muscle?
Superior gluteal vessels
86
Ischial bursitis is a friction bursitis of the bursae that lies between the ischial tuberosity. What movement causes increased pain in this condition?
Movement of the gluteus maximus or sitting for prolonged periods of time
87
A pt received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured aa motor nerve in the area. Later, he had great difficulty rising to a standing position from a seated position. What muscle was most likely affected by the injury?
Gluteus maximus
88
Into which parts of the gluteal region should an intramuscular antibiotic be injected to avoid nerve injury?
Anterior and superior to a line between the posterior superior iliac spine and the greater trochanter
89
Which muscles would be affected by an avulsion fracture of the greater trochanter?
Piriformis
Obturator internus
Gluteus medius
Gluteus minimus
90
Would the gluteus maximus be affected by an avulsion fracture of the greater trochanter?
No
