Lecture 11 Flashcards
1
Q
What is the mechanical axis?
A
Axis of hip joint that rotation of hip joint happens around (connects centre of hip to center of knee joint)
2
Q
Any muscle located posterior to the center of rotation will cause?
A
lateral rotation
3
Q
Any muscle located anterior to the centre of rotation will cause?
A
medial rotation
4
Q
A tough fibrous sheath that invests the thigh like a sleeve.
A
deep fascia of thigh (fascia lata)
5
Q
Fascia lata is thickened laterally where it forms a band.
A
Iliotibial tract or band (ITT or ITB)
6
Q
The __ is split in its upper part and invests the tensor fascia lata muscle between its two layers and acts as a tendon for this muscle.
A
ITT/ITB (Iiliotibial tract/band)
7
Q
Deep fascia on thigh attaches to deep fascia in abdomen, therefore for abdominal palpation what do you ask of your patient?
A
- that they flex their hip joint
8
Q
What are the superficial gluteal muscles?
A
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fascia lata
9
Q
What are the innervations of the superficial gluteal muscles?
A
- Glut max: innervated by inferior gluteal nerve
- Glut med, glut mini, & tensor fascia lata: innervated by superior gluteal nerve
10
Q
What is an immigrant muscle of the superficial gluteal muscles? Why?
A
Tensor fascia lata is not located in the gluteal region, it is on lateral side of upper thigh –> immigrant muscle (muscle forms close to gluteal legion but migrates to upper lateral side of thigh)
11
Q
What is the origin & insertion of gluteus maximus?
A
Ori:
- Posterior Iliac crest
- Sacrum
- Coccyx
- Sacrotuberous ligament
Ins:
- Iliotibial tract (band)
- Gluteal tuberosity of femur
12
Q
What are the functions of gluteus maximus?
A
- Extension of thigh (hip joint) – MAIN FUNCTION
- Abduction of thigh (hip joint) – upper 1/3
- Adduction of thigh (hip joint) – lower 2/3
- Lateral rotation of thigh (hip joint)
- Posterior pelvic tilt
- Helps lock knee in extension
13
Q
What is the innervation of gluteus maximus?
A
- inferior gluteal nerve
14
Q
What is the MAIN FUNCTION of gluteus maximus?
A
- extension of thigh (hip joint)
15
Q
The attachment of the gluteus maximus to the ITT causes?
A
- knee stability - helps lock knee in extension
16
Q
Which muscle has their posterior third covered by the gluteus maximus?
A
gluteus medius
17
Q
What is the origin & insertion of gluteus medius?
A
Ori: External surface of ilium between the anterior and posterior gluteal lines
Ins: Lat. surface of greater trochanter
18
Q
What are the functions of gluteus medius?
A
- Abduction of thigh (hip joint) - entire muscle – MAIN FUNCTION
- Flexion of thigh (hip joint) – anterior fibers
- Medial rotation of thigh (hip joint) – anterior fibers
- Extension of thigh (hip joint) – posterior fibers
- Lateral rotation of thigh (hip joint) – posterior fibers
19
Q
What is the innervation of gluteus medius?
A
superior gluteal nerve
20
Q
What is the origin & insertion of gluteus minimus?
A
Ori: Gluteal surface of ilium; between the anterior and inferior gluteal lines
Ins: Anterior surface of greater trochanter
21
Q
What are the functions of the gluteus minimus?
A
- Abduction of thigh (hip joint) – entire muscle
- Flexion of thigh (hip joint) – anterior fibers
- Medial rotation of thigh (hip joint) – anterior fibers
- Extension of thigh (hip joint) – posterior fibers
- Lateral rotation of thigh (hip joint) – posterior fibers
22
Q
What is the innervation of gluteus minimus?
A
superior gluteal nerve
23
Q
Which two muscles of the superficial gluteal muscles have the same fucntions?
A
- gluteus medius
- gluteus minimus
24
Q
What the deltoid muscles of the hip joint (i.e., don’t do adduction)?
A
- gluteus medius
- gluteus minimus
25
When is the Trendelenburg sign/gait positive?
- When leg is raised (hip joint if flexed) pelvis would fall down
26
What is the origin & insertion of tensor fascia lata?
Ori: Lateral side of ASIS & anterior part of the iliac crest
Ins: Tibia (Gerdy’s tubercle) via ITB (ITT) (1/3 of the way down the thigh)
27
What are the functions of tensor fascia lata?
- Flexion of thigh (hip joint)
- Abduction of thigh (hip joint)
- Medial rotation of thigh (hip joint)
- Anterior pelvic tilt
- Tenses ITB to support femur on tibia during standing
28
What is the innervation of tensor fascia lata?
superior gluteal nerve
29
What muscles comprise the deep gluteal muscles?
- Piriformis
- Superior Gemellus
- Obturator internus
- Inferior gemellus
- Quadratus femerus
- Obturator externus
30
Which deep gluteal muscle is commonly considered a part of the adductor group?
obturator externus
31
What are the common functions of the deep gluteal muscles?
- Lateral rotation of thigh (hip joint) - ALL
- Abduction - piriformis, superior gemellus, obturatory internus, inferior gemellus
- Adduction - quadratus femerus, obturator externus
32
What is the innervation of the deep gluteal muscles?
- sacral plexus
33
What is the origin & insertion of piriformis?
Ori: Anterior sacrum
Ins: Superior border of greater trochanter
34
What are the functions of piriformis?
- Lateral rotation of thigh (hip joint) – when hip is extended
- Horizontal abduction of thigh (hip joint)
35
What is the innervation of piriformis?
- nerve to piriformis from sacral plexus
36
What is piriformis syndrome?
If one (or both) branches of the sciatic nerve pass through the piriformis --> muscle can pinch nerve --> piriformis syndrome
37
What is the origin & insertion of superior gemellus?
Ori: Ischial spine
Ins: Medial surface of the greater trochanter
38
What are the functions of superior gemellus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
39
What is the innervation of superior gemellus?
nerve to obturator internus (from sacral plexus)
40
What is the origin & insertion of obturator internus?
Ori: Inner surface of obturator membrane
Ins: Medial surface of the greater trochanter
41
What are the functions of obturator internus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
42
What is the innervation of obturator internus?
Nerve to obturator internus (from sacral plexus)
43
What is the origin & insertion of inferior gemellus?
Ori: Ischial tuberosity
Ins: Medial surface of greater trochanter
44
What are the functions of inferior gemellus?
- Lateral rotation of thigh (hip joint)
- Horizontal abduction of thigh (hip joint)
45
What is the innervation of inferior gemellus?
Nerve to quadratus femoris (from sacral plexus)
46
Which three deep gluteal muscles run together?
- Superior gemellus
- obturator internus
- inferior gemellus
47
What is the origin & insertion of quadratus femoris?
Ori: Ischial tuberosity
Ins: Quadrate tubercle of femur
48
What are the functions of quadratus femoris?
- Lateral rotation of thigh (hip joint)
- Adduction of thigh (hip joint) - weak
49
What is the innervation of quadratus femoris?
Nerve to quadratus femoris (from sacral plexus)
50
What is the origin & insertion of obturator externus?
Ori: Outer surface of the obturator membrane
Ins: Trochanteric fossa
51
What are the functions of the obturator externus?
- Lateral rotation of thigh (hip joint)
- Adduction of thigh (hip joint) - weak
52
What is the innervation of obturator externus?
obturator (from lumbar plexus)
53
What divides the thigh into 3 compartments?
3 intermuscular septae
54
What are the 3 compartments of the thigh?
- anterior (extensor) compartment
- medial (adductor) compartment
- posterior (flexor) compartment
55
What compartment houses the extensor muscles of the thigh?
anterior (extensor) compartment
56
What is the anterior (extensor) compartment innervated by?
femoral nerve
57
What is the one exception to the anterior (extensor) compartment?
The sartorius muscle is located in this compartment and is innervated by the femoral nerve; however, it is an exception in that it flexes the hip and knee joints
58
What muscle houses the adductor muscles of the thigh?
medial (adductor) compartment
59
What is the innervation of the medial (adductor) compartment?
obturator nerve
60
What are the 2 exceptions to the medial (adductor) compartment?
exception for pectineus muscle that is innervated by femoral nerve and adductor magnus muscle that is innervated by both obturator and tibial nerves
61
What compartment houses the flexor muscles in the thigh?
posterior (flexor) compartment
62
What is the posterior (flexor) compartment innervated by?
sciatic nerve
63
What is the origin & insertion of biceps femoris?
Ori:
- Long head: Ischial tuberosity
- Short head: Linea aspera
Ins:
- Head of fibula
- Lateral condyle of tibia
64
What are the muscles of the posterior (flexor) compartment of the thigh?
- biceps femoris
- semitendinosus
- semimembranosus
65
What are the functions of biceps femoris?
- Flexion of leg (knee joint) - entire muscle
- Extension of thigh (hip joint) – long head
- Lateral rotation of leg @ knee joint (when knee is flexed)
66
What is the innervation of biceps femoris?
Tibial (long head) and common fibular (peroneal) (short head) branches of sciatic nerve
67
What is the origin & insertion of semitendinosus?
Ori: Ischial tuberosity
Ins: Proximal part of medial surface of shaft of tibia (forms Pes anserine tendon)
68
What are the functions of semitendinosus?
- Flexion of leg (knee joint)
- Extension of thigh (hip joint)
- Medial rotation of leg @ knee joint) – when knee if flexed
69
What is the innervation of semitendinosus?
tibial branch of sciatic nerve
70
What is the origin & insertion of semimembranosus?
Ori: Ischial tuberosity
Ins: Posterior aspect of medial condyle of tibia
71
What are the functions of semimembranosus?
- Flexion of leg (knee joint)
- Extension of thigh (hip joint)
- Medial rotation of leg @ knee joint - when knee is flexed
72
What is the innervation of semimembranosus?
tibial
73
What is the lateral hamstring?
Biceps femoris
74
What are the medial hamstrings?
semitendinosus & semimembranosus
75
What does shortening of the hamstring cause?
low back pain
- Shortening can pull on ischial tuberosity --> posterior pelvic tilt --> lumbar spine follows movement of pelvis and changes tension of ligaments & mucles --> low back pain
76
What is the girdle that attaches the lower limb to the axial skeleton called?
pelvic girdle
77
What is the pelvic girdle made up of?
hip bones & sacrum
78
What are the 4 parts of the lower limb?
- gluteal
- thigh (from hip to knee)
- leg (crura) (from knee to ankle)
- foot (pes) (from heel to toes)
79
What make bones make up the thigh?
femur & patella
80
What bones make up the gluteal region?
hip
81
What bones make up the leg region?
tibia & fibula
82
What bones make up the foot region?
- tarsal bones
- metasarsal bones
- 14 phalanges
83
What is the sacrum made up of?
- 5 rudimentary vertebrae fused later on in life (20-30 years of age)
84
What does the sacrum articulate with superiorly?
L5
85
What does the sacrum articulat w/ inferiorly?
coccyx
86
What does the sacrum articulate with laterally?
- 2 hip bones (sacroiliac joints vix auricular surfaces)
87
What does the vertebral canal become in the sacrum?
sacral canal
88
What is the premature opening at the bottom of the sacral canal?
sacral hiatus
89
What forms from the fusion of many vertebral processes (ex., TVP's) on the posterior aspect of the sacrum?
sacral crests
90
What is the name of the foramina on the sacrum that allow passage for posterior rami of S1-S4 nerves?
posterior sacral foramina
91
Why is the anterior surface of the sacrum very smooth?
because it faces organs
92
What is the name of the foramina on the sacrum that allow passage for anterior rami of S1-S4 nerves?
Anterior foramina
93
What is the edge called where L5 vertebra will sit?
sacral promontory
94
What are the 'wings' of the sacrum that help form the sacroiliac joint?
sacral ala
95
The anterior border of this surface contributes to the formation of?
pelvic inlet (Superior Aperture)
96
Horns on the top of the surface of the 1st coccygeal vertebra which meet the sacral cornu protecting the exiting coccygeal spinal nerve.
Coccygeal cornu
97
What are two other names for the hip bone?
- os coxa
- innominate bone
98
What are the 3 bones that make up the hip bone?
- ilium
- ischium
- pubis
99
What is the socket of the hip bone called?
acetabulum
100
Permits passage of important nerves and vessels as they travel from pelvis to thigh
Obturator foramen
101
When you put your hands on your hips which part of the ilium are you touching (i.e., the most superior part)?
iliac crest
102
What is the prominent bump on the iliac crest called?
iliac tubercle (tuberculum)
103
What are the 3 lines across the lateral surface of the ilium?
- posterior gluteal line
- anterior gluteal line
- inferior gluteal line
104
What is the small groove on top of the acetabulum called?
supra-acetabular groove/sulcus
105
What feature of the ilium gives attachment to the rectus femoris muscle?
supra-acetabular groove/sulcus
106
Why is the medial surface of the ilium smooth (i.e., the iliac fossa)?
because it is housing abdominal organs
107
What is an important attachment point for powerful ligaments that support the SI joint on the medial side of the ilium?
iliac tuberosity
108
What is the line called on the medial side of the ilium that helps divide the top of the pelvis to the bottom of the pelvis?
arcuate line
109
What is the chunky line where the ilium attaches to pubis called?
iliopectineal (iliopubic) eminence
110
What is the articular surface on the ilium called that articulates with the sacrum?
auricular surface
111
What are the two projections off the anterior aspect of the ilium called?
- anterior superior iliac spine
- anterior inferior iliac spine
112
What are the two projections off the posterior aspect of the ilium called?
- posterior superior iliac spine
- posterior inferior iliac spine
113
What is just inferior to the posterior inferior iliac spines?
greater sciatic notch
114
What is the section of the ischium that comes into contact with the ischium called?
the body
115
What is the sharp projection off of the body of the ischium?
ischial spine
116
What sits in between the posterior inferior iliac spine and the ischial spine?
greater sciatic notch
117
What is just inferior to the ischial spine of the ischium?
lesser sciatic notch
118
What is the arm/bridge on the ischium?
ischium ramus
119
Along the ischial ramus is a prominent bumpy ledge which is called?
ischial tuberosity
120
T/F: ischial tuberosity is only seen on the medial side of the hip bone
False, only seen on lateral side
121
What is the name of the inferior border of the ischiopubic ramus called (i.e., where it attaches to pubic bone)?
ischiopubic ramus
122
What is the smallest bone of the 3 fused hip bones?
pubis
123
What is the structure on the pubis that forms an attachment to the other pubic bone?
body
124
Sharp line superior to the superior ramus
pectineal line
125
The superior ramus units with the ilium superiorly at the?
illiopectineal eminence
126
What is bounded by the iliopubic eminence and ischiopubic eminence?
obturator foramen
127
The Body articulates with the body of the pubic bone on the other side at the __ __. . It has a rounded __ __ on its superior surface that ends laterally as the prominent __ __
pubic symphysis; pubic crest; pubic tubercle
128
The __ __ (7) projects postero-laterally from the body and joins the ilium and ischium at its base
Superior Ramus
129
The __ __ (8) joins to the inferior ischial ramus to form the inferior border of hip bone (the ischio-pubic ramus).
Inferior Ramus
130
Deep, cup-shaped, hemispherical depression on the lateral surface of the hip bone formed by the pubis, ilium, & ischium
acetabulum
131
What does the rim or margin of the acetabulum serve as an attachment for?
fibrocartilage structure called acetabular labrum
132
Deep notch below the acetabular labrum.
acetabular notch
133
Circular non-articular depression at the bottom of the cavity of the acetabulum.
acetabular fossa
134
The curved articular surface of the acetabulum for articulation with the head of the femur
lunate surface
134
What converts the notch of the acetabulum into the acetabular foramen?
transverse acetabular ligament
135
the longest and strongest bone in the skeleton
Femur
136
What is situated a little below & behind the centre of the head of the femur?
fovea capitis femoris (fovea of the head)
137
What does the fovea capitis femoris (fovea of the head) of the femur give attachment to?
ligamentum teres femoris (round ligament of the femur)
138
Large quadrilateral eminence, situated at the junction of the neck with the upper part of the body (femur).
greater trochanter
139
Deep depression on the medial surface of the femur for insertion of tendon of obturator externus muscle.
trochanteric fossa
140
conical eminence of the femur
lesser trochanter
141
Located between the trochanters on the anterior aspect of the proximal end of femur
intertrochanteric line
142
Located between the trochanters on the posterior aspect of the proximal end of femur
intertrochanteric crest
143
How is the lesser trochanter of the femur best viewed?
posteriorly
144
The Body or Shaft of the femur , almost cylindrical in form and convex in front, is strengthened by a prominent longitudinal ridge, the?
linea aspera
145
The linea aspera of the femur is prolonged superiorly by 3 ridges, what are they called?
- lateral: gluteal tuberosity
- intermediate ridge: pectineal line
- medial ridge
146
Below the superior 3 ridges of the linea aspera, it is prolonged into 2 ridges called?
supracondylar ridges - enclosing a triangular area, the popliteal surface
147
What separates the medial and lateral condyle of the femur in the anterior view?
patellar surface
148
What separates the medial and lateral condyle of the femur in the posterior view?
intercondylar fossa
149
Above each condyle is an elevation called?
medial and lateral epicondyles
150
What is on top of the medial epicondyle?
adductor tubercle
151
Flat, triangular bone, situated on the front of the knee joint.
patella
152
What does the patella articulate with?
anterior surface of the knee
152
What is the patella usually regarded as?
sesamoid bone
153
The __ __ is convex and marked by numerous rough, longitudinal striæ
anterior surface
154
What separates the patella from the skin?
bursa
155
What covers the anterior surface of the patella?
expansion from the tendon of the quadriceps femoris, which is continuous below with the superficial fibers of the patellar ligament
156
The __ __ of the patella presents above a smooth, oval, articular area, divided into two facets by a vertical ridge; the ridge corresponds to the groove on the patellar surface of the femur, and the facets to the medial and lateral parts of the same surface; the lateral facet is the broader and deeper
posterior surface
157
What does the rough posterior surface of the patella give attachment to?
patellar ligament
158
What is the superior border of the patella called?
base
159
What does the base of the patella give attachment to?
portion of the quadriceps femoris tendon which is derived from the rectus femoris and vastus intermedius muscles
160
What do the medial and lateral borders of the patella give attachment o?
portions of the quadriceps femoris which are derived from the vastus lateralis and vastus medialis muscles
161
What does the apex of the patella give attachment to?
patellar ligament (tendon)
162
What does the patella articulate with?
femur
163
Which bone of the leg is largest of the two bones (the weight bearing bone)?
tibia
164
The Upper end of the tibia is large, and expanded into two eminences, the __ and __ __
medial and lateral condyles
165
The superior articular surface of the tibia presents two smooth articular facets separated by the __ __.
intercondylar eminence
166
What does the intercondylar eminence of the tibia consist of?
medial and later intercondylar tubercle
167
Anterior to the condyles of the tibia, there is a large elevation, the?
tibial tuberosity
168
The medial condyle of the tibia presents posteriorly a deep transverse groove, which is an attachment for what?
semimembranosus muscle
169
The lateral condyle of the tibia presents posteriorly a flat articular facet, for articulation with the head of the fibula called?
fibular facet
170
__ __ is located on the lateral condyle where the iliotibial band (iliotibial tract) inserts (tibia)
Gerdy's tubercle
171
The anterior border of the tibia, the most prominent of the three, is __
subcutaneous
172
The interosseous or lateral border of the tibia gives attachment to the __ __.
interosseous membrane
173
The medial surface of the tibia is smooth and __
subcutaneous
174
What does the posterior surface of the tibia present?
soleal line
175
What is the large process of the distal medial side of the tibia?
medial malleolus
176
The distal lateral surface of the tibia presents the __ __, the inferior surface articulates with the __
fibular notch; talus
176
The fibula is on the __ side of the tibia
lateral
176
What is the superior point of the head of the fibula called?
apex
177
The medial border of the fibula give attachment to?
interosseous membrane
178
__ __ of the fibula descends to a lower level than the medial malleolus of the tibia.
lateral malleolus
179
Behind and beneath the articular surface of the lateral malleolus (on its medial surface) is a rough depression, which gives attachment to the posterior talofibular ligament called __ __
malleolar fossa
180
The foot is made of three parts, what are they called?
- tarsus
- metatarsus
- digits
181
How many tarsal bones are there?
7
182
What are the tarsal bone groups?
- Proximal group: talus above and calcaneus below.
- Intermediate group: navicular; articulates posteriorly with the head of the talus.
- Distal group: consists of cuboid and three cuneiforms (medial, intermediate and lateral).
183
What does the proximal group of tarsal bones consist of?
talus & calcaneus
184
What does the intermediate group of tarsal bones consist of?
navicular
185
What does the distal group of tarsal bones consist of?
- cuboid
- cuneiforms: medial, intermediate, lateral
186
The metatarsal bones are made up of 5 which are numbered from __ to __
medial to lateral
187
The fifth metatarsal bone is recognized by a rough eminence, the __, on the lateral side of its base
tuberosity
188
__ __ of the body of the talus presents a smooth trochlear surface, for articulation with the inferior surface of the distal end of the tibia
Superior surface
189
Inferior surface of the talus presents two articular areas, the posterior and middle calcaneal surfaces, separated from one another by a deep groove, the __ __
sulcus tali
190
In the foot the sulcus tali lies above a similar groove upon the upper surface of the calcaneus, and forms, with it, a canal (sinus tarsi) filled up by the __ __ __
interosseous talocalcaneal ligament
191
What does the posterior surface of the talus articulate with (inferiorly)?
calcaneus
192
What does the head of the talus articulate with (anterior)?
navicular
193
The medial surface of the talus articulates with the?
medial malleolus
194
The lateral surface of the talus articulates with the?
lateral malleolus
195
What is the largest tarsal bone?
calcaneus
196
Where is the calcaneus situated? What is its purpose?
the lower and back part of the foot, serving to transmit the weight of the body to the ground, and forming a strong lever for the muscles of the calf
197
How many surfaces does the calcaneus present?
6
198
The superior surface of the calcaneus has 3 articular facets for the? The calcaneus also has an articular surface for which bone?
talus; cuboid
199
What is the sulcus called on the superior surface of the calcanenus?
calcaneal sulcus
200
On this surface there is a sulcus, the calcaneal sulcus. In the articulated foot this sulcus lies below a similar one on the under surface of the talus, and the two form a canal (__ __) for the lodgment of the interosseous talocalcaneal ligament
sinus tarsi
201
What is the plantar surface of the calcaneus called (what touched the ground)?
calcaneal tuberosity with lateral and medial processes
202
Where does the plantar fascia attach to?
calcaneal tuberosity
203
Anterior to the calcaneal tuberosity is the?
calcaneal tubercle
204
What is the horizontal eminence of the medial surface of the calcaneus called?
sustentaculum tali
205
Calcaneus: Below the sustentaculum tali is a groove for the tendon of the?
flexor hallucis longus
206
What is the elevated ridge that separates two oblique grooves on the lateral surface of the calcaneus?
fibular (peroneal) tubercle or trochlea
207
What is in front and behind the navicular bone?
talus behind and the cuneiform bones in front
208
What does the anterior surface of the navicular bone articulate with?
three cuneiform bones
209
What does the posterior surface of the navicular bone articulate with?
head of talus
210
The medial surface of the navicular bone presents a rounded __
tuberosity
211
The __ __ is placed on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones
cuboid bone
212
Where does the axis of the foot passes through?
2nd toe and metatarsal bone
213
What is abduction and adduction of the toes considered relative to?
2nd toe
214
What does the medial cuneiform articulate with?
1st metatarsal
215
What do the cuneiform bones articulate with anteriorly?
navicular
216
What does the intermediate cuneiform articulate with?
2nd metatarsal
217
What does the lateral cuneiform articulate with?
3rd metatarsal
