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Musculoskeletal Module > Lecture 9 > Flashcards

Lecture 9 Flashcards

1
Q

What is the gluteal sulcus/fold?

A

A combination of the Gluteus Maximus muscles

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2
Q

What is the relative position of the Gluteal region and the pelvis?

A

Gluteal region = Posterior to pelvis

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3
Q

What is the Gluteal region bound Superiorly and inferiorly to?

A

Gluteal region is bound:

  1. Superiorly: to Illiac crests
  2. Inferiorly: to Gluteal Sulcus/Fold (created by the gluteus maximum muscles)
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4
Q

What is another name for the gluteal sulcus?

A

gluteal fold

creation of the gluteus maximus muscles

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5
Q

What are the 3x components of the hip bones from largest to smallest?

A

Illium + Ischium + Pubis

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6
Q

What is the largest and smallest component of the hip bones?

A

Largest: Illium
Ischium
Smallest: Pubis

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7
Q

What is the most lateral part of the hiip bones?

A

Illiac crest

  • hip bones
  • poking laterally
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8
Q

What is the most Posterior part of the Ischium?

A

Ischial spine

pokes posteriorly

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9
Q

Gluteus Maximus

A

Largest mucle in body
Very very powerful
Hip extensor (standing up from sitting, walking up stairs)
Origin: Upper portion of illium, Posterior Sacrum, Coccyx, sacrotuberous Ligament (attached across sacrum and illium proximally)
Insertion: ITB, gluteal tuberosity of femur (lateral aspect of femur, alongside tensor facia lata and into ITband-thick band of fascia i lateral thigh)
Action: Extends and laterally rotates the thigh
Nerve Supply: Inferior gluteal Nerve

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10
Q

Gluteus Medius

A

Deep to Gluteus Maximus
Origin: Illium between posterior and middle gluteal lines (illiac crest)
Insertion: Greater trochanter (proximal femur onto greater tuberosity)
Action: Abducts and internally rotates thigh, steadies pelvis
Primary ABDuctor of the hip - upon contraction femur moves out Laterally
-really important for holding your Pelvis Level when you Walk
- Problem: Lurching Gate. v. distinctive. hip problems/surgery. Lean to one side as you walk, as other/only one leg takes all the weight (pelvis isnt being held level by the abducting gluteus medius/ not moving femur out laterally)
Nerve Supply: Superior Gluteal

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11
Q

Gluteus Minimus

A

Origin: illium between middle and inferior gluteal lines
Insertion: Greater tichanter
Action: Abducts and internally rotates thigh
Nerve Supply: Superior Gluteal

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12
Q

Piriformis

A

“little pear”
comes through Sciatic notch -> into sacrum
Origin: Anterior Sacrum, sacrotuberous Ligament
Insertion: Greater trochanter
Action: Externally rotates thigh
Nerve Supply: Sacral Plexus

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13
Q

Obturator Internus

A

Origin: Obturator Foreamen and membrane
Insertion: Greater trochanter
Action: Externally rotates the thigh
Nerve Supply: Nerve to OI (sacral plexus)

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14
Q

Superior and Inferior Gemelli

A

Origin:Ischial spine (s) and ischial tuberosity (i)
Insertion: Greater trochanter
Action: Externally rotates thigh
Nerve Supply: Nerve to OI (s). Nerve to QF (i)

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15
Q

Quadratus Femoris

A

Rectangular/Quadrangular shaped muscle
Inferior
Innervation directly from sacral plexus
Origin: Ischial Tuberosity
Insertion: Quadratic tubercle (intertrochanteric crest of femur)
Action: externally rotates thigh
Nerve Supply: nerve to QF (sacral plexus)

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16
Q

Tensor Fascia Lata

A

Origin: ASIS, iliac crest
Insertion: ITB
Action: Abducts thighh, dynamic stabiliser
Nerve Supply: Superior Gluteal

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17
Q

What is the most inferior part of the ischium?

A

Ishcial tuberosity

-large protuberance inferiorly

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18
Q

Where is the ASIS located?

A

Anterior Superior Illiac Spine

Superior spine on the Anterior side of the Illium

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19
Q

Where is the AIIS located?

A

Anterior Inferior Illic Spine

Inferior spine on the Anterior side of the Illium

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20
Q

Where do the 2x parts of the pubis meet?

A

Anterior

Comes to meet together at the midline in the Pubis Symphosis

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21
Q

What is the Pubic Symphysis?

A

Meeting point in the midline of the pubic bones of the pelvis

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22
Q

Where is the Ischial spine located?

A

superior spine poking posteriorly of the ischium

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23
Q

Where is the Ischial Tuberosity located?

A

inferiorly

a protuberance poking posteriorly from the Ischium

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24
Q

What is the pelvic part of the hip joint called?

A

Acetabulum

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25
Q

What are the essential features of the acetabulum?

A

Pelvic part of the hip joint
Combining point of the 3x components of the hip joint
Triadic Cartilage: Aren’t ossified in utero/children (still cartilaginous) therefore - 3x pieces of cartilage that are yet to join

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26
Q

What is the state of the Acetabulum in Utero/childhood?

A

Unossified
Triadic Cartilage
-the 3x pieces are unossified, hence are just 3x pieces of cartilage yet to fuse together

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27
Q

What is the name for the Acetabulum in utero/childhood?

A

Triadic Cartilage

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28
Q

What are the 5x components of the entire boney pelvis?

A 
Hip bones:
1. Ischium
2. Illium
3. Pubis
\+
4. Sacrum
5. Coccyx
-all bound together by very strong ligaments
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29
Q

What is the sacrotuberous ligament continuous with?

A

Posterior Sacroilliac ligament
extends across the sciatic notch, and along with sacrospinous ligament, converts the notch into Greater and Lesser Sciatic Foramina

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30
Q

What 2x ligaments extend across the sciatic notch? and what landmarking affect does this have on the pelvis?

A

Sacrotuberous ligament (Sacrum –> Ischial tuberosity)
+ Sacrospinous ligament (sacrum –> Ischial spine)
extend across the sciatic notch
Converts notch into Greater and Lesser Sciatic Foramina

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31
Q

What the 2x attachments of the sacrotuberous ligament?

A

Sacrum –> Ischial Tuberosity (inferior protuberance)

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32
Q

What are the 2x attachments of the sacrospinous ligament?

A

Sacrum –> Sichial spine

superior spike poking posteriorly

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33
Q

What is the Posterior Sacroilliac ligament continuous with?

A

Sacrotuberous ligament

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34
Q

What are the 2x attachemnts of the Posteior Sacroilliac ligament?

A

Posterior/back surface of the pelvis

Superior Posterior Sacrum –> Posterior Superior Illiac Spine

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35
Q

What occurs within the landmark of the Greatest Sciatic Foreamen?

A

structures EXIT OUT
Superiorly
Lower limb arteries
-superior and inferior gluteal arteries = corresponding nerves, pass superior and inferorior to Piriformus
Nerves from pelvis going into the the gluteal region (e..g sciatic nerve)

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36
Q

Is the greatest sciatic foreamen for Entry or Exit of structures?

A

EXIT/ OUT
-e.g. superior and inferior gluteal arteries + corresponding nerves (sciatic nerve) pass superior and inferior to piriformis

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37
Q

What is the example nerve which runs out of the Greatest sciatic foreamen?

A

Sciatic nerve

+ superior and inferior gluteal arteries + corresponding nerves (sciatic nerve) pass superior and inferior to piriformis

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38
Q

What occurs within the landmark of the Lesser Sciatic Foreamen?

A

structures Entering INTO this opening
Inferiorly
e.g. into Genitourinary system or Peroneum
-entering or leaving the Peroneum, so supply the peroneum
e.g. Pudendal Nerve
-superior leaves pelvis via greater s.f., but hooks around and Enters pelvis via Lesser sciatic foramen

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39
Q

What are the 2x structures going Into the Lesser sciatic foreamen genreally going to?

A
  1. Genitourinary system
    typically: 2. Peroneum
    (entering or leaving the peroneum to supply the peroneum)
    e.g. Pundendal Nerve
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40
Q

What is the example nerve which runs into the Lesser sciatic foreamen?

A

Pundendal Nerve
Leaves pelvis via greater s.f.
But hooks around and enters pelvis via Lesser sciatic foreamen

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41
Q

Through which landmark is the Peroneum supplied in the pelvis?

A

via ENTERY (mainly) and exit of vessels through the LESSER sciatic foreamen (e.g. Pundendal nerve) to supply the peroneum

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42
Q

What are the 6x Short External Rotators of the thigh?

A
  1. Pirformis
  2. Superior Gemeli
  3. Inferior Gemeli
  4. Obturator Internus
  5. Obturator Externus
  6. Quadratus Femoris
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43
Q

What are the 2x layers of muscle in the gluteal region?

A
  1. Superficial layer = Gluteus/gluteal muscles

2. Deep Layer= Hip rotators

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44
Q

Are the gluteal muscles part of the superficial or deep layer of muscles in the gluteal region?

A

Superficial = gluteal muscles in gluteal region

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45
Q

Are the hip rotator muscles part of the superficial or deep layer of muscles in the gluteal region?

A

Deep= hip rotator muscles in gluteal region

46
Q

What is the largest and most powerful muscle in the body?

A

Gluteus maximus
very powerful
Hip Extensor - standing up from sitting down, walking up stairs
Nerve supply: Inferior gluteal nerve

47
Q

What is the nerve supply for the Gluteus Maximus muscle?

A

Inferior Gluteal Nerve

48
Q

What is the name of the primary abductor of the hip joint?

A

Gluteus Medius
Contraction = moving the Femur out Laterally
- helps to Hold/keep the Pelvis Level when Walking
Problem: Abductor Lurch/Gluteus Medius Lurch

49
Q

What muscle is affected during a lurching gate?

A

Gluteus Medius
Trendelenburg Gait/Abductor Lurch/ Gluteus Medius Gate
Leaning, one side taking all the weight, Pelvis isnt being held level during walking

50
Q

What is the Trendelenburg Gait/Abductor Lurch/Gluteus Medius Gate involving?

A

Gluteus Medius affected
- is the Primary abductor of the hip joint, functions to hold the hip level when walking
Pelvic stabilisation
Injury to muscle or nerve supplying it (superior gluteal nerve)
=thigh abduction weakened as gluteus medius no longer contracts to support the pelvis and stop it from tilting to lifted side
-results in a Leaning to Unaffected side “the sound side sags” when walking. In order to clear the leg on the unaffected side during Swing through phase.

As other leg/side takes all the weight. Pelvis isnt being held level during walking- failure to have complete abduction

51
Q

What is the nerve supply for Gluteus Medius?

A

Superior Gluteal Nerve

52
Q

What is the action the Gluteus Medius muscle?

A

ABDuctor of the hip

Contraction = making Femur move out Laterally

53
Q

What are an example of both internal and external rotation?

A

Internal rotation = pointing toes inwards/towards midline

External rotation = pointing toes out laterally/ outwards. Ballet 1st position

54
Q

What 4x Short External rotator muscles are located inferior to Piriformis?

A
  1. Gemellus Superior
  2. Gemellus Inferior
  3. Obturator Internus
    -3x separate origins.
    -1x Common insertion- form 1x combined 3x headed tendon on to Greater Trochanter of Femur
    All external rotator muscles of the hip joint
  4. Quadratus Femoris
    All have Common innervation Directly from the Sacral Plexus (including piriformis)
55
Q

What is the relationship between Gemellus Superior and Inferior and Obturator Internus?

A

All External rotators
3x different origins
1x common Insertion. Greater trochanter of femur. combine to form single tendon with 3x heads medially

56
Q

What is the common insertion point of the 3x headed muscle of the 3x inferior external rotators of the hip?

A

Greater trochanter of the femur
Gemellus Superior, Inferior and Obturator Internus
-3x different origins, 1x common insertion as fuse to form single tendon (with 2x medial heads(origins))

57
Q

What is the innervation for the Short External Rotator muscles of the hip inferior to Piriformis?

A

Innervation Directly from the Sacral plexus

Gemellus Superior and Inferior, Obturator Internus and Quadratus Femorus

58
Q

Which muscles receive direct innervation from the sacral plexus?

A

Short External Rotator muscles of the Hip

  1. Gemellus Superior
  2. Gemellus Inferior
  3. Obturator Internus
  4. Quadratus Femoris
  5. Priformis
59
Q

What muscles is pear shaped in the hip?

A

Piriformis

-comes out through the sciatic notch in the sacrum to insert onto the femur

60
Q

Which muscle in the hip comes out through the sciatic notch in the sacrum and inserts onto the femur?

A

Piriformis

  • pear shaped muscle
  • short external rotator (of hip joint)
  • innervated directly by the sacral plexus
61
Q

What are the 4x Posterior Thigh muscles?

A
  1. Biceps Femoris
  2. Semi-tendinosus
  3. Semi-membranosus
  4. Adductor Magnus
62
Q

Biceps Femoris

A

Origin: Long Head: Ischial Tuberosity. Short Head: Linea Aspera
Insertion: Head of Fibula
Action: Flexes and externally rotates leg at knee (rotates leg at knee; extends thigh at hip)
Nerve Supply: Sciatic Nerve. Long Head BF: Tibial nerve. Short Head BF: Peroneal Nerve

63
Q

What origin and nerve supply for the Long Head of biceps femoris?

A

Origin: Ischial Tuberosity

Nerve Supply: Tibial nerve

64
Q

What is the origin and nerve supply for the short head of biceps femoris?

A

Origin: Linea Aspera (comes off 1/2 way down Linea Aspera and is attached to the Deep fascia)
Nerve Supply: Common Peroneal Nerve

65
Q

Semitendinosus

A

Origin: Ischial Tuberosity
Insertion: Superior Part of Medial Tibia (Pes Anserinus)
attaches to front/medial side of knee- next to satorius and gracilis
Action: Flexes and internally rotates leg. Extends thigh
Nerve Supply: Tibial Nerve ( branch of sciatic)

66
Q

Semimembranosus

A

Fleshier/Less Tendinus
Deeper of the two
Origin: Ischial Tuberosity
-partially swings across the back of the knee
Insertion: Medial condyle of tibia - Wider attachment across posterior aspect of the knee
Action: Flexes and internally rotates leg. Extends thigh.
Nerve Supply: Tibial NErve (branch of sciatic)

67
Q

Adductor Magnus

A

Origin: Adductor part= Inferior Pubic Ramus
Hamstring part = Ischial Tuberosity
Insertion: Linea Aspera, Medial Supra condylar ridge, Adductor Tubercle
Action: Adducts thigh, can both flex and extend thigh by different fibres
Nerve Supply: Adductor part= Obturator Nerve. Hamstring part=Sciatic Nerve

68
Q

What is the origin and nerve supply of the Adductor part of Adductor Magnus?

A

Origin: Inferior Pubic Ramus

Nerve supply: Obturator Nerve

69
Q

What is the origin and nerve supply of the Hamstring part of Adductor Magnus?

A

Origin: Ischial Tuberosity

Nerve Supply: Tibial nerve (branch off sciatic nerve)

70
Q

Where do the gluteal arteries arise from?

A

Internal Illiac Arteries

71
Q

What is the relationship between the structures exiting/going out of the greater sciatic foreamen and the piriformis?

A

Leave/Exit/Out of
Superior and Inferior Gluteal Arteries
+ corresponding nerves (sciatic nerves)
pass superior and inferior to piriformis

72
Q

What anastomosing occurs of the arteries around the hip?

A

Superior and Inferior Gluteal arteries anastomes

Then S&I G.A. anastomose with the Circumflex arteries (branches of profunda femoris)

73
Q

What are the circumflex arteries branches of? and what do they anastomose with?

A

Circumflex arteries = branches off profunda femoris artery

anastomose with superior and inferior gluteal arteries, after both sets have anastomosed themselve

74
Q

What are the branches off the Profunda Femoris arteries called?

A

Circumflex arteries

75
Q

What is the location and function of the Superior Gluteal artery?

A

Leaves via Greater Sciatic Foreamen
Leaves Laterally
runs Superior to Piriformis
supplies Gluteus Medius and Minimus

76
Q

What is the location and function of the Inferior Gluteal Artery?

A

Leaves vie Greatest Sciatic foreamen
Leaves Laterally
runs Inferior to Piriformis
supplies Gluteus Maximus

77
Q

What are the essential features of the sciatic nerve?

A

Largest nerve in the body
Continuation of the main part of the sacral plexus
Under gluteal region. Under Gluteus Maximus
Inferior to Piriformis (10-20% have sciatic nerve superior/through piriformis)
Well protected
as is Very important for the functioning of the Lower Limb
Own artery running with it - as is so big - called “Artery to sciatic nerve” - a branch of Inferior Gluteal artery
Deep from hamstring to knee, Posterior aspect of thigh
Divides usually in Distal thigh, but can be higher - needs to be considered during surgery otherwise can be injured

78
Q

What is the largest nerve in the body?

A

Sciatic Nerve

79
Q

What is the location of the Sciatic nerve relative to piriformis?

A

Inferior to Piriformis, Under Gluteal region and gluteus Max

10-20% of people have sciatic nerve running superior/through piriformis

80
Q

What occurs in 10-20% of the population regarding the relationship between sciatic nerve and piriformis

A

Normally sciatic nerves runs INFERIORLY to piriformis

but 10-20% of population of sciatic nerve running superiorly/through piriformis

81
Q

What is the location of the sciatic nerve through the leg?

A 
Deep from hamstring to knee
runs on Posterior aspect of the thigh
Well protected
has its own artery as is so big
important to the functioning of the lower limb
82
Q

What is the the sciatic nerve important for the functioning of?

A

Sciatic nerve is important for the function of the lower limb
- continuation of main part of sacral plexus

83
Q

What is the name for the continuation of the main part of the sacral plexus?

A

Sciatic nerve

84
Q

What is the sciatic nerve a main continuation of?

A

Sacral plexus

–> main continuation is sciatic nerve

85
Q

What is the name of the sciatic nerves artery and where does it originate from?

A

Artery to sciatic nerve

from Inferior Gluteal Artery

86
Q

What is the relationship between the sciatic nerve and the gluteal region?

A

Sciatic nerve is under gluteal muscles and gluteus maximus

80-90% of the time Inferior to Piriformis (otherwise runs superior/through)

87
Q

Where does the Sciatic nerve usually divide?

A

Distal thigh
but can sometimes occur much higher
therefore needs to be considered during surgery to avoid injury
Even if the sciatic nerve hasnt divided into the thigh, the parts of the sciatic nerve that supply the hamstrings are going to go on and become the tibial nerve

88
Q

What needs to be considered during surgery of the thigh to avoid neural injury?

A

The location of Sciatic nerve branching
usually branches into tibial and common peroneal(fibular) nerve distally, but can occur higher
therefore needs to be considered to avoid injury during surgery

89
Q

Where is the origin of the Short head of Biceps Femoris?

A

Comes off 1/2 way down the Femur

and is also attached to the Deep fascia

90
Q

Is biceps femoris medial or lateral to the knee?

A

Lateral

91
Q

When sitting what structure do you sit down on?

A

NOT Gluteus maximus
Flex hip fully forward, muscles slide up and forward, sit on ischial tuberosity
–> therefore painful when you sit too long, as you dont have much muscle sitting there + varying amounts of adipose tissue

92
Q

What is the relationship between flexion, sitting, ischial tuberosity and gluteus Maximus?

A

Sitting = flex hip forward= all muscles slide superiorly and forward
Not sitting on Gluteus maximus
Just sitting on ischial tuberosity
–> therefore get painful when you sit too long as you’re not sitting on muscle + varying amounts of adipose tissue

93
Q

Why cant you sit for too long?

A

Actually sitting on ischial tuberosity
Sitting = Flexion of hip = muscles slide superiorly and forwards
Not sitting on a muscle or gluteus maximus
–> therefore you get pain if sitting too long as no muscle + varying amounts of adipose tissue

94
Q

Why is the ischial tuberosity so large?

A

Both semitendinosus and Semimembranosus originate off there

- so many muscles pulling on it

95
Q

What is the common origin of semitendinosus and semimembranosis?

A

Ischial tuberosity

-they make the ischial tuberosity so big as it has so many muscles pulling on it

96
Q

Where does SemiTENdinosus insert?

A

Medial side of knee

next to Satorius and Gracilis (coming in from front and medial side) Pes Anserinus

97
Q

What is the relationship between Satorius, SemiMEMbranosus and Gracilis?

A

All 3x attach on the medial side of knee

Pes Anserinus

98
Q

What 2x compartments are adductor magnus part of?

A

Posterior and Medial compartment

Comes off the ishcial tuberosity

99
Q

What are the essential features of the hamstring muscles?

A 
Cross 2x joints - hip and knee
attach to pelvis posteriorly 
insert Below knee
Knee Flexion and Hip Extension
All supplied by tibial nerve
100
Q

Which muscle in the thigh crosses 2x joints?

A

Hamstring muscles
Posteriorly attach to pelvis - and cross hip joint
Insert below knee - cross Knee joint
Knee Flexion and Hip Extension

101
Q

What nerve supplies the hamstring muscles?

A

Tibial nerve (from sciatic nerve)

102
Q

What movements to the hamstring muscle lead to?

A

Hip Extension and Knee Flexion
as crosses both joints
attaches posteriorly to ischial tuberosity (crosses hip joint)
inserts below knee (crosses knee joint)

103
Q

Summary of Trendelenburg Gait

A

Gluteus Medius normally contracts to support and stabilize pelvis
Weakened thigh abduction
Gluteus Medius no longer contracts and supports and stabilizes pelvis.
Doesnt stop it from tilting to the unaffected side “the sound side sags” - during SWING phase of gait cycle
-in order to try and clear the leg

104
Q

Where is the safe side for intragluteal injections and what structure determines the safety of lack of it?

A

SuperioLateral side
Lateral side = safe for sciatic nerve
superior as Gluteal region is a common site for intramuscular injections as Large muscle area for venous absorption

105
Q

Where is the safe side of the butt regarding the Sciatic nerves and intramuscular injections?

A

LAteral part of buttocks

-hence superiolateral intragluteal muscle injections

106
Q

Why is the gluteal muscles a common area for intramuscular injections?

A

Gluteal muscles are a Large muscle area for Venous absoprtion

107
Q

Where is a large muscle area, good for venous absorption, utilized for intramuscular injections?

A

Gluteal muscles

Superiolateral = safe= avoids sciatic nerve

108
Q

What is piriformis syndrome?

A

Sciatic nerve is compressed by piriformis muscle

Pain, tingling and numbness in buttocks and down path of sciatic nerve (lower thigh and into leg)

109
Q

What is the condition called when the piriformis muscle is compressing a nerve, leading to pain, tingling and numbness?

A 
Piriformis syndrome
Nerve=sciatic nerve
pain, tingling and numbness occur in
1. buttocks
2. down the path of the sciatic nerve, into lower thigh and leg
110
Q

When do hamstring injuries usually occur?

A

Kicking or running sports
-sudden change from stationing to sprinting
-kicking against resistance(football or person)
Midsubstance strains or tears within the muscle
-can strain pretty easily
can avulse the ischial tuberosity completely

Musculoskeletal Module (27 decks)

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