Quiz 3- Lec 17-19

Question 1

important osteology and ligaments

Answer 1

Question 2

osteology of femur: proximal end

identify: greater trochanter and gluteal tuberosity

Answer 2

Question 3

important ligaments in the gluteal region

Answer 3

• sacrospinous ligament
• sacrotuberous ligament

Question 4

2 important foramina of gluteal region

(formed by notches and ligaments)

Answer 4

• greater sciatic foramen
• lesser sciatic foramen

Question 5

major structures that leave the pelvis through:

greater sciatic foramen to enter the gluteal region

Answer 5

1. superior and inferior gluteal artery, nerve, vein
2. piriformis m
3. pudendals (internal pudendal artery & vein, and pudendal nerve)
4. sciatic nerve
5. posterior femoral cutaneous
6. nerve to obturator internus
7. nerve to quadratus femoris

Question 6

major structures that leave the gluteal region through:

lesser sciatic foramen to enter the perineum

Answer 6

1. pudendals (pudendal nerve, internal pudendal vein & artery)
2. nerve to obturator internus

Question 7

structures that enter gluteal region thru

lesser sciatic foramen

Answer 7

obturator internus tendon

Question 8

muscles of gluteal region

Answer 8

1. GLUTES
   
   • maximus
   • medius
   • minimus
2. tensor fasciae latae
3. piriformis
4. superior gemellus
5. obturator internus
6. inferior gemellus
7. quadratus femoris
8. obturator externus

Question 9

tensor fasciae latae:

origin, insertion

Answer 9

• o:
  
  • anterior 1/4 of lateral lip of iliac crest lateral side of ASIS &
  • interspinous fossa fascia lata & gluteal fascia
• ins: travels b/w 2 layers of fascia lata to insert on IT band (tract)

Question 10

tensor fasciae latae:

act, inn

Answer 10

• action: abduction, medial rotation, & flexion of hip; assists w/ knee extension; helps to tense fascia lata
• inn: superior gluteal nerve (L4)

Question 11

gluteus maximus:

origin, insertion

Answer 11

• origin
  
  • ilium posterior to posterior gluteal line
  • sacrotuberous ligament
  • dorsal surface of distal 2 sacral segments and coccyx
  • [aponeurosis of erector spinae, dorsal sacroiliac lig & fascia lata]
• ins
  
  • superior and superficial fibers insert into IT tract
  • deep fibers insert into gluteal tuberosity

Question 12

gluteus maximus:

action, innervation

Answer 12

• action: power extension of hip, raise trunk from flexed position, superior fibers abduct hip, other fibers adduct hip; lateral rotation of hip, tenses fascia lata
• inn: inferior gluteal nerve

Question 13

gluteus medius:

origin, insertion

Answer 13

• origin:
  
  • ilium between posterior and anterior gluteal lines
  • gluteal fascia
• ins
  
  • diagonal ridge of lateral surface of greater trochanter

Question 14

gluteus medius:

action, innervation

Answer 14

• actions:
  
  • abduction of hip (stabilizes pelvis)
  • anterior fibers flex & medially rotate hip
  • posterior fibers extend & laterally rotate hip
• innervation: superior gluteal nerve

Question 15

gluteus minimus:

origin, insertion

Answer 15

• o: ilium between anterior and inferior gluteal lines
• ins: depression on anterior side of greater trochanter

Question 16

gluteus minimus:

actions, innervation

Answer 16

• actions:
  
  • abduction of hip (also stabilizes pelvis)
  • flex and medially rotate hip
• inn: superior gluteal nerve

Question 17

CC: lurch gait is a symptom of lesion of which nerve?

Answer 17

inferior gluteal nerve

(characterized by posterior leaning of the trunk at heel strike in order to keep hip extended during stance phase.)

Question 18

combined actions of gluteus medius and minimus….

Answer 18

prevents pelvic tilt/drop on the contralateral side

Question 19

CC: Trendelenburg gait and sign is a symptom of lesion of which nerve?

Answer 19

lesion of superior gluteal nerve

(When standing on the right leg, if the left hip drops, it’s a positive right Trendelenburg sign (the contralateral side drops because the ipsilateral hip abductors do not stabilize the pelvis to prevent the droop)

Question 20

piriformis

origin, insertion

Answer 20

• o:
  
  • pelvic surface of sacrum (lateral parts of S2 - S4 segments)
  • [ventral sacroiliac & sacrotuberous ligaments]
• ins:
  
  • “tip” of greater trochanter

Question 21

piriformis:

actions, innervation

Answer 21

• actions:
  
  • laterally rotate hip
  • abductor of thigh w/ hip flexed
• innervation: twigs from ventral rami (S1 & S2), nerve to piriformis in pelvis

Question 22

obturator iNTERNUS & superior & inferior gemelli

origin & insertion

Answer 22

• origin
  
  • Obturator internus: bony internal margin of obturator foramen and obturator membrane
  • Superior gemellus: external surface of ischial spine
  • Inferior gemellus: superior edge of ischial tuerosity, next to obturator notch
• insertion: all 3 thru combined tendon into medial side of greater trochanter, anterosuperior to trochanteric fossa

Question 23

obturator INTERNUS, & superior/inferior gemelli

actions, innervation

Answer 23

• actions: all 3 laterally rotate hip and abduct the thigh with hip flexed
• inn:
  
  • Obturator internus & superior gemellus: nerve to obturator internus
  • Inferior gemellus (and quadratus femoris): nerve to quadratus femoris

Question 24

quadratus femoris:

origin, insertion

Answer 24

o: lateral side of ischial tuberosity and from part of body of ischium
ins: quadrate tubercle and bone inferior to it

Question 25

quadratus femoris: action, innervation

Answer 25

action: laterally rotates hip; weak adductor inn: nerve to quadratus femoris (also inn. inferior gemellus)

Question 26

which muscles in gluteal region are supplied by: ## Footnote **superior gluteal artery**

Answer 26

* G. **max** (superficial branch) * G. **med** * G. **min** (deep branch)

Question 27

which muscles in gluteal region are supplied by: ## Footnote **inferior gluteal artery**

Answer 27

* G. **max** and * to most short lateral rotators (and to “hamstrings”) & ischiadic branch to the sciatic nerve

Question 28

cruciate anastomosis: define and included arteries

Answer 28

* “cross-like” configuration of arteries in upper posterior thigh near the lesser trochanter * includes: * Branch from inferior gluteal * 1st perforating/ascending branch * Medial circumflex (transverse br.) * Lateral circumflex (transverse br.)

Question 29

variation in sciatic nerve (tibial & common fibular/peroneal)

Answer 29

an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve as it passes under or through the piriformis muscle

Question 30

normal relationship between sciatic nerve and piriformis

Answer 30

normally, sciatic nerve is inferior/deep to piriformis

Question 31

abnormal variation of fibular nerve could include:

Answer 31

1. piercing piriformis 2. superior/superficial to piriformis

Question 32

how to reproduce piriformis syndrome? which group is often affected?

Answer 32

* reproduce with FAIR maneuver (flexion, adduction & internal rotation - stretches piriformis). * rowers and rock climbers often develop symptoms

Question 33

cc: sciatica | (NOT A DIAGNOSIS)

Answer 33

* compression of sciatic nerve or roots producing radicular pain – reproduced by straight leg raise w/30-70° passive hip flexion (Lasegue’s sign)

Question 34

Cutaneous nerves (list)

Answer 34

1. inferior cluneal nerves 2. posterior cutaneous nerve of the thigh 3. superior cluneal 4. middle cluneal

Question 35

cluneal nerves and assoc. rami

Answer 35

1. Superior (dorsal rami L1-L3 2. Middle (dorsal rami S1-S3) 3. Inferior (ventral rami S1-S3 from posterior cut. nerve of thigh)

Question 36

rami assoc. w/ **posterior cutaneous nerve of the thigh**

Answer 36

* (ventral rami of S1-3) * Dorsal division fibers from S1 & S2 & * ventral division fibers from S2 & S3 S1 fibers go to posterior leg

Question 37

what is the preferred location for an ## Footnote **intramuscular injection?**

Answer 37

* Superolateral quadrant or * above a line that connects the PSIS and superior margin of the greater trochanter

Question 38

again, where is the preferred site for intragluteal injections to avoid sciatic nerve?

Answer 38

between tubercle of iliac crest & anterior superior iliac spine

Question 39

lymphatics of the gluteal/lower limb?

Answer 39

1. superficial inguinal nodes --\> drain into external iliac nodes 2. deep inguinal nodes (*in femoral ring and canal)* 3. external iliac nodes 4. popliteal nodes

Question 40

**superficial inguinal nodes** receive lymph from:

Answer 40

* lower limb * perineum * gluteal region * lower abdominal wall

Question 41

popliteal nodes drain into:

Answer 41

deep inguinal nodes, along deep veins

Question 42

2 bursae in gluteal region?

Answer 42

1. ischial bursa 2. trochanteric bursa

Question 43

ischial bursa is found where?

Answer 43

between gluteus max & ischial tuberosity

Question 44

trochanteric bursa is found where?

Answer 44

between gluteus max & lateral surface of greater trochanter

Question 45

standing goal of standing

Answer 45

maintaining equilibrium

Question 46

what force exerts rotatory movements at major joints of lower limb?

Answer 46

gravity

Question 47

what rotary movement at hip? what offsets this?

Answer 47

* tendency is toward **hyperextension** * opposed by **iliofemoral** and **ischiofemoral**

Question 48

what rotary force at the knee? what offsets this?

Answer 48

* tendency is toward **hyperextension** at knee * opposed by **gastrocnemius muscles**

Question 49

**what rotary force at the ankle?** what offsets this?

Answer 49

* tendency is **dorsiflexion at the ankle** * to oppose this, plantar flexors are active

Question 50

the driving action opposes which force?

Answer 50

ground reaction force

Question 51

which muscles are involved in: ## Footnote **heel strike of stance phase**

Answer 51

* Hip: * gluteus maximus & hamstrings contract to resist hip flexion (prevent trunk from going into flexion on thigh) * Knee: * quadriceps femoris group contract to prevent knee from flexing

Question 52

what muscles are involved in: ## Footnote **midstance**

Answer 52

* Hip: * gluteus medius/minimus contract to prevent opposite side of the pelvis from sagging/drop (maintain pelvic balance…keep pelvis level) * Knee: * (toe off on opposite side) and previous quadriceps femoris contraction (from heel strike) brings trunk forward causing knee extension

Question 53

which muscles are involved in: ## Footnote **toe off**

Answer 53

* Hip: * anteriorly arising adductors and iliopsoas contract to resist hip extension (prevent trunk from lagging behind) and initiate high swing * Knee: * quadriceps femoris shows small contraction to support knee and initiate leg swing

Question 54

describe: **acceleration** of swing phase

Answer 54

acceleration is generated by **plantar flexors in toe off** and **flexing adductors, iliopsoas & quadriceps femoris** to bring limb forward to prepare for next heel strike

Question 55

describe: **midswing** phase of swing phase

Answer 55

swinging limb is beneath body and is shortened (hip & knee flexion and ankle dorsiflexion) to clear ground

Question 56

describe: **deceleration** of swing phase

Answer 56

acceleration (forward motion of limb) is reduced by hamstring contractions at hip and knee to ready the foot for heel strike & quadriceps femoris contract to prepare the knee for heel strike

Question 57

list the segments of the traditional **stance** phase of gait cycle

Answer 57

1. initial contact 2. foot flat 3. midstance 4. heel off 5. toe off

Question 58

list the segments of the traditional **swing** phase of gait cycle

Answer 58

* acceleration * midswing * deceleration