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69 Cards in this Set

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gluteal region (area)
posterior to pelvis from level of iliac crests (L4) to the inferior border of gluteus maximus; Intergluteal cleft is midline groove
gluteal fold
marks inferior border of the gluteus maximus; disappears when hip joint is flexed; marks the boundary between gluteal region and posterior thigh
intramuscular injections
gluteal region is a common site; In order to avoid the sciatic nerve, the superolateral quadrant is considered a "safe zone" for injection
superficial gluteal muscles
gluteus maximus, gluteaus medius, gluteus minimus, tensor fascia lata; innervation by inferior or superior gluteal nerves
gluteus maximus
• Origin: ilium, sacrum, coccyx, sacrotuberous ligament
• Insertion: iliotibial tract and gluteal tuberosity of the femur
• Innervation: inferior gluteal n.
• Action: extend hip joint (e.g., rising from sitting position, climbing stairs)
• Associated Bursae: Trochanteric; Ischial
gluteus medius
• Origin: ilium (deep to gluteus maximus)
• Insertion: greater trochanter of femur
• Innervation: superior gluteal n.
• Action: abduct hip joint; keep pelvis level when contralateral leg is raised
gluteus minimus
▪ Origin: ilium (deep to gluteus medius)
▪ Insertion: greater trochanter
▪ Innervation: superior gluteal n.
▪ Action: abduct hip joint; keep pelvis level when contralateral leg is raised
tensor fascia lata
▪ Origin: ASIS
▪ Insertion: iliotibial tract
▪ Innervation: superior gluteal n.
▪ Action: tense the fascia lata, thus improving efficiency of other thigh muscles and assisting venous return
lesion of superior gluteal nerve
o If the superior gluteal n. is injured, when a person is asked to stand on one limb, the pelvis tilts towards the unsupported side (this is called a positive Trendelenburg test)
o So, injury to the left superior gluteal n. will cause the pelvis to tilt on the right side.
deep gluteal muscles
laterally rotate and stabilize hip joint; innervation by branches of sacral plexus; priformis, obturator internus, superior and inferior gemelli, quadratus femoris
piriformis
▪ part of deep gluteal muscles
▪ inn: branches of sacral plexus, action: laterally rotate and stabilize hip
▪ Superior gluteal vessels/nerve emerge superior to it
▪ Inferior gluteal vessels/nerve emerge inferior to it
▪ Origin: anterior surface of the sacrum
▪ Insertion: greater trochanter
obturator internus
▪ deep gluteal muscle; laterally rotate and stabilize hip joint; innervation: branches of sacral plexus
- Origin: internal aspect of obturator membrane and border of obturator foramen
▪ Insertion: trochanteric fossa
superior and inferior gemelli
▪ part of deep gluteal muscles
▪ laterally rotate and stabilize hip joint
▪ inn: branches of sacral plexus
▪ Origin: ischial spine (superior gemellus); ischial tuberosity (inferior gemellus)
▪ Insertion: trochanteric fossa
quadratus femoris
▪ deep gluteal muscle
▪ laterally rotate and stabilize hip joint
▪ inn: branches of sacral plexus
▪ Origin: ischial tuberosity
▪ Insertion: intertrochanteric crest
gluteal vessels
• Gluteal arteries arise from the internal iliac a.
• Superior gluteal a.
o Exits greater sciatic foramen superior to piriformis
• Inferior gluteal a.
o Exits greater sciatic foramen inferior to piriformis
• Superior and inferior gluteal veins accompany the arteries and are tributaries of the internal iliac vein
sciatic nerve
• (L4-S3)
• Exits greater sciatic foramen inferior to piriformis
• Courses deep to gluteus maximus (but does NOT innervate gluteal muscles)
• Sciatic nerve really consists of two nerves: tibial n. and common fibular n.
tibial and common fibular nerve
usually separate in the distal thigh (e.g., just proximal to the popliteal fossa); however, this can vary (e.g., in ~12% of people, the two nerves separate as they leave the pelvis, with the common fibular n. passing through piriformis)
pifiromis syndrome
• Excessive use of the gluteal muscles in some athletes (e.g., ice skaters, cyclists, rock climbers) can lead to hypertrophy or spasm of the piriformis muscle, which can compress the sciatic nerve
compression of common fibular nerve
In individuals with a proximal split of the sciatic nerve (~12%), the common fibular n. can become compressed as it passes through piriformis.
posterior compartment of thigh
hamstrings (inn: tibial nerve, extend hip joint and flex knee joint), short head of biceps femoris (inn: common fibular n, flex knee joint)
hamstrings
posterior compartment of thigh
▪ Origin: ischial tuberosity
▪ Innervation: tibial n. (of sciatic n.)
▪ Action: extend hip joint and flex knee joint
▪ Semitendinosus (medial)
o Insertion: medial aspect of proximal tibia
▪ Semimembranosus (medial, deep to semitendinosus)
o Insertion: medial tibial condyle
▪ Long head of Biceps femoris (lateral)
o Insertion: proximal fibula
short head of biceps femoris
posterior compartment of thigh
▪ Origin: linea aspera
▪ Insertion: proximal fibula (via shared tendon with long head)
▪ Innervation: common fibular n. (of sciatic n.)
▪ Action: flex knee joint
anterior compartment of thigh
action: flex hip joint and extend knee joint; innervation: femoral nerve; iliopsoas, sartorius, quadriceps femoris, pectineus
femoral nerve
o (L2-L4)
o Passes deep to the inguinal ligament
o Innervates muscles in the anterior compartment of the thigh and skin on anteromedial thigh
o Terminal branch, the saphenous nerve, innervates skin on anteromedial aspect of knee, leg, and foot
iliopsoas
▪ anterior compartment of thigh
▪ Origin: iliac fossa (iliacus); lumbar vertebrae (psoas major)
▪ Insertion: lesser trochanter of femur
▪ Action: flex hip joint (if LE is free); flex and stabilize the trunk (if LE is fixed)
psoas abscess
Infections/diseases (e.g., tuberculosis) of posterior abdominal structures (e.g., vertebrae) can spread to the sheath covering psoas major
iliopsoas test
Iliopsoas is closely related to many abdominal organs. In cases of suspected intra-abdominal disease/inflammation, the patient is asked to flex the hip joint against resistance on the affected side
sartorius
▪ anterior compartment of thigh
▪ Origin: ASIS
▪ Insertion: medial aspect of proximal tibia
▪ Action: flex, abduct, laterally rotate hip joint; flex knee joint (sit cross legged)
muscles of quadriceps femoris
rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
quadriceps femoris
in anterior compartment of thigh; flex hip joint and extend knee joint, innervated by femoral nerve
o rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
rectus femoris
• part of quadriceps femoris of anterior compartment
▪ inn: femoral nerve
▪ Origin: anterior inferior iliac spine (AIIS)
• Action: flex hip joint and extend knee joint
vastus lateralis
• part of quadriceps femoris of anterior compartment
▪ inn: femoral nerve
▪ Origin: greater trochanter and linea aspera
• Action: extend knee joint
vastus medialis
• part of quadriceps femoris of anteiror compartment
▪ inn: femoral nerve
▪ Origin: linea aspera
• Action: extend knee joint
vastus intermedius
• part of quadriceps femoris of anterior compartment of thigh
▪ inn: femoral nerve
▪ Origin: femoral shaft (deep to rectus femoris)
• Action: extend knee joint
quadriceps tendon
4 parts of quadricep unite distally to form the quadriceps tendon; continues as patellar ligament and inserts on the tibial tuberosity
patella
▪ (large sesamoid bone) is embedded in quadriceps tendon
▪ Protects the joint capsule and quadriceps tendon, particularly during activities like kneeling
▪ Increases leverage of the quadriceps (increasing the power of knee extension)
patellar tendon reflex
tests the L4 spinal nerve. With knees flexed and relaxed, the patellar ligament is tapped to elicit a "knee jerk" reaction (patellar reflex). Tapping the patellar ligament stimulates nerve fibers in the quadriceps, causing the muscle to contract and extend the knee.
prepatellar bursa
between skin and patella; can develop bursitis
suprapatellar bursa
deep to quadriceps tendon; can develop bursitis
trochanter bursa
between gluteus maximus and greater trochanter
ischial bursa
between gluteus maximus and ischial tuberosity
pectineus
▪ Origin: pubis
▪ Insertion: proximal femur
▪ Action: adduct hip joint; weakly flex hip joint
▪ Innervation: typically femoral n. (similar to the rest of the compartment), but may receive branch of obturator n.)
medial compartment of thigh
• Origin: pubis
• Action: adduct hip joint
• Innervation: obturator nerve (L2-L4)
• adductor longus, brevis, magnus; gracilis, obturator externus
obturator nerve
o (L2-L4)
o Courses along lateral wall of pelvis and exits via obturator canal
o Innervates muscles of medial compartment of thigh; skin on medial thigh
adductor longus
Insertion: linea aspera; addcut hip joint; in medial compartment of thigh
adductor brevis
medial compartment of thigh; deep to pectineus and adductor longus; insertion: linea aspera
adductor magnus
o Adductor part
• Insertion: linea aspera
▪ action: adduct hip, inn: obturator

o Hamstring part
• Origin: ischial tuberosity
• Insertion: adductor tubercle of femur
• Action: extend hip joint
• Innervation: tibial n. (of sciatic n.)
• Distally, its tendon creates the adductor hiatus
gracilis
▪ medial compartmentn of thigh
▪ inn: obturator nerve
▪ forms pes anserinus with tendons of sartorius and semitendinosus
▪ Insertion: medial aspect of proximal tibia
▪ Actions: weakly adduct hip joint, flex/medially rotate knee joint
pes anserinus
The tendons of gracilis, sartorius, and semitendinosus fuse distally to insert on the proximal tibia, forming the pes anserinus, or "goose's foot." Irritation of the bursa underlying the pes anserinus (pes anserinus bursitis) can cause pain on the medial aspect of the knee.
obturator externus
▪ medial compartment of thigh; Origin: external aspect of obturator membrane, border of obturator foramen
▪ Insertion: trochanteric fossa of femur
▪ Action: laterally rotate and stabilize the hip joint
arteries of thigh
femoral artery, deep artery of thigh, lateral and medial circumflex femoral arteries, obturator artery
veins of thigh
great saphenous vein, deep veins (accompany arteries and share the same names; femoral vein), perforating veins
femoral vein
▪ Receives blood from popliteal vein, deep vein of the thigh, and great saphenous vein
▪ Drains into the external iliac vein
perforating veins
connect the superficial to the deep veins of the thigh
great saphenous vein
o Courses along medial aspect of thigh
o Enters saphenous opening in the fascia lata to drain into femoral vein
femoral triangle borders
o Inguinal ligament (superiorly)
o Adductor longus (medially)
o Sartorius (laterally)
femoral triangle contents
o "NAVEL" (lateral to medial: Nerve, Artery, Vein, Empty space, Lymph)
o Femoral nerve (and its branches)
o Femoral sheath (AVEL)
femoral sheath
o Fascial tube enclosing the femoral vessels and femoral canal
o Does not enclose the femoral nerve
o Divided into 3 compartments:
• Lateral contains the femoral artery
• Intermediate contains the femoral vein
• Medial contains the femoral canal
femoral ring
o The proximal opening of the femoral canal
o area of weakness where femoral hernias can occur
o Normally, the ring is closed by extraperitoneal fatty tissue, and this fatty tissue is overlaid by parietal peritoneum
femoral hernia
o Abdominal viscera (loop of intestine) can protrude through the femoral ring into the femoral canal, forming a femoral hernia
o lies in the femoral triangle, medial to the femoral vein, lateral to the lacunar ligament, and inferior to the inguinal ligament
o may emerge through the saphenous opening into the subcutaneous tissue of the thigh
o occur more frequently in females
femoral canal
o contains loose connective tissue, fat, lymphatic vessels
o Primary function is to allow expansion of femoral vein when venous return from the lower limb is increased (e.g., during strenuous activity)
femoral artery
• Primary source of blood to lower extremity
• Continuation of external iliac artery (change names at inguinal ligament)
• Supplies anterior and medial compartments of thigh
femoral pulse
can be felt just inferior to the midpoint of the inguinal ligament, with patient in supine position. Compression at this location will stop blood flow through the femoral artery.
deep artery of thigh
• Largest branch of femoral artery
• Supplies posterior compartment of thigh
lateral and medial circumflex femoral arteries
o Typically branches of the deep artery of the thigh (can be branches of the femoral a.)
o Medial circumflex femoral a. supplies most of the blood to the head and neck of the femur
o Lateral circumflex femoral a. supplies muscles on the lateral aspect of thigh
obturator artery
• Branch of the internal iliac artery
• Passes through obturator canal to enter medial compartment of the thigh
• Supplies medial and posterior compartments of thigh
adductor canal boundaries
o Vastus medialis (anterolateral)
o Adductor longus and magnus (posterior)
o Sartorius (medial)
adductor canal contents
o Femoral artery
o Femoral vein
o Saphenous nerve (terminal branch of femoral n.)
adductor canal
• A fascial tunnel running from the apex of the femoral triangle to the adductor hiatus in the tendon of adductor magnus
• Provides a passage for femoral vessels to reach the popliteal fossa on the posterior aspect of the knee, where they become popliteal vessels