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113 Cards in this Set
- Front
- Back
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Dorsal Root
Dorsal Root Ganglion Ventral Root |
Dorsal Root
Sensory nerve processes bringing information into the spinal cord Dorsal Root Ganglion Nerve cell bodies of unipolar sensory neurons Ventral Root Nerve cell processes of efferent fibers (cell bodies located in ventral horn) traveling to muscle |
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Spinal Nerve
Dorsal Ramus (Rami) Ventral Ramus (Rami) |
Spinal Nerve
A mixture of sensory & motor nerve processes Dorsal Ramus (Rami) Mixture of sensory & motor processes which branch posteriorly (supply muscles and skin of posterior part of the trunk?) Ventral Ramus (Rami) Mixture of sensory & motor processes which branch anteriorly (supply anterior trunk and limbs, I believe?) These processes form the Brachial, Lumbar & Sacral Plexi |
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Nerves of the lumbar plexus
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Iliohypogastric (T12 L1)
Ilioinguinal (L1) Genitofemoral (L1,2) Lateral Femoral Cutaneous (L2,3) Femoral (L2,3,4) Saphenous (L2,3,4) Obturator (L2,3,4) |
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Which nerves of the lumbar plexus are sensory, which are motor, and which are mixed?
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Sensory:
Iliohypogastric (T12, L1) Ilioinguinal (L1) Genitofemoral (L1, L2) Lateral Femoral Cutaneous (Br of Femoral n.) (L2,L3) Sensory & Motor: Obturator (L2,3,4) Femoral (L2,3,4) (none are purely motor) |
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What area does the lateral femoral cutaneous nerve innervate?
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The skin on the lateral side of the thigh (aptly named!)
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What area does the femoral nerve innervate?
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The anterior and partly medial aspects of the thigh and leg
(anterior branches of the femoral do the patch along the front of the thigh, saphenous nerve supplies the front of the shin) |
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What two branches of the femoral nerve leave the femoral triangle?
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2 branches leave the femoral triangle
Nerve to Vastus Medialis Saphenous nerve |
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What area does the obturator nerve innervate? (cutaneously)
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the patch of skin on the medial side of the thigh above the knee (imagine the blue oval on the slide)
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Obturator nerve motor distribution (what branches does it have)
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Anterior branch - hip joint, gracilus, adductor brevis, adductor longus, cutaneous branch to middle thigh
Posterior branch - Obturator externus, adductor magnus, to knee joint |
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Which muscles does the femoral nerve innervate?
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psoas group
iliacus pectineus sartorious rectus femoris vastus medialis vastus lateralis vastus intermedius articularis genu So, basically the anterior thigh. Quads, hip flexors... |
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Nerves of the sacral plexus
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Posterior Femoral Cutaneous (S1,2,3,4)
Pudendal (S2,3,4) Superior Gluteal (L4,5 S1) Inferior Gluteal (L5 S1,2) Sciatic -Common Peroneal --Deep Peroneal (L4,5 S1) --Superficial Peroneal (L5 S1,2) -Tibial (L4,5 S1,2,3) --Medial Plantar (S2,3) --Lateral Plantar (S2,3) -Sural (S 1,2) |
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Have you memorized and drawn the sciatic nerve's cutaneous distribution?
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Probably not
Pretty pictures on slide set |
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What are the motor and cutaneous branches of the sciatic nerve?
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Motor:
Sciatic Common peroneal Sural Cutaneous: Posterior femoral cutaneous Common peroneal sural |
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Major vessels of the gluteal region
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Superior Gluteal
Inferior Gluteal Internal Pudendal |
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Auricular Surface
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Rough area on back of ilium where sacrum attaches
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What are the 3 gluteal lines?
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Anterior, posterior, and inferior gluteal lines on ilium
Difficult to see (look these up!) What attaches to them? |
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Ischial Spine
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Point on ischium that separates greater and lesser sciatic notches/foramen, ischiofemoral ligament attaches there
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What's the difference between the intertrochanteric crest and line?
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Crest is the ridge between the greater and lesser trochanter (posterior of femur), line is on the anterior side
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Gluteal Tuberosity
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Bumpy area up at the top of linea aspera, splits into two lines, the gluteal and pectineal lines
No, I think that's what he said, but I believe there's the pectineal line on the medial side (goes toward lesser trochanter) and the gluteal tuberosity on the lateral side |
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Anterior thigh muscles
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Iliopsoas
Sartorius Quadriceps Group Rectus Femoris Vastus Lateralis Vastus Medialis Vastus Intermedius Tensor Fascia Lata Articularis Genu |
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Iliopsoas
Origin: Insertion: Nerve: Action: |
Actually two muscles
Iliacus Psoas Major Origin: iliacus - iliac fossa & iliac crest psoas - transverse processes & bodies T12 - L5 Insertion: (common) lesser trochanter of the femur Nerve: iliacus - femoral nerve (L2,3) psoas (L1,2,3,) Action: hip flexion, slight abduction of the thigh; flexion of lumbar spine (reverse action) |
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Sartorius
Origin: Insertion: Nerve: Action: |
Origin:
ASIS Insertion: Superior medial surface of the tibia (pes anserinus) Nerve: Femoral n. (L2,3) Action: thigh flexion, abduction, & external rotation flexion of leg |
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Quadriceps Group
Origin: Insertion: Nerve: Action: |
Insertion:
tibial tuberosity via patella tendon Nerve: Femoral nerve (L2,3,4) Action: extension of the leg Flexion of the thigh (rectus) |
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Articularis Genu
Origin: Insertion: Nerve: Action: |
Origin:
lower ¼ of the anterior surface of the femur Insertion: articular capsule of the knee joint. Nerve: Femoral branch to vastus intermedius (L2,3,4) Action: places tension on the suprapatellar bursa |
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Tensor Fascia Lata
Origin: Insertion: Nerve: Action: |
Origin:
iliac crest & ASIS Insertion: iliotibial band Nerve: Superior Gluteal n. (L4,5) Action: Flexion, Abduction, & Internal Rotation of thigh Flexion of leg |
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Pectineus
Origin: Insertion: Nerve: Action: |
Origin:
superior ramus of Pubis Insertion: line extending from lesser trochanter to linea aspera (pectineal line) Nerve: Femoral nerve (L2,3) Action: adduction, flexion, and internal rotation of the thigh |
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Adductor Brevis
Origin: Insertion: Nerve: Action: |
Origin:
inferior pubic ramus Insertion: upper half of linea aspera Nerve: Obturator nerve (ant. Branch of L2,3,4) Action: adduction, slight flexion of the thigh |
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Adductor Group
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Pectineus
Adductor Brevis Adductor Longus Adductor Magnus Gracilis |
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Adductor Longus
Origin: Insertion: Nerve: Action: |
Origin:
Anterior pubic ramus Insertion: middle portion of linea aspera Nerve: Obturator nerve (ant. Branch of L2,3,4) Action: adduction, flexion |
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Gracilis
Origin: Insertion: Nerve: Action: |
Origin:
Inferior pubis ramus Insertion: Superior medial tibia (pes anserinus) Nerve: Obturator nerve (L2,3) Action: adduction of the thigh flexion of the leg |
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Origin:
Insertion: Nerve: Action: |
Origin:
ischial tuberosity, Ischium & pubic ramus Insertion: line from the lesser trochanter to linea aspera entire length of femur (linea aspera) medial supracondylar line adductor tubercle Nerve: Obturator nerve (L2,3,4) Action: adduction and internal rotation of the thigh Flexion of the thigh from position of extension Extension of the thigh from position of flexion |
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Muscles of the Medial Thigh
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Pectineus
Adductor Brevis Adductor Longus Gracilis Adductor Magnus Articularis Genu? |
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Major Vessels of the Gluteal Region
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Superior Gluteal
Inferior Gluteal Internal Pudendal |
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Posterior Pelvic Muscles
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Gluteus Maximus
Gluteus Medius Gluteus Minimus |
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Gluteus Maximus
Origin: Insertion: Nerve: Action: |
Origin:
posterior gluteal line Posterior sacrum and coccyx sacrotuberous ligament Insertion: gluteal tuberosity of the femur iliotibial band. Nerve: inferior gluteal n. (L5 S1,2) Action: extension, external rotation, and abduction of the thigh |
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Gluteus Medius
Origin: Insertion: Nerve: Action: |
Origin:
outer surface of ilium Anterior and posterior gluteal line Insertion: lateral surface of greater trochanter Nerve: superior gluteal n. (L5 S1) Action: abduction of thigh internal rotation of the thigh (anterior fibers) external rotation of the thigh (posterior fibers) |
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Gluteus Minimus
Origin: Insertion: Nerve: Action: |
Origin:
outer surface of ilium between anterior and inferior gluteal lines Insertion: anterior border of greater trochanter Nerve: superior gluteal n. (L5 S1) Action: abduction and internal rotation of the thigh |
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Six deep external hip rotators
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Piriformis
Obturator Externus Gemellus Superior Gemellus Inferior Quadratus Femorus Obturator Internus |
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Piriformis
Origin: Insertion: Nerve: Action: |
Origin:
Anterior sacrum sacrotuberous lig. Insertion: greater trochanter Nerve: nerve to piriformis (L5 S1) Action: external rotation of the thigh horizontal abduction when the thigh is flexed to 90o |
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Obturator Internus
Origin: Insertion: Nerve: Action: |
Origin:
pelvic surface of obturator membrane margin of obturator foramen Insertion: greater trochanter Nerve: nerve to obturator internus (L5 S1) Action: external rotation of the thigh horizontal abduction when the thigh is flexed to 90o |
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Gemellus Superior
Origin: Insertion: Nerve: Action: |
Origin:
outer surface of ischial spine Insertion: greater trochanter Nerve: nerve to gemellus superior (L5 S1) Action: external rotation of the thigh horizontal abduction when the thigh is flexed to 90o |
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Gemellus Inferior
Origin: Insertion: Nerve: Action: |
Origin:
upper part of ischial tuberosity Insertion: greater trochanter Nerve: nerve to gemellus inferior (L5 S1) Action: external rotation of the thigh horizontal abduction when the thigh is flexed to 90o |
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Quadratus Femoris
Origin: Insertion: Nerve: Action: |
Origin:
ischial tuberosity Insertion: quadrate tubercle of femur Nerve: nerve to quadratus femoris (L5 S1) Action: external rotation of the thigh |
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Obturator Externus
Origin: Insertion: Nerve: Action: |
Origin:
External pubis & ischium, obturator foramen margin obturator membrane Insertion: trochanteric fossa of femur Nerve: obturator n. (L3,4) Action: external rotation of the thigh |
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Structures Exiting the Greater Sciatic Notch
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Superior Gluteal Artery, Veins, & Nerve
PIRIFORMIS SCIATIC Inferior Gluteal Artery, Veins, & Nerve Posterior Fem. Cut. n. Nerves to Gemelli & Quadratus Femoris Int. Pudendal artery Pudendal n. |
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Structures Exiting and Entering the Lesser Sciatic Notch
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EXITING
Tendon of Obturator Internus Gemellus superior and inferior muscles attach to the tendon ENTERING Int. Pudendal artery Pudendal n. Nerve to Obturator Internus |
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Posterior Thigh Muscles
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Hamstrings
-Biceps Femoris -Semimembranosis -Semitendinosis Popliteus |
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Intercondylar Fossa
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The middle of the posterior part of the distal femur
(depression between the condyles at the back of the femur... opposite side as the patella) |
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Patellar articular surface
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Surface of femur that the patella articulates with...
between condyles on the anterior side |
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Soleal line
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1. a ridge that extends obliquely downward and medially across the back of the tibia from the fibular articular facet; it gives origin to the soleus muscle.
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Biceps Femoris
Origin: Insertion: Nerve: Action: |
Origin:
long head –ischial tuberosity short head - lower ½ of lateral lip of linea aspera Insertion: head of fibula lateral tibial condyle Nerve: long head - tibial division of sciatic nerve (L5 S1,2) short head - peroneal division of sciatic nerve (L5 S1,2) Action: extension of the thigh flexion and external rotation of the lower leg |
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Semimembranosus
Origin: Insertion: Nerve: Action: |
Origin:
lateral ischial tubersoity Insertion: posterior medial tibial condyle Oblique popliteal ligament Nerve: tibial division of sciatic nerve (L5 S1,2) Action: extension of the thigh flexion and internal rotation of the lower leg |
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Semitendinosus
Origin: Insertion: Nerve: Action: |
Origin:
medial ischial tuberosity Insertion: Superior medial tibial condyle (pes anserinus) Nerve: tibial division of sciatic nerve (L5 S1,2) Action: extension of the thigh flexion and internal rotation of the lower leg |
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Popliteus
Origin: Insertion: Nerve: Action: |
Origin:
lateral femoral condyle posterior lateral meniscus Insertion: tibia above soleal line Nerve: tibial nerve (L4,5 S1) Action: flexion and internal rotation of the tibia on the femur when in an open chain |
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What muscles attach at the Pes Anserinus?
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Sartorius
Gracilis Semitendinosus |
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Popliteal Fossa
what are its borders? What does it contain at Superficial and deep levels? |
The compartment of the lower posterior 1/3 of the thigh
Superior Borders Biceps Femoris m. (lat) Semitendinous m. (med) Inferior Borders Medial Head of Gastrocnemius (med) Lateral Head of Gastrocnemius (lat) -Superficial Sural n. Lesser Saphenous v. Lymph nodes -Deep Popliteal Artery Superior & Inferior Genicular Branches Tibial and Common Peroneal nerves |
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Arteries at the knee
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Superior Genicular
Medial Lateral Inferior Genicular Medial Lateral |
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Nerves of the popliteal fossa
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Tibial n.
Medial Sural Cut. n. Common Peroneal n. Lateral Sural Cut. n. Sural n. |
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Acetabular Labrum
Definition, purpose, structure |
The Acetabular Labrum is a peripheral ring of fibrocartilage that completely encircles the Acetabulum
Acts to grasp the head of the femur, increasing joint stability The Acetabulum is positioned facing lateral, inferior, & anterior The upper portion therefore forms an “OVERHANG” which sustains the highest forces through the femoral head Articular cartilage is thickest superiorly for both the femoral head & Acetabulum |
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Femoral Head Structure
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The shape varies from slightly larger that a true hemisphere to almost 2/3’s of a sphere
The head is completely covered in articular cartilage except for the Fovea Ligamentum teres attaches to the fovea |
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Hip labral impingement - Pincer
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Femoral neck runs into labrum in flexion and internal rotation (at extreme ranges)
Usually caused by greater overhang of labrum or bulge Can cause disruption of blood flow and cell death |
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Hip labral impingement - CAM
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Bulge on femur causes damage at superior rim of cartilage (contact in extreme flexion and internal rotation)
Can cause disruption of blood flow and cell death |
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Femoral angulations
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As a result of developmental changes that occur both in utero as well as after birth, there are 2 angulations that affect the hip joint & the distribution of joint forces
Angle of Inclination (frontal plane) Angle of Torsion (transverse plane) |
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Femoral angulations - frontal plane
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Angle of inclination
Frontal Plane: In Infants, the angle is ~ 150o In adults, the typical angle is 125o In the elderly, the angle decreases to 120o Walking early may decrease angle more? The angle can vary among individuals as well as between the sexes Females, due to a greater pelvic width, can have a smaller angle A pathologic decrease in the angle – COXA VARA A pathologic increase in the angle – COXA VALGA During development, the knee may develop compensatory angulations COXA VALGA - GENU VARA COXA VARA - GENU VALGA |
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Femoral angulations - transverse plane
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Transverse Plane:
“Angle of Torsion” A medial rotation of the femoral shaft in relation to the head & neck of the femur TYPICAL ANGLE is 12 degrees Can range from 8 degrees to 25 degrees Pathologic increased termed – Anteversion Pathologic decrease termed – Retroversion |
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Femoral Anteversion
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Result of abnormal forces on the femur during growth
“W” Sitting Clinical Manifestations: Asymmetrical hip ROM Increased Internal Rotation Toeing-In During Gait “Knock-Knees” |
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Femoral Retroversion
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Result of abnormal forces on the femur during growth
More common in Obese Children Cause of Slipped Capital Epiphysis Clinical Manifestations: Asymmetrical hip ROM Increased External Rotation Toeing-Out During Gait “Chaplin-Walk” |
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What can you watch for as a patient is walking away from you?
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The too many toes sign... 2-3 is normal. 1 toe visible on lateral side of foot indicates internal rotation, 4 or 5 toes indicates external rotation.
Doesn't tell you what point the rotation is coming from though. |
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What could you expect about a person's angle of inclination if she has excessive hip internal rotation compared to external rotation (test lying prone with knees bent)
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It is greater than normal (she has femoral anteversion), so her "zero" is at internal rotation
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What could create a toed-out gait?
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femoral retroversion
or external tibial torsion or something at the ankle? |
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What are the advantages and disadvantages of the "overhang" of the femur?
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It gives the abductors a greater moment arm
Causes the femoral neck to be susceptible to fractures with bone weakening |
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What are the major/main trabeculae of the femoral head and neck?
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Arcuate bundle
Supporting bundle |
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What are the accessory trabeculae of the femoral head and neck?
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Trochanteric bundle (or medial accessory bundle)
Lateral bundle |
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How do the trabeculae create strength in the head of the femur?
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The arcuate (which supports through the neck) and the supporting bundle (which supports weight from the pelvis) intersect, creating the "nucleus of the head"
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What is a common site of femoral neck fractures?
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the "zone of weakness" at the thin part of the neck between bundles of trabeculae
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Trabecular systems of the pelvis
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Pelvis also has 2 main trabecular systems
Sacroacetabular system From SI joint to femoral head Sacroischial system From SI joint to ischium |
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Hip joint capsule shape and attachments
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The capsule is very dense and strong
Shaped like a cylindrical sleeve Attaches to the: Entire periphery of the acetabulum via the labrum The neck of the femur |
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Fibers of hip joint capsule
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Comprised of 4 distinct sets of fibers
Longitudinal Oblique Arcuate circular The circular fibers form zona obicularis divides capsule into a lateral and medial chamber See picture |
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What are frenula?
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“Accordion-Like” folds are found on the inferior & superior aspects of the capsule, termed FRENULA
Permit full abduction and adduction range of motion (can stick together if you don't move enough to stimulate fluid formation) |
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Hip joint ligaments
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The capsule is strengthened by three dense and strong ligaments
Anterior -Iliofemoral or Y Ligament of Bigelow -Pubofemoral Posterior -Ishiofemoral |
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Role of ligamentum teres
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Ligamentum Teres
Does not function to support the joint Primary Purpose is to serve as a guide for the branch from the obturator artery as it travels to the fovea on the head of the femur |
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Name 4 intracapuslar components (in hip)
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Transverse Acetabular Ligament
Acetabular Labrum Ligamentum Teres Acetabular Fat Pad |
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Hip Joint Anastmoses
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Medial circumflex
Lateral circumflex Inferior gluteal Superior gluteal Branch from the posterior division of the obturator artery Via the ligamentum teres |
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How many degrees of freedom does the hip joint have and what motion(s) and plane(s) does it move in?
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3 degrees of freedom:
Abduction-Adduction (frontal plane) Flexion-Extension (sagittal plane) Internal-External Rotation (transverse plane) |
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What are the loose-pack and closed-pack positions of the hip?
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Loose Pack Position
35o flexion & abduction with slight external rotation Closed Pack Position Maximum hyperextension, internal rotation, and adduction |
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Specializations of the Fascia Latae
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Gluteal Aponeurosis
Iliotibial Band or Tract Medial Retinaculum Lateral Retinaculum |
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Organization of the Fascia Latae
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The fascia lata has 2 invaginations:
Medial Intermuscular Septum Lateral Intermuscular Septum) These invaginations help to create three compartments: Anterior, Medial and Posterior |
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Femoral Triangle
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Defined as the subfascial space of the upper 1/3 of thigh
Borders: Superior = Inguinal Lig. Lateral = Sartorius m. Medial = Add. Longus m. Femoral artery bisects the Triangle Floor: Iliopsoas m. (lat) Pectineus m. (med) Contains: Saphenous Opening Drainage of the Greater Saphenous Vein into the Femoral Vein Femoral Artery and Vein Enters the thigh via the femoral sheath Femoral nerve |
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Femoral Sheath
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Femoral Sheath
Covers the femoral vessels for 2-3 cm beyond inguinal lig. Formed… Anteriorly by fascia transversalis Posteriorly by fascia iliacus Contents: LATERAL = Femoral artery MIDDLE = Femoral vein MEDIAL = Femoral canal - Femoral ring superiorly |
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Adductor canal
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Adductor Canal
Fascia compartment that forms path for femoral artery through middle 1/3 of the thigh The canal ends at the adductor hiatus (formed by adductor magnus) At the adductor hiatus, the femoral artery travels posteriorly and becomes the popliteal artery The borders of the canal include: Medial - Sartorius m. Anterior - Vastus Medialis m. Posterior - Adductor Longus & Magnus m. |
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Popliteal fossa
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The compartment of the lower posterior 1/3 of the thigh (“knee pit”)
Superior Borders: Biceps Femoris m. (lat) Semitendinous m. (med) Inferior Borders: Medial Head of Gastrocnemius (med) Lateral Head of Gastrocnemius (lat) Contains: Popliteal Artery Genicular Branches Tibial nerve Common Peroneal nerve (not shown) |
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Arteries of the lower extremity
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Common Iliac Artery
Internal Iliac Artery External Iliac Artery Femoral Artery Popliteal Artery Anterior Tibial Artery Posterior Tibial Artery |
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Major Branches of internal iliac artery
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Major Branches:
Obturator Internal Pudendal Inferior Gluteal Superior Gluteal |
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Obturator artery
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Branch of internal iliac
Travels along the lateral pelvic wall and exits the pelvis through the obturator foramen (canal) Accompanied by obturator vein & nerve After exiting the pelvis, it divides into Anterior and Posterior branches These branches supply blood to the: Muscles of medial thigh: Obturator externus Pectineus Adductors Gracilis Ilium and femoral head |
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Internal pudendal artery
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Terminal branch of Internal Iliac a.
Exits the pelvis through the Greater Sciatic Foramen Re-enters the pelvis through the Lesser Sciatic Foramen Supplies the external genitalia |
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Inferior gluteal artery
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Branch of internal iliac artery
Exits the Pelvis through the Greater Sciatic Foramen Supplies: Pelvic diaphram Piriformis Quadratus Femorus Proximal Hamstrings Gluteus Maximum |
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Superior gluteal artery
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Exits the pelvis through the Greater Sciatic Foramen
Supplies: Gluteus Medius Gluteus Maximus Gluteus Minimus Tensor Fascia Lata |
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Arteries entering and exiting the pelvis
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Exiting through the Obturator Foramen
Obturator Exiting through the Greater Sciatic Foramen Internal Pudendal Superior Gluteal Inferior Gluteal Entering the Pelvis through the Lesser Sciatic Foramen Internal Pudendal |
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External Iliac artery
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Becomes the Femoral artery after it passes under the Inguinal Ligament out of the pelvis
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Major branches of femoral artery
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Continuation of external iliac artery
Major Branches: Superficial Iliac Circumflex Superficial Epigastric External Pudendal Profunda (Deep) Femoral Descending Genicular Saphenous Branch |
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Superficial iliac circumflex artery
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The first branch of femoral artery after exiting from under the Inguinal ligament
Supplies the iliac crest |
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Superficial epigastric artery
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Branches off femoral artery approximately 1 cm below the Inguinal ligament
Supplies: Superficial fascia of the abdomen Abdominal wall Umbilicus |
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External pudendal artery
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branch of femoral
Superficial Deep Each artery travels medial across the floor of the femoral triangle (pectineus & adductor longus muscles) to supply the medial thigh and genitalia |
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Profunda femoral
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branch of femoral
Large artery which travels parallel, but deep to the Femoral artery (lateral) Major Branches: Lateral Femoral Circumflex Medial Femoral Circumflex Perforating arteries |
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Lateral femoral circumflex
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Branch of profunda femoral
Sometimes arises from the femoral artery Branches to: Anterior Gluteal region Greater Trochanter Knee via Descending (genicular?) branch |
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Medial femoral circumflex
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Branch of deep profunda
Arises at the same location as the Lateral Femoral Circumflex Branches to: Neck & Head of femur |
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Perforating branches
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branch off of deep profunda femoral artery
Three to four branches that course around the femoral shaft |
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Descending Genicular Artery
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The last major branch from the Femoral artery
Divides into two branches Saphenous Articular |
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Popliteal Artery
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Continuation of femoral
Major Branches: Lateral Superior Genicular (1) Medial Superior Genicular (2) Lateral Inferior Genicular (3) Medial Inferior Genicular (4) |
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Anterior Tibial Artery
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Split of the popliteal
Passes through the interosseous membrane and continues distally in the anterior compartment Major Branches: Dorsalis Pedis Arcuate |
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Termination of anterior tibial artery
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Dorsalis pedis
Arcuate & Deep Plantar Branch |
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Posterior Tibial Artery
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Split of the popliteal
Travels distally within the posterior compartment of the leg Major Branches: Medial Plantar Lateral Plantar Plantar Arch the medial and lateral plantar arteries pass under the metatarsals and form the Plantar Arch |
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Medial Plantar Artery
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Split of the Posterior Tibial artery just distal to the medial malleolus
Supplies the medial plantar surface of the foot |
