Dissection 25 Lower Limb

Front 1

Define the vertical axis of the hip?

Back 1

The axis runs from the head of the humerus to the adductor tubercle (not through the shaft)

Front 2

What are the movements of the knee?

Back 2

The knee is biaxial, it allows flexion and extension and rotation of a flexed knee. It also rotates to lock

Front 3

Name the gluteal muscles?

Back 3

Gluteus maximus, minimus, medius and tensor fascia lata

Front 4

Why are the gluteal muscles grouped as such?

Back 4

They are innnervated from the gluteal nerves off the lumbosacral plesus (

Front 5

What are the nerve fibers of the Superior gluteal nerve?

Back 5

L4-S1

Front 6

What are the nerve fibers of the inferior gluteal nerve?

Back 6

L4-S1

Front 7

Gluteus maximus
-Attachments
-Nerve
-Artery
-Actions

Back 7

-Sacrotuberous ligament, ilium, sacrum, coccyx to gluteal tuberosity (minor) andIT band
-Inferior gluteal n.
-Inferior and superior gluteal arteries and profunda femoris (penetrating branch)
-EXTENSION of hip
-lateral rotation
-Maintain extension of an extended knee

Front 8

Gluteus medius

-Attachments
-Nerve
-Artery
-Actions

Back 8

-Dorsal ilium to iliac crest to greater trochanter
-Superior gluteal nerve (L4-S1)
-Superior gluteal artery
-ABDUCTION OF THIGH
-extension
-lateral rotation

Front 9

Gluteus minimus

-Attachments
-Nerve
-Artery
-Actions

Back 9

-Similar to glut med but more anterior
-Superior gluteal nerve
-superior gluteal artery
-medial rotation
-flexion
-adbuction

Front 10

Tensor Fascia Lata

-Attachments
-Nerve
-Artery
-Actions

Back 10

ASIS to IT band
-Superior gluteal n.
Superior gluteal a.
-Abduct
-Medially rotate
-Flex

Front 11

How does the medius/minimis complex control the motion of the pelvis?

Back 11

When one leg is off the ground the medius and minimus of the supporing leg contract and raise the pelvis of the opposite side.

Ex. standing on left leg, left medius/minimus contract and elevate right ASIS

Front 12

How would a patient walk if he/she has lost function of the minimus/medius complex (lesion of the superior gluteal nerve)

Back 12

As the left foot is not in contact with the ground the right him will sag.
Tendelenburg sign

Front 13

Name the four anterior thigh muscles, innervated by the femoral n.?

Back 13

(Quips)
Quadratus femoris
Iliopsoas
Pectineus
Sartorius

Front 14

Iliopsoas

-Attachments
-Nerve
-Artery
-Actions

Back 14

-Transverse processes of L1-L5 etc. to lesser trochanter
-Lumbar plexus (psoas)
-Femoral nerve (Iliocus)
-Internal iliac artery
-FLEXION

Front 15

Sartorius
-Attachments
-Nerve
-Artery
-Actions

Back 15

ASIS-Medial tibia (near tibial tuberosity)
-Femoral n.
-Femoral a.
-Flexion (hip)
-Lateral rotation (hip)
-Knee flexion and medial rotation

Front 16

What are the boundaries of the femoral triangle?

Back 16

Sartorius, inguinal ligament, Adductor longus

Front 17

What is the pes anserinus?

Back 17

Tendon at medial tibia where muscles of sartorius and gracilis attach

Front 18

What is the division status of the femoral nerve?

Back 18

It is a posterior nerve (L2-4) from the lumbar plexus

Front 19

What are the nerve roots of the sciatic nerve?

Back 19

L4 ? to S3

Front 20

What are the terminal branches of the posterior division nerves in the lumbosacral plexus?

Back 20

Femoral
gluteals
peroneals

Front 21

What are the terminal branches of the anterior division nerves in the lumbosacral plexus?

Back 21

Tibial
Obturator

Front 22

Which of the quadriceps muscles has actions in the hip?

Back 22

Rectus femoris,

It is a flexor

Front 23

Rectus femoris

-Attachments
-Nerve
-Artery
-Actions

Back 23

-Anterior inferior iliac spine to quadriceps femoris tendon
-Femoral n.
-Lateral circumflex of femoral atery
-Flex hip
-extend knee

Front 24

Vastus intermedius

-Attachments
-Nerve
-Artery
-Actions`

Back 24

-Most anterior and lateral surfaces of the femor to part of quadriceps tendon
-femoral n.
-femoral a.
-Extends knee

Front 25

Vastus Lateralis

-Attachments
-Nerve
-Artery
-Actions

Back 25

-Lateral lip of linea apsera to quadriceps tendon
-femoral n.
-femoral artery
-no action at the hip
-extend the knee

Front 26

Follow the quadriceps tendon to the leg?

Back 26

Quadriceps tendon to patellar ligament to tibial tuberosity

Front 27

Vastus medialis
-Attachments
-Nerve
-Artery
-Actions

Back 27

-Medial line of the linea aspera to quadriceps tendon
-femoral n.
-femoral a.
-extends knee

Front 28

Pectineus

Back 28

-Pecten of pubis to pectineal line of femur (medial superior portion)
-Femoral n and some times Obturator
-Medial circumflex femoral atery and obturator artery
-Adducts thigh
-flex hip (poorly)

Front 29

Why does the pectineus some times have an identity crisis?

Back 29

It can be innervated by the femoral n (posterior division) and the obterator (anterior division).

Front 30

What muscle is innervated by the obturator and crosses the knee?

Back 30

gracilis

Front 31

What compartment is the original source of the adductor muscles?

Back 31

they were anterior (obturator nerve)

Front 32

What are the adductors?

Back 32

Gracilis,
(Pectineus always adducts sometimes innervated by obterator always innervated by the femoral)
-Adductor longus
-Adductor brevis
-Adductor magnus

Front 33

Gracilis
-Attachments
-Nerve
-Artery
-Actions

Back 33

-pubic symphysis to medial surface of tibial shaft
-obturator n
-obturator artery, medial cirumflex, and profunda femoris
-FLEX knee
-adduct hip
-MEDIALLY rotates KNEE

Front 34

Adductor longus
-Attachments
-Nerve
-Artery
-Actions

Back 34

-Pubis to linea aspera (superificial to the brevis)
-obturator n.
-obturator artery, and medial cirumflex femoral
-adducts hip
-flexes hip
-medially rotates (weakly)

Front 35

Adductor brevis
-Attachments
-Nerve
-Artery
-Actions

Back 35

-Pubic symphosis (inferior to longus) to linea aspera
-Anterior and posterior obturator n.
-Obturator artery and medial cirumflex femoral a.
-Adducts hip
-Flexes hip
-Medially rotates

Front 36

Adductor magnus (anterior)
-Attachments
-Nerve
-Artery
-Actions

Back 36

-Pubis and ramus of ischium to linea aspera
-Obturator n.
-Obturator a.
-Adducts
-Flexes
-medially rotates

Front 37

What is unique about the innervation of the adductor magnus?

Back 37

It has dual innervation
Anterior portion-obturator
Posterior portion-tibial nerve

Front 38

Adductor magnus (posterior)
-Attachments
-Nerve
-Artery
-Actions

Back 38

-Ischial tuberosity to linea aspera and adductor tubercle
-TIBIAL n.
-popliteal a.
-Adducts hip
-extends hip

Front 39

What occurs in the adductor hiatus?

Back 39

The femoral vessels pass through and become the popliteal vessels

Front 40

What muscle medially rotate the knee?

Back 40

Gracilis
popliteus
sartorius
semitendinous and semimembranous

Front 41

What are the posterior thigh muscles?

Back 41

Semitendous
Semimembranous
Biceps femoris

Front 42

What is the original location of the posterior thigh muscles?

Back 42

They were originally anterior muscles (tibial nerve)

Front 43

What is an exception to the anterior origin of the posterior muscles?

Back 43

The short head of the biceps femoris was originally posterior and remained so (peroneal nerve).

Front 44

Semitendinous
-Attachments
-Nerve
-Artery
-Actions

Back 44

-Ischial tuberosity to medial tibia
-tibial n.
-Inferior gluteal artery and popliteal artery
-Extends hip
-Flexes knee
-medially rotates knee

Front 45

Semimembranous
-Attachments
-Nerve
-Artery
-Actions

Back 45

-Ischial tuberosity to medial condyle (superior to tendinous)
-Tibial n.
-Profunda femoris a, inferior gluteal, popliteal
-Extends hip
-Flexes knee
-Rotates tibia medially

Front 46

Biceps femoris
-Attachments
-Nerve
-Artery
-Actions

Back 46

-Long head-from ischial tuberosity, short head from lina aspera to LATERAL fibula
-long head from tibial n.
-short head from common peroneal n.
-inferior gluteal, popliteal, profunda femoris
-flex knee
-extend hip
-LATERALLY rotate knee

Front 47

What is unique about the biceps femoris?

Back 47

It is innervated by two nerves, one from each division
-long head from tibial (anterior)
-short head from peroneal (posterior)

Front 48

Does the biceps femoris have an identity crisis?

Back 48

Sort of.
The long head was anterior and migrate posterior (tibial n.)
The short head was posterior and remained (common peroneal n.)

Front 49

What are the nerves of the lumbar plexus?

Back 49

Subcostal (T12)
iliohypogastric (T12-L1)
Ilioinguinal (T12-L1)
Genitofemoral (L1-2)
Lateral femoral cutaneous (L2-3)
Obturator (L2-4)
Femoral (L2-4)

Front 50

What is the course of the subscostal nerve?

Back 50

Leaves T12 and traces quadratus lumborum just inferor to the 12 rib

Front 51

What is innnervated by the subcostal, iliohypogastric, ilioinguinal nerves?

Back 51

They are T12-L1 and innervate the lowest two dermatomes of the trunk as well as muscular innervation to the abdominal muscles.

Front 52

What can result from dennervation of the iliohypogastric nerve?

Back 52

greater risk of direct inguinal hernia

Front 53

Trace the course of the genitofemoral nerve?

Back 53

L1-2 traces superior margin of psoas spilts into genital branch to deep ring of inguinal and to cremaster muscles and sensory to laterl portion of the scrotum or labia majorum.
Femoral branch travels with the external iliac artery to proximal thigh

Front 54

What is the course of the lateral cutaneous nerve?

Back 54

(L1-2) L 1 and 2 dermatomes and sensory to lateral thigh
*susceptible to compression under inguinal ligament

Front 55

What is the course of the femoral nerve?

Back 55

L2-4 descends lateral to the psoas major

Compression leads to wasting in the anterior compartment of the thigh

Front 56

What is the course of the obturator nerve?

Back 56

L2-4 descends medial to psoas major through obturator foramen to innervate the adductor compartment

Front 57

What is the function of the lumbosacral trunk?

Back 57

Connects the sacral plexus to the lumbar plexus
Sacral plexus is L4 and L5

Front 58

Where does the superior gluteal nerve emerge from the gluteal region?

Back 58

Superior to the piriformis

Front 59

Where does the inferior gluteal nerve emerge from the gluteal region?

Back 59

Inferior to the piriformis

Front 60

What does the sciatic nerve innnervate?

Back 60

Muscles of the posterior compartment of the thigh (tibial nerve) and all muscles of the lower leg

Front 61

What are the lateral rotator muscles?

Back 61

PGOGOQ
Piriformis
Superior gemellus
Obturator internus
Inferior gammellus
Obturator externus
Quadratus femoris

Front 62

Piriformis
-Attachments
-Nerve
-Artery
-Actions

Back 62

-Anterior sacrum through greater sciatic foramen to greater trochanter
-nerve to piriformis
-Superior/inferior gluteal
-Lateral rotation

Front 63

Superior and inferior gemellus

-Attachments
-Nerve
-Artery
-Actions

Back 63

-Ishcium to greater trochanter
-nerve to each
-Inferior gluteal artery
-Lateral rotation

Front 64

What does the tendon of the obturator internus run between?

Back 64

The superior and inferior gemellus

Front 65

Quadratus externus
-Attachments
-Nerve
-Artery
-Actions

Back 65

-ischial tuberosity to intertrochanteric crest
-nerve to quatratus femoris
-medial cirumflex artery
-Lateral rotation

Front 66

Through what does the tendon of the obturator internus pass?

Back 66

Lesser sciatic foramen

Front 67

Where do the nerves that innervate the lateral rotators arise?

Back 67

Sacral plexus

Front 68

Where does the sciatic divide?
Into what does it divide?

Back 68

It divides into the tibial nerve and the common peroneal at the top of the popliteal fossa.

Front 69

Where is the safe injection site for gluteal injections?

Back 69

The superior lateral portion.

Front 70

Describe the safe hand position for gluteal injections.

Back 70

Under the palm when the thum is along the iliac crese and the tip of the thumb touches the ASIS.

Front 71

What becomes of the external iliac artery?

Back 71

It becomes the femoral and deep femoral, etc.

Front 72

What becomes of the internal iliac artery?

Back 72

It becomes the obturator and the gluteal branches

Front 73

How does the internal and external iliac arterial systems anastomose?

Back 73

They use the cruciate anastomosis gluteal branches of internal to circumflex and penetrating branches of deep femoral.

Front 74

Describe the cruciate anastomosis

Back 74

4 branches
3 from deep femoral connect to 1 from internal iliac
Deep femoral
-transverse branch of lateral cirumflex
-transverse branch medial circumflex
-Transverse branches

Front 75

What supplies the artery to the head of the ligament of the femur?

Back 75

Not the femoral
the obturator

Front 76

What provides the majority of the blood to the head of the femur?

Back 76

The femoral cirumflex
Medial branch is more significant

Front 77

Which branch of the cirumflex artery is the most important?

Back 77

The medial

Front 78

What are the general movements of the Adductors?

Back 78

GAAAP
-Adduction
-Medial Rotation
-no action at the knee

Front 79

What are the general actions of the anterior (formerly posterior compartment) muscles?

Back 79

Extension of the knee
*only the rectus femoris has any other action flexion of the hip
**Sartorius and Pecineus do their own thing

Front 80

What is the general action of the glutes?

Back 80

-all but maximus ABduct
-Max and Med- Extend the hip and laterally rotate hip
-Minimus and TFL Flex hip and medially rotate the hip

Front 81

What are the actions of PGOGOQ?

Back 81

Lateral rotation of the hip

Front 82

What are the Abductors of the hip?

Back 82

Sartorius and the Gluts (not Maximus)

Front 83

What muscle ABducts that is not innervated by the a gluteal branch?

Back 83

Sartorius

Front 84

What muscles of adduction are not innervated by the obturator?

Back 84

Pectineus (can be partly obturator but is always femoral)
Adductor magnus inferior portion is innervated by tibial nerve

Front 85

what muscles extend the knee?

Back 85

Quadriceps femoris

Front 86

What is the single lateral rotator of the knee?

Back 86

biceps femoris