Gluteal Region, Posterior Thigh, Popliteal Fossa

Front 1

1. What are the attachments of the sacrotuberous ligament?

Back 1

a. PSIS, PIIS
b. Sacrum, coccyx
c. Ischial tuberosity

Front 2

2. What are the attachments of the sacrospinous ligament?

Back 2

a. Sacrum, coccyx
b. Ischial spine

Front 3

a. What are the borders of the greater sciatic foramen?

Back 3

i. Greater sciatic notch
ii. Sacrotuberous ligament
iii. Sacrospinous ligament

Front 4

b. What structures pass superior to the piriformis in the greater sciatic foramen?

Back 4

i. Superior gluteal vessels and nerve

Front 5

c. What structures pass inferior to the piriformis in the greater sciatic foramen?

Back 5

i. Inferior gluteal vessels and nerves
ii. Pudendal nerve
iii. Sciatic nerve
iv. Posterior femoral cutaneous nerve

Front 6

a. What are the boundaries of the lesser sciatic foramen?

Back 6

i. Sacrospinous ligament
ii. Sacrotuberous ligament
iii. Lesser sciatic notch

Front 7

b. What structures pass through the lesser sciatic foramen?

Back 7

i. Tendon of obturator internus
ii. Pudendal nerve

Front 8

a. What are the attachments of the gluteus maximus?

Back 8

i. Origin→ Ilium posterior to posterior gluteal line
ii. Insertion→ IT tract to lateral condyle of tibia

Front 9

b. What innervates the gluteus maximus?

Back 9

i. Inferior gluteal nerve

Front 10

c. What are the attachments of the gluteus medius?

Back 10

i. Origin→ Between anterior and posterior gluteal lines
ii. Insertion→ Greater trochanter

Front 11

d. What innervates the gluteus medius?

Back 11

i. Superior gluteal nerve

Front 12

e. What are the attachments of the gluteus minimus?

Back 12

i. Origin→ Between anterior and inferior gluteal lines
ii. Insertion→ Greater trochanter

Front 13

f. What innervates the gluteus minimus?

Back 13

i. Superior gluteal nerve

Front 14

g. What are the attachments of the tensor fascia lata?

Back 14

i. Origin→ ASIS
ii. Insertion→ IT tract

Front 15

h. What innervates the tensor fascia lata?

Back 15

i. Superior gluteal nerve

Front 16

i. What are the attachments of the piriformis?

Back 16

i. Origin→ anterior surface of sacrum, sacrotuberous ligament
ii. Insertion→ Greater trochanter

Front 17

j. What innervates the piriformis?

Back 17

i. Ventral rami of S1-S2

Front 18

k. What are the attachments of the obturator internus?

Back 18

i. Origin→ Obutrator membrane
ii. Insertion→ Trochanteric fossa

Front 19

l. What innervates the obturator internus?

Back 19

i. Nerve to obturator internus (L5-S1)

Front 20

m. What are the attachments of the superior gemelus?

Back 20

i. Origin→ Ischial spine
ii. Insertion→ Greater trochanter

Front 21

n. What innervates the superior gemellus?

Back 21

i. Nerve to obturator internus

Front 22

o. What innervates the inferior gemellus?

Back 22

i. Nerve to quadratus femoris

Front 23

p. What are the attachments of the inferior gemellus?

Back 23

i. Origin→ Ischial tuberosity
ii. Insertion→ Greater trochanter

Front 24

a. What are the attachments of the quadratus femoris?

Back 24

i. Origin→ Ischial tuberosity
ii. Insertion→ Intertrochanteric rest

Front 25

r. What innervates the quadratus femoris?

Back 25

i. Nerve to quadratus femoris (L5-S1)

Front 26

a. Where is the trochanteric bursa located?

Back 26

i. Between gluteus maximus and greater trochanter

Front 27

b. What are the symptoms of friction bursitis?

Back 27

i. Point tenderness over greater trochanter
ii. Radiates along IT tract to tibia

Front 28

c. Where is the ischial bursa located?

Back 28

i. Between gluteus maximus and ischial tuberosity

Front 29

d. Where is the gluteofemoral bursa located?

Back 29

i. Separates IT tract from superior part of proximal attachments of vastus lateralis on femur

Front 30

e. How will a defect in the gluteus medius and gluteus minimus manifest?

Back 30

i. Trendelenburg gait

Front 31

a. What are the symptoms of piriformis syndrome?

Back 31

i. Localized buttock pain
ii. Localized tenderness over greater sciatic notch

Front 32

b. How do you dx piriformis syndrome?

Back 32

i. Patient supine
ii. Examiner flexes hip and extends knee at right angle to reproduce pain

Front 33

c. What causes piriformis syndrome?

Back 33

i. Compression of sciatic nerve by piriformis, fibroustissue, or vascular anomalies

Front 34

d. How do you tx piriformis syndrome?

Back 34

i. PT
ii. OMM
iii. NSAIDs

Front 35

a. What is the surgical treatment for piriformis syndrome?

Back 35

i. Nerve decompression by releasing piriformis or other obstruction

Front 36

a. What are the extensors of the thigh?

Back 36

i. Semitendinosus
ii. Semimembranosus
iii. Long head of biceps femoris

Front 37

b. What flexes the leg?

Back 37

i. Short head of biceps femoris

Front 38

c. What are the internal rotators of the flexed leg?

Back 38

i. Semitendinosus
ii. Semimembranosus

Front 39

d. What is the external rotator of the flexed leg?

Back 39

i. Biceps femoris

Front 40

e. What are the attachments of the semitendinosus?

Back 40

i. Origin→ Ischial tuberosity
ii. Insertion→ superior tibia

Front 41

f. What is the innervation of the semitendinosus and semimembranosus?

Back 41

i. Tibial division of sciatic nerve (L5-S2)

Front 42

g. What are the attachments of the semimembranosus?

Back 42

i. Origin→ Ischial tuberosity
ii. Insertion→ Medial condyle of tibia

Front 43

h. What are the attachments of the long head of biceps femoris?

Back 43

i. Ischial tuberosity
ii. Lateral side of fibular head

Front 44

i. What is the innervation of the long head of the biceps femoris?

Back 44

i. Tibial division of sciatic nerve (L5-S2)

Front 45

j. What are the attachments of the short head of biceps femoris?

Back 45

i. Linea aspera and lateral supracondylar line of femur
ii. Lateral side of fibular head

Front 46

k. What is the innervation of the short head of biceps femoris?

Back 46

i. Fibular division of sciatic nerve (L5-S2)

Front 47

l. What muscles insert on the pes anserinus?

Back 47

i. Sartorius
ii. Gracilis
iii. Semitendinosus
iv. SGT PES

Front 48

m. What gives blood supply to the muscles of the posterior compartment?

Back 48

i. Perforating branches of profunda femoris

Front 49

a. What are the symptoms of a hamstring injury?

Back 49

i. Contusion or tearing of muscle fibers
ii. Apparent hematoma

Front 50

o. What can result from forced hip flexion with extended knee?

Back 50

i. Avulsion fracture of ischial tuberosity
ii. Tears all hamstrings except short head of biceps femoris

Front 51

a. What is the origin of the superior and middle clunial nerves?

Back 51

i. Lateral cutaneous branches of posterior L1-L3

Front 52

b. Where are the superior clunial nerves found?

Back 52

i. Inferolaterally across iliac crest

Front 53

c. What does the superior clunial nerve supply?

Back 53

i. Skin of superior buttock to tubercle of iliac crest

Front 54

d. Where is the middle clunial nerve found?

Back 54

i. Exits through posterior sacral foramina
ii. Passes laterally to gluteal region

Front 55

e. What does the middle clunial nerve supply?

Back 55

i. Skin over sacrum
ii. Adjacent area of buttock

Front 56

f. What is the origin of the inferior clunial nerve?

Back 56

i. Posterior cutaneous nerve of thigh
ii. Anterior rami of S2-S3

Front 57

g. What is the course of the inferior clunial nerve?

Back 57

i. Emerges from inferior border of gluteus maximus
ii. Ascends superficial to it

Front 58

h. What does the inferior clunial nerve innervate?

Back 58

i. Skin of inferior half of buttock to greater trochanter

Front 59

a. What contributes to the sacral plexus?

Back 59

i. L4-S4

Front 60

b. How will a superior gluteal nerve injury present?

Back 60

i. Gait abnormalities
ii. + Tredelenburg gait

Front 61

c. What makes up the nerve to piriformis?

Back 61

i. S1-S2

Front 62

i. What are the two divisions of the sciatic nerve?

Back 62

1. Fibular
2. Tibial

Front 63

ii. Where is it safe to give intragluteal IM injections?

Back 63

1. Superolateral quadrant of region
2. Superior to a lien between PSIS and superior border of greater trochanter

Front 64

iii. Where should an anesthetic block of the sciatic nerve be given?

Back 64

1. A few cm inferior to line between PSIS and superior border of greater trochanter

Front 65

e. What will a complete section injury to the sciatic nerve look like?

Back 65

i. Loss of extension of hip and flexion of knee

Front 66

f. How will an incomplete section injury to the sciatic nerve present?

Back 66

i. Usually after a stab wound
ii. Slow to heal

Front 67

g. What is Hilton’s law?

Back 67

i. The nerves crossing a joint supply the muscles acting on it, the skin over the joint, and the joint itself

Front 68

a. With what does the superior gluteal artery anastomose?

Back 68

i. Inferior gluteal
ii. Medial circumflex femoral

Front 69

b. What does the superficial branch of the superior gluteal artery supply?

Back 69

i. Gluteus maximus

Front 70

c. What does the deep branch of the superior gluteal artery supply?

Back 70

i. Tensor fascia lata
ii. Gluteus medius
iii. Gluteus minimus

Front 71

d. In what anastomosis does the inferior gluteal artery participate?

Back 71

i. Cruciate

Front 72

e. What does the inferior gluteal artery supply?

Back 72

i. Gluteus maximus
ii. Obturator internus
iii. Quadratus femoris
iv. Superior hamstrings

Front 73

f. What is the largest branch of the internal iliac artery?

Back 73

i. Superior gluteal artery

Front 74

g. What is the origin of the inferior gluteal artery?

Back 74

i. One of two terminal division of internal iliac artery

Front 75

a. What are the borders of the popliteal fossa?

Back 75

i. Superolateral→ biceps femoris
ii. Superomedial→ semitendinosus and semimembranosus
iii. Inferior→ two heads of gastroc
iv. Roof→ Popliteal fascia and skin
v. Floor→ femur, knee joint capsule

Front 76

b. What are the contents of the popliteal fossa?

Back 76

i. Popliteal artery
ii. Popliteal vein
iii. Tibial nerve
iv. Common fibular nerve
v. Plantaris and popliteus muscles
vi. Popliteal lymph nodes

Front 77

c. What is the popliteal artery? Where does it course?

Back 77

i. Continuation of femoral artery
ii. Descends close to posterior aspect of femur
iii. Ends at lower border of popliteus→ A/P tibial arteries

Front 78

d. What do the muscular branches of the popliteal artery supply?

Back 78

i. Lower adductor magnus and hamstrings
ii. Proximal portions of gastroc, soleus, plantaris

Front 79

e. What do the cutaneous branches of the popliteal artery supply?

Back 79

i. Skin of posterior leg

Front 80

f. What are the genicular branches of the popliteal artery?

Back 80

i. Medial and lateral superior
ii. Middle
iii. Medial and lateral inferior

Front 81

g. What does the popliteal vein receive in the popliteal fossa?

Back 81

i. Saphenous vein

Front 82

h. What are the symptoms of a popliteal aneurysm?

Back 82

i. Aneurysm of popliteal artery→
ii. Venous thrombosis
iii. Peripheral edema
iv. Pressure on tibial nerve causing leg pain

Front 83

i. What is a popliteal (Baker) cyst?

Back 83

i. Synovial cyst
ii. Becomes infected, spreads inferiorly

Front 84

i. What are the superior branches of the genicular anastomosis?

Back 84

1. Descending branch of LCFA
2. Descending genicular artery

Front 85

ii. What branches of the popliteal artery participate in the genicular anastomosis?

Back 85

1. All of them

Front 86

iii. What are the inferior branches of the genicular anastomosis?

Back 86

1. Posterior tibial recurrent
2. Circumflex fibular
3. Anterior tibial recurrent