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95 Cards in this Set
- Front
- Back
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Nerve of gluteus maximus
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Inferior gluteal
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Origin of gluteus maximus
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posterolateral ilium
dorsal sacrum sacrotuberous ligament |
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Insertion of gluteus maximus
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iliotibilal tract
gluteal tuberosity of femur |
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Action of gluteus maximus
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HIP EXTENSION
Lateral rotation of Hip |
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Gluteal muscles innervation
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Gluteus maximus- inferior gluteal
Gluteus medius, gluteus minimus- superior gluteal |
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Innervation gluteus medius, gluteus minimus
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Superior gluteal nerve
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Origin of gluteus medius, gluteus minimus
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lateral ilium
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Insertion of gluteus medius, gluteus minimus
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greater trochanter of femur
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Action of gluteus medius, gluteus minimus
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ABduction of hip
Lateral support of pelvis other actions (like deltoid) |
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Tensor fascia lata innervation
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Superior gluteal nerve
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Tensor fascia lata origin
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anterior iliac crest
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Tensor fascia lata insertion
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Iliotibial tract
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Tensor fascia lata action (OPPOSITE OF GLUTEUS MAX)
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HIP FLEXION
MEDIAL ROTATION OF HIP |
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Piriformis innervation
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Branches from S1 + S2 ventral rami
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Piriformis origin
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anterior sacrum
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Piriformis insertion
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greater trochanter
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Piriformis function (same as gluteus max)
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Lateral rotation of hip
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What is the key to the gluteal region
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PIRIFORMIS!
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What are the 5 short lateral rotator muscles?
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- piriformis
- superior gemellus - obturator internus - inferior gemellus - quadratus femoris |
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Obturator internus + superior gemellus Innervation
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nerve to obturator internus & superior gemellus
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Obturator internus origin
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internal aspect of obturator foramen & membrane
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Insertion of obturator internus
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medial - greater trochanter
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Inferior gemellus + quadratus femoris innervation
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Nerve to inferior gemellus & quadratus femoris
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Obturator externus origin
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obturator membrane (external aspect)
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Obturator externus insertion
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trochanteric fossa of femur
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Obturator externus innervation
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Obturator
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Biceps femoris long head innervation
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tibial portion of sciatic
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Biceps femoris long head origin
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Ischial tuberosity
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Biceps femoris long head + short head INSERTION
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head of fibula
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Biceps femoris long head + short head ACTION
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extension of hip (long head only)
flexion of knee lateral rotation of leg |
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Biceps femoris short head nerve
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common peroneal
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Biceps femoris short head origin
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linea aspera of femur
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Semitendinosus, semimembranosus NERVE
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tibial portion of sciatic
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Semitendinosus, Semimembranosus Origin
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Ischial tuberosity
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Semitendenosus, Semimembranosus action
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Extension of hip
flexion of knee medial rotation of leg |
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Semitendenosus insertion
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anteromedial aspect of tibia below knee
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Semimembranosus insertion
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posteromedial aspect of medial tibial condoyle
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Gluteal fold
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demarcates border between gluteal and and posterior thigh regions
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intergluteal cleft
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separates buttocks
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Bony landmarks of gluteal
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iliac crest
ASIS PSIS ischial tuberosity greater trochanter |
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What do sacrotuberous and sacrospinous ligaments do?
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Close off the greater and lesser sciatic notches to form GREATER and LESSER SCIATIC FORAMINA
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Function of ligaments
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stabilize joints of pelvis
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Greater sciatic foramen is condiuit for
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structures entering/leaving pelvis
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Lesser sciatic conduit for
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structures entering/leaving perineum
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Function of sacroiliac joint
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- inc stability
- transfer body weight to lower extremities |
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Where does innervation of gluteal region come from?
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branches of sacral plexus
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3 main muscular components of the gluteal region
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- superficial layer: gluteus max, min, medius
- tensor fascia - deeper layer: smaller muscles |
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What is the MAIN function of medius/minimus complex when standing on one foot?
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Gluteus medius/minimus complex of opposite limb CONTRACTS to keep pelvis from sagging
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What is positive TRENDELENBURG?
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- When pelvis sags to opposite side during standing on one foot
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What does positive Trendelenburg indicate?
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- weakness or paralysis of gluteus medius/minimus complex
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What is a bursa?
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Closed sac w/ synovial membrane and containing fluid
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Where is bursa found?
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area subject to friction: where tendon passes over bone
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Trochanteric bursa
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gluteus max slide over greater trochanter
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Ischial bursa
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gluteus max slide over ischial tuberosity
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Gluteofemoral bursa
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separate IT tract from vastus lateralis on femur
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What is bursitis?
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inflammed bursa
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QWhat are vessels above piriformis?
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Superior gluteal n, a, v
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What are vessels below piriformis
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inferior gluteal n, a, v
sciatic n posterior femoral cutaneous n n to sup. gemellus + obturator int internal pudendal a, v pudendal n |
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What are vessels below piriformis (deep to obturator int. and sup. gemellus)
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n to inf. gemellus + quadratus femoris
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Trace sciatic nerve
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exit below piriformis
descend to posterior thigh opsterior of adductor magnus (plane between it and hamstring muscles) |
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Trace pudendal nerve and internal pudendal vessels
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exit piriformis
enter lesser sciatic foramen perineum |
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Trace posterior cutaneous nerve
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below piriformis muscle
supplies skin inferior to gluteal fold |
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Why is gluteal good for intramuscular injections
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large surface area for venous absorption
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where to inject on gluteal region?
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upper outer
(superolateral) |
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In normal circumstances, what happens when you lift one foot up?
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gluteus medius/minimus complex on the side of support reflexively contracts to prevent pelvis from dropping on unsupported side
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Negative Trendelenburg
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lateral balance maintained
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Positive Trendelenburg
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pelvis tilts on opposite side of body
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What structures traverse lesser sciatic foramen?
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- pudendal n
- internal pudendal a, v - nerve to obturator internus |
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PIRIFORMIS vs. OBTURATOR INTERNUS
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piriformis traverses greater sciatic foramen
obturator internus traverses lesser sciatic foramen |
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Where do divisions of the sciatic nerve pass through?
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87% both tibial n/ common peroneal n pass inferior to piriformis after emergence from greater sciatic foramen
12% two divisions pass in the pirformis |
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How is injury to gluteus medius/minimus caused?
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- mechanical injury to sup. gluteal nerve
- injury to central nervous pathways that control sup gluteal nerve - muscular weakness- intrinsic nerve disease (multiple sclerosis) - muscular weakness- intrinsic muscular disease (muscular dystrophy) |
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Less common causes of positive trendelenburg
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- dislocation of hip joint
- abnormal inlclination between neck + shaft of femur |
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What happens to gait in positive Trendelenburg?
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pelvis descends on unsuppported side
lower extremity becomes too long and unable to clear ground when foot is brought forward compensation: indvidiual leans away from unsupported side RESULT = waddling gait |
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What characteristics (3) are common to all 3 hamstring muscle groups? What is exception?
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1. have common site of origin from ischial tuberosity
2. innervated by tibial portion of sciatic nerve 3. span distance btwn and act upon two joints (hip-knee) - Exception: short head of biceps femoris |
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The adductor magnus and its relation to the hamstring muscles?
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- Originiates from ischial tuberosity
- tibial nerve innervation - extensor action at hip - ONLY ACTS ON HIP (not 2 joints) |
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What are the components of the pes anserinus and where do they come together?
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- sartorius, gracilis, semitendinosus
- antero-medial tibia |
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What are the two dynamic stablizers of knee joint?
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- IT tract (lateral)
- Pes anserinus (medial side) |
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Action of hamstrings
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- FLEXION OF KNEE
- HIP EXTENSION (except short head of biceps femoris) - MEDIAL/ LATERAL ROTATION of leg |
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Trace the sciatic nerve
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- emerge from greater sciatic foramen
- deep to gluteus max - posterior to adductor magnus - in plane between adductor magnus and hamstring muscles |
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EWhat is special about adductor magnus- how is it the other hamstring?
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Innervation: tibial nerve
Action: hip extension Origin: ischial tuberosity |
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What does adductor magnus m. form with the femur ? (Hiatus)
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Tendinous hiatus- fem. artery and vein pass through it
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What is teh main source of blood supply to thigh?
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- deep femoral artery
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What are the major branches of deep femoral artery?
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- medial femoral circumflex
- lateral femoral circumflex - 4 perforating branches |
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Superolateral boundary of politeal fossa
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biceps femoris
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Superomedial boundary of politeal fossa
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semimembranosus and semitendinosus
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Inferolateral boundary of politeal fossa
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gastrocnemus lateral head
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INferomedial boundary of politeal fossa
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gastrocnemius medial head
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Floor of boundary of politeal fossa
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posterior femur, capsule of knee joint, politeus m.
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Roof boundary of politeal fossa
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skin, fascia
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What can rupture the politeal artery?
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Supracondylar femoral fractures
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What is anastomosis?
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reconnection of 2 streams that previously branched out
- genicular, cruciate |
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What are two sites of anastomosis?
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Hip (femoral)
Knee (popliteal) |
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Cruciate anastomosis- name the vessels that will compensate if femoral is occluded
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- inferior gluteal a
- med. femoral circumflex a - lateral femoral circumflex a - 1st perforating branch of deep femoral a |
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Genicular anastomosis- which arteries compensate?
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genicular
descending genicular a recurrent branches of tibial a |
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What position does knee get occluded and anastomosis has to work?
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when knee is in full flexion
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