Waldman Pain Review Chapters 65-94

Front 1

The sciatic nerve innervates the motor and sensory parts of the distal lower extremity except for which part innervated by which nerve?

Back 1

The medial calf and foot, which are innervated by the saphenous, which is formed from the continuation of the femoral.

Front 2

Give the origin of the sural nerve

Back 2

Formed from the tibial nerve (medial branch) which is given off before the tibial nerve goes deep to the gastrocnemius, and from the peroneal nerve (lateral branch) by the biceps femoris before it reaches the fibular head. They anastamose, go posterior to the lateral malleolus, and give off branching rami

Front 3

Give the borders of the femoral triangle, the positioning of the thigh to where it is most easily seen, and its contents from lateral to medial

Back 3

Borders:
Medial: adductor longus
Lateral: sartorius
Superior: inguinal ligament
Floor: pectineus
Roof: Fascia lata except for cribiform fascia by saphenous opening

It is most easily seen in the FABER position.

Contents are NAVEL: femoral nerve, femoral branch of the genitofemoral nerve, femoral artery, femoral vein (all in the femoral sheath), extra space, lymphatics/lacunar ligament.

Front 4

What are the main motor branches of the femoral nerve?

Back 4

Iliacus, pectineus, quadriceps femoris, sartorius

Front 5

Name the muscles inserted into the pes anserine area from anterior to posterior. What collagenous structure is this insertion superficial to?

Back 5

Sartorius, gracilis, semitendinosis. Superior to the insertion of the MCL.

Front 6

What divisions of what nerve roots form the lateral femoral cutaneous nerve?

Back 6

The posterior divisions of L2 and L3

Front 7

Describe the course of the LFCN from the root level

Back 7

From L2 and L3 nerve roots to the lumbar plexus. Posterior divisions go just lateral to the ilioinguinal nerve. Passes under the inguinal ligament just medial to the anterior superior iliac spine. Stays under the fascia lata. Lateral branch goes just anterior to the greater trochanter and down to the knee. Medial branch goes to the anterior thigh.

Front 8

What is LFCN neuropathy called?

Back 8

meralgia paresthetica

Front 9

Describe the anatomy behind the greater and lesser sciatic foramina

Back 9

The greater sciatic foramen is formed from the greater sciatic notch and the sacrospinous ligament going from the ischial spine to the sacrum. The lesser sciatic foramen is formed from the lesser sciatic notch, the sacrospinous ligament superiorly, and the sacrotuberous ligament inferomedially.

Front 10

Describe the origin and course of the ilioinguinal nerve

Back 10

From L1, sometimes T12. Travels along the concavity of the ilium, then perforates the transverse abdominis, wrapping medially to innervate the area around the medial inguinal crease. May join up with the iliohypogastric. Goes through the superficial inguinal ring to the inguinal canal. Does not go through the deep inguinal ring. Innervates the upper scrotum in men and the mons pubis in women.

Front 11

Describe the origin and course of the iliohypogastric nerve

Back 11

Like the ilioinguinal nerve, it originates from T12 and L1, goes along the concavity of the ilium and pierces the transverse abdominis. There a posterior branch goes and innervates the lateral gluteal area and an anterior branch passes through the external oblique muscle and innervates the inferior aspect of the abdomen/inguinal areas.

Front 12

Describe the origin and course of the genitofemoral nerve.

Back 12

Originates at L1/2, goes along the convexity of the ilium, runs anteriorly to the psoas behind the ureter. Just above the inguinal ligament it divides into a femoral and genital branch. The femoral branch travels next to the femoral nerve through the inguinal canal. The genital branch goes through the inguinal canal and deep inguinal ring to innervate the cremaster and the scrotum in men. In women, it passses through the round ligament to innervate the ipsilateral mons pubis and labia majora.

Front 13

What nerve primarily innervates the hip joint?

Back 13

The obturator nerve.

Front 14

What nerves form the peripatellar plexus?

Back 14

Branches from the anterior division of the lateral femoral cutaneous nerve and the saphenous nerve

Front 15

Describe the course of the obturator nerve and the muscles it innervates. What muscle does it confusingly NOT innervate, given it's name (and what nerve innervates it)?

Back 15

Start with ventral roots of L2-4. Pass along the psoas to the medial border of the pelvic brim. Runs lateral to the internal iliac artery and the ureter. Lies anterior to the obturator vessels and goes to the thigh through the obturator foramen/obturator canal. It turns into an anterior and posterior branch, separated by the obturator externus and then the adductor brevis. The posterior branch innervates the obturator externus, adductor brevis, sometimes the adductor magnus, and it sometimes gives an articular branch to the knee. The anterior division gives off a branch to the articulation of the hip joint. It sometimes innervates the pectineus. It also innervates the adductor longus, sometimes brevis, gracilis. The obturator internus is not innervated by the obturator nerve, rather by the "nerve to the obturator internus".

Front 16

Describe the formation and course of the superior hypogastric nerves and inferior hypogastric plexus

Back 16

Start as a sympathetic/parasympathetic plexus from a combination of an extension of the lumbar plexus and sacral parasympathetics. Travel around the aorta. At around L4 level, just inferior to the formation of the common iliac arteries, it forms the superior hypogastric plexus. At L5, they divide into the superior hypogastric nerves and follow the iliac vessels to around the bladder and viscera. Here they form the inferior hypogastric plexus.

Front 17

Where does the ganglion of impar (aka ganglion of Walther) lie?

Back 17

Just in front of the sacrococcygeal joint.

Front 18

What is the terminal ganglion of the sacral sympathetic and parasympathetic chains?

Back 18

The ganglion imapr

Front 19

Where does the tibial nerve lie in relation to the soleus? Tibialis posterior? FHL and FDL?

Back 19

deep to the soleus, directly superficial to the tibialis posterior, equal depth and medial to the FHL, equal depth and lateral to the FDL.

Front 20

Where does the peroneus longus insert?

Back 20

The first metatarsal and medial cuneiform

Front 21

Where does the peroneus brevis insert?

Back 21

the fifth metatarsal

Front 22

What part of the femoral head is not covered in hyaline cartilage? What is attached to this area?

Back 22

The fovea. The ligamentum teres.

Front 23

What lies inside the ligamentum teres?

Back 23

The central branch of the obturator artery.

Front 24

What major muscle groups attach to the greater trochanter? The lesser trochanter?

Back 24

The greater trochanter receives insertions from the gluteal group, the lesser from the adductor group.

Front 25

Give femoral shaft to head angles for coxa valga and coxa vara

Back 25

Coxa valga: greater than 135 degrees
Coxa vara: less than 125 degrees

Front 26

Name the three major ligaments supporting the hip joint and their location

Back 26

anterior: iliofemoral
posterior: ischiofemoral and pubofemoral

Front 27

What muscle(s) are the main hip flexor?

Back 27

iliopsoas.

Front 28

What muscle(s) are the main hip extensor?

Back 28

gluteus maximus and hamstrings

Front 29

What muscle(s) are the main hip abductors?

Back 29

Gluteus medius and minimus

Front 30

What muscle(s) are the main hip adductors?

Back 30

Adductor brevis and longus

Front 31

What muscle(s) are the main hip internal rotators?

Back 31

tensor fascia lata. When hip flexed, gluteus medius and minimus (anterior fibers).

Front 32

What muscle(s) are the main hip external rotators?

Back 32

Gluteus medius and minimus (posterior fibers) with hip in extension, quadratus femoris, gamelli, piriformis, obturator internus and externus

Front 33

What two structures does the ischial bursa lie between?

Back 33

The ischial tuberosity and the gluteus maximus

Front 34

What three structures does the greater trochanteric bursa lie between?

Back 34

The greater trochanter, the iliotibial tract, and the tendon of the gluteus medius.

Front 35

What nerve innervates the gluteus medius?

Back 35

The superior gluteal nerve

Front 36

What is another name for the inominate bones?

Back 36

The iliac wings.

Front 37

List the major ligamentous/fascial stabilizers of the sacroiliac joint

Back 37

Thoracolumbar fascia from the 12th rib, lumbar spinous and transverse processes, pelvic brim. Sacrotuberous ligament, iliolumbar ligament. Interosseus ligament. Dorsal sacroiliac ligament. Anterior sacroiliac ligament. Sacrospinous ligament. Pubic symphysis.

Front 38

List the major muscles attaching to the sacroiliac joint

Back 38

gluteus maximus, gluteus medius, latissimus dorsi, multifidi, biceps femoris, psoas, piriformis, transverse abdominis, abdominal obliques.

Front 39

What is the largest joint as regards to articular surface and joint volume?

Back 39

the knee

Front 40

How do the menisci of the knee receive the bulk of their nutrition?

Back 40

Via the synovial fluid

Front 41

In extension, what part of the patella is in contact with the articular groove of the femur?

Back 41

The superior pole

Front 42

What are the main flexor muscles of the knee? The secondary flexor muscles?

Back 42

The hamstrings. Secondary muscles include the gracilis, sartorius, and gastrocnemius

Front 43

The orientation of the superficial and deep inferior patellar bursa are in relation to what structure?

Back 43

The patellar ligament.

Front 44

List the main components of the hindfoot, midfoot, and forefoot

Back 44

Hindfoot: talus and calcaneus
Midfoot: tarsal bones (navicular, cuboid, cuneiform)
Forefoot: metatarsals and phalanges

Front 45

What joint is responsible for ankle flexion and extension? For inversion and eversion? What degree of eversion and inversion?

Back 45

The junction of the fibula, tibia, and talus creates a mortise that allows for dorsi- and plantarflexion. The talocalcaneal joint allows for 15 degrees of eversion and 30 degrees of inversion.

Front 46

What is thought to be the main function of the calcaneocuboid and talonavicular joints? How do they do this?

Back 46

Possibly climbing. They allow about 20 degrees of adduction and 10 degrees of abduction.

Front 47

Where do the deep layers of of the deltoid ligament attach? The superficial layers?

Back 47

The deep layers of the deltoid ligament attach to the medial talus. The superficial layers attach to the talus, the sustenaculum tali, and the navicular tuberosity.

Front 48

What nerves innervate the ankle joint?

Back 48

The deep peroneal and the tibial.

Front 49

Where does the anterior talofibular ligament run?

Back 49

From the lateral malleolus to the lateral talus.

Front 50

Name the four major ligaments of the ankle.

Back 50

Deltoid medially. Laterally, the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament.

Front 51

What is prone to being entraped in the anterior tarsal tunnel?

Back 51

The deep peroneal nerve.

Front 52

Where does the deep peroneal nerve lie in the leg as it descends to the ankle?

Back 52

Right next to the anterior tibial artery in front of the interosseous membrane.

Front 53

What are the three components of the tarsal tunnel? What structures pass through it?

Back 53

The medial malleolus, the flexor retinaculum, and the lacunate ligament. The tibial nerve, tibial artery, tibial vein, tibialis posterior, flexor digitorum longus, flexor hallucis longus.

Front 54

Where does the achilles bursa lie?

Back 54

Between the base of the tibia, the posterior calcaneus, and the achilles tendon.

Front 55

What is the most common reason for coxa valga? For coxa vera?

Back 55

Coxa valga: slipped femoral epiphysis

Coxa vara: femoral neck fracture or other proximal femoral fracture.

Front 56

What is the strongest ligament in the human body?

Back 56

The iliofemoral ligament (of Bigelow)