1
Q
where are the lateral rotator muscles located
A
deep to the gluteal muscles
2
Q
superficial lateral rotator muscles
A
gluteus Medius
gluteus maximus
3
Q
intermediate lateral rotator muscles
A
- gluteus Medius
- lateral rotators
4
Q
deep lateral rotator muscles
A
- gluteus minimus
- lateral rotators
5
Q
where do the lateral rotator muscles run
A
from the bony pelvis to the greater trochanter and upper posterior femur
6
Q
what are the lateral rotator muscles
A
- piriformis
- obturator internus
- superior and inferior gemelli
- quadatrus femoris
- abturator externus
7
Q
where does the piriformis attach
A
to the pelvis surface of the lateral part of the sacrum and the femur
8
Q
where does the piriformis leave
A
the pelvic through the greater sciatic foramen
9
Q
where does the obturator internus muscle originate
A
obturator membrane of the pelvis
10
Q
where does the tendon of the obturator interus exit
A
through the lesser sciatic foramen
11
Q
where does the obturator interus insert
A
on the femur
12
Q
what is formed with in obturator membrane
A
pudendal canal and carriers structures that supply the perineum
13
Q
where are the superior and inferior gemelli
A
run above and below the obturator internus
14
Q
where does the quadratus femoris run
A
from the ischial tuberosity to the femur
15
Q
where does the obturator externus run
A
from the outer surface of the obturator membrane to the femur
16
Q
what is better seen from anterior view
A
obturator externus
17
Q
gemellus pain syndrome
A
- most common conditions with these muscles
- they aid in flexion but not their primary function which can make them strained
- puts pressure on surrounding nerve (posterior femoral cutaneous nerve)
18
Q
what nerve runs over the gemelli muscles
A
- posterior femoral cutanous nerve
19
Q
symptoms of gemellus pain syndrome
A
- reduced range of motion of hip
- feeling and sensation to the skin of the posterior thigh from the nerve compression causing numbness in the skin
20
Q
what are gluteal muscles supplied by
A
branches of the internal iliac artery, primarily the superior and inferior gluteal arteries
21
Q
what do the vessel go through the supply the guteal muscles
A
greater sciatic foramen, superior and inferior to the pirifiormis muscle and travel along the posterior surface of the ilium, deep to the glute muscles
22
Q
what do the venous branches of the gluteal muscle drain into
A
internal iliac vein
23
Q
what is internal iliac artery stenosis (IIAS)
A
consequences of atherosclerosis
- narrowing of the internal iliac arteries reduces blood supply to the structures supplied by branches of the internal iliac artery (superior and inferior gluteal arteries)
24
Q
symptoms’ of internal iliac artery stenosis
A
- cramping of muscles in lower back, hip, buttock, thigh further induced by exercise
25
atherosclerosis
buildup of fats, cholesterol, and other substance in an on arterial wall (plaque) which can restrict blood flow
26
what innervates the gluteal region
- superior gluteal nerve
- inferior gluteal nerve
- posterior femoral cutaneous nerve
- sciatic nerve
- pudendal nerve
27
superior gluteal nerve
motor innervation too:
- gluteus medius
- gluteus minimus
- tensor fasciae latae
28
inferior gluteal nerve
motor innervation too:
- gluteus maximus
29
posterior femoral cutaneous nerve
sensory innervation:
- skin of the posterior thigh
30
sciatic nerve
muscles that make up the posterior thigh
31
what is the largest nerve in body
sciatic
32
pudendal nerve
motor innervation:
- anal sphincters and the urethral sphincter
sensory innervation:
- perineum
- penis
- scrotum
- labia majora
- clitoris
33
what is the largest branch of the sacral plexus
sciatic nerve (L4,5 and S1,2,3)
34
pathway of the sciatic nerve: gluteal region
- after forming from the sacral plexus
- the sciatic nerve leaves the pelvic via the greater sciatic foramen and emerge below the piriformis muscle
- sciatic nerve runs deep to the gluteus maximus
35
pathway of the scaitic nerve: posterior thigh
- passes superficial to the lateral rotator muscles
- enters the posterior thigh deep the hamstrigns
36
what does the sciatic nerve innervate in posterior thigh
- biceps femoris
- semimembranosus
- semitendiosus
- hamstrings
- portion of the adductor magnus
37
piriformis syndrome (sciatica)
- caused by compression of the sciatic nerve by the piriformis muscle
- where the nerve emerges over the lateral rotator muscles from under the piriformis
38
symptoms of sciatica
- pain
- tingling
- numbness
- pain in lower back (where spinal nerve converge to form the sciatic nerve) and down thigh
- pain can be triggered from sitting for prolonged periods, compressing the sciatic nerve
39
what is the hip joint
strong and stable "ball and socket" joint between the head of the femur and the cup-shaped acetabulum of hip bone
40
important stabilizing elements of the hip joint
- acetabular labrum
- ligamentum teres
- fibrous capsule
41
acetabular labrum
- the cavity of the acetabulum is deepened by a rim of fibrocartilage, the acetabular labrum
42
by deepening the acetabulum
more than half of the femoral head can fit
- improves the stability of the hip joint
43
ligamentum teres
acts as a secondary stabilizer of the hip joint, supplementing the work of the capsular ligament
44
fibrous capsule
- is a thick and strong group of ligaments that help hold the head of the femur in the acetabulum
45
how is the fibrous capsule oriented
in a spiral fashion around the hip joint so that they tighten during extension and go slack during flexion
46
what is the weakest in the posterior inferior region
fibrous capsule
47
what is traumatic posterior hip subluxation
occurs when the head of the femur is forced partially out of the acetabulum
48
most common way to get traumatic posterior hip subluxation
- fall on a flexed and adducted hip
49
symptoms of traumatic posterior hip subluxation
- painful and limited motion
- fibrous capsule and ligametum teres can be torn or disrupted
50
traumatic posterior hip subluxation fibrous capsule
typically tears in its posterior regions, since it is weaker than the anterior aspect
51
traumatic posterior hip subluxation radiographs
can reveal a characteristic posterior acetabular lip (labrum) fracture
52
how are the 3 compartment of the thigh formed by
intermuscular septa
53
intermuscular septa
fibrous connective-tissue sheets that partition muscle groups in the lower limb
54
what muscles make up the anterior compartment of thigh
- quadriceps muscles
- sartorius muscle
55
what muscles make up the posterior compartment of the thigh
- hamstrings
56
medical compartment of thigh what is in it
contains primarily adduct msucles
- triangular shaped
57
where do the adductor muscles originate
pubis
58
where do the adductor muscle interset
linea aspera of femur
59
list the medial compartment of thigh muscles
- pectineus
- adductor brevis
- adductor longus
- gracilis
- adductor magnus
60
what is the deepest and largest muscle of the medical compartment of thigh
adductor magnus
61
where does adductor magnus insert
along the length of the linea aspera
62
function of the adductor magnus
adduction
extend and medically rotate the thigh at hip
63
adductor hiatus formation
At its most distal insertion site, a smaller ‘hamstring’ part inserts on the adductor tubercle of the femur, forming it
64
function of the adductor hiatus
- allows the passage of vessels between the anterior and posterior thigh
65
adductor magnus strain
- common injuries among soccer, hockey, football players
- occurs from tearing of muscle that happens when muscle has been forced to stretch or contract beyond its limits
66
symptoms of adductor magnus strain
- limited movement of the hip
- weird gate
- pain with adduction, extension or medial rotation of the thigh
67
what occurs in athletes as result of adductor magnus strain
trigger points
68
localization pain adductor magnus strain: groin
deep aching pain may radiate to the pelvis and groin area, near the origin of the adductor magnus
69
localization pain adductor magnus strain: thigh
pain is felt at the front and/or back of the thigh along the body of the muscle
70
localization pain adductor magnus strain: knee
pain may radiate to the knee, near the insertion of the adductor magnus
71
muscles of the posterior compartment
hamstrings
72
where do posterior compartment muscles originate
from the ischial tuberosity of the ischium
73
where do posterior compartment muscles insert
on the posterolateral (fibula) and posteromedial (tibia) aspects of the knee
74
what are the posterior muscles of thigh responsible for
extending the hip and flexing the knee
75
list the posterior thigh compartment muscles
- semitendinosus
- semimembranosus
- biceps femoris
76
what is the femoral triangle
area in the upper anterior thigh that contains major neurovasular strucutres
77
superior border of femoral triangle
inguinal ligament
78
lateral border of femoral triangle
satorius muscle
79
medial border of femoral triangle
adductor longus
80
muscle floor of the femoral triangle
iliopsoas and pectineus
81
roof of femoral triangle
fascia lata
82
fascia lata
a thick connective tissue layer that covers and holds the musculature of the thigh
83
what does the iliac artery do when is passes deep to the inguinal ligament
continues as the femoral artery which supplies branches to the hip and thigh
84
branches that supply the hip region
- deep femoral artery (profunda femoris)
- circumflex arteries (multiple branches that anastomose around the neck of femur)
85
what branches of femoral artery supply the thigh
- profunda femoris artery (deep femoral)
- superficial femoral artery
86
profunda femoris artery
- main source of blood supply to the thigh and the femoral supplies rest
87
femoral vein
drains the thigh and the rest of the lower limb
88
saphenous vein
- longest tributary
- drains the superficial tissues of most of the lower limb
89
where does the great saphenous vein emptie
into the femoral vein in the upper thigh
90
what does the femoral triangle contain
femoral artery and femoral vein
91
where does the femoral artery and vein go after femoral triangle
adductor hiatus
92
adductor (hunters) canal femoral artery and vein
they go through it to the posterior knee where they change their name to popliteal artery and vein
93
avascular necrosis of femoral head
- arises when blood supply to the femoral head (circumfelx arteries) is disrupted
- caused from trauma to joint or bone
94
what happens from avascular necrosis of femoral head
- necrosis or tissue death
95
avascular necrosis of femoral head symptoms
- none in early stages
- pain can range from mild to severe
- affected joint may hurt only during weight bearing activities but eventually pain may persist when lying down
- pain can go to groin, thigh, buttocks
96
location of avascular neurosis of femoral head + structures involved
- femoral head
- neck
- circumflex arteries
97
what supplies innervation to hip and thigh
- femoral nerve
- obturator nerve
- lateral cutaneous nerve
- sciatic nerve
98
femoral nerve
- innervates quadriceps muscles
- skin on anterior thigh
99
where does femoral nerve run
along the femoral artery and vein in the femoral triangle
100
obturator nerve
- innervates muscles of the medial compartment (adductors) by motor branches
- skin of medial thigh via cutaneous branch
101
lateral cutaneous nerve
- supplies skin on the lateral aspect of the thigh above the knee
102
sciatic nerve
- innervate to hamstring muscles
103
obturator nerve entrapment
- can occur from many reasons such as inflammation of the adductor muscels
- bc it travels between the adductor longus and adductor brevis its susceptible to impingment
104
pain of obturator nerve entrapment
can follow the course of the nerve along the medial thigh and can radiate to the groin and/or knee
105
sensory changes of obturator nerve entrapment
cutaneous branches of this nerve supply the skin of the medial thigh hence, individuals may experience numbness and paresthesia
106
motor change obturator nerve entrapment
- impingement can lead to adductor weakness, limited range of motion at hip joint, and pain that worsens with activity
107
what is the point of ligament in the knee joint
- provides stability and support its movements
108
what are the ligaments of the knee
- patellar ligament
- collateral ligament
- cruciate ligament
109
patellar ligament
- continuation of the quadriceps tendon
- keep the patella in proper position
110
what are the 2 collateral ligaments
medial collateral ligament
lateral collateral ligament
111
function of collateral ligaments
stabilize the hinge motion of the knee, preventing excessive medial or lateral movement
112
medial collateral ligament
joins the distal demur to the proximal tibia
113
lateral collateral ligament
joins the distal femur to the head of the fibula
114
what are the 2 cruciate ligaments
- anterior cruciate ligament
- posterior cruciate ligament
115
what are the cruicate ligaments
deep ligaments of the knee that prevent the femur and tibia from sliding forwards or backwards
116
anterior cruciate ligament (ACL)
prevents anterior disolcation of the tibia on the fixed femur
117
posterior cruciate ligament (PCL)
prevents posterior dislocation of the tibia on the fixed femur
118
what are the menisci
- C-shaped
- fibrocartilaginous pads on the condyles of the tibia
- deep to the articular surface of the tibia
- increase stability
- shock absorbers
119
what are the 2 meniscus
medial
lateral
120
medial meniscus tear
- injured or torn from jumping, changing direction quick, rotation of the knee
121
symptoms of medial meniscus tear
- popping sensation
- pain to localized area
- swelling + stiffness
- loss of cushioning makes movements, difficult and painful
122
what are the posterior compartment of the leg responsible for
- plantarflexing foot and ankle
123
muscles of the posterior compartment of leg
- popliteus
- gastronemius
- plantaris
124
popliteus
- deepest muscle of posterior compartment
125
origin of popliteus
lateral femur
126
insertion of popliteus
posterior surface of tibia
127
gastrocnemius origin
- has 2 heads that oringinate on the medial and lateral sides of the femur
128
insertion of gastrocnemius
the calcaneus
129
function of the gastronemius
- cross to joints so flexs the leg and foot
130
plantaris origin
posterolateral femur
131
insertion of plantaris
calcaneus
132
what is the popliteual fossa
- diamond shaped area of the knee
- nerve and vessel travel between the thigh and knee found here
133
medial border of the popliteal fossa
semimbranosus
134
lateral border of popliteal fossa
biceps femoris
135
where is the plantaris in the popliteal fossa
lateral inferior
136
inferior lateral border of popliteal border
lateral head of gastrocenemius
137
medial inferior border of the popliteal border
medial head of gastrocnemius
138
muscles in the popliteal border
- semimbranosus
- biceps femoris
- plantaris
- lateral head of gastrocnemius
- medial head of gastrocemius
139
medial gastrocnemius strain
- high risk because it crosses 2 joints and injuried alot in sports
140
symptoms of medial gastrocnemius strain
- calf pain
- possible budge
- tenderness
- pain and weakness when flexing the leg at the knee joint
141
what suppleis the knee and leg
branches of femoral artery
branches of femoral vein
142
branches off femoral artery that supply the knee and leg
- popliteal artery ---> anterior tibial artery
- posterior tibial artery
- fibular artery (peroneal artery)
143
popliteal artery
continuation of the femoral artery and found in the popliteal fossa
144
anterior tibial artery
branch off popliteal artery
- supplies anterior compartment of leg
145
posterior tibial artery
supplies posterior compartment of leg
146
fibular artery (peroneal arterty)
supplies lateral compartement of leg
147
branches of the femoral vein that drain the knee and leg (order of draining)
- fibular vein-->posterior tibial vein--> anterior tibial vein--> popliteal vein--> femoral vein
- small saphenous vein-->great saphenous vein-->popliteal vein--> femoral vein
148
fibular vein
drains lateral compartment of leg
149
posterior tibial vein
drains the fibular vein and posterior compartment of leg
150
anterior tibial vein
drains the anterior compartment of leg
151
small saphenous vein
drains from lower leg into popliteal vein
- (short or lesser saphenous vein)
152
great saphenous vein
drains the superifical tissue of most of the lower limb
153
popliteal vein
found in popliteal fossa and drains into the femoral vein
154
deep vein thrombosis
involves the formation of a blood clot in a deep vein
- from decreased blood flow increased tendency to clot, injury to blood vessel
155
risk factors of deep vein thrombosis
- age
- obesity
- trauma
- lack of movement
- use of birth control
156
symptoms of deep vein thrombosis
- pain that starts in calf
- cramp or soreness
- red vein or discolored on skin
- warm and swollen
157
what innervate the knee and leg
- sciatic nerve splits to form tibial and common peroneal nerves at the distal thigh
158
common peroneal (fibular nerve)
innervates the muscles of lateral and anterior compartments of the leg
159
tibial nerve
descends posteriorly through popliteal fossa and innervates the muscles of the posterior leg
160
branchs of the common peroneal (fibualr) nerve
superficial fibular nerve
deep fibular nerve
161
superifical fibular nerve
innervates muscles of the latereal compartment of leg
162
deep fibular nerve
innervates muscles of the anterior compartment of the leg
163
contents of the popliteal fossa
- popliteal artery
- popliteal vein
- tibial nerve
- common peroneal nerve
164
common peroneal nerve dysfunction
occurs when there is damage to the peroneaal (fibular) nerve leading to loss of movement or sensation in the foot and leg
- truama or injury to the knee
- impairment to the foot (drop foot, impaired gait)
165
what nerve could be affect from medial gastrocneumius strain
posterior tibial artery , tibial nerve
166
functions of bones in the foot
faciliate movement of the foot while bearing the weight of the body
167
list the tarsal bones
- calcaneus
- talus
- cuboid
- navicular
- intermediate, lateral, medial cuneiforms
168
this larger bone, the _____ is part of the ankle joint
talus
169
the ____ bone is a good landmark because of its long rectangular shape
navicular
170
this bone, the ____ articulates with the first metatarsal
medial cuniform
171
the ____ articulates with the second metatarsal
intermediate cuniform
172
the ______ articulates with the third metatarsal
lateral cuneiform
173
this square shaped bone, the ____ is almost as thick as it is wide
cuboid
174
the _____ forms the heel of the foot
calcaneus
175
stress facture
is a small crack in a bone or serve bruising within a bone
- it is NOT a complete break
- caused by overuse and repetitive activity
176
where do stress fractures occur
in bones with weight bearing functions
- second and third metatarsal bones of the foot recieve the greatest impact of force as you push ass when walking/running
-
177
symtpom of stress fracture
pain that worsens with weight bearing activity, and dimishes during rest
- swelling
- difficulty walking and performing low impact activities (climbing stairs)
- can be difficult to see on x-ray due to their size
178
what is the ankle joint
is a synovial joint located in the lower limb
179
what makes the ankle joint
bones of the leg (tibia and fibula) articualting with the foot (talus)
- tibia and fibula together form a joint in which the talus sits
180
what does the ankle joint do
hinge joint permitting dorsiflexion and plantarflexion of the foot
- strengthened by tendons and ligament
181
what do ligament of the foot and ankle do
stabilize
182
ligaments of the foot
- deltoid
- spring
- plantar fascia
183
what does the deltoid ligament do
help stabilize the ankle during plantar flexion, external rotation and pronation of the foot to prevent overstrtching of muscles
184
where is the deltoid ligament
runs between the tibia and talus
185
what does the spring ligament do
(calcaneonavicular) stabilizes the medial longitudinal arch and the talus
186
where is the spring ligament
runs between the navicular and calcaneus bone
187
what is the longest ligament in the foot
planatar fascia
188
what does the plantar fascia do
thick fascia helps support the medial longitudinal arch of the foot
189
deltoid ligament sprain
caused by sudden rotation o the ankle
190
symptoms of deltoid ligament sprain
- pain of medial ankle
- swelling
- bruising
- damage to ligament and surrounding structures
- difficulty walking
- bearing weight
191
what can the muscles in the foot be divided into
extrinsic and intrinsic muscles
192
intrinsic muscles of the foot location
- sole of the foot
193
function of the intrinsic muscles of foot
stabilize the arches of the foot
- individually control movement of the digitis
194
where are extrinsic muscles/location
arise from the anterior, posterior, and lateral, compartment of the leg
195
function of extrinsic muscles
- eversion
- inversion
- plantar flexion
- dorsiflexion
196
tibialis posterior muscles
is an important extrinsic muscle attaching onto the navicular in the foot
197
posterior tibial tendonitis
- very important tendon of the leg functioning to support the medial longitudinal arch of the foot during walking
198
what can cause posterior tibial tendonitis
- acute injury
- fall
- overuse
can tear it or become inflamed
199
what usually happens with posterior tibial tendontitis
the medial longitudinal arch may slowly fall (collapse) over time
200
symptoms of posterior tibial tendinitis's
- pain around foot and ankle
- swollen, warm, red
- prone to rolling medially (ankle) and toes and foot rotate laterally
201
what 2 main arteries supply the ankle and foot
- dorsalis pedis artery
- posterior tibial artery
202
where does the dorsalis pedis artery come from and supply
- branch of the anterior tibial artery
- supplies the dorsum of the foot
203
what does the posterior tibial artery supply
plantar surface of the foot
204
what is the dorsal surface of the foot drained by
dorsal venous arch
205
what does the dorsal venous arch drain into
small saphenous vein laterally and the great saphenous vein medially
206
what does the dorsal venous arch drain
distal surfaces of the foot, such as the toes, via smaller branches
207
varicose veins
- are twisted, enlarges veins caused by weak or damaged valves in the veins
- can cause backflow and pooling of blood in the vein
- causing them to stretch or twist
208
early stages of varicose veins
- simply a cosmetic concern
209
lateral stages of varicose veins
can cause uncomfortable symptoms such as aching pain and discomfort due to the pooling of the blood
- possible permanent damage to the veins
210
innervation to the ankle and foot
tibial nerve
deep fibular nerve
superficial fibular nerve
211
where does the tibial nerve travel
descends in the posterior compartment of the leg supplying the muscles and enters the foot
212
what does the tibial nerve innervate
intrinsic muscles of the plantar surface of foot
213
where does the deep fibular nerve travel
descends into the anterior compartment of the leg
214
what does the deep fibular nerve suuply
muscles and part of the skin on the dorsum of foot
215
where does the superficial fibular nerve travel
descends in the lateral compartment of the leg
216
what does the superficial fibular nerve supply
muscles and the skin of the lower anterior leg and most skin on the dorsum of the foot
217
tibial nerve dysfunction
occurs when there is damage to the tibial nerve, which supplies muscles of the leg
- loss of movement or sensation in the foot
- caused from trauma, continuous pressure on the nerve for a long period of tome, pressure on the nerve from nearby structures and overuse
218
symptoms of tibial nerve dysfunction
changes in sensation to the skin on the sole of the foot (burning, numbness, tingling)
- pain in sole of foot and toes
- changes in motor innervation can manifest as weakness of muscles that plantarflex the foot at the ankle joint
ANAT 380
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