Anatomy Block III- Gluteal Region, Thigh, Lumbosacral Plexus
what makes up the bony structure of the lower limb
os coxae
femur
patella
tibia
fibula
a. os coxae
b. femur
c. patella
d. fibula
e. tibia
a. iliac crestes
b. anterior superior iliac spine
c. greater trochanter
d. ischial tuberosity
e. pubic crest and symphysis
f. posterior superior iliac spine
a. iliac crest
b. iliotibial tract
c. tensor fasciae latae
d. gluteus maximus
e. ischial tuberosity
f. iliotibial tract
a. gluteus medius
b. gluteus maximus
c. iliotibial tract
a. gluteus medius
b. piriformis
c. superior gemellus
d. tendon of obturator internus
e. inferior gemellus
f. quadratus femoris
a. gluteus minimus
b. piriformis
c. superior gemellus
d. inferior gemellus
e. obturator internus
a. piriformis muscle
b. sciatic nerve
c. inferior gemellus muscle
d. quadratus femoris muscle
e. gluteus medius
tensor fascia lata
a. tensor fascia latae
b. gluteus minimus
c. gluteus medius
d. quadratus femoris
e. gluteus maximus
f. piriformis
g. superior and inferior gemelli
h. obturator internus
i. obturator externus
what contributes to lateral rotation of the thigh
quadratus femoris
gluteus maximus
piriformis
superior and inferior gemelli
obturator internus
obturator externus
(sartorius)
what contributes to medial rotation of the thigh
gluteus medius
gluteus minimus
tensor fasciae latae
(pectineus)
a. inferior gluteal nerve and vessels
b. supeiror gluteal nerve and vessels
c. sciatic nerve
Trendelenberg Test
what does the Trendelenberg Test try to show
paralysis of the gluteus minimus and medius
what will the trendelenberg test show
hip falls to the opposite side of paralysis
what is the action of the gluteus maximus
extends the thigh and does lateral/external thigh rotation
what innervates the gluteus maximus
inferior gluteal nerve L5-S2
where does the gluteus maximus run
off posterior superior iliac spine and down near sacrum, runs over and blends with iliotibial tract
what is the action of the gluteus medius and minimus
abducts and medially rotates thigh (when hip flexed)
what innervates the gluteus medius and minimus
superior gluteal nerve L4-S1
where is the gluteus medius? minimus?
directly underneath gluteus maximus but pokes out top, under gluteus minimus
where does the gluteus medius run
from posterior os coxae to femur
what is the shape of the piriformis
triangular shaped
what action does the piriformis do
lateral thigh rotation
what innervates the piriformis
anterior rami S1-S2
what are the roles of the superior gemellus and obturator internus
lateral rotators of thigh
what innervates the superior gemellus and obturator internus
nerve to obturator internus L5-S1
what are the roles of the inferior gemellus and quadratus femoris
lateral rotators of thigh
what innervates the inferior gemellus and quadratus femoris
nerve to quadratus femoris L5-S1
where is the tensor fascia latae and what does it tense on
anterior muscle on front of hip joint, tenses in IT band/tract
what is the fascia latae
deep CT around most of thigh muscles
how to tight IT band symptoms manifest themselves
can be at hip or condyle of femur as it crosses knee
what supplies the blood to the gluteal region
superior and inferior gluteal arteries
where should you do a gluteal intramuscular injection
upper lateral quadrant of buttock to avoid sup/inf gluteal nerves and sciatic nerves
a. iliotibial tract
b. fascia lata
what deep fascia surrounds the thigh
fascia latae and iliotibial tract/band
what compartments are formed by intermuscular septa
anterior, medial, posterior
what do muscles in the same compartment normally share
muscle action
innervation
blood supply
what is the shared action of the muscles in the anterior compartment of the thigh
flex thigh at hip, extend leg at knee
what is the innervation of the anterior thigh compartment
femoral nerve L2-L4
what is the major hip flexor muscle
iliopsoas
what innervates the iliacus
femoral nerve L2-L3
what innervates the psoas major
L1-L3 lumbar nerves
which of the quadriceps femoris muscles crosses the hip and can cause hip flexion
rectus femoris
what innervates the quadriceps femoris
femoral nerve
what are the muscles in the anterior compartment of the thigh
iliopsoas
quadriceps femoris
sartorius
(pectineus)
what muscles make up the iliopsoas
iliacus
psoas major
what muscles make up the quadriceps femoris
rectus femoris
vastus medialis
vastus lateralis
vastus intermedius
where do the four muscles of the quadriceps femoris insert
onto quadriceps tendon, which inserts on patella and then patella inserts onto tibia via patellar ligament
a. psoas major
b. iliacus
c. sartorius
d. rectus femoris
e. vastus lateralis
f. vastus medialis
g. pectineus
what is the path of the sartorius
originates at anterior superior iliac spine, crosses anterior portion of the thigh and knee, inserts at media side of tibia
what is the role of the sartorius
flexes thigh and knee and laterally rotates leg (due to crossing orientation)
why is the pectineus included in the anterior compartment muscles even though it is an ADDUCTOR and should be in the medial compartment functionally?
because it is innervated by the femoral nerve
what is the action of the pectineus
adduction of the leg
weak thigh flexor
medial rotator
what is the blood supply of the anterior compartment of the thigh
femoral artery
a. vastus intermedius
b. femoral nerve and vessels
c. sartorius
d. vastus medialis
e. rectus femoris
f. vastus lateralis
a. adductor longus
b. gracilis
what is the function of the medial compartment of the thigh
adduction of the thigh
what muscles make up the medial compartment of the thigh
gracilis
adductor longus
adductor brevis
adductor magnus
obturator externus
what is the path of gracilis
from pubic region of os coxae and inserts to tibia to the same region as sartorius
what is the action of the gracilis
adduction of leg
flexes thigh and knee
what innervates the gracilis
obturator nerve L2-L4
what innervates the adductor longus
obturator nerve
what innervates the adductor brevis
obturator nerve
what does the obturator externus do
lateral rotation of the thigh, not much adduction
what innervates the obturator externus
obturator nerve L2-L3
what do the adductor brevis and longus do
adduct the thigh
what are the two portions of the adductor magnus
adductor portion and hamstring portion
what are the funcitons of the adductor portion of the adductor magnus
adduction and flex thigh
what innervates the adductor portion of the adductor magnus
obturator nerve L2-L4
what innervates the hamstring portion of the adductor magnus
tibial nerve or sciatic before tibial branches off, from L4
what gives blood supply to the medial leg
obturator artery
what artery gives off branches to the posterior compartment but runs in the medial compartment
deep femoral artery
which adductors doesnt the obturator innervate
pectineus (femoral)
hamstring portion of adductor magnus (tibial)
what is the function of the hamstring portion of the adductor magnus
extend hip
a. adductor longus
b. adductor magnus
a. obturator externus
b. adductor brevis
c. adductor longus
d. adductor magnus
where does the hamstring portion of the adductor magnus attach?
to the adductor tubercle
a. adductor tubercle, where hamstring attaches
a. deep femoral vessels
b. adductor magnus
c. adductor brevis
d. gracilis
e. adductor longus
obturator nerve
a. semitendinosus
b. biceps femoris
c. semimembranosus
what is the functino of the posterior compartment of the thigh
extend thigh and flex leg
what are the components of the hamstrings muscles
semitendinosus
semimembranousus
biceps femoris
where is the semitendinosus muscle
medial side on top of semimembranosus but thickens near popliteal fossa
where is the semimembranosus muscle
medial side under semitendinosus, flatter and more membranous
what are the actions of the semitendinosus
thigh extension and knee flexion
what are the actions of the semimembranosus
thigh extension and knee flexion
what are the actions of the biceps femoris
thigh extension and knee flexion
what innervates semitendinosus
tibial nerve
what innervates semimembranosus
tibial nerve
what innervates the biceps femoris
long head: tibial division of sciatic nerve L5-S2
short head: common fibular division of sciatic nerve
what nerve is present in the posterior compartment of the thigh
sciatic nerve
what gives blood to the posterior compartment
perforating branches of the deep femoral artery
what are the parts of the sciatic nerve
tibial division
common fibular division
a. piriformis
b. common fibular nerve
c. common fibular nerve
d. tibial nerve
a. iliotibial band/tract
b. biceps femoris: short head
c. biceps femoris: long head
d. semitendinosus
e. semimebranosus
f. sciatic nerve
a. inguinal ligament
b. adductor longus
c. apex of femoral triangle
d. sartorius
what passes through the saphenous opening
great saphenous vein
what often protrudes through the femoral canal in a femoral hernia
small intestine
how can the femoral hernia affect the body
can interfere with venous drainage, usually doesnt fix itself
what is the femoral triangle and canal
triangular space containing femoral vessels and nerve
what is the base of the femoral triangle
inguinal ligament
what is the lateral border of the femoral triangle
sartorius
what is the medial border of the femoral triangle
adductor longus
what forms the apex of the femoral triangle
adductor longus and sartorius
what does the femoral sheath cover
all but the femoral nerve
what is a femoral hernia
herniation through the femoral canal
is femoral herniation more common in women or men
women
what is the difference between hiatal and inguinal hernias
what nerves make up the lumbar plexus
iliohypogastric nerve
ilioinguinal nerve
lateral femoral cutaneous nerve
femoral nerve
obturator nerve
lumbosacral trunk
what nerves make up the sacral plexus
superior gluteal nerve
inferior gluteal nerve
nerve to piriformis
sciatic nerve (common fibular division and tibial division)
posterior femoral cutaneous nerve
pudendal nerve
what kind of innervation supplies the leg extensors?
posterior division of anterior ramus
what kind of innervation supplies the thigh abductors
posterior division of anterior ramus
what kind of innervation supplies the leg flexors
anterior division of anterior ramus
what kind of innervation supplies the thigh adductors
anterior division of anterior ramus
a. femoral nerve
b. lateral femoral sheath
c. intermediate femoral sheath
d. medial/canal femoral sheath
femoral hernia
a. femoral nerve
b. obturator nerve
c. lumbosacral trunk
a. superior gluteal nerve
b. inferior gluteal nerve
c. sciatic nerve, top part common fibular division and bottom part tibial division
a. dorsal ramus
b. posterior division of anterior ramus
- supplies dorsal mass muscles (leg extensors, thigh abductors)
d. anterior division of anterior ramus
- supplies ventral mass muscles (leg flexors, thigh adductors)
e. ventral ramus
f. ventral root
g. spinal nerve
h. dorsal root
what provides autonomics to the lower extremities
lumbosacral plexus
what type of general nervous function does the lumbosacral plexus provide
sympathetics only= vasomotor to blood vessels and stimulation of arrector pili and sweat glands in the skin
what levels does the femoral nerve originate from
posterior divisions L2-L4
what region does the femoral nerve innervate
anterior thigh
what levels does the obturator nerve originate from
anterior divisions L2-L4
what region does the obturator nerve innervate
medial thigh
which sacral plexus nerves form the posterior divisions of the anterior rami
superior and inferior gluteal nerves
what levels does the sciatic nerve originate from
L4-S3
what does the tibial division of the sciatic nerve innervate? which division of the anterior ramus is it from
posterior thigh, anterior division
what does the common fibular division of the sciatic nerve innervate? which division of the anterior ramus is it from
mostly to lower leg and foot, posterior division
a. ventral rami
b. ventral rami
c. ventral rami
d. dorsal rami
what contributes to the cutaneous innervations of the gluteal region
posterior rami for upper inner quadrant, ventral rami for the rest
a. lateral femoral cutaneous nerve
b. cutaneous branches of femoral nerve
c. cutaneous branches of obturator nerve
d. genitofemoral nerve
what nerves innervate the anterior thigh cutaneously
genitofemoral nerve
cutaneous branches of obturator nerve
cutaneous branches of femoral nerve
lateral femoral cutaneous nerve
what does the genitofemoral nerve innervate cutaneously
cutaneous region of the upper anterior part of the thigh
what do the cutaneous branches of the obturator nerve innervate cutaneously
upper medial part of the anteiror cutaneous region of the thigh
what do the cutaneous branches of the femoral nerve innervate cutaneously
anterior and lower medial cutaneous region of the thigh
what does the lateral femoral cutaneous nerve innervate cutaneously
upper lateral region cutaneous region of the thigh
what nerves innervate the posterior thigh cutaneously
posterior femoral cutaneous nerve
cutaneous branches of obturator nerve
lateral femoral cutaneous nerve
a. cutaneous branches of obturator nerve
b. posterior femoral cutaneous nerve
c. lateral femoral cutaneous nerve
what is the main innervation of the posterior thigh?
posterior femoral cutaneous nerve