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Zumpano Gross II
NYCC Zumpano final exam lower extremity SP10, 2nd tri
Question | Answer |
---|---|
urinary system components | kidneys & bladder |
genital system components | gonads, genital ducts, external genitalia |
how many dev stages of kidney | 3 |
name 3 dev stages of kidney | PMM: pronephric, mesonephric, metanephric |
pronephric kidney means "before" kidney- what does the pronephric kidney consist of? | Pronephric duct |
Mesonephric kidney means "middle" kidney - what does the mesonephric kidney consist of? | Mesonephric tubules and Para(next to)mesoenephric duct |
Metanephric means large or "final" kidney- what does the metanephric kidney consist of? | True kidney |
The __________kidney forms and degenerates during week 4, leaving behind the _________ duct. | pronephric, pronephric |
Why does the pronephric duct stop half way down the embryo? | because there is only undifferentiated intermediate mesoderm below. |
During the degeneration of the pronephric kidney during week 4, the pronephric duct continues to form, eventually merging with the ___________ and the ________. | mesonephric duct and cloaca |
The mesonephric tubules + ___________ duct comprise the mesonephric kidney (Middle stage of development) | paramesonephric |
The _____________kidney begins to forms at the end of week 4 (end of pronephric kidney) and persists through month ___. | mesonephric is week 4 to month 2. |
mesonephric tubules form in a ________ to _________ sequence. | cranial to caudal/head to tail |
paramesonephric duct + ______________ TUBULEs = mesonephric (middle stage) kidney | mesonephric |
at what stage of kidney dev. does the cloaca fuse with the developing kidney? | meso(middle)nephric tubule + paramesonephric duct = mesonephric kidney fusing with cloaca |
When the pronephric duct (degenerating) joins the mesonephric tubules, what is formed? | mesonephric duct |
tubules first, then ________ | ducts |
terminal part of hindgut | cloaca |
mesonephric duct (pronephric duct + mesonephric tubules + paramesonephric duct) fuses with the terminal part of the hindgut/cloaca to become the | METAnephric kidney |
final development stage of kidney | METAnephric kidney |
the _______ bud forms as a diverticulum from the wall of the mesonephric duct. | uretic |
The URETIC bud forms as a diverticulum from the wall of the __________ duct. | Mesonephric |
The URETIC bud grows into the surrounding mesenchyme which induces the formation of the ___________ _____. | metanephric cap (the end cap) |
What induces the mesenchyme to form the metanephric cap? | URETIC bud growing into surrounding mesoderm |
What develops from the URETIC bud? | ureters! and collecting duct system |
What develops from the metanephric cap? | Nephrons or functional units of the kidneys (don't need this stuff til the end) |
metanephric cap = | nephrons or functional units of kidney |
URETIC bud = | ureters! and collecting duct system |
The META(final)nephric kidney begins to form during week | 5 |
METAnephric kidney has, surrounding it, the metanephric duct which persists as part of the ? | male genitalia |
In the METAnephric kidney, the ___________ begins to form from the mesonephric duct. This structure will give rise to the ureters! and collecting duct system. | URETIC bud |
In the METAnephric kidney, there is a _____________ of intermediate mesoderm which will give rise to nephrons or functional units of the kidney. | mesonephric cap |
In the METAnephric kidney, there is _________ intermediate mesoderm surrounding the mesonephric duct, which will persist as part of the male genitalia. | genital |
In the METAonephric kidney, the _________________ forms the cloaca just under/caudal to the metanephric cap of intermediate mesoderm. | urogenital sinus |
Opening of the cloaca (ya gotta have one) is called the | urogenital sinus in the metanephric kidney |
The mesonephric duct has an offshoot called the | ureteric bud! |
The ureteric bud off the mesonephric duct forms a mushroom head called the | mesonephric cap |
The ureteric bud forms the __________portion of the kidney. | collecting |
What does the ureteric bud put inside the mushroom head/METAnephric cap? | the kidney! (renal pelvis, minor and major calices, collecting ducts - all the parts of the collecting system) |
Once the collecting system is in place, formed by the ureteric bud, what does the mushroom head/METAnephric contribute to the final kidney? | The filtering unit = Bowman's capsule and Loop of Henle |
2 structures formed by the METAnephric cap/mushroom head off the uretic bud: | Filtering unit of Bowman's capsule and Loop of Henle |
components of the collecting system formed by the uretic bud off the mesonephric duct: | Collecting system is renal pelvis, major calyx, minor calyx |
Metanephric cap forms the ___________ elements. | excretory (filtering units) |
In the rush to the finish, the permanent kidneys ascend through the _____________ cavity and the ____________ kidneys begin to degenerate. | abdominal, mesonephric (like antennae off the bladder) |
As the permanent kidneys rise to their final positions under the diaphragm, the mesonephric kidneys degenerate but, above them on the same "stalk" forms the __________! | gonads |
At the end of kidney-gonad-adrenal-bladder-duct formation, where is everything in relation from diaphragm down? | adrenals, kidneys, ureters, gonads on gonadal arteries/veins, all leading to bladder. |
the bladder and urethra arise from the ____-gut. | hind |
hindgut is also known as | cloaca |
Once the mesonephric duct fuses with the cranial end of the __________, the urogenital sinus forms. | cloaca |
When does the urogenital sinus form? | When the meso(middle)nephric duct fuses with the cranial end of the cloaca |
Urogenital sinus forms from ________ endoderm of cloaca. | hindgut |
The urogenital sinus is divided in half by the ___________________ | urorectal septum |
What divides the urogenital sinus in half? | uro-rectal septum |
on one side of the uro-rectal septum is the? and on the other side is the? | urogenital membrane, anal membrane |
diverticulum of urogenital sinus that once served to collect wastes produced by the embryo and fetus before placenta evolved. | allantois |
What brings the openings of the mesonephric (middle) duct to the caudal end of the bladder??????? | EXTROPHY |
EXTROPHY | process that brings the openings of the meso(middle)nephric duct to the caudal end of the bladder |
renal agenesis | urteric bud or mesonephric cap fail to develop and shrivels up |
polycystic kidney | failure of fusion due to cysts - uteric bud is left as a blind end |
2 defects of kidney formation | renal agenesis and polycystic kidney |
defects in kidney positions are called ___________ positions (like pregnancies) | ectopic |
2 defects of kidney POSITION | pelvic kidney (doesn't ascend) and horseshoe kidney (doesn't separate from other kidney) |
pelvic kidney is a kidney ________ defect | position |
renal agenesis means | kidney fails to develop |
what brings the openings of the mesonephric duct and uretic bud down to the end of the bladder to form the trigone? | EXTROPHY |
THE PROCESS WHICH BRINGS THE MESONEPHRIC DUCTS TO THE ELVEL OF THE PELVIC URETHRA AND RESULTS IN THE URETERS OPENING INTO THE CRANIAL END OF THE BLADDER | EXTROPHY |
how do the ureters get down to the level of the pelvic urethra and finally open into the cranial end of the bladder? | EXTROPHY |
The bladder eventually looks like an urn with two handles on either side (each part of handle has a separate upper and lower portion) - this forms the | trigone and is brought about by EXTROPHY |
in males, the pelvic urethra becomes | prostatic and membranous urethra |
in males, the urogenital sinus becomes | penile urethra |
in males, the prostatic and membranous urethra developed from the | pelvic urethra |
in males, the penile urethra developed from the | urogenital sinus |
in females, like tamales, the pelvic urethra becomes | membranous urethra |
in felmales, like tamales, the urogenital sinus becomes | the vestibule of the vagina |
the hindgut is _____derm | endo |
endoderm makes the ____gut | hind |
hindgut is | endoderm |
endoderm makes the | hindgut |
in both sexes, the upper 2/3 of the rectum is derived from | endoderm (hindgut) |
in both sexes, the lower 1/3 of the rectum is derived from | ectoderm (same as skin) |
where is the transition level of upper 2/3 of rectum from endoderm vs. lower 1/3 of rectum from ectoderm? | anal columns - lower end |
Is the upper 2/3 of anus innervated differently from lower 1/3? | yes, because upper is endoderm derived and lower 1/3 is ectoderm derived like skin |
Normal development: urachus (allatois) occludes to form the | median umbilical ligament |
the median umbilical ligament is formed normally by the occluding of the | allantois/urachus |
urachus | allantois |
3 possible complications of abnormal urachus/allantois | urachal sinus, urachal diverticulum, urachal cyst |
Glut max origin | outer surface of ilium and iliac crest; dorsal surface of sacrum; lateral aspect of the coccyx and SACROTUBEROUS ligament |
Glut max insertion | iliotibial tract and gluteal tuberosity of femur |
Glut max innervation | Inferior Gluteal nerve (Fibular portion of sciatic) |
Glut max spinal levels | L5, S1, S2 |
gluteus medius origin | betwen the anterior and POSTERIOR gluteal lines |
gluteus medius insertion | lateral aspect of greater trochanter |
gluteus medius innervation | Superior gluteal n. |
gluteus medius spinal levels | L5 |
gluteus medius blood supply | Superior gluteal a. (just like s.g.n.) |
gluteus medius action | aBduction and MEDIAL rotation of the hip |
g. minimus origin | between anterior and INFERIOR gluteal lines |
g. minimus insertion | anterior aspect of greater trochanter and femuroacetabular JOINT capsule |
g. minimus innervation | Superior gluteal n. |
g. minimus spinal level | L5 |
g. minimus blood supply | Superior gluteal a. (like s.g.n.) |
g. minimus action | aBduction and medial rotation |
TFL origin | ASIS and anterior iliac crest |
TFL insertion | Iliotibial tract/band |
TFL innervation | Superior gluteal n. |
TFL spinal levels | L4,L5 |
TFL blood supply | Superior gluteal artery |
TFL action | tenses the iliotibial tract, thigh aBduction |
Piriformis origin | ventrolateral aspect sacrum |
Piriformis insertion | greater trochanter |
Piriformis innervation | N. to Piriformis (fibular portion of lumbosacral) |
Piriformis spinal level | S1 |
Piriformis blood supply | ? |
Piriformis action | laterally rotates an EXTENDED thigh, aBducts a FLEXED thigh |
Superior gemellus origin | outer surface of the ischial spine |
Super gem insertion | medial surface of greater trochanter |
Super gem innervation | n. to Obturator internus (tibial portion of plexus) |
Super gem spinal level | S1 |
Super gem blood supply | Inferior gluteal artery |
Super gem action | laterally rotates an EXTENDED thigh, aBducts a FLEXED thigh |
Obturator INternus origin | inner surface of the obturator membrane and obturator foramen |
obturator INternus insertion | medial surface of the greater trochanter |
obturator INternus innervation | n. to Obturator INternus (tibial branch of sciatic) |
obturator INternus spinal level | S1 |
obturator INternus blood supply | Obturator artery |
obturator INternus action | laterally rotates an EXTENDED thigh, aBducts a FLEXED thigh |
inferior gemellus origin | ischial tuberosity |
inferior gemellus insertion | medial surface of greater trochanter |
inferior gemellus innervation | n. to QUAD femoris |
inferior gemellus spinal levels | L5, S1 |
inferior gemellus blood supply | inferior gluteal a. |
inferior gemellus action | laterally rotates an EXTENDED thigh, aBducts a FLEXED thigh |
QUAD femoris origin | lateral border of ischial tuberosity |
QUAD femoris insertion | QUADrate tubercle and intertrochanteric crest |
QUAD femoris innervation | n. to QUAD femoris (tibial portion of sciatic n.) |
QUAD femoris spinal levels | L5, S1 |
QUAD femoris blood supply | inferior gluteal a. |
QUAD femoris action | lateral rotation only. |
which muscle performs lateral rotation only out of the post thigh muscles? | QUAD femoris |
Coccygeus origin | ischial spine and SACROSPINOUS lig. |
Coccygeus insertion | Coccyx and inferior sacrum |
Coccygeus innervation | Ventral Rami S4 and S5 (same as spinal levels) |
Coccygeus spinal levels | Ventral Rami S4 and S5 (same as innervation) |
Coccygeus blood supply | inferior gluteal artery |
Coccygeus action | Anterior pull of coccyx; Compresses pelvic OUTLET and supports pelvic viscera with Levator ani muscles |
Pubococcygeus origin | pubis and tendinous arch |
Pubococcygeus insertion | coccyx and ventral SACRO-COCCYGEAL lig. |
Pubococcygeus innervation | inferior rectal nerve |
Pubococcygeus spinal levels | S234 |
Pubococcygeus blood supply | inferior gluteal artery |
Pubococcygeus action | COMPRESSES pelvic outlet and supports pelvic viscera |
Ilio-coccygeus origin | iliac portion of tendinous arch |
Ilio-coccygeus insertion | coccyx and ANOcoccygeal lig |
Ilio-coccygeus innervation | inferior rectal nerve and S4 ventral ramus (different from pubococcygeus because Ilio includes S4 ventral ramus as well as inferior rectal n.) |
Ilio-coccygeus spinal levels | S234 |
Ilio-coccygeus blood supply | inferior gluteal artery (same as pubococcygeus and coccygeus) |
Ilio-coccygeus action | COMPRESSES pelvic outlet and supports pelvic viscera |
Name 3 lower back disorders with lower extremity referral: | 1-Herniated disc (HNP), 2-Facet syndrome, 3-Dysfunction/subluxation |
Dysfunction of the lower back may also be referred to as | subluxation |
herniated disc of the lower back may also be referred to as | HNP |
what syndrome of the joints may be associated with the lower back and lower extremity referral | facet syndrome |
Link between the axial skeleton and the pelvic girdle | SI joint |
The SI joint is the link between what two skeletal systems? | axial and pelvic |
Where is the bone to bone contact or JOINT SURFACE of the SI? | between the ilium and sacral AURICULAR surfaces (ear-shaped articular surfaces) |
The Sacroiliac joint is classified as primarily a ____________, but the internal joint may show synovial characteristics. | syndesmosis (immovable) |
What is the debate about the synovium of the SI joint? | As to whether it is a true synovial joint or has just become movable as a pseudoarthrosis |
Name the 3 SI ligaments: | Anterior Sacroiliac ligament, Posterior sacroiliac ligament, Interosseous sacroiliac ligament |
Describe the locations of the 3 SI ligaments, according to the Functional Anatomy of the Limbs and Back pg 249, fig 15-14 | Horizontal slice through SI: anterior SI lig is tiny, in front of the joint cavity (surrounded by articular cartilage). The Interosseous lig is between the joint cavity and anterior lig. The Posterior SI lig connects the PSIS to the sacral base and down. |
Which of the SI ligaments has both long and short fibers? | the Posterior sacroiliac ligament (has a lot more ground to cover) |
2 related ligaments to the Anterior, Interosseous, and Posterior sacroiliac ligaments: | sacrotuberous and sacrospinous ligament |
Which is more superficial posteriorly: sacrotuberous or sacrospinous ligament? | sacrotuberous ligament |
The _____________ligament converts the greater sciatic notch into a greater sciatic foramen. | Sacrospinous |
What does the sacrospinous ligament do to the greater sciatic notch? | converts it into a greater sciatic foramen |
The _________ ligament forms a lower boundary for the lesser sciatic notch, converting this notch into the lesser sciatic foramen. | SacroTUBEROUS |
Which ligament forms the lesser sciatic foramen via its attachment to the lesser sciatic notch? | SacroTUBEROUS |
Sacroiliac syndrome | ? |
what is the articulation between the femur and os coxae called? | Acetabulofemoral articulation |
4 bones of the acetabulofemoral articulation | ilium, pubis, ischium, femur |
Where do the 3 pelvic bones ossify and when? | in the acetabulum at the age of 16 (called Os coxae) |
The fusion of the os coxae combined with the head of the femur forms a spheroidal shaped ___________ joint. | Synovial! |
How many degrees of freedom for the acetabulofemoral joint? | 3 |
Fractures of the "hip" | ? |
What surrounds the acetabulo-femoral joint? | Capsular ligament |
What lies just inside the capsular ligament of the AF joint? | Acetabular LABRUM |
where is the acetabular labrum in relation to the ligamentum teres? | No where. It stops in a half-moon shape, with its free edges on either side of the Ligamentum Teres of the Femur |
Where is the acetabular labrum in relation to the capsular ligament? | Inside it, forming a half moon until it reaches the ligamentum teres of the femur. |
What is the acetabular labrum? | a fibrocartilaginous mass that makes the acetabulum deeper as a cavity |
Where does the Ligamentum Teres of the Femur attach to the femur? | fovea capitis |
What bridges the gap of the open U-shape of the acetabular labrum, and on which the Ligamentum Teres of the femur rests? | Transverse acetabular ligament (traverses the acetabulum) |
There is a ligament from each bone of the os coxae to the femur in the posterior, and a ligament from 2 of the bones in the anterior. Name the five ligaments: | Posterior: Iliofemoral, Ischiofemoral, Pubofemoral ligaments...Anterior: Iliofemoral & Pubofemoral ligaments |
What ligament of the hip joint is not visible from the front? | Ischiofemoral ligament |
The smooth articular surface of the head of the femur occupies more than a hemisphere and ends at a neck, but it is interrupted at one point by a pit, or fovea, into which the _________________ __________ attaches. | Ligamentum Teres of the Femur |
The tightening of _____________ ligament during extension helps to make the extended position of the acetabulofemoral joint the most stable one. | Ischiofemoral (at the ischial rim of the acetabulum and covering the lower, posterior aspect of the joint) |
What is the common action of the Iliofemoral, Ischiofemoral, and Pubofemoral ligaments? | Tend to limit medial rotation of the femur, inasumuch as this movement would increase their spiral. Lateral rotation tends to unwind their spiral and is checked entirely by muscles. |
dislocations of the hip are either: | acquired or transitory, correlated to Lig Teres of Femur |
DJD | degenerative joint disease, correlated to LTF |
Hip Pointer | ?correlated to LTF |
charlie horse | ?correlated to LTF |
the patella is a _________ of the quadriceps tendon | sesamoid |
Where does the patella ride? | patellar groove of distal femur |
The patella forms a __________________ joint. | planar synovial joint |
What kind of joint does the patella form in the quadriceps tendon? | planar synovial joint |
location of patellar ligament (vs tendon) | portion of the quadriceps tendon between the patella and tibial tuberosity |
patello-femoral anthrolign | ? correlated to the patellofemoral joint |
chondromalacia patella | ? correlated to the patellofemoral joint |
Iliotibial band syndrome | ? correlated to the patellofemoral joint |
Where are the patellar bursae and how many? | 3: at quad tendon, on surface of ligament, under patella. Suprapatellar, Infrapatellar, and one in the ligament itself. |
What is one of the most mechanically complicated joints in the body? | tibio-femoral joint |
What bones comprise the knee? | Femur and Tibia |
The knee is made up of two _________ joints (bone surfaces) | condylar |
The two condylar joints of the knee each allow 2 degrees of motion: | flexion/extension & anterior/posterior gliding |
Together, the knee joint complex allows __ degrees of motion. | 3 |
What are the 3 degrees of motion of the entirely assembled knee? | F/E, A-P glide, Rotation! |
which of the 3 motions allows the knee to "lock" into extended posture? | A-P glide and Rotation! |
IVD is made of | fibrocartilage |
IVD forms an | amphyarthrosis |
ALL is _______ at the top, _______ at the bottom. | ALL: thin up top, thick down below |
Posterior Longitudinal Ligament is thick where? thin where? | thick up top, thin below |
What ligaments in lumbosacrum? | ALL, PLL, Ligamentum Flavum, Supraspinous ligament, Interspinous ligament, ILIOlumbar ligament |
function of ALL? | prevents hyperextension of vertebral column |
function of PLL? | prevents hyperflexion of vertebral column |
Radicular pain is pain on the | nerve root |
radicular pain is pain on the nerve root. What are symptoms? | pain, numbness, dermatomal distribution of symptoms |
sequestered disc | piece of nucleus breaks off |
contained HNP | bulge or protrusion |
uncontained HNP | rupture of annulus fibrosis and leaking of nucleus pulposis |
uncontained HNP is also referred to as | an extrusion |
facet syndrome can result from | overexertion, rotational stress involving 2 joints |
facet syndrome presents with | pain on one side, one region but LBP will be greater than assoc. leg pain |
is referred pain dermatomal? | no |
referred pain is not dermatomal. What kind of pain is dermatomal? | radicular pain (nerve pathway) |
sacroiliac syndrome | caused by trauma, pregnancy. Starts deep and dull over PSIS. Traditional side posture adjusting works. |
where does pain from SI syndrome start? | PSIS |
When Ca++ is leached from the bone in postmenopausal women, what occurs? | drop in bone density then fracture |
Where are common fractures of the hip? | neck of femur, intertrochanteric line, intertrochanteric crest |
what kind of cartilage surrounds an articulating surface of bone? | hyaline cartilage |
the acetabular labrum is made of | fibrocartilage, like an IVD |
Hip joint ligaments are for the 3 's': | strength, support, stability |
prevents hyperextension of the hip joint | ilio-femoral ligament |
prevents hyperflexion of the hip joint | ischio-femoral ligament |
prevents hyperaBduction of the hip joint | pubo-femoral ligament |
only cause of dislocation to iliofemoral ligament (the one which prevents hip extension)? | heavy trauma |
what structure supplies blood to the head of the femur? | ligamentum teres of the femur |
supplies blood to head of femur | ligamentum teres of femur |
acquired dislocation of the hip | stays out, no arterial tear |
transitory dislocation of the hip | fast and tearing with damage |
hip pointer is a contusion to the | ASIS |
hip pointer is a contusion (blow) to the ASIS and is common in sports as an | avulsion fracture |
with this hip injury, blood may pool and there may be a bone formation in the quadriceps | Charlie horse |
90% of knee pain is from | living |
tendons attach | muscle to bone |
ligaments attach | bone to bone |
patello-femoral anthrolign develops | over time |
where does chondromalacia patella develop? | medial knee |
patello-femoral arthralgia with softening and erosion of the articular cartilage in the medial knee (weak vastus medialis) are signs of | Chondromalacia Patella |
bad medial knee cartilage that gets soft and weak is condition called | chondro-malalacia patella (bad medial knee cartilage) |
friction over the lateral epicondyle of femur usually in runners results in | Iliotibial band/tract syndrome |
function of patellar bursae | assist with smooth motion/gliding |
what two actions of the 3 degrees of freedom (flex/extend, rotation, A-P gliding) allow the knee to "lock" into extended posture? | rotation and A-P gliding |
sprains are _____________ in nature, while strains are __________ in nature. | sprain=ligamentous (you strain a muscle) |
5 external knee ligaments | articular capsule (coronary ligament), oblique popliteal ligament, arcuate popliteal ligament, tibial/medial collateral ligament, fibular/lateral collateral ligament |
5 internal knee ligaments | Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial meniscus, Lateral meniscus, Transverse ligament of the knee |
function of transverse ligament of the knee | holds menisci together |
when identifying PCL vs. ACL on knee from anterior, what do you look for on the cadaver? | the point of origin tells you which one it is |
On the surface of the posterior knee, what 3 ligaments can you see? | Oblique popliteal under the semimembranosus tendon, Arcuate popliteal from the lateral side and the Articular capsule on superior and inferior surfaces |
which ligament is just under the semimembranosus tendon on the medial knee? | Oblique popliteal ligament |
function of oblique and arcuate popliteal ligaments? | straighten articular capsule |
which ligaments straighten the articular capsule | oblique popliteal ligament and arcuate popliteal ligament (they make an "X" on the posterior surface) |
Tibial/medial collateral and Fibular/lateral collateral ligaments, along with the posterior cruciate ligament, and medial meniscus provide | structural stability for the knee |
prevents varus stress from the lateral epicondlyle of femur to the head of the fibula | fibular/lateral collateral ligament |
why wouldn't the medial/tibial collateral ligament prevent varus stress from the lat epicondyle of the femur to the fibula? | because it's not on the fibular side, fool |
the ligament which begins on the posterior tibial plateau and extends forward to the inside aspect of the medial femoral epicondyle | posterior cruciate ligament (inside) |
which ligament opposes the function of the anterior cruciate ligament? | the posterior cruciate ligament! |
ligament which begins on the anterior tibial plateau and stretches backwards tothe inside aspect of the lateral epicondyle of femur | anterior cruciate ligament |
function of anterior cruciate ligament | prevents posterior translation of femur on the tibia |
which ligament prevents anterior translation of the femoral condyles on the tibal plateau? | the Posterior cruciate ligament |
what kind of stresses injure medial and lateral menisci? | rotational stresses |
what are menisci injuries? | torn cartilage tears |
which meniscus is usually injured in the knee | medial |
severance of ligament is a _______ degree injury | 3rd |
severance of ligament is a 3rd degree injury and may involve the | 3 cruciate, 1 collateral, 2 cartilage |
when a ligament is torn but still intact, and moderate pain involving other tissues may be present, what degree injury? | 2nd |
ligament degree of injury with no long term disability, mild pain | 1st degree |
what are ligamentous injuries (sprains) based on? | amount of fibers torn |
terrible triad of | O'Donoghue |
joint of tibia and fibula that is synovial, usually planar but may be trochoid or sellar: | Superior Tibiofibular joint |
joint of tibia and fibula which is a syndesmosis, formed by the interosseous memebrane | Middle tibiofibular joint |
joint of the tibia and fibula which is a syndesmosis, formed by the anterior and posterior tibiofibular ligaments, and may have a small synovial compartment from the toalocurual joint | Distal tibiofibular joint |
muscles involved in shin splints | Tibialis anterior and soleus |
What type of joint is the Superior tibiofibular joint? | synovial (then planar, trochoid or sellar but at the very least, it is synovial) |
does the fibula bear weight? | little |
lateral head of gastrocnemius, fibular collateral ligament, popliteus and the articular capsule are all convergent at the | superior tibiofibular joint |
the posterior tibiofibular ligament, the lateral malleolus, the tendo calcaneus (Achilles)are all present at the | distal tibiofibular joint |
2 types of tibial fractures: | boot top and Potts |
boot top fracture | like a ski boot hitting the tibia |
Potts fracture of tibia | evulsion fracture of tibia and fragments |
most common long bone fractured with compound injuries | TIBIA |
synovial hinge joint made up of three bones: tibia, fibula, talus | Talocrural joint (ankle joint) |
the _____ of the talus is wedge shaped, meaning? | trochlea, wider anteriorly than posteriorly |
why does the talus push the fibula and tibia away from one another during dorsiflexion? | because it is wedge-shaped at the trochlea, being wider in the anterior part |
Which joint resists the natural wedging apart of the tibia and fibula by the talus when dorsiflexing the ankle? | Tibiofibular joint (assume he means distal) |
The medial collateral ligament of the ankle (talocrural joint) is also called the | Deltoid ligament |
how many parts to the deltoid (medial collateral) ligament of the ankle? | 4: anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar ligaments |
what bones are connected by the deltoid ligament (medial collateral) of the ankle? | tibia to the navicular, calcaneus, and the talus on both anterior and posterior, hence all the tibio-______ names |
Name the 3 lateral collateral ligaments of the ankle: | Anterior TaloFibular, Posterior TaloFibular, CalcaneoFibular ligaments |
which is injured more often, the medial (deltoid) collateral or lateral collateral ligament of the ankle? | lateral |
what bone is involved in every connection of the weaker lateral collateral ligament of the ankle? | fibula |
the fibula connects to 2 bones as 3 ligaments in the lateral collateral ligament of the ankle: | talus (Talo-) and the calcaneus (Calcaneo-) |
most frequently injured major joint in the body | ankle (talocrural) joint |
what ligaments are most commonly injured in the body? | the Anterior TaloFibular ligament and the CalcaneoFibular ligament of the lateral collateral ligament of the ankle (inversion sprain) |
tarsometatarsal foot joints are | plane synovial |
metatarso-phalangeal foot joints are | ellipsoid synovial |
interphalangeal foot joints are | ginglymus synovial |
are all the foot joints synovial? | yes, all three |
3 ligaments you can see on the plantar surface of the foot | It's going to be a long or a short spring. (Long plantar, Short plantar, Spring Plantar) |
What tendon can be seen with the "It's going to be a Long or a Short Spring" ligaments along the arch of the foot? | Tendon of Fibularis (peroneus) Longus |
What provides the ligamentous support of the medial longitudinal arch of the foot? | It's going to be a Long or a Short Spring: Long plantar lig, Short plantar lig, and the Spring plantar ligament of the medial longitudinal arch |
the ___________ develops into the ovaries and the medulla degenerates during female differentiation of the gonads | CORTEX becomes ovaries |
Within the Cortex of the female, the cords proliferate and form primordial ____________ | follicles |
The primordial follicles of the cortex in the female incorporate the primary | germ cells |
What develops within the follicles? | OOGONIA |
In males, cortical cells degenerate and the __________ differentiates into the sperm producing system. | Medulla (just like in females) |
What tubes link with the mesonephric tubules to form the mesonephric duct? | Seminiferous tubules (sperm has gotta get out somehow!) |
Where do germ cells form spermatoogonia in males? | In the seminiferous tubules that connected to the mesonephric tubules and made the mesonephric duct. |
the development of genital ducts involves 2 sets: | mesonephric and paramesonephric ducts |
mesonephric ducts are connected to the | bladder |
paramesonephric ducts form lateral to the | mesonephric ducts |
cranial ends of the ____________ ducts open into the pelvic cavity | paramesonephric |
Caudal ends of the paramesonephric ducts grow towards the | urogenital sinus |
The paramesonephric ducts cross over the mesonephrics as they grow caudally towards the ______________ | urogenital sinus (tail) |
Paramesonephric ducts cross over the mesonephrics and grow towards the posterior wall of the urogenital sinus. This causes the sinus to swell and form the | genital tubercle |
What causes the swelling of the genital tubercle? | the paramesonephric ducts crossing the mesonephrics on their way to the posterior wall of the urogenital sinus |
The ductus deferens, epididymis, seminal vesicles and seminiferous tubles develop from the | PARAmesonephric ducts and tubules in males |
the prostate and pelvic urethra develop in part from the | UROGENITAL sinus (endoderm) and MESODERM |
the urogenital sinus is derived from ____________ | endoderm |
what develops from the urogenital sinus (endoderm) and mesoderm? | prostate and urethra |
where does the femal genital tract come from? | Mars. No, the paramesonephric ducts. (In males, the mesonephrics do this) |
The cranial ends of the paramesonephrics in females open over the _________ | ovaries (head is ovaries) |
The caudal/dorsal ends of the paramesonephric ducts in females do what? | FUSE together to form the utero-vaginal canal and give rise to the glands of the uterus, upper 2/3 of vagina, and epithelial lining of the uterus. |
What gives rise to the glands, epithelial lining and upper 2/3 of the vagina? | paramesonephric fusion |
The upper 2/3 of the vagina is derived from paramesonephric fusion (mesoderm is in the word!), but what is the lower 1/3 derived from? | Endoderm (hindgut) |
Mesoderm folds form __________ swellings around the cloacal membrane | cloacal=mesoderm |
What divides the urogenital sinus from the anal sinus? | Urorectal septum (very important;-) |
forms the glans | genital tubercle |
forms the shaft of penis | urethral folds |
urethral folds form the shaft of the penis by | fusing along the midline |
what forms the penile urethra | urethral folds fusing along the midline |
what forms the scrotum | genital/labioscrotal swellings |
What forms the clitoris | genital tubercle (like the glans penis) |
What forms the labia minora | urethral folds (like the shaft of penis) |
What forms the labia majora | genital/labioscrotal swellings (like the scrotum) |
gonadal vessels, common iliacs, urinary bladder, rectum, ureters, kidneys suprarenals, renal vessels, abdominal aorta, and inferior vena cava are all structures of the | posterior abdominal wall |
what 3 things define the bones of the posterior abdominal wall | Lumbar vertebrae, wing of the ilium, sacrum |
Lumbar vertebrae, sacrum, and ____________ define the posterior abdominal bony structures. | wing of the ilium |
forms the iliopsoas tendon and is a primary hip __________. | Psoas, Iliacus, flexor |
The psoas minor (present in ~30%) has no role in the lower extremity but assists | psoas major |
Forms a major portion of the posterior abdominal wall, blending with Iliolumbar ligaments from L4,L5 then coming over to iliac crest. Is giving you the dickens right now. | Quadratus Lumborum |
4 muscles of post ab wall | QL, psoas major, psoas minor (if present), Iliacus |
pain generator for LBP | QL |
Which muscle may create a large intersection of fibrous adhesions to QL and must be separated? | Psoas mjr. |
Lower extremity moving muscles of the post ab wall | psoas major and iliacus (minor assists if present) |
What flares out as lateral layers, becoming continuous with the abdominal muscles and making core training a must to prevent LBP? | thoracolumbar fascia |
altered shoulder position can relate to LBP. It is a ________ ____________ _________ from upper to lower extremity. | closed kinetic chain |
Is the QL incorporated into the thoracolumbar fascia? | yes |
2 layers of thoracolumbar fascia | lateral external and deep/posterior layer |
how does psoas major help maintain stabilization of head and trunk? | attaches to vertebral discs |
psoas major can cause an aching back due to its attachment at the IVD's and if it is | hypertonic |
which nerve can become entrapped through psoas major? | Obturator n. |
the Obturator n. can become entrapped through the | psoas major |
The femoral nerve is postioned ____________ to psoas major and exits the pelvis ____________ the inguinal ligament. | lateral, under |
what 3 abdominal nerves will be pinned only in the pelvis for the id test? | obturator, lateral femoral cutaneous, femoral |
L1 ventral ramus which supplies the skin in the suprapubic region | Iliohypogastric |
L1 ventral ramus which innervates the skin along the proximomedial thigh, root of penis, upper scrotum or mons pubis and labia majora | Ilioinguinal |
L1-L2 nerve which supplies the cremaster and scrotal skin | genital branch of genitofemoral nerve |
L1-L2 nerve which supplies the skin over the femoral triangle | femoral branch of genitofemoral nerve |
the subcostal n. is really a thoracic nerve passing under the ___________________ of the diaphragm | lateral arcuate ligament |
how does the psoas major pass through the diaphragm? | medial arcuate ligament |
nerve of T12 which passes under the lateral arcuate ligament of the diaphragm and supplies the skin over the anterior gluteal region and greater trochanter | Subcostal n. (T12) |
L2-L3 nerve that runs over the iliacus muscle to supply the skin over the lateral thigh | Lateral Femoral Cutaneous n. |
what n. supplies the genital area? | genital branch of genitofemoral n. |
what n. supplies the femoral triangle area? | femoral branch of genitofemoral n. |
syndrome of compression of Lateral Femoral Cutaneous n. just below the ASIS, from things like heavy police belts, etc. | Meralgia paresthesia |
can SI pain refer to the lateral thigh? | yes via gluteus medius and piriformis |
why do all the dermatomes curve in and downward? | due to the 180degree rotation of the lower extremities in the fetus |
will radicular pain shoot down thigh? | no, that's referred |
Straight pain means | crossing multiple dermatomes |
spiral pain means | following a dermatome (indicates disc) |
subcostal nerve supplies the skin around where a parachute harness would set in the front | anterior gluteal and greater trochanter (front underwear line, right under the inguinal ligament) |
supplies skin right above the underwear line, above the genitals where some people should shave | iliohypogastric |
supplies the skin of the gentials and medial upper thigh under the scrotum | ilioinguinal |
supplies femoral triangle (where your forearms sit when you rest them on your legs and lean forward like watching a game) | femoral branch of genitofemoral but L1, L2 is the forearm resting place |
supplies the inside knee just above the adductor tubercle | Obturator n. (L2,L3,L4 spinal levels but L3 dermatome) |
Which dermatome is just above the knee and drops medial then straight down like a ribbon crossing the patella | L4 |
emerges from MEDIAL border of psoas mjr. Innervates adductors of the thigh (ad longus and brevis sandwich) and a patch of skin just above the knee (adductor hiatus area) | Obturator n. |
Obturator n. spinal levels | L2, L3, L4 |
emerges from the LATERAL border of psoas major and separates into several anterior femoral cutaneous branches and saphenous n. either before or after it passes under the inguinal ligament | Femoral n. |
spinal levels of femoral n. | L2, L3, L4 (same as obturator) |
supplies knee extensors and thigh flexors | Femoral n. |
what nerve supplies knee extensors (quads) and thigh flexors (iliopsoas)? | Femoral n. |
emerges from lateral border of psoas major and branches into several anterior femoral cutaneous n. and saphenous n. | Femoral n. |
supplies knee extensors and thigh flexors | Femoral n. |
gives off saphenous n. | Femoral n. |
L2, L3, L4 spinal levels | Femoral and Obturator n. |
What leads to the lumbosacral plexus of nerves? | Lumbosacral trunk |
what nerves comprise the lumbosacral trunk? | L4, L5 |
Name lumbar and sacral divisions from T12 to S4 as either trunks or plexuses? | Lumbar plexus (T12-L4), Lumbosacral trunk (L4, L5), Lumbosacral Plexus (inferior half of L4, L5 through S4) |
what separates the pelvis from the thigh | inguinal ligament |
lumbosacral trunk (L4,L5) sits directly on top of the | anterior sacroiliac ligament and lumbar sympathetic ganglia. Ergo, both can be impacted by HVLA side posture adjustments to alleviate compression |
the Obturator splits into an anterior and posterior branch around the | Obturator externus muscle |
what merges with communicating branches of the femoral n. to form the subsartorial plexus, supplying a small patch of skin on the medial thigh (subsartorially, I'm guessing) | Anterior branch of Obturator n. |
subsartorial complex comprised of | femoral n. branches and ANTERIOR branch of OBTURATOR n. after it pops through ABOVE obturator externus |
Looking at the Obturator Externus muscle, how would you distinguish the anterior from posterior branches, based on their exits? | anterior emerges from above the muscle, while posterior emerges through the middle of it |
emerges from the middle of obturator externus. Supplies 2 muscles in the adductor compartment of the thigh and will terminate at the joint capsule of the knee, supplying it | posterior branch of obturator n. |
supplies joint capsule of knee | Posterior branch of obturator n. |
supplies aDductor longus, aDductor brevis and the joint capsule of the knee | Posterior branch of obturator n. |
what spinal nerves contain the axons for preganglionic sympathetic neurons that leave the spinal cord via the ventral roots, via the WHITE COMMUNICATING BRANCHES in the region? | T1-L2 |
what spinal levels supply the sympathetic trunk (thoracolumbar) division of the ANS? | T1-L2 |
contain the axons for pregang sympathetics from T1-L2 | white communicating branches |
pass from paravertebral ganglion to adjacent ventral rami | gray rami communicans |
gray rami communicans go from _______________ to adjacent ventral rami | gray rami communicans (just remember "rami" is in the name and it's the target, too) |
When the thoracic sympathetic trunk passes under the ___________ ligament, it becomes the lumbar sympathetic trunk. | medial arcuate ligament |
what passes through the medial arcuate ligament with the lumbar sympathetic trunk? | Psoas major! |
what passes through the lateral arcuate ligament? | Quadratus lumborum |
the obturator externus remains fixed in place while the obturator internus runs out to the | greater trochanter |
the nerves of the lumbosacral plexus all exit through the | greater sciatic foramen |
what nerves form the lumbosacral plexus | L4, L5, S1-S4 |
obturator foramen is covered by the | obturator externus |
what two ligaments create the greater and lesser sciatic foramen | inside: sacrospinous, outside: sacrotuberous |
what 2 muscles create the pelvic diaphragm? | coccygeus and levator ani (pubococcygeus, iliococcygeus, ischiococcygeus) |
describe the nerves of the lumbosacral lexus with mixed anterior and posterior divisions | the sciatic (L4-S3) divided into tibial and common fibular divisions, with the anterior divisions from tibial half and the posterior divisions are from common fibular half |
nerve that exits the greater sciatic foramen, emerges from the inferior border of piriformis and runs to the popliteal fossa where it branches into the tibial and common fibular nerves. | sciatic (L4-S3) |
sciatic spinal levels | L4-S3 |
which nerve contains both anterior and posterior divisions of the lumbosacral plexus besides the sciatic? | the PFC! Posterior Femoral Cutaneous from S1,S2 posterior Fibular and S2,S3 anterior Tibial |
S1-S3 nerve exiting via greater sciatic foramen and running deep to gluteus maximus, emerging from its inferior border | PFC |
since the Posterior Femoral Cutaneous nerve emerges out of the gr. sciatic foramen and from under the gluteus max, it runs alongside the sciatic, innervating the posterior thigh. Dermatome level of PFC? | S2 |
the PFC is half anterior tibial and half posterior fibular (S1-S3) so it's easy to remember its dermatome is 2-faced... | S2 |
the little patch of skin over the obturator n. patch is innervated by | anterior femoral cutaneous n. |
the side of your leg is innervated by | lateral femoral cutaneous n. (L3) |
hands on your hips area innervated by | subcostal n. (L1) |
the back of your thigh is innervated by | PFC (S2) |
the bullseye target of your arse is innervated by | S3 |
enters via greater sciatic foramen and innervates hip joint, inferior gemellus and quadratus femoris | N. to Quadratus Femoris (L4-S1) |
n. to Quadratus Femoris comes off the anterior division of the lumbosacral plexus (tibial) and innervates the | hip joint, inferior gemellus, quadratus femoris |
exits the greater sciatic foramen then re-enters the pelvis via the lesser sciatic foramen | n. to obturator internus |
innervates superior gemellus and obturator internus | n. to obturator internus (L5-S2) |
exits via greater sciatic foramen then re-enters the pelvis via the lesser sciatic foramen and innervates most of the perineum | Pudendal nerve (S2-S4) |
prolonged sitting like horseback riding, rowing, studying can lead to incontinence and sex dysfunction. This is due to loss of motor nuclei to muscles innervated by the | Pudendal nerve (S2-S4) |
Anterior tibial lumbosacral nerves: | Nerve to Quadratus Femoris, N. to Obturator Internus, 1/2 of PFC, Pudendal n. Coccygeus, Levator ANI |
everything outside of the pelvis is called | perineum |
nerves of the posterior lumbosacral divisions (common fibular) are | superior gluteal, inferior gluteal, n. to piriformis, common fibular, 1/2 PFC, perforating cutaneous |
exits via the greater sciatic foramen and emerges along the superior border of piriformis, innervating gluteus medius, gluteus minimus, and TFL | Superior gluteal n. (L4-S1) |
exits via greater sciatic foramen and emerges along the inferior border of piriformis, innervating gluteus maximus | Inferior Gluteal n. (L5-S2) |
exits via greater sciatic foramen and innervates the piriformis | n. to Piriformis (S1 sometimes with S2) |
passes through sacrotuberous ligament | Perforating cutaneous (L5-S2) |
posterior divisions of lumbosacral plexus - what muscles separates superior and inferior gluteal nerves? | Nerve to Piriformis |
Where is the N. to Piriformis in relationship to its muscle? | underneath it |
describe the deep gluteal region, from bottom to top | Lift away gluteus max: branches of pudendal, sacrotuberous ligament with perforating cutaneous n. through it, Pudendal n., Nerve to Obturator Internus, PFC, Sciatic, Inferior Gluteal nerve and artery, Piriformis muscle, Superior Gluteal nerve and artery |
pudendal means | perineum |
cluneal means | buttocks |
transition between back and lower extremities | buttocks |
upper and middle cluneal (buttocks) come from ______ rami | dorsal |
lower cluneal (buttocks) come from _____ rami | ventral (we're going in and under, men, so ventral rami for the lowest cluneal makes sense) |
Superior Cluneal n. comes from lateral cutaneous branches of dorsal rami _______ | L1-L4 |
Superior cluneal n. | lateral cutaneous branches dorsal rami L1-L4 |
Middle cluneal n. comes from lateral cutaneous branches of dorsal rami _______ | S1-S3 |
Middle cluneal n. | lateral cutaneous branches dorsal rami S1-S3 |
Lower cluneal n. comes from ventral rami _______ | S1-S3 |
Lower cluneal n. | branches of VENTRAL rami S1-S3 |
each innominate bone is comprised of | ilium, ischium, pubis |
which bone has nothing to do with the obturator foramen? | ilium |
the pelvic brim is what 2 lines? | arcuate and pectineal lines |
attachement of quadratus lumborum to the pelvis | iliolumbar ligament |
where does the QL attach to the pelvis | iliolumbar ligament |
what ligament can be torn in a hernia | lacunar |
what ligament is on the pectineal line? | pectineal ligament |
ligament hidden by sacrotuberous ligament | sacrospinous |
posterior sacroiliac ligament blends with | sacrotuberous ligament |
sacrotuberous ligament blends with | posterior sacroiliac ligament |
sacrotuberous ligament hides (3) | pudendal V.A.N. and the Nerve to Obturator Internus |
pudendal VAN and nerve to obturator internus are hidden by what ligament? | sacrotuberous |
what ligament is at the top of the pubic symphysis | Superior pubic ligament |
where is the superior pubic ligament | at the top of pubic symphysis |
what ligament is at the bottom of the pubic symphysis? | arcuate ligament (over the arc of the pelvis!) |
what muscle bends backwards at 90 degrees through the lesser sciatic notch to attach to the greater trochanter? | obturator internus |
from whence doth the obturator internus arrive and to where doth it attach? | Obturator Internus ariseth from the pelvic aspect of the obturator membrane (in foramen) and attacheth on the medial surface of the greater trochanter of femur (remembereth: O.I. separates the inferior and superior gemelli brothers) |
what is the name of the insertion site for obturator internus on the greater trochanter? | just the medial surface of the trochanter of femur |
what represents the division between the true and false pelvi? | pelvic brim |
iliopectineal line/linea terminalis, sacral promontory, ala of ilium, and pubic symphysis make up the (2) | arcuate line and pectineal line (ie, the pelvic brim) |
the pelvic outlet stretches from | pubic symphysis to coccyx |
false pelvis is | ala of ilium above linea terminalis and contains the abdominal viscera |
bounded by the pelvic inlet and pelvic outlet | true pelvis |
demarcation of pelvic inlet | linea terminalis |
bounded posteriorly by the sacrum and coccyx and anteriorly by pubic symphysis | pelvic outlet |
contains the rectum, urinary bladder and reproductive organs. In females, must also allow passage of fetal head. | pelvic outlet |
what structure allows us to breathe by providing resistance to pushing down of organs by diaphragm when respiring? | pelvic diaphragm! |
by attaching to pubic bone, ilium and ischium, the _________________ attaches a muscle to each plane. | pelvic diaphragm |
pelvic diaphragm muscles: | levator ani and coccygeus (ischiococcygeus) |
Both men and women have what pelvic muscles? | Coccygeus (ischiococcygeus) and Levator Ani muscles (Pubococcygeus, Iliococcygeus and puborectalis) |
What muscle of the Levator Ani (Iliococcygeus and Pubococcygeus) is different between men and women? | Both have subcategory of pubococcygeus called puborectalis, but men have Levator Prostatae and women have Sphincter Vaginae |
The levator ani and coccygeus (ischio) form the pelvic diaphragm. What forms the lateral walls? | Obturator internus and Piriformis |
sometimes considered part of pubococcygeus (2) | puborectalis and pubovaginalis/spinchter vaginae +/- levator prostatae |
pubococcygeus has 3 parts when considered to incorporate | levator prostratae or pubovaginalis, puborectalis, and pubococcygeus proprius (proper) |
list parts of levator ani and pelvic muscles from sacrum to pubic symph looking down/birds'eye view | sacrum, piriformis, Coccygeus (ischio-), Obturator Internus above Tendinous arch, Iliococcygeus, Pubococcygeus (puborectalis, levator prostatae/pubovaginalis) |
what is line for top of the bowl looking down into the pelvic diaphragm | linea terminalis |
In the pin test cadaver id, how will you identify the pelvic diaphragm muscles? | as either Coccygeus or Levator Ani |
where is pubovaginalis/levator prostatae always located in relation to puborectalis? | most anteriorly |
thickening that divides pelvic diaphragm from lateral wall muscles | Tendinous Arch |
what muscles compresses the pelvic outlet, supports the pelvic viscera with levator ani and prevents PELVIC PROLAPSE | Coccygeus! |
Coccygeus is innervated by ventral rami of S4 and S5 while Pubococcygeus (levator ani portion anteriorly) is innervated by the | inferior rectal nerve |
Pubococcygeus is innervated by the inferior rectal nerve, while coccygeus is innervated by the ventral rami of S4 and S5. What is the innervation for the middle guy, iliococcygeus? | a combination! Inferior rectal nerve and S4 Ventral Rami |
vertebral level of abdominal aorta bifurcation | L4 |
The ______ iliac is over the pelvic brim and the ________ iliac is running from the false pelvis to the inguinal ligament | internal, external |
Once the external iliac artery crosses under the inguinal ligament, its name changes to | Femoral artery |
What percentage of blood supplied by femoral artery to lower extremity? | 99% |
The internal iliac artery stays within the pelvic brims so we know it feeds all of the pelvic | viscera |
ligament that stretches from anus to coccyx | anococcygeal ligament |
why are iliococcygeus and pubococcygeus lumped together? | because they both share origin off tendinous arch |
3 muscles of levator ani | pubococcygeus, iliococcygeus, puborectalis |
innervation of Levator ani | ventral rami S3, S4 and perineal branchof pudendal nerve |
The greater sciatic foramen exists __________to the pelvic diaphragm and provides passageway for structures to tleave the pelvic cavity and enter the _________ region. | superior, gluteal |
The lesser sciatic foramen exists inferior to the _________________ and provides a passageway for neurovascular structures to pass from gluteal region back into the __________ region. | pelvic diaphragm, perineal |
what is the most important thing that the lesser sciatic foramen allows to pass from the gluteal region back into the perineal region? | Pudendal neurovascular bundle |
common iliacs, internal and external iliacs, urinary bladder, ureters, rectum and anus, autonomic nerves and nerves of LUMBOSACRAL plexus are all contents of both sexes' ____________. | True pelvis |
Contents of male true pelvis | prostate, seminal v's, ductus deferens |
contents of female true pelvis | uterus, ovaries, vagina |
spinal level of pubococcygeus | S234 |
innervation of pubococcygeus | inferior rectal n. |
Lumbar vertebrae through ____ are paired/fed by lumbar arteries. | L4 (at bifurcation) |
L5 is supplied by the __________ artery instead of the paired lumbar arteries. | Iliolumbar |
Ilio lumbar artery supplies ____ | L5 |
artery that supplies gluteus minimus and medius, and TENSOR FASCIA LATAE | Superior gluteal artery (and nerve) |
Artery that supplies gluteus maximus | Inferior gluteal artery (and nerve) |
In females, the ________ arteries come directly off the anterior branch of the internal iliac artery. | Uterine |
Obturator artery supplies | medial thigh muscles |
Internal pudendal artery supplies | perineum |
Name the 3 posterior branches of the internal iliac artery | Iliolumbar, Lateral sacral, Superior gluteal |
muscle which separates superior gluteal artery from inferior gluteal artery | piriformis |
The inferior gluteal artery runs between what 2 nerves? | ventral rami of S1 and S2 |
Starting at the piriformis, list the arteries off the anterior branch of the internal iliac artery | Emerging under piriformis, Inferior Gluteal, branching is Internal Pudendal laying on levator ani, Middle rectal, Inferior Vesicular, Obturator A with N, Patent part of Umbilical, branch down Superior vesicular, from patent turns Obliterated/Remnant U.a. |
inferior gluteal artery runs between | S1 and S2 |
Superior gluteal artery runs between | L4/L5 (lumbosacral trunk) and S1 |
SLIP | from bottom of posterior internal: Superior gluteal, Lateral sacral, Iliolumbar = Posterior |
PILS | Posterior=iliolumbar, lateral sacral, superior gluteal |
Name the 2 arteries off the external iliac artery | inferior epigastric and deep circumflex iliac artery |
Branches of External iliac are __________, supplying blood from other parts of body. | anastomotic |
Which iliac artery supplies blood from other parts of body and is therefore considered anastamotic | External iliac |
If the obturator artery is not present, what takes care of that? | an enlarged pubic branch from the external iliac's Inferior Epigastric |
The first branch off the PILS is Iliolumbar. It has a compound name. What are the two branches of it? | Iliac and Lumbar branches |
The superior gluteal artery may, instead of PILS, arise from (2) | Internal pudendal or Inferior Gluteal arteries of the anterior branch of internal iliac (they are just below where the missing superior gluteal would exit above the piriformis) |
The Iliolumbar of PILS may arise off the _____________ itself instead of off the posterior branch. | internal |
Because the Superior gluteal may arise off the Internal pudendal or the Inferior gluteal, it makes since that these three also may arise together from a ______________. | common stem. |
where does an abnormal obturator artery arise from? | pubic branch of Inferior epigastric (external) |
What do you call an enlarged pubic branch of the inferior epigastric artery? | ABNORMAL obturator artery |
Branches of the Internal Iliac artery are variable by ____ | sex/gender |
How does the internal iliac artery differ in females? | Inferior vesicular to bladder is replaced by a Uterine artery that arises with the Middle Rectal artery. |
In females, the _____________ is replaced by the uterine artery (with middle rectal intact). The uterine then turns around to give off? | inferior vesicular, inferior vesicular and vaginal arteries |
2 pouches created by ____________ in females. | peritoneum |
Name the 2 pouches created by the peritoneum in females | Utero-vesicular pouch (between bladder and uterus) and Recto-uterine pouch (between uterus and rectum) |
recto-uterine pouch of the famous burst ovarian cyst fluid retention, peritoneal cystitis problem is also called | the pouch of Douglas |
What is the generic name for the peritoneum covering the uterus? | Broad ligament |
the broad ligament covers the | uterus |
what is the broad ligament | the peritoneum covering the uterus in broads |
on top of the broad ligament is a cord-like ligament from the uterus to the abdominal wall, with the broad ligament hanging under it like a shower curtain | Round ligament |
We don't say Fallopian tubes anymore - we say | Uterine tube |
Inside the uterine tube are 3 divisions: | ampulla, infundibulum, fimbria |
ampulla is Latin for flask, so it makes sense that it is the curved portion over the ___________ and is the most frequent site of fertilization, probably due to drinking from a flask. | ampulla curves over the ovary, like handles |
from medial to lateral, name the sections of the uterine (fallopian) tube | isthmus, ampulla, infundibulum, fimbria |
what part of the uterine tube is the infundibulum associated with? | fimbria |
blood supply from the uterus is dragged down during | development |
what is in the suspensory ligament of the ovary? | Ovarian artery and vein |
the ovarian artery and vein are in the | suspensory ligament of ovary |
the infundibulo-pelvic ligament | suspensory ligament of ovary |
why does it make sense for the suspensory ligament to be called the infudibulo-pelvic ligament? | because the infundibulum is hanging from the pelvic wall, is suspended. It contains the ovarian artery and vein. |
how are the top and body of uterus connected? | junction of the Ligament of the Ovary and the Round Ligament (the curtainrod above the broad lig) |
lateral compartment of hip | gluteals, abductors, 5 lateral rotators |
posterior compartment of hip | hamstrings |
medial compartment of hip | adductors |
anterior compartment of hip | quads and iliofemoral gp (psoas mjr, iliacus, psoas minor) and Sartorius |
abductors are on the ____________ hip | lateral |
thigh flexion takes place in the _______ hip | anterior |
thigh extensiont takes place in the ___________ hip | posterior |
thigh adduction takes place at the ___________ hip | medial |
lateral nerves of the hip | superior gluteal n., inferior gluteal n. |
anterior nerve of the hip | femoral n. |
medial nerve of the hip | obturator n. (anterior branch of obturator n, and posterior branch of obturator n.) |
posterior nerve of the hip | TIBIAL division of sciatic (the anterior division of lumbosacral plexus) |
spinal level within a nerve is different from a major spinal nerve supplying a | dermatome |
anterior hip spinal levels | femoral is posterior division of lumbar plexus L2 -L4 |
medial hip spinal levels | obturator n. is lumbar plexus L2-L4 |
posterior hip spinal levels | tibial division is anterior of sciatic L4-S3 |
lateral hip spinal level | superior gluteal nerve L4-S1 and inferior gluteal nerve L5-S2 |
contraction of what fetal structure pulls the gonads into the pelvis from the posterior abdominal wall? | gubernaculum |
what fetal structure attaches to the gonads cranially and the genital swellings caudally (scrotum or labia majora) then pulls the gonads into the pelvis from the posterior abdominal wall? | gubernaculum |
as the gubernaculum contracts, it creates the ______________ canal. | inguinal canal |
what creates the inguinal canal? | contraction of the gubernaculum |
ovarian ligament, round ligament of uterus, and labia majora are derivatives of the | gubernaculum |
the gubernaculum contracts, drags gonads into the pelvis, creates the inguinal ligament, and from it is derived: (3) | round ligament of uterus, Ovarian ligament, labia majora |
Who's the most special fellow in the gonadal development bunch, who creates our ovarian and round ligaments, who makes the labia majora, who's our friend? | Gubernaculum! |
Nerves supplying skin of gluteal region (buttocks) | cluneal |
gluteus max nerve | inferior gluteal nerve |
gluteus medius nerve | superior gluteal nerve |
gluteus minimus nerve | superior gluteal nerve |
TFL nerve | superior gluteal nerve |
piriformis nerve | nerve to piriformis |
superior gemellus nerve | n. to Obturator Internus |
Obturator internus | n. to Obturator Internus |
inferior gemellus nerve | n. to Quadratus Femoris |
quadratus femoris | n. to Quadratus Femoris |
LONG head of biceps femoris nerve | tibial division of sciatic n. |
semimembranosis nerve | tibial division of sciatic n. |
semitendinosis nerve | tibial division of sciatic n. |
SHORT head of biceps femoris nerve | common fibular division of sciatic n. |
where do inferior cluneal n. branches come from? | ventral, not dorsal, rami of S1-3 |
Pudendal VAN passes deep to sacrotuberous ligament so technically it is IN the _______ sciatic foramen | lesser |
where does the gluteus max originate? | PSIS |
is the inferior cluneal nerve touching gluteus max? | no, it's right below it |
gluteus MEDIUS origin | ASIS to SI joint |
demarcating line between lateral thigh and posterior thigh | quadratus femoris |
what muscles does obturator internus separate | the superior and inferior gemelli brothers, but sup. is innervated by n. to obturator internus while inferior gemellus is innervated by n. to quadratus femoris |
what is between gluteus medius and maximus | the vascular plane/arcade that contains the Superior Gluteal VAN |
what 3 muscles end up in the sacrotuberous ligament? | gluteus maximus, Biceps femoris long head, Semitendinosis so sacrotuberous ligament and knee (gait) both go to low back! |
spasm of the gluteus maximus will alter ____________ joint mechanics | sacroiliac |
outer surface of ilium and PSIS, dorsal surface of sacrum, lateral aspect of coccyx and SACROTUBEROUS | origin of gluteus maximus |
Gerdy's tubercle, iliotibial tract | insertion of gluteus maximus |
Gerdy's tubercle | insertion of gluteus maximus onto gluteal tuberosity of femur |
spinal level glu max | S1 - right inbetween the drawing you memorized; think! Inferior gluteal nerve is L5, S1, S2 so gluteus max is right in the middle |
extends thigh and lateral rotation of thigh (S1 on the bun) | gluteus maximus |
S1 on the bun | gluteus maximus |
what muscle of hip resembles deltoid because of the three distinct fiber bands that have different actions? | gluteus medius |
between anterior and posterior gluteal lines | gluteus Medius origin |
greater trochanter of femur | gluteus Medius insertion |
gluteus medius nerve | superior gluteal nerve (along with glu min and TFL) |
abduction and medial rotation, however divided into 3 so anterior medially rotates and adducts, middle abducts, posterior division laterally rotates and abducts, just like deltoid | gluteus medius |
is gluteus medius more of a medial or lateral rotator? why? | medial, because it originates between the anterior and posterior gluteal lines towards the front of the hip |
if S1 is on the bun (gluteus max), then L5 is on the side (______________) | gluteus medius |
L5 on the side | Gluteus medius spinal level (again, the middle level of the drawing you memorized as L4-S1) |
gluteus medius spinal level | L5 on the side |
numbness on outside of leg and top of foot but also weakness in hip abduction describes the ___________ & ____________ for gluteus medius | dermatome (numbness) myotome (weakness) |
gemelli may or may not be present but _______________ is always there | obturator internus |
when there is a strain, cough, or sneeze, go through the ____ muscles to see if motor weakness or loss | L5 |
between anterior and inferior gluteal lines (spans the hip) | gluteus minimus (short and broad) |
anterior aspect of the greater trochanter and joint capsule | insertion of gluteus minimus |
the gluteus minimus is very ___________ and under the superior gluteal VAN vascular plane | tendinous |
spinal level of gluteus minimus | L5 (nerve injury is a pathological injury) |
abduction and medial rotation | action of gluteus minimus (and gluteus medius) |
L5 vs S1 myotome distinguish by | L5 heel walk (dorsiflexion) for gluts medius and minimus vs. S1 toe walk for gluteus MAX (S1 on the bun) |
L1 is _____ walk/gluteus medius and minumus | heel |
S1 on the bun is _____ walk/gluteus maximus | toe |
when you walk and plant one foot on the ground, gluteus medius and minimus contract, pulling the hip toward the greater trochanter on the ___________ side. | supported |
Normal function of hip __________ requires the origins (proximal attachments) of gluteus medius and minimus to pull the iliac blade towards their insertions (distal attachments) at the greater trochanter. | abduction (origins pull insertions) |
what 2 muscles prevent the pelvis from dropping below a horizontal plane connecting the iliac crests to the other side, or to the side which has the foot off the ground? | gluteus medius and minimus (origins pull insertions toward them in abduction) |
a swinging gait/lurch on right side (susan sarandon) means | injured superior gluteal nerve on the left side = Trendelenburg's sign |
Trendelenburg's sign | injured Superior Gluteal n. (L5 on the side) ie, gluteus medius and minumus that are paralyzed and therefore unable to pull their insertions on iliac crest towards the greater trochanter to stabilized supporting side while other foot is off the the ground |
If the lurch (Trendelenburg's sign) is on the left, the paralyzed Superior Gluteal and malfunctioning L5 on the side/glu medius and minimus are bad on the | right! |
In Trendelenburg's sign, the pathology is on the _____________, not the _______________. | pathology on weight-bearing side |
if there is no leg dermatome problem (L5 on the side) and heel walk okay (superior gluteal nerve) then it's not a disc problem but a | peripheral nerve |
ASIS and anterior iliac crest | origin of TFL |
iliotibial tract | insertion of TFL |
TFL innervation | superior gluteal nerve (+glu medius and minumus) |
out of all the muscles innervated by superior gluteal nerve (TFL, gluteus medius, gluteus minimus), and knowing superior gluteal nerve is L4, L5, S1, what's the most superiorly placed muscle and therefore its most superiorly placed spinal level? | TFL, L4 and L5 (the glut medius and minimus are L5 and S1) |
tenses the iliotibial tract, thereby stabilizing the thigh on the leg; thigh abduction. | TFL |
ventrolateral aspect of the sacrum origin | piriformis |
greater trochanter insertion | piriformis (and the glutes minimus and medius) |
nerve of piriformis | nerve to piriformis |
where does the n. to piriformis come from? | after superior and inferior gluteal nerves on common fibular portion of lumbosacral plexus (posterior), the nerve to piriformis has levels S1 and S2 according to drawing you memorized;-) |
major spinal level of n. to piriformis? | S1 (remember glute medius and minimus are half S1 so when piriformis gets compressed, guess who else suffers?) |
laterally rotates an extended thight; abducts a flexed thigh | piriformis, the Kung Fu muscle |
spasms and hypertonicity of piriformis compress the | sciatic n. |
what structures pass inferior to the piriformis? | inferior gluteal nerve and artery, pudendal n., Internal pudendal artery and vein, sciatic nerve, PFC |
sciatica can produce S1 dermatome symptoms. Why? | because the inferior gluteal n. passes below it and that is Gluteus Maximus (S1 on the bun) |
sciatica can produce L5/S1 compression on the roots so causing | gluteus medius (L5,S1), gluteus minimus (L5/S1), gluteus maximus (S1) problems with PFC so back of leg, too |
the sciatic has 3 possible relationships to the piriformis | under, common fibular through with tibial under, common fibular split over and tibial under |
which position of sciatic to piriformis relationship presents the most likelihood of compression? | common fibular piercing through piriformis and tibial under |
PIN structures under Piriformis muscle | Pudendal n., Internal Pudendal Artery and Vein, N. to Obturator Internus |
what is running right under the sacrotuberous ligament and if you sit on your ass too long, can give you saddle anesthesia, not to mention deprive your nether regions of blood? | Internal pudendal artery & vein, Pudendal nerve |
what happens to the internal pudendal artery once it crosses over coccygeus and spreads north on the levator ani muscle? | it splits into an inferior rectal branch and perineal arteries as it heads toward the genitalia |
PIN structures | Pudendal nerve (S234) from anterior tibial division of lumbosacral plexus, INTERNAL PUDENDAL Artery & Vein (headed north to your junk), and the N. to Obturator Internus (headed to ob. int. and superior gemellus) |
what 2 nerves come off the lumbar plexus and have NO sacral components, but supply the medial and anterior leg? | Obturator n. and Femoral n. |
describe the sciatic n. | Tibial anterior division for posterior leg divides at foot into lateral plantar and medial plantar nerves. Common fibular posterior into common fibular nerve, lateral sural cutaneous + superficial fibular n. for lateral leg + Deep fibular to anterior leg |
what nerve joins the tibial nerve and the common fibular nerve after they have separated (as the proper sciatic)? | Sural nerve |
nerve of tarsal tunnel | Tibial nerve |
originates outer surface of ischial spine | superior gemellus |
originates from ischial tuberosity | inferior gemellus |
originates from inner surface of the obturator membrane and obturator foramen | Obturator internus, between the superior gemellus at ischial spine and inferior gemellus at ischial tuberosity |
why is the obturator internus cooler than superior or inferior gemellus? | because it originates on the INSIDE of the obturator membrane and foramen, then wraps 90 degrees backward through the lesser sciatic foramen and stretches all the way across to the medial surface of the greater trochanter. Separates the gemelli! |
S1 is not only gluteus maximus spinal level, but because it's S1 on the bun, is also (2) | superior gemellus and obturator internus (since they are both innervated by n. to obturator internus, they would have the same spinal level) |
just like piriformis, the Kung Fu muscle, the superior gemellus and obturator internus both laterally? | rotate an extended thigh and abduct a flexed thigh. HiiiiYah!! |
stabilization of the hip joint | superior gemellus and obturator internus (S1, nerve to Obturator Internus) |
origin is ischial tuberosity | inferior gemellus |
inserts on medial surface of greater trochanter | inferior gemellus |
inferior gemellus nerve | Nerve to Quadratus Femoris |
spinal levels of inferior gemellus | L5 &,S1 equally just like Quadratus Femoris |
laterally rotates an extended thigh, abducts a flexed thigh | superior gemellus, Obturator internus, Inferior gemellus |
spinal levels of superior gemellus and obturator internus? spinal levels of inferior gemellus and Quadratus femoris | S1, L5 & S1 |
lateral border of the ischial tuberosity | Quadratus Femoris muscle origin |
walk me around the ischial tuberosity from the posterior and tell me the origins of 4 muscles of the hip: | top is inferior gemellus, then quadratus femoris, then long head biceps femoris, most medial is semitendinosis and way up in there is semimembranosis |
inserts on quadrate tubercle and intertrochanteric crest | duh - Quadratus Femoris |
where is the quadrate tubercle? | just below the intertrochanteric crest on the back of the femur between greater and lesser trochanters |
spinal levels of quadratus femoris | L5 & S1 (same as inferior gemellus) |
only action is LATERAL ROTATION but does stabilize the hip. It is NOT affected by Limb postion. | Quadratus Femoris |
where does n. for Quadratus femoris come from? | tibial (anterior) division of lumbosacral plexus. Is furthest lateral right before actual sciatic nerve and is next to nerve to obturator internus. |
lateral hip rotator with a 90 degree insertion. | quadratus femoris (just like pronator quadratus) |
upper medial border of popliteal fossa | semimem and semiten |
lower medial border of popliteal fossa | medial head of gastrocnemius |
upper lateral border of popliteal fossa | biceps femoris |
lower lateral border of popliteal fossa | lateral head of gastrocnemius |
dermatome of popliteal fossa | S2 |
what nerve supplies the cutaneous innervation of back of thigh, popliteal fossa, right down between gastroc heads? | PFC |
describe the cutaneous innervation/dermatome of hip to gastroc posteriorly | hand on hip is L1/Iliohypogastric, greater trochanter skin T12/Subcostal, rub your butt dorsal rami L1,2,3/superior cluneal, pinch your butt dorsal rami S1,2,3/middle cluneal, L5ontheside LatFemCut, PFC is S2, MFC S3 knee fat, dogbite obdurator |
dermatome medial gastroc | L4 |
dermatome lateral gastroc | L5 |
Lateral femoral cutaneous n. dermatome level | S1 |
Posterior femoral cutaneous n. dermatome level | S2 |
Medial femoral cutaneous n. dermatome level | S3 |
Middle cluneal n. dermatome level | S3 |
Lower cluneal n. dermatome level | S4,5 (not much left!) |
where is the pectineal line on femur? | right below the lesser trochanter on the back |
what makes up the linea aspera? | the spiral line on the medial side and the continuation of gluteal tuberosity on lateral side |
spiral line is where? | just below pectineal line, under lesser trochanter on posterior femur |
semimembranosus, semitendinosus, and biceps femoris are referred to as the ___________- muscles (posterior thigh muscles) | ischio-crural |
all ischiocrurual (posterior thigh muscles) arise from the ischial tuberosity except: | short head of biceps femoris from the linea aspera and lateral supracondylar ridge |
besides being the only posterior/ischiocural/hamstring muscle that doesn't arise from the ischial tuberosity, what else is different about the Short Head of Biceps Femoris? | It is the only hamstring innervated by the common fibular division of sciatic (all others by tibial) |
how are the tibial and common fibular nerves joined once again after they are separated as the sciatic? | by the Sural n. |
ischial tuberosity, linea aspera and lateral supracondylar ridge of femur | origin of long head and short head of biceps femoris |
insertion of biceps femoris is odd because | it is split by the lateral collateral ligament (fibular collateral ligament) |
head of fibula and lateral condyle of tibia | insertion of biceps femoris (split by lateral collateral ligament of knee) |
just like superior gemellus and obturator internus are S1, then inferior gemellus and quadratus femoris are L5 & S1, describe the levels for the hamstrings: | biceps femoris is S1 (it's higher and on the outside like sup. gem. and ob.int. and piriformis) while semimembranosus and semitendinosus are L5 & S1 (like inferior gemellus and quad femoris) |
tibial division of sciatic nerve to long head of | biceps femoris |
short head of biceps femoris innervation | common fibular divison of biceps femoris |
flexes knee and laterally rotates leg AT THE KNEE | biceps femoris, but long head will also extend the thigh at the hip |
tendons of pes anserinus | semitendinosus, gracilis, sartorius |
originates on more medial (but not most medial) ischial tuberosity | semitendinosus |
inserts medial surface of proximal tibia (pes anserinus) | semitendinosus |
semitendinosus nerve | tibial division of sciatic |
spinal levels semitendinosus | L5 & S1 |
flexes leg (at knee) and medially rotates the tibia; extends the thigh at the hip | semitendinosus! |
medial knee rotator | semitendinosus |
attached at pes anserinus and medially rotates knee | semitendinosus |
most medial origin of ischial tuberosity | semimembranosus |
inserts posterior aspect of medial condyle of tibia | semimembranosus |
part of its tendon is REFLECTED, forming the | oblique popliteal ligament (semimembranosus) |
what is strange about semimembranosus, similar to biceps femoris being split by lateral collateral ligament? | semimem has a small part that is reflected, forming the oblique popliteal ligament. A tendon forming a ligament. |
spinal level semimembranosus | L5 & S1 (semiten and semimem) |
flexes the leg and medially rotates the tibia (knee), extends thigh at hip | semitendinosus and semimembranosus both! |
contents of popliteal fossa (4) | Popliteal Artery, Popliteal Vein, Common Fibular Nerve, Tibial Nerve |
Common Finns never taste new PAPoV | Contents of Popliteal fossa: Common fibular nerve, Tibial nerve, Popliteal Artery, Popliteal Vein |
name all the muscles innervated by the tibial nerve (11) in the thigh and leg | Biceps long head, Semiten, Semimem, posterior part of Adductor Magnus, Plantaris, Gastrocs, Soleus, Popliteus, Flexor Hallucis Longus, Flexor Digitorum Longus, Tibialis Posterior |
name all the muscles innervated by the tibial nerve division called Medial Plantar Nerve (4) | Abductor hallicus, Flexor hallucis brevis, Flexor digitorum brevis, First lumbrical toe 2(all medial arch is innervated by medial plantar n.) |
name the plantar muscles innervated by the tibial division called Lateral Plantar N. (6 groups) | Abductor digiti minimi, Flexor digiti minimi BREVIS, Quadrate Plantae, Three lateral lumbricals (toes 3-5), All 4 dorsal interossei, All 3 plantar interossei, Adductor hallicus (transverse and oblique heads) |
Common Finns Never Taste New PAPoV | Common Fibular Nerve, Tibial Nerve, Popliteal Artery, Popliteal Vein = contents of popliteal fossa |
where does the sural nerve come from? | from the tibial and common fibular portions of the sciatic after they have split above the popliteal fossae |
How is the sural n. made? | Tibial nerve gives off Medial Sural Cutaneous n. and Common Fibular gives off the Sural Communicating N. They meet and form the SURAL nerve itself. |
What does the Sural n. innervate? | skin on the distal 2/3 of postlateral calf and lateral foot over pinky toe |
what innervates the bottom of the heel? | medial calcaneal nerve (sural n. to the lateral outside foot, medial plantar to the inside front 3 toes, lateral plantar to the outside 2 toes) |
The Great Saphenous nerve does not run through the __________________, but runs with the Saphenous vein. | adductor canal |
what does the Sural n. give off? | the Lateral Sural Cutaneous n. for the outside of the leg skin, vs the sural n. which goes all the way down to the lateral foot |
Describe arterial branches from popliteal artery | superior medial and lateral genicular, medial genicular artery, sural arteries (to the lateral knee), Inferior medial and lateral genicular arteries, Anterior Tibial artery, Posterior Tibial artery, FIbular artery |
where does the anterior tibial artery go after it breaks from the popliteal artery? | at the top of the interosseous membrane between fibula and lateral tibial condyle is a little opening - it jumps through and rests along the anterior face of the interosseous membrane all the way down the leg with the Deep Fibular nerve |
name the 4 compartments of the thigh | flexor, extensor, abductor, adductor |
flexor compartment of thigh contains | Femoral n. |
extensor compartment of thigh contains | Tibial division of sciatic n. |
adductor compartment of thigh contains | Obturator n. |
abductor compartment of thigh contains | Gluteal nn. |
what compartment of thigh are gluteal nn. in? | abductor/lateral compartment |
Pain and temperature on medial leg presents with ____ neuropathy but Femoral n. entrapment | L4 |
Pain and temperature on medial leg presents with L4 neuropathy but _________ n. entrapment | Femoral |
what nerve supplies almost entire L4 dermatome? | saphenous |
Femoral entrapment is often misdiagnosed as | saphenous entrapment |
why is femoral entrapment often misdiagnosed as saphenous entrapment? | because saphenous supplies almost entire L4 dermatome |
if knee surgery scars are present, which nerve is probably entrapped? | saphenous |
A short distance below the inguinal ligament, the ___________ nerve divides. | femoral |
what does the femoral nerve divide into: | muscular branches to quads-sartorius-pectineus, Anterior Femoral Cutaneous branches and Saphenous n. to medial leg |
What nerve runs alongside the femoral artery? | Saphenous n. |
One long cutaneous branch of the femoral nerve runs deeply in the thigh (with the femoral vessels in the _______________) but becomes subcutaneous just above the knee. Branch? | adductor canal, Saphenous n. |
It is distributed to the skin of the medial surface of the knee and leg, and to the medial border of the foot as far as the base of the big toe. Nerve? | Saphenous n. |
2 specializations of the fascia lata | Iliotibial band/tract and Saphenous hiatus/opening |
where is the IT band sitting? | on the vastus lateralis |
where is the saphenous hiatus? | oval opening at the superomedial fascia lata (in the groin area above sartorius and below inguinal ligament) Just below pubic tubercle |
It transmits the great saphenous vein and other smaller vessels (like superficial epigastric artery and superficial external pudendal artery), as well as the femoral branch of the genitofemoral nerve. | Saphenous hiatus |
The Saphenous Hiatus transmits the ___________________ and other smaller vessels (like superficial epigastric artery and superficial external pudendal artery), as well as the femoral branch of the genitofemoral nerve. | the great saphenous vein |
The Saphenous Hiatus transmits the ___________________ and other smaller vessels (like superficial epigastric artery and superficial external pudendal artery), as well as the femoral branch of the _______________nerve. | Saphenous hiatus = great saphenous vein and genitofemoral branch of femoral n. |
What is NOT within the femoral sheath? | the femoral nerve (it sits on the iliopsoas most lateral and is the N in NAVL from lateral to medial) |
Contents of femoral sheath? | AVL = Femoral Artery, Vein, Lymph |
formed from the aponeurosis of gluteus maximus and tensor fascia lata | iliotibial band |
what syndrome causes pain along the vastus lateralis? | IT band syndrome |
originates pretty much from the coccyx to the pubic tubercle, is continous with the fascia of the lower anterior abdominal wall, and inferiorly with the crural fascia. | the Fascia Lata |
specialties of the deep fascia lata: | falciform ligament and cribriform fascia that make the saphenous hiatus |
known as the "Axilla of the Lower Limb" | Femoral triangle |
floor muscles of femoral triangle | iliopsoas and pectineus (from lateral to medial) |
contents of femoral triangle, not femoral sheath | NAVL |
contents of femoral sheath, not femoral triangle | AVL (no femoral nerve in the sheath, only in the triangle) |
the apex (tip at bottom) of the femoral triangle formed by | sartorius and adductor longus forming a point |
medial border of femoral triangle | adductor longus |
lateral border of femoral triangle | sartorius |
superior/BASE of femoral triangle | inguinal ligament |
floor of femoral triangle | iliopsoas and pectineus |
weakest part of abdominal wall in females that is prone to hernia (even though mine is in the internal oblique)? | femoral sheath |
what creates iliopsoas tendinitis in kickers and dancers? | the iliopsoas bursa |
specializations of facia lata (4) | IT band, falciform ligament, cribriform fascia, saphenous hiatus |
what ligament can be perforated by a femoral sheath hernia? | lacunar |
exit of the obturator n. from the pelvis to get into the adductor compartment (the little hole in the obturator membrane) | Obturator canal |
why are we certain the obturator n. is not in the femoral triangle? | because the Obturator Externus which it innervates is UNDER pectineus, and pectineus forms the floor of the femoral triangle |
What 2 divisions of the femoral n. are in the femoral triangle? | N. to Vastus Medialis and Saphenous n. |
saphenous nerve is the _____ dermatome | L4 |
Hunter's canal, subsartorial canal = both names for the | Adductor canal |
contents of Adductor canal | Femoral ARTERY, Femoral VEIN, Femoral nerves to VASTUS MEDIALIS & SAPHENOUS nerve |
contains femoral artery, femoral vein, nerve to vastus medialis (femoral) and saphenous nerve (femoral) are all contained in the | Adductor canal |
what is the function of the Adductor canal? | allows the femoral artery and femoral vein to travel the anterior thigh then ENTER THE POSTERIOR THIGH |
why doesn't the saphenous nerve enter the posterior thigh? | Because it's on its way to the medial leg and is going to pop out above the inside knee |
what exits the Adductor hiatus? | Femoral artery and femoral vein, changing names to Popliteal artery and Popliteal vein as they exit |
artery coming off femoral that supplies posterior thigh | profunda femoris |
profunda femoris (deep artery of thigh) | off femoral artery, supplies posterior thigh. |
what artery is between the pectineus and iliopsoas? | Medial femoral circumflex |
what muscle is always medial to Medial Femoral Circumflex artery | pectineus (MFCircus dives under it) |
what artery off profunda femoris looks is shaped like a sideways "Y" and heads under femoral nerve branches towards the rectus femoris? | lateral femoral circumflex (LFCircus) |
artery that pops out above medial knee off the femoral artery | descending genicular |
descending genicular artery | The descending genicular artery (highest genicular artery) arises from the femoral artery just before it passes through the opening in the tendon of the Adductor magnus |
The descending ___________ artery (highest genicular artery) arises from the femoral artery just before it passes through the opening in the tendon of the Adductor magnusIt immediately divides into: | genicular |
The _____________________ is "Y" shaped and has a branch to the hip joint proximally and a downward branch to vastus lateralis. | Lateral Femoral Circus (Circumflex) artery |
Besides inguinal ligament, what muscle innervated by Femoral n. forms the roof of the Femoral Triangle? | Iliacus, the only iliopsoas gp muscle innervated by femoral n. |
name all the anterior thigh muscles supplied by femoral n. | iliacus, sartorius, quads, articularis genu |
"anconeus" of the knee | articularis genu |
formed from posterior divisions L2-L4 of lumbar plexus | FEMORAL n. |
origin of psoas major | T12 - L5 (the whole thing!) vertebrae and IVD's and the transverse processes of all the lumbar |
how does the psoas major attach? | with iliacus as iliopsoas into the lesser trochanter |
nerves of psoas major | ventral primary rami L1-L3 |
why doesn't T12 innervate psoas major? | because it's a subcostal/iliocostal nerve |
why doesn't L4 innervate psoas major, just L1-L3? | because L4 goes to Femoral n. and L4 has too much other shit going on - the upper half is already so busy with Femoral, Obturator and accessory Obturator that it doesn't want to deal with any hip flexor execept Iliacus |
what is the innervation of psoas major? | primary ventral rami L1-L3 |
femoral n. is running right on top of the only hip flexor it innervates -what is it? | iliacus (L2) |
you know genitofemoral n. is a combination of L1 and L2 (like the sural nerve is from tibial and common fibular nn.). Since genitofemoral lies on top of psoas major, what could L1 conveniently innervate on its way to the the junk? | psoas minor, if it's there at all |
psoas MINOR nerve | L1 branch |
Psoas Major nerve | primary ventral rami L1-L3 |
the psoas major can either (2) or ipsilaterally flex trunk | flex the thigh at the hip or flex the trunk to the hip... either way it's the major hip flexor when combined with iliacus |
Since psoas minor doesn't get into the true pelvis but stays above the brim, where does it insert? | pectineal line |
origin of iliacus | iliac fossa |
insertion of iliacus | with psoas major onto the lesser trochanter (wraps around the back like a parachute truss) |
iliacus is the only iliopsoas muscle of the three innervated by | FEMORAL n. (L1-L3 posterior lumbar plexus) |
what is the spinal level of iliacus (think of where lateral femoral cutaneous is headed) | L2 - they are both on the outside of the lumbar plexus |
If the psoas mjr or iliacus is outside or below the inguinal ligament, label it? | Iliopsoas |
components of pes anserinus | gracilis, sartorius, semitendinosus tendons all at superomedial tibia |
medial knee slow twitch white fiber postural muscle that stabilizes the upper limb, stabilizes body over knee (like a physioball on a golf tee) | Sartorius! |
origin of sartorius? | ASIS |
where does sartorius insert? | pes anserinus so superomedial part of tibia (inside knee) |
Sartorius crosses 2 joints so it has a lot of actions. Hip actions? Knee actions? | Hip: flex, abduct, laterally rotates thighKnee: flex, medially rotates leg at knee |
The muscle that lets a person Irish Step Dance (at the hip/thigh and the knee/leg) | Sartorius! |
A good mnemonic to remember the muscles which contribute tendons to this conjoined tendon and the innervations of these muscles is SGT FOT (sergeant FOT) | the muscles of pes anserinus: Sartorius, Gracilis, semiTendinosus innervations: Femoral, Obturator, Tibial nerves |
SGT FOT (sergeant FOT) | pes anserinus muscles and innervations: Sartorius!, Gracilis, semiTendinosus ... Femoral, Obturator, Tibial |
The sciatic nerve itself cannot technically innervate anything because | it is merely the designation for the common sheath that encases the tibial and common fibular nerves |
It is a major cause of chronic knee pain and weakness. __________medial portion of the knee is inflammed. If the bursa underlying the tendons of the sartorius, gracilis, and semitendinosus gets irritated from overuse or injury. | pes anserinus bursitis |
all the quadriceps together form the _______________ that envelopes the patella then inserts at the tibial tuberosity as the patellar ligament. | quadricep tendon |
angle of attachment to tibial tuberosity created by patellar tendon to increase the moment arm of joint? | 45 degrees |
all quadriceps muscles are innervated by the | femoral nerve, but primarily its L3, L4 contributions |
all quads will _______ the knee | extend |
which quad initiates thigh flexion (presumably taken over by psoas major/iliacus)? | Rectus femoris |
Vastus Lateralis, Vastus Intermedius, Rectus Femoris and Vastus Medialis are all innervated by the femoral n. and have spinal levels | L3,L4 |
what is the only iliopsoas gp. muscle innervated by femoral? spinal level? | iliacus L2 |
Iliacus is Femoral L2 so all the quads are Femoral ________ (completely covering the spinal levels inside Femoral n.;-) | L3,L4 |
which muscle of your false pelvis is driving you up the wall and what is its spinal level? | iliacus, L2 but no problems out of quads, L3, L4! |
what is psoas major spinal level? | none listed - just primary ventral rami of L1-L3 so those are the intersegmental spinal levels |
quad spinal levels | L3, L4 because Iliacus is L2 |
the lateral patellar retinaculum is formed by | vastus lateralis, of course! |
the medial patellar retinaculum is formed by | vastus medialis and rectus femoris |
which quad blends medially and laterally but helps form the medial patellar retinaculum? | Rectus Femoris |
which muscle creates a huge lateral pull on the patella and which muscle counteracts this pull? | vastus lateralis pulls, vastus medialis oblique fibers counteract |
insertion of quads means the bony landmark insertion so what is that? | tibial tuberosity |
The quad with 2 heads of origin - a straight head and reflected head | Rectus femoris |
straight head of rectus femoris begins at the | ASIS just below sartorius |
reflected head of rectus femoris begins at the rim of the | acetabulum |
where do both reflected/acetabular and straight/ASIS heads of the rectus femoris attach? | with the other 3 quads onto the tibial tuberosity |
patellar tendon stretches from quads to patella but from patellar apex to tibial tuberosity is the | patellar ligament |
what kind of bone is the patella | sesamoid |
origin of vastus medialis | intertrochanteric line on front of trochanter and medial lip of linea aspera on back of trochanter |
what's about the only place to palpate the vastus medialis | just above the medial knee under sartorius |
weakness of this muscle allows patella to track laterally during knee extension, causing bony contact with the lateral femoral condyle (ouch) | vastus medialis |
push button sign | trochanteric bursa inflammation |
which muscle allows the patella to track medially if weak? | vastus lateralis |
origin of vastus lateralis | lateral lip of linea aspera |
origin of vastus intermedius | anterior and lateral surfaces of femoral shaft |
deep to vastus intermedius but sometimes blended with it. Innervated by femoral nerve just like quads, sartorius, and iliacus. | articularis genu |
origin of articularis genu, the "anconeus" of the knee? | distal femoral shaft |
insertion of articularis genu, which makes it such a wowser if it goes wrong and causes entrapment | retracts synovial capsule of knee to which it inserts and pulls it out of the way when knee extended |
retracts the snyovial capsule to prevent pinching during extension | articularis genu |
yoinks back the synovial capsule of the knee during extension to prevent pinching | articularis genu |
pectineus is innervated by the _________ nerve, conveniently because it forms the floor of something very important to this nerve | femoral, forms the floor of femoral triangle, even though nerve is in triangle but not in the sheath (NAVL) |
the pectineus originates on a line named after it. What is that line and where is it? | Pectineal line of the pubic bone |
the pectineus inserts on a line named for it, too. What is the name of the line and where is it? | Pectineal line of the femur |
what must you say when identifying the origin and insertion of the pectineus? | either pectineal line OF THE PUBIC BONE or pectineal line OF THE FEMUR |
job of the pectineus | hip adduction and flexion (Rockettes!) |
innervation of pectineus that makes it different from most of the aDDuctors? | femoral nerve |
where is the pectineal line of the femur? | just inferior to the lesser trochanter on the back |
spinal level of pectineus (think of it as just more iliacus innervated by femoral n.) | L2, just like iliacus (quads are L3,L4) |
forms medial part of floor of femoral triangle | pectineus |
How many branches of the Obturator n. (L234 of lumbar plexus)? | Anterior and Posterior |
muscles innervated by Anterior division of obturator n. from lumbar plexus | sandwich: Adductor longus, Adductor Brevis, Gracilis |
Graceful whether she is long or brief. | Anterior branch of Obturator n. is Gracilis, Adductor Brevis, Adductor Longus |
what lies between adductor longus and adductor brevis? | femoral artery and vein in the adductor canal (saphenous nerve is on top of adductor longus and joins the vessels below it) |
Add longus, brevis and gracilis all originate from | ramus and body of pubic bone |
what 3 muscles all originate from ramus and body of pubic bone and are all 3 innervated by the anterior division of obturator nerve? | adductor longus, adductor brevis, gracilis |
graceful if she's long or brief, adductor longus, adductor brevis and gracilis all function to | adduct and medially rotate the thigh |
iliacus, pectineus and gracilis are all spinal level | L2 |
adductor longus and brevis are spinal level | L3 |
Iliacus, pectineus and gracilis are all odd looking muscles that share the same spinal level. | L2 |
Adductor longus and brevis look like the quads and their spinal level is | L3 |
innervation of adductor longus, adductor brevis and gracilis? | anterior branch of obturator n. |
iliacus, pectineus and gracilis are all odd looking muscles with the same spinal level (L2) but what don't they share? | Nerve: iliacus and pectineus are femoral n. while gracilis is part of the adductor triumverate innervated by anterior branch of obturator n. |
inserts on the middle third of the linea aspera | adductor longus |
inserts on the pectineal line (waaaay up there) of femur and proximal linea aspera | adductor brevis |
inserts into pes anserinus and is the adductor representative | gracilis |
gracilis isn't just an old adductor - she ___________ the thigh as well | medially rotates the thigh |
works with sartorius to stabilize the pelvis over the knee | gracilis (L2, anterior branch of obturator n., also medially rotates thigh as well as adducts) |
Nerve between adductor longus and adductor brevis | anterior branch of obturator |
nerve laying under adductor brevis on its way to obturator externus | posterior branch of obturator n. |
adductor part of adductor magnus origin | ischiopubic ramus |
hamstring part of adductor magnus origin | ischial tuberosity (with the other hamstrings) |