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Zumpano Gross II

NYCC Zumpano final exam lower extremity SP10, 2nd tri

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
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)
Created by: Red R. Abbit Red R. Abbit on 2010-07-08
