Download Anatomy – Whole Block 4 Review

CENTER OF GRAVITY
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Does the Center of Gravity lie in front of or behind the Hip Joint?
o It lies behind the hip joint, which tends to extend the hip.
What ligament prevents further extension of hip joint (due to the Center of
Gravity) by passively supporting the weight of the trunk?
o Iliofemoral Ligament
What group of muscles adds support by flanking the vertebral column and
allowing movements to correct trunk and pelvic girdle balance?
o Paraspinal Muscles
What muscle of the leg further supports the Center of Gravity?
o Tibialis Anterior pulls the Tibia Anteriorly to balance the Center of
Gravity
What ligament supports joints against Lateral Movements in the Hip and
Thigh Region?
o Tensor Fascia Latae and IT Band
What ligament supports joints against Lateral Movements in the Knee
Region?
o Fibulocollateral Ligament (LCL)
Where does the Fibulocollateral Ligament (LCL) originate and insert?
o Originate: Lateral Condyle of the Femur
o Insert: Head of the Fibula
THE GLUTEAL REGION
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What are the three bones of the hip?
o Ischium
o Ilium
o Pubis
What is the junction of the three hipbones called?
o Acetabulum
What are the two ligaments of the Greater and Lesser Sciatic Notch?
o Sacrotuberous Ligament
o Sacrospinous Ligament
What passes through the Pudendal (Alcock’s) Canal?
o Internal Pudendal Artery
o Internal Pudendal Vein
o Pudendal Nerve
Where does the Fibrous Joint Capsule of the Hip Joint attach to the Femur?
o Intertrochanteric Line (Anterior)
What type of joint is the Hip Joint?
o Synovial Joint
What is the Articular Surface of the Acetabulum called?
o Lunate Surface
What type of cartilage lines the Hip Joint?
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o Hyaline
What is the Ligamentum Teres?
o Ligament of the Head of the Femur
Where does the Ligament of the Head of the Femur originate?
o The Acetabular Notch and the Transverse Ligament
What travels inside of the ligament of the Head of the Femur? What larger
artery gives off this branch?
o Artery to the Head of the Femur
o Obturator Artery
Where do all of the ligaments that stabilize the hip joint originate and insert
from?
o The Pelvic Bone to the Femur
What is the most important ligament of the Hip Joint?
o Iliofemoral (Anterior)
What are the Posterior and Inferior Ligaments of the Hip Joint?
o Posterior: Ischiofemoral Ligament
o Inferior: Pubofemoral Ligament
What is the Zona Orbicularis?
o Forms a locking ring around the neck of the femur to stabilize the hip.
What do the blood vessels travel through to get to the head and neck of the
femur?
o Retinacula – capsular fibers that reflect back to add for protection.
What position is most vulnerable for dislocation of the Hip Joint?
o Flexed and Adducted (sitting with thighs crossed)
What type is dislocation is most vulnerable?
o Posterior Dislocation
What three arteries are involved in the Cruciate Anastomosis?
o Inferior Gluteal Artery
o Lateral and Medial Circumflex Femoral Arteries
o First Perforating Artery of the Profunda Femoris Artery
What are the four muscles that flex the hip?
o Iliopsoas
o Pectineus
o Rectus Femoris
o Tensor Fascia Latae
Where do the Iliacus and the Psoas Major insert?
o Lesser Trochanter of the Femur
What muscle is the most powerful extensor of the hip joint?
o Gluteus Maximus
What muscles abduct the hip?
o Gluteus Medius
o Gluteus Minimus
o Tensor Fascia Latae
o Piriformis
o Obturator Internus
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What are the 6 Short Lateral Rotator Muscles of the Hip?
o PGOGOQ
o P: Piriformis
o G: Superior Gemelli
o O: Obturator Internus
o G: Inferior Gemelli
o O: Obturator Externus
o Q: Quadratus Femoris
Access above and below the Piriformis allows for the passage of
neurovascular structures to the Gluteal Region. What structures pass
through the Suprapiriform Foramen?
o Superior Gluteal V.A.N.
Access above and below the Piriformis allows for the passage of
neurovascular structures to the Gluteal Region. What structures pass
through the Infrapiriform Foramen?
o Inferior Gluteal V.A.N.
o Pudendal V.A.N.
o Sciatic N.
o Posterior Femoral Cutaneous N.
What nerve roots form the Posterior Femoral Cutaneous N.?
o S1, S2, S3
What nerve roots form the Superior Gluteal N.?
o L4, L5, S1
What nerve roots form the Inferior Gluteal N.?
o L5, S1, S2
What nerve roots form the Sciatic N.?
o L4, L5, S1, S2, S3
From what Iliac Trunk does the Superior Gluteal Artery originate?
o Posterior Trunk of Iliac Artery
From what Iliac Trunk does the Inferior Gluteal Artery originate?
o Anterior Trunk of Iliac Artery
THE THIGH
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What is the normal Angle of Inclination of the Femur?
o 125-130 degrees
What is an Angle of Inclination greater than 130 degrees?
o Coxa Valga
What is an Angle of Inclination less than 100 degrees?
o Cova Vera
What is the Superficial Fascia that covers the thigh?
o Cribiform Fascia
What vein pierces the Fossa Ovalis of the Cribiform Fascia?
o Great Saphenous Vein
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What are the three components of the thigh?
o Anterior, Medial, Posterior
What are the muscles of the Anterior Thigh?
o Rectus Femoris
o Vastus Medialis
o Vastus Lateralis
o Vastus Intermedius
o Sartorius
What is the nerve supply to the Anterior Thigh?
o Femoral Nerve
What is the blood supply to the Anterior Thigh?
o Femoral Artery, Femoral Vein
What is the Obliquus Genu? What muscle does the fibers come from?
o Stabilizes the Patella
o Fibers from the Vastus Medialis
What are the muscles of the Medial Thigh?
o Adductor Longus
o Adductor Brevis
o Adductor Magnus
o Pectineus
o Gracilus
o Obturator Externus
What is the nerve supply to the Medial Thigh?
o Obturator Nerve
What is the blood supply to the Medial Thigh?
o Obturator
What are the boundaries of the Femoral Triangle?
o Inguinal Ligament
o Sartorius Muscle
o Adductor Longus Muscle
What structures run through the Femoral Triangle?
o Femoral Vein
o Femoral Artery
o Femoral Nerve
o Great Saphenous Vein
o Lymph Nodes
o Fat
What is the Adductor Canal?
o The canal below the Sartorius Muscle
o Sub-Sartorial Canal
o Hunter’s Canal
What is contained in the Adductor Canal?
o Femoral V.A.N.
o Saphenous Nerve (Longest branch of the Femoral Nerve)
What are the muscles of the Posterior Thigh?
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o Semitendenosus
o Semimembranous
o Long Head of the Biceps Femoris
o Short Head of the Biceps Femoris
What is the nerve supply to the Posterior Compartment of the Thigh?
o Tibial Nerve
What is the blood supply to the Posterior Compartment of the Thigh?
o Deep Femoral Artery
The Short Head of the Biceps Brachii is an exception. Why?
o It is innervated by the Common Fibular Nerve (not the Tibial)
What is the Pes Anserinus?
o Goose foot from three muscles:
 Semitendinosus
 Gracilis
 Sartorius
Where does the Pes Anserinus insert?
o Medial Aspect of the Tibia
When does the Femoral Artery become the Popliteal Artery?
o After it passes through the Adductor Magnus Muscle
What is in the Popliteal Fossa? What is the deepest structure?
o Popliteal Artery (deepest)
o Popliteal Vein
o Tibial Nerve
o Fibular Nerve
THE KNEE AND THE LEG:
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The Synovial Hinge Joint of the knee is composed of three Articular Surfaces.
What are these?
o Two Femorotibial Articulations between the Lateral and Medial
Condyles
o One intermediate Femoropatellar Articulation between the Patella
and Femur
What are the aspects of stabilization of the knee?
o Muscles and their tendons
 Vastus Lateralis
 Vastus Medialis
o Ligaments connecting the Femur and the Tibia
How does the Popliteus Tendon pass out of the Joint Capsule? Where does it
attach?
o Through a hole in the Fibrous Layer of the Capsule
o Attaches to Tibia
The tendon of what muscle forms the superior aspect of the Joint Capsule?
o Quadraceps Femoris
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What is the bursae of the knee that is important during extension of the leg?
o Suprapatellar Bursa
What are the two important ligaments of the knee joint that function in
stability?
o Medial Collateral (MCL)
o Lateral Colateral (LCL)
What type of force does the MCL and LCL protect against?
o MCL: Valgus
o LCL: Varus
What is the function of the Medial and Lateral Menisci?
o Deepen the shallow tibial articular surfaces and help to prevent sideto-side rocking of the femur on the tibia
What is the difference between the Medial and Lateral Menisci?
o Medial Meniscus: Oval
o Lateral Meniscus: Circular
Where does the Anterior Cruciate Ligament (ACL) Originate and Insert?
What is its function?
o Originates: Anterior Part of the Intercondylar Region
o Inserts: Lateral Femoral Condyle
o Function: Prevents slipping during extension of the knee
Where does the Posterior Cruciate Ligament (PCL) Originate and Insert?
What is its function?
o Originates: Posterior Part of the Intercondylar Region
o Inserts: Medial Femoral Condyle
o Function: Prevents slipping of the femur towards the tibia (flexing the
knee)
What connects the two menisci anteriorly?
o Transverse Genicular Ligament
To what ligament is the Tibial Collateral Ligament attached?
o Medial Miniscus
What is the only muscle allowed through the joint capsule?
o Popliteus Muscle
What muscle is the Oblique Popliteal Ligament formed from?
o Semimembranous Muscle
What is the most important function of the Popliteus Muscle?
o The key to unlocking the extended leg
When the knee locks (when extended) what way does it slightly rotate?
o Medially
What does the Unhappy Triad contain?
o Anterior Cruciate Ligament
o Medial Meniscus
o Medial (Tibial) Collateral Ligament
What is significant about the Unhappy Triad?
o When the knee is hit from the lateral side, usually all three ligaments
tear at the same time.
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The Synovial Membrane extends where?
o Tendon of the Quadriceps Femoris
Where does the IT Band insert?
o Gerdy’s Tubercle of the Tibia (lateral)
What are the three compartments of the Leg?
o Anterior, Posterior, and Lateral
What are the muscles of the Anterior Compartment of the leg?
o Tibialis Anterior M
o Extensor Digitorium Longus M
o Extensor Hallucis Longus
o Fibularis Tertius M
What is the nerve supply to the Anterior Compartment of the leg?
o Deep Fibular Nerve
What is the blood supply to the Anterior Compartment of the leg?
o Anterior Tibial Artery
What holds the Extensor Muscles against the leg?
o Extensor Retinaculum
Where does the Fibularis Tertius (Anterior Compartment) insert?
o Only on Digit 5
What are the muscles of the Lateral Compartment of the leg?
o Fibularis Longis M.
o Fibularis Brevis M.
What is the nerve supply to the Lateral Compartment of the leg?
o Superficial Fibular Nerve
What is the blood supply to the Lateral Compartment of the leg?
o Fibular Artery
What are the Superficial Muscles of the Posterior Compartment of the leg?
o Gastrocnemius
o Plantaris
o Soleus
What are the Deep Muscles of the Posterior Compartment of the leg?
o Popliteus
o Flexor Hallucis Longus M
o Flexor Hallucis Digitorum M
o Tibialis Posterior M
What is the nerve supply to the Posterior Compartment of the leg?
o Tibial Nerve
What is the blood supply to the Posterior Compartment of the leg?
o Posterior Tibial Artery
What muscles make up the Triceps Surae?
o Gastrocnemius (Medial and Lateral Head)
o Soleus
What is the order of structures passing into the sole of the foot around the
MEDIAL Malleolus?
o Tom, Dick, and Very Naughty Harry
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o Tibialis Posterior
o Flexor Digitorum Longus M.
o Posterior Tibial Artery
o Posterior Tibial Vein
o Tibial Nerve
o Flexor Hallucis Longus M
What drains the Great Saphenous Vein?
o Femoral Vein
What drains the Small Saphenous Vein?
o Popliteal Vein
Where does lymph drain from the Great Saphenous Vein?
o Superficial Inguinal Lymph Nodes
Where does lymph drain from the Small Saphenous Vein?
o Popliteal Lymph Nodes
THE FOOT AND ANKLE
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What three bones make up the Ankle (Talocrural) Joint?
o Tibia
o Fibula
o Superior Talus (Trochlea)
What is the name of the socket formed by the Tibia and the Fibula, where the
Talus sits?
o Malleolar Mortise
Is the Malleolar Mortise stronger when the foot is Dorsiflexed or Plantar
Flexed?
o Dorsiflexed
When is the ankle joint most unstable (Dorsiflexion or Plantar Flexion)?
o Plantar Flexion
What is the Subtalar Joint?
o The joint between the Talus and the Calcaneus
How is the ankle joint reinforced LATERALLY?
o Lateral Ligament of the Ankle
 Anterior Tibiofibular Ligament
 Posterior Tibiofibular Ligament
 Calcaneofibular Ligament
How is the ankle joint reinforced MEDIALLY?
o Deltoid Ligament
 Tibionavicular
 Tibiacalcaneal
 Anterior Tibiotalar
 Posterior Tibiotalar
What is the ligament that is most frequently torn in an Ankle Sprain?
o Lateral Ligament of the Ankle:
 Anterior Tibiofibular Ligament***
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 Calcaneofibular Ligament
Name the 7 Tarsal Bones.
o Calcaneus
o Talus
o Lateral, Intermediate, Medial Cunieforms
o Cuboid
o Navicular
What bones make up the Forefoot?
o Metatarsals
o Phalanges
What bones make up the Midfoot?
o Cunieforms
o Cuboid
o Navicular
What bones make up the Hindfoot?
o Talus
o Calcaneus
What are the three important ligaments that support the longitudinal arch?
o Plantar Calcaneonavicular Ligament (Spring Ligament)
o Long Plantar Ligament
o Short Plantar Ligament
What are the four compartments of the foot?
o Medial Compartment (big toe)
o Central Compartment
o Lateral Compartment
o Interosseous Compartment
What are the two Intrinsic Muscles of the Dorsal Foot?
o Extensor Digitorum Brevis – Intrinsic
o Extensor Hallucis Brevis – Intrinsic
What are the two Extrinsic Muscles of the Dorsal Foot?
o Extensor Digitorum Longus
o Extensor Digitorum Brevis
What is the band on the Dorsal Foot that holds all of the muscles in place
called?
o Inferior Extensor Retinaculum
What is the Plantar Aponeurosis? What arch does it support?
o Thickening of deep fascia in the sole of the foot.
o Longitudinal Arch
What are the 3 Superficial Muscles of the Plantar Foot (Layer One)?
o Flexor Digitorum Brevis M
o Abductor Digiti Minimi <
o Abductor Hallucis M
What are the 3 Muscles of the Plantar Foot (2nd Layer)?
o Lumbrical M
o Flexor Digitorum Longus
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o Quadratus Plantae
What are the 3 Muscles of the Plantar Foot (3rd Layer)?
o Adductor Hallucis (Transverse and Oblique Heads)
o Flexor Digiti Minimi
o Flexor Hallucis Brevis (Medial and Lateral Heads)
What are the muscles of the Plantar Foot (4th Layer)?
o PADs – Plantar Interossei Adduct (3)
o DABs – Dorsal Interossei Abduct (4)
What is the keystone bone of the Medial Arch?
o Head of the Talus
CLINICAL COORELATIONS:
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What is Trendelenburg Sign?
o Tests for entrapment of Superior Gluteal Nerve
o If someone stands on their left leg, and their right hip drops, then the
Gluteus Medius and Gluteus Minimus on their supported side is not
working.
What is Piriformis Syndrome?
o Neuromuscular Disorder where the Sciatic Nerve is
compressed/irritated by the Piriformis Muscle.
o Causes pain, tingling, numbness
Where do you perform an Intramuscular Injection?
o Superolateral Quadrant of the Buttock
What is the Alternative Site for an Intramuscular Injection?
o Between Anterior Superior Iliac Spine, Tubercle of the Iliac Crest, and
the Greater Trochanter
What nerves are you trying to avoid when performing an Intramuscular
Injection?
o Superior Gluteal Nerve
o Sciatic Nerve
What is Meralgia Parasthetica?
o Numbness and tingling of outer thigh
o Compression of Lateral Cutaneous Nerve of Thigh (as it passes under
Inguinal Ligament)
What is Gluteal Crush Injury Compartment Syndrome?
o Secondary complication following trauma
o Increase in interstitial pressure due to internal bleeding. Fascia is
tough and the pressure causes ischemia in the thigh muscles.
What is the Galeazzi Test (Allis Sign)?
o Holding infants feet against their buttocks and comparing the two
knees.
o If one is higher than the other, the test is positive for Congenital Hip
Dislocation.
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What is Perthes Disease?
o Deformity of the Femoral Head
o Loss of blood supply due to the Cruciate Anastomoses causes the bone
to stop growing, leading to a weak bone and a loss of bone mass.
o Found in children.
What is Osgood-Schlatter Disease (OSD)?
o A painful lump just below the knee due to inflammation of the Patellar
Ligament at the Tibial Tuberosity
o Due to overuse
What is the difference between Westphal’s Sign and Cerebellar Disease?
o Westphal’s Sign: Absence or Decrease of Patella Tendon Reflex
o Cerebellar Disease: Multiple oscillation of leg
What is a Popliteal Artery Aneurysm?
o Causes dilation of the Popliteal Artery
 Edema and pain in the Popliteal Fossa (back of knee)
How do you bypass a Popliteal Artery Aneurysm?
o Ligate the Femoral Artery using the Genicular Anastomoses
o Superficial Lateral Geniculate Artery
What is a Motorbike Passenger Fracture of the Femur?
o Both condyles are broken using a Y or T shape
What is the most common Dislocation of the Patella?
o Lateral
o Due to lateral tension of Iliotibial Banda and predominance of Vastus
Lateralis M.
What ligament does the Anterior Drawer Sign test?
o ACL
o Pull up on the leg
What ligament does the Posterior Drawer Sign test?
o PCL
o Push down on the leg
What is a Baker’s Cyst?
o Collection of Synovial Fluid that has escaped the knee joint
What is Foot Drop?
o Irritation to the Common Fibular Nerve (Common Peroneal Nerve)
causes the foot to drop.
What are Varicose Veins caused by?
o Valvular Incompetence
What is Elephantiasis/Lymphedema?
o Swelling of the legs when lymph isn’t flowing normally
What does sensory to the medial leg?
o Saphenous
What does sensory to the lateral leg?
o Sural
What is a Pott’s Fracture?
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o An ankle fracture where there is forced eversion (abduction) of the
foot.
What ligament is affected during a Pott’s Fracture?
o Deltoid
What bone is fractured during a Pott’s Fracture?
o The Fibula
What is the Chopart’s Amputation?
o Amputation made between the Calcaneus/Talus and the
Cuboid/Navicular.
o Only the Calcaneus and Talus are left of the foot bones.
What is the Lisfranc Amputation?
o Amputation made between the Cunieforms and the Metatarsals.
o All bones still in tact besides the Metatarsals and the Phalanges