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1. What is the superficial fascia of leg?
A: fascia lata (b/c it’s milky white). It invests thigh, leg, and dorsal foot
2. What is the ilio-tibial band?
A: the thickened portion of fascia lata on lateral aspect of leg
3. What is the IT tract?
A: Ilio-tibial band + gluteus maximus fibers inserting on it + tensor fascia lata
4. What does the superficial fascia contain?
A: superficial inguinal lymph nodes, superior portion of great saphenous vein, femoral br of genitofemoral n, ilio-inguinal n brs, superficial epigastric vein, and ant cut n of thigh
5. Where does most of the superficial lower limb drain?
A: Into vertical group of superficial inguinal lymph nodes
6. What drainage does the horizontal group receive?
A: Drainage from ant abdominal wall below umbilicus + perineal contents + uterine fundus
7. What are the 2 main veins of importance in leg?
A: great saphenous vein and small saphenous vein
8. What drains the medial thigh and leg? Where does it drain into? What is it continuous with?
A: a) great saphenous vein b) drains into femoral vein in femoral triangle c) continuous w/medial dorsal venous arch of foot
9. What drains the posterior leg? Where does it drain to? What is it continuous with?
A: a) small saphenous vein b) drains into deep veins of popliteal fossa c) continuous with lateral dorsal veinous arch of foot
10. What cutaneous nn innervate the lateral thigh?
A: lateral femoral cutaneous nerve (L2-3)
11. What cutaneous nn innervate the anterior thigh?
A: mainly brs of femoral n (L2-3)
12. What cutaneous nn innervate the posterior thigh?
A: dominated by posterior femoral cutaneous nn
13. What kind of joint is the hip joint?
A: ball-and-socket joint
14. What types of mvmt are possible?
A: gliding, rotation, and very limited translation
15. What is the purpose of the ligament of the head of the femur?
A: serves to limit mvmt, particularly translation, but does NOT prevent dislocation of the joint
16. What factors increase the congruity of the hip joint?
A: a) bony rim of acetabulum is most robust and congruent superiorly, where biomechanical need for osseous support is greatest b) soft-tissue stabilizers include the acetabular labrum and tough fibrous joint capsule c) fiber orientation of HIP LIGAMENTS counters tension in a neutral standing position, where center of mass passes just posterior to the center of femoral head
17. Describe the articulation of hip joint
A: multiaxial synovial joint; spheroidal femoral head articulates moderately but not completely congruently w/cotyloid (cup-shaped) acetabulum
18. What is the acetabulum?
A: an incomplete ring
19. What is the lunate surface of the acetabulum?
A: covered with articular cartilage
20. What is the acetabuluar fossa?
A: contains intra-articular fat pad
21. What is the acetabular labrum?
A: fibrocartilagenous ring surrounding acetabulum increasing depth and congruence
22. What is the transverse acetabuluar ligament?
A: it is part of the acetabular labrum but contains no chondrocytes; covers notch at anterior-inferior margin, leaving foramen to allow communication of nervous and vascular supply
23. What does the neutral position of hip joint correspond to?
A: Corresponds to erect posture; femoral head and its articular cartilage is not completely covered by acetabulum. Anterio-superior aspect is exposed.
24. What is required so that the articular surfaces are in full contact w/acetabulum?
A: 90 degree flexion + abduction + lateral rotation
25. What position does this bring the thigh into?
A: quadrepedal position; “true physiological position of hip”
26. What does extension do to the ligaments of hip joint? Flexion?
A: Extension winds ligaments around neck of femur, and flexion unwinds them
27. What is the iliofemoral ligament?
A: anterior location, apex attached to ASIS and base attached along length of trochanteric line. Contains thickened bands of ilio-trochanteric band and inferior band surrounding a weaker central section
28. Where is the ilio-tendono-trochanteric ligament?
A: superior to the iliofemoral ligament
29. What is the puborfemoral ligament?
A: anterior, iliopubic eminence and superior ramus of pubis to anterior surface of trochanteric fossa.
30. What is the ishiofemoral ligament?
A: arises from posterior surface of acetabular rim and labrum, attaching to inner surface of greater trochanter anterior to trochanteric fossa. Some fibers blend w/zona orbicularis
31. What 2 main aa vascularize thigh?
A: inferior gluteal and superior gluteal aa
32. What a is inferior to piriformis m, supplies glut max m as well as sciatic n, and gives rise to trochanteric network?
A: inferior gluteal artery
33. What a is superior to piriformis, supplies glut medius and minimus and tensor fascia lata m, w/superficial br to glut max
A: superior gluteal artery
34. What is the cruciate anastomosis? What does it help circumvent?
A: connects internal iliac w/femoral artery. Helps circumvent ext iliac block
35. What is cruciate anastomosis composed of?
A: medial femoral circumflex a, lateral femoral circumflex a – transverse br, inferior gluteal a, and 1st perforating a
36. What is gluteus maximus used for? What is it innervated by?
A: powerful extensor; climbing stairs and running; not generally walking. Innervated by inferior gluteal n
37. What are medius and minumus used for? What are they innervated by?
A: abductors. Fcns to counteract pelvic tilt; used extensively in walking. Innervated by superior gluteal n
38. What is Trendelenburg’s sign?
A: failure of lateral gluts (medius/min) which results in side-to-side lurching, due to failure to counteract pelvic tilt.
39. What are the lateral (short) rotators mostly innervated by?
A: Mostly innervated by lumbosacral plexus associated w/tibial n (caudal ventral)
40. What are the exceptions to the lateral rotator innervation?
A: piriformis = caudal dorsal Obdurator external = cranial ventral
41. Where do ALL lateral rotators insert ?
A: Insert posterior proximal femur along “inside” of intertrochanteric crest
42. What are the mm in order from superior to inferior (lateral rotators)?
A: piraformis, superior gemellus, obdurator internus, inferior gemellus, obdurator externus, and quadratus femoris
43. What m originates from anterior sacrum? What is its n?
A: piraformis (CAD). Innervated by n to piraformis from peroneal div of lumbosacral plexus; enters anterior
44. What m originates from ishial spine? What is its n?
A: superior gemellus. Innervated by n to obdurator internus from lumbosacral plexus (enters lesser sciatic formamen)
45. What m originates from obdurator membrane? Innervation?
A: Both obdurators (internus and externus). Internus gets n to obdurator from lumbosacral plexus while externus gets obdurator n.
46. What m originates from ishial tuberosity? Innervation?
A: inferior gemellus. Innervated by n to quadratus femoris from lumbosacral plexus (deep to inf gemellus)
47. What m originates from medio-superior to glut tuberosity? Innervation?
A: quadratus femoris; Innervated by n to quadratus femoris from lumbosacral plexus (deep to quad fem)
48. What is a landmark for the sciatic n?
A: piriformis m (sciatic n emerges inferior to it)
49. What is sciatica?
A: real or referred pain along sciatic n. Can result from a) n impingement from intervertebral disk rupture or collapse b) intrapelvic tumor c) n inflammation
50. In approx 85% of cases the sciatic n exits the pelvis where?
A: deep to muscle belly of piriformis
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