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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
51. In 11% of cases, sciatic does what?
A: splits the common peroneal n and tibial n
52. Where might you want to give an intramuscular injection?
A: thumb and thenar eminence on ASIS, then “safe” area is under your outstretched hand
53. What is piriformis syndrome?
A: evolving compression of sciatic n by piriformis m. Assocaited w/acute trauma to bum and occurs when sciatic n exits posterior to piriformis. Pt finds sitting difficult and hip flexion and internal rotation very painful; almost impossible.
54. What is Pace’s sign?
A: On physical exam, forcing internal rotation of extended thigh will cause pain
55. What is tx for piriformis syndrome?
A: rest and oral anti-inflammatory drugs
56. What stxs would you want to avoid when giving an intramuscular injection?
A: greater trochanter and superior gluteal n
57. What m does the glut max (in leg) correspond to in the arm?
A: Glut max is an extensor. It corresponds to the deltoids
58. What m does tensor fascia lata m (in leg) correspond to in the arm?
A: Tensor fascia lata is a strong hip flexor. It corresponds to anterior deltoids
59. Where is the fascia lata thicker and more regular?
A: on the lower leg
60. What is the fascia lata continuous with?
A: the intermuscular septa (between vasa recta and biceps femoris
61. What 2 mm wraps around to the posterior part of thigh (and thus can potentially be tagged on the posterior leg – when we are used to seeing it anteriorly)?
A: vasa lateralis and adductor magnus (if it is big enough)
62. What does tight fascia around lower limb help with
A: assists in venous return
63. Great saphenous v is like what v we saw in the arm?
A: cephalic v
64. Small saphenous v is like which v we saw in the arm?
A: basilica v
65. Why do we have natal folds?
A: If you didn’t have it, gravity would pull all your butt fat down your leg. Eew!
66. Why does glut max insert lower than natal fold?
A: b/c it is a hip extensor
67. Where is the intertrochanteric crest? Line?
A: Crest is on posterior side of femur. Line is on anterior side of femur. (Both run between greater and lesser trochanter)
68. What attaches to the crest? Line?
A: muscle attaches to the crest. Ligaments attach to the line.
69. What is the best way to dislocate your hip?
A: Be a passenger in the car with your legs crossed and have knee hit dash hard. (Hip is flexed and adducted)
70. Which m inserts on the posterior side of the greater trochanter? Anterior side?
A: Glut med inserts on posterior. Glut min inserts on anterior
71. What way do the glut med fibers run?
A: oblique course
72. What are some good landmarks when looking at glut med?
A: find greater trochanter, across from it you should find ischial tuberosity
73. When you test passive motion of internal rotation on your patient, he complains of a dull achy pain. What could be one possible dx?
A: bursitis. There is a bursa present on top of ischial tuberosity to cushion obturator internis tendon. You can also palpate the the ischial tuberosity and elicit pain that way too.
74. What does the inferior gluteal a supply?
A: think of it as the posterior hip artery. It supplies: inferior portion of glut max, the lateral rotators, has a slip to the sciatic n, and also supplies the posterior hamstrings
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