Anatomy #2 - Pt 2

What are the proximal attachments of biceps femoris (hamstrings)?

PA of long head: Tuberosity of ischium

PA of short head: Linea aspera and lateral supracondylar line of femur

What is the distal attachment of biceps femoris?

Lateral head of fibula - tendon split into 2 parts by LCL

What are the innervations and actions of biceps femoris?

Nerve to LH: tibial division of sciatic

Nerve to SH: common fibular

Action: flex knee, lateral rotation of leg

What are the attachments of semitendinosis?

PA: ischial tuberosity

DA: Pes anserine and medial surface of superior part of tibia

What are actions and innervation of semitendinosis?

N: Tibial division of sciatic

A: flex knee, medial rotation of leg

What are the attachments of semimembranosus?

PA: Ischial tuberosity

DA: Medial condyle of tibia and lateral condyle of femur

What are the actions and innervation of semimembranosus?

N: Tibial division of sciatic

A: flex knee, medial rotation of leg

What presentation during the Thomas test would indicate a tight iliopsoas?

Lordosis of lumbar spine, thigh flexed off table

What presentation during a Thomas test would indicate a tight rectus femoris?

Knee extended, not able to relax to 80 deg of knee flexion

What presentation during the Ober test would indicate tight TFL?

Hip flexion and abduction above midline

If a patient’s pelvis remains level during the Trendelenberg test, what does this indicate?

Strong glute med and min

During the Trendelenberg test, if the pt’s pelvis tilts to the opposite side of the standing leg, what is the problem?

Weakness in the glute med and min on standing side

What compensatory movement often shows in trendelenberg gait?

Wide swing of leg to accommodate for lack of foot clearance

What side will someone with a trendelenberg gait lean towards to assist in foot clearance?

Towards the weak side

What does the straight leg test assess?

Lumbar radiculopathy - pain felt in back, butt, or into leg with hip flexion

What does the 90 90 straight leg test measure?

Hamstring tightness - pt can’t straighten leg at the knee with hips flexed

What muscles does the femoral nerve innervate?

Iliacus

Sartorius

All quads

Pectineus

What muscles does obterator nerve innervate?

Adductor longus

Adductor brevis

Adductor portion of adductor magnus

Gracilis

Obturator externus

The sciatic nerve is made up of what 2 branches?

Common fibular and tibial

What are the motor responsibilities of the tibial branch of sciatic nerve?

Posterior leg and foot

What are the motor responsibilities of common fibular branch of sciatic nerve?

Lateral compartment, tibialis anterior, toe extensors

What movement occurs at the sacroiliac joint?

Slight gliding and rotational movements

The greater sciatic foramen is created by what ligament?

Sacrospinous

The bursa that separates gluteus maximus from greater trochanter is which?

Trochanteric bursa

The bursa that separates iliotibial tract from superior part of proximal attachment of vastus lateralis is which?

Gluteofemoral bursa

The bursa that separates inferior part of gluteus maximus from ischial tuberosity is which?

Ischial bursa

What are the proximal attachments of gluteus maximus?

Ilium behind posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberus ligament

What are the distal attachments of glute max?

Iliotibial tract, some fibers on gluteal tuberosity

What are actions and innervation of glute max?

N: inferior gluteal nerve

A: Extend thigh from flexed position, lateral rotation, knee stability

When seated, are you sitting on glute max?

No, it only pads ischial tuberosities when hips extended

What are attachments of gluteus medius?

PA: external surface of ilium between ant. and post. gluteal lines

DA: lateral surface of greater trochanter

What are actions and innervation of glute med?

N: superior gluteal nerve

A: abduct and medially rotate thigh, keeps pelvis level when opposite leg is raised

What are attachments of glute min?

PA: external surface of ilium between ant. and inf. gluteal lines

DA: anterior surface of greater trochanter

What are actions and innervation of glute min?

N: superior gluteal nerve

A: abduct and medially rotate thigh, keeps pelvis level when opposite leg is raised

What are the attachments of piriformis (deep gluteal)?

PA: Anterior sacrum and sacrotuberus ligament

DA: Superior border of greater trochanter

What are actions and innervations of piriformis?

N: ventral rami of S1-S2

A: laterally rotates extended thigh, abducts flexed thigh, steady femoral head

What is proximal attachment and innervation of superior gemellus?

PA: ischial spine

N: nerve to obturator internus (L5, S1)

What is proximal attachment of obturator internus and innervation?

PA: pelvic surface of obturator membrane

N: nerve to obturator internus (L5, S1)

What is proximal attachment and innervation of inferior gemellus?

PA: ischial tuberosity

N: nerve to quadratus femoris (L5, S1)

What muscles make up the triceps coxae?

Superior gemellus

Obturator internus

Inferior gemellus

What is the distal attachment of all triceps coxae?

Medial surface of greater trochanter - trochanteric fossa

What are the actions of triceps coxae?

laterally rotates extended thigh, abducts flexed thigh, steadies femoral head

What are the attachments of quadratus femoris?

PA: Lateral border of ischial tuberosity

DA: Quadrate tubercle on intertrochanteric crest

What are actions and innervations of quadratus femoris?

N: Nerve to quadratus femoris (L5, S1)

A: laterally rotates thigh, steadies femoral head

What are actions and innervations of obturator externus?

N: obturator (L3, L4)

A: laterally rotates thigh and steadies femoral head

What are attachments of obturator externus?

PA: Obturator foramen and membrane

DA: Trochanteric fossa of femur

What is piriformis syndrome?

Common fibular nerve pierces piriformis, which may lead to entrapment

What is a symptom of piriformis syndrome?

Pain in butt

What is the innervation of all hamstrings (biceps femoris, semitendinosis, semimembranosus)?

Sciatic

Coxa vara means:

Decreased angle of inclination - closer to 90 degrees

One with coxa vara will have ___ leg length?

Shorter

What is the normal adult range for angle of inclination of femur?

125-130 degrees

Coxa valga means:

Increased angle of inclination

One with coxa valga will have ____ leg length

Increased

Coxa valga can lead to increased risk of what?

Femoral head dislocation

Someone with coxa valga could walk with ____ rotation?

External

If the angle of torsion of the femur is greater than 15 degrees, which way will the toe point when hip is aligned?

In - pigeon toe

If the angle of torsion of the femur is less than 15 degrees, which way will the toe point when hip is aligned?

Out

Excessive anteversion is an angle of torsion _____ than 15 degrees?

Greater

Retroversion is an angle of torsion ____ 15 degrees?

Less

Vara/varum is a ____ in angle (< or >?)

Decrease

Valga/valgus is a _____ in angle (< or >?)

Increase

If the knees are in valgum, are the knees closer together or farther apart?

Closer together - GUM = sticking knees together

If the knees are in varum, are the knees closer together or farther apart?

Farther apart - RUM = space for rum bottle between legs

What is Q angle?

Angle between quadriceps tendon and patellar tendon

An increased Q angle is risk for what?

Patellar subluxation

The medial circumflex artery supplies blood to what part of leg?

Neck of femur and hip joint

The lateral circumflex artery supplies blood to what part of the leg?

Muscles in hip region

The artery to the head of femur comes from what?

Branch of obturator artery

What are all the movements of the hip joint?

Flex/ext, abd/add, IR/ER, circumduction

What ligaments are taut during external rotation of hip?

Superior iliofemoral and pubofemoral

What ligament is taut during internal rotation of the hip?

Ishciofemoral

Hip abduction tightens what ligaments of the pelvis?

Pubofemoral and ischiofemoral

Hip adduction tightens what ligament of the pelvis?

Superior iliofemoral

What is an ortolani sign of the hip?

Audible clunk or click

To test for congenital hip dislocation, how should you administer an Ortolani’s test?

Flex hip and knees in supine, then abduct thighs

What are treatment options for congenital hip dislocation?

Double/triple diapering

Pavlik harness

What nerve could possibly be damaged in a posterior hip dislocation?

Sciatic

What is a common MOI for posterior hip dislocation?

Knee strikes dashboard in car accident

Where does the femur lie in relation to acetabulum when hip is posteriorly located?

Femur posterior to acetabulum

After an anterior dislocation of the hip, where does the femoral head typically lie?

Inferior to acetabulum

Anterior dislocation occurs when hip is forced into what positions?

Extension, abduction, and lateral rotation

What MOI of the hip causes a central dislocation of the femur?

Blow to lateral aspect of hip, especially with hip in abduction

Where does the femoral head end up after a central dislocation?

Driven deeper into acetabulum

A slipped capital femoral epiphysis (SCFE) is a fracture through what part of the femur?

The growth plate

In SCFE, the femoral head is ______ and the neck moves ______?

Seated, upward

Legg Calve Perthes (LCP) comes from what? How long does it usually last?

Blood loss to the femoral head - bone dies and stops growing

Usually resolves in 2 years

LCP occurs in what patient demographic?

Kids under 10 years old - mostly boys

What is a common treatment for LCP?

Hippotherapy - abduction and unweighting for pain relief

Avascular necrosis (AVN) of the femoral head is caused by what?

Interruption of blood supply to the bone

AVN typically follows what kinds of pathology?

Trauma

ETOH abuse

Sickle cell

A labral tear at the hip creates what kind of sensation?

“giving way” - snapping clunk

What position does a pt most often feel pain with a labral tear?

Hip flexion

Femoral acetabular impingement (FAI) manifests into 2 types - what are they?

Cam - femoral head shape is too large in acetabulum

Pincer - acetabulum covers femoral head too much

FAI happens at what stage of life?

Childhood - hip bones don’t form normally

FAI leads to what decreased ROM?

IR and adduction

In one form of snapping hip syndrome, iliopsoas subluxes over what landmark of the femur?

Lesser trochanter

In another from of snapping hip syndrome, the lateral IT band moves over what landmark of the femur?

Greater trochanter

In a total hip replacement, what parts are replaced?

Both the head and neck of femur, and acetabulum

In a partial hip replacement, what portion of the hip is NOT replaced?

Acetabulum