Gross Anatomy - Lecture Exam III

What are the 3 primary functions of the lower extremity?

1. support weight of body

2. provide a stable foundation while standing

3. allow locomotion

How is the LE different from the UE in bones, joints, muscles, and blood vessels?

bones = heavier/strong with well marked areas for muscle/ligament attachments

joints = stronger/more stable, good bony configurations

muscles = more powerful, less capable of delicate movements

blood vessels = larger

How is the foot adapted for functioning of the lower extremity?

take impact of whole body with every steps

sustains weight during prolonged standing

standing/walking on uneven ground

What a complete pelvic bone consists of:

2 innominates

Ilium

Ischium

Pubis

The 2 innominates of the pelvis articulate with what?

sacrum and femur

What vertebrae form the false pelvis?

posterior = lumbar vertebrae

lateral = ilium

anterior = abdominal wall

What vertebrae form the true pelvis?

posterior = sacrum and coccyx

lateral and anterior = ilium, ischium, pubis

Is the false pelvis completely surrounded by bone? What does it help to protect?

No! also contains soft tissue

abdominal viscera

Is the true pelvis completely surrounded by bone? What does it surround in females?

Yes, birth canal

Why is the false pelvis called the major?

because it contains more area

What are the 4 functions of the pelvic bone?

1. protect pelvic viscera

2. transmits body weight to limbs/absorbs stress

3. locomotion (pelvis swings side to side)

4. bony support for birth canal (female only

Sexual dimorphism: how does general structure of pelvis differ for males and females?

male = thicker prominent processes, longer

female = thinner, not as prominent, shorter

Sexual dimorphism: how does pelvic inlet of pelvis differ for males and females?

male = heart shaped

female = round/oval

Sexual dimorphism: how does pelvic outlet of pelvis differ for males and females?

male = narrower

female = wider

Sexual dimorphism: how does anterior superior iliac spines (ASIS) of pelvis differ for males and females?

male = closer together

female = farther apart

Sexual dimorphism: how do greater sciatic notches of pelvis differ for males and females?

male = narrower

female = wider

Sexual dimorphism: how does obturator foramen of pelvis differ for males and females?

male = round

female = triangular

Sexual dimorphism: how does acetabulum of pelvis differ for males and females?

male = face laterally

female = face more anteriorly (you can see most of it)

Sexual dimorphism: how does symphysis pubis of pelvis differ for males and females?

male = longer

female = shorter

Sexual dimorphism: how does the pelvic arch differ for males and females?

male = acute (<90)

female = obtuse (>90)

What feature on an innominate bone separates the true pelvis from the false pelvis?

arcuate line

The sacrum articulates with which feature on an innominate?

auricular surface

What are the 4 groups that pelvic bones have been classified into?

android = typical male

gynecoid = typical female

anthropoid = exaggerated male (longer)

platypelloid = exaggerated female (wider)

How does a pelvic fracture occur?

direct trauma or transmitted by forces during fall on feet or knees

Where are the most common places for a pelvic fracture?

pubic rami (superior and inferior

acetabulum

sacroiliac

most lateral aspect of ilium

What else is likely to fracture when the pelvic bone is fractured? Why?

sacrum

the pelvis is a bony ring, common to have a fracture 180 degrees opposite from initial fracture

What is a risk associated with fracture of the pelvic bone?

injury to nerves, blood vessels, or visceral organs = high mortality rate

What is a hip pointer? What can they result in?

contusion injury of soft tissue associated with iliac crest

hematoma

What are the 3 primary ossification centers associated with the pelvis?

1 for each ilium, ischium, and pubis

How many total primary ossification centers of the pelvis?

6 (3 right, 3 left)

How many secondary ossification centers are associated with the pelvis? Where?

5

iliac crest

anterior inferior iliac spine

ischial tuberosity

pubis symphysis

center of acetabulum

Name 2 of the secondary ossification centers associated with an innominate bone? (question from slides)

acetabulum and pubis symphysis

Of the 3 lines that are found below the greater and lesser trochanters, which is the most medial?

spiral line

When does the pelvic bone complete ossification?

between 20-22 years of age

What is the average length of a femur?

1/4 of the body, about 18 inches

What are the 5 secondary ossification centers associated with the femur?

head

greater trochanter

lesser trochanter

distal end (condyles, epicondyles)

When does the femur complete ossification in females? Males?

female = 15

male = 17.5

Where is the angle of inclination found on the femur?

where the neck of the femur meets the shaft of the bone

How does angle of inclination differ from birth through adulthood?

birth = greatest angle (145 degrees)

adulthood = 125 degrees (when bone is ossified)

What are 2 advantages of the angle of inclination?

greater mobility at hip joint and bipdeal locomotion

What is one disadvantage of the angle of inclination?

stress on neck of femur so increased risk of fracture as one ages

What is coxa valga? What is it associated with clinically?

increase in angle of inclination

associated with developmental dysplasia of hip (congential dislocation)

What is coxa vara? What is it associated with clinically?

decrease in angle of inclination

fractures in proximal part of femur and Ricket's

What is a subcapital fracture?

fracture through neck of femur, "broken hip"

What is a population that is at risk for subcapital fracture and why?

older individuals because of osteoporosis, especially postmenopausal women due to decreased estrogen

What is a major consequence of a subcapital fracture?

interrupt blood supply leading to avascular necrosis of head of femur

What kind of bone is the patella? Where is it found?

sesamoid bone

within common tendon of insertion for quadriceps

What is the superior border of the patella called? Inferior?

superior = base

inferior = apex

Which facet of the patella is larger, lateral or medial?

lateral

What are the functions of the patella?

additional leverage to quadriceps during last part of extension of leg

increase power of extension

Explain the ossification of the patella and why it is unique

from a single ossification center that appears at age 3

When does ossification of the patella complete for females? Males?

female = 10

male = 13

What happens during a direct fracture of the patella?

small comminuted fragments, tendon of insertion holds the pieces

What happens during an indirect fracture of the patella?

quadriceps contracts suddenly causing transverse fracture through body of bone

What are 3 common symptoms of a patella fracture?

1. severe pain

2. swelling/tenderness

3. inability to carry out extension at knee joint

What is patella emarginata?

superior lateral portion of patella remains unossified

What is bipartite patella?

superior lateral portion ossifies independently, gets a secondary ossification center

T/F? A bipartite patella is a fracture

False

What is chondromalacia?

softening/fissuring of articular cartilage on posterior aspect of patella

What are common causes of chondromalacia?

trauma and overuse/muscle weakness that causes misalignment of patella

What are symptoms of chondromalacia?

dull pain around/under patella

pain intensifies when going from flexion to extension

Why is the fascia lata important?

prevents quadriceps muscles from bulging during contraction

What are the 2 muscles that insert into the iliotibial tract?

gluteus maximus and tensor fascia latae

What passes through the saphenous opening?

great saphenous vein (them terminates at femoral vein)

Where is the saphenous opening located?

proximal anterior aspect of fascia lata

What is iliotibial band syndrome?

overuse injury at distal end of band, repetitively rubs over lateral condyle of femur and irritates bursa

Someone with iliotibial band syndrome might complain of stinging where?

lateral aspect of knee

An overuse of what muscle is likely associated with iliotibial band syndrome?

gluteus maximus

What movements can occur at the hip joint?

flexion

extension

hyperextension

abduction

adduction

lateral rotation

medial rotation

circumduction (makes it universal!)

What muscle or muscles work better due to the presence of the patella bone?

quadriceps (better extension)

Where on a patella would chondromalacia show up on an X-Ray or MRI?

posterior surface (articular cartilage)

What is the name of the opening found at the proximal, anterior aspect of the fascia lata?

saphenous opening

If someone has weakness of the psoas major and iliacus muscles, what movements will they have difficulty completing?

getting up from reclining position, climbing stairs, walking up incline

What internal structures are associated with the psoas major and iliacus? Are they superficial or deep?

kidneys, lower intestinal tract, pancreas, appendix

superficial

What joints are associated with the psoas major and iliacus? Are they superficial or deep?

sacroiliac and vertebral

deep

What structure is the psoas minor sometimes mistaken for?

genitofemoral nerve in lumbar plexus

What are common causes of atrophy of the quadricep muscles?

immobilization/patients refined to bed

What are some signs and symptoms of atrophy of the quadricep muscles?

abnormal patella movements, loss of joint mobility, difficulty extending leg against resistance

How can you test for atrophy of the quadricep muscles?

have patient try to extend leg against resistance while sitting or laying down

How does the the articularis genu develop?

separates from the deepest layer of vastus intermedius

Where is the articularis genu found?

deep to quadriceps and covers anterior aspect of femur

What is the function of the articularis genu?

retracts the synovial membrane of the knee joint to help stabilize the knee

What is a Charley Horse?

cramping or spasm of quadriceps

What is jumper's knee? What population is more susceptible to this injury?

overuse injury at common tendon of insertion of quadriceps and patellar ligament

common in athletes who jump/run

How do you carry out the patellar reflex? What spinal nerves are being tested?

tap patellar ligament

L2, L3, L4

An every day movement that might be impaired with weakness of the iliacus or the psoas major

walking upstairs, up incline, reclining to sitting

What is a quadricep muscle that can carry out action at both the hip and the knee joint?

rectus femoris

What are you testing for when you carry out the patellar reflex?

segmental innervation of quadriceps L2, L3, L4

Where is the hiatus tendinous found? What structure passes through this opening?

deep to adductor longus, posterior to hamstrings

femoral vessels become popliteal vessels

A pulled groin is associated with what muscle?

adductor strain

How can a person get a pulled groin?

stretch past tensile strength

direct blow to medial thigh

sports (quick start)

What are some symptoms associated with a pulled groin?

pain/tenderness

stiffness

weakness of muscle

bruising

T/F? A strain of the iliopsoas is also classified as a pulled groin

True

What are the 2 bursae associated with the gluteus maximus?

trochanteric and ischial

What does trochanteric bursae separate?

superior part of gluteus maximus from greater trochanter

What does ischial bursae separate?

inferior part of gluteus maximus and ischial tuberosity

What movement will be limited with weakness of the gluteus maximus?

can't get from sitting to standing

A medial thigh muscle which can carry out action at both the hip and knee joint

gracilis

The hamstring action of the adductor magnus muscle

extends the femur

Explain how the tensor fascia lata and gluteus maximus help the stabilize the knee

both insert into iliotibial tract, that tightens it, crosses the knee joint to stabilize