Gross I unit III exam

primary functions of lower extremity

support weight of body, provide a stable foundation while standing, allow locomotion (walking/running)

pelvic bone

consists of a single innominate bone on each side

innominate bone

articulates with the sacrum, femur, and the other innominate bone; consists of ilium, ischium, and pubis- 3 bones separate up to age 18-20 when they fuse into 1

ilium

largest and uppermost portion of pelvic bone

ischium

L shaped bone consisting of a body and ramus

obturator foramen

large oval opening found at inferior aspect of each innominate, closed by piece of membrane called obturator membrane

false/major pelvis

bounded posteriorly by lumbar vertebrae, laterally by ilium, and anteriorly by abdominal wall; helps support and protect much of abdominal viscera

true/minor pelvis

bounded posteriorly by sacrum and coccyx, laterally and anteriorly by ilium, ischium, and pubis; surrounds birth canal in females

functions of pelvic bone

protects pelvic viscera, transmits body weight to limbs and absorbs stresses of muscular activity, allows locomotion by causing pelvic bone to swing from side to side, provides bony support for birth canal in females

sexual dimorphism of pelvic bone

pelvic bones used in forensics to determine male vs female, most obvious differences are due to adaptations of female pelvis for childbearing

general structure of male pelvis

thicker, prominent processes, longer

general structure of female pelvis

thinner, processes not so prominent

characteristics of male pelvis

heart shaped pelvic inlet, narrow pelvic outlet, round/oval obturator foramen, laterally facing acetabulum, longer symphysis pubis, acute angle of pelvic arch, narrow sciatic notch and AS iliac spine

characteristics of female pelvis

round/oval pelvic inlet, wider pelvic outlet and greater sciatic notch, AS iliac spines further apart, triangular obturator foramen, anterior facing acetabulum, shorter symphysis pubis, obtusely angled pelvic arch

android pelvis

typical male pelvis

gynecoid pelvis

typical female pelvis

anthropoid pelvis

exaggerated male pelvis

platypelloid pelvis

exaggerated female pelvis

parts of pelvis most prone to fracture

pubic rami, acetabulum, region of sacroiliac joint, most lateral aspect of ilium

fractures of pelvis

result from direct trauma or forces transmitted to boned during fall on feet or knees, often fractures in 2 places- first under trauma and other 180 degrees opposite first, may cause injury to blood vessels/nerves/organs in pelvis, high morbidity and mortality rates due to hemorrhagic shock and pelvic organ damage

hip pointers

common painful contusion injury of soft tissue associated with iliac crest, very common in contact sports, usually result in painful hematoma in area of injury

ossification centers of pelvic bone

3 primary- ilium, ischium, pubis and 5 secondary- iliac crest, anterior inferior iliac spine, ischial tuberosity, pubis symphysis, center of acetabulum, completes ossification between 20-22 years old, one of last bones to finish ossification

femur

longest/heaviest/strongest bone in body, length 1/4 of body, averages at 18 inches, transmits weight from pelvic bone to tibia in standing position, well covered with muscles so only proximal and distal ends palpable

ossification of femur

1 primary for shaft, 4 secondary for head, greater trochanter, lesser trochanter, and distal end, bone completes ossification at 15 in females and 17.5 in males

angle of inclination

the way the neck of the femur meets the shaft of the bone and creates an angle, greatest at birth and gradually diminishes until adult angle reached at ossification, allows greater mobility at hip joint by increasing leverage of muscles attached to proximal end of femur, great advantage for bipedal locomotion, puts considerable stress on neck of femur

coxa valga

increase in angle of inclination, common with developmental dysplasia of hip

angle of inclination at birth

145 degrees

angle of inclination at ossification

125 degrees

coxa vara

decrease in angle of inclination, can occur in fractures to proximal part of femur in Rickett’s

fractures of femur

commonly fractured even though it’s strongest in body, frequently age and sex related

subcapital fractures of femur

fracture through neck, known as “broken hip”, fairly common in older individuals suffering from osteoporosis, interrupt blood supply to femoral head in avascular necrosis

patella

large sesamoid bone, develops within common tendon of insertion of quadriceps, triangular shaped, superior border is base, inferior border is apex, posterior has 2 articular surfaces, anterior surface convex and marked by numerous foramina and longitudinal lines

main function of patella

gives additional leverage to quadriceps during last part of extension of leg, helps to increase power of extension movement

ossification of patella

occurs from single center that appears early in 3rd year of life, completely ossified by 10 years in female and 13 in male

direct trauma fractures of patella

usually results in bone broken into a number of small fragments (comminuted), usually non-displaced fractures

indirect trauma fractures of patella

usually the result of quadriceps muscles contracting suddenly and causing a transverse fracture through body of bone, may be displaced or non-displaced

common symptoms of fractured patella

severe pain, swelling and tenderness, inability to carry out extension at knee joint

patella emarginata

patella in which superior lateral portion of bone remains unossified

bipartite or tripartite patella

patella in which superior lateral portion ossifies independently, quite common occurring in 3% of population

chondromalacia

softening and fissuring of articular cartilage on posterior aspect of patella, common in young adults, usual cause is trauma, overuse or muscle weakness which causes a misalignment of patella, most frequent complaint is dull pain around or under patella that worsens with exercise, pain may intensify when going from flexion to extension at knee joint

fascia lata

connective tissue investment of thigh region, enhances effectiveness of contraction of quadriceps, provides dense sheath for thigh and prevents thigh muscles from bulging outward during contractions of muscles

iliotibial band syndrome (ITBS)

overuse syndrome occurring at distal end of iliotibial band, repeatedly rubs over lateral condyle of femur irritating and inflaming bursae, stinging pain at lateral aspect of knee that worsens when running up and down hills or climbing stairs, often caused by overused gluteus maximus pulling on iliotibial tract

lateral rotation of femur

rotation of femur around longitudinal axis so knee is turned outward

muscles of anterior hip region

iliacus, psoas major, psoas minor

iliacus

occupies iliac fossa within abdominal cavity,

iliacus origin

iliac fossa, sacrum

iliacus insertion

lesser trochanter of femur

iliacus and psoas major actions

flexion of femur at hip joint, helps maintain posture

psoas major origin

bodies and transverse processes of lumbar vertebrae

psoas major insertion

lesser trochanter of femur

psoas major

large muscle situated along lateral aspect of lumbar vertebrae, is found within abdominal cavity

clinical notes associated with psoas major and iliacus

weakness of muscles will result in marked disability in carrying out stair climbing, walking up inclines, getting up from reclining position, any disease or inflammation of these structures may result in pain when muscles are contracting

if both psoas major and iliacus are weak

muscles will become depressed and can lead to a lateral deviation (scoliosus)

psoas minor origin

bodies of T12-L2

psoas minor insertion

iliopubic eminence of pubis

psoas minor action

flexion of pubic bone (upward movement)

psoas minor nerve supply

L1 and sometimes L2

psoas minor

missing in about half of population, when present is small and insignificant lying superficially to psoas major, often mistaken for nerve coming off lumbar plexus, well developed in mammals able to carry out lots of flexion of lumbar vertebrae (cats)

anterior thigh muscles

sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

quadriceps

the collective name for rectus femoris and 3 vastus muscles, all supplied by branches of femoral nerve, common tendon of insertion on base of patella

sartorius

longest muscle in body, narrow and superficial

sartorius origin

anterior superior iliac spine (ASIS)

sartorius insertion

superior medial shaft of tibia

sartorius actions

flexion of hip joint and knee joint only when both occur at same time, abducts femur, medially rotates leg (between knee and ankle)

patellar ligament

portion of tendon of insertion that runs from apex of patella to tibia

rectus femoris origin

anterior inferior iliac spine, acetabulum of pelvic bone

vastus lateralis origin

greater trochanter, intertrochanteric line, linea aspera of femur

vastus lateralis

largest of quadriceps muscles, forms a broad fleshy mass on thigh

rectus femoris

most superficial of quadriceps, situated in middle of thigh between vastus lateralis and vastus medialis, superficial to vastus intermedius

vastus medialis origin

intertrochanteric line and linea aspera of femur

vastus intermedius origin

anterior-lateral aspect of femur

articularis genu

a distinct bundle of muscle fibers that occasionally separates from deepest layers of vastus intermedius and becomes a separate muscle

actions of all quadriceps

extend leg at knee joint, tonus of muscles play a role in strengthening knee joint

additional action of rectus femoris

flexes femur at hip joint

additional action of articularis genus (when present)

retracts synovial membrane of knee joint to help stabilize knee

atrophy of quadriceps

one will have difficulty extending leg against resistance and will press on distal end of femur during walking to prevent flexion from occurring at knee joint, patients confined to bed for long periods of time, can result in abnormal patellar movement and loss of joint mobility

quadriceps test

patient asked to extend knee against resistance while lying down or sitting with knee in flexion, if functioning normally they can be easily seen and palpated, with atrophy patient will have difficulty carrying out extension at knee joint

charley horse

indicates cramping or spasm of quadriceps, also indicates trauma to muscles, can cause tearing of muscle fibers, lead to formation of painful hematoma and bruising

jumper’s knee/ patellar tendonitis

painful overuse injury of common tendon of insertion of quadriceps and/or patellar ligament, common in activities with continuous jumping or running, individuals complain of pain and soreness in area of common tendon or patellar ligament that is intensified with activity

patellar reflex

tapping patellar ligament used to test for segmental innervation of L2, L3, L4, if leg is able to be extended during test spinal nerves are functioning properly

muscles of medial thigh

gracilis, pectineus, adductor longus, adductor brevis, adductor magnus

common action of muscles of medial thigh

adduction of femur

common nerve supply of medial thigh muscles

obturator nerve

gracilis origin

ramus of ischium and inferior ramus of pubis

gracilis insertion

superior medial shaft of tibia

gracilis actions

adducts femur, flexion of leg at knee joint

gracilis nerve supply

obturar L2,L3,L4

surgeons often transplant which muscle to replaced another damaged muscle and why?

gracilis because it is a weak adductor it can be removed

pectineus origin

superior ramus (pubic pecten) of ramus

pectineus insertion

pectineal line and linea aspera of femur

pectineus actions

adducts femur, flexion at hip joint

pectineus nerve supply

femoral and obturator (both L2-L4)

adductor longus origin

superior ramus of pubis

adductor longus insertion

linea aspera of femur

adductor brevis origin

inferior ramus of pubis

aductor brevis insertion

pectineal line and linea aspera of femur

adductor magnus origin

rami of ischium and pubis

adductor magnus insertion

linea aspera and adductor tubercle of femur

adductor magnus actions

adducts femur, extends femur at hip joint

adductor magnus nerve supply

obturator (L2-L4) and sciatic (L4-S3)