Gross I unit III exam

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229 Terms

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primary functions of lower extremity
support weight of body, provide a stable foundation while standing, allow locomotion (walking/running)
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pelvic bone
consists of a single innominate bone on each side
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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
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ilium
largest and uppermost portion of pelvic bone
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ischium
L shaped bone consisting of a body and ramus
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obturator foramen
large oval opening found at inferior aspect of each innominate, closed by piece of membrane called obturator membrane
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false/major pelvis
bounded posteriorly by lumbar vertebrae, laterally by ilium, and anteriorly by abdominal wall; helps support and protect much of abdominal viscera
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true/minor pelvis
bounded posteriorly by sacrum and coccyx, laterally and anteriorly by ilium, ischium, and pubis; surrounds birth canal in females
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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
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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
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general structure of male pelvis
thicker, prominent processes, longer
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general structure of female pelvis
thinner, processes not so prominent
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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
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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
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android pelvis
typical male pelvis
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gynecoid pelvis
typical female pelvis
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anthropoid pelvis
exaggerated male pelvis
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platypelloid pelvis
exaggerated female pelvis
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parts of pelvis most prone to fracture
pubic rami, acetabulum, region of sacroiliac joint, most lateral aspect of ilium
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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
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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
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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
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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
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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
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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
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coxa valga
increase in angle of inclination, common with developmental dysplasia of hip
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angle of inclination at birth
145 degrees
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angle of inclination at ossification
125 degrees
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coxa vara
decrease in angle of inclination, can occur in fractures to proximal part of femur in Rickett’s
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fractures of femur
commonly fractured even though it’s strongest in body, frequently age and sex related
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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
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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
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main function of patella
gives additional leverage to quadriceps during last part of extension of leg, helps to increase power of extension movement
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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
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direct trauma fractures of patella
usually results in bone broken into a number of small fragments (comminuted), usually non-displaced fractures
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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
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common symptoms of fractured patella
severe pain, swelling and tenderness, inability to carry out extension at knee joint
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patella emarginata
patella in which superior lateral portion of bone remains unossified
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bipartite or tripartite patella
patella in which superior lateral portion ossifies independently, quite common occurring in 3% of population
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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
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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
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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
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lateral rotation of femur
rotation of femur around longitudinal axis so knee is turned outward
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muscles of anterior hip region
iliacus, psoas major, psoas minor
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iliacus
occupies iliac fossa within abdominal cavity,
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iliacus origin
iliac fossa, sacrum
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iliacus insertion
lesser trochanter of femur
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iliacus and psoas major actions
flexion of femur at hip joint, helps maintain posture
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psoas major origin
bodies and transverse processes of lumbar vertebrae
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psoas major insertion
lesser trochanter of femur
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psoas major
large muscle situated along lateral aspect of lumbar vertebrae, is found within abdominal cavity
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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
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if both psoas major and iliacus are weak
muscles will become depressed and can lead to a lateral deviation (scoliosus)
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psoas minor origin
bodies of T12-L2
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psoas minor insertion
iliopubic eminence of pubis
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psoas minor action
flexion of pubic bone (upward movement)
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psoas minor nerve supply
L1 and sometimes L2
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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)
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anterior thigh muscles
sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius
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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
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sartorius
longest muscle in body, narrow and superficial
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sartorius origin
anterior superior iliac spine (ASIS)
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sartorius insertion
superior medial shaft of tibia
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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)
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patellar ligament
portion of tendon of insertion that runs from apex of patella to tibia
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rectus femoris origin
anterior inferior iliac spine, acetabulum of pelvic bone
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vastus lateralis origin
greater trochanter, intertrochanteric line, linea aspera of femur
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vastus lateralis
largest of quadriceps muscles, forms a broad fleshy mass on thigh
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rectus femoris
most superficial of quadriceps, situated in middle of thigh between vastus lateralis and vastus medialis, superficial to vastus intermedius
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vastus medialis origin
intertrochanteric line and linea aspera of femur
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vastus intermedius origin
anterior-lateral aspect of femur
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articularis genu
a distinct bundle of muscle fibers that occasionally separates from deepest layers of vastus intermedius and becomes a separate muscle
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actions of all quadriceps
extend leg at knee joint, tonus of muscles play a role in strengthening knee joint
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additional action of rectus femoris
flexes femur at hip joint
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additional action of articularis genus (when present)
retracts synovial membrane of knee joint to help stabilize knee
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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
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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
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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
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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
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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
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muscles of medial thigh
gracilis, pectineus, adductor longus, adductor brevis, adductor magnus
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common action of muscles of medial thigh
adduction of femur
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common nerve supply of medial thigh muscles
obturator nerve
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gracilis origin
ramus of ischium and inferior ramus of pubis
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gracilis insertion
superior medial shaft of tibia
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gracilis actions
adducts femur, flexion of leg at knee joint
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gracilis nerve supply
obturar L2,L3,L4
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surgeons often transplant which muscle to replaced another damaged muscle and why?
gracilis because it is a weak adductor it can be removed
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pectineus origin
superior ramus (pubic pecten) of ramus
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pectineus insertion
pectineal line and linea aspera of femur
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pectineus actions
adducts femur, flexion at hip joint
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pectineus nerve supply
femoral and obturator (both L2-L4)
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adductor longus origin
superior ramus of pubis
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adductor longus insertion
linea aspera of femur
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adductor brevis origin
inferior ramus of pubis
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aductor brevis insertion
pectineal line and linea aspera of femur
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adductor magnus origin
rami of ischium and pubis
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adductor magnus insertion
linea aspera and adductor tubercle of femur
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adductor magnus actions
adducts femur, extends femur at hip joint
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adductor magnus nerve supply
obturator (L2-L4) and sciatic (L4-S3)