ATTR 219, exam 2 and exam 3 material
ATTR 219, exam 2 and exam 3 material ATTR 219
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This 18 page Class Notes was uploaded by Jordan Sparks on Monday October 17, 2016. The Class Notes belongs to ATTR 219 at West Virginia University taught by Vincent G. Stilger in Fall 2016. Since its upload, it has received 5 views.
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Date Created: 10/17/16
Anatomy of the hip Hip and pelvic region are not synonymous o Hip is articulation of femur with pelvis o Pelvis consists of sacrum, coccyx, and 2 large hip bones on either side Hip bones known as innominates Have left and right innominate Pelvis and innominates protect the reproductive organs o Also serves as part of the birth canal Also serves as a stable platform which supports the body weight o Links the sacrum with weight transmission into the lower extremities Females have lighter, thinner, and smoother bones than males in the hip and pelvic region (because of pregnancy) o Doesn’t play into injury Innominates Consists at birth of 3 separate bones joined by hyaline cartilage o Ilium o Ischium o Pubis Ilium Largest bone of the innominate o Posterior is known as ala or wings o Anterior is known as iliac fossa A lot of muscular attachment on the iliac fossa Bones are also more flared in females o Broader, wider hips Iliac crest is thickened superior ridge o Serves as a point of muscular attachment o Common contact injury-hip pointers Spines of ilium Anterior superior iliac spine (ASIS) o Easiest to palpate (put patient into extension) Anterior inferior iliac spine (AIIS) Posterior superior iliac spine (PSIS) o Under the dimples about butt Posterior inferior iliac spine (PIIS) o Most difficult to palpate Most are easily palpated and serve as muscular attachment o Hip, trunk, thigh Other structures of the ilium Greater sciatic notch-deep indentation inferior to PIIS o Serves as passageway for sciatic nerve and some tendons Auricular surface-large roughened region on iliac fossa o Articulates with sacrum to form sacroiliac (SI) joint o Iliacus muscle originates on iliac fossa Ischium Lower posterior portion of innominate and marked by several structures Ischial spine-between the greater and lesser sciatic notches o Attachment for sacrospinous ligament o Physician (OBGYN) will measure to determine pelvic outlet Farther apart in females Too small, what happens? C-section Tubercle-small bony projection Foramen-opening Lesser sciatic notch-indentation below ischial spine o Passageway for blood vessels and nerves o Extremely vascular Ischial tuberosity-large rough inferior portion of ischium o Inferior (below) the lesser sciatic nerve o Origin for hamstrings, sit on, strongest part of the innominate o Also farther apart in females Pubis Most anterior part of the innominate Pubic symphysis-anterior midline where 2 pubic bones meet o This articulation is held together by fibrocartilage o Fibrocartilage-cartilage containing collagen fibers Pubic rami-armlike projections from the pubic symphysis o Superior pubic rami-from body of pubis and goes superior, posterior, and laterally to form anterior portion of acetabulum o Inferior pubic rami-goes posterior, inferior, and lateral to unite with ischial tuberosity Pubic tubercles are most prominent portion of pubic bones Iliopectineal (arcuate) line-sharp curved line at inferior margin of iliac fossa o Point of muscular attachment Pubic arch-“V” shaped and is inferior to pubic symphysis o Formed by inferior pubic rami o “V” shape is upside down “V” Obturator foramen-opening between pubis and ischium o Passageway for blood vessels, nerves, and tendons Acetabulum Sits at fusion site of all 3 sections of the innominates Deep socket/depression on lateral surface of innominate o Socket to articulate with head of femur Slopes slightly inferior and anterior More lateral for males Femoral head goes into acetabulum Anterior thigh muscles Muscles of the hip and trunk Primary flexor of hip and trunk is the iliopsoas o Iliopsoas consists of 2 muscles Psoas major and iliacus If hip flexor is tight it pulls on vertebral column-back pain 40-50% of people do not have a psoas minor but if you do it sits inferior to the psoas major Iliacus o Origin: upper 2/3 of iliac fossa, iliac crest, base of sacrum o Insertion: tendon of psoas major, joint capsule, lesser trochanter o Action: flexion of hip/thigh o Nerve: femoral o Artery: iliac branch of iliolumbar and gluteal Trochanter-bony prominence on proximal femur Psoas major o Origin: transverse processes, intervertebral discs, and bodies of all lumbar vertebrae o Insertion: lesser trochanter of femur o Action: flexes hip/thigh, and when thigh is lifted flexes vertebral column nd rd o Nerve: 2 and 3 lumbar plexus o Artery: iliolumbar Medial thigh muscles Obturator nerve innervates everything medial Adductor longus o Origin: anterior part of pubis and pubic symphysis o Insertion: middle portion of medial lip of linea aspera o Action: assists in flexion of hip/thigh, primary action is adduction o Nerve: obturator o Artery: medial femoral circumflex and obturator Adductor brevis o Origin: inferior pubic rami o Insertion: line from lesser trochanter to the linea aspera o Action: adducts hip/thigh; assists in hip flexion o Nerve: anterior branch of obturator o Artery: obturator and medial femoral circumflex Adductor magnus o Separates hamstrings from quads o Origin: ischial tuberosity, pubic rami, ischium o Insertion: from greater trochanter to linea aspera, to medial supracondylar line, adductor tubercle o Action: adducts hip/thigh; upper portion flexes thigh; lower portion extends thigh o Nerve: sciatic and posterior branch of obturator o Artery: medial femoral circumflex, obturator, and popliteal as the muscle goes distally Pectineus o Origin: iliopectineal line on superior pubic rami o Insertion: lesser trochanter to linea aspera o Action: adduction, flexion, and internal rotation of hip/thigh o Nerve: femoral o Artery: medial femoral circumflex and obturator Femur Longest and strongest bone in the body Head is globe shaped and articulates with the acetabulum o Head of femur is also very smooth o Acetabulum and head of femur=hip joint Head has a shallow depression known as the fovea capitis o Serves as a point of ligamentous attachment Neck connects to the head and offsets the thigh from the hip o Allows for better ease of movement Other structures on femur: o Greater trochanter-later and muscular attachment for gluteus maximus Very easy to palpate o Lesser trochanter-medial and inferior to the greater trochanter Attachment for iliopsoas Very hard to palpate o Trochanteric fossa-deep depression on medial side of greater trochanter o Intertrochanteric line-between the trochanters anterior Serves as muscular attachment o Gluteal tuberosity-posterior and inferior to the greater trochanter Serves as attachment for gluteal muscles Gluteal tuberosity continues distal as the linea aspera Other structures Labrum acetabulare-fibrocartilage ring that surrounds the acetabulum o Helps deepen the socket of the joint Rarely hear of torn labrums in the hip Transverse acetabular ligament-attaches from superior pubic rami to the labrum acetabulare Ligamentum teres-hollow cone ligament that contains synovial fluid o Compressed between head of femur and acetabular socket o Synovial Ligamentum teres contains neurovascular structures that supply the head of the femur Also is a synovial membrane lining within the acetabulum Sacrotuberous ligament-inferior/lateral border of sacrum to the ischial tuberosity Sacrospinous ligament-inferior/lateral border of sacrum to the iscial spine These 2 ligaments are very strong and have attachment to glutes Femoral triangle Important junction between trunk and lower limb o Vessels and nerves supplying lower extremity Base (top) is formed by the inguinal ligament o Runs from ASIS to the pubic tubercles Lateral border by the Sartorius Medial border by the adductor longus Pectineus muscle comprises the floor (posterior) of the femoral triangle Scarpa’s triangle-junction at apex or distal point of adductor longus and Sartorius Femoral triangle contains femoral nerve, artery, vein, and lymph nodes (N.A.V.L) from lateral to medial o Structures continue distally, will pass anterior to the adductor longus muscles o Lymph nodes swollen will indicate infection in lower extremity- sore on palpation View femoral triangle by placing individual in figure 4 position Hip joint Synovial ball and socket joint-allows for a wide range of motions/movement o Rare to see injuries here Automobile accidents Fat pad inferior to hip joint in the floor of the acetabulum Hip joint surrounded by a joint capsule and is reinforced by 3 strong ligaments 1. Iliofemoral “Y” ligament-strongest ligament in the body a. Prevents excessive extension and maintains erect posture b. From AIIS to distal intertrochanteric line 2. Pubofemoral ligament-prevents excessive abduction and checks (limits) extension 3. Isciofemoral ligament-prevents extension and distal and posterior to acetabulum Comes off of innominate (ischio, pubo, ilio) All 3 ligaments are taut in extension o Relaxed in flexion and external rotation Movements of the hip Flexion-135° Extension-30° Abduction-45° Adduction-20-30° Internal rotation-35° External rotation-45° Nervous innervation Sciatic-largest nerve in the body and consists of 2 nerves bound together-common peroneal and tibial o Splits lower 1/3 of posterior thigh o Comes off sacral plexus Located between greater trochanter and ischial tuberosity o Palpating the nerve-flex position, half way in between ischial tuberosity and greater trochanter o Runs under the piriformis muscle Femoral-largest branch of lumbar plexus o Femoral triangle and has many terminal branches o Innervates Sartorius and quadriceps Obturator-branch of lumbar plexus o Runs through obturator foramen and enters the thigh o Anterior and posterior branches Separated by adductor brevis muscle o Anterior innervates gracilis, adductor longus and brevis o Posterior innervates adductor magnus and external rotators Nerves also coming off of the lumbosacral plexus and innervates different areas of the hip and pelvis o Piriformic, gemellus, etc. Arteries Femoral o A continuation of the external iliac artery Located in femoral triangle and changes name from external iliac artery to femoral at the inguinal ligament o Femoral is anterior and then goes deep and medial and comes out posterior Then referred to as popliteal o Branches off of femoral include the profunda femoris Coming off of profunda femoris are medial and lateral femoral circumflex Supply anterior thigh muscles, adductors, hip joint o Superficial branches off femoral Superficial epigastric-blood supply to lower part of abdominal wall Superficial circumflex iliac-blood supply to skin of groin External pudendal (genital)-blood supply to skin of lower abdomen and external genitalia Obturator o Branch of internal iliac artery in pelvis Enters thigh through obturator foramen along with obturator nerve o Blood supply to bladder, ilium, adductor muscles, and hip joint (head of femur) Gluteal (Posterior) Region Muscles Common artery-superior gluteal Common action-abduction Listed superficial to deep Gluteus maximus o Most superficial o Origin: posterior crest of ilium, posterior sacrum and coccyx, sacrotuberous ligament o Insertion: gluteal tuberosity of femur and tensor fascia latae (IT band) o Action: strong extensor; upper fibers assist in abduction; lower fibers assist in adduction o Nerve: inferior gluteal st o Artery: superior and inferior gluteal, 1 branch of profunda femoris Gluteus medius o Origin: outer surface of iliac crest o Insertion: lateral surface of greater trochanter of femur o Action: abduction of the thigh o Nerve: superior gluteal o Artery: deep branch of superior gluteal Gluteus minimus o Smallest and deepest o Origin: outer surface of iliac crest below the origin of the gluteus medius o Insertion: anterior border of greater trochanter of femur o Action: abduction and internal rotation of thigh; may assist in flexion of hip o Nerve: superior gluteal o Artery: deep branch of superior gluteal Bursa of the hip Trochanteric bursa-located behind greater trochanter and deep to gluteus maximus and tensor fascia latae Iliopsoas bursa-between joint capsule and iliopsoas muscle insertion in area of lesser trochanter Hip is also a synovial joint similar to the knee 6 deep outward rotators Primarily involved in external rotation Considered to be part of the gluteal or posterior region of the hip Piriformis-“key muscle” o Origin: anterior pelvic surface of sacrum and sacrotuberous ligament o Insertion: upper border of greater trochanter of the femur o Action: external rotation of hip/thigh; abduction of thigh when thigh is flexed st nd o Nerve: 1 and 2 sacral o Artery: superior gluteal, inferior gluteal, internal pudendal Gemellus superior o Origin: outer surface of ischial spine o Insertion: blends with tendon of obturator internus into the medial surface of greater trochanter o Action: external rotation of hip/thigh o Nerve: sacral plexus o Artery: inferior gluteal Obturator internus o Origin: inner aspect of pelvis, margin of obturator foramen, obturator fascia o Insertion: medial surface of greater trochanter of femur o Action: external rotation of hip/thigh o Nerve: sacral plexus o Artery: internal perdunda and superior gluteal Gemellus inferior o Origin: proximal region of ischial tuberosity o Insertion: blends with tendon of obturator internus into the medial surface of greater trochanter o Action: external rotation of hip/thigh o Nerve: sacral plexus o Artery: inferior gluteal Obturator externus o Deep to everything anteriorly and can only see small part posteriorly o Origin: outer margin of obturator foramen and rami of pubis o Insertion: trochanteric fossa of femur o Action: external rotation of hip/thigh o Nerve: posterior branch of obturator o Artery: obturator and medial femoral circumflex Quadratus femoris o Origin: lateral border of ischial tuberosity o Insertion: anterior portion of greater trochanter and intertrochanteric line o Action: external rotation of hip/thigh; adduction o Nerve: sacral plexus o Artery: medial femoral circumflex P-GO-GO-Q=order of external rotators from superior to inferior Anatomy of the knee Tibia Proximal end forms the tibial plateaus (proximal=top) o Articulates with the femoral condyles Tibial plateaus separated by intercondylar tubercles o Have a medial and a lateral tubercle Lateral tibial plateau is smaller compared to the medial Tibial plateaus slope posteriorly (towards the back) Cruciate ligaments and meniscus attach anterior (in front) and posterior to the tubercles Distal to plateaus is the tibial tuberosity-can palpate (under kneecap) o Common insertion for patellar tendon Distal and anterior to the tibial plateaus are the lateral and medial condyles Lateral condyle has a facet that articulates with head of the fibula o Facet-extremely smooth surface of a bone Just medial to the lateral condyle is a point known as Gerdy’s tubercle (point of muscular attachment) Primal pictures-tibial menisci shows these structures Femur Has a medial and lateral condyle-“femoral condyle” o Medial condyle is slightly more distal (longer) than the lateral o What happens then at the terminal end of full extension? Toes point out because of extra space to take up on lateral side-slight external rotation Femoral condyles project more posterior than they do anterior Groove that is anterior between the condyles o Trochlear or patellofemoral groove Patella fits into groove Posteriorly the condyles are separated by the intercondylar notch or fossa-more narrow in females than males-increased likelihood of tearing ACL Linea aspera-longitudinal ridge on the posterior surface of femur o Also called rough line Medial and lateral supracondylar lines (supra=above)-lines that run from each femoral condyle posteriorly into the linea aspera Sitting directly superior (above) to each condyle is an epicondyle Just superior to the medial epicondyle is a projection known as the adductor tubercle o Adductor tubercle serves as a point of attachment for the adductor adductor magnus muscle Posterior view of right femur on google may show these structures Small groove is also present within each medial and lateral condyle to accommodate the medial and lateral meniscus Patella-kneecap Largest sesamoid bone we have in our body Patella is a rounded triangular bone and only has articulation with the femur o Posterior part of patella only articulates with trochlear groove on femur Posterior surface of patella is divided into 3 facets: o Odd o Medial o Lateral As flexion increases in the knee, to contact with the patella moves proximal o Contact begins at 10-20 degrees of flexion and is mostly distal on posterior patella o 45 degrees of flexion-contact in the middle o 60 degrees of flexion-superior o 90-135 degrees of flexion-odd facet contracts the patellofemoral groove Fibula does not have direct articulation with the knee and thus is non- weight bearing o Serves for ligamentous and muscular attachment Joints/articulations of the knee Tibio-femoral Patellafemoral Superior tibiofibular Nervous Innervation Sciatic nerve provides most of the motor and sensory innervation to the lower extremity o Sciatic comes off of the lumbosacral plexus o Splits into the common peroneal and tibial nerves at the proximal popliteal space Tibial pierces the gastrocnemius muscle Common peroneal wraps around the fibular head Branch of the tibial nerve is known as the sural nerve o Innervation to the skin of the posterior lower leg and lateral foot Common peroneal innervates the knee and short head of the bicep femoris muscle Tibial also innervates the knee and muscles of the posterior lower leg Hamstrings Biceps femoris o Origin of long head: ischial tuberosity-what you sit on o Origin of short head: linea aspera and proximal 2/3 of lateral supracondylar line o Insertion: head of fibula; lateral condyle of tibia, deep fascia on lateral lower leg o Action: flexes knee/lower leg; extends hip/thigh; external rotates hip/lower leg o Nerve to long head: tibial nerve of sciatic o Nerve to short head: common peroneal of sciatic o Artery: profunda (deep) femoris and popliteal Semitendinosus o Origin: ischial tuberosity and tendon of biceps femoris o Insertion: upper anterior medial condyle of the tibia-common pes anserine insertion o Action: flexes knee/lower leg; extends hip/thigh; internal rotation of hip/lower leg o Nerve: tibial branch of sciatic o Artery: profunda femoris and popliteal Semimembranosus o Origin: ischial tuberosity o Insertion: posterior surface of medial tibial condyle o Action: flexion of knee/lower leg; extends hip/thigh; internal rotation of hip/lower leg o Nerve: tibial branch of sciatic o Artery: profunda femoris and popliteal Short head of biceps femoris has no action with hip/thigh Pes anserine is common insertion for the semitendinosus, gracilis and Sartorius Vascular structures Popliteal artery branches off of the femoral o Femoral runs through the adductor magnus muscle Lateral to the popliteal artery is the popliteal vein and lateral to the vein is the popliteal nerve Popliteal branches off to form 5 different arteries in the knee o Most blood supply to knee and surrounding structures 1. Superior medial genicular-distal femur, knee joint, patella 2. Superior lateral genicular-distal femur, knee joint, patella 3. Inferior medial genicular-knee and proximal tibia 4. Inferior lateral genicular-knee joint and gastrocnemius 5. Middle genicular-ligaments of the knee and synovial membrane Popliteal branches off then to form the anterior and posterior tibial arteries Synovium Synovial membrane lines the joint cavity of the knee o Secretes synovial fluid for joint lubrication Lubricates articular hyaline cartilage of bone ends o Creates smoother movements/motion within the knee Knee is the largest synovial joint in the body o Contains less than 1 mL of fluid (30 mL=1 oz) o Synovium however can expand to hold 80 mL of fluid Synovial capsule is 2 finger widths superior to the patella, and posteriorly to the origin of the gastrocs o Laterally to the LCL and medially to the MCL Synovial membrane is the innermost layer of the joint that houses the synovial fluid External ligaments of the knee Lateral (fibular) collateral ligament (LCL)-lateral epicondyle of the femur to the head of the fibula o Major lateral stabilizer of the knee o 2” long and rounded cord like structure o easy to palpate-left ankle on right knee at 90 degrees o directly under the tendon of the biceps femoris near the fibular attachment o lateral side of the femoral condyle, LCL attachment is located between the gastroc and the popliteus Rarely injured because it is protected by? o The opposite extremity Medial (tibial) collateral ligament (MCL)-medial epicondyle of the femur to the medial condyle of the tibia o Also extends distally past the medial tibial condyle o Major medial stabilizer of the knee o MCL is about 4.5” long and a broad flat band o Divided into superficial and deep layers Deep fibers of the MCL attach to the following structures: o Joint capsule (posterior portion of MCL) o Medial meniscus o Coronary ligaments o Retinaculum of vastus medialis muscle With 30 degrees of flexion, anterior fibers of MCL are taut (tight), and with 0 degrees of extension, posterior fibers of MCL are taut Patellar ligament (tendon) o Direct extension of the quadriceps tendon Quadriceps tendon is superior to the patella Patellar tendon is inferior to the patella o Patellar tendon then inserts into the tibial tuberosity o Average length of patellar tendon is 3” Posterior and on each side of the patellar tendon from the distal patella to the tuberosity are infrapatellar fat pads o Shock absorber and nutrition for tendon o Attached to anterior portion of meniscus Cruciate ligaments Cruciate means to “cross” o Always remember in relation to the tibia Posterior cruciate ligament (PCL) o Posterior tibia to the anterior femur o Passes superior, anterior, and medial from its tibial attachment and attaches to the lateral surface of the medial femoral condyle o Prevents posterior displacement of the tibia Shorter, thicker, and stronger than the ACL o Torn when someone lands on the flexed knee-90% do not need to be reconstructed Anterior cruciate ligament (ACL) o Anterior tibia to posterior femur o Passes posterior and lateral from its tibial attachment o Fans out to accommodate its attachment to the medial margin of the lateral femoral condyle o Prevents anterior displacement of the tibia o Average length is 1 ¼“ to 1 ½” Average width is ½“ o Fibers of the ACL are taut in extension o Blood supply from the middle genicular artery and fat pad Both the ACL and PCL are contained within their own fibrous sheath o Keeps them out of direct contact with synovial fluid Coronary ligaments Also known as the meniscotibial ligaments and attach the meniscus to the tibial plateaus o Assist in limiting excessive motion of the meniscus Transverse genicular ligament o Ties the medial and lateral meniscus together anteriorly Quadriceps Rectus femoris (rectus=straight) o Origin: anterior inferior iliac spine o Insertion: superior aspect of the patellar tendon into the tibial tuberosity o Action: flexion of hip/thigh; extension of knee/lower leg o Nerve: femoral o Artery: lateral femoral circumflex Vastus lateralis o Origin: lateral surface of femur below the greater trochanter and the upper half of the linea aspera o Insertion: lateral border of patella to patellar tendon and the tibial tuberosity o Action: extension of knee/lower leg o Nerve: femoral o Artery: lateral femoral circumflex Vastus intermedius o Origin: upper 2/3 of anterior femur and the lower half of the linea aspera o Insertion: superior border of patella to the patellar tendon and tibial tuberosity o Action: extension of knee/lower leg o Nerve: femoral o Artery: lateral femoral circumflex Vastus medialis o Origin: length of linea aspera, medial supracondylar line and tendon of adductor magnus o Insertion: medial border of patella to patellar tendon and tibial tuberosity o Action: extension of knee/lower leg o Nerve: femoral o Artery: femoral and profunda femoris (deep femoral) Femoral nerve innervates all quadriceps Bony insertion for all quadriceps is tibial tuberosity All quadriceps extend the knee/lower leg Rectus femoris is the only quadriceps that has effect on the hip Rectus femoris is the only quadriceps that has 2 joints-the rest have 1 Rectus femoris is the only one without origin in the linea aspera Anterior and posterior meniscofemoral ligaments Posterior (ligament of Wrisberg)-posterior portion of the lateral meniscus to the lateral surface of the medial femoral condyle o Runs immediately posterior to the PCL Anterior (ligament of Humphry)-posterior portion of the lateral meniscus to the lateral surface of the medial femoral condyle o Runs immediately anterior to the PCL o Can’t see on primal images Joint capsule Sleeve like band of ligaments that encircles the knee joint o Posterior, lateral and medial aspect of the knee-most significant Runs from the femoral condyles to the proximal end of the tibia Retinaculum Medial retinaculum-attaches along medial border of patella o Primary function-hold the patella medially Lateral retinaculum-attaches along the lateral border of patella o Primary function-hold patella laterally Patella dislocation does not equal knee dislocation Patella can only dislocate laterally Have to get quadriceps to relax to reduce patella dislocation- straighten leg and usually it will go back-if not, use your thumbs to put it there-has to go over lateral femoral condyle Menisci 2 menisci or cartilage o medial “C” shape o lateral “O” shape Also referred to as semilunar cartilage due to half moon shape “horns” of menisci-ends of menisci Menisci are beveled in shape and paper thin towards the midline (beveled=thick on outside) Tibial menisci on primal pictures Femoral condyles sit right upon the menisci Medial meniscus has attachment to: o Deep portion of the MCL o Semimembranosus tendon During flexion, semimembranosus helps retract the medial meniscus to prevent impingement Lateral meniscus is not as firmly attached as the medial and thus less prone to injury o Able to slide more freely anterior and posterior-partly attached due to attachment to the popliteus o May have attachment to ACL Menisci posses little to no innervation o Minimal pain Vascularity of Menisci Outer 1/3 has a good blood supply Middle 1/3 us questionable Inner 1/3 is totally avascular-does derive some nutrition from synovial fluid Discoid meniscus Solid meniscus with no semilunar shape o Found moreso in women than men o Occurs usually to the lateral meniscus Loud snap at the knee during flexion and extension o Obviously menisci will be more prone to injury Other Muscles Satorius o Origin: anterior superior iliac spine (ASIS) o Insertion: upper anterior medial condyle of tibia-pes anserine o Action: flexion of hip; flexion of knee/lower leg o Nerve: femoral o Artery: femoral Gracilis o Origin: anterior/medial edge of pubic symphysis o Insertion: upper anterior/medial condyle of tibia-pes anserine o Action: adducts the hip/thigh; flexion of knee/lower leg; internally rotates hip o Nerve: obturator o Artery: profunda femoris; obturator; medial femoral circumflex Tensor fasciae latae o Origin: anterior iliac crest and ASIS o Insertion: iliotibial tract and the lateral femoral condyle, lateral tibial condyle, and the head of the fibula o Action: abduction of hip; flexion of hip; may assist in knee/lower leg extension o Nerve: superior gluteal o Artery: lateral femoral circumflex and superior gluteal o Can’t tear it Popliteus o Origin: lateral condyle of femur o Insertion: posterior surface of tibia above soleal line o Action: internally rotates tibia on femur; weak flexor of lower leg o Nerve: tibial o Artery: inferior geniculars o Very deep o IT band Bursa of knee Bursa=closed, fluid filled sacs lined with synovium Suprapatellar (quadriceps) bursa-superior to patella between the quadriceps tendon and the femur o Largest bursa in knee Light blue on primal pictures Prepatellar bursa-anterior between skin and outer surface of patella o Susceptible to direct trauma Deep infrapatellar bursa-posterior to patella tendon and anterior to infrapatellar fat pads Superficial infrapatellar bursa-between the skin and anterior surface of the infrapatellar tendon Pes anserine bursa-between pes anserine tendon and MCL on the proximal medial side of the tibia Biceps femoris bursa-between tendon of biceps femoris and fibular attachment of the LCL Popliteal bursa-posterior lateral aspect of the knee under popliteus o Often continuation of synovial sac Semimembranosus bursa-between semimembranosus insertion and the origin of gastrocnemius o Just posterior to the medial femoral condyle