Lab 6 - Lower Limb I: Hip and Thigh
Palpate the iliac crests and follow them anteriorly to the anterior superior iliac spine. This is the attachment of the __________ muscle.
Answer
Anteriorly near the midline the pubis bone can be felt
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| Fig1. Location of Iliac Crests, ASIS and Pubis |
What attaches to the pubic tubercle?
Answer
Follow the iliac crests posteriorly to the dimples of the lower back
The dimples indicate the posterior superior iliac spine
The dimples also indicate the position of _________ joint.
Answer
The gluteal region is dominated by the prominent subcutaneous fat and large gluteal muscles
The vertical midline groove between the two gluteal muscles is the gluteal cleft and the lower margin, the inferior edge of the gluteus maximus, is the gluteal fold
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| Fig2. Gluteal Landmarks |
Fig2a. Where to give a Gluteal Injection |
Where in the gluteal region are intramuscular injections given and why?
Answer
Place your hand just above the medial side of each gluteal fold, sit down or flex your thigh - you should be able to palpate the ischial tuberosity
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| Fig3. Lower Limb |
Fig3a. Posterior Thigh |
Which muscle group attaches on the ischial tubeosities?
Answer
Next palpate your greater trochanter by placing a finger along the lateral side of the hip, about a hand's breadth inferior to the iliac crest.
Flex and extend your thigh and feel the movement of the greater trochanter
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| Fig4. Femoral Neck Fracture |
Fig4a. Hip Fracture Patient Leg External Rotation |
In what position would the lower limb present in a femoral neck fracture?
Answer
Place both hands on your hips with thumbs pointing backward and palms posteriorly, raise one leg off the ground and feel the contraction in the gluteus medius, tensor fascia lata.
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| Fig5. Weak Gluteus Medius Abductor Gait |
If the gluteus medius was weak on the left side, what would happen to the hips when you lift your right lower limb off the ground to take a step, while supporting your weight with the stance, left limb?
Answer
The femur is covered by muscle bulk but the medial and lateral epicondyles and patella are palpable at the distal end
Palpate the three muscle groups of the femur: quadriceps, adductors and hamstrings
Sit in the "cross-legged" position and appreciate the function and location of the sartorius muscle
Follow the patellar ligament from the patella to the tibial tuberosity
Extend your knee against resistance and note the vastus medialis and lateralis
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| Fig6. Anterior and Medial Thigh |
Fig6a. Anterior Thigh and Femoral Borders of Femoral Triangle |
Which three muscles of the thigh attach together on the medial side of the tibia, and pull as medial rotators of the leg?
Answer
Locate the boundaries of the femoral triangle: inguinal ligament, sartorius and adductor longus
Take a femoral pulse
A femoral hernia occurs inferior to the inguinal ligament and may appear as a distinct swelling in the femoral triangle
Palpate for any swelling which may be due to a hernia or enlarged lymph nodes
Look for a visible great saphenous vein through the skin on the medial side of the thigh. It drains into the femoral vein in the femoral triangle.
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| Fig7. Femoral Triangle |
What structures are found within the femoral triangle?
Answer
On the posterior thigh follow the hamstrings to their distal attachments on the tibia
A diamond-shaped fossa is formed at the back of the knee, the popliteal fossa
The upper medial border of the fossa is formed by the tendons of the _________ muscles
Answer
The upper lateral border of the fossa is formed by the tendons of the biceps femoris muscles
The lower borders are formed by the _________ muscle.
Answer
The popliteal artery and vein lie deep within the popliteal fossa. Flex your knee and push your fingers firmly into the fossa to obtain a pulse.
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| Fig8. Popliteal Fossa |
Fig8a. Popliteal Artery and Vein and Sciatic Nerve in Fossa |
If a popliteal pulse is not felt what might this indicate about the femoral artery? Why?
Answer
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| Fig9. Stepping Gait Analysis |
Consider the action of stepping onto a bus. What movements and muscle contractions take place in performing this activity?
Answer
Note: There are no case studies for this lab.