6- Hip, buttock and thigh Flashcards
(100 cards)
1
Q
What happens to the lower limb during development?
A
It twists during develop and you get a permanent pronation at the mid-thigh level
2
Q
What specific words are given to the flexion and extension of the foot?
A
Dorsiflexion (pointing toes up)
Plantarflexion (pointing toes down)
3
Q
What are the three parts of the pelvis (hip bone)?
A
Ilium
Ischium
Pubis
4
Q
What marks the ends of the iliac crest?
A
ASIS and PSIS
5
Q
What is the name given to the surface of the hipbone that articulates with the sacrum?
A
Auricular Surface
6
Q
What lies in between the greater and lesser trochanters?
A
Intertrochanteric line (anteriorly) Intertrochanteric crest (posteriorly)
7
Q
What short ridge is found just inferior to the lesser trochanter?
A
Gluteal tuberosity
8
Q
A longer ridge downwards along the shaft of the humerus and originates from the short ridge below the lesser trochanter (on the posterior surface). What is this long ridge called?
A
Linea aspera
9
Q
Which tubercle is found just superior to the medial epicondyle?
A
Adductor tubercle
10
Q
What are the two notable parts of the ischium onto which ligaments attach?
A
Tuberosity and spine
11
Q
What kind bone is the patella?
A
sesamoid bone
12
Q
What do the condyles of the femur articulate with?
A
with the plateau of the tibia
13
Q
Which pelvic bones make up the acetabulum?
A
All three of them (ilium, ischium and pubis)
14
Q
What notches are present on the posterior aspect of the pelvis?
A
Greater sciatic notch and lesser sciatic notch
15
Q
What name is given to the incomplete part of the acetabulum?
A
acetabular notch
16
Q
What is the angle of inclination?
A
The angle that the long axis of the shaft makes with the long axis of the head and neck
around 125 degrees
17
Q
What structures form the greater and lesser sciatic foramina?
A
Sacrospinous ligament
Sacrotuberous ligament
18
Q
Where do the sacrotuberous and sacrospinous ligaments attach?
A
sacrotuberous - sacrum —–> ischial tuberosity
sacrospinous - sacrum —–> ischial spine
19
Q
What are the two fascia found in the thigh?
A
Superficial fascia – e.g. subcutaneous tissue
Deep fascia – fascia lata
20
Q
What is the name given to the lateral thickened area of the fascia lata?
A
Ilio-tibial tract
21
Q
What are the four compartments of this region?
A
Gluteal compartment
Anterior compartment of the thigh
Medial compartment of the thigh (adductor compartment)
Posterior compartment of the thigh
22
Q
What movements are the muscles of the gluteal region responsible for?
A
Extension, abduction and external rotation of the femur
23
Q
What are the gluteal muscles?
A
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- (tensor fasciae latae – this is neurologically a gluteal muscle (innervated by superior gluteal nerve) but functionally it is more of an anterior compartment muscle)
24
Q
What are the short external rotators of the hip?
A
Piriformis
Obturator internus
Quadratus femoris
Gemelli (superior and inferior)
25
Describe the attachments of gluteus maximus.
Proximal – posterior ilium
(posterior part of the iliac crest and thick fascia of the sacrum and coccyx)
Distal – gluteal tuberosity and ilio-tibial tract
26
What proportion of the gluteus maximus fibres attach to the gluteal tuberosity?
About 25% attach to the gluteal tuberosity and the rest are attached to the ilio-tibial tract
27
What movements is the gluteus maximus responsible for?
major extensor (and stabiliser) of the hip joint
28
What does the ilio-tibial tract insert into?
Anterolateral tubercle of the tibia
NOTE: there is a lateral intermuscular septum that goes between the iliotibial tract and the posterior surface of the femur
29
Describe the attachments of gluteus medius.
Proximal – posterior ilium
(broad attachment to the external surface of the ilium (between the anterior and posterior gluteal lines))
Distal – greater trochanter
30
Describe the attachments of gluteus minimus.
Proximal – posterior ilium
(broad attachment to the external surface of the ilium (between the anterior and inferior gluteal lines))
Distal – (just below the) greater trochanter
31
What movement are gluteus medius and gluteus minimus responsible for?
Abduction (and stabilisation of the hip joint)
32
What movement are the deep muscles of the gluteal region responsible for?
External/lateral rotation
NOTE: one of its main functions is to stabilise the hip joint
33
Describe the attachments of tensor fasciae latae.
Proximal – ASIS
| Distal – ilio-tibial tract
34
Which compartment is tensor fasciae latae in?
Neurologically it is more like a gluteal compartment muscle because it is innervated by the superior gluteal nerve
In terms of action, it is a flexor of the hip so it functions more like an anterior compartment muscle
35
What are the attachments of the piriformis?
from the sacrum and its local connective tissue
(across the hip joint)
to the greater trochanter
36
Describe the attachments of obturator internus.
Rim of the obturator foramen
| Greater trochanter of the femur
37
What movement are the muscles of the anterior compartment of the thigh responsible for?
Hip flexion
| Knee extension
38
Which muscles are in the anterior compartment of the thigh?
Tensor fasciae latae
Pectineus (side note: can be classed as being in the medial compartment since it is an adductor functionally)
Ilio-psoas
Sartorius
Quadriceps (rectus femoris, vastus medialis, vastus intermedius, vastus lateralis)
39
What is the most powerful flexor of the hip?
Ilio-psoas
40
Describe the attachments of Ilio-psoas.
Iliopsoas = posts major |+ iliacus
Psoas major attaches to the lateral parts of the lumbar vertebrae and T12 and Iliacus attaches to the iliac fossa and crest
The two muscles then come together to form a common tendon that attaches to the lesser trochanter
41
*Describe the attachments of pectineus
from the superior ramus of pubis
| superior of shaft of femur
42
Describe the attachments of Sartorius.
Sartorius comes off ASIS and descends inferiorly and medially. It crosses the knee and attaches to the upper part of the shaft of the tibia
43
What is the main supplier of the anterior compartment muscles?
femoral nerve
44
Describe the arrangement of the quadriceps muscles.
Rectus femoris is most superficial with vastus medialis and vastus lateralis on either side of rectus femoris
Vastus intermedius is deep to rectus femoris
45
Where do the quadriceps attach distally?
They come together to form a quadriceps tendon, which attaches to the patella
There is a patellar tendon between the patella and the tibial tuberosity on the anterior of the tibia
The patellar tendon is part of the quadriceps tendon with the patella in between as a sesamoid bone
46
What small muscle is found underneath vastus intermedius?
Articularis genu
pulls capsule out of the knee joint during flexion and extension
47
*What bursa is found just above the knee joint?
Suprapatellar bursa
48
What movement are the muscles in the medial compartment of the thigh responsible for?
Adduction of the hip
49
Which muscles make up the medial compartment of the thigh?
```
Obturator externus
Gracilis
Adductor brevis
Adductor longus
Adductor magnus
(pectineus)
```
50
Where do most of the muscles of the medial compartment attach proximally?
Pubic bone
51
Describe the attachments of adductor magnus.
It has a broad attachment to the shaft of the femur (medial lip of the linea aspera) and a smaller attachment to the adductor tubercle (just superior to the medial epicondyle)
The gap in between is called the hiatus of adductor magnus
52
What movements are the muscles of the posterior compartment of the thigh responsible for?
Hip extension
| Knee flexion
53
Which muscles make up the posterior compartment of the thigh?
Semitendinosus
Semimembranosus
Biceps femoris
54
Where do the all muscles of the posterior compartment attach proximally?
Ischial tuberosity
55
Describe the attachments of biceps femoris.
The long head of biceps femoris comes from the ischial tuberosity and the short head comes off the shaft of the femur (lateral lip of linea aspera)
They cross over laterally to attach to the head of the fibula
56
What are the borders of the femoral triangle?
Superior – Inguinal Ligament
Lateral – Sartorius
Medial – Adductor Longus
57
What are the contents of the femoral triangle (medial to lateral)?
Deep inguinal lymph nodes
Femoral Vein
Femoral Artery
Femoral Nerve
58
What is the name given to the opening in the fascia lata over the femoral triangle and what is its purpose?
Saphenous Opening – it allows the draining of the long saphenous vein into the femoral vein
59
What structures form the Adductor Canal?
Anterior – Vastus Medialis
Posterior – Adductor Longus and Adductor Magnus
Medial – Sartorius
60
What are the contents of the Adductor canal?
Femoral artery
Femoral vein
Saphenous nerve (major branch of the femoral nerve)
61
What passes through the greater and lesser sciatic foramen?
Greater sciatic foramen: structures passing from the pelvis to the thigh
Lesser sciatic foramen: structures passing from the pelvis to the perineum
62
Where does the sciatic nerve lie within the gluteal region?
Inferior and medial quadrant
| NOTE: there are variations in terms of the emergence of the sciatic nerve relative to piriformis
63
What two nerves does the sciatic nerve consist of?
Tibial Nerve
| Common Peroneal Nerve
64
Where would you perform an intramuscular injection into the gluteal region?
Superior and lateral quadrant
65
What does the sciatic nerve supply (give branches)?
Give the specific supply in the posterior compartment
Supplies all the hamstring muscles (muscles of the posterior thigh) and all the muscles below the level of the knee
```
In the posterior compartment:
Tibial nerve (almost all)
- Semitendinosus
- Semimembranosus
- Long head of biceps femoris
- Hamstring component of adductor magnus
Common peroneal:
- Short head of biceps femoris
```
66
Give the path of the sciatic nerve
Passes from pelvis to buttock via greater sciatic notch/foramen
Passes along posterior aspect of the thigh
67
Where does the sciatic nerve enter the gluteal region?
usually, enters inferior to the piriformis
however, there are variations. There nerve can split around the piriformis or it can pass anteriorly.
68
What test is used to assess the function of the hip abductors?
Trendelenberg test
When a patient lifts one foot off the floor, their hip abductors (gluteus medius and gluteus minimus) should contract to keep the pelvis level despite the extra weight of the raised foot on the opposite side
69
Describe the structure of the acetabulum.
The acetabulum has a depression in the middle (acetabular fossa) and a lunate surface (surrounding the fossa)
There is an acetabular notch, which is filled in by the transverse acetabular ligament
70
What is the small depression on the head of the femur called?
Fovea capitis
71
What are the ligaments of the hip joint?
Iliofemoral ligament (Y shaped)
Ischiofemoral ligament
Pubofemoral ligament
Ligament of the head of the femur
72
Describe how the arrangement of the ligaments of the hip joint changes when the hip is flexed and extended.
When the hip is flexed, these ligaments are relaxed
When the hip is extended (e.g. when standing) the ligaments wind, which pulls the head of the femur into the acetabulum and helps stabilise the joint when in the standing position
73
Describe the blood supply to the head of the femur.
The main blood supply is via the medial circumflex femoral artery and the lateral circumflex femoral artery (both from profunda femoris)
There is a small blood supply from the artery of the head of the femur (branch of obturator artery - this is more important in children)
74
What type of hip fracture is most likely to need a hip replacement and why?
Intracapsular – this is more likely to disrupt the blood supply and cause avascular necrosis of the head of the femur
(blood supply comes from dorsal to proximal direction)
75
When does the external iliac artery become the femoral artery?
As it passes under the inguinal ligament
76
What main branch does the femoral artery give off that gives rise to the medial and lateral circumflex femoral arteries?
Profunda femoris
77
At what point do the superficial femoral artery and the femoral vein become the popliteal artery and vein?
As they pass through the hiatus of adductor magnus
78
Which arteries, that supply the buttock and thigh, are branches of the internal iliac?
Superior gluteal and Inferior gluteal arteries
| Obturator artery
79
What is the main superficial vein of the thigh?
Long saphenous vein
80
What joins the long sephanous vein at the sapheno-femoral junction?
the femoral artery
81
What are the deep veins of the thigh?
```
Popliteal vein
Femoral vein
External iliac vein
Sapheno-femoral junction
Venae comitantes of the profunda femoris artery
```
82
What are the main groups of lymph nodes in the thigh?
Deep inguinal lymph nodes
Superficial inguinal lymph nodes
External iliac lymph nodes
83
Which nerve supplies the anterior compartment and which division of the lumbosacral plexus gives rise to this?
Femoral nerve – posterior division of the lumbosacral plexus (L234)
84
Which nerve supplies the medial compartment and which division of the lumbosacral plexus gives rise to this?
Obturator nerve – anterior division of lumbosacral plexus (L234)
85
Which nerve supplies the posterior compartment of the thigh and which nerve roots give rise to this nerve?
Sciatic nerve (L45S123)
86
What does the sciatic nerve (and its terminal) branches supply?
posterior thigh
| anterior and posterior leg and foot
87
Which nerves supply the gluteal muscles and which nerve roots give rise to these nerves?
Superior gluteal nerve (L45S1)
| Inferior gluteal nerve (L5S12)
88
Describe the relationship between the distribution of dermatomes in the lower limb and the spinal nerves that supply them.
the more superior the spinal nerve, the more superior the area of skin it innervates (i.e.the dermatome)
89
What function does the sacrotuberous ligament have?
Prevents upward tilting of the sacrum
90
What are the actions at the acetabular/hip joint?
(allows all types of movement)_
| Flexion, extension, abduction, adduction, lateral rotation, internal rotation, circumduction
91
What is the lumbar plexus formed from?
by the ventral rami of L1-4
92
What is the sacral plexus formed from?
- Lumbosacral trunk (L4,5)
(a branch of the lumbar plexus)
- Ventral rami of S1-S4
93
What spinal nerves make up the femoral nerve?
(from lumbar plexus)
L2,3,4
Derived from the posterior divisions
94
What spinal nerves make up the obturator nerve?
(from lumbar plexus)
L2,3,4
Derived from the anterior divisions
95
What is the main nerve arising from the sacral plexus?
sciatic nerve
96
What spinal nerves make up the sciatic nerve?
| What are its 2 branches?
L4-S3
made up of 2 nerves:
Peroneal (fibular) nerve
Tibial nerve
97
What spinal nerves make up the superior gluteal nerve?
L4,5 + S1
98
What spinal nerves make up the inferior gluteal nerve?
L5 + S1,2
99
What does the obturator nerve supply?
Innervates all of the muscles in the adductor compartment except:
- The hamstring half of the adductor magnus
- Pectineus
100
Where do the gluteal muscles attach proximally?
posterior ilium
