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MSK > Hip > Flashcards

Hip Flashcards

1
Q

what are the hip bones called

and alongside x they form what?

A

inominate bones

x = sacrum

the pelvic girdle

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2
Q

what are the articulations of the hip bones

A
  • sacroiliac joint : articulation with the sacrum
  • pubic symphysis : ​articulation between the right and left inominte bone
    • hip joint: articulation with the head of the femur
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3
Q

describe the inominate bone

A
  • its composed of three bones: ilium, ischium and pubic
  • as a child they are seperate adn only begin fusing at the ages of 15-17
  • once they fuse they form a triradiate cartilage
  • they also form the acetabulum ; cup socket for the femoral head to articulate with the hip
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4
Q

label this

A
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5
Q

describe the ilium

what are the surfaces?

describe its key features and names of parts?

A
  • widest part and its the top
  • has two surfaces:
    • external surface: which is convex and provides attatchment for gluteal muscles
    • internal surface : which is concave and produces the iliac fossa
  • the superior margin is the iliac crest which extends :
    • anteriorly into the anterior superior iliac spine and anterior inferior iliac spine
    • posteriorly into the posterior superior iliac spine and posterior iliac spine
    • the posterior aspect creates the greater sciatic notch
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6
Q

describe the ischium

what are its key features?

what are points of attatchment?

A
  • forms the posterior inferior asect of the innominate bone
  • composed of a ramus of ischium
  • posterior aspect forms a ischial tuberosity (which you sit on when sitting in a chair)
  • on the posteriomedial aspect of the innominate bone is the ischial spine
  • important attatchments of the ischium are:
    • sacrospinous ligament : this goes from the ischial spine to the sacrum and creates the greater sciatic notch
    • ​sacrotuberous ligament : this goes from the sacrum to the ischial tubersity forming the lesser sciatic notch
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7
Q

what are the ligaments associated with the ischium and whats their function?

A
  • sacrospinous ligament
  • sacrotuberous ligament

limit the rotationof the inferior part of the sacrum upon transmission of weight of the body down the vertebral coloumn in the erect position

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8
Q

describe the hip joint

whats the points of articulation

whats its functions

A
  • ball and socket synovial joint
  • the head of the femur articulates with the pelvis acetabulum
  • function is to enable mobility to lower limbs without weakening the ability of the lower limbs to support the weight of the body
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9
Q

whats the acetebulum and where is it (anatomical words)

describe the whole structure (what is it associated with )

A

inferolateral aspects of the pelvis

surrounded by a fibrocartilaginous collar = acetabular labrum providing it with a more secure fit for the hemispheric femoral head

the acetabulum its self is covered in hyaline cartilage except a small part known as the acetabular notch which contins fibroelastic fat covered with synovial membrane

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10
Q

whats the function of the acetabular labrum

A

increases the articular contact by 10% so that more than 50% of the femoral head is in contact with socket at any given one time

this increases the stability of the joint but sacrifices some mobility (however more stable than the shoulder joint)

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11
Q

describe the femoral head

A
  • articulates with the acetabulum of the pelvis
  • covered in hyaline cartilage
  • has a small depression known as the fovae capitis where the ligamentum teres attaches
  • this ligament contains the artery to the femoral head
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12
Q

describe the femoral shaft

A
  • belwo the femoral head
    • passes inferiorly and posteriorly and laterally making a 125 degree angle (with the long axis of femoral shaft)
  • this angle is smaller in females
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13
Q

label this

A

image

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14
Q

how are the greater and lesser trochanters connected anteriorly and posteriorly

A

anteriorly = intertrochanteric line

posteriorly = intertrochanteric crest

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15
Q

what is on the posterior aspect of the femoral shaft and what attaches to it?

A

linea aspera

intermusula speta and…..

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16
Q

whats above the linae aspera

A

gluteal tubersity

this is insertion of the gluteal maximus

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17
Q

inferiorly to the linea aspera what does the linea aspera divide into

A
  • lateral and medial supracondylar lines
  • medial margin continues inferiorly and terminates at the adductor tubercule of the medial formal condyle
  • lateral marginof the linea aspera contunies inferirly to form the lateralsupracondyular line and terminares at the lateral formal condyle
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18
Q

describe the condyles of the femor

A
  • medial margin of linea aspera continues inferiorly and terminates at the adductor condyle of the medial formal condyle
  • lateral margin of linea aspera continues inferiorly and forms the lateral formal condyle
  • seperating the two condyles is intercondylar noch POSTERIORLY
  • ANTERIORLY the patella covers the space trochlear (patellofemoral groove) between the lateral and medial condyles
  • ths
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19
Q

what covers the hip joint? describe it

A

the capsule

it sits 5-6mm outside the acetabular labrum proximally (closer to the pelvis)

and

distally it attatcehs to the intertrochanteric line anteriorly and neck of femur posteriorly

capsule fibres ascend anteriorly as logntindal retincula containing blood vessels for the femoral head and neck

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20
Q

describe the 2 parts of the capusle and name the ligaments

A
  • intracapsular; ligamentum teres (carries blood supply to the femoral head, attatches from the fovae capitis to the trochlear notch)
  • extracapsular; iliofemoral. pubofemoral and ischiofemoral ligaments
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21
Q

label this

A

iliofemoral (from the iliac to the femoral head)

ischiofemoral ( from ischium to the femoral head)

pubofemoral (from pubis to the femoral head)

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22
Q

iliofemoral ligament

A

from iliac to the femoral head

storngest ligamatn in the body

inverted Y shape,

lies superior+anterior to the hip joint and blends in with the capsule

the baseof the Y shape is attatches to the anterior inferior iliac spine of the femur.

in the stadnign positionit ‘scrws the head of the femour inot the acetabulum’ and prevents the trunk from falling backward without the need for muscules = PREVETNS HYPEREXTENSION OF THE HiP

when sitting it become relaxed and allows the pelvis to tilt backwards into its sittign position

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23
Q

pubofemoral ligament

A

lies inferior and anterior to the hip joint

triangular shaped

base is attatched to the superior pubic ramus

its apex is the intertrochanteric line anteriorly

function is to prevent excessive abduction and extension of the hip joint

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24
Q

ischiofemoral ligaments

A

spiral shaped and attaches to the body of ischium posterioly

its inferior fibres spiral superolaterally from the body of the ischium to attacth tot he superolateral end of the intertrochanteric line of the femur, anteromedial. ot the base of the greater trochanter

it wraps all the way aroudn the back of the femoral head and neck and iserts anteriorly , deep to the lateral fibres of the iliofemoral ligament

weakest of the 3 ligaments

prevents excessive interal (medial rotation

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25
Q

transverse ligament

A

bridges the acetabular notch

creates a tunnel where b vessels and nerves enter the hip joint

26
Q

is there a synovial membrane in the hip joint?

A

yes

27
Q

describe the synovial membrane of hip joint

A

lines the capsule and is attatched to the margins of the articular sufarces

ensheathes the ligamentum teres

covers the pad of fat contained in the acetabular fossa

28
Q

what are the stabalising factors of the hip joint

A

cup shaped acetabulum

acetabular labrum - deepen the acetabulum

capsule

ligamentum teres

extracapsular ligaments

muscles surrounding the hip joint

29
Q

where are the muscles of the hip joint in association to the ligaments

A

anteriorly where ligaments are stronget = medial flexors (located anteriorly) are fewer adn weaker

posterirly where the ligaments are weaker = lateral rotators (extensors) are greater in munber and stronger - they pull the head of the femur into the acetabulum

30
Q

muslces groups involved in the hip joint

A

superfical muscles

deep muscles

posterior thigh

31
Q

superifical muscles

A

gluteal maximus / medius/ minimus + tensor fascia lata muscle

abductors of the hip and extend the lower limb at the hip joint

32
Q

tensor fascia lata

A

O = ASIS

i= between two layers of iliotiial band of fascia lata between the upper and middle two thirds of the thigh

N= superior gluteal nerve

f =

  • stabalise the hip in extesnion (assists g. maximus) + soem fibres insert into the iliotibial tract in the standing position and so help stabalise the kneeby steadying the condyles of femur on articular surfaces of the tibia
  • used in water sking and horse riding
    • minor function is to hoist the foscia lataupwards which c tightening of the compartments of the thigh and compressing the lower limbs
33
Q

fascia of the thigh

A
  • enclosed the thigh musles and seperates them into anterior, medial and posterior
  • superiorly it is contininous witht he fascia of the abdominal wall and perineal region
  • inferiroly it is contious with the fascia of the lower limb
  • it is thinnest medially over the adductor muscles
  • theres a saphenous opening in the fascia lata between the below the inguinal ligament and is entry point for the saphenous vein wc trains into femoral vein and fr the llympathic vessels wc drain inot the superficial inguinal lymph nodes
    • thickest on the lateral aspect wher it forms the iliotibial tract/band and runs from the iliac crest to the lateral tibial condyle
34
Q

iliotibila tract

A

O = iliac crest

I= lateral epicondyle of the femur

F = stabilised the knee

shortened when sit down

becoems tight easily casuing lateralkne pain, patellar instbaility and other issues B treated with physio

35
Q

gluteus maximus

A

largest gluteal muscle

O= posterior surface of ilium, sacrum and coccyx and crosses the buttock at a 45 degreee angle

I = superior fibres insert into iliotibial tract and inferior fibres insert into gluteal tuberosity of the femur

F = extend lower limb at hip oint, main extensor of thigh, and lateral (external) rotation of the hip

used in stepping and walking

superior fibres help with extension of hte knee since they are attatched to the iliotibila tract

IN= inferior gluteal nerve (L5S1S2)

36
Q

gluteus medius

A

inbetween mini and maxi

O= gluteal (posteior) surface of ilium

I = lateral surface of greater trochanter

F= abducts and medially rtate the lower limb at the hip joint

whilst walking it secures the pelvis in the horisontal alignment, oreventing downward tilt towrds unsupported limb

IN = superiro gluteal nerve L4 L5 S1

37
Q

gluteus minimu

A

O = ilium

I= anterior asepct of the greater trochanter

F = abducts and medial rotationof lower limb at hip joint and maintains the pevlis horisozonatl allignemtn wehn walking

IN= superior gluteal nerve L4 L5S1

38
Q

deep muscles of the gluteus

A

function is to laterally rotate the lowerl limb + stabilise the hip joint by pulling the femoral head deep into the acetabulum

piriformis

obturator internus

obturator externus

superior gemellus

inferior gemellus

quadratus femroris

39
Q

piriformis

A

key landmark because sciatic nerve emerges from the levis inferior to it

O = anterior surface of sacrum travels inferiorlaterally through greater sicatic foramen

I= superior aspectof the greater trochanter of femur

F = lateral rotation and abduction

N = nerve to piriformis

40
Q

obturator internus

A

lateral wall of the pelvis cavity

O = medial surface of the obturator membrane adn from the adjascent pubis and ischium , travels through the lesser sciatic foramen

I = posterior aspect of the greater trochanter below the insertionof the piriformis and superior gemellus

F = lateral rotation adn abduction of lower limb

N = nerve to obturator

41
Q

superior gemellus

A

O = ischial spine

I = posterior aspect of the greater trochanter

IN = nerve to obstrator

F. =lateral rotation adn abduction

42
Q

inferior gemellus

A

O= ischial tuberosity

I = posterior aspect of the greater trochanter

IN= nerve to quadratus femoris

43
Q

what seperates the superior and inferior gemelli and what des this mean in terms. of IN?

A

obturator internus tendon

superior = nerve to obturator internus

inferior = nerve to quadratus femoris

44
Q

quadratus femoris

A

most infeirr of the deep gluteal muscles

O = lteral aspect o the ischial tuberosity

I= lateral aspect of the greatertrochanter

F = abduct adn lateral rotation

IN+nerve to quadratus femoris

45
Q

obturator externus

A

aka medial compartment of the thigh

O= external surface of the ob. membrane ,

I= passes posterior to neck of femur and inserts onto posteiror aspect of the greater trochanter

F. = Abd. and lat. rot

IN+ obtruator nerve L2 L3L4

46
Q

nerve supply to the hip

A

sciatic nerve posteirorly

obtruator nerve inferiorly

femoral nerve anteriorly

47
Q

bloos dupply to the femoral head

A

extracpsular aterial ring that is formed posteriorly by large branch of

medial formal circumflux artery adn lateral femoral circulflex artery

they give retinalculars whc are small b vessels into the metaphysis of the of the femoal neck

ligamentumteres also intracapsualr wc comes from the obturator artery

48
Q

what artery t femoral head is important in kids

A

ligamentum teres because it is major blood supply to the femoral epiphysis (head)

in adults after epiphysial fusion only small amont of head near fovia is nurished by b supply from it, most b supply is from MCFA branches

and so distrubing the reticlars (Ascenidng cervial branhces) of the MFCA in an intracapsular fracture would result in avacualr necrosis because most b supply cut off to femoral head cut off

49
Q

describe the lumbar sacral plexus

A

formed by anterior ramiof L1 2 4 - they combine to form peripheral nerveswc descend from the posterior abdominal wall to the lower limbs where they innervate their target structures

L4 anterior ramigves off a rbanch wc combinse with the L5 anterior ramus to from the lumbosacral trunk

posteiror divios of the lumbar plexus form the nerves that supply the anterior thigh d to the 90 rotation teh exensors are anterior

50
Q

describe the roots of the lumbar plexus

A

L1 = ilioinguinal nerve root = In skin of genitalia and upper media thigh

L1 + L2 = genitofemoral wc divies into the femoral adn genital branch . femoral branch innervates the upper anterior thigh ksin

L2 + L3 = lateral cutanoeus nerve of tigh (lateral femoral cutanoeus nerve) formed from the posterior divisions of L2 and L3 = IN the anterolateral thigh as far inferirly as the knee

  • anterior deivisons* L2 L3 L4 = obturator nerve = IN medial thigh and is nerve of the medial compartment of the thigh (so adductors)
  • postieor divisions* L2 L3 L4 = femoral nerve anteriot thigh via anterior femoral cutanoeus nbranch via its saphenous branch innervates the medial aslect of thigh skin
51
Q

sacral plexus describe it

A

frmed y anrterior rami of S1 S2 S3 S4 S5 adn infor from L4 AND L5

2 desitnations is the lowerl limb and lelvis msicles

52
Q

nerves of the sacral plexus

A

L4 L5 S1 superior gluteal nerve = leaves via greater sciatic foramenn above the piriformis muscle alongside the superior gluteal arteru and vin , no sensory branches important in injury

L5 S1 S2 = inferior gluteal nerve = leavs via the greater sciatic fromaen but entes the gluteal region below the piriformis muscle along side the infeiro gluteal arty adn veinonly inervates the glu. maximus

scaitic nerve = L4 L5 S1 S2 S3

S1 S2 S3 = posteiror cutanoeus nerve of the thigh / posterior femroal cutaenous nerve = anterior divisions of S1 S2 S3 leavesvia the greater sciatic belwo the priformis muscles and innervates skin of posteior thigh and leg

53
Q

nerves thatleavebelow the prifiroms

A

post. femoral cut. nerve S1 S2S3 / sciaticL4L5S1S2S3 / inferior gluteal nerveL5S1S2

54
Q

nerves that leave aboe the piriformis

A

superior gluteal nerve(L4 L5 S1)

55
Q

how are the greater and lesser sciatic fromaen creater

A

graterdue tot sacrospinatous

lessre due oto the sacrotubersous

56
Q

what geos through thegreater sciatic foreamen

A
  • piriformis
  • sciatic nerve
  • inferiorGN and A nad V
  • posteiro femoral cutanoue nerve=
  • nerve to obruator
  • nere to quadratus femoris \
  • pudenal nerve
57
Q

what goes through the lesser sciatic foraemn

A

tendon of obtruator intebus

nerve toobtruator intetbus

pudenal nerve

58
Q

posterior thigh compartment? what is it also knownas? what does it include? fucntion of these muscles?innervation?

A

hamstrings

includes ; semitendinosus semimembranosus bicep femoris long head

F = extednt he lower limb at the hip joint

IN = sciatic nerve

59
Q

bicep femoris

A

2 heads

logn head and short head

O= long head) ischial tuberosity

I = (long head) head of fibula

O= short head ) linea aspera

I= ischial tuberosity

IN=long head) tibial part of sciatic nerve

IN= short head = common peroneal part of sciatic nerve

F. = extend lower limb at hip joint ad externally rotate the leg (below knee) and knee joint

60
Q

semitendinosis

A

medial to bicep femoris and superficial to semimembranosus

F = flex leg at knee joint, extend lowelr limb at hip joint and medially rotate the thigh at hip joint adn externally rotate the leg at knee joint

IN= tibial part of sciatic nerve

61
Q

semimembranosus

A

medial to the bicep femoris and deep to semitendinosus

O = ischial tuberosity

I= medial tibial condyle

F = flex leg at knee joint and externally roate theleg at knee joint but interally roate the thigh at hip joint and extend the thigh at hip joint

IN= tibial part of sciaic nerve

MSK (17 decks)

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