Sem 2 - H - Gluteal region & hip joint (articulation, capsule, ligaments, arteries)- Hip bone, femur, gluteal muscles/nerves/vessels

Question 1

What are two other names for the hip bone? Which bones make up the hip bone?

Answer 1

Hip bone - innominate bone and os coxae Ilium, ischium and pubic bone make up the hip bone

Question 2

What muscle attaches in the iliac fossa? What does the iliac crest connect? Which two bones surround the obturator foramen?

Answer 2

Iliacus arises in the iliac fossa Pubic crest connects anterior superior iliac spine (ASIS) to posterior superior iliac spine (PSIS) Ischium and pubic bone surround the obturator foramen

Question 3

What lies immediately below the auricular surface of the ilium? What does the auricular surface of the ilium articulate with?

Answer 3

Just below the auricular surface of the ilium is the greater sciatic notch

The auricular surface of the ilium articulates with the sacrum to form the SI joint

Question 4

What are the gluteal lines and which surface of the ilium do these lines lie on? What does the meeting point of the three hip bones form?

Answer 4

The gluteal lines are on the lateral surface of the ilium and divide up the ilial surface

• Posterior gluteal line
• Anterior gluteal line
• Inferior gluteal line

The meeting point of the three hip bones forms the acetabulum

Question 5

What forms the greater and lesser sciatic foramen?

Answer 5

The greater and lesser sciatic foramen are formed by sacrospinous and sacrotuberous ligaments

Sacrospinous ligament - ischial spine to sacum

Sacrotuberous ligament - ischial tuberosity to sacrum

Question 6

Hip joints lie more lateral than the knee joint Femur therefore needs to angle inwards as it moves downwards What is this angle known as and what is the measurement of this angle?

Answer 6

The femur needs to angle inward as it moves downwards - this angle is known as the angle of inclination

Angle of inclination is the angle between the long axis of the femoral shaft and long axis of the femoral head/neck - 125 degrees

Question 7

So that the femoral head is able to insert into the acetabulum, there is a torsion of the femoral neck This torsion is known as femoral neck antversion (antversion means rotated forwards) What direction does the femoral neck anteversion cause the femoral head to face? What is the angle of anteversion (torison)?

Answer 7

Because of the femoral neck anteversion, the femoral head will face medially, anteriorly and superiorly

Angle of antversion is the angle between the transverse axis of the femoral condyles and axis of the femoral head and neck - the angle is approximately 12 degrees

Question 8

What is the tuberosity that lies on the lateral aspect of the superior part of the linea aspera and what muscle forms part of its attachment here?

Answer 8

The gluteal tuberosity is at the lateral aspect of the superior linea aspera - gluteus maximus forms part of its insertion here

Question 9

What are the muscles of the superficial and deep gluteal regions?

Answer 9

Superficial gluteal muscles -Gluteus maximus, gluteus medius and minimus, tensor fasci latae Deep gluteal muscles - piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris

Question 10

What is the attachments of the gluteus maximus muscle?

Answer 10

The gluteus maximus attaches at the posterior sacrum, sacrotuberous ligament and ilium behind the posterior gluteal line and 3/4 of its fibres insert into the iliotibial tract, and 1/4 of its fibres - the deep fibres - insert into the gluteal tuberosity

Question 11

What is the function of the gluteus maximus? What is its nerve supply?

Answer 11

The gluteus maximus is the main extensor of the hip and assists in lateral rotation of the hip Its is innervated by the inferior gluteal nerve (L5,S1,2)

Question 12

State the attachment, function and nerve supply of the gluteus maximus

Answer 12

Attachment - Posterior sacrum, sacrotuberous ligament &ilium behind the posterior gluteal line into the iliotibial tract (3/4 of fibres) and the deep fibres into the gluteal tuberosity of femur (1/4 of fibres)

Function - Main extensor of the hip and assists in lateral rotation of the hip

Innervation - Inferior gluteal nerve (L5,S1,2)

Question 13

What is the attachment of the tensor fascia latae?

Answer 13

Attaches from the anterior iiac crest and anterior superior iliac spine (ASIS) and inserts into the iliotibial tract

Question 14

What is the function and nerve supply to the tensor fascia latae?

Answer 14

Function Tenses the iliotibial tract and fascia latae as well as supporting the femur on tibia during standing Innervation - Superior gluteal nerve (L4,5,S1)

Question 15

State the attachments, function and nerve supply of the tensor fascia latae

Answer 15

Attachment - Anterior iliac crest and ASIS to the iliotibial tract Function - Tenses the iliotibial tract and fascia latae and supports femur on tibia whilst standing Innervation - Superior gluteal nerve (L4,5,S1)

Question 16

If completely reflecting the gluteus maximus, what muscle will be seen and what muscle lies deep to this?

Answer 16

If reflecting gluteus maximus, will see the gluteus medius with the gluteus minimus lieing deep to the medius

Question 17

What is the function and innervation of the gluteus medius and minimus?

Answer 17

Gluteus medius and minimus abduct the hip and medially rotate the hip Innervation - Superior gluteal nerve (L4,5,S1)

Question 18

What is the attachment of the gluteus medius?

Answer 18

Gluteus medius attaches to the ilium between the posterior and anterior gluteal lines to the lateral aspect of the greater trochanter of the femur

Question 19

What is the attachment of the gluteus minimus?

Answer 19

The gluteus minimus attaches between the anterior and inferior gluteal lines to the anterior surface of the greater trochanter of the femur

Question 20

State the attachments, function and nerve supply of gluteus medius and minimus

Answer 20

Gluteus medius - ilium between posterior and anterior gluteal lines to the lateral surface of the greater trochanter

Gluteus minimus - ilium between anterior and inferior gluteal lines to the anterior surface of the greater trochanter

• Function - abduct & medially rotate hip joint
• Innervation - Superior gluteal nerve (L4,5,S1)

Question 21

How does the superior gluteal nerve reach the tensor fascia latae?

Answer 21

Superior gluteal nerve exits the pelvis superior to the pifiromis before coursing between gluteus medius and minimus before coming anterior to innervate the tensor fascia latae

Question 22

What is the attachment, function and nerve supply of the piriformis?

Answer 22

Attachment - arises at the anterior surface of the sacrum and sacrotuberous ligament before passing through the greater sciatic foramen to the superior border of the greater trochanter of the femur

Function - lateral rotation of hip joint

Innervation - Nerve to pifiromis (anterior rami S1,2)

Question 23

What is the attachment, function and nerve supply of the obturator internus?

Answer 23

Attachment- Arises form the pelvic surface of the membrane and margins of the obturator foramen before passing through the lesser sciatic foramen to the trochanteric fossa

Function - laterally rotates the hip

Innervation - Nevre to obturator internus (L5,S1)

Question 24

What is the attachment, function and nerve supply of the superior and inferior gemellus muscles

Answer 24

Superior gemellus - ischial spine (nerve to obturator intenrus (L5,S1))

Inferior gemellus - ischial tuberosity (nerve to quadratus femoris (L5,S1))

• They blend with the tendon of the obturator internus to insert into the trochanteric fossa
• Function - lateral rotation of the hip

Question 25

Where does the main muscular bulk of the obturator internus lie?

Answer 25

The main muscular bulk of the obturator internus lies in the pelvis and therefore mainly the tendon is visible when looking from the gluteal compartment

Question 26

What is the attachment of the quadratus femoris?

Answer 26

The quadratus femoris attaches from the ischial tuberosity to the quadrate tubercle on the intertrochanteric crest of the femur

Question 27

State the attachment function and nerve supply of the quadratus femoris?

Answer 27

Attachment Ischial tuberosity to the quadrate tubercle on the intertrochanteric crest of the femur Function - lateral rotation of the hip Innervation - nerve to quadratus femoris (L5,S1)

Question 28

State the attachment function and nerve supply of the only muscle of the medial compartment of the hip that does not adduct the hip?

Answer 28

Obturator externus

Attachment - outer surface of obturator membrane and margins of obturator foramen behind the neck of the femur to the trochanteric fossa Function - lateral rotation of the hip Innervation - Obturator nerve (L3,4 roots)

Question 29

What are the superior gemellus, obturator internus and inferior gemellus collectively known as?

Answer 29

These three muscles together are collectively known as the triceps coxae

Question 30

In terms of walking, you plant one limb and swing the other forward In order to be able to do this we twist the pelvis Describe how the planted limb and advancing limb twist during walking?

Answer 30

Medial rotation of the planted limb occurs whilst lateral rotation of the advancing limb happens to keep the distal lower limb from pointing inwards

As well as medial rotation of the planted limb, there is also abduction of the planted limb to support the pelvis on the opposite side

Question 31

What are the nerve roots of the sciatic nerve? What are the ways in which it leaves the pelvis?

Answer 31

Nerve roots - L4,5,S1,2,3

Usually the sciatic nerve leaves the pelvis inferior to the pirfiormis

• The tibial division almost always is inferior to the pifiromis
• The common fibular divsion can leave inferior, directly through or superior to the piriformis

Question 32

What muscle are the superior and inferior gluteal vessels/nerve relative to? What do the nerves supply?

Answer 32

The gluteal nerves and vessels are relative to the piriformis Superior gluteal nerve - gluteus medius, minimus and tensor fascia latae Inferior gluteal nerve - gluteus maxiimus

Question 33

What does the inferior gluteal artery give branches to once leaving the pelvis?

Answer 33

Inferior gluteal artery - mainly supplies the gluteus maximus and comes towards the cruciate anastamosis at the femoral neck area

Question 34

What does the superior gluteal artery give branches to once leaving the pelvis?

Answer 34

Superior gluteal artery - gives off a superficial and deep branch Superficial branch enters the deep surface of the gluteus maximus Deep branch splits into superior and inferior division with the inferior dvision continuing to travel with the superior gluteal nerve

Question 35

What is the nerve that runs very closely associated with the sciatic nerve? What are its nerve roots? What branches does this nerve give to supply the skin of the lower half of the buttocks?

Answer 35

This nerve would be the posterior cutaneous nerve of the thigh (S1,2,3) The posterior cutaneous nerve of the thigh gives the inferior clunial nerves to supply the skin of the lower half of the buttocks

Question 36

Where do all the clunial nerves arise?

Answer 36

The superior clunial nerves arise from the posterior ami of L1,2,3 lumbar nerves The middle clunial nerves arise from the posterior rami of S1,2,3 sacral nerves The inferior clunial nerves arise from the posterior cutaneous nerve of the thigh (anterior rami S1,2,3)

Question 37

What type of joint is the hip joint?

Answer 37

The hip joint is a synovial ball and socket joint

Question 38

The acetabulum forms a very deep socket for the head of the femur The acetabulum is a cup-like depression located on the inferolateral aspect of the pelvis. Its cavity is deepened by the presence of? What is the ligament connecting the acetabular fossa to the fovea of the head of the femur? What artery runs in this ligament?

Answer 38

The acetabulum is deepened further by a fibrocartilaginous collar known as the acetabular labrum The ligament of the head of the femur (ligamentum teres) attaches fovea of femur to acetabular fossa - the artery to the head of femur, a branch of the obturator artery runs within this

Question 39

Inferiorly there is a gap in the acetabulum known as the acetabular notch Which ligament bridges this notch? What is the fat pad in the acetabular fossa covered by?

Answer 39

The transverse acetabular ligament bridges the acetabular notch The fat pad in the acetabular fossa is covered by the synovial membrane and is therefore not part of the hip joint articular surface

Question 40

Describe the capsule attachments of the hip joint? (acetabulum and femur)

Answer 40

The capsule aessentially attaches around the acetabulum and cuts across at the acetabular notch

On the femur, anteriorly the capsule comes across the intertrochanteric line and posteriorly, the capsule extends to the distal end of the neck of the femur

Question 41

Each of the hip bones has a ligament associated with the hip joint Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament State the attachments of the iliofemoral ligament?

Answer 41

Iliofemoral ligament attaches from the anterior ifnerior iliac spine (AIIS) to the intertrochanteric line

Question 42

Restate the iliofemoral ligament attachments and its function? Remember it has upper and lower bands

Answer 42

Iliofemoral ligament

Attachment - AIIS to the intertrochanteric line

Function - fibres become taight during certain movement at hip joint

Limits -

• * Extension
• * Lateral rotation
• * Upper band limits adduction
• * Lower band limits abduction

Question 43

State the attachments of the pubofemoral ligament

Answer 43

Pubofemoral ligament attaches from the iliopubic eminence to the lower part of the intertrochanteric line

Question 44

Restate the pubofemoral ligament attachments What is the function of the pubofemoral ligament?

Answer 44

Attachment - from iliopubic eminence to the lower part of the intertrochanteric line Function

• To limit
  
  • * Extension
  • * Lateral rotation
  • * Abduction

Question 45

What are the attachments of the ischiofemoral ligament?

Answer 45

Ischiofemoral ligament attaches from the posterior aspect of the acetabulum to the greater trochanter of the femur - the fibres spiral to converge at the greater trochanter of the femur

Question 46

Due to the spiralling of the fibres, the ischiofemoral ligament is special in the movements it limits- usually posterior to the joint ligament would limit flexion for example

• What movements does the ischiofemoral ligament limit?

Answer 46

• Limits - Extension due to the fibres becoming taught when extending the hip because of the spiralling
• Limits - Medial rotation as this will stretch the fibres
• Limits - Adduction because the tilt of the greater trochanter away from the midline will stretch the fibres

Question 47

Restate the movements limited by all the hip joint ligaments The ligaments deal with all the movements except flexion as this is limited by the presence of the trunk

Answer 47

Iliofemoral limits-

• Extension &lateral rotation Upper band limits adduction Lower band limits abduction

Pubofemoral limits -

• Extension, lateral rotation and abduction

Ischiofemoral limits -

• Extension, medial rotation and adduction

Question 48

What are the main arteries supplying the hip joint?

Answer 48

Medial and lateral circumflex femoral arteries mainly

As well as superior/inferior gluteal arteries and the artery to the head of the femur (from obturator artery)

Question 49

Where do the medial and lateral circumflex femoral arteries arise? What branches are given and from which one to supply the head and neck of the femur? What can fracture of the neck of the femur do to this circumflex artery?

Answer 49

Medial and lateral circumflex femoral arteries arise from the profunda femoris branch of the femoral artery

Medial circumflex femoral arteries give retinacular branches which supply the head and neck of the femur

The neck of the femur can fracture tearing the medial circumflex femoral artery causing avascular necorsis of the femoral head