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Yr 2 - Movement > Gluteal Region and Hip - SDL > Flashcards

Gluteal Region and Hip - SDL Flashcards

1
Q

What is the pelvic girdle?

A

A bony ring formed by the left and right innominate bones and the sacrum

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2
Q

What are the 4 articulations with the pelvis?

A
  1. 2x sacroiliac joints
  2. Sacrococcygeal symphysis
  3. Pubic symphysis
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3
Q

What does each innominate bone articulate with posteriorly?

A

The sacrum at the sacroiliac joint

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4
Q

What does each innominate bone articulate with anteriorly?

A

Each other at the pubic symphysis

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5
Q

How does the innominate bone develop?

A

Develops in the embryo as three separate bones – the ilium, ischium and pubic bone.

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6
Q

What is the area at which the ilium, ischium and pubis fuse?

A

Acetabulum - a ‘socket’ which articulates with the head of the femur to form the hip joint

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7
Q

What are the functions of the pelvis?

A
  1. Transfer of weight from the upper axial skeleton to the lower appendicular components of the skeleton, especially during movement.
  2. Provides attachment for a number of muscles and ligaments used in locomotion.
  3. Contains and protects the abdominopelvic and pelvic viscera.
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8
Q

What is the pubic symphysis?

A

A secondary cartilaginous joint between the 2 pubic bones

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9
Q

What is the pubic symphysis made of?

A

The articular surfaces are covered by a layer of hyaline cartilage and are connected by a fibrocartilaginous disc.

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10
Q

In the latter stages of pregnancy, the pelvis of the mother-to-be undergoes changes – what are these and why are they necessary?

A

Elasticity of the symphysis pubic joint and pelvis ligaments is increased à allowing expansion of pelvic outlet.

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11
Q

Why can major pelvic fractures be fatal?

A

The pelvis supports many internal organs and this can damage these organs

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12
Q

The pelvic girdle is strengthened by very strong ligaments. What are these?

A

Sacrospinous and sacrotuberous ligaments

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13
Q

What are the sacrotuberous and sacrospinous ligaments attachments between?

A

Between the sacrum and the innominate bones

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14
Q

In addition to providing stability, what do these ligaments transform the greater and lesser sciatic notches of the ischium into?

A

The greater and lesser sciatic foramina

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15
Q

What do the foramina allow?

A

They allow important structures, including vessels and nerves, to pass between the inside of the pelvis and the gluteal region

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16
Q

What does the femur articulate with proximally?

A

The acetabulum to form the hip joint

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17
Q

What does the femur articulare with distally?

A

The tibia to form the knee joint

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18
Q

Femur labelled diagram

A
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19
Q

What type of joint is the hip joint?

A

Ball and socket (synovial) formed by the articulation between the acetabulum of the pelvis (innominate bone) and the head of the femur.

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20
Q

Why is the hip joint a stable joint? What factors contribute to stability?

A

Stable:

  • Good fit
  • Acetabular labrum
  • Strong joint capsule
  • Surrounding ligaments and muscles

Mobility:

  • Ball and socket joint
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21
Q

Diagram of internal structure of hip joint

A
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22
Q

Diagram of iliofemoral, pubofemoral and ischiofemoral ligament

A
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23
Q

What are the main arteries delivering blood to the hip?

A
  • The medial and lateral circumflex arteries - these anastamose around the hip joint
  • (There is also a good contribution from the obturator artery)
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24
Q

What are the medial and lateral circumflex arteries branches of?

A

The profunda femoris (deep artery of the thigh)

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25
Q

What may fractures of the femoral neck lead to?

A

Fractures of the femoral neck which disrupt the blood supply to the head of the femur may lead to avascular necrosis of the femoral head

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26
Q

What movements are possible at the hip joint?

A
  • Flexion
  • Extension
  • Adduction
  • Abduction
  • Medial rotation
  • Lateral rotation
  • (Circumduction)
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27
Q

What are the 2 groups of muscles in the gluteal region?

A

Superficial and deep

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28
Q

How do the superficial gluteal muscles generally move the hip?

A

Generally extend, abduct or rotate the hip

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29
Q

How do the deep gluteal muscles generally move the hip?

A

Generally act as rotators of the hip

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30
Q

What do the superficial muscles in the gluteal region consist of?

A
  • 3 glutei
    • Gluteus maximum
    • Gluteus medius
    • Gluteus minimus
  • Tensor fascia lata (TFL)
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31
Q

Order of glutei muscles from superficial to deep?

A
  1. Gluteus maximus
  2. Gluteus medius
  3. Gluteus minimus
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32
Q

Why is gluteus maximum often used as a site for placing intramuscular injections?

A

Gluteus maximus is the largest and most superficial muscle of the buttock

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33
Q

What are the actions of gluteus maximus?

A

It is the main extensor of the thigh, and assists with lateral rotation. However, it is only used when force is required, such as running or climbing.

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34
Q

Origin and insertion of gluteus maximus?

A

Origin: sacrum, sacrotuberous ligament

Insertion: iliotibial tract and the gluteal tuberosity of the femur

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35
Q

Innervation of gluteus maximus?

A

Inferior gluteal nerve.

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36
Q

What is the iliotibial tract?

A

a lateral thickening of the fascia lata.

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37
Q

What is the fascia lata? What is the function of the iliotibial tract?

A

Fascia lata is the deep fascia of the thigh.

The iliotibial tract acts to stabilise the hip and knee, and originates from the gluteus maximus and tensor fascia lata.

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38
Q

Labelled diagram of gluteus medius and minimus

A
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39
Q

Origin and insertion of gluteus medius?

A

Origin: the gluteal surface of the ilium

Inserts: into the lateral surface of the greater trochanter

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40
Q

Origin and insertion of gluteus minimus?

A

Origin: from the ilium and converges to form a tendon

Inserts: the anterior side of the greater trochanter.

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41
Q

Which nerve innervates both gluteus medius and minimus? Which spinal nerves contribute to this nerve?

A

Superior gluteal nerve. L4-S1.

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42
Q

Actions of gluteus medius and minimus?

A

Abducts and medially rotates the leg

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43
Q

When one leg is being abducted away, how does the pelvis stay level? What is this important for?

A

The pelvis stays ‘level’ because the hip abductors on the right - the ‘stance’ limb – contract and pull on the right side of the pelvis, making sure that the pelvis doesn’t tilt down to the left.

This action is extremely important for normal gait – when we’re walking, most of the time we only have one foot or the other on the ground.

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44
Q

What causes a ‘waddling’ gait. What is this called?

A

The Trendelenburg sign – seen if the abductors on one side are paralysed.

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45
Q

What is tensor fascia lata?

A

Is considered a muscle of the superficial gluteal region

46
Q

Origin and insertion of tensor fascia lata?

A

Origin: ASIS

Inserts: into the iliotibial tract

47
Q

Action of tensor fascia lata?

A

When it contracts it tenses the fascia lata and the iliotibial tract (as the iliotibial tract inserts onto the lateral tibia): this is extremely important for stabilising the extended knee. It also contributes to flexion of the hip joint

48
Q

Innervation of tensor fascia lata?

A

Superior gluteal nerve

49
Q

What are the actions of the deep gluteal muscles?

A

These are lateral rotators of the hip (similat to the rotator cuff muscles in the shoulder)

50
Q

What are the deep gluteal muscles?

A
  • Piriformis
  • Obturator internus
  • Quadratus femoris
  • Superior gemellus
  • Inferior gemellus
51
Q

Diagram of deep gluteal muscles

A
52
Q

Where do the deep gluteal muscles generally arise/insert?

A

They arise from the posterior parts of the pelvis, and insert, generally, on the more posterior regions of the proximal femur

53
Q

Which muscle acts as an important landmark for the identification of vessels and nerves of the gluteal region?

A

Piriformis

54
Q

Origin and insertion of piriformis?

A

Originates from within the pelvis and passes out into the gluteal region through the greater sciatic foramen

Origin: anterior surface of the sacrum. It then travels infero-laterally, through the greater sciatic foramen

Inserts: into the greater trochanter of the femur.

55
Q

Action of piriformis?

A

Lateral rotation and abduction.

56
Q

Innervation of piriformis?

A

The muscle is innervated by the ventral rami of S1 and S2 (and L5 to a lesser extent), which join to form the nerve to the piriformis.

57
Q

How does the sciatic nerve exist the pelvis (in relation to piriformis)?

A

Emerges from the pelvis through the greater sciatic foramen –> inferior to the lower border of piriformis

58
Q

Origin and insertion of the gemelli?

A

Origin: The superior gemellus muscle originates from the ischial spine, the inferior from the ischial tuberosity.

Insert: They both attach to the greater trochanter of the femur.

59
Q

Action of the gemelli?

A

Lateral rotation and abduction.

60
Q

Origin and insertion of obturator internus?

A

Origin: Originates from the pubis and ischium at the obturator foramen. It travels through the lesser sciatic foramen.

Inserts: attaches to the greater trochanter of the femur.

61
Q

Action of obturator internus?

A

Lateral rotation and abduction

62
Q

Origin and insertion of quadratus femoris?

A

Origin: It originates from the lateral side of the ischial tuberosity

Insert: attaches to the quadrate tuberosity on the intertrochanteric crest.

63
Q

Action of quadratus femoris?

A

Lateral rotation

64
Q

How do the vessels and nerves that supply the gluteal region enter and exit the pelvis? What is an important landmark for this?

A

Via the sciatic foramina.

Piriformis is an important landmark for some of these structures, which enter the gluteal region either superior, or inferior, to the muscle

65
Q

Diagram of the major arteries and nerves of the gluteal region

A
66
Q

What structures emerge superior to piriformis?

A

Superior gluteal nerve and superior gluteal vessels.

67
Q

What structures emerge inferior to piriformis?

A

Inferior gluteal nerve and vessels and the sciatic nerve

68
Q

What is the vascular supply of the gluteus maximus, medius and minimus muscles? Which larger vessels do these arteries branch from?

A
  • Gluteus maximus: supplied by the superior and inferior gluteal artery
  • Gluteus medius: inferior gluteal artery
  • Gluteus minimus: inferior gluteal artery

The superior gluteal artery is the largest branch of the internal iliac artery and arises from its posterior division.

The inferior gluteal artery originates from the anterior division of the internal iliac artery.

69
Q

Which larger veins do the gluteal veins drain into?

A

They drain into the internal iliac vein

70
Q

Which nerves accompany the gluteal vessels and what spinal nerves contribute to them?

A

Superior gluteal nerve:

  • Is accompanied by the superior gluteal artery and vein for much of its course
  • Roots: L4, L5, S1

Inferior gluteal nerve:

  • Is accompanied by the inferior gluteal artery and vein for much of its course
  • Roots: L5, S1, S2

Sciatic nerve:

  • Roots: L4, L5, S1, S2, S3
71
Q

Looking at the diagram, can you explain why, when giving an intramuscular injection into the buttock, you must always place it in the upper, lateral quadrant of the buttock?

A

The upper outer quadrant of this area must be used to avoid any damage to the sciatic nerve

72
Q

What muscle is the principal flexor of the hip joint?

A

Iliopsoas

73
Q

origin of psoas major?

A

The psoas major originates from the lumbar vertebrae

74
Q

Innervation of psoas major?

A

anterior rami of L1-3

75
Q

Origin of iliacus?

A

Iliacus originates from the iliac fossa of the pelvis

76
Q

Innervation of iliacus?

A

femoral nerve

77
Q

Where does iliacus and psoas major insert?

A

These muscles insert onto the lesser trochanter of the femur

78
Q

Under what structure do these muscles (iliacus and psoas major) pass on their way from the pelvis into the anterior thigh?

A

Inguinal ligament

79
Q

Iliopsoas forms the lateral part of the ‘floor’ of which important neurovascular region in the anterior thigh?

A

Femoral triangle

80
Q

What muscles are involved in flexion at the hip?

A

Iliopsoas, sartorius, rectus femoris, adductor magnus (adductor component)

81
Q

What muscles are involved in adduction at the hip?

A

Adductor magnus, adductor longus, adductor brevis, pectineus

82
Q

What muscles are involved in lateral rotation at the hip?

A

Piriformis, obturator internus, the gemelli, quadratus femoris, sartorius

83
Q

What muscles are involved in abduction at the hip?

A

Piriformis, obturator interus, the gemelli, sartorius, gluteus medius, gluteus minimus

84
Q

What muscles are involved in extension at the hip?

A

Gluteus maximus, adductor magnus (hamstring portion)

85
Q

What muscles are involved in medial rotation at the hip?

A

Gluteus medius, gluteus minimus, (tensor fascia lata)

86
Q

Is this a right or a lieft hip?

A

Right

87
Q

Identify muscle 2, 3 and 4

A

2 - Gluteus medius

3 - Gluteus maximus

4 - Piriformis

88
Q

Tensor fascia lata attaches to what landmark?

A

2 - ASIS

89
Q

Landmark number 5 is the …

A

Ischial tuberosity

90
Q

Where does muscle 2 insert?

A

On the greater trochanter

91
Q

Name muscles 1, 2, 3, 4 and 7

A

1 - Piriformis

2 - Superior gemellus

3 - Tendon of obturator internus

4 - Inferior gemellus

7 - Quadratus femoris

92
Q

The nerve indicated by the number 6 is typically formed by which spinal nerves?

A

L4-S3

93
Q

Muscle 3 inserts distally into the … ?

What blood vessel supplies muscle 3?

A

Gluteal tuberosity and iliotibial tract

Inferior gluteal artery

94
Q

What is the common hamstring origin?

A

Ischial tuberosity

95
Q

The muscle indicated by the number 1 originates from the…

A

Anterior surface of the sacrum

96
Q

What is structure 5? How does it leave the pelvis?

A

Sciatic nerve - leaves the pelvis via the greater sciatic foramen

97
Q

Name 1-8

A

1 - Piriformis

2 - Superior gemellus

3 - Tendon of obturator internus

4 - Inferior gemellus

5 - Sacrotuberous ligament

6 - Sciatic nerve

7 - Quadratus femoris

8 - ischial tuberosity

98
Q

Iliopsoas inserts onto which landmark?

A

6

99
Q

Identify muscle 2.

What is 3? What inserts into it? What is its function?

A

2 - tensor fascia lata

3 - iliotibial tract: gluteus maximus and tensor fascia lata insert into it, it stabilises the knee joint

100
Q

What are the lateral rotators of the hip joint?

A
  • Obturator internus
  • Piriformis
  • Superior and inferior gemelli
  • Quadratus femoris
  • Gluteus maximus
101
Q

What is 5? What are its attachments?

A

Sacrotuberous ligament - attaches from the sacrum to the ischial tuberosity

102
Q

The muscle indicated by number 3 emerges into the gluteal region via the?

A

Lesser sciatic foramen

103
Q

Vessel number 1 is a branch of the?

A

Internal iliac artery

104
Q

How does muscle 2 act upon the hip?

A

Medial rotator and abductor

105
Q

Which muscles inserts into region 9?

A

Gluteus maximus

106
Q

Which nerve innervates muscle 2?

A

Superior gluteal nerve

107
Q

What passes through the greater sciatic foramen?

A
  • Piriformis
  • Sciatic nerve
  • Superior gluteal nerve, artery and vein
  • Pudendal nerve
  • Inferior gluteal nerve, artery and vein
108
Q

Which gluteal muscles insert in the region indicated by the number 2?

A
  • Inferior gemellus
  • Superior gemellus
  • Obturator internus
109
Q

What is the obturator artery a branch of?

A

The internal iliac artery

110
Q

Which vessel typically gives rise to the medial and lateral circumflex arteries of the hip joint?

A

Profunda femoris

Yr 2 - Movement (39 decks)

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