Anatomy of the Hip and Knee - Clinical

Question 1

the hip is a diarthrodial joint, what does this mean?

Answer 1

A diarthrodial joint is one in which the adjoining bone ends are covered with a thin cartilaginous sheet and joined by a joint capsule lined by a synovial membrane, which secretes synovial fluid

Question 2

the hip is a ______-bearing joint

Answer 2

weight

Question 3

what type of synovial joint is the hip?

Answer 3

Ball and Socket

Question 4

the hip is a stable joint enhanced by what?

Answer 4

Enhanced by static and dynamic stabilisers

Static stabilisers– ligaments and shape of the hip

Dynamic stabilisers - muscles

Question 5

what is the normal angles of the hip?

Answer 5

Neck Shaft ~130deg

Fem Anteversion 15deg

Acet Anteversion 20deg

Question 6

cover the labels and name the different parts of the pelvis

Answer 6

Question 7

what bones make up the hip?

Answer 7

Question 8

name the different labels of the surface anatomy

Answer 8

Question 9

name the ligaments of the hip

Answer 9

Inguinal ligament connects anterior superior iliac spine to pubic tubercle

The iliofemoral ligament is a ligament of the hip joint which extends from the ilium to the femur in front of the joint. It is also referred to as the Y-ligament - most important one

Question 10

picture showing anatomy of the hip joint

Answer 10

Head of the femur and the acetabulum covered in hyaline cartilage and if damaged it doesn’t repair itself, and if bone exposed you start to get arthritis process

Question 11

what are the static hip stabilisers?

Answer 11

Bony morphology:

• Congruence
• Anteversion of ball and socket

Labrum

-ve intra-articular pressure

Question 12

what are the dynamic stabilisers of the hip?

Answer 12

Musculature (never truly NWB-ing)

Question 13

what are the Hip Flexors, their origin, insertion and invervation?

Answer 13

Question 14

whats the storngest muscle that flexes the hip?

Answer 14

Psoas muscles is strongest muscles that flexes the hip

Question 15

what are the Hip extensors, their origin, insertion and invervation?

Answer 15

Question 16

a

Answer 16

gluteus maximus

Question 17

b

Answer 17

biceps fomoris

Question 18

c

Answer 18

semitendinosus

Question 19

d

Answer 19

semimembranosus

Question 20

what muscles make up the hamstring?

Answer 20

biceps femoris

semimembranosus

semitendinosus

Question 21

what are the Hip abductors, their origin, insertion and invervation?

Answer 21

Question 22

name a and b

Answer 22

a = gluteus medius

b = gluteus minimus

Question 23

what are the Hip adductors, their origin, insertion and invervation?

Answer 23

Question 24

cover the labels and name the hip adductors

Answer 24

Question 25

what are the Hip Internal Rotators, their origin, insertion and inervation?

Answer 25

Question 26

what are the Hip external Rotators, their origin, insertion and inervation?

Answer 26

Question 27

Diagnosing Hip Pathology is done how?

Answer 27

* “C” sign * Exacerbating Factors * Worse WB-ing (weight bearing) * Difficulty tying shoe laces * Site of pain: - Trochanteric - Buttock - Groin - Referred

Question 28

what is shentons line?

Answer 28

If shentons line is disrupted then points to hip pathology

Question 29

Blood Supply to Femoral Head is done by what?

Answer 29

* Capsule via Medial and Lateral Fem. Circumflex * Intramedullary * Ligamentum Teres via acetabular branch of Obturator Artery

Question 30

how is a extra-capsilar injury managed?

Answer 30

* Always fix * Blood supply intact

Question 31

how is a intra-capsular injury managed?

Answer 31

* Blood supply (to femoral head) compromised * Management based on age of patient, and displacement: - Undisplaced-Fix - Displaced and Young – Fix - Displaced and Old – Replace (either hemiarthroplasty or THR)

Question 32

what type of joint is the knee and what movements does it do?

Answer 32

• Sophisticated hinge - Flexion extension primary plane of motion - But also rotation, varus/valgus, AP translation

Question 33

is the knee: - Weightbearing - diarthrodial

Answer 33

Weightbearing - yes diarthrodial - yes

Question 34

is the knee more or less stable than the hip and what does this mean?

Answer 34

* Less stable than hip, more reliant on soft tissue constraints * Prone to injuries

Question 35

Bony anatomy of th eknee: how. many articulating surfaces and what is the ROM?

Answer 35

* 3 Articulating surfaces * Relatively unconstrained * Normal ROM -5 – 130deg Femur, tibia and fibula

Question 36

what is the patella and its role?

Answer 36

* Largest sesamoid bone in body (Sesamoid bone is a bone placed within a tendon) * Thickest hyaline cartilage * 3x body weight through PFJ on stairs, 7x during squats * Role in increasing extensor lever arm

Question 37

what is the Knee Alignment?

Answer 37

Question 38

what are some static some tissue constraints?

Answer 38

Collateral ligaments ACL/PCL (cruciate ligament) Capsule ITB Meniscii

Question 39

what are some dynamic tissue constraints?

Answer 39

Quadriceps Hamstrings Medial and lateral gastroc. Popliteus

Question 40

what is the soft tissue anatomy of the knee

Answer 40

Question 41

what muscles make up the knee extensors, what is their origin, insertion and inervation?

Answer 41

All are parts/make up the quadriceps

Question 42

what muscles make up the knee flexors, what is their origin, insertion and inervation?

Answer 42

Question 43

what muscles make up your hamstrings?

Answer 43

Semitendinosus Semimembranosus Biceps femoris

Question 44

what ar ethe Meniscii?

Answer 44

* Crescent of fibrocartilage * Avascular centrally * Medial C-shaped - Less mobile and Firmly attached to tibia * Lateral “Circular” - More mobile and Unattached at popliteus hiatus A meniscus is a piece of cartilage found where two bones meet (joint space). Menisci (plural of meniscus) protect and cushion the joint surface and bone ends. In the knee, the crescent-shaped menisci are positioned between the ends of the upper (femur) and lower (tibia) leg bones

Question 45

what is the role of meniscii?

Answer 45

* Load Transmission * Stability - Esp AP translation * Proprioception * Shock absorbtion

Question 46

what are different knee injuries that may occur?

Answer 46

* Meniscal tears * Ligament injuries * OCD lesions (osteochondral defects) * Loose bodies * Fractures * Quads/Patellar tendon ruptures

Question 47

How do ACL injuries occur, how do they present and what investigation is required?

Answer 47

* Knee buckles during pivot * Unable to play on * Immediate haemarthrosis (haemorrhage into a joint space ) * Recurrent instability * X-ray - Haemarthrosis, Segond fracture (a type of avulsion fracture (soft tissue structures pulling off fragments of their bony attachment) from the lateral tibial plateau of the knee, immediately below the articular surface of the tibia)