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MD2002 > Glenohumeral And Hip Joints > Flashcards

Glenohumeral And Hip Joints Flashcards

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1
Q

Explain glenohumeral joint

A

Ball head of humerus and socket glenoid cavity of scapula

Unstable like egg and spoon but great mobility

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2
Q

Hip joint explained

A

Ball head of femur and socket acetabulum of hip

Stable but limited mobility

Eenture weight upper body transmitter through hip and femur

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3
Q

Movement at glenohumeral and hip joints

A

Flexion and extension
Abduction and addiction
Medial and lateral rotation
Circumspection

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4
Q

Shape of bony surfaces of glenohumeral joint

A

Glenoid fossa shallow with glenoid labrum attached to edge which depends socket and helps stabilise

Humerus head 1/3 of sphere only 1/3 in contact with glenoid fossa

Held in place by rotator cuff muscles (SITS)

Surfaces covered by hyaline cartilage(synovial)

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5
Q

Ligaments at glenohumeral joint

A

Intrinsic (both anterior)

Glenohumeral weak
Transverse humeral which supports biceps tendon

Extrinsic (both superior)
Coracoacromial
Coracohumeral

There are no ligamentous support posteriorly or inferiorly

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6
Q

What is the coracoacromial arch

A

Coracoid process
Acromion
Coracoacromial ligament

Prevents superior displacement of humerus

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7
Q

GH joint capsule

A

Loose attaching medially to glenoid fossa margin and labrum
Laterally attaches to anatomical neck of humerus

Capsule encloses proximal attachment of long head of biceps

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8
Q

Openings in the GH joint

A

Biceps tendon passes through to its insertion

Synovial membrane passes through capsule anteriorly to form subscapularis bursa

Bursa protects subscapularis tendon from being damaged by edge of glenoid

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9
Q

What’s the most common dislocation of GH joint

A

Subcoracoid dislocation
(Anterior dislocation)

Dislocated in abduction
Axillary nerve and circumflex humeral artery at risk

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10
Q

Bursae at GH joint

A

Bursae are sac like cavities bear joint which contain synovial fluid

Subscapularis bursa communicates with joint cavity

Bursitis - inflammation of bursae lead to degenerative changes in tendons resulting in difficulty initiating movements for example if supraspinatus tendon affected there is an inability to initiate abduction

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11
Q

Muscles of scapular region

A

Superficial - lat dorsi (trunk to humerus) and trapezius (trunk to scapula)

Deep - (trunk to scapula) rhomboids and levator scapulae

Scapular (intrinsic shoulder muscles - scapula to humerus) - deltoid, teres major and SITS - supraspinatus infraspinatus teres minor and subscapularis

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12
Q

What are the rotator cuff muscles

A

Superspinatus
Infraspinatus
Teres minor
Subscapularis

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13
Q

What muscles bring about scapulothoracic movement

A

Trapezius
Rhomboids
Levator scapular

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14
Q

What are rotator cuff muscles and how do they work

A

Short powerful muscles that stabilise joint by pulling head of humerus into glenoid fossa
Tone of muscles is major stabilising factor at GH joint

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15
Q

What is job of supraspinatus

A

First 15’ of abduction (deltoid then takes over up to 90)

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16
Q

What does infraspinatus do

A

Lateral rotation

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17
Q

what does teres minor do

A

Lateral rotation

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18
Q

What does subscapularis do

A

Media rotation

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19
Q

What rotator cuff muscles are posterior scapula

A

Supraspinatus
Infraspinatus
Teres minor

Attach to greater tuberosity of humerus

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20
Q

How are rotator cuff muscles supplied

A

Supraspinatus and infraspinatus are supplied by suprascapular nerve

Teres minor supplied by axillary nerve

Subscapularis supplied by subscpualr nerves of posterior cord

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21
Q

Where does subscapularis rotator cuff attach

A

Anterior scapular muscle attaches to subscapular fossa and attaches to lesser tuberosity of humerus

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22
Q

What muscles attach the upper limbs to the scapula

A

Deltoid
Teres major
Triceps
4 rotator cuffs

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23
Q

Landmark of teres major

A

Divides axilla from arm

Posterior wall of axilla

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24
Q

Teres major attachments

A

Lateral margin of scapula to medial lip of bicipital groove of humerus

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25
What supplies teres major
Lower subscapular nerve
26
What is function of teres major
Addicts and medially rotates humerus
27
Attachments of deltoid
Clavicle acromion and spine of scapula to deltoid tuberosity of humerus
28
Supply of deltoid
Axillary nerve
29
What does deltoid do
Abducts arm but requires supraspinatus to initiate first 15' Flexes and medially rotates the arm (clavicles head) Extend and laterally rotate arm (spinal part)
30
Where does tricpes brachii do and where does it attach
Long head attaches to infraglenoid tubercle of scapula to ulna Assists in stabilising addicted GH joint
31
Where does coracobrachialis attach and what does it do
Attaches to coracoid process of scapula to middle 1/3 of humerus Resists dislocation of shoulder joint
32
Movement of GH joint and muscles which do it
``` Flexion - Pec major and deltoid Extension - deltoid (back) Lateral rotation - infraspinatus Medial rotation - subscapularis Adduction - Pec major and latissimus dorsi Abduction - deltoid ```
33
Gateways to scapular region
Suprascapular notch Quadrangular space Upper triangular space Lower triangular (triangular interval)
34
What comes through suprascapular notch
Above scapular Suprascapular nerve to supraspinatus and infraspinatus Suprascapular artery (branch of subclavian artery which forms anastomoses with circumflex scapular of axillary artery
35
Suprascpaular artery anastomisises with which other artery
Circumflex scapular of axillary artery
36
What comes through quadrangular space
Under GH joint Axillary nerve Posterior circumflex humeral artery
37
What goes through upper triangular space
Circumflex scapular artery
38
What goes through lower triangular space
Radial nerve and profunda brachii artery
39
Hip joint explained shape etc
Trades mobility for stability Acetabulum is deep with lunate lined articular surface Femoral head large and approximately 2/3rd of a sphere Femoral head covered in hyaline cartilage except for fovea for ligament also uncovered in acetabulum which Carries blood supply to femoral head in children
40
What supplies blood to femoral head in children
Fovea for ligament
41
How is acetabulum formed
Fusion of ilium pubis and ischium
42
What does acetabulum have around edges and what can happen to it
Acetabular labrum Can tear and cause pain
43
Osteology of femur
``` Head fovea Neck Greater trochanter Intertrochanteric crest on side Intertrochanteric line (capsular attachment) Lesser trochanter ```
44
Where does hip joint xapsukeand ligaments insert into
Intertrochanteric line anteriorly
45
When are epiphysis of 2 trochanter and femoral head fused
18-19 years
46
Synovial layers of capsule send
Retinacular fibres medially along femoral neck toward head
47
Ligaments that reinforce the fibrous capsule of hip joint
Iliofemoral (anterior and superior) strongest Pubofemoral (anterior and inferior) Ischiofemoral (posterior) weakest
48
Attachment of iliofemoral anterior and superior ligaments What does it do
Anterior inferior iliac spine to intertrochanteric line Prevents hyperextension of hip during standing
49
What does pubofemoral anterior and inferior attach to and what does it do
Blends with iliofemoral attaches from obturator crest of pubic bone to merge with fibrous capsule Prevents overabduction of hip joint and tightens during abduction and extension of the hip
50
What's the iliofemoral ligament attachments
Attaches from acetabular rim ischial to medial part of greater trochanter
51
Where is greater trochanter on hip joint X-ray
Opposite middle of acetabulum
52
Which part of hip joint shows X-ray changes of osteoarthritis first
Suoerilateral part of acetabulum (top)
53
Hip joint slipped femoral capital epiphysis in adoslecnt
Abnormal growth of epiphysis causes femoral neck to move slightly anteriorly and into external rotation Hip pain groin pain in adolescent progressing to painful limp with decreased range of hip movement Pinning head in place
54
Neurovascular supply to hip joint
Retinacular arteries Medial and lateral circumflex arteries Nerves are femoral, obturator, superior gluteal and nerve to quadrator femoris. Follows hiltons law- nerves supplying muscles acting on joint innervate joint
55
Relations to hip joint
Lateral to hip joint - gluteus medius, tensor fascia latae and iliotibial tract Anterior to hip joint - femoral artery, nerve then vein Medially - branches of obturator nerve and vessels Posterior- sciatic nerve (with posterior femoral cutaneous nerve and inferior gluteal vessels adjacent
56
Muscles at hip joint
Flexors(anterior thigh) - pectineus, iliposoas, sartorial Adductors (medial thigh) - adductors longus, brevis, Magnus, gracilis and obturator externus Extensors (posterior thigh) - flex knee also - semitendinosus Semimembranosus Biceps femoris ``` Abductors and rotator of thigh (gluteal region) Gluteus maximus, medius, minimus Tensor fascia latae Piriformis Obturator internus Superior and inferior gemelli Quadratus femoris ```
57
Flexors of hip
Pectineus Iliopsoas Sartorius Rectus femoris
58
What does rectus femoris do
Flex hip at thigh and steady hip joint
59
Pectineus attachment, innervation and function
Pubis to femur Adducts and medially rotates Femoral nerve
60
Iliopsoas is??!
Psoas major Psoas minor Iliacus all combined
61
Iliopsoas attachment, function, innervation
Psoas major and minor attach Vertebrae to femur Iliacus attache Iliac crest/SI to femur Stabilise hip joint and flexes Iliacus supperlied by Femoral nerve Psoas major and minor supplied by anterior rami of L1,2,3
62
Sartorius attachments, function and innervation
Anterior superior iliac spine to superior medial tibia Flexes, adducts and laterally rotates thigh and flexes at knee Femoral nerve
63
Flexors of the hip are supplied mainly by
Femoral nerve
64
Adductors of hip and their innervation
Adductor longus and adductor brevis - pubis to femur Supplied by obturator nerve
65
Adductors of hip are
Adductor Magnus Obturator externus Gracilis Obturator nerve Mainly
66
Adductor Magnus
Two parts - adductor and hamstring Adductor - pubis and ischial ramus to femur Obturator nerve Hamstring - ischial tuberosity to femur Sciatic nerve
67
Obturator externus
Obturator foramen and membrane to femur Adducts laterally rotates and steadies head of femur Obturator nerve
68
Gracilis
Pubis to superior medial tibia Flexes and partially medial rotation of leg Obturator nerve
69
Extensor of hip are and are supplied by
Semitendinous and semimembranous Biceps femoris All supplied by sciatic nerve
70
Semitendinosus
Ischial tuberosity to superior medial tibia
71
Semimembranosus
Post medial condyle of tibia to medial tibia
72
Biceps femoris
Ischial tuberosity (long head) or femur (short head) to fibula Partial flexors when knee flexes
73
Abductors and medial rotators of thigh
Gluteus maximus Gluteus medius minimus and tensor fascia latae Piriformis, obturator internus, superior and inferior gemelli Quadratus femoris
74
What muscles hip to stabilise the hip joint
Piriformis Quadrator femoris Obturator externus
75
Dashboard injury
Posterior dislocation Sitting with hips flexed blow to knee sends force through femur and dislocates posteriorly Sciatic nerve at risk!
76
Gait 1 swing phase
Lift lower limb and flex hip - iliopsoas and rectus femoris
77
Gait 2 swing phase
Flex hip more iliopsoas and femoris - extend knee quadriceps
78
What are the quadriceps
Vastis medialis, lateralis and intermedius, rectus femoris
79
What prevents patellar lateral dislocation
Vastus mediallis
80
Gait 3 stance phase
Abductors Keep pelvis level - gluteus medius minimus with adductors (Magnus longus and brevis) to counter balance Medial rotation hip gravity aided by anterior fibres of gluteus minimus and medius
81
Gait 4 push off
Extend hip via hamstrings (gluteus maximus if power needed) | Extend knee quadriceps
82
Gait 5 swing phase
Keep foot pointing forward via lateral rotation at hip by shortcut , lateral rotators such as piriformis, obturator externus and internus with gemelli

MD2002 (22 decks)

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