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Y2 CONTROL & MOVEMENT > L2 - Pelvis & Hip Joint > Flashcards

L2 - Pelvis & Hip Joint Flashcards

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1
Q

What is the function of the pelvic girdle?

How does it compare to the shoulder girdle?

A

it connects the vertebral column to the femurs

it is much stronger and less flexible than the shoulder girdle

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2
Q

What are the 3 bones and 3 joints of the pelvic girdle?

A

Bones:

  • left and right innominate (hip) bones
  • sacrum

Joints:

  • 2 sacroiliac joints
  • pubic symphysis joint
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3
Q

What is the main function of the pelvis?

A

it bears the weight of the upper body when walking

the vertebral column transfers body weight to the lower limbs through the pelvis

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4
Q

What is the secondary function of the pelvis?

A

it protects the pelvic viscera and blood vessels

it protects the foetus during pregnancy

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5
Q

What are the articulations of the innominate bones?

A

the innominate bones articulate posteriorly with the sacrum

they articulate anteriorly at the pubic symphysis joint

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6
Q

Label the features of the pelvic girdle

A
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7
Q

What are the 3 bones that fuse together to form the innominate (hip) bone?

What do they form when they fuse?

A
  1. ileum
  2. ischium
  3. pubis

These fuse at the acetabulum

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8
Q

What does the acetabulum articulate with?

A

the acetabulum articulates with the femoral head

this is the hip joint

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9
Q

Label the bones and articulation of the hip joint

A
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10
Q

What are the 2 main ligaments in the pelvis?

What structures do they form?

A

Sacrospinous ligament:

this runs from the sacrum to the ischial spine

this forms the greater sciatic foramen

Sacrotuberous ligament:

this runs from the sacrum to the ischial tuberosity

this forms the lesser sciatic foramen

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11
Q

How does the sciatic nerve pass through the pelvis?

A

it passes from inside the pelvis out into the lower limb via the greater sciatic foramen

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12
Q

Which colours represent the ligaments and the foramina of the of the pelvis?

A

red - greater sciatic foramen

green - lesser sciatic foramen

pink - sacrotuberous ligament

purple - sacrospinous ligament

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13
Q

What is the function of the acetabular labrum?

A

it is a lip of cartilage that deepens the articular surface

this makes the acetabulum a better fit for the femoral head

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14
Q

Label the features of the acetabulum

A
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15
Q

What is the role of the fibrous capsule?

A

it is a strong and dense fibrous capsule that surrounds the femoral head within the acetabulum

even if the femoral head is moving within the acetabulum, the fibrous capsule surrounding it keeps it stable

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16
Q

What are the proximal and distal attachments of the fibrous capsule?

A

proximal attachment:

rim of the acetabulum

distal attachment:

femoral neck (intertrochanteric line and greater trochanter)

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17
Q

What are the three ligaments of hip joint?

A
  1. pubofemoral ligament
  2. iliofemoral ligament
  3. ischiofemoral ligament
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18
Q

What is the role of the pubofemoral ligament?

A

it prevents excessive abduction

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19
Q

What is the role of the iliofemoral ligament?

A

it is the strongest ligament

it prevents hyperextension of the hip during standing as it “screws in” the femoral head

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20
Q

What is the weakest ligament of the hip joint?

A

ischiofemoral ligament

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21
Q

What is the function of the hip joint ligaments?

How do they acheive this?

A
  1. they spiral around the hip joint
  2. they become taut when the hip is extended
  3. they pull the femoral head into the acetabulum

THIS IMPROVES STABILITY

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22
Q

Which ligaments are shown in the diagram?

A
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23
Q

Which ligament is this?

A

ischiofemoral

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24
Q

What are the 3 factors that provide stability of the hip joint?

A
  1. the anatomy of the acetabulum
  2. fibrous capsule
  3. the ligaments - iliofemoral, ischiofemoral and pubofemoral
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25
What are the typical injuries that occur to the hip?
1. fractures to the pelvic ring 2. dislocation of the hip joint 3. fracture to the neck of the femur - 'hip fracture'
26
What happens in a congenital hip problem?
children can have problems with development of the hip joint, leading to joint laxity, subluxation and dislocation of the hip if this is not detected and treated early, the hip fails to develop
27
28
Label the features on the AP pelvis X-ray
29
Which points of the pelvis are common sites for fracture in elderly people?
the superior and inferior pubic rami
30
What is Shenton's line? Why is this clinically significant?
it is a **smooth line** along the medial aspect of the femur, over and around the top of the obturator foramen in a hip fracture, Shenton's line is often disrupted and no longer smooth
31
32
What fracture is shown below? What is significant about the yellow line?
**fracture of the pubic rami** both the superior and inferior pubic rami have been fractured Shenton's line has been disrupted and is no longer smooth on the fractured side
33
What type of fracture is shown in the X-ray? What usually causes it?
**'Open book' fracture** the pubic symphysis is splayed wide open this occurs when there is a large force causing compression on the anterior surface of the pelvis
34
What type of fracture is shown in the image? What causes this and why can it be fatal?
**'Vertical shear' fracture** this occurs when one part of the pelvis moves more vertically relative to the other it can be fatal due to the presence of blood vessels and the risk of them being torn and causing concealed bleeding into the pelvis
35
What device is this? When is it used and why?
**Pelvic binder** it is put on the patient at the site of accident it is slipped underneath the patient, wrapped around and tightened up to keep the pelvis as stable as possible in case there are fractures present
36
Label the parts of the proximal femur
37
Where is the subtrochanteric region of the femur?
the region underneath the lesser trochanter
38
What are the 4 regions in which a fracture of the proximal femur can occur?
1. **subcapital #** is just underneath the head of the femur 2. **transcervical #** is a fracture through the neck of the femur 3. **trochanteric #** 4. **subtrochanteric #** is just underneath the trochanteric region
39
What fracture is shown in the X-ray?
this is a fracture of the neck the femur this is a typical **"hip fracture"**
40
How is Shenton's line affected in a hip fracture (neck of femur fracture)?
Shenton's line cannot be traced due to loss of alignment
41
What type of fracture is shown here? What is the problem when interpreting this X-ray clinically?
this is a fracture through the femoral neck (hip fracture) Shenton's line does not look disrupted even though a fracture is present
42
Which arteries that supply the hip joint are shown?
43
What artery is the main supply to the hip joint?
**medial circumflex artery** this gives off the branches that enter the joint capsule to supply the femoral head
44
How does blood go from the aorta to the hip? Which arteries must it pass through?
1. the abdominal aorta divides into a left and right **common iliac artery** 2. each common iliac artery divides into **internal and external iliac arteries** 3. the external iliac artery passes underneath the inguinal ligament and becomes the **femoral artery** 4. the **profunda femoris** is a large branch of the femoral artery 5. the profunda femoris gives rise to the **medial circumflex artery** and **lateral circumflex artery** which supply the hip
45
46
What may happen if a fracture to the neck of the femur tears the surrounding blood vessels?
Most of the blood supply to the hip is via the lateral and medial circumflex arteries if these are compromised, it may lead to **avascular necrosis** of the head of the femur
47
What other artery contributes to the blood supply at the hip?
**inferior gluteal artery** this comes from the internal iliac artery
48
What is the cruciate anastomosis? Which vessels are involved?
it is a collateral artery supply to the hip joint consisting of: 1. medial circumflex arteryy 2. lateral circumflex artery 3. inferior gluteal artery 4. first perforating artery of profunda femoris
49
What happens if a fracture to the femoral neck tears the medial circumflex artery?
it leads to loss of blood supply to the femoral head this can lead to avascular necrosis of the femoral head
50
What condition is shown in these X-rays?
**arthritis of the hip** it is characterised by joint space narrowing
51
Why is hip arthritis painful for the patient?
every time the patient moves, there is bone grinding on bone as the articular cartilage has been worn away this causes pain on moving and the pain eases with rest
52
Which injury is shown in the X-ray? How is the appearance of the limb affected?
**posterior dislocation** the limb appears shortened and internally rotated
53
How is the position of the limb different after posterior dislocation and fracture of the hip?
When the hip is fractured, the limb appears **shortened** and **externally rotated** In posterior dislocation, the limb appears **shortened** and **internally rotated**
54
What causes posterior dislocation of the hip?
Impact when the hip is: 1. flexed 2. internally rotated 3. adducted This occurs when impact is applied in the seated position This causes the head of the femur to be driven posteriorly out of the acetabulum
55
What injuries are associated with posterior dislocation of the hip?
1. sciatic nerve injury (L4-S3) 2. acetabular fracture
56
What injury is shown in the X-ray? What causes it?
**anterior dislocation** occurs when force is applied during extreme **abduction** with **external rotation** of the hip this causes the femoral head to be levered out anteriorly
57
How does the limb appear in an anterior dislocation?
it appears: 1. externally rotated 2. abducted 3. flexed
58
What injury is shown in the X-ray?
**medial dislocation / acetabular fracture** the head of the femur is driven medially into the pelvis
59
What is DDH?
developmental dysplasia of the hip it is a congenital abnormality causing hip dysplasia
60
What happens in DDH?
the ligaments around the hip are lax (loose) the head of the femur can sublux and move slightly out of the acetabulum this means that the acetabulum doesn't develop properly as it is not in contact with the head of the femur
61
What are the different types of hip dysplasia that may be present in DDH?
1. subluxation 2. high dislocation 3. low dislocation
62
What is the treatment for DDH and how does it work?
a cast and harness is used to keep the head of the femur within the acetabulum this allows for normal development to continue
63
What movements are possible at the hip joint?
1. flexion 2. extension 3. abduction 4. adduction 5. external/internal rotation
64
Which muscles are shown on the diagram and what is their function?
65
Where are the flexors/extensors of the hip joint located?
Flexors lie anteriorly Extensors lie posteriorly Lateral rotators also lie posteriorly
66
What is iliopsoas formed from? What is its insertion?
**Psoas major:** comes off the lumbar vertebrae and forms part of the posterior body wall **Iliacus:** comes off the iliac fossa of the pelvis These muscles come together and form a common tendon that inserts onto the **lesser trochanter**
67
What is the function of iliopsoas?
it is a primary flexor of the hip joint it pulls the lesser trochanter up towards the pelvis and trunk when it contracts
68
What is the function of rectus femoris? Where does it insert?
It is a flexor of the hip It attaches to the anterior inferior iliac spine
69
What is the function of sartorius?
it flexes the hip joint
70
What is the insertion and function of the adductor muscles?
they come off of the pubic bone medially and insert onto the femur they are adductors of the hip
71
Why do the adductor muscles play an important role in walking?
they bring the legs back towards the midline during walking this allows you to walk with one foot in front of the other
72
Which muscles are shown in this diagram?
Orange - gluteus muscles Green - short hip muscles Blue - hamstring muscles Pink - adductor muscles
73
What are the functions of the gluteus muscles?
Gluteus maximus - **extensor** of the hip Gluteus minimus and gluteus medius are **abductors** of the hip
74
What are the functions of the short hip muscles and the hamstring muscles?
Short hip muscles - primarily **lateral rotators** Hamstring muscles - **extensors** of the hip
75
Which structures are shown by the red lines?
**superior and inferior gluteal neurovascular bundles** these consist of an artery, vein and nerve they emerge above and below the piriformis muscle
76

Y2 CONTROL & MOVEMENT (69 decks)

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