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Lower Limb Anatomy > Lower Limb > Flashcards

Lower Limb Flashcards

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1
Q

What type of joint is the hip

A

Multiracial synovial joint of the ball and socket variety

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2
Q

The articular surfaces of the hip joint

A
  1. Acetabulum - formed by fusion of ilium, ischium and pubis bone, covered by hyaline cartilage and forming 3/4 of the socket
  2. Acetabular notch - the missing inferior segment of the socket, traversed by the transverse ligament to complete the socket
  3. Acetabular labrum - a fibrocartilaginous rim extending the margin of the acetabulum by about 10%
  4. Femoral head
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3
Q

The hip capsule and its attachments

A

Capsule is attached circumferentially around labrum and transverse ligament: passes laterally like a sleeve, attached to neck of femur
Anteriorly: attached to intertrochanteric line
Posteriorly: it extends for only half this distance, attached halfway along the femoral neck
Synovial membrane is attached to the articular margins

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4
Q

Describe iliofemoral ligament

A

Strongest ligament: triangular, from lower half of AIIS to intertrochanteric line
Limits extension, anterior and superior to hip joint

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5
Q

Describe pubifemoral ligament

A

Attached to superior ramus and obturator crest of pubic bone, blends with the capsule
Prevents over abduction, anterior and inferior to hip joint

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6
Q

Describe ischiofemoral ligament

A

Weakest ligament: from the pesteriorinferior margin of acetabulum, spirals upwards, blends with capsule, posterior to hip joint

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7
Q

Describe ligamentum teres

A

Attached centre of head of femur to the transverse ligament

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8
Q

What is the blood supply of the hip joint

A

Branches from the circumflex femoral artery, form retinacular arteries/trochanteric anastomosis to supply head and intracapsular part of neck of femur
Branch of obtrurator artery supplies ligamentum teres, usually atrophies by age 7

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9
Q

Neve supply of the hip joint

A

Femoral nerve - to nerve to rectus femoris
Obturator nerve - anterior division
Sciatic nerve - nerve to quadratus femoris
These 3 nerves also supply the knee

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10
Q

In relation to the hip joint what is anterior

A

Flexors
1.ilipsoas, femoral artery
2. Pectineus, femoral vein
3. Femoral nerve - lateral to the artery, between iliacus and Psoas tendon

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11
Q

In relation to the hip joint what is superior

A

Abductors and medial rotators
Medial- rectus femoris
Lateral - gluteus minimus

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12
Q

In relation to the hip joint what is inferior

A

Adductors - obturator externus

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13
Q

In relation to hip joint what is posterior

A

Lateral rotators, extensors
Piriformis, obturator internus tendon, gemelli, sciatic nerve

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14
Q

In relation to the hip joint what is lateral

A

The capsule blends with the iliotibial tract

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15
Q

In relation to the hip joint what is medial

A

Acetabular fossa

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16
Q

What factors help with stability of the hip joint

A

Bony: snug fit of femoral head into acetabulum
Ligaments: particularly iliofemoral ligament
Muscular: short muscles of the gluteal region are important stabilisers - piriformis, obturator internus, gemelli, quadratus femoris and also gluteus medius and minimus

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17
Q

What is the most stable position of the hip joint

A

Extension

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18
Q

What position is the hip most unstable

A

Flexed and adducted

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19
Q

What muscles cause flexion at the hip

A

Psoas major, iliacus
Assisted by rectus femoris, sartorius, pectineus

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20
Q

What is the degree of full flexion of hip with knee flexed

A

120 degree

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21
Q

What muscles cause extension at the hip

A

Gluteus maximus, hamstrings

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22
Q

What is the degree of extension at the hip and what is it limited by

A

20 degrees, limited by tension in iliofemoral ligament

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23
Q

What causes adduction at the hip joint

A

Pectineus, adductors longus, brevis, Magnus

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24
Q

What is the degree of adduction at the hip joint and what is it limited by

A

30 degrees, limited by touching other leg or tension of gluteus med and min

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25
What causes abduction at the hip joint
Gluteus medius and minimus Assisted by tensor fasciae lata and sartorius
26
What limits abduction at the hip and what is the degree of abduction
Limited by tension in adductors and pubofemoral ligament to 60 degrees
27
In the sitting position what other muscles are abductors
Piriformis, gemelli, obtruator muscles
28
What causes medial rotation at the hip joint
Anterior fibres of gluteus medius and minimus
29
What is the degree of medial rotation at the hip and what limits it
40, limited by tension in the lateral rotators and ischiofemoral ligament
30
What causes lateral rotation in the hip joint
Piriformis, obturator internus and gemelli, quadrants femoris, obturator externus Assisted by gluteus maximus and sartorius
31
What separates the adductor compartment from the anterior compartment of the thigh
The medial intermuscular septum
32
Origin, insertion and nerve supply of adductor longus
Origin- body of pubis, in angle between pubic crest and symphysis Insertion- aponeurotic flat tendon into middle 1/3 of linea aspera of femur Nerve supply - anterior division of obturator nerve l2-l4 mostly l3
33
Origin, insertion, nerve supply and relations of adductor brevis
Origin - body and inferior ramus of pubis, deep to Pectineus and adductor longus Insertion- upper part of linea aspera, immediately behind Pectineus and adductor longus Nerve supply: anterior division of obturator nerve l2-4 mostly l3 Relations: anterior division of obturator nerve passes on its anterior surface, posterior division passes down behind
34
Origin, insertion, nerve supply and relation of adductor Magnus
Hamstring origin: ischial tuberosity Adductor origin: ischiopubic ramus Hamstring insertion: adductor tubercle of femur Adductor insertion: along medial supracondylar line, linea aspera and gluteal tuberosity Hamstring part nerve supply: tibial part of sciatic nerve l4 Adductor part nerve supply: posterior division of obturator nerve l2-4 Relations: formed by fusion of adductor and hamstring muscles, medial branch of circumflex femoral artery passes between the two muscles
35
Origin, insertion, nerve supply and relations to Gracilis
Origin: edge of inferior ramus of pubis and the adjoining ishcial ramus Insertion: superior part of the medial surface of the shaft of the tibia, just behind sartorius Nerve supply: anterior division of obturator nerve l2-3 Most superficial muscle of medial thigh
36
Origin, insertion, nerve supply of obturator externus
Origin - whole of obturator membrane and anterior bony margin of obturator foramen Insertion - medial surface of greater trochanter in the trochanteric fossa Nerve supply - posterior division of obturator nerve l3-4
37
Origin of gluteus maximus
Ilium behind posterior gluteal line Lumbar fascia Dorsal sacrum coccyx Sacrotuberous ligament
38
Insertion of gluteus maximus
Iliotibial tract to the lateral condyle of the tibia - 3/4 of the muscle Gluteal tuberosity of the femur remaining 1/3
39
Blood supply of gluteal maximus
Superior and inferior gluteal artery
40
Nerve supply of gluteus maximus
Inferior gluteal nerve l5-s2
41
Action of gluteal maximus
Lateral rotation and extension Supports extended knee through iliotibial tract
42
Origin and insertion of gluteus medius
Origin - surface of ilium, between middle and posterior gluteal lines Insertion - converges to flat tendon which is attached to lateral surface e of greater trochanter
43
Origin of gluteus minimus
Gluteal surface of ilium between middle and inferior lines
44
Insertion of gluteus minimus
Anterior surface of greater trochanter
45
Nerve supply of gluteal medius and minimus
Superior gluteal nerve l4-s1
46
Action of gluteus minimus
Abducts hip joint Rotates thigh medically Constantly in play during walking
47
Origin, insertion and nerve supply of tensor fascia lata
Asis and anterior iliac crest Iliotibial tract - lateral condyle of tibia Superior gluteal nerve l4-s1
48
Origin of Piriformis
Anterior sacrum, sacrotuberous ligament
49
Insertion of Piriformis
Rounded tendon inserted into medial surface of upper border of greater trochanter
50
What does Piriformis pass through
Greater sciatic foramen
51
Nerve supply of Piriformis
Anterior rami s1 and s2
52
Action of Piriformis
Lateral rotation
53
Origin of obturator internus
Internal surface of lateral wall of pelvis
54
What is the route of obturator internus
Make a right angled bend around the lesser sciatic notch (ischium) - enters the gluteal region
55
Insertion of obturator internus
Medial surface of greater trochanter above trochanteric fossa
56
Nerve supply of obturator internus
Its own nerve l5-s2
57
Action of obturator internus
Lateral rotation
58
Origin and nerve supply of superior gemellus
Arises from ischial spine Supplied by nerve to obturator internus
59
Origin and nerve supply of inferior gemellus
Arises from ischial tuberosity at margin of lesser sciatic notch Supplied by nerve to quadratus femoris
60
Origin of quadratus femoris
Ischial tuberosity
61
Insertion of quadratus femoris
Quadratus tubercle of femur
62
Nerve supply of quadratus femoris
Its own nerve l4-s1
63
Actions of Piriformis, obturator internus, gemelli, quadratus femoris
Act together to adjust and stabilise the hip joint Lateral rotators of extended thigh Abductors of flexed thigh
64
Origin of semimenbranosus
Lateral parry of ischial tuberosity
65
Insertion of semimembranosus
Back of the medial condyle of tibia From there 3 expansions 1. Passes forward along medial surface of condyle, deep to tibial collateral ligament of knee 2. Passes obliquely upwards to lateral femoral condyle as oblique popliteal ligament 3. One forms strong fascia overlying popliteus - reaches soleal line of tibia
66
Origin of Semitendinosus
Medial part of ischial tuberosity
67
Insertion of semitendinosus
Upper part of subcutaneous surface of tibia, behind gracilis
68
Origin of biceps femoris
Long head - from ischial tuberosity Short head - whole length of linea aspera and upper part of lateral supracondylar line of femur
69
Describe the tendon of biceps femoris
Folded or split around fibular collateral ligament of the knee joint
70
Insertion of biceps femoris
Head of fibula
71
Blood supply of hamstrings
Profunda femoris artery
72
Hamstring nerve supply
Tibial component of sciatic nerve l5-s2 Except short head of biceps - supplied by common perineal
73
Actions of hamstrings
Flex knee joint Extend the hip With knee semi flexed biceps femoris is lateral rotator, semimembranosus and semitendinosus are medial rotators
74
Hamstring order of insertion to medial upper tibia anterior to posterior pneumonic
Say grace before tea mum Sartorius Gracilis Before semiTendinosus semiMembranosus
75
Where does the obturator nerve divide
Obturator notch
76
What does the anterior division of obturator nerve supply and what is its route
Supplies adductor longus and brevis and Gracilis Passes above obturator externus, ends in sub sartorial plexus and supplies skin to medial side of thigh
77
What does posterior division of obturator nerve supply and what is its route
Supplies obtruator externus, adductor Magnus Gives off branch to popliteal fossa which supplies capsule of knee joint, passes with middle genicular artery
78
Origin of sciatic nerve
Sacral plexus l4-s3
79
Course of sciatic nerve
Enters gluteal region via greater sciatic foramen inferior to Piriformis, in contact with the ischium, descends deep to femoris Bifurcates into tibial and common fibular nerves at apex of popliteal fossa
80
Distribution of sciatic nerve
Posterior compartment of thigh Gemelli, hamstrings Branch - nerve to obturator internus
81
Boundaries of obturator foramen
Pubis and ischium
82
What goes through obtruator foramen
It is completely closed by obturator membrane, except for a small passageway - obturator canal Obturator nerve and vessels pass
83
What ligaments seperate the sciatic foramina
Sacrotuberous ligament - extending between the sacrum and the ischial tuberosity Sacrospinois ligament - extending between the sacrum and the ischial spine
84
Boundaries of greater sciatic foramen
Superior and anterior - greater sciatic notch Posterior - sacrotuberous ligament Inferior - scarospinous ligament
85
Structures that pass through greater sciatic foramen
Superior gluteal vessels and nerve Piriformis Inferior gluteal vessels and nerve Sciatic nerve Perforating cutaneous nerve Posterior femoral cutaneous nerve Nerve to quadratus femoris Nerve to obturator internus Pudendal nerve Internal pudendal vessels
86
Boundaries of lesser sciatic foramen
Lesser sciatic notch Superior - sacrospinous ligament Posterior - sacrotuberous ligament
87
Structures that pass through lesser sciatic foramen
Tendon of obturator internus Nerve to obturator internus Internal pudendal vessels Pudendal nerve

Lower Limb Anatomy (4 decks)

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