m7: pelvis and hip Flashcards by aespicy buldak

(Posterior) Right and left pelvic bones ↔ sacrum and fifth lumbar

(Anterior) Left and right hemipelvis ↔ pubis symphysis

Pelvic Girdle

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Femoral head ↔ Acetabulum

Very stable structurally + Very mobile

Hip abductor muscles on the weight-bearing leg must create a force to counterbalance about _% of body’s weight during each step taken.

Hip joint

85%

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Latin word, “bowl”/ “basin”

A bridge between the lower extremities and the entire head, arm, and trunk complex (HAT).

Pelvis

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Providing a stable base for HAT

Containing and supporting the visceral contents

Transmitting and absorbing forces to and from both HAT superiorly and the lower extremities inferiorly.

Functions of the Pelvis

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Major role in elevating and lowering the body:

Climbing

Rising from a chair

Lifting the limb, as when the foot is elevated to tie a shoelace.

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Hip muscles may function by:

moving the femur on the pelvis (e.g., flexing the hip to step up onto a step)

by moving the pelvis over the femur (e.g.,leaning over to pick up an object from the floor).

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Supporting and transferring the weight of the HAT to the femurs in standing or to the ischial tuberosities in sitting.

Rotating during walking to create a rhythmic pelvic swing so a smooth translation of both the trunk and the lower extremities occurs.

Providing a broad area for muscular attachment.

Pelvis

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3 Innominate bones (R) and (L)

Ilium
Ischium
Pubis

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“wing/ear”
Largest, superior
Iliac crest (_) highest point of the pelvis
Iliac tubercle ()

Ilium

Iliac crest (L4)
Iliac Tubercle (L5)

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▪ (Origin of Sartorius, Inguinal Ligament/ poupart’s/ aponeurosis of external oblique)
▪ Measurement landmark of:
1.
2.

ANTERIOIR SUPERIOR ILIAC SPINE (ASIS)

LLD, Q-angle
Fulcrum for hip abduction, adduction

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▪ (Origin of rectus femoris straight head)

ANTERIOIR INFERIOR ILIAC SPINE (AIIS)

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▪ S2
▪ Dimples of Venus
▪ Measurement landmark of: _ Test

POSTERIOR SUPERIOR ILIAC SPINE (PSIS)

Schober’s Test

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Fracture of the iliac wing

Duverney’s Fracture

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▪ “fish”
▪ Posterior
▪ Ischial tuberosity
▪ Ischiogluteal bursa

Ischium

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▪ “sit bone”
▪ For weightbearing in sitting
▪ Origin of hamstrings

Ischial Tuberosity

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▪ Prolonged sitting causes bursitis; Tailor’s/weaver’s/ boatman’s bottom

Ischiogluteal bursa

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▪ “crotch”
▪ Common site of adductor origin

Pubis

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_ _ = origin of pectineus

Superior Ramus

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_ /= origin of adductor longus

Pubic Tubercle/ Body

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Inferior Ramus
a.
b.
c.

a. Adductor Magnus
b. Gracilis
c. Adductor Brevis

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Obturator foramen
a.
b.

a. Lumbar and sacral nerves
b. Blood vessels

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▪ Triradiate ligament connects ilium, ischium, pubis (Fused after birth)
▪ Covered by fibrous cartilage: glenoid labrum
▪ Orientation: (LIA) Lateral, Inferior, Anterior

Acetabulum

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▪ Sacral promontory
▪ Sacral body

Sacrum

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▪ “tail bone”
▪ Painful coccyx “_”
􏰀 MOI: falling in seated position

Coccyx

coccygodynia

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▪ Carries abdominal organs ▪ Male: Heart, smaller ▪ Female: Oval, larger ▪ Borders: 1. 2. 3.

Pelvis Inlet/Pelvic Brim 1. Ant: Symphysis pubis 2. Post: Sacral promontory 3. Lat: Iliopectineal line

▪ Carries reproductive organs ▪ Borders: 1. 2. 3.

Pelvis Outlet 1. Ant: Pubic arch 2. Post: Coccyx 3. Lat: Ischial tuberosity

▪ (N) ASIS = PSIS ▪ APT = ASIS < PSIS ▪ PPT = ASIS > PSIS

Pelvic Tilt

▪ ASIS = PSIS XXX:

Pelvic tilt

▪ Iliac crest (L) = (R) XXX:

Pelvic obliquity/list

▪ Pubic tubercle = Greater trochanter XXX: _, _, _

True LLD, coxa vara, dislocation

▪ 25% of the general height

Femur

Neck Shaft Angle ▪ Adult= ▪ Child= ▪ Increased = ▪ Decreased =

125 degrees 160 degrees coxa valga > 135 degrees coxa vara < 120 degress

▪ (N) 8-15 degrees ▪ Increased – _ (in-toe, patellar squinting, knocked knees) ▪ Decreased – _ (out-toe, frog eyes/ grasshopper, bowleg)

Femoral Torsion Anteversion Retroversion

▪ “Angle of Wiberg” ▪ (N) 20-30 ▪ ↑ angle = more stable ▪ ↓ angle = less stable ▪ Aging increases center edge angle

Center Edge Angle

▪ Covered by hyaline and fibrous cartilage ▪ Orientation: _ , _ , _ ▪ Blood supply: - 20% obturator artery - 80% Medial circumflex arter

Femoral head (SAM) Superior, Anterior and Medial

▪ G. Med/Min ▪ Red carpet muscles

Greater Trochanter

POOSIQ (Sup to inf)

● Piriformis ● Obturator internus ● Obturator externus ● Superior gemellus ● Inferior gemellus ● Quadratus femoris

Iliopsoas

Lesser Trochanter

▪ Ligaments: weakened by relaxin, aldosterone ▪ Movement: Nutation/Counternutation

Sacroiliac Joint (SI)

▪ Multiaxial ball-and-socket joint that has maximum stability because of the deep insertion of the head of the femur into the acetabulum

Acetabulofemoral Joint

Hip Joint Resting position:

30° flexion, 300 abduction, slight lateral rotation

Hip joint Closed Packed Position:

Full extension, medial rotation, and abduction

Hip joint Capsular Pattern:

Flexion, abduction, medial rotation (but in some cases, medial rotation is limited)

▪ AKA: Y ligament of bigelow ▪ Strongest ligament of the body ▪ Restricts: Extension, ER small amount AD

Iliofemoral ligament

▪ Restricts extension ▪ Weakest

Ischiofemoral Ligament

▪ Restricts AB, Extension

Pubofemoral ligament

FACTORS AFFECTING HIP STABILITY ● ● ●

● Architecture/stability ● Ligaments – Y ligament ● Atmospheric pressure is negative, creates a suction

BOUNDARIES → SUPERIOR: _ _ (forms the base the femoral triangle) → MEDIAL: _ _ → LATERAL: _

inguinal ligament adductor longus sartorius

→ LATERAL: sartorius → Contents (lat.to med.):

􏰀 Femoral nerve 􏰀 Femoral artery 􏰀 Femoral vein 􏰀 Lymph nodes

▪ MC direction of Hip ▪ D/L: posterior ▪ MOI: dashboard injury, FAddIR + PCL injury

Hip dislocation

▪ A metal prosthesis anchored to the person’s _ by bone cement replaces the femoral _ and _ ▪ A plastic socket cemented to the hip bone replaces the _.

Hip replacement ▪ A metal prosthesis anchored to the person’s femur by bone cement replaces the femoral head and neck ▪ A plastic socket cemented to the hip bone replaces the acetabulum.

Gluteal region MUSCLE: ORIGIN: Outer surface of ilium (1), sacrum, coccyx, sacrotuberous ligament INSERTION: Iliotibial and gluteal tuberosity of femur NERVE: INFERIOR Gluteal Nerve - L5, S1, S2 ACTIONS: ● Extends and laterally rotates the thigh at the hip joint ● The upper fibers abduct and the lower fibers adduct the thigh at the hip joint ● Posteriorly tilts the pelvis at the hip joint ● Extends the leg at the knee joint

GLUTEUS MAXIMUS

Gluteal region MUSCLE: ORIGIN: Outer surface of ilium (2) INSERTION: LATERAL surface of greater trochanter of femur NERVE: Superior gluteal nerve (1) ACTIONS: (1) ● Abducts thigh at hip joint ● Tilts pelvis when walking to permit opposite leg to clear ground

GLUTEUS MEDIUS

Gluteal region MUSCLE: ORIGIN: Outer surface of ilium (3) INSERTION: ANTERIOR surface of greater trochanter of femur NERVE: Superior gluteal nerve (2) ACTIONS: (2) ● Abducts thigh at hip joint ● Tilts pelvis when walking to permit opposite leg to clear ground

GLUTEUS MINIMUS

Gluteal region MUSCLE: ORIGIN: Iliac crest INSERTION: Iliotibial tract NERVE: Superior Gluteal Nerve (3) ACTIONS: Assists gluteus maximus in extending the knee joint

TENSOR FASCIA LATAE

Gluteal region MUSCLE: ORIGIN: Anterior surface of sacrum INSERTION: UPPER border of greater trochanter of femur (1) NERVE: 1st and 2nd sacral nerves ACTIONS: Lateral rotator of thigh at hip joint (1)

PIRIFORMIS

Gluteal region MUSCLE: ORIGIN: Inner surface of obturator membrane INSERTION: UPPER border of greater trochanter of femur (2) NERVE: Sacral plexus (1) ACTIONS: Lateral rotator of thigh at hip (2) joint

OBTURATOR INTERNUS

Gluteal region MUSCLE: ORIGIN: Spine of ischium INSERTION: UPPER border of greater trochanter of femur (3) NERVE: Sacral plexus (2) ACTIONS: Lateral rotator of thigh at hip joint (3)

GEMELLUS SUPERIOR

Gluteal region MUSCLE: ORIGIN: Ischial tuberosity INSERTION: UPPER border of greater trochanter of femur (4) NERVE: Sacral plexus (3) ACTIONS: Lateral rotator of thigh at hip joint (4)

GEMELLUS INFERIOR

Gluteal region MUSCLE: ORIGIN: Lateral border of ischial tuberosity INSERTION: Quadrate tubercle of femur NERVE: Sacral plexus (4) ACTIONS: Lateral rotator of thigh at hip joint (5)

QUADRATUS FEMORIS

Anterior MUSCLE: ORIGIN: Anterior superior iliac spine (ASIS) INSERTION: Upper medial surface of shaft of tibia NERVE: Femoral nerve (1) ACTIONS: ● Flexes, abducts, laterally rotates thigh at hip joint ● Flexes and medially rotates leg at the knee join

SARTORIUS

Anterior MUSCLE: ORIGIN: Iliac fossa of hip bone INSERTION: With psoas into lesser trochanter of femur NERVE: Femoral nerve (2) ACTIONS: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on thigh as in sitting up from lying down (1)

ILIACUS

Anterior MUSCLE: ORIGIN: Superior ramus of pubis INSERTION: Upper end of linea aspera of shaft of femur NERVE: Femoral nerve (3) ACTIONS: Flexes and adducts thigh at hip joint

PECTINEUS

Anterior MUSCLE: ORIGIN: Transverse processes, bodies and intervertebral discs of the 12th thoracic and five lumbar vertebrae INSERTION: With iliacus into lesser trochanter of femur NERVE: Lumbar plexus ACTIONS: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on thigh as in sitting up from lying down (2)

PSOAS

Medial MUSCLE: ORIGIN: Inferior ramus of the pubic bone INSERTION: Upper part of shaft of tibia on medial surface NERVE: Obturator Nerve - L2, L3 ACTIONS: Adducts thigh at hip joint (1); Flexes leg at KNEE joint

GRACILIS

Medial MUSCLE: ORIGIN: Body of pubis, medial to pubic tubercle INSERTION: Posterior surface of shaft of femur (linea aspera) (1) NERVE: Obturator Nerve - L2, L3, AND L4 ACTIONS: Adducts thigh at hip joint and assists in lateral rotation (1)

ADDUCTOR LONGUS

Medial MUSCLE ORIGIN: Inferior ramus of pubis ONLY INSERTION: Posterior surface of shaft of femur (2) NERVE: Obturator Nerve - L2, L3 ONLY ACTIONS: Adducts thigh at hip joint and assists lateral rotation (2)

ADDUCTOR BREVIS

Medial MUSCLE: ORIGIN: Inferior ramus of pubis, ramus of ischium, ischial tuberosity INSERTION: Posterior surface of shaft of femur (3); adductor of tubercle of femur NERVE: ● Adductor portion: obturator nerve ● Hamstring portion: sciatic nerve ACTIONS: Adducts thigh at hip joint and assists in lateral rotation (3); hamstring portion extends thigh at hip joint

ADDUCTOR MAGNUS

Medial MUSCLE: ORIGIN: Outer surface of obturator membrane and pubic and ischial rami INSERTION: Medial surface of greater trochanter NERVE: Obturator Nerve - L2, L3 ONLY (2) ACTIONS: Laterally rotates thigh at hip joint

OBTURATOR EXTERNUS

m7: pelvis and hip Flashcards

(69 cards)