MSK Session 8 Flashcards
0
Q
What bridges the acetabular notch?
A
Transverse acetabular ligament
1
Q
What is in the acetabular fossa?
A
Fat pad covered by synovial membrane
2
Q
What is the articular area of the acetabulum?
A
Lunate surface
3
Q
What are the flexor muscles of the hip?
A
Iliopsoas Rectus femoris Sartorius Pectineus Adductor brevis and longus
4
Q
Which muscles are the adductors of the hip?
A
Pectineus
Adductor brevis and longus
Adductor magnus
Obturator externus
5
Q
Which muscles are the lateral rotators of the hip?
A
Piriformis Gluteus maximus Obturator internus Gemellin Quadratus femoris Obturator externus
6
Q
Which are the extensors of the hip?
A
Gluteus maximus
Hamstrings
Adductor magnus
7
Q
Which are the abductors of the hip?
A
Gluteus medius
Gluteus minimus
8
Q
Which are the medial rotators of the hip?
A
Gluteus medius and minimus
9
Q
What supplies blood to the hip joint?
A
Medial and lateral circumflex femoral arteries
10
Q
Where do the circumflex femoral arteries arise from?
A
Usually profunda femoris artery
Occasionally femoral artery
11
Q
Can the artery to the head of the femur support the hip joint alone?
A
No - will cause AVN
12
Q
Where is the acetabulum not complete?
A
Inferiorly at the acetabular notch
13
Q
What is the acetabular labrum?
A
Fibrocartilaginous rim attached to the margin of the acetabulum
14
Q
What is the function of the acetabular labrum?
A
Increase articular contact area by 10% so more than half the femoral head fits in
15
Q
What innervates the hip joint?
A
Anterior: femoral nerve
Inferior: obturator nerve
Posterior: nerve to femoris
Superior: superior gluteal
16
Q
Where can pain in the hip be referred from?
A
Vertebral column
17
Q
How does Hilton’s law apply to the hip joint?
A
Nerves supplying the muscles across the joint supply the joint too
18
Q
What forms the joint capsule in the hip?
A
Loose external fibrous layer and internal synovial membrane
19
Q
Where does the joint capsular of the hip attach?
A
Periphery of acetabular rim
Intertrochanteric line
Proximal to intertrochanteric crest
20
Q
What path do most fibres of the joint capsule of the hip take?
A
Spiral
21
Q
What forms the orbicular zone?
A
Deep fibres of the joint capsule passing circularly around the femoral neck
22
Q
What restricts extension of the hip to 10-20 degrees beyond vertical?
A
Joint capsule of hip
23
Q
What happens to the spiralling fibres in the joint capsule of the hip upon flexion?
A
Unwind
24
What pulls the femoral head medially into the acetabulum?
Muscles and ligaments
25
What is the structure of the iliofemoral ligament?
Anterior and superior
| Y shaped
26
What is the function of the iliofemoral ligament?
Prevent hyperextension of the hip during standing by screwing femoral head into acetabulum
27
Which is the strongest ligament in the body?
Iliofemoral
28
What is the structure of the pubofemoral ligament?
Interior and inferior
| Blends w/medial part of iliofemoral ligament
29
What is the function of the pubofemoral ligament?
Prevent overabduction of the hip by tightening during both extension and abduction
30
What is the structure of the ischiofemoral ligament?
Posterior
| Spirals superolaterally to the femoral neck
31
Which of the three ligaments in the hip is the weakest?
Ischiofemoral
32
What is seen in congenital dislocation of the hip?
Femoral head superior
+ve Trendelenburg sign
Arthritis in adulthood
33
What is seen in acquired posterior hip dislocation?
Femoral head inferior and posterior on lateral surface of ilium
Shortened leg
Medial rotation
34
What is vulnerable to damage in acquired posterior dislocation of the hip?
Sciatic nerve
35
What is seen in acquired anterior hip dislocation?
Femoral head inferior to acetabulum
| Acetabulum margin fracture
36
Which muscles make up the superficial layer of the buttock and gluteal region?
Gluteus maximus, medius and minimus
37
What is the main action of gluteus maximus?
Extension
Lateral rotation
Assist in rising from sitting
38
What is the main action of gluteus medius?
Abduction
Medial rotation
Pelvic stability
39
What is the main action of gluteus minimus?
Abduction
Medial rotation
Pelvic stability
40
What innervated gluteus maximus?
Inferior gluteal nerve
41
What innervates gluteus medius?
Superior gluteal nerve
42
What innervates gluteus minimus?
Superior gluteal nerve
43
What is the main action of piriformis?
Lateral rotation of extended thigh
Abduct flexed thigh
Steady femoral head in acetabulum
44
What innervates piriformis?
Branches of anterior rami of S1 and 2
45
What is the main action of obturator internus, superior gemelli, and inferior gemelli?
Laterally rotate extended thigh
Abduct flexed thigh
Steady femoral head in acetabulum
46
What innervates obturator internus?
Nerve to obturator internus
47
What innervates superior gemelli?
Nerve to obturator internus
48
What innervates inferior gemelli?
Nerve to quadratus femoris
49
What innervates quadratus femoris?
Nerve to quadratus femoris
50
What is the main action of quadratus femoris?
Laterally rotate thigh
| Steady femoral head in acetabulum
51
What is the function of the superficial layer of buttock and gluteal region muscles?
Extension, abduction and medial rotation of femur
| Prevent pelvic drop on opposite side to the flexed leg when walking
52
What is the general function of the deep layer muscles of the buttock and gluteal region?
Abduct flexed femur
Laterally rotate femur
Keep femur within joint
Main plain pelvic stability during walking
53
Which muscles form the deep layer of the buttock and gluteal region?
```
Piriformis
Obturator internus
Superior gemelli
Inferior gemelli
Quadratus femoris
```
54
Which muscle divides the greater sciatic foramen into two?
Piriformis
55
What is hip dysplasia?
abnormal relationship b/w femoral head and acetabulum
56
What can be abnormal in hip dysplasia?
Neck and shaft angle
57
Who is more affected by hip dysplasia?
Higher incidence in females
58
Which hip is more often affected in hip dysplasia?
Left
59
Why does hip dysplasia lead to dislocation at birth?
Abnormal forces experienced
60
What is the Ortolani test?
Forward pressure on femoral heads to move posteriorly dislocated into acetabulum
61
What does movement in the Ortolani test indicate?
Subluxation/dislocation that can be reduced
62
What is the Barlow test?
Backward pressure applied to femoral heads to feel for complete/partial displacement
63
What is the Galeazzi test used at 3-6 months?
Lie supine w/hips and knees flexed to 90 degrees and look for discrepancy in length and asymmetry
64
What are the treatments for hip dysplasia?
Harness if 6 months or harness ineffective
65
What is hip dysplasia often associated with in adulthood?
Arthritis
66
What is slipped upper femoral epiphysis?
Fracture through physis allowing femur to ride up and forward in relation to the epiphysis so the shaft moves superiorly but articulation with the hip is maintained
67
If slipped upper femoral epiphysis is not caught early what can develop?
Leg length discrepancy
| Arthritis
68
What is the typical age of a patient presenting with slipped upper femoral epiphysis?
10-16 y.o.
69
What is the treatment for slipped upper femoral epiphysis?
Internal fixation w/single cannulated screw
70
Why should you look carefully for other injuries in acquired hip dislocation?
Due to stability of joint if dislocation is caused force must have been large and likely to have caused other damage
71
Which is the more common type of hip dislocation?
Posterior
72
What happens in posterior hip dislocation?
Femoral head forced posteriorly tearing through inferior and posterior joint capsule
73
What is anterior hip dislocation a consequence of?
Extension, abduction and lateral rotation
74
What is anterior hip dislocation associated with?
Fracture
75
What must occur for femoral neck fracture in a patient less that 40 y.o.?
High energy collision w/lower limb extension
76
If an elderly patient become confused following femoral neck fracture what is the associated mortality rate?
50%
77
Why are women >40 y.o. more likely to obtain femoral neck fracture than men?
Effects of osteoporosis
78
Why do femoral neck fractures often lead to femoral head AVN?
Intracapsular so main blood supply is likely to be disrupted
79
How does the limb often appear in femoral neck fracture?
Shortened
| Laterally rotated
80
What does treatment depend of femoral neck fracture depend on?
Age and health - would replacement be more effective?
81
Why must you fix femoral neck fracture even in immobile patients?
To reduce mortality
82
What causes trochanteric fracture?
Direct impact or torsional force
83
Why is trochanteric fracture less likely to disrupt the blood supply than femoral neck fracture?
Extra-capsular
84
Who are trochanteric fractures most common in?
Elderly
85
What are the treatments for trochanteric fracture?
Dynamic hip screw
| Cephalomedullary fixation
86
What is cephalomedullary fixation?
Rod down centre of bone to prevent excessive shortening
87
How does the impact of trochanteric fracture compare to that of femoral neck fracture?
Lower associated mortality rate
| Likely to decrease mobility
88
What are the three bursae of the hip?
Trochanteric
Iliopsoas
Ischiogluteal
89
Which is the largest bursa of the hip?
Trochanteric
90
Where is the trochanteric bursa located?
B/w gluteus maximus and greater trochanter
91
Where is the iliopsoas bursa located?
Deep to iliopsoas
92
Which is the most powerful flexor of the hip?
Iliopsoas
93
In 15% of people what does the iliopsoas bursa communicate with?
Hip joint
94
How is iliopsoas bursa inflammation confused with hernia?
Can present as swelling below inguinal ligament
95
Where is the ischiogluteal bursa located?
Near ischial tuberosity
96
What causes inflammation of the ischiogluteal bursa?
Cycling/horse riding
97
What is the treatment for bursitis in the hip?
Rest and physiotherapy to increase length of corresponding muscle and tendon units to prevent further aggrevation
98
What can arthritis of the hip be due to?
Inflammation of the joint in synovium
Damage to cartilage
Combination of the two
99
What is earl y onset pain in arthritis usually due to and subsequently followed by?
Inflammation w/mechanical process later
100
What is the progression of osteoarthritis?
Cartilaginous damage --> compromised cartilage repair --> mechanical grinding causing pain --> increased mechanical load worsens effects
101
What can predispose to development of arthritis?
Previous joint injuries
102
Why do bone spurs form in osteoarthritis?
Narrowed joint space due to loss of cartilage so spurs form to counteract bone changes
103
What are the treatments for osteoarthritis?
NSAIDs
Muscle relaxants
Inter-articular corticosteroid injections
Modify lifestyle
104
What is the progression of rheumatoid arthritis?
Inflammation in synovium --> destruction of cartilage --> mechanical problems --> v.deformed bones --> bone ankylosis --> fusion of bones
105
What are the stages of rheumatoid arthritis development?
Syvonitis
Pannus
Fibrous ankylosis
Bony ankylosis
106
What happens in syvonitis?
Synovium inflamed and thickened
| Bone and cartilage gradually eroded
107
What is pannus?
Layer of vascularised fibrous tissue that extends over an organ/structure
108
What happens during pannus formation in rheumatoid arthritis?
Exposed and pitted bones, no cartilage left
109
What happens in fibrous ankylosis during rheumatoid arthritis?
Fibrous CT invades
110
What happens in bony ankylosis in rheumatoid arthritis?
Bones fused
