Musculoskeletal system of the hips and thigh Flashcards
(37 cards)
Where are the 3 openings in the pelvis
What are the main ligaments that form these openings
Greater and lesser sciatic notch
Obturator foramen
Sacrotuberous ligament
Sacrospinous ligament
Describe the main features found on the pelvis regarding the attachments of the gluteus max, med and min
Describe other key structures on the pelvis
Gluteus max post to post gluteal line
Gluteus medius between post and ant gluteal line
Gluteus minimus ant to ant gluteal line
All 3 muscles attach to the ilium
ASIS, AIIS, pubic tubercle
Obturator foramen covered by obturator membrane
Greater sciatic notch, ischial spine, lesser sciatic notch, ischial tuberosity under the PIIS
Describe the functions of the gluteus muscles in relation to the mechanical axis
Post to mechanical axis
-Max, med and min => lat rot and hip ext
Ant to mechanical axis
-Med and min => med rot and hip flex
Which 2 muscles are the main hip extensors
Gluteus max
Tensor fascia lata
Where does the gluteus maximus attach
innervation?
Function?
Sacrotuberous ligament, gluteal tuberosity, ilium, iliotibial tract
Inf gluteal nerve L5-S2
Thigh ext, lat rot, running and climbing against gravity
Where does the tensor fascia lata attach
Innervation?
Function?
ASIS, ant of iliotibial tract
Sup gluteal nerve L4-S1
Counters gluteus max
- lat rot
- abduction
- med rot
Sustains tension of iliotibial tract
What happens when you get pain at the side of your knee
Friction between iliotibial band and lateral epicondyle of femur
What 2 muscles are the main hip abductors and medial rotators
What are their attachments
What are they innervated by
What other functions do they have
Gluteus medius
Gluteus minimus
Sup gluteal nerve L4-S1
Attach to ilium and greater trochanter
Abduct hip, stabilises pelvis so we don’t fall when on 1 leg
What is Trendelburg’s sign
Damage to L4-5 => weak gluteus med and min => Can’t stabilise hip
Tilts hip to side before lifting legs for stability => wasting of muscles
What 5 muscles are the main hip lateral rotators
What are their attachments
What are they innervated by
Piriformis Superior gemellus Inferior gemellus Quadratus femoris Obturator internus
Piriformis attaches to ant sacrum, greater trochanter
All except quadratus femoris attach to greater trochanter
Quadratus femoris attaches to quadrate tubercle at base of greater trochanter and intertrochanteric crest
All have a different nerve supply
Describe the nerves that emerge from the superior piriformis foramen of greater sciatic notch
What are their innervations and their function
Superior gluteal nerve L4-S1
Motor, no cutaneous
Describe the nerves that emerge from the inferior piriformis foramen of greater sciatic notch
What are their innervations and their function
Inferior gluteal nerve L5-S2
Motor, no cutaneous
Sciatic nerve L4-S3
Innervates post thigh and hamstrings, no sensory
Post cutaneous thigh S1-3
Post thigh and leg compartment, cutaneous for perineum
Pudendal S2-4 => inf rectal
Ext genitalia, anal canal, cutaneous for perineum
Perforating cutaneous S2-3 (perforates through sacrotuberous ligament
Post thigh and leg
Describe the arteries that emerge from the superior piriformis foramen of the greater sciatic notch
What artery do they come from
What do they supply
Superior gluteal from post div of int iliac
Gluteus max, med, min
Tensor fascia lata
Piriformis
Hip joint
Describe the arteries that emerge from the inferior piriformis foramen of the greater sciatic notch
What artery do they come from
What do they supply
Inferior gluteal from ant div of int iliac
Gluteus max Piriformis Obturator internus Both gemellus Quadratus femoris
Internal pudendal from ant div of int iliac
Rectum
Perineum
Genitalia
Describe the importance of knowing the surface anatomy of the gluteal region
How would you avoid damage and pain here with injections
What are the consequences
Sciatic nerve comes behind piriformis at sacrum
Avoid IM injections into the sciatic nerve
Place fingers on ASIS and iliac tubercle, inject in between
Damage to the sciatic nerve => pain radiates down leg => paralysis
What are the 3 compartments in the thigh
What nerves supply them
What is their main function
Anterior
- Femoral L2-4
- Extend knee
Medial
- Obturator L2-4
- Adductor
Posterior
- Tibial branch of sciatic
- Flex knee
What are the 3 main neuromuscular structures in the thigh
Anterior
-Femoral nerves and vessels
Medial
-Obturator nerves and vessels
Posterior
-Sciatic nerve
What are the 3 openings from the abdomen and pelvis
Anterior
-Femoral
Medial
-Obturator canal
Posterior
-Greater sciatic foramen
Name the main muscles of the anterior thigh compartment (leg extensors)
Psoas major Iliac Pectineus Sartorius Vastus medialis Vastus lateralis Rectus femoris (vastus intermediairs underneath)
What are the attachments and innervations of
- Psoas major
- Iliacus
- Vastus lateralis
- Vastus medialis
- Rectus femoris
- Pectineus
- Sartorius
Psoas major
- L1-3
- Lumbar vertebrae and lesser trochanter
Iliacus
- Femoral nerve L2-4
- Iliac fossa and lesser trochanter
Vastus lateralis
- Femoral nerve
- Greater trochanter and lateral of linea aspera => quadriceps tendon
Vastus medialis
- Femoral nerve
- Intertrochanteric line and medial of linea aspera => quadriceps tendon
Rectus femoris
- Femoral nerve
- Ilium superior to acetabulum and patella => quadriceps tendon
Pectineus
- Femoral nerve
- Pectineal line ant => post
Sartorius
- Femoral nerve
- ASIS => superior medial surface of tibia
What are the 6 main muscles of the medial thigh compartment (hip adductors)
Obturator externus Pectineus Adductor brevis Adductor longs Adductus magnus Gracilis
What are the attachments and innervations of
- Obturator externus
- Pectineus
- Adductor brevis
- Adductor longus
- Adductor magnus
- Gracilis
Obturator externus
- Obturator nerve L2-4
- Ext obturator membrane => post of greater trochanter
Pectineus
- Femoral nerve L2-4
- Pectineal line ant => post
Adductor brevis
- Obturator nerve L2-4
- Inf pubic rami => linea aspera
Adductor longus
- Obturator nerve
- Pubis => linea aspera
Adductor magnus
- Obturator nerve
- Inf pubic rami and ischial rami => linea aspera
Gracilis
- Obturator nerve
- Inf pubic ramus and pubis => medial surface of tibia
Name the 4 main muscles in the posterior thigh compartment (hip extensors and knee flexors)
Semitendinosus
Semimembranosus
Biceps femoris (LH)
Biceps femoris (SH)
What are the attachments and innervations of
- Semitendinosus
- Semimembranosus
- Biceps femoris (LH)
- Biceps femoris (SH)
Semitendinosus
- Tibial nerve L4-S3
- Ischial tuberosity => medial surface of tibia
Semimembranosus
- Tibial nerve L4-S3
- Ischial tuberosity => medial tibial condyle
Biceps femoris (LH)
- Tibial nerve
- Ischial tuberosity => fibula head
Biceps femoris (SH)
- Common fibula
- Post of linea aspera => fibular head
SH is posterior to LH, lateral
Semitendinosus posterior to semimembranosus, medial
