The hip and pelvis

Question 1

What does the pelvis consist off

Answer 1

the hip bone ( hemi pelvis either side of the sacrum), sacrum- centrally placed, coccyx- distal bone

Question 2

What 3 bones form the hip bone

Answer 2

the ilium, the ischium and the pubis. These bones meet and fuse in the centre of the asatablum

Question 3

The hip bones- iliac crest

Answer 3

runs all the way from the anterior to posterior, this finishes in 2 points, the anterior superior iliac spine, anterior inferior iliac spine, and the posterior superior iliac spine and the posterior inferior iliac spine

Question 4

The hip bones- pubis

Answer 4

has a superior pubic rami and an inferior pubic rami, this fuses with ischium rami

Question 5

structure of the sacrum

Answer 5

a dense block of 5 rudimentary vertebra which are fused together (no movement between vertebra), it has a medial and sacral crest that acts as processes, the top area is called the sacral promontory, concave anteriorly and convex posteriorly

Question 6

Sacrum- joint and foramen

Answer 6

sacral iliac joint on the sacral side, it has a foramen that travels all the way through- spinal nerve routes emerge from the sacral foramen

Question 7

Structure of the coccyx

Answer 7

3-4 rudimental vertebra these articulate at the sacral articular junction- little bit of movement but often lost at old age

Question 8

Anterior palpable structures

Answer 8

iliac crest, anterior superior iliac spine, inguinal ligament- not a true ligament as it doesn’t cover muscle- it goes from ASIS to pubic tubercle, pubic symphysis and pubic tubercle

Question 9

Posterior palpable structures

Answer 9

posterior superior iliac spine and inferior, sacrum, sacral spinal proceses, coccyx, ischial tuberosity- origin for hamstrings and extensor aspect of adductor magnus

Question 10

Proximal femur- anterior

Answer 10

femoral head, femoral neck- after articular cartilage, greater trochanter- laterally facing, intertrochanteric line- this is were the hip ligaments attach too, lesser trochanter

Question 11

Proximal femur- posterior

Answer 11

pectineal line, gluteal tuberosity, intertrochanteric crest- between greater and lesser trochanter, linea aspera

Question 12

what is the linea aspera

Answer 12

off the gluteal tuberosity (where gluteus maximus inserts), this develops a posterior line and a pectineal line, these bond together to form the linear aspera. it distally divides into a medial and lateral supracondylar ridges, ridge mark attachments of powerful thigh muscles

Question 13

femoral neck inclinations

Answer 13

Normal- 125°, coxa valga is were the inclination is more than 130°, coxa vera is a deformity where the angle is lessened, effecting the biomechanics of the hip (<120°)

Question 14

Femoral torsion

Answer 14

Normal degree of femoral torsion 12-15°, retroversion this is were the angle is less than 15°, anteversion is were the angle is greater than 15°

Question 15

what are anteverted hips

Answer 15

the femoral torsion angle is bigger than 15° (35°) this leads to the hip correcting itself by moving the toes inwards, this is an intoing gate, the patella is inwards and the food is medially rotated (inwards)

Question 16

effect of anteverted hips

Answer 16

detrimental effect on lower limb biomechanics, internal tibial torsion

Question 17

femoral head blood supply

Answer 17

ligamentum teres- artery within it, artery of the ligaments of the head of the femur
medial and lateral circumflex arteries
nutrient arteries within the femoral shaft

Question 18

classification of the hip joint

Answer 18

synovial, polyaxial ball and socket joint with 3 degrees of movement

Question 19

the hip joint surfaces- acetabulum

Answer 19

lunate surface of hyaline cartilage- horseshoe shaped, thickest above centrally, for weight bearing, non articular region of acetabular fossa and notch is covered with fat

Question 20

the hip joint surfaces- acetabular labrum

Answer 20

fibro cartilaginous rim, triangular in cross section, labreal tear- clicking and catching of joint

Question 21

head of femur

Answer 21

spheroid in shape, covered wit hyaline cartilage, thicker centrally than at the periphery- greater wear and tear, cartilage is deficient over the fovea, as soon as the articular cartilage is finished, then into the neck which is vulnerable to fracture

Question 22

ligaments of the hip joint

Answer 22

iliofemoral ligaments (anterior), pubofemoral ligament (anterior), ischiofemoral ligament (posterior), ligamentum teres (intrenal)

Question 23

iliofemoral ligament- structure

Answer 23

formed by 2 bands (superior and inferior), both bands originate from the AIIS, they cover all the intertrochanteric line (line between greater and lesser trochanter)

Question 24

iliofemoral ligament- apex and base

Answer 24

Apex- from the AIIS, base- to the intertrochanteric line

Question 25

iliofemoral ligament- limits

Answer 25

superior band limits extension/ adduction, inferior band limits extension/ abduction

Question 26

pubofemoral ligament- apex and base

Answer 26

apex- from the pubic eminence, base- to the capsule and the medial band of the iliofemoral ligament and intertrochanteric line

Question 27

pubofemoral ligament- limits

Answer 27

extension and abduction

Question 28

ischiofemoral ligament- apex and base

Answer 28

apex- the inferior aspect of the ischium, base- the capsule and the anterior part of the greater trochanter deep to the iliofemoral ligament

Question 29

ischiofemoral ligament- limits

Answer 29

extension and medial rotation

Question 30

ligamentum teres- apex and base

Answer 30

apex- from pit (fovea) in the head of the femur, base- to the acetabular notch and transverse acetabular ligament

Question 31

inguinal ligament

Answer 31

connects ASIS to the pubic tubercle

Question 32

Hip joint stability- ligaments and muscle

Answer 32

strong surrounding ligaments- fibrous capsule is strong, arrangement of powerful and strong muscles

Question 33

Hip joint stability- acetabulum

Answer 33

cup shaped acetabulum, deepend by the acetabular labrum- ring of cartilage that surrounds the acetabulum

Question 34

Hip joint stability- ball and socket, oblique angle of femoral neck

Answer 34

vacuum effect of ball and socket- held well, oblique angle of femoral neck- on weight bearing and drives head of femur deeper into acetabulum

Question 35

limitations to range of motion

Answer 35

tension to antagonists, soft tissue apposition- obese and late stage pregnancy, tension in ligaments limits range, relative congruence of articular surface

Question 36

hip range of motion- flexion and extension

Answer 36

Flex- 100-120, ext- 15-20

Question 37

hip range of motion- abduction and adduction

Answer 37

abd 40-45, add- 15-30

Question 38

hip range of motion- lateral and medial rotation

Answer 38

lat- 45-60, medial- 30-40

Question 39

closed pack position for hip

Answer 39

maximum extension, medial rotation, abduction

Question 40

open pack position for hip

Answer 40

slight flexion, abduction, lateral rotation

Question 41

classification- sacroiliac joint

Answer 41

synovial, plane joint (gliding and sliding, no physiological movement). Ridged articular surfaces- can lead to issues if one ridge gets stuck on another

Question 42

joint movement- sacroiliac joint

Answer 42

nutation and counternutation

Question 43

what is nutation

Answer 43

the sacrum moves forward into the pelvis, this is the closed pack position for the SIJ, anterior tilting of the sacral promontory, anterior rotation of the coccyx

Question 44

what is counter nutation

Answer 44

the sacrum moves backwards, posterior tilting of the sacral promontory, anterior rotation of the coccyx

Question 45

interosseous (between bones) sacroiliac ligament

Answer 45

massive ligament forming the bond between the ilium and the sacrum (syndesmosis), from- the anterior surface of the ilium, to- posterior aspect of the articular surface on the sacrum

Question 46

ventral sacroiliac ligament

Answer 46

from- lateral sacrum, to- the medial aspect of the ilium, provides anterior stability and the thickening of capsule

Question 47

what is the sacrotuberous ligament

Answer 47

from- PSIS, sacral tubercles, lateral margins of sacrum and coccyx, to- ishcial tuberosity, and ischial ramus

Question 48

what does the sacrotuberous ligament limit

Answer 48

it limits nutation of the sacrum and posterior rotation of the ilium

Question 49

what is the sacrospinous ligament

Answer 49

apex- the spine of the ischium, too- the lateral margins of the sacrum and coccyx, limits- nutation of the sacrum and posterior rotation of the ilium past the sacrum

Question 50

Upper band of the iliolumbar ligament

Answer 50

from- transverse processes of L5, too- posterior aspect of the iliac crest

Question 51

lower band of the iliolumbar ligament

Answer 51

from- transverse processes of L5, to- anterior sacrum and ventral sacro-iliac ligament

Question 52

what is the classification of the symphysis pubis

Answer 52

secondary cartilaginous joint

Question 53

symphysis pubis joint

Answer 53

interpunic disc, superior pubic ligament, inferior arcuate ligament, supported by hyaline cartilage end plates on either aspect of interpubis, minimal recorded movement

Question 54

Similarities between symphysis pubis and SIJ

Answer 54

they have no muscles that control their movement directly, muscles do not contribute to the stability of the joint, joints are influenced by muscles the lumbar spine and hip joint