0618 - Anatomy of Hip, Thigh, and Glut

Question 1

What is the key surface anatomy of the Gluteal region?

Answer 1

Posterior to pelvis, between iliac crests and gluteal sulcus.

PSIS creates a dimple at level of 2nd piece of sacrum.

Line between highest points of pelvis - supracristal line, level L4 spinous process

Tubercle of iliac crest is L5 body.

Question 2

Where must injections be given in the gluteal region.

Answer 2

Upper outer quadrant of each cheek. Avoid sciatic nerve which runs transversely from more medial then straight down the middle more or less.

Question 3

Briefly describe the Ilium

Answer 3

Briefly describe the Ilium

Large fan-shaped Ala

Contains Iliac crest and for spins - ASIS AIIS, PSIS, PIIS

Iliopubic eminence is junction with pubic bone.

Question 4

Briefly describe the pubis

Answer 4

Smallest of three hip bones. Quadrilateral body

Forms anterior inferior section of acetabulum

Upper surface of body is the pubic crest - terminates laterally at pubic tubercle

Has superior and inferior pubic rami.

Pubis and Ischium border the obturator foramen.

Symphysis medially - secondary cartilaginous joint.

Question 5

Briefly describe the ischium

Answer 5

L-shaped bone

Body joins with ilium and pubis at acetabulum

Inferior extension - ischial tuberosity

Ischial ramus joins pubic ramus to enclose obturator foramen.

Ischial spine extends medially to seperate greater and lesser sciatic formaina.

Question 6

Outline the Femur

Answer 6

Head, neck, and shaft

Head is directly over the knee, means everything has to have a slope.

Capsule of hip joint attaches around neck of femur, with circumflex vessels running through and supplying head. “retrograde blood supply” - if you break neck (subcapital/basal cervical fractures), you ruin femoral head blood supply.

Question 7

Outline the acetabulum

Answer 7

Hip Socket - confluence of the ilium, ischium, and pubis.

Cartilage is thickest superiorly (ilium) - weight bearing part.

Notch is confluence of pubis and ischium - no cartilage.

Directed downward, laterally, and posteriorly.

Question 8

What are the three most important ligaments supporting the hip?

Answer 8

Sacroiliac, sacrospinous, sacrotuberous.

Question 9

What are the gluteal muscles (small and large - 9)

Answer 9

3 large glutei (maximus, medius, minimus)

6 smaller “rotator muscles:

Piriformis

Obturator (internus and externus)

Gemelli (superior and inferior)

Quadratus femoris

Question 10

Outline Gluteus Maximus (origin, insertion, action, nerve supply)

Answer 10

Origin - Posterior Iliac crest and surface, dorsal surface of sacrum and coccyx.

Insertion - Iliotibial tract (fascia) ->lateral condyle of tibia (1/4 on gluteal tuberosity of femur)

Innervation - Inferior Gluteal Nerve (L5, S1, S2)

Action - Extend thigh, lateral rotation, stabilises, and assists in rising from sitting position.

Question 11

Outline Gluteus Medius (origin, insertion, innervation, Action)

Answer 11

Origin - External surface of ilium between anterior and posterior gluteal lines

Insertion - Greater trochanter of femur

Innervation and Action common with Glut Minimus

Innervation - Superior Gluteal Nerve (L5, S1)

Action - Abduct and medially rotate thigh, keep pelvis level when opposite leg raised.

Question 12

Outline Gluteus Minimus (origin, insertion, innervation, action)

Answer 12

Origin External surface of ilium between anterior and inferior gluteal lines

Insertion - Greater trochanter of femur

Innervation and action common with Glut Medius

Innervation - Superior Gluteal Nerve (L5, S1)

Action - Abduct and medially rotate thigh, keep pelvis level

Question 13

Outline Piriformis (origin, insertion, innervation, importance)

Answer 13

Origin - Anterior surface of sacrum and sacrotuberous ligament

Insertion - Superior border of greater trochanter of femur

Innervation - S1/S2

Importance - overlies the sciatic nerve.

Question 14

Outline the borders of the femoral triangle

Answer 14

Superior - Inguinal ligament,

Lateral - medial border of sartorius

Medial - Medial border of adductor longus

Floor - Pectineus and adductor longus muscles (medial), iliopsoas (lateral)

Roof - Fascia lata, cribriform fascia at saphenous opening.

Question 15

What are the muscles that make up Quadriceps femoris? What is their common attachment, innervation, and action?

Answer 15

Rectus Femoris

Vastus Lateralis

Vastus Medialis

Vastus Intermedius

Common attachment - Base of patella and patellar ligament to tibial tuberosity.

Innervation - Femoral Nerve (L2,3,4)

Action - Extend leg at knee joint. Rectus femoris also steadies hip and helps iliopsoas to flex thigh.

Question 16

Outline rectus femoris (origin, insertion, innervation, action).

Answer 16

Origin - ASIS and ilium superior to acetabulum

Insertion - Base of patella, and via patella ligament to tibial tuberosity

Innervation - femoral nerve (L2-4)

Action - Extend leg at knee joint. Steady hip and help iliopsoas flex thigh.

Question 17

Why is adductor magnus important?

Answer 17

Adductor hiatus allows passage for femoral artery and femoral vein to become the popliteal a and v.

Question 18

Outline vastus lateralis (origin, insertion, innervation, action).

Answer 18

Origin - Greater trochanter and lateral lip of linea aspera of femur

Insertion - Base of patella, and via patella ligament to tibial tuberosity

Innervation - femoral nerve (L2-4)

Action - Extend leg at knee joint.

Question 19

Outline vastus medialis (origin, insertion, innervation, action).

Answer 19

Origin - Intertrochanteric line and medial lip of linea aspera of femur

Insertion - Base of patella, and via patella ligament to tibial tuberosity

Innervation - femoral nerve (L2-4)

Action - Extend leg at knee joint.

Question 20

Outline vastus intermedius (origin, insertion, innervation, action).

Answer 20

Origin - anterior and lateral surfaces of body of femur

Insertion - Base of patella, and via patella ligament to tibial tuberosity

Innervation - femoral nerve (L2-4)

Action - Extend leg at knee joint.

Question 21

Why is iliopsoas important?

Answer 21

Infection in lumbar spine can spread via iliopsoas to the bursa, and vice versa.

Question 22

Outline the greater sciatic notch.

Answer 22

Most important structure is sciatic nerve. which comes out under piriformis. Also has nerve to quadratus femoris.

Entrance Can be found 1/3 of way from ischial tuberosity to PSIS.

Exit can be located just medial to mid-point of greater trochanter and ischial tuberosity.

Question 23

What is the composition of the Sacrum and the Coccyx?

Answer 23

Sacrum - fusion of 5 sacral vertebrae. Articulates with ilium - sacroiliac joint.

Coccyx - Fusion of 4 coccygeal bones.