1: Gluteal-Thigh-Hip Lecture

Question 1

What are the five regions of the lower extremity?

Answer 1

The pelvic girdle, the thigh, the leg, the ankle, and the foot.

Question 2

What does the pelvic girdle consist of?

Answer 2

The ilium, ischium, and the pubis bones.

Question 3

What does the thigh consist of?

Answer 3

The femur bone.

Question 4

What does the leg consist of?

Answer 4

The tibia and the fibula bones.

Question 5

What does the ankle, or tarsus, consist of?

Answer 5

A proximal row of three tarsal bones: talus, calcaneus, and the navicular.

A distal row of four tarsal bones: three cuneiform bones, and the cuboid bone.

Question 6

What does the foot consist of?

Answer 6

Nineteen bones: five metatarsals, fourteen phalanges (two in the great toe and three in each of the other toes).

Question 7

What is the articulation between the pelvic girdle and the axial skeleton?

Answer 7

The strong and immobile sacroiliac joint.

The pelvic girdle is extremely stable at the expense of mobility.

Question 8

Describe the components and movement of the sacroiliac joint? What does this change?

Answer 8

The ilium articulates with the sacrum posteriorly.

The joint is only slightly movable, but in pregnant women the ligaments slacken and to facilitate parturition.

Question 9

Describe the hip joint components and function?

Answer 9

The femur articulates with the hip bone at the acetabulum.

Function is to transmit forces between the pelvis and the thigh while permitting mobility (ball and socket)

Question 10

What are the movements of the hip joint?

Answer 10

Abducton/adduction
Flexion/extension
Rotation
Circumduction (not as good as shoulder)

Question 11

What is the direction of dislocation of the hip joint? What causes this?

Answer 11

They are posterior more often than anterior.

Flexion of the hip tends to unwind the capsular ligaments so that the hip is less stable.

Question 12

How can osteoarthritis of the hip be treated?

Answer 12

Because the abductor group contracts strongly to keep the pelvis level when the contralateral foot is raised, a cane held in the opposite hand will help alleviate pressure within the joint.

Question 13

What are the flexors of the thigh and what compartment do they lie in?

Answer 13

Anterior compartment.

Iliopsoas: consists of the iliacus and the psoas major.

The rectus femoris and sartorius muscles assist in flexion (innervated by the femoral nerve).

Question 14

What are the abductors of the hip joint and where are they located?

Answer 14

In the gluteal region: gluteus medius, gluteus minimus, and to a lesser extent the fasciae latae.

Question 15

What are the extensors of the hip joint and where are they located?

Answer 15

In posterior compartment of the thigh and gluteal region.

Gluteus maximus, hamstrings, semitendinosus, semimembranosus, long head of the biceps femoris, and posterior portion of the adductor magnus.

Question 16

What are the adductors of the thigh and what is their location?

What are these muscles innervated by?

Answer 16

Lie in the medial compartment.

Adductors magnus (anterior portion), longus, and brevis; the pectineus, and the graciis.

Innervated by the obturator nerve.

Question 17

What are the external (lateral rotators) and where are they located?

Answer 17

They lie in the deep gluteal region.

Piriformis, superior and inferior gemelli, and obturators internus and externus.

Question 18

What are the internal (medial) rotators? Describe their relative strength compared to the lateral rotators?

Answer 18

Not as powerful as the lateral rotators.

Gluteus medius and minimus, and the tensor fascia lata.

Question 19

Where does the hip region receive blood from?

Answer 19

The iliac arteries (internal and external).

Question 20

What is a trendelenburg gait? What nerve is involved?

Answer 20

Superior gluteal nerve (L4-S1 posterior)

A hip drop or “abductor lurch” gait because of an inability to keep the pelvis level when the contralateral foot is raised off the ground.

Lurch is a shift of the body weight directly over the ipsilateral femoral head.

Question 21

What occurs with palsy of the inferior gluteal nerve? What is this nerves origin?

Answer 21

(L5-S2, posterior)

Results in difficult in rising from a seated position and in climbing stairs due to weakness of hip extension.

Question 22

What must be considered when giving an intramuscular injection in the gluteal region? What is the origin of this nerve?

Answer 22

The injection needs to be in the upper lateral quadrant to avoid the sciatic nerve.

Hand placed so thumb touches greater trochanter and fingers on iliac crest. Aim between pointer and middle finger.

Sciatic nerve is L4-S2 anterior and posterior

Question 23

Why do fractures of the femoral neck occur frequently in elderly?

What can occur when the femoral neck is fractured?

Answer 23

Due to reabsorption and weakening of the bony trabeculae or from a fall or muscle spasm.

The head may undergo avascular necrosis from a disruption of branches of the medial circumflex artery.

Question 24

What causes dislocation of the hip? Is this common?

Answer 24

Severe trauma, enough to fracture acetabulum. Hip joint is least stable in a flexed position, which slackens the ligaments of the fibrous capsule.

Uncommon because the joint is so stable.

Question 25

What is usually damaged when the hip is dislocated posteriorly? What happens if the articular capsule is torn as a result of the dislocation?

Answer 25

The sciatic nerve.

If the articular capsule is torn, the blood supply to the femoral head could be jeopardized.

Question 26

What is osteoarthritis and how does a cane improve this?

Answer 26

Degeneration of the articular cartilage resulting in pain and a limited range of motion.

A cane should be held in the opposite hand of the affected hip. When the unaffected leg is raised, the arm and cane balance the trunk. Abductor action to stabilize pelvis is therefore unnecessary and weight bearing joint is relieved of as much as 75% of the compressive loading.

Question 27

What is the fascia lata? What are its components?

What movements does it aid in?

Answer 27

The deep fascia of the thigh. The iliotibial tract (band) is the lateral thickening of the fascia lata.

Extension of the thigh at the hip. At the knee, the fascia and muscles function in extension and flexion of the leg.

Question 28

What is the fascia septa?

What are its components?

Answer 28

A portion of the fascia lata that divides the thigh musculature into anterior and posterior compartments.

Has a lateral intermusclar septum and a medial intermuscular septum.

Question 29

What are the lateral rotators of the hip?

Answer 29

Glut maximus, piriformis, superior gemellus, obturator internus, inferior gemellus, and the quadratus femoris.

Question 30

What innervates the gluteus maximus?

Answer 30

The inferior gluteal nerve.

Question 31

What innervates the gluteus medius and minimus?

Answer 31

The superior gluteal nerve.

Question 32

What innervates the piriformis?

Answer 32

Ventral rami of S1 and S2.

Question 33

What is sciatica? What is it caused by?

Answer 33

Low back pain that radiates down the thigh and leg.

Caused by compression of the intervertebral discs in L5-S1 region, causing irritation of the sciatic nerve.

May also occur if the nerve runs through the piriformis, getting compressed when it contracts.

Question 34

What are the three blood supplies to the head of the femur? Which is the most important?

Answer 34

Lateral circumflex femoral artery, obturator artery, and the medial circumflex artery (most important).

Question 35

What does the external illiac artery become? When?

Answer 35

External iliac becomes the femoral artery after the inguinal ligament, then becomes the popliteal artery when it goes through the adductor hiatus.

Question 36

What are the three muscles of the posterior thigh compartment? What innervates them? What is the exception?

Answer 36

Semimembranous (medial)

Semitendinosus

Biceps femoris (laterl)

All innervated by the tibial nerve, EXCEPT the biceps short head which is innervated by common fibular nerve.

Question 37

What does the sciatic nerve made up of and split into?

Answer 37

The tibial and common fibular nerves.

Question 38

What is the sural nerve and why is it important? How do you find it?

Answer 38

Travels down the posterior of leg and is harvested for nerve grafts.

Travels with the safinous vein. If you use a tourniquet around the leg below the knee, you will find the vein and thus the nerve next to it.

Question 39

What are the seven muscles of the anterior thigh?

Answer 39

Iliopsoas, sartorius, quadriceps: rectus femoris, vastus lateralis, vastus medialis, vastuc intermedius, and the pectineus.

Question 40

What are all of the anterior thigh muscles innervated by? What are the two exceptions?

Answer 40

The femoral nerve.

Iliopsoas innervated by ventral rami of S1 and S2.

Pectineus is innervated by the femoral AND obturator nerve.

Question 41

What components are involved in the patellar tendon reflex?

Answer 41

Afferent nerves from L3 and L4, interneurons from afferent to efferent, efferent (femoral nerve) neurons, and active neuromuscular junctions.

Question 42

What is the sequence of the vessels in the femoral triangle?

Answer 42

NAVL

Nerve, artery, vein, lymphatics.

Question 43

Describe the location of a femoral hernia?

Answer 43

Medial to the vessels of the femoral triangle and below the inguinal ligament.

Question 44

What nerve can be impinged in obese people and pregnant women?

Answer 44

The lateral femoral cutaneous nerve.

Question 45

What are four dermatome markers in the pelvis and lower limb?

Answer 45

Inguinal region: L1

Anterior knee: L4

Second toe: L5

Posterior leg and thigh: S1-S2

Question 46

What are the five muscles of the medial thigh?

What are they innervated by? What is the exception?

Answer 46

1. Gracillis
2. Obturator externus
3. Adductor longus
4. Adductor brevis
5. Adductor magnus

Innervation: obturator nerve EXCEPT adductor magnus which is innervated by the tibial nerve and the obturator n.)

Question 47

What is a gluteus maximus gait?

Answer 47

When you have a weak glut max and you compensate by thrusting pelvis forward “gluteal lurch”

Question 48

What is a high step gait?

Answer 48

When there’s a problem with the anterior compartment of the leg and you can’t dorsiflex your foot (foot drop).

Compensate by flexing at the hip to swing the leg forward and slapping foot down.