5 - Hip Joint Flashcards
Label the muscles on this diagram.
Label this diagram.
What are the three articulations in the hip bones?
- Pubic symphis
- Sacroiliac joint
- Hip joint
Label this diagram of a lateral view of the inominate bone.
What are the two surfaces of the ilium and what attaches to each?
- Inner: concave fossa providing attachement for iliacus muscle
- Outer: Convex shape for gluteal muscle attachment
What would you not see in the hip bones of a 30 year old compared with a 15-25 year old?
In 15-25 year old you would see triradiate cartilage between the three bones, forming the acetabulum. Fusion begins at 13-15.
What are the two ligaments that attach to the ischium and what is their function?
- Form the sciatic foramens
- Limit rotation of the inferior part of the sacrum during transmission of weight of the body down the vertebral column when in erect position
What is the hip joint made up of?
- Synovial ball and socket joint between acetabulum and femoral head
- Ensure mobility without weakening ability of the lower limbs to support weight of the body
- Large range of movement and very stable joint
Label the osteology of the proximal femur.
- Fovea capitis for ligamentum teres with artery
- 125 degree angle with long axis of femoral shaft, slightly smaller angle in females
What attaches to the linea aspera and the gluteal tuberosity?
- LA: Intermuscular septa and muscles of thigh attach
- GT: site of insertion of gluteus maximus
What happens to the linea aspera towards the distal end of the femur?
Inferiorally they diverge to form lateral and medial lines.
- Medial continues inferiorly as the medial supracondylar ridge and terminates at the adductor tubercle on the medial condyle
Where is the capsule of the hip joint and what are the intra and extracapsular ligaments involved in the stabilisation of the joint?
- Attaches to edge of acetabulum to the intertrochanteric line anteriorly, and the femoral neck posteriorly.
- Iliofemoral: prevent hyperextension whilst standing without muscle activity. When sitting allows pelvis to tilt back
- Ischiofemoral: Prevents xs medial rotation of hip joint
- Pubofemoral: prevent xs abduction and extension of hip joint
What factors increase the stability of the hip joint?
- Ligamentum teres
- Cup-shaped acetabulum
- Capsule
- Acetabular labrum
- Extracapsular ligaments (pull femoral head in)
- Muscles surounding joint
What is the relationship between muscles and ligaments in the hip joint?
- Anteriorly the ligaments are stronger so few medial flexors and weaker
- Posteriorly ligaments are weaker so greater number lateral rotators and stronger
Name the main
- Flexors
- Extensors
- Abductors
- Addutors
- Lateral rotaters
- Medial rotators
And their assisters.
What factors restrict flexion and extension of the hip?
F: Unflexed knee as hamstring muscles are not relaxed
E: Iliofemoral ligament and joint capsule
What is the nerve supply to the muscles of the hip joint?
- Sciatic nerve: posteriorly
- Femoral nerve: anteriorly
- Obturator nerve: inferiorly (medial and adductors)
- Superior gluteal nerve: abductor gluts
- Nerve to Quadratus Femoris
What is the blood supply to the capsule of the hip?
Intracapsular break leads to avascular necrosis as retinacular arteries are disrupted
What is Trendelenburg’s sign?
- Superior gluteal nerve damage due to visible weakness in abductors
- Injury: injections, fracture to greater trochanter (site of glut medius insertion), surgery, dislocation
- When standing on injured side, there is drooping on opposite side
How is the lumbosacral plexus linked?
- Lumbar plexus is L1-L4 from anterior rami and they descend along posterior abdominal wall to supply anterior thigh
- L4 gives off branch that combines with L5 anterior ramus that forms the lumbosacral trunk
What are the nerves of the lumbar plexus and what are their nerve roots and where they innervate?
- L is purely sensory
What are the nerves of the sacral plexus, their nerve roots and where do they innervate?
- Anterior rami S1-S4 with L4-L5 contribution via lumbosacral trunk
- Innervate lower limb, pelvic muscles/organs and perineum
What structures exit the greater sciatic foramen?
Above piriformis:
- Superior gluteal nerves and vessels
Below piriformis:
- Sciatic nerve
- Nerve of obturator internus
- Inferior gluteal nerve and vessels
- Nerve to quadratus femoris
- Pudendal nerves and arteries
What structures pass through the lesser sciatic foramen?
- Tendon and nerve of obturator internus
- Pudendal nerve and returning vessels
What is the course of the sciatic nerve in the thigh?
- L4 to S3
- Below piriformis horizontally midway between posterior superior iliac spine and ischial tuberosity
- Enters posterior compartment of thigh at level of greater trochanter and lies on posterior surface of adductor magnus and is crossed by long head of biceps femoris
- Splits in tibial and common peroneal (fibular) nerve at superior popliteal fossa, and has both sensory and motor nerves
- Tibial supplies hamstrings
- Common peroneal supplies short head biceps femoris
Where are the safe sites for IM injections in the buttocks?
- Avoid injury to sciatic nerve
With the palm of your hand, locate the greater trochanter of the femur.
SSpread your index and middle fingers posteriorly from the anterior superior iliac spine to the furthest area possible. This is the correct injection site.
Remove your fingers and insert the needle at a 90-degree angle.
Describe the anatomical structure and relevance of the fascia lata?
- Deep fascia of thigh, enclosing muscles and providing an attachement for intermuscular septae dividing thigh into three compartments
- Thinnest medially over adductor muscles
- Saphenous opening below inguinal ligament to allow saphenous vein and lymph vessels to drain into superficial inguinal lymph nodes
- Iliotibial tract: thickened fascia lata at lateral aspect from iliac crest to tibial condyle
What is the function of the tensor fascia lata and where does it insert?
- Assit glut med and min with abduction
- Stabilise hip in extension
- Stabilise knee with glut max when standing by pulling IT tract so stabilises femoral condyle on articular surface
- Venous return by pulling IT so compression of muscle compartments
What issues can the iliotibial band cause?
When seated can get tight so lateral knee pain and patellar instability. Can correct with physiotherapy
What is the gluteal region?
Posterior pelvic girdle at proximal femur, muscles move the lower limb at hip joint.
- Superficial: abduct and extend. gluts and tensor fascia lata
- Deep: laterally rotate and some medial rotation
What are the functions, origins and insertions of the three gluteal muscles?
Maximus: posterior ileum, sacrum and coccyx and inserts on gluteal tuberosity and IT tract
Medius: Posterior ilum and inserts on lateral surface of greater trochanter
Minimus: Ilum to anterior surface of greater trochanter
How does the gluteus maximus work with the hamstrings?
- Works with them to allow trunk to be extended from flexed position by tilting pelvis backwards, e.g from sitting to standing
- Can also assist with knee extension as attached to IT
What are the deep gluteal muscles, what are they innervated by, what are their actions, insertions and origins?
- Piriformis: anterior surface of sacrum inserts onto posterosuperior greater trochanter
- Superior Gemellus: ischial spine and inserts on medial greater trochanter
- Obturator Internus: medial surface of obturator membrane and pubis/ischium and inserts on medial greater trochanter
- Inferior Gemellus: ischial tuberosity and inserts on greater trochanter
- Quadratus Femoris: Flat square orign on lateral ischial tuberosity and inserts inferior to i.gemellus on trochanter
What is the obturator externus?
- Sometimes classed as deep gluteal but sometimes medial thigh compartment
- From the obturator membrane
- Innervated by obturator nerve (L2-L4)
- Adduction and lateral rotation
What muscles make up the posterior thigh compartment and what are they innervated by?
- Hamstrings
- Adductor magnus has small posterior component from ischial tuberosity (common embryonic origin as hamstrings so innervated by same nerve)
Where do the hamstrings originate and insert?
- All originate from ischial tuberosity apart from short biceps which originates from linea aspera
- Semimembranosus: posterior medial tibial condyle
- Semitendranosus: Superior medial aspect of tibia pes anserinus
- Biceps Femoris: Head of fibula. Common tendon posteriorly
What are the actions of each of the hamstring muscles and label this diagram of them?
BF: Flex knee, extend thigh at hip, laterally rotate hip and knee
ST: Flex knee, extend thigh, medially rotate thigh at hip and medially rotate leg at knee
SM: Flex knee, extend thigh, medially rotate thigh at hip and knee
What is a pulled hamstring?
- Sudden muscular exertion that results in stretching of posterior thigh e.g jumping, sprinting and lunging
- Muscle sprain, partial tear/full tear from ischial tuberosity, sometimes accompanied by alvusion of a fragment of a bone
What hip injury can cause damage to the sciatic nerve?
Posterior dislocation
What is the tensor fascia lata?
The tensor fasciae latae works in synergy with the gluteus medius and gluteus minimus muscles to abduct and medially rotate the femur
