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1 - PBS2 > 69 - Joints of the Hip Complex > Flashcards

69 - Joints of the Hip Complex Flashcards

1
Q

Location of fat pad within hip joint

A

Intra-articular but extra-synovial

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2
Q

Name for socket of hip joint

A

Acetabulum

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3
Q

Where do the ileum, ischium and pubis join?

A

Within the acetabulum.

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4
Q

Two parts of the acetabulum

A

Weight bearing area (exterior, horseshoe shape)

Non-weight-bearing (acetabular notch and fossa, trabecular bone)

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5
Q

Role of fat pad

A

Spreads synovial fluid in joint, shock absorption

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6
Q

Two lumps of bone either side of anatomical neck of femur

A

Lesser and greater trochanters

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7
Q

Depression in the head of femur

A

Fovea

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8
Q

Role of fovea of femur

A

Ligament attaches to acetabulum of hip.

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9
Q

Name of holes around neck of femur

A

Vascular foraminae

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10
Q

Attachment of capsule on femur

A

Around area near greater and lesser trochanters anteriorly.

Posteriorly attaches more proximally.

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11
Q

Role of greater and lesser trochanters of femur

A

Traction epiphises, where tendons attach.

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12
Q

Intertrochanteric line

A

Area where capsule attaches to femur anteriorly

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13
Q

Pressure epiphysis of femur

A

Near head of femur.

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14
Q

Perthes’ disease

A

Avascular necrosis of head of femur from disruption of blood supply.
Leads to interruption of pressure epiphysis near head of femur.

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15
Q

Femoral head and neck
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3

A
  • Head of femur 2/3 of sphere – directed upwards, medially & anteriorly – therefore anterior part lies outside acetabulum, protected by (psoas) bursa
  • Head of femur articulates with roof of acetabulum (area of thickest cartilage)
  • Mid-region of femoral neck narrower than circumference of head – gives joint greater ROM without contacting rim of acetabulum
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16
Q

Bony architecture of proximal femur
1
2

A

•Trabecular system – 2 systems that intersect:

  • Superior: medial & arcuate – Due to compression through head & neck from gravity
  • Inferior: medial & lateral – Run between trochanters, in response to muscle pulls on greater & lesser trochanters
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17
Q

Area of relative weakness of femur

A

Mid-neck.
Where trabecular bones don’t align.
Fractures associated with falls in the elderly.

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18
Q

Normal angle between head of femur and body in adults (neck-shaft angle)

A

~135 degrees

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19
Q

Normal angle between head of femur and body in a newborn

A

Over 150 degrees

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20
Q

Role of neck-shaft angle of femur

A

Enables femur to swing free of pelvis in locomotion

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21
Q

Pathologically increased neck-shaft angle of femur

A

Coxa valga

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22
Q

Pathologically decreased neck-shaft angle of femur

A

Coxa vara

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23
Q

Angle of torsion of femur

A

About 15 degrees.

Angle between head of femur (tilted anteriorly) and body of femur.

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24
Q

Effect of increasing torsion angle of femur

A

Priority is to get the head of the femur back into the socket.
Can compensate with other joints, EG going pigeon toed, medially rotating femur

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25
Q

Effect of coxa vara in adolescence

A

Coxa vara increases stress on femoral neck.
Increased shear forces on femoral head can cause proximal femoral epiphysis to break off.
Leads to ‘slipped capital femoral epiphysis.’

26
Q

During standing, where does the line of gravity pass, relative to the hip joint?

A

Passes behind hip

27
Q

Position of greatest hip stability

A

Extension, abduction, medial rotation.

28
Q 
Ligamentous support of hip joint 
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A
  • Capsule attaches at base of long neck
  • 3 ligaments: strong iliofemoral ligament in front, weaker behind (pubofemoral & ischiofemoral) ligaments – latter blend with capsule not directly to femur). Lined by synovial membrane.
  • Maximum stability in extension – due primarily to iliofemoral ligament - spirals & tightens with hip extension
  • Lined internally by ring of fibres – ‘zona orbicularis’
  • Posterior capsule does not extend as far distally –no limit to extension
29
Q

Three ligaments supporting hip joint

A 
Strong iliofemoral ligament in front
Weaker behind (pubofemoral & ischiofemoral) ligaments latter blend with capsule not directly to femur). Lined by synovial membrane.
30
Q

Why is the iliofemoral ligament the strongest of those supporting the hip?

A

Line of gravity passes behind hip joint, so iliofemoral (anterior) needs to be the strongest

31
Q

What do pubofemoral and ischiofemoral ligaments attach to?

A

Blend with capsule of hip joint

32
Q

Intra-articular surfaces of hip joint

A

Labrum – bridges acetabular notch, triangular, deepens cup & increases surface area - often torn in hip injury

*posterior dislocation

Ligament of head of femur – has no supporting role - directs branch of obturator artery to femoral head (regresses after puberty)

33
Q

Role of labrum in hip joint

A

bridges acetabular notch, triangular, deepens cup & increases surface area

34
Q

Injury in which labrum of hip joint is particularly vulnerable

A

Posterior dislocation

35
Q

Role of ligament of head of femur

A

Has no supporting role - directs branch of obturator artery to femoral head (regresses after puberty)

36
Q

Attachments of ligament of head of femur

A

Notch at front of acetabular region to fovea of femur.

37
Q

Name for reflections of fibrous tissue from capsule of hip joint to femoral head

A

Retinacular fibres

38
Q

What do retinacular fibres contain?

A

Retinacular vessels.

These are critical for blood supply to the head of the femur.

39
Q

When are the retinacular vessels endangered?

A

Injury to neck of femur

40
Q

Primary movements of hip joint

A

Flexion and extension

41
Q

What is medial rotation of hip joint associated with?

A

Extension of hip joint (locks joint)

42
Q

Primary hip flexor

A

Iliopsoas (combination of psoas major and iliacus)

43
Q

Most powerful hip extensor

A

Gluteus maximus

44
Q

Muscles involved in adducting femur

A

Adductor muscles

45
Q

Role of gluteus medius and minimus

A

Abductors at hip.
Maintain position of pelvis in coronal plane (from below), by contracting on side of weight-bearing limb to prevent unsupported side of pelvis from dropping.

46
Q

Movements from gluteus medius

A

Both flexion and extension

47
Q

Name for gait from damage to gluteus medius and minimus

A

Trendellenberg gait.

48
Q

Hilton’s law

A

Joint receives pain & proprioceptive fibres from branches to muscles that move the joint – also pass to overlying skin

49
Q

Nerves innervating hip joint
1
2
3

A

Hip joint innervated by articular branches of femoral, obturator & gluteal nerves

50
Q

Referred pain from hip

A

Knee or medial thigh (from compression of obdurator nerve)

51
Q

Referred pain to hip

A

From lumbar spine

52
Q

Blood supply of the hip joint
1
2
3

A
  • Via anastomoses between branches of medial (primarily) and lateral femoral circumflex arteries (normally off profunda femoris)
  • Small supply from artery of head of femur (regresses after puberty)
  • Retinacular vessels pass across femoral neck, bound down by ‘retinacular’ fibres (from capsule)
53
Q

Main role of femoral artery

A

Takes blood from pelvis to back of the knee

54
Q

Two branches from femoral artery that supply hip joint

A

Medial and lateral femoral circumflex arteries

55
Q

Posture of fractured neck of femur

A

Muscle spasm causes external rotation and shortening of limb

56
Q

Structures along anterior of hip

A

Femoral artery

57
Q

Structures along posterior of hip

A

Sciatic nerve, medial to head of femur

58
Q

Structure endangered with a traumatic hip dislocation

A

Sciatic nerve (often associated with fractured posterior lip of acetabulum)

59
Q

Why is early re-articulation of traumatic hip dislocation important?

A

Disruption of blood supply can lead to necrosis

60
Q

Congenital hip dislocation

A 
Shallow acetabulum (developmental dysplasia).
If not treated, a false joint can form above the acetabulum

1 - PBS2 (96 decks)

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