Anatomy of the Hip and Knee Flashcards
What kind of joint is the hip joint?
- Diarthrodial joint (movable type of joint characterised by presence of fibrocartilage or hyaline cartilage that lines opposing bony surfaces)
- Ball and socket synovial joint
Can the hip joint be decribed as stable?
- Stable joint, with stability being enhanced by static (ligaments) and dynamic stabilisers (muscles)
Descibe the normal angles of the hip joint?
- Neck shaft about 130o
- Femoral anteversion 15o
- Acetabular anteeversion 20o
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What is B?
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Coxa valga (>140 degrees)
What is C?
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Coxa vara (<125 degrees)
What are some static hip stabilisers?
- Bony morphology
- Ball and socket provides good stability
- Labrum
- Negative intra-articular pressure
What are the dynamic hip stabilisers?
Musculature
What are the hip flexors?
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What are the hip extensors?
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What is the illio-psoas: origin, insertion, innervation?
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What is the rectus femoris: origin, insertion, innervation?
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What is the sartorius: origin, insertion, innervation?
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What is the pectineus: origin, insertion, innervation?
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What is the glut max: origin, insertion, innervation?
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What is the semitinosus: origin, insertion, innervation?
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What is the semimembranosus: origin, insertion, innervation?
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What is the bicep fem: origin, insertion, innervation?
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What is the glut. med: origin, insertion, innervation?
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What is the glut. min: origin, insertion, innervation?
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What is the tensor fascia latae: origin, insertion, innervation?
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What is the adductor longus: origin, insertion, innervation?
What is the adductor brevis: origin, insertion, innervation?
What is the adductor magnus: origin, insertion, innervation?
What is the gracilis: origin, insertion, innervation?
What is the tensor fascia latae: origin, insertion, innervation?
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What is the sup. gemellus: origin, insertion, innervation?
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What is the psoas: origin, insertion, innervation?
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What is the piriformis: origin, insertion, innervation?
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What is the inferior gemellus: origin, insertion, innervation?
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What is the obturator internus: origin, insertion, innervation?
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What is the obturator externus: origin, insertion, innervation?
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What is the quadratus femoris: origin, insertion, innervation?
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What are the hip abductors?
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What are the hip adductors?
What are the hip internal rotators?
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What are the hip external rotators?
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What are indicators that pathology is from the hip?
- “C” sign
- Exacerbating factors
- Weight bearing, difficulty flexing hip such as tying shoes
- Site of pain
- Trochanteric
- Buttock
- Groin
- Referred
What is the “C” sign indicating a normal hip?
Called Shenton’s line
What is Shenton’s line formed by?
Medial edge of femoral neck
Inferior edge of superior pubic ramus
Loss of contour of Shenton’s line is indicative of what?
Fracture of neck of femur
Blood supply of femoral head comes via what?
Blood supply of femoral head comes in via a capsule from medial and lateral femoral circumflex arteries:
- Also intramedullary and ligamentum teres blood supply
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Fractures can be extra-capsular or intra-capsule which changes what blood supply is disrupted, describe this?
- Extra-capsular
- Always fix
- Blood supply intact
- Intra-capsular
- Blood supply compromised
- Management based on age of patient and displacement
- Undisplaced – fixed
- Displaced and young – fix
- Displaced and elderly – replace (hemiarthroplasty or THR)
What is the mangement of an intra-capsular femoral neck fracture?
- Management based on age of patient and displacement
- Undisplaced – fixed
- Displaced and young – fix
- Displaced and elderly – replace (hemiarthroplasty or THR)
What is hemiarthroplasty?
Surgical procedure which replaces one half of the hip joint (the head of femur)
What kind of joint is the knee?
Hinge synovial joint
What movements occur at the knee?
- Flexion/extension
- Small amount of rotation
How does stability of the knee compare to the hip?
Less stable than hip and more reliant on soft tissue constrains
What are the 3 articulating surfaces at the knee?
- Fibula, tibia and patella
What is the normal ROM of the knee?
- -5 to 130 degrees
What kind of bone is the patella?
- Sesamoid bone (a bone placed within a tendon)
What is a sesamoid bone?
Bone placed within a tendon
What is the function of the patella?
- Role in increasing extensor lever arm
Where is the thickest hyaline cartilage in the body found?
Patella
How does the knee angle (tibio-femoral angle) compare to the mechanical axis?
Is 6 degrees of valgus relative to mechanical axis
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What are the soft tissue constraints of the knee?
- Static
- Collateral ligamnets
- ACL/PCL
- Capsule
- ITB
- Meniscii
- Dynamic
- Quadriceps
- Hamstrings
- Medial and lateral gastrocnemius
- Popliteus
What are the knee extensors?
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What are the knee flexors?
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What is the rectus femoris: origin, insertion, innervation?
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What is the vastus medialis: origin, insertion, innervation?
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What is the vastuls lateralis: origin, insertion, innervation?
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What is the vastus intermedius: origin, insertion, innervation?
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What is the biceps femoris: origin, insertion, innervation?
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What is the semimembranosus: origin, insertion, innervation?
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What is the semitendinosus: origin, insertion, innervation?
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What is the gastrocnemius: origin, insertion, innervation?
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What are meniscii?
- Crescent of fibrocartilage between surfaces
Describe the shape of meniscii?
- Avascular centrally
- Medial C-shaped
- Less mobile
- Firmly attached to tibia
- Lateral circular
- More mobile
- Unattached at popliteus hiatus
What is the function of meniscii?
- Load transmission
- Stability
- Proprioception
- Shock absorption
What are examples of knee injuries?
- Meniscal tears
- Ligament injuries
- Example is ACL injury
- Knee buckles during pivot
- Unable to play on
- Immediate haemarthrosis
- Recurrent instability
- X-ray – hamerthrosis, segond fracture
- Example is ACL injury
- OCD lesions
- Loose bodies
- Fractures
- Open or classed
- Quads/patellar tendon ruptures
- Knee dislocation
- Ligaments need to be compromised for this to occur