Exam 4 Flashcards
hip bone
• Acetabulum – cup shaped depression articulates with head of femur
o Acetabular fossa - nonarticular fossa
o Lunate surface- peripheral acetabulum is articular portion
o Acetabular notch
ilium
• Two portions:
1. Wing (Ala)
External Surface (Dorsum Ilii)
1. Posterior gluteal line
o Shortest
o Gluteus maximus origin posterior to posterior gluteal
2. Anterior gluteal line
o Longest
o Gluteus medius origin between 1 & 2
3. Inferior gluteal line
o Least distinct
o Gluteus minimus origin between 2 & 3
**Rectus Femoris origin btwn inferior gluteal line & margin actebulum
Internal Surface
ilium cont
• Superior- Iliac Crest o Anterior- Anterior superior iliac spine (ASIS) o Posterior- Posterior superior iliac spine (PSIS) o External Lip Fascia Lata Tensor fascia latae o Internal Lip Iliac fascia Iliacus • Inferior-Arcuate Line • Anterior Border o Anterior superior iliac spine (ASIS) Sartroius Iliacus Tensor fasciae latae m Inguinal ligament o Anterior INFERIOR iliac spine Iliofemoral ligament Straight head rectus femoris Porstion iliacus m o Notch between two spines o Groove medial to AIIS for psoas major/iliacus
ilium 3
o Iliopectineal eminence Site of fusion btwn pubis/ilium medial to groove for iliopsoas • Posterior Border o Posterior Superior iliac spine (PSIS) Sacroiliac ligament o Posterior Inferior iliac spine • Iliac Fossa- concave area Nutrient foramen in its center Iliacus m • Sacroiliac joint Posterior to iliac fossa Articulation between sacrum and ilium • Iliac tuberosity- attachment sacroiliac ligaments Poateior to articular area 2. Body External Surface -forms portion acetabulum Internal Surface -part wall bony pelvis -Obterator internus takes origin • No ramus • Body joins lateral projection of superior ramus of pubis @ acetabulum • Body/Wing Separated externally margin acetabulum Internally arcuate line • Greater Sciatic Notch o Both ischium and ilium o Proximally- Inferior to PIIS o Distally- ends ischial spine
ischium
• Single ramus • Body joins lateral projection of superior ramus of pubis @ acetabulum • Strongest/most inferior hip bone • Body o External Surface Forms part of acetabular fossa Part of lunate surface Ischial Spine • separates greater/lesser sciatic notches • Attachments: o Sacrospinalis ligament o Superior gemellus muscle
ischium 2
Ischial tuberosity
• Other attachments:
o Quadratus femoris- lateral tuberosity tear-dropped facet
o Inferior gemellus- superomedial tuberosity
• Quadrilateral Portion: upper part
o Oblique line – separates hamstring origins
Semimebranosus- upper lateral
Long head biceps femoris & semitendinosus–below
• Triangular Portion: lower region
o Adductor Magnus
o Sacrotuberous ligament
o Internal Surface
Obterator Internus attaches
ischium 3
• Ischial Ramus o Directed anteriorly from ischial tuberosity o Joins inferior pubic ramus o External Surface Adductor magnus Obturator externus o Internal Surface Obturator internus o Lateral border sharp/thin Forms margin obturator foramen o Medial border Perineum attachments
pubis
• Body o Gracilis o Adductor Longus o Adductor Brevis • Superior Rami o Medial to LAteral Portion Pubic crest – most medial Pubic tubercle- lateral to pubic crest, inguinal ligament attachment o Lateral Portion Pectin Pubis – laeral to pubic tubercle • Pectineus attaches Iliopectineal line- lateral extension pubic crest
pubis cont
• Inferior rami o fused to ischial ramus > ischiopubic ramus o Directed posterolateral from pubic symphysis o Adductor compartment attachments: Gracilis Adductor brevis Adductor magnus Obturator externus
sacrum
• Five fused sacral vertebrae
• Base: superior, articulates 5th lumbar vertebra
o ALAE – large triangle areas
Lateral
Support Psoas major & lumbosacral trunks
Anterior ¾ each ala = Costal process
Posterior ¼ each= Transverse process
• Apex: inferior end, articulates w/ coccyx
• Vertebral canal: dorsal, ventral rootlest of spinal nerves
sacrum 2
• Surfaces o Anterior “pelvic surface” Iliacus origin- superolateral Piriformis orgin – segments 1-4 o Posterior Convex Narrower Middle Sacral Crest- midline longitudinal ridge • Rudimentary spinous processes of sacral vertebrae Sacral grooves • Laminae of vertebrae • Between middle sacral crest & articular crest… longitudinal ridge of articular processes Posterior Sacral Foramina • Lateral to articular crests o Lateral x2 Broad superior, thin inferior
sacrum 3
Auricular surface
• covered hyaline cartilage
• articulates with ilium at sacroiliac joint
Sacral Tuberosity
• Posterior to auricular suface
• 3 depressions for dorsal sacroiliac ligament
Thin Inferior
o Gluteus Maximus
o Sacrospinous
o Sacrotuberous
• Ossifcation
o Primary center & 2 epiphyseal plates: body each sacral vertebra
o 2 ossifcation centers: each vertebral arch
o 2 epiphyseal plates: each lateral seface
o 1 ossifcation center: lateral portion each upper 3 vertebrae
coccyx
• 4 verebrae (can range 3-5) • No laminae, pedicles, spinous processes • Lateral Processes o Sacrotuberous lig o sacrospinous lig o Gluteus Maximus • Anterior surface- concave o Sacrococcygela ligament attached • Posterior Surface o Cocygeal Cornua- large pair of superior articular processes • Ossifcation: o 1st 1-4y o 2nd 5-10y o 3rd 10-15y o 4th 15-20y
hip joint
• Ball/Socket • Acetabulum o Articular/nonarticular regions o 1/5 pubis- medial o 2/5 ischium – lateral o Ilium- superior • Acetabular Fossa o Deepest, nonarticulating o Primarily ischium • Lunate Surface o Aricualr surface o Cartilage covered o Acetabular labrum¬- attaches to lateral margin & synovial membrane deepens acetabulum Fibrocartilagnious ring o Acetabular Notch- lunate incomplete inferiorly Cont w/ fossa Transverse acetabular ligament –bridges notch • Foramen for blood vessels to supply joint • Head of Femur o Direction superior/medial o Surface covered articular cartilage – thicker above supporting weight Exception: rough depression center = fovia captiis femoris • Ligament capitus femoris attaches
hip joint 2
• Ligaments:
1. Articular Capsule
• Strong, loose around joint
• Attach: margins acetabulum few mm from labrum
o Lateralarlly to medial side of greater trochanter
o Anteriorly intertrochanteric line
o Posterirly 1 cm above intertrochanteric crest
o Fibers over neck of femur > acetabular rim
• Inferioly- blends transvers acetabular ligament
• THICK anterior/superior for greater R area
• Thin posterior/inferior
• Distally become zona orbicularis
• Proximally become iliofemorla, pubofemoral, ischiofemoral
2. Acetabular Labrum
• Triangular
• Fibrocartilaginous
• Deepens cavity
• Blends transverse acetabular at acetabular notch
• Helps hold head femur in acetabulum
hip joint 3
- Transverse Acetabular
- Zona Orbicularis
• DISTAL part of articular capsule become this
• Around neck fo femur - Iliofemoral
• longest, widest, strongest
• inverted Y
o stem: ilium immed below AIIS
o Base 1: anterior part greater trochanter
Often called Iliotrochanteric ligament
o Base 2: intertrochanteric line
• Anterior joint
• Transversed by: articular branch deep branch medial femoral circumflex - Pubofemoral
• Not well developed
• Anterior to iliofemoral
• Origin:
o obturator crest
o superior ramus of pubis (anterior iliopectineal eminence)
• direction inferiorlateral
• Attach: Neck of femur
• Blend w/ iliofemoral
hip joint 4
- Ischiofemoral
• Triangular
• Posterior capsule
• Origin:
o Posterior body ischium
o Inferior acetabulum
• Dreiction superior lateral in spiral course
• Attach:
o Posterosuperior part neck fo femur below greater trochanter
• Below this ligament the capsule of hip is thin - Ligament capitus femoris
• 4 cm long
• Btwn head femur & acetabulum
• Intracapsular
• Enclosed by tub- like extension of synovial membrane
• Proximal (3 bands)
o 2 lateral bands: fixed to margins acetabular notch
o Medial band blends transverse acetabular ligament
• Distal:
o Fovea capitus on femur
hip joint 4
• Synovial Membrane- inner surface of articular capsule
o Acetabulum corsses over transverse acetabular ligament to acetabular fossa
o Tubal reflexion around ligamentum capitus femoris
• Nerve to hip joint: o Femoral o Obturator o Accessory obturator o Inferior gluteal nerves • Blood vessels to hip joint: o Medial/lateral femoral circumflex o Superior/inferior gluteal o Obterator o 1st perforating **HEAVY LIGAMENTS AVASCULAR
sacroiliac joint
• Synovial joint • Auricular sacrum & ilium at 1st 3 sacral vertebrae • Lined by cartilage • Narrow joint cavity surrounded by articular capsule • Ligaments 1. Anterior Sacroiliac • Ventrolateral surface sacrum to margins of auricular suface of ilium 2. Posterior Sacroiliac • Strong • 2 sets fibers: o Deep/Short Fibers Origin: tuberosity of ilium & PIIS Passes inferomedially Attach: posterolateral sacrum o Superical/Long Fibers Oblique Origin: PSIS Attach: 3rd tubercle of sacrum Blends sacrotuberous ligament 3. Interosseous • Strong fibers unite 2 articular bones • Blend posterior sacroiliac lig • Suspend sacrum between 2 iliac bones
psoas major m
Origin:
• transverse process lumbar vertebrae
• intervertebral discs last thoracic/all lumbar vertebrae
• tendinous arches (allow passage lumbar A/V
**Deep to inguinal ligament
Insertion:
• lesser trochanter femuer medial to iliacus
• bursa spearats tendon from pubis & hip joint capsule
Nerve: L2/L3
Function: Flex hip & lumbar spine
psoas minor m
Inconstant muscle Anterior to Psoas major Origin: • T12 & L1 vertebrae & intervertebral disc Insertion: • Iliopecitneal eminence • Iliac fascia Nerve: L1 Function: Flex lumbar spine
iliacus m
Origin: • Upper 2/3 iliac fossa • iliac crest to ASIS/AIIS • superolateral Ala • Sacroiliac lig • Iliolumbar lig **Tapers to tendon on lateral side psoas major m Insertion: • Base lesser trochanter femur Nerve: femoral Function: Flex hip
iliacus minor m
Iliacus Minor- detached part iliacus occasionaly present
O: ASIS
I: Intertrochanteric line femur or iliofemoral lig
fascia of gluteal region
Subcut fascia: cont thigh/back layers: superficial fatty layer/ deep membranous layer
Deep fascia: Cont fascia lata
Fascia lata divides around gluteus maximus
Tendon gluteus maximus ends in IT band
Gluteal aponeruosis = vertical fibers between iliac crest and superior gluteus maximus
gluteus maximus m
Origin: • Posterior gluteal line ilium • Posterior surface coccyx • Aponeurosis sacrospinalis m • Sacrotuberous lig • Gluteal aponeurosis (covering m body) Insertion: • IT band- proximal/superifical fibers • Gluteal tuberosity- deep fibers
**3 bursae on deep surface
o Greater trochanter- LARGEST
o Ischial tuberosity- most commonly missing
o Btwn tendon gluteus maximus & vastus lateralis
Nerve: inferior gluteal n
Function: Extend, lateral rotate, abduct thigh
gluteus medius m
Posterior ½ covered gluteus maximus Anterior ½ covered gluteal aponuerosis Origin: • Outer ilium btwn iliac crest & posterior gluteal line posteriorly • Anterior gluteal line anteriorly Insertion: • Oblique bony ridge greater trochanter (laterally) Nerve: superior gluteal n Function: • Abduct thigh • Medially rotate extended hip • Anterior fibers: flex/medial rotate hip • Posterior portion: lateral rotate hip • STABILIZE PELVIS IN MOVEMENT
gluteus minimus m
Deep gluteus medius Between medius and minimus = superior gluteal n/ deep superior gluteal vessels Anterior ½ covered gluteal aponuerosis Origin: • Outer ilium btwn anterior & inferior gluteal line • Greater sciatic notch Insertion: • Anterior greater trochanter **Bursa- btwn tendon & greater trochanter Nerve: superior gluteal n Function: • Abduct hip • Medially rotate extended hip • Weak hip flexor • STABILIZES PELVIS DURING MOTION
tensor fascia latae
Enclosed upper fibers Iliotibial band Origin: • Anterior iliac crest near ASIS Insertion: • Iliotibial tract just distal to level greater trochanter o IT attaches inferior lateral tibial condyle/forms part knee capsule Nerve: superior gluteal n Function: • Medially rotate hip • Hip flexor
piriformis
Origin: • Anterior Sacrum btwn 1-4 sacral foramina **Through Greater sciatic foramen Insertion: • Supieror greater trochanger posterior to obeterator internus/gemelli Nerve: S1 or S1/S2 Function: • Lateral rotator • Abductor of flexed hip • Assist hip extension
obturator internus m
Origin: • Superior/inferior pubic rami • Ischial ramus • Ilial/ischial wall of true pelvis • Obturator membrane **Through lesser sciatic foramen > right angle over bone btwn spine/tuberosity of ischium BURSA HERE **Tendon gest fibesr from gemelli m **2nd bursa btwn hip joint capsule/ tendon Insertion: • medial greater trochanger anterior to trochanteric fossa Nerve: N to obturator Internus (L5-S1/S2) Function: • Lateral rotator • Abductor of flexed hip • hip extension
superior gemellus m
Origin: • outer surface ischial spine **partial fusion obeterato internus tnedon Insertion: • medial greater trochanter Nerve: n obturator internus Function: • Lateral rotator hip
inferior gemellus m
Origin: • Superomedial ischial tuberosity **partial fusion obeterato internus tnedon Insertion: • medial greater trochanter Nerve: n quadratus femoris Function: • Lateral rotator hip
quadratus femoris
(Between inferior gemellus & adductor magnus) Origin: • Lateral edge ischial tuberosity Insertion: • Quadrate tubercle femur Nerve: n quadratus femoris (L4-S1) Function: • Lateral rotator hip • Adducts hip
obturator externus m
*Covers outer suface anterior pelvic wall Origin: • Ischium/Pubis surrounding medial margin obturator foramen/membrane Insertion: • Trochanteric fossa femur Nerve: posterior division obturator n Function: • Lateral rotator hip • Adducts hip
lumbar plexus
- Anterior primary rami L1-L3, part of L4, some T12
- Posterior/in psoas major
- T12/L1 forms
iliiohypogastric n
iliohypogastric(T12/L1)
• cranial end of lateral psoas major
• crosses quadratus lumborum, passes iliac crest, enters intneral surface of transversus abdominis & internal oblique
• Lateral cutaneous branches – posterior gluteal area
• Anterior cutaneous branches – hypogastric region
• Muscle branches: transversus abdominis & internal oblique
ilioinguinal n
Ilioinguinal (L1)
• Lateral border psoas major
• Caudal to iliohypogastric
• Parallel w/ iliohypogastric across quadratus lumborum to iliac crest, pierces trasnversus abdominis
• Communication w/ iliohypogastric: btwn transversus abdominis & internal oblique
• w/ sperm cord through superifical inguinal ring
• TO: Medial thigh, root of penis, anterior scrotum
genitofemoral n
genitofemoral (L1, L2)
• passes through Psoas major to ventral surface
• genital branch: joins spermatic cord/round ligament
o lateral scrotum & adjacent thigh
• femoral branch
o lateral to genital branch
o deep to inguinal ligament in lateral femoral sheath
o skin over anterior thigh
Anterior
L2, L3, L4
obturator (L2,3,4) • medial to psoas major • enters pelvis under iliac vessels • exitsthrough obturator canal accessory obturator (L3,L4) • Present 10% • Medial psoas • Leaves pelvis: passing superior to pubic ramus • Deep to pectineus in thigh > m branch • Hip joint articular branch
posterior
L2, L3, L4
o Posterior:
Femoral (L2,3,4)
• Through psoas major
• Distal between psoas major & iliacus
• Leaves pelvis deep to inguinal ligament
• Lateral femoral artery
lateral femoral cutaneous (L2,L3)
• Middle/lateral border psoas major
• Over iliacus
• To ASIS
• Inferior inguinal ligament
• Over Sartorius
• Anterior branch- skin over lateral/anterior thigh
• Posterior branch – skin lateral thigh from greater trochanter distally to mid-thigh
sacral plexus
• Lumbosacral trunk: pats L4, L5-S3, part S4
• Medial to piriformis
• Converge at greater sciatic foramen
• All branches EXCEPT S4 branch into anterior/posterior divisions
***L4= Nervus furcalis > divided ino two plexuses
• ANTERIOR DIVISION
o N to quadratus femoris/inferior gemellus (L4-S1)
Greater sciatic foramen, ventral to sciatic n
Articular branch to hip joint
o N to obturator internus/superior gemellus (L5-S2)
greater sciatic foramen
reenters through lesser sciatic foramen to bturator internus
sacral plexus 2
• POSTERIOR DIVISION o N to piriformis (S2 or S1/S2) o Superior gluteal (L4-S1) Greater sciatic foramen superior to piriformis Superior branch to gluteus minimus Inferior branch to gluteus medius/minimus, tensor fascia latae o Inferior gluteal (L5-S2) Greater sciatic foramen Inferior piriformis Supplies gluteus maximus
sciatic
• SCIATIC
o Largest n in body, largest branch sacral plexus
o Anterior division: L4-S3
o Posterior divison L4-S2
o Supplies: posterior leg M, all M leg, foot, skin foot most skin leg, all joints in LE
o Greater sciatic formane inferior to piriformis
o Cranial end: rests posterior ischium btwn ischial tuberosity & greater trochanter of femur
o Crosses obturator internus tendon, gemelli m, quadratus femoris
o Accompanied: posterior femoral cutaneous, inferior gluteal A
o Articular branches to hip joint
o 1 antaomic n
sciatic 2
o 2 physiologic n in 1 connective sheath
Tibial (anterior L4-S3)
Common peroneal (posterior L4-S2)
o Posterior femoral cutaneous (S2, S3A or S1/S2P)
o Skin gluteal region, posterior thigh, perineum, upper leg
o Gluteal branches
Inferior cluneal – lateral gluteus maximus
o Perineal branches
o Medial to proximal thigh, perineum, scortum, base penis/labia majora
o Femoral branches
o Skin posterior/medial thigh & popliteal fossa
o Sural branches
o skin distal popliteal fossa
Coccygeal Plexus
• part S4, S5, coccygeal anterior rami
common iliac a 1
o common iliac artery o splits between L5-S1 o external iliac larger terminal branch medial border psoas major intervertebral disc to inguinal ligament deep to ligament btwn symphysis pubis & ASIS Crossed by: • Ureter • Ovarian A/V • Gential branch genitofemoral n • Deep circumflex iliac v • Ductus deferens • Round ligament Inferior epigastric • Ascends superior/medial subperitoneal tissues o Through transversalis fascia o Btwn rectus abdominis & posterior rectus sheath • Forms lateral umbilical fold • Anastomoses w/ branches superior epigastric a above umbilicus
common iliac a 2
Deep circumflex iliac • Opposite origin inferior epigastric on medial side • Lateral deep to inguinal ligament • Ascends toward ASIS o Femoral Artery o Superifical external pudendal o Deep external pudendal Distal to superifical branch Medially across pectinues/adductor longus Anastomoses internal puedendal artery o Profunda femoris 2-5 cm distal to inguinal lig Largest branch of femoral From lateral aspect femoral Spirals posteriorinferior then to medial Lateral femoral circumflex • Goes form rectus femoris & sartorius • Ascending branch o Superior deep to fascia lata o Enter fibrous capsule as retinacular branches o Anastamose: medial femoral circumflex superior gluteal deep circumflex iliac
profunda femoris a cont
Medial femoral circumflex
• MOST IMPORTANT ADULTS FOR NECK FO FEMUR
• 25% comes off femoral
• Disappear btwn pectineus & psoas
• Enter fibrous capsule as retinacular branches
• Acetabular branches: opposite acetabular notch
o Enters with acetabular branch of obturator
o Supplies fat in acetabular fossa & around round ligament to head of femur
• Anastamose:
o Lateral femoral circumflex
internal iliac
supply viscera, walls pelvis
Obturator Artery
• Joines obturator n lateral wall pelvis to enter obturator canal
o Foveolar branch – w/ ligament head of femur, supplies head femur
NEED FOR KIDS! –during ossification
Adults doesn’t matter
veins
o Internal Iliac Vein
Superior gluteal’
• Above piriformis
• Greater sciatic foramen
Inferior gluteal
• Anastomose medial femoral circumflex & 1st perforating
• Greater sciatic foramen inferior to piriformis
superficial inguinal nodes
o lop-sided T o stem T parallels great saphenous known as Inferior group foot, le, thigh, perineum 4-6 nodes o cross T parallels inguinal ligament Known as superior group Superifical, lateral protion gluteal region, anterior abdominal wall 5-7 nodes Pass primarily to external iliac nodes within false pelvis Some go deep inguinal lymph nodes
deep inguinal nodes
o 1-3 nodes
o Within femoral sheath
o Medial to femoral vein
o Lowest/ most constant node belwo termination great saphenous vein in femoral vein
o Intermediate node: most variable, midway along length femoral canal
o Uppermost: near femoral ring, superior femoral canal – cloquet or node of Rosenmuller
o Vessles from: femoral, deep femoral, perineum, superirfical inguinal nodes
o Efferent go to external iliac
nodes cont
External iliac nodes o Above pelvic brim o Afferent-from inguinal nodes o Efferent- merge to common iliac Internal iliac nodes o Within pelvis o Afferent- pelvic organs, deeper gluteal regions o Coruse with superior/inferior gluteal bv o Efferent- common iliac
