FT2: w7 notes Flashcards
Boundaries of gluteal region
Superiorly
Iliac crest
Inferiorly
Gluteal fold
Medially
Gluteal cleft (natal cleft)
Laterally
Greater trochanter
Anteriorly
Anterior superior iliac spine (ASIS)
ITB - iliotibial band/tract
Proximal attachment
Distal attachment
Iliotibial band/tract (ITB) - a lateral thickening (superficial structure) of the fascia lata
* Extends from the ilium, descends all the way down to the tibia
Proximal attachment
Gluteus maximus
Distal attachment
Lateral intermuscular septum (IMS) of the thigh
Then attaches to the linea aspera of the femur
Medial rotation =
internal rotation
Lateral rotation =
external rotation
4 muscles that are considered content of the pelvis (either true or false)
iliacus, psoas major (iliopsoas), piriformis, obturator internus
Superficial muscles of the gluteal region
Extensors, abductors and medial rotators of the hip
* Iliotibial tract (not a muscle, but is a superficial structure)
* Tensor fasciae latae (TFL)
* Gluteus maximus
* Gluteus medius
* Gluteus minimus
Tensor fasciae latae (TFL)
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Superior gluteal nerve
(L4-S1)
Proximal attachment
Iliac crest b/n ASIS & iliac tubercle
Distal attachment
Lateral condyle of tibia via ITB
Position & orientation in relation to joint(s) crossed
Lateral to hip jt
Oblique orientation
Lateral to knee jt
Vertical orientation
Function
Abduction
Medial rotation
Lateral stability of knee
Gluteus maximus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Inferior gluteal nerve
(L4, L5, S1)
Proximal attachment
External/post ilium posterior to posterior gluteal line, dorsal sacrum & coccyx, sacrotuberous lig.
Distal attachment
Gluteal tuberosity & lateral tibial condyle via ITB
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Oblique orientation
Lateral to knee jt
Vertical orientation
Function
Extension
Lateral rotation
Lateral stability of knee
Gluteus medius
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Superior gluteal nerve
(L4, L5, S1)
Proximal attachment
Posterolateral ilium, between posterior & anterior gluteal lines
Distal attachment
Greater trochanter (lat)
Position & orientation in relation to joint(s) crossed
Lateral to hip jt
Oblique orientation
Function
Abduction
Medial rotation of hip jt
Gluteus minimus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Superior gluteal nerve
(L4, L5, S1)
Proximal attachment
Posterolateral ilium, between posterior & anterior gluteal lines
Distal attachment
Greater trochanter (ant)
Position & orientation in relation to joint(s) crossed
Lateral to hip jt, slightly anterior
Oblique orientation
Function
Abduction
Medial rotation of hip jt
Deep muscles of the gluteal region
lateral rotators of the hip, all deep to the gluteus maximus
* Piriformis
* Tricep coxae (obturator internus, superior gemellus, inferior gemellus)
* Quadratus femoris
Obturator externus - obturator externus is also a lateral rotator, but is grouped with the adductor muscles in the medial compartment
deep muscles in order from most superior to most inferior
Piriformis
Most superior
Superior gemellus
Obturator internus
Inferior gemellus
Quadratus femoris
Most inferior
Obturator externus
Deep to OI & IG
Piriformis
Most superior
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Sacral plexus
S1 & S2
Proximal attachment
Anterior surface of sacrum
Distal attachment
Greater trochanter
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Almost horizontal orientation
Function
Lateral rotation of hip jt
Assists in abduction of flexed hip
Superior gemellus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Branches from sacral plexus
(L5, S1)
Proximal attachment
Ischial spine
Distal attachment
Greater trochanter
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Horizontal orientation
Function
Lateral rotation of hip jt
obturator internus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Sacral plexus
Nerve to obturator internus
(SN L5-S2)
Proximal attachment
Obturator membrane (internal surface)
Distal attachment
Greater trochanter
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Horizontal orientation
Function
Lateral rotation of hip jt
Inferior gemellus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Branches from sacral plexus
(L5, S1)
Proximal attachment
Ischial tuberosity (upper aspect)
Distal attachment
Greater trochanter
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Horizontal orientation
Function
Lateral rotation of hip jt
Quadratus femoris
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Branches from sacral plexus
(L5, S1)
Proximal attachment
Ischial tuberosity (lateral border)
Distal attachment
Intertrochanteric crest
Position & orientation in relation to joint(s) crossed
Posterior to hip jt, slightly inferior
Horizontal orientation
Function
Lateral rotation of hip jt
Obturator externus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Functionx
Innervation
Obturator nerve
(L3, L4)
Proximal attachment
Obturator membrane (external surface)
Distal attachment
Trochanteric fossa of femur
Position & orientation in relation to joint(s) crossed
Posterior to hip jt
Horizontal orientation
Function
Lateral rotation of hip jt
Muscle location crossing a joint will dictate the action produced at a joint
Flexors
Extensors
Adductors
Abductors
Rotators
Flexors
Anterior
*reverse at the knee & distal
Knee & below: flexors = posterior
Extensors
Posteriorly
*reverse at the knee & distal
Knee & below: extensors = anterior
Adductors
Medially
Abductors
Laterally
Rotators
Horizontally & obliquely
Femoral neck
Acts as a strut & allows the head of the femur to sit inside the acetabulum whilst allowing and increased range of movement & leverage
articular margin
where the synovial membrane will attach
* Where hyaline cartilage stops & periosteum of the bone will continue
fovea capitis
attachment site for the ligamentum teres
Hip joint
Histological classification
Synovial
Hip joint
Functional classification
Ball & socket
Ball = head of femur
Socket = acetabulum (concaved)
* Sacrificed mobility in order to gain stability - it’s a WB joint
Hip joint
3 degrees of movement
Ball & socket = triaxial
Movement
Plane
Flexion/extension
Sagittal
Adduction/abduction
Coronal
Medial & lateral rotation
Horizontal
Articulating surfaces of the hip bone
Lunate surface of acetabulum & head of femur (except fovea capitis)
* It is a deep set articulation - its rather congruent as 2/3 of femoral head sit inside the acetabulum * Lined with hyaline articular cartilage
Acetabulum features
Articular part
Non-articular part
Acetabular labrum
Articular part of acetabulum
Crescentic lunate surface - only articular surface of the acetabulum
* Surrounds the acetabular fossa
* Tissue type: hyaline cartilage covers this
Non-articular part of acetabulum
Acetabular fossa - rough and non-articular
* Surrounded by the crescentic lunate surface
Acetabular labrum
Acetabular labrum - deepens the articulation of the hip joint & allows it to receive more of the femoral head
* Acts as a ‘lip’
Bursa definition
Pouch of synovial membrane filled with synovial fluid
Wherever there is friction = bursa will be present
function of bursa
Reduces friction between 2 structures that slide upon each other
types of bursa
- Trochanteric bursa (TB)
- Gluteofemoral bursa (GFB)
- Ischial bursa (IB)
Capsular ligaments
Capsular (extrinsic)
Iliofemoral (anterior/superior)
Pubofemoral (anterior/inferior)
Ischiofemoral (posterior)
IF ligament (anterior/superior)
Iliofemoral ligament - y-shaped ligament attaching between the iliac bone & the intertrochanteric line of the femur
* Strongest
* Prevents hyperextension by screwing femoral head to acetabulum
Line of gravity lies posterior to the hip joint = tendency for the trunk to extend posteriorly = strong ligaments are located anteriorly to prevent this (iliofemoral ligament)
PF ligament (anterior/inferior)
Pubofemoral ligament - attaches between the pubic bone & neck of the femur
* Prevents over-abduction by tightening during abduction
* Limits hip extension to 10-15° by tightening during extension
ISF ligament (posterior)
Ischiofemoral ligament - attaches to the articular margin of the acetabulum & greater trochanter
* Weakest
* Could prevent/limit hyperflexion
Intracapsular ligaments
Intracapsular (intrinsic)
Ligamentum teres
Transverse acetabular
Ligamentum teres
Ligamentum teres (ligament of the head of the femur) - includes fibres that blend with the labrum, attach to the inferior horns of the lunate surface & also attach to the transverse ligament
* Sits on top of the fat pad, side the hip
Fat pad
Sits in acetabular fossa & covered with a layer of synovial membrane
Transverse acetabular ligament
bridges the acetabular notch & attaches to the inferior horns of the acetabulum
Most close packed position for hip
Extension and medial rotation
* Stabilising ligaments come under maximum tension
Most congruent position of the hip
Flexed, abducted and laterally rotated
Neurovascular structures of the gluteal region
Superior gluteal nerve & artery
Inferior gluteal nerve & artery
Superior gluteal nerve & artery
Origin
Anatomical relationships
Distribution (branches)
Origin
SGN - Posterior divisions of sacral plexus (L4, L5 & S1)
SGA - Branches from inferior gluteal artery in true pelvis
Anatomical relationships
Travel as a neurovascular bundle from true pelvis, through GSF above piriformis to gluteal region
Distribution (branches)
Gluteus medius
Gluteus minimus
Tensor fasciae late
Hip jt
Inferior gluteal nerve & artery
Origin
Anatomical relationships
Distribution (branches)
Origin
IGN - Posterior divisions of sacral plexus (L5, S1 & S2)
IGA - Branches from the internal iliac artery in the true pelvis
Anatomical relationships
Travel as a neurovascular bundle from true pelvis, through GSF below piriformis to gluteal region
Distribution (branches)
Gluteus maximus
Nerves of the gluteal region
Femoral n
Obturator n
Superior gluteal n
Femoral nerve
supplies
Femoral nerve lies anterior to the hip joint
Supplies rectus femoris (of the quadriceps muscle group) & pectineus (adductor)
Obturator nerve
supplies
Obturator nerve lies medial to the hip joint
Supplies the adductor muscle group & lateral rotators (esp. obturator externus)
superior gluteal nerve
supplies
Superior gluteal nerve lies posterosuperior to the hip joint
Supplies abductors gluteus medius & minimus
NOTE: the cutaneous nerves of the superior, inferior and medial gluteal region do no follow the above pattern
* This area of skin is supplied by posterior primary rami (dorsal rami)
