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ALT > FT2: w7 notes > Flashcards

FT2: w7 notes Flashcards

1
Q

Boundaries of gluteal region

A

Superiorly
Iliac crest

Inferiorly
Gluteal fold

Medially
Gluteal cleft (natal cleft)

Laterally
Greater trochanter

Anteriorly
Anterior superior iliac spine (ASIS)

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2
Q

ITB - iliotibial band/tract

Proximal attachment
Distal attachment

A

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

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3
Q

Medial rotation =

A

internal rotation

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4
Q

Lateral rotation =

A

external rotation

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5
Q

4 muscles that are considered content of the pelvis (either true or false)

A

iliacus, psoas major (iliopsoas), piriformis, obturator internus

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6
Q

Superficial muscles of the gluteal region

A

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

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7
Q

Tensor fasciae latae (TFL)

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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8
Q

Gluteus maximus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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9
Q

Gluteus medius

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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10
Q

Gluteus minimus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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11
Q

Deep muscles of the gluteal region

A

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

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12
Q

deep muscles in order from most superior to most inferior

A

Piriformis
Most superior

Superior gemellus

Obturator internus

Inferior gemellus

Quadratus femoris
Most inferior

Obturator externus
Deep to OI & IG

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13
Q

Piriformis
Most superior

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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14
Q

Superior gemellus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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15
Q

obturator internus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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16
Q

Inferior gemellus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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17
Q

Quadratus femoris

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function

A

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

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18
Q

Obturator externus

Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Functionx

A

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

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19
Q

Muscle location crossing a joint will dictate the action produced at a joint

Flexors
Extensors
Adductors
Abductors
Rotators

A

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

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20
Q

Femoral neck

A

Acts as a strut & allows the head of the femur to sit inside the acetabulum whilst allowing and increased range of movement & leverage

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21
Q

articular margin

A

where the synovial membrane will attach
* Where hyaline cartilage stops & periosteum of the bone will continue

22
Q

fovea capitis

A

attachment site for the ligamentum teres

23
Q

Hip joint
Histological classification

A

Synovial

24
Q

Hip joint
Functional classification

A

Ball & socket

Ball = head of femur
Socket = acetabulum (concaved)
* Sacrificed mobility in order to gain stability - it’s a WB joint

25
Q

Hip joint
3 degrees of movement

A

Ball & socket = triaxial

Movement
Plane

Flexion/extension
Sagittal

Adduction/abduction
Coronal

Medial & lateral rotation
Horizontal

26
Q

Articulating surfaces of the hip bone

A

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
27
Q

Acetabulum features

A

Articular part
Non-articular part
Acetabular labrum

28
Q

Articular part of acetabulum

A

Crescentic lunate surface - only articular surface of the acetabulum
* Surrounds the acetabular fossa
* Tissue type: hyaline cartilage covers this

29
Q

Non-articular part of acetabulum

A

Acetabular fossa - rough and non-articular
* Surrounded by the crescentic lunate surface

30
Q

Acetabular labrum

A

Acetabular labrum - deepens the articulation of the hip joint & allows it to receive more of the femoral head
* Acts as a ‘lip’

31
Q

Bursa definition

A

Pouch of synovial membrane filled with synovial fluid
Wherever there is friction = bursa will be present

32
Q

function of bursa

A

Reduces friction between 2 structures that slide upon each other

33
Q

types of bursa

A
  • Trochanteric bursa (TB)
    • Gluteofemoral bursa (GFB)
    • Ischial bursa (IB)
34
Q

Capsular ligaments

A

Capsular (extrinsic)
Iliofemoral (anterior/superior)
Pubofemoral (anterior/inferior)
Ischiofemoral (posterior)

35
Q

IF ligament (anterior/superior)

A

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)

36
Q

PF ligament (anterior/inferior)

A

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

37
Q

ISF ligament (posterior)

A

Ischiofemoral ligament - attaches to the articular margin of the acetabulum & greater trochanter
* Weakest
* Could prevent/limit hyperflexion

38
Q

Intracapsular ligaments

A

Intracapsular (intrinsic)
Ligamentum teres
Transverse acetabular

39
Q

Ligamentum teres

A

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

40
Q

Fat pad

A

Sits in acetabular fossa & covered with a layer of synovial membrane

41
Q

Transverse acetabular ligament

A

bridges the acetabular notch & attaches to the inferior horns of the acetabulum

42
Q

Most close packed position for hip

A

Extension and medial rotation
* Stabilising ligaments come under maximum tension

43
Q

Most congruent position of the hip

A

Flexed, abducted and laterally rotated

44
Q

Neurovascular structures of the gluteal region

A

Superior gluteal nerve & artery

Inferior gluteal nerve & artery

45
Q

Superior gluteal nerve & artery

Origin
Anatomical relationships
Distribution (branches)

A

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

46
Q

Inferior gluteal nerve & artery

Origin
Anatomical relationships
Distribution (branches)

A

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

47
Q

Nerves of the gluteal region

A

Femoral n

Obturator n

Superior gluteal n

48
Q

Femoral nerve
supplies

A

Femoral nerve lies anterior to the hip joint

Supplies rectus femoris (of the quadriceps muscle group) & pectineus (adductor)

49
Q

Obturator nerve
supplies

A

Obturator nerve lies medial to the hip joint

Supplies the adductor muscle group & lateral rotators (esp. obturator externus)

50
Q

superior gluteal nerve
supplies

A

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)

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