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MD2002 > Glenohumeral And Hip Joints > Flashcards

Glenohumeral And Hip Joints Flashcards

1
Q

Explain glenohumeral joint

A

Ball head of humerus and socket glenoid cavity of scapula

Unstable like egg and spoon but great mobility

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2
Q

Hip joint explained

A

Ball head of femur and socket acetabulum of hip

Stable but limited mobility

Eenture weight upper body transmitter through hip and femur

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3
Q

Movement at glenohumeral and hip joints

A

Flexion and extension
Abduction and addiction
Medial and lateral rotation
Circumspection

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4
Q

Shape of bony surfaces of glenohumeral joint

A

Glenoid fossa shallow with glenoid labrum attached to edge which depends socket and helps stabilise

Humerus head 1/3 of sphere only 1/3 in contact with glenoid fossa

Held in place by rotator cuff muscles (SITS)

Surfaces covered by hyaline cartilage(synovial)

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5
Q

Ligaments at glenohumeral joint

A

Intrinsic (both anterior)

Glenohumeral weak
Transverse humeral which supports biceps tendon

Extrinsic (both superior)
Coracoacromial
Coracohumeral

There are no ligamentous support posteriorly or inferiorly

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6
Q

What is the coracoacromial arch

A

Coracoid process
Acromion
Coracoacromial ligament

Prevents superior displacement of humerus

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7
Q

GH joint capsule

A

Loose attaching medially to glenoid fossa margin and labrum
Laterally attaches to anatomical neck of humerus

Capsule encloses proximal attachment of long head of biceps

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8
Q

Openings in the GH joint

A

Biceps tendon passes through to its insertion

Synovial membrane passes through capsule anteriorly to form subscapularis bursa

Bursa protects subscapularis tendon from being damaged by edge of glenoid

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9
Q

What’s the most common dislocation of GH joint

A

Subcoracoid dislocation
(Anterior dislocation)

Dislocated in abduction
Axillary nerve and circumflex humeral artery at risk

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10
Q

Bursae at GH joint

A

Bursae are sac like cavities bear joint which contain synovial fluid

Subscapularis bursa communicates with joint cavity

Bursitis - inflammation of bursae lead to degenerative changes in tendons resulting in difficulty initiating movements for example if supraspinatus tendon affected there is an inability to initiate abduction

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11
Q

Muscles of scapular region

A

Superficial - lat dorsi (trunk to humerus) and trapezius (trunk to scapula)

Deep - (trunk to scapula) rhomboids and levator scapulae

Scapular (intrinsic shoulder muscles - scapula to humerus) - deltoid, teres major and SITS - supraspinatus infraspinatus teres minor and subscapularis

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12
Q

What are the rotator cuff muscles

A

Superspinatus
Infraspinatus
Teres minor
Subscapularis

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13
Q

What muscles bring about scapulothoracic movement

A

Trapezius
Rhomboids
Levator scapular

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14
Q

What are rotator cuff muscles and how do they work

A

Short powerful muscles that stabilise joint by pulling head of humerus into glenoid fossa
Tone of muscles is major stabilising factor at GH joint

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15
Q

What is job of supraspinatus

A

First 15’ of abduction (deltoid then takes over up to 90)

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16
Q

What does infraspinatus do

A

Lateral rotation

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17
Q

what does teres minor do

A

Lateral rotation

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18
Q

What does subscapularis do

A

Media rotation

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19
Q

What rotator cuff muscles are posterior scapula

A

Supraspinatus
Infraspinatus
Teres minor

Attach to greater tuberosity of humerus

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20
Q

How are rotator cuff muscles supplied

A

Supraspinatus and infraspinatus are supplied by suprascapular nerve

Teres minor supplied by axillary nerve

Subscapularis supplied by subscpualr nerves of posterior cord

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21
Q

Where does subscapularis rotator cuff attach

A

Anterior scapular muscle attaches to subscapular fossa and attaches to lesser tuberosity of humerus

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22
Q

What muscles attach the upper limbs to the scapula

A

Deltoid
Teres major
Triceps
4 rotator cuffs

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23
Q

Landmark of teres major

A

Divides axilla from arm

Posterior wall of axilla

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24
Q

Teres major attachments

A

Lateral margin of scapula to medial lip of bicipital groove of humerus

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25
Q

What supplies teres major

A

Lower subscapular nerve

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26
Q

What is function of teres major

A

Addicts and medially rotates humerus

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27
Q

Attachments of deltoid

A

Clavicle acromion and spine of scapula to deltoid tuberosity of humerus

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28
Q

Supply of deltoid

A

Axillary nerve

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29
Q

What does deltoid do

A

Abducts arm but requires supraspinatus to initiate first 15’

Flexes and medially rotates the arm (clavicles head)
Extend and laterally rotate arm (spinal part)

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30
Q

Where does tricpes brachii do and where does it attach

A

Long head attaches to infraglenoid tubercle of scapula to ulna

Assists in stabilising addicted GH joint

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31
Q

Where does coracobrachialis attach and what does it do

A

Attaches to coracoid process of scapula to middle 1/3 of humerus

Resists dislocation of shoulder joint

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32
Q

Movement of GH joint and muscles which do it

A 
Flexion - Pec major and deltoid
Extension - deltoid (back)
Lateral rotation - infraspinatus 
Medial rotation - subscapularis 
Adduction - Pec major and latissimus dorsi
Abduction - deltoid
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33
Q

Gateways to scapular region

A

Suprascapular notch
Quadrangular space
Upper triangular space
Lower triangular (triangular interval)

34
Q

What comes through suprascapular notch

A

Above scapular

Suprascapular nerve to supraspinatus and infraspinatus

Suprascapular artery (branch of subclavian artery which forms anastomoses with circumflex scapular of axillary artery

35
Q

Suprascpaular artery anastomisises with which other artery

A

Circumflex scapular of axillary artery

36
Q

What comes through quadrangular space

A

Under GH joint

Axillary nerve
Posterior circumflex humeral artery

37
Q

What goes through upper triangular space

A

Circumflex scapular artery

38
Q

What goes through lower triangular space

A

Radial nerve and profunda brachii artery

39
Q

Hip joint explained shape etc

A

Trades mobility for stability

Acetabulum is deep with lunate lined articular surface

Femoral head large and approximately 2/3rd of a sphere

Femoral head covered in hyaline cartilage except for fovea for ligament also uncovered in acetabulum which Carries blood supply to femoral head in children

40
Q

What supplies blood to femoral head in children

A

Fovea for ligament

41
Q

How is acetabulum formed

A

Fusion of ilium pubis and ischium

42
Q

What does acetabulum have around edges and what can happen to it

A

Acetabular labrum

Can tear and cause pain

43
Q

Osteology of femur

A 
Head fovea
Neck
Greater trochanter
Intertrochanteric crest on side
Intertrochanteric line (capsular attachment) 
Lesser trochanter
44
Q

Where does hip joint xapsukeand ligaments insert into

A

Intertrochanteric line anteriorly

45
Q

When are epiphysis of 2 trochanter and femoral head fused

A

18-19 years

46
Q

Synovial layers of capsule send

A

Retinacular fibres medially along femoral neck toward head

47
Q

Ligaments that reinforce the fibrous capsule of hip joint

A

Iliofemoral (anterior and superior) strongest

Pubofemoral (anterior and inferior)

Ischiofemoral (posterior) weakest

48
Q

Attachment of iliofemoral anterior and superior ligaments

What does it do

A

Anterior inferior iliac spine to intertrochanteric line

Prevents hyperextension of hip during standing

49
Q

What does pubofemoral anterior and inferior attach to and what does it do

A

Blends with iliofemoral attaches from obturator crest of pubic bone to merge with fibrous capsule

Prevents overabduction of hip joint and tightens during abduction and extension of the hip

50
Q

What’s the iliofemoral ligament attachments

A

Attaches from acetabular rim ischial to medial part of greater trochanter

51
Q

Where is greater trochanter on hip joint X-ray

A

Opposite middle of acetabulum

52
Q

Which part of hip joint shows X-ray changes of osteoarthritis first

A

Suoerilateral part of acetabulum (top)

53
Q

Hip joint slipped femoral capital epiphysis in adoslecnt

A

Abnormal growth of epiphysis causes femoral neck to move slightly anteriorly and into external rotation

Hip pain groin pain in adolescent progressing to painful limp with decreased range of hip movement

Pinning head in place

54
Q

Neurovascular supply to hip joint

A

Retinacular arteries
Medial and lateral circumflex arteries

Nerves are femoral, obturator, superior gluteal and nerve to quadrator femoris.

Follows hiltons law- nerves supplying muscles acting on joint innervate joint

55
Q

Relations to hip joint

A

Lateral to hip joint - gluteus medius, tensor fascia latae and iliotibial tract

Anterior to hip joint - femoral artery, nerve then vein

Medially - branches of obturator nerve and vessels

Posterior- sciatic nerve (with posterior femoral cutaneous nerve and inferior gluteal vessels adjacent

56
Q

Muscles at hip joint

A

Flexors(anterior thigh) - pectineus, iliposoas, sartorial

Adductors (medial thigh) - adductors longus, brevis, Magnus, gracilis and obturator externus

Extensors (posterior thigh) - flex knee also - semitendinosus
Semimembranosus
Biceps femoris

Abductors and rotator of thigh (gluteal region)
Gluteus maximus, medius, minimus
Tensor fascia latae
Piriformis
Obturator internus
Superior and inferior gemelli
Quadratus femoris
57
Q

Flexors of hip

A

Pectineus
Iliopsoas
Sartorius
Rectus femoris

58
Q

What does rectus femoris do

A

Flex hip at thigh and steady hip joint

59
Q

Pectineus attachment, innervation and function

A

Pubis to femur
Adducts and medially rotates
Femoral nerve

60
Q

Iliopsoas is??!

A

Psoas major
Psoas minor
Iliacus

all combined

61
Q

Iliopsoas attachment, function, innervation

A

Psoas major and minor attach
Vertebrae to femur

Iliacus attache
Iliac crest/SI to femur

Stabilise hip joint and flexes

Iliacus supperlied by Femoral nerve
Psoas major and minor supplied by anterior rami of L1,2,3

62
Q

Sartorius attachments, function and innervation

A

Anterior superior iliac spine to superior medial tibia

Flexes, adducts and laterally rotates thigh and flexes at knee

Femoral nerve

63
Q

Flexors of the hip are supplied mainly by

A

Femoral nerve

64
Q

Adductors of hip and their innervation

A

Adductor longus and adductor brevis - pubis to femur

Supplied by obturator nerve

65
Q

Adductors of hip are

A

Adductor Magnus
Obturator externus
Gracilis

Obturator nerve Mainly

66
Q

Adductor Magnus

A

Two parts - adductor and hamstring

Adductor - pubis and ischial ramus to femur
Obturator nerve

Hamstring - ischial tuberosity to femur
Sciatic nerve

67
Q

Obturator externus

A

Obturator foramen and membrane to femur
Adducts laterally rotates and steadies head of femur
Obturator nerve

68
Q

Gracilis

A

Pubis to superior medial tibia
Flexes and partially medial rotation of leg
Obturator nerve

69
Q

Extensor of hip are and are supplied by

A

Semitendinous and semimembranous
Biceps femoris

All supplied by sciatic nerve

70
Q

Semitendinosus

A

Ischial tuberosity to superior medial tibia

71
Q

Semimembranosus

A

Post medial condyle of tibia to medial tibia

72
Q

Biceps femoris

A

Ischial tuberosity (long head) or femur (short head) to fibula

Partial flexors when knee flexes

73
Q

Abductors and medial rotators of thigh

A

Gluteus maximus
Gluteus medius minimus and tensor fascia latae
Piriformis, obturator internus, superior and inferior gemelli
Quadratus femoris

74
Q

What muscles hip to stabilise the hip joint

A

Piriformis
Quadrator femoris
Obturator externus

75
Q

Dashboard injury

A

Posterior dislocation
Sitting with hips flexed blow to knee sends force through femur and dislocates posteriorly

Sciatic nerve at risk!

76
Q

Gait 1 swing phase

A

Lift lower limb and flex hip - iliopsoas and rectus femoris

77
Q

Gait 2 swing phase

A

Flex hip more iliopsoas and femoris - extend knee quadriceps

78
Q

What are the quadriceps

A

Vastis medialis, lateralis and intermedius, rectus femoris

79
Q

What prevents patellar lateral dislocation

A

Vastus mediallis

80
Q

Gait 3 stance phase

A

Abductors Keep pelvis level - gluteus medius minimus with adductors (Magnus longus and brevis) to counter balance

Medial rotation hip gravity aided by anterior fibres of gluteus minimus and medius

81
Q

Gait 4 push off

A

Extend hip via hamstrings (gluteus maximus if power needed)

Extend knee quadriceps

82
Q

Gait 5 swing phase

A

Keep foot pointing forward via lateral rotation at hip by shortcut , lateral rotators such as piriformis, obturator externus and internus with gemelli

MD2002 (22 decks)

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