Glenohumeral And Hip Joints Flashcards
Explain glenohumeral joint
Ball head of humerus and socket glenoid cavity of scapula
Unstable like egg and spoon but great mobility
Hip joint explained
Ball head of femur and socket acetabulum of hip
Stable but limited mobility
Eenture weight upper body transmitter through hip and femur
Movement at glenohumeral and hip joints
Flexion and extension
Abduction and addiction
Medial and lateral rotation
Circumspection
Shape of bony surfaces of glenohumeral joint
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)
Ligaments at glenohumeral joint
Intrinsic (both anterior)
Glenohumeral weak
Transverse humeral which supports biceps tendon
Extrinsic (both superior)
Coracoacromial
Coracohumeral
There are no ligamentous support posteriorly or inferiorly
What is the coracoacromial arch
Coracoid process
Acromion
Coracoacromial ligament
Prevents superior displacement of humerus
GH joint capsule
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
Openings in the GH joint
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
What’s the most common dislocation of GH joint
Subcoracoid dislocation
(Anterior dislocation)
Dislocated in abduction
Axillary nerve and circumflex humeral artery at risk
Bursae at GH joint
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
Muscles of scapular region
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
What are the rotator cuff muscles
Superspinatus
Infraspinatus
Teres minor
Subscapularis
What muscles bring about scapulothoracic movement
Trapezius
Rhomboids
Levator scapular
What are rotator cuff muscles and how do they work
Short powerful muscles that stabilise joint by pulling head of humerus into glenoid fossa
Tone of muscles is major stabilising factor at GH joint
What is job of supraspinatus
First 15’ of abduction (deltoid then takes over up to 90)
What does infraspinatus do
Lateral rotation
what does teres minor do
Lateral rotation
What does subscapularis do
Media rotation
What rotator cuff muscles are posterior scapula
Supraspinatus
Infraspinatus
Teres minor
Attach to greater tuberosity of humerus
How are rotator cuff muscles supplied
Supraspinatus and infraspinatus are supplied by suprascapular nerve
Teres minor supplied by axillary nerve
Subscapularis supplied by subscpualr nerves of posterior cord
Where does subscapularis rotator cuff attach
Anterior scapular muscle attaches to subscapular fossa and attaches to lesser tuberosity of humerus
What muscles attach the upper limbs to the scapula
Deltoid
Teres major
Triceps
4 rotator cuffs
Landmark of teres major
Divides axilla from arm
Posterior wall of axilla
Teres major attachments
Lateral margin of scapula to medial lip of bicipital groove of humerus
What supplies teres major
Lower subscapular nerve
What is function of teres major
Addicts and medially rotates humerus
Attachments of deltoid
Clavicle acromion and spine of scapula to deltoid tuberosity of humerus
Supply of deltoid
Axillary nerve
What does deltoid do
Abducts arm but requires supraspinatus to initiate first 15’
Flexes and medially rotates the arm (clavicles head)
Extend and laterally rotate arm (spinal part)
Where does tricpes brachii do and where does it attach
Long head attaches to infraglenoid tubercle of scapula to ulna
Assists in stabilising addicted GH joint
Where does coracobrachialis attach and what does it do
Attaches to coracoid process of scapula to middle 1/3 of humerus
Resists dislocation of shoulder joint
Movement of GH joint and muscles which do it
Flexion - Pec major and deltoid Extension - deltoid (back) Lateral rotation - infraspinatus Medial rotation - subscapularis Adduction - Pec major and latissimus dorsi Abduction - deltoid
Gateways to scapular region
Suprascapular notch
Quadrangular space
Upper triangular space
Lower triangular (triangular interval)
What comes through suprascapular notch
Above scapular
Suprascapular nerve to supraspinatus and infraspinatus
Suprascapular artery (branch of subclavian artery which forms anastomoses with circumflex scapular of axillary artery
Suprascpaular artery anastomisises with which other artery
Circumflex scapular of axillary artery
What comes through quadrangular space
Under GH joint
Axillary nerve
Posterior circumflex humeral artery
What goes through upper triangular space
Circumflex scapular artery
What goes through lower triangular space
Radial nerve and profunda brachii artery
Hip joint explained shape etc
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
What supplies blood to femoral head in children
Fovea for ligament
How is acetabulum formed
Fusion of ilium pubis and ischium
What does acetabulum have around edges and what can happen to it
Acetabular labrum
Can tear and cause pain
Osteology of femur
Head fovea Neck Greater trochanter Intertrochanteric crest on side Intertrochanteric line (capsular attachment) Lesser trochanter
Where does hip joint xapsukeand ligaments insert into
Intertrochanteric line anteriorly
When are epiphysis of 2 trochanter and femoral head fused
18-19 years
Synovial layers of capsule send
Retinacular fibres medially along femoral neck toward head
Ligaments that reinforce the fibrous capsule of hip joint
Iliofemoral (anterior and superior) strongest
Pubofemoral (anterior and inferior)
Ischiofemoral (posterior) weakest
Attachment of iliofemoral anterior and superior ligaments
What does it do
Anterior inferior iliac spine to intertrochanteric line
Prevents hyperextension of hip during standing
What does pubofemoral anterior and inferior attach to and what does it do
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
What’s the iliofemoral ligament attachments
Attaches from acetabular rim ischial to medial part of greater trochanter
Where is greater trochanter on hip joint X-ray
Opposite middle of acetabulum
Which part of hip joint shows X-ray changes of osteoarthritis first
Suoerilateral part of acetabulum (top)
Hip joint slipped femoral capital epiphysis in adoslecnt
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
Neurovascular supply to hip joint
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
Relations to hip joint
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
Muscles at hip joint
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
Flexors of hip
Pectineus
Iliopsoas
Sartorius
Rectus femoris
What does rectus femoris do
Flex hip at thigh and steady hip joint
Pectineus attachment, innervation and function
Pubis to femur
Adducts and medially rotates
Femoral nerve
Iliopsoas is??!
Psoas major
Psoas minor
Iliacus
all combined
Iliopsoas attachment, function, innervation
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
Sartorius attachments, function and innervation
Anterior superior iliac spine to superior medial tibia
Flexes, adducts and laterally rotates thigh and flexes at knee
Femoral nerve
Flexors of the hip are supplied mainly by
Femoral nerve
Adductors of hip and their innervation
Adductor longus and adductor brevis - pubis to femur
Supplied by obturator nerve
Adductors of hip are
Adductor Magnus
Obturator externus
Gracilis
Obturator nerve Mainly
Adductor Magnus
Two parts - adductor and hamstring
Adductor - pubis and ischial ramus to femur
Obturator nerve
Hamstring - ischial tuberosity to femur
Sciatic nerve
Obturator externus
Obturator foramen and membrane to femur
Adducts laterally rotates and steadies head of femur
Obturator nerve
Gracilis
Pubis to superior medial tibia
Flexes and partially medial rotation of leg
Obturator nerve
Extensor of hip are and are supplied by
Semitendinous and semimembranous
Biceps femoris
All supplied by sciatic nerve
Semitendinosus
Ischial tuberosity to superior medial tibia
Semimembranosus
Post medial condyle of tibia to medial tibia
Biceps femoris
Ischial tuberosity (long head) or femur (short head) to fibula
Partial flexors when knee flexes
Abductors and medial rotators of thigh
Gluteus maximus
Gluteus medius minimus and tensor fascia latae
Piriformis, obturator internus, superior and inferior gemelli
Quadratus femoris
What muscles hip to stabilise the hip joint
Piriformis
Quadrator femoris
Obturator externus
Dashboard injury
Posterior dislocation
Sitting with hips flexed blow to knee sends force through femur and dislocates posteriorly
Sciatic nerve at risk!
Gait 1 swing phase
Lift lower limb and flex hip - iliopsoas and rectus femoris
Gait 2 swing phase
Flex hip more iliopsoas and femoris - extend knee quadriceps
What are the quadriceps
Vastis medialis, lateralis and intermedius, rectus femoris
What prevents patellar lateral dislocation
Vastus mediallis
Gait 3 stance phase
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
Gait 4 push off
Extend hip via hamstrings (gluteus maximus if power needed)
Extend knee quadriceps
Gait 5 swing phase
Keep foot pointing forward via lateral rotation at hip by shortcut , lateral rotators such as piriformis, obturator externus and internus with gemelli
