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MD2002 > Glenohumeral and Hip Joints > Flashcards

Glenohumeral and Hip Joints Flashcards

1
Q

How stable and mobile are the glomerohumeral and hip joints respectively ?

A

GH: UNSTABLE (Egg and spoon) but GREAT MOBILITY

Hip: STABLE but LIMITED MOBILITY

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2
Q

What are the ball and socket parts of the GH and hip joints ?

A

GH: Ball- Head of humerus
Socket- Glenoid cavity of scapula

Hip: Ball- Head of femur
Socket: Acetabulum of hip

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3
Q

Why is the GH joint less stable than the hip joint ?

A

Partly because the glenoid fossa is shallow

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4
Q

How much of the humeral head is in contact with the glenoid ?

A

1/3

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5
Q

Which muscles keep the GH joint in place ?

A

Rotator cuff muscles

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6
Q

What kind of connective tissue covers surfaces of the glenoid head of humerus ?

A

Hyaline cartilage

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7
Q

What structure attaches to the edge of the glenoid fossa and deepens the socket and helps to stabilise the joint ?

A

Glenoid labrum

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8
Q

What structure is the glenoid labrum fused with ?

A

Tendon of long head of biceps

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9
Q

Is the joint capsule of the GH joint loose or not ? Why ?

A

-Loose, especially inferiorly to allow abduction

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10
Q

Which structures support the joint capsule of the GH joint ?

A

Tendons of rotator cuff muscles

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11
Q

What structures is the joint capsule of GH attached to ?

A

Attached to glenoid fossa margin and labrum and anatomical neck of humerus.

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12
Q

Which structure does the capsule of the GH joint enclose (other than the joint itself) ?

A

It encloses the proximal attachment of long head of biceps.

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13
Q

What are the opening on the fibrous capsule of the GH joint ? What is the role of each?

A
  1. Biceps tendon passes through to its insertion.
  2. Subscapularis bursa
    - Protects the subscapularis tendon from being damaged by the edge of the glenoid
  3. Subacromial bursa
    - Protects the supraspinatus tendon from being injured
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14
Q

What is a bursa ?

A

Sac-like, synovial fluid-filled cavity near joints which also help facilitate movement.

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15
Q

What are possible effects of bursitis ? Give an example specific to the GH joint.

A

May lead to degenerative changes in the associated tendons resulting in difficulty initiating certain movements (Example: supraspinatus tendon, inability to initiate abduction.)

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16
Q

What are the ligaments present around the GH joint ? Where are they located relative to the joint ?

A

Intrinsic (both anterior) ligaments:
􏰀Glenohumeral
Transverse humeral

Extrinsic (both superior)
Coracoacromial
Coracohumeral

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17
Q

How strong is each of the ligaments around the GH joint ?

A

Glenohumeral: weak

Coracoacromial: strong 􏰀
Coracohumeral: strong

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18
Q

What is the function of the transverse humeral ligament ?

A

Keeps the biceps tendon in bicipital groove

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19
Q

What is the Coraco-acromial arch ?

A

coracoid process + acromion + coraco- acromial ligament

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20
Q

What is the function of the coraco-acromial arch ?

A

Prevents superior displacement of humerus

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21
Q

Why do most luxations occur inferiorly or posteriorly in the shoulder ?

A

Because there are no ligaments inferiorly or posteriorly.

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22
Q

Which of the ligaments surrounding the GH joint is considered a capsular ligament ?

A

Glenohumeral ligament

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23
Q

Why is the hip joint more stable than the GH joint ?

A

Because the acetabulum is deeper

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24
Q

What are the main components of the acetabulum ?

A

Acetabular fossa+Lunate surface

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25
Q

What type of connective tissue if the lunate surface of the acetabulum made of ?

A

Hyaline cartilage

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26
Q

What structure serves to further increase the depth of the acetabulum ? What connective tissue is this structure made of ?

A

Acetabular Labrum

Made of fibrocartillage

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27
Q

What is a major disadvantage of the acetabular

labrum ?

A

It may tear and cause pain

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28
Q

What is the Transverse acetabular ligament ? Why is this particularly important for children ?

A

“A portion of the acetabular labrum, which cross the acetabular notch, and convert it into a foramen through which the nutrient vessels enter the joint.”

Because if there is an injury to the femur, they will stop growing

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29
Q

What connective tissue is the head of the femur covered by ?

A

Hyaline cartilage except for the fovea capitis which is used for ligament attachment

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30
Q

What is another name of Acetabular Labrum ?

A

Cotyloid ligament

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31
Q

What is the hip joint attached ?

A

Attached to the acetabular rim, ligament transverse acetabular ligament, intertrochanteric line and neck of the femur

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32
Q

What does the capsule of the hip joint enclose ?

A

Everything, including the ligament of the head of the femur, but not the articular cartilage

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33
Q

How does the capsule manage to enclose the epiphysis of the femoral head completely ?

A

Because the synovial layers of the capsule sends retinacular fibres medially along the femoral neck towards the head.

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34
Q

What are the ligaments present around the hip joint ? Where are they located relative to the joint ?

A

Iliofemoral -Anterior and superior
Pubofemoral -Anterior and inferior
Ischiofemoral -Posterior

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35
Q

How strong are iliofeoral and ischiofemoral ligaments ?

A

Iliofemoral ligament- strongest

Ischiofemoral ligament- weakest

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36
Q

What are the functions of the iliofemoral and pubofemoral ligaments ?

A

Iliofemoral- Prevents hyperextension of hip joint during standing

Pubofemoral- Prevents overabduction of hip joint; tightens during abduction and extension of hip

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37
Q

Which of the hip joint ligaments are considered capsular ligaments ?

A

All three of them (iliofemoral, pubofemoral, ischiofemoral)

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38
Q

What is the zona orbicularis ?

A

Zone formed by circular winding of some deep fibres of the fibrous capsule around the neck of the femur

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39
Q

What is the function of the capsular ligaments of the hip during extension ?

A
  • Prevent overextension
  • Stabilize the joint
  • Save energy during standing
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40
Q

In which way do capsular ligaments of the hip attach around the joint so they are taut in extension ?

A

Spiral around the joint and attach to femur so that they are taut in extension.

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41
Q

What is the vascular supply of the hip joint ?

A

Cruciate anastomosis, made by:

  1. Medial circumflex femoral artery (retinacular branches)
  2. Lateral circumflex femoral artery (retinacular branches)
  3. Obturator artery

Trochanteric anastomosis, made by:

  1. Medial circumflex femoral artery
  2. Lateral circumflex femoral artery
  3. Superior gluteal artery
  4. Inferior gluteal artery
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42
Q

What is a possible event which can affect blood supply to the head of the femur ?

A

Fracture of the femoral neck

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43
Q

What movements are possible at the hip joint ?

A

Flexion and Extension
Abduction and Adduction
Medial and Lateral Rotation
Circumduction

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44
Q

What movements are possible at the GH joint ?

A

Flexion and Extension
Abduction and Adduction
Medial and Lateral Rotation
Circumduction

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45
Q

What movements at the GH joint does pectoralis major allow ?

A

Adduction, medial rotation, flexion, extension

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46
Q

What are the flexors of the GH joint ?

A

Pectoralis Major, Deltoid (anterior/clavicular fibers), Biceps brachii (long head) and Coracobrachialis

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47
Q

What is the origin and insertion of pectoralis major ?

A

ORIGIN- Clavicular head (medial half of clavicle) Sternocostal head (sternum, superior six costal cartilages, aponeurosis of external oblique muscle)
INSERTION- Lateral lip of intertubercular sulcus (groove) of humerus

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48
Q

What is the origin and insertion of Deltoid (anterior/clavicular fibers) ?

A

ORIGIN- Lateral third of clavicle

INSERTION- Deltoid tuberosity of humerus

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49
Q

What is the origin and insertion of biceps brachii (long head) ?

A

ORIGIN- Supraglenoid tubercle

INSERTION- Tuberosity of radius and fascia of forearm via bicipital aponeurosis

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50
Q

What is the pectoralis major innervated by ?

A

Medial and lateral pectoral nerves

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51
Q

Which muscle makes up the anterior axillary fold ?

A

Pectoralis Major

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52
Q

What are coracobrachialis and biceps (long head) innervated by ?

A

Musculocutaneous nerve

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53
Q

What are the extensors of the GH joint ?

A

Latissimus Dorsi, Triceps (long head), Deltoid (posterior/spinal fibers), Teres Major, Pectoralis Major

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54
Q

What movements at the GH joint does latissimus dorsi allow ?

A

Only extension

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55
Q

What muscle forms the posterior axillary fold ?

A

Latissimus Dorsi

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56
Q

What is the latissimus Dorsi innervated by ?

A

Thoracodorsal nerve

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57
Q

What are all the movements allowed by the long head of the triceps ?

A
  • Stabilises adducted GH joint
  • Extends GH joint
  • Extends arm
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58
Q

What is the origin and insertion of the latissimus dorsi ?

A

ORIGIN-
Spinous processes of inferior six thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior three or four ribs
INSERTION-
Floor of intertubercular sulcus (groove) of humerus

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59
Q

What is the origin and insertion of the deltoid (posterior/spinal fibers) ?

A

ORIGIN-
Acromion
INSERTION-
Deltoid tuberosity of humerus

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60
Q

What is the origin and insertion of the triceps (long head) ?

A

ORIGIN-
Infragleoid tubercle of the scapula
INSERTION-
Olecranon

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61
Q

What is the origin and insertion of the teres major ?

A

ORIGIN-
Inferior part of lateral border of scapula
INSERTION-
Medial lip of intertubercular sulcus of humerus

62
Q

What is the exact role of teres major and pectoralis major in the extension of the arm ?

A

Extend the already flexed arm

63
Q

What are the rotator cuff muscles ?

A

Supraspinatus, Infraspinatus, Teres minor, Subscapularis (SITS)

64
Q

Where do all rotator cuff muscles originate/insert ?

A

ORIGIN-
Scapula
INSERTION-
Humerus

65
Q

What is a scapulohumeral muscle ? Give examples.

A

Intrinsic shoulder muscle

E.g. Rotator Cuff Muscles

66
Q

How are rotator cuff muscles arranged around the GH joint ?

A

Form a musculotendinous cuff around the glenohumeral joint (tendons blend with the capsule of the shoulder joint)

67
Q

What movement are rotator cuff muscles responsible for ? Which muscle is an exception to that ?

A

Rotation of the arm

Supraspinatus

68
Q

How do rotator cuff muscles stabilise the shoulder joint ?

A

By pulling the head of the humerus into the glenoid fossa

69
Q

What is the main stabilising factor at the GH joint ?

A

The tone of rotator cuff muscles

70
Q

What movement is supraspinatus responsible for ?

A

Initiation of abduction (first 15 degrees)

71
Q

What movement is supraspinatus responsible for ?

A

Lateral rotation

72
Q

What movement is teres minor responsible for ?

A

Lateral rotation

73
Q

What movement is subscapularis responsible for ?

A

Medial rotation

74
Q

Where is each of the rotator cuff muscles located, relative to the scapula and humerus ?

A

Supraspinatus, infraspinatus teres minor: from the posterior aspect and lateral border of the scapula to the greater tubercle of the humerus

Subscapularis: from the anterior aspect of the scapula to the lesser tubercle of the humerus

75
Q

What is each of the rotator cuff muscles innervated by ?

A

Supraspinatus and infraspinatus: suprascapular nerve

Teres minor: suprascapular nerve

Subscapularis: superior and inferior subscapular nerves

76
Q

What are abductors of the GH joint ?

A

Deltoid (middle/spinal fibers) and Supraspinatus (initiates the first 15 degrees)

77
Q

What are the adductors of the GH joint ?

A

Teres Major, Coracobrachialis, Lat Dorsi and Pec Major

78
Q

What is the origin and insertion of the deltoid (middle/spinal nerves) ?

A

ORIGIN-
Clavicle, acromion and spine of scapula
INSERTION-
Deltoid tuberosity of the humerus

79
Q

How is the deltoid (middle/spinal fibers) innervated ?

A

Axillary nerve

80
Q

What are all the movements performed by the deltoid muscle ? Which part of the deltoid is responsible for which movement ?

A
  • Abduction (middle/spinal fibers-acromial part)
  • Flexion and medial rotation (anterior/clavicular fibers-clavicular part)
  • Extension and lateral rotation (posterior/spinal fibers-spinal part)
81
Q

What are all the movements performed by the teres major muscle ?

A
  • Adducts
  • Medially rotates humerus
  • Extends flexed arm
82
Q

What is the teres major innervated by ?

A

Lower subscapular nerve

83
Q

What are all the movements performed by the coracobrachialis muscle ?

A
  • Adducts
  • Weakly flexes GH
  • Resists dislocation of shoulder joint
84
Q

What is the coracobrachialis muscle pierced and innervated by ?

A

Musculocutaneous nerve

85
Q

Where is the coracobrachialis muscle relative to humerus and scapula ?

A

Between the coracoid process and the humerus, between brachialis and triceps

86
Q

What is the origin and insertion of the acromial part (middle/spinal fibers) of the deltoid ?

A

ORIGIN-
Spine of scapula
INSERTION-
Deltoid tuberosity of humerus

87
Q

What is the origin and insertion of the supraspinatus muscle ?

A

ORIGIN-
Supraspinous fossa of scapula
INSERTION-
Superior facet of greater tubercle of humerus

88
Q

What is the origin and insertion of the coracobrachialis muscle ?

A

ORIGIN-
Coracoid process
INSERTION-
Medial side of middle humerus

89
Q

Which movement of the humerus increases the range of abduction ?

A

Lateral rotation

90
Q

Which muscles of the back also contribute to abduction of the GH joint ?

A

Trapezius

Serratus anterior

91
Q

What are the prime movers of each movement at the GH joint ?

A 
Abduction: Deltoid
Adduction: Pec Major and Lat Dorsi
Flexion: Pec Major and Deltoid
Extension: Deltoid
Lateral rotation: Infraspinatus
Medial rotation: Subscapularis
92
Q

What are the gateways to the scapular region ?

A

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

93
Q

What passes through the Suprascapular notch ?

A

• Suprascapular and Suprascapular artery

94
Q

What is the quadrangular space delimited by ? What passes through it ?

A

Humerus, long head of triceps, teres minor, teres major

  • Axillary nerve
  • Posterior circumflex humeral artery
95
Q

What is the upper triangular space delimited by ? What passes through it ?

A

Long head of triceps, teres minor, teres major

• Circumflex scapular artery

96
Q

What is the lower triangular space delimited by ? What passes through it ?

A

Long head of triceps, teres major, humerus

• Radial nerve and profunda brachii artery

97
Q

What are the flexors of the hip ?

A

Iliacus and Psoas major (together = Iliopsoas)

Sartorius and Rectus Femoris (flex hip but also act on knee joint)

98
Q

Where do muscles flexing the hip pass, relative to the pelvis, femur and hip joint ?

A

They pass from the pelvis to the femur, anterior to the hip joint

99
Q

What space do Iliacus and psoas major pass through to get into the femoral region ?

A

Retro-inguinal space

100
Q

What two compartments does the fascia of psoas major create in the femoral region ?

A

Muscular and vascular compartments

101
Q

Which structures are found in the muscular compartment formed by the fascia of psoas major ?

A

Femoral nerve and iliopsoas (Iliacus + psoas major)

102
Q

What is the origin and insertion of the iliacus ?

A

ORIGIN-
Posterior abdominal wall (iliac fossa)
INSERTION-
Lesser trochanter of femur

103
Q

What is the origin and insertion of the psoas major ?

A

ORIGIN-
Posterior abdominal wall (lumbar transverse processes, intervertebral discs, and adjacent bodies from TXII to LV and tendinous arches between these points)
INSERTION-
Lesser trochanter of femur

104
Q

What is the origin and insertion of the Rectus Femoris (straight and reflected heads) ?

A

ORIGIN-
Anterior superior iliac spine, ilium just superior to the acetabulum
INSERTION-
Base of patella via common Quadriceps femoris tendon

105
Q

What is the origin and insertion of the Sartorius ?

A

ORIGIN-
Anterior superior iliac spine
INSERTION-
Medial surface of medial tibial condyle (pes anserinus)

106
Q

What is the origin and insertion of the Pectineus ?

A

ORIGIN-
Superior ramus of pubis
INSERTION-
Pectineal line of femur

107
Q

What are all the flexors of the hip ?

A

Iliacus, psoas major, sartorius, pectineus, rectus femoris, Tensor fascia latae

108
Q

What are the flexors of the hip innervated by ?

A

􏰀-Iliacus, psoas major, sartorius, pectineus, rectus femoris, Tensor fascia latae - by the femoral nerve
-Psoas major (L1-L3)

109
Q

What are the adductors of the hip ?

A

Pectineus
Adductor magnus, longus, and brevis
Gracilis
Obturator externus

110
Q

What is the origin and insertion of the Adductor Longus ?

A

ORIGIN-
Body of pubis inferior to pubic crest
INSERTION-
Middle third of linea aspera of femur

111
Q

What is the origin and insertion of the Adductor Brevis ?

A

ORIGIN-
Body and inferior ramus of pubis
INSERTION-
Proximal part of linea aspera of femur

112
Q

What is the origin and insertion of the Adductor Magnus ?

A

ORIGIN-
Adductor part: inferior ramus of pubis, ramus of ischium
Hamstring part: ischial tuberosity
INSERTION-
Linea aspera, medial supracondylar line, adductor tubercle of femur

113
Q

What is the origin and insertion of Gracilis ?

A

ORIGIN-
Body and inferior ramus of pubis
INSERTION-
Medial surface of medial tibial condyle (pes anserinus)

114
Q

What is the origin and insertion of Obturator externus ?

A

ORIGIN-
Margins of obturator foramen and external surface of obturator membrane
INSERTION-
Trochanteric fossa of femur

115
Q

What are the adductors of the hip innervated by ?

A 
Pectineus- Femoral nerve 
Adductor magnus- Tibial and obturator nerve 
Adductor longus- Obturator nerve  
Adductor brevis- Obturator nerve  
Gracilis- Obturator nerve  
Obturator externus- Obturator nerve
116
Q

Where do muscles extending the hip pass, relative to the pelvis, femur and hip joint ?

A

Muscles that pass from the pelvis to the lower limb, posterior to the hip joint

117
Q

Where are the hamstring muscles found, relative to surrounding structures ?

A

Between the ischial tuberosity and the tibia and fibula

118
Q

What muscles are included amongst hamstring muscles ?

A

Biceps femoris, semitendinous and semimembraneous

119
Q

What are all the movements the hamstring muscles are responsible for ?

A

Extend the hip
Flex the leg
Extend the body if the thigh is fixed

120
Q

What are the extensors of the hip ?

A 
Guteus Maximus (prime mover) 
Hamstring muscles (biceps femoris, semitendinous and semimembraneous) 
Adductor magnus
121
Q

What are all the movements allowed by the gluteus maximus ?

A

Extension of the hip when standing from sitting and climbing stairs
Externally rotates the femur
Abducts the femur
Locks the knee

122
Q

Which structure is particularly important in locking the knee (besides gluteus maximus) ?

A

Iliotibial tract

123
Q

What is the origin and insertion of the biceps femoris ?

A

ORIGIN:
Ischial tuberosity and lateral lip of linea aspera
INSERTION:
Head of fibula

124
Q

What is the origin and insertion of the semitendinous muscle ?

A

ORIGIN:
Ischial tuberosity
INSERTION:
Medial surface of medial tibial condyle (pes anserinus)

125
Q

What is the origin and insertion of the semimembraneous muscle ?

A

ORIGIN:
Ischial tuberosity
INSERTION:
Medial condyle of tibia; reflected attachment forms oblique popliteal ligament

126
Q

What is the origin and insertion of the gluteus maximus ?

A

ORIGIN:
Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; and sacrotuberous ligament
INSERTION:
Iliotibial tract and gluteal tuberosity

127
Q

How are the extensors of the hip innervated ?

A

Guteus Maximus - Inferior gluteal nerve

Biceps femoris- Sciatic Nerve
Semitendinous- Sciatic Nerve
Semimembraneous- Sciatic Nerve
Adductor magnus- Sciatic Nerve

128
Q

Which of the hamstring muscles act on both knee and hip joints ? How come ?

A

Semitendinous, semimembranous and long head of biceps femoris
NOT short head of biceps femoris

Because all hamstrings except the short head of the biceps femoris originate from the ischial tuberosity

129
Q

Where do muscles abducting the hip pass, relative to the pelvis, femur and hip joint ?

A

Pass from the pelvis to the femur, lying lateral to the hip joint

130
Q

What are the muscles which are responsible for abduction of the hip joint ?

A

Gluteus medius
Gluteus minimus
Tensor fascia latae

131
Q

What do the fascia lata and gluteus maximus attach to, to aid gluteus medius and gluteus minimus in abducting the hip ?

A

Iliotibial tract

132
Q

Muscles performing which two movements at the hip keep the pelvis level when walking or standing on one level ?

A

Abduction and adduction (􏰀 All abductors of one side keep pelvis level when limb of the same side is weight bearing)

133
Q

What is the origin and insertion of the gluteus medius ?

A

ORIGIN-
External surface of ilium between anterior and posterior gluteal lines
INSERTION-
Greater trochanter of femur

134
Q

What is the origin and insertion of the gluteus minimus ?

A

ORIGIN-
External surface of ilium between anterior and inferior gluteal lines
INSERTION-
Greater trochanter of femur

135
Q

What is the origin and insertion of the Tensor fascia latae ?

A

ORIGIN-
Anterior superior iliac spine; anterior part of iliac crest
INSERTION-
Lateral condyle of tibia via Iliotibial tract

136
Q

What are the abductor muscles innervated by ?

A

Superior gluteal nerve

137
Q

Where do muscles laterally rotating the hip pass, relative to the pelvis, femur and hip joint ?

A

Pass from the pelvis to the femur, lying close to and posterior to the hip joint

138
Q

What are the lateral rotators of the hip ?

A 
Inferior gemellus
Obturator internus
Obturator externus
Piriformis
Quadratus femoris 
Superior gemellus
139
Q

What are the muscles responsible for lateral rotation innervated by ?

A

Obturator internus and superior gemellus - Obturator internus nerve

Inferior gemellus and quadratus femoris - Nerve to quadratus femoris

Piriformis - Anterior branches of S1-S2

140
Q

Which movement allows the foot to keep pointing forward during walking ?

A

Lateral rotation of the femur

141
Q

What are the bounds of the femoral triangle ?

A

Inguinal ligament (base), the sartorius muscle laterally (apex), and the adductor longus muscle medially

Floor: pectineus (medially) and the iliopsoas (laterally)

Roof: fascia lata (deep fascia of the thigh), subcutaneous tissue and skin

142
Q

Which neurovascular structures does the femoral sheath contain ?

A

Femoral artery and vein BUT NOT the nerve.

143
Q

Where is the adductor canal present within the femoral triangle ?

A

At the apex of the triangle

144
Q

What are other names for the adductor canal in the hip ?

A

Subsartorial canal, Hunter’s Canal

145
Q

Which neurovascular structures does the adductor canal of the hip contain ?

A

From medial to lateral, deep inguinal lymph nodes (in femoral canal), femoral vein, femoral artery and femoral nerve.

146
Q

Where is the femoral canal found ?

A

Between the medial wall of the femoral sheath and the femoral vein

147
Q

What is the shape of the femoral canal ?

148
Q

What does the femoral canal contain ?

A

Deep inguinal lymph nodes

149
Q

What is a major role of the femoral canal, besides containing deep inguinal lymph nodes ?

A

􏰀Allows the femoral vein to expand

150
Q

What is the base of the femoral canal (opening) called ?

A

Femoral ring

151
Q

What is a possible consequence of the weak nature of the femoral ring ?

A

Femoral Hernia

MD2002 (108 decks)

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