Gluteal Region

Question 1

3 bones of the hip bone and their site of fusion

Answer 1

ilium
ischium
pubis

acetabulum is where they fuse, fusion of former triradiate cartilage

Question 2

lunar surface of hip bone

Answer 2

articular surface for femur head

Question 3

dx of congenital hip dysplasia, which lines on xray

Answer 3

tri radiate cartilage is helpful

more common in girls

hilgenriener horizontal line, perkins vertical line creat quadrants- ossification center for femoral head should be found in lower inner quadrant

shentons line denoted by continuous, symmetrical line b/w obturator foramen and medial femur, broken in CHD

Question 4

hip joint contents

Answer 4

head of femur in acetabulum of hip bone

articular capsule surrounding, one of the strongest, lined by synovial membrane internally and bursa anteriorly

Question 5

hip joint ligaments

Answer 5

iliofemoral ligament- strongest, anterior aspect of jioin and prevents hyperextension

pubofemoral ligament- anterior/inferior, prevents hyperabduction

ischiofemoral- strong triangular ligament posteriorly

fibers are spiralled, become tight in extension to help stabilize while standing

Question 6

acetabular labrum

Answer 6

deepens hip joint, protects rim of acetabulum

stretches across inferior aspect of lunate surface, forms transverse acetabular ligament

Question 7

transverse acetabular ligament attachment to femur

Answer 7

ligament of the head- attaches to femoral head at the fovea

contains artery of the head to vascularize the femoral head

Question 8

4 arteries vascularizing head of the femur

Answer 8

medial and latter circumflex arteries (from profundal femoral artery)

retinacular arteries (femoral neck vessels, branches from circumflex arteries)

artery of the head- from obturator artery that courses w/i ligament of the head

medial circumflex is main contributor

Question 9

“hip fracture”

Answer 9

truly a femoral neck fractur or inter trochanteric fractures

Question 10

femoral neck fracture complication

Answer 10

often assoc w/ osteoporosis- high incidence of AVN of femoral head after damage to vessels

Question 11

intertrochanteric fracture

Answer 11

usually in elderly, usually from a fall

dont need replacement as much, lower AVN risk

Question 12

joints of the pelvic girdle

Answer 12

sacroiliac joints- synovial b/w sacrum and hip bones, stabilized by sacroiliac ligaments

pubic symphysis- cartilagenous joint in midline for joining pubic portion of hip bones, has a disc

Question 13

2 strong posterior ligaments of the sacrum/hip

Answer 13

sacrotuberous

sacrospinous

Question 14

4 openings in pelvis

Answer 14

greater sciatic foramen- above sacrospinous ligament

lesser sciatic- under sacrospinous

obturator
beneath inguinal ligament

Question 15

5 things exiting greater sciatic foramen

Answer 15

piriformis muscle

sciatic nerve

superior/inferior gluteal nerves/vessels

posterior femoral cutaneous nerve

pudendal nerve and internal pudendal artery

Question 16

lesser sciatic foramen contents

Answer 16

pudendal nerve and internal pudendal artery go back in the LSF

obturator internus tendon

Question 17

gluteus maximus

Answer 17

arises from sacrum and sacrotuberous ligament, inserts into gluteal tuberosity and IT band after coursing inferolaterally

extend and laterally rotate thigh at hip joint

innervated by inferior gluteal nerve(L5, S1,2)

Question 18

gluteus medius and minimus

Answer 18

abductors of hip (in addition to tensor fascia lata), play essential rol in stabilizing pelvis during ambulation (contralateral leg)

superior gluteal nerve (L4,5 S1)

Question 19

trendelenburg gait

Answer 19

secondary to weakness of gluteal minimus/medius or damage to superior gluteal nerve

compensatory gait, bring body weight over pathological side to have room to bring leg thru

Question 20

trendelenburg test

Answer 20

patient stands on each leg, checking strenght of hip abductors

Question 21

5 lateral rotators of hip joint

Answer 21

obturator internus
superior gemellus
inferior gemellus
quadratus femoris
piriformis

Question 22

piriformis

Answer 22

pear shaped muscle, exits GSF attaches greater trochanter

sacral plexus on anterior surface

Question 23

nerves to lateral rotators of hip

Answer 23

nerve to piriformis- piriformis alone

nerve to obturator internus- both that muscle and superior gemellus

nerve to quadratus femoris- both that muscle and gemellus inferior

Question 24

3 hamstrings and innervation

Answer 24

semimembranosis
semitendinosis (these two are medial)
biceps femoris (lateral, most commonly injured)

sciatic nerve (L5, S1,2)

Question 25

origin insertion and blood supply of hamstrings

Answer 25

arise from ischial tuberosity, insert distal to knee joint vascularized by perforating arteries from deep femoral artery(anterior artery)

Question 26

hamstring fn, risk of injury

Answer 26

flexors of knee and extensors of hip two joints! risk of tearing

Question 27

popliteus muscle

Answer 27

unlocks the knee when in full extension, initiates flexion of the knee

Question 28

pulled hamstring

Answer 28

sudden acceleration of muscles, can tear proximal tendinous attachment or avulse small fragment of ischial tuberosity often have hematomas as big arteries ruptured

Question 29

sciatic nerves is actually 2 nerves:

Answer 29

tibial nerve common fibular or peroneal nerve

Question 30

sciatic exits...

Answer 30

GSF below piriformis exceptions w/ fibular portion going through or over piriformis

Question 31

track of sciatic nerve

Answer 31

along posterior thigh innervating hamstrings divides into tibial and common fibular in the popliteal region

Question 32

safe zone for gluteal injections (antibiotics)

Answer 32

upper outer placement want to avoid sciatic nerve and superior gluteal nerve

Question 33

posterior hip dislocation cause, complicaitons

Answer 33

usually from car accidents w/ high degree of force posteriorly can damage sciatic nerve, fracture the posterior aspect of acetabulum medical emergency- high risk of AVN from damaged femoral neck vessels

Question 34

leg presentation of hip fracture vs hip dislocation

Answer 34

both shortened fractures- externally rotated dislocation- internally rotated

Question 35

cutaneous innervation to posterior thigh

Answer 35

posterior femoral cutanous nerve (S1,2,3)

Question 36

obturator internus muscle

Answer 36

covers lateral wall of pelvis (obturatur foramen) exits pelvis via LSF, tendon inserts into greater trochanter

Question 37

gemelli muscles

Answer 37

assist obturator internus small tendons are parallel, fust w/ obturator tendon superior muscle from ischial spine, inferior from posterior ischium, both insert onto greater trochanter

Question 38

quadratus femoris

Answer 38

short flat quadrangular msucle, inferior to gemelli and obturator internus attaches posterior ischium and inserts trochanteric crest of femur

Question 39

contents of GSF above piriformis

Answer 39

superior gluteal nerve, artery, vein

Question 40

LSF contents

Answer 40

obturator internus muscle/tendon pudendal nerve and internal pudendal artery (coming from GSF, towards perineum)

Question 41

GSF contents below piriformis

Answer 41

sciatic nerve inferior gluteal nerve, artery, vein pudendal nerve and internal pudendal vessels (exiting only to reenter via LSF) posterior femoral cutaneous nerve