Gluteal Region Flashcards
3 bones of the hip bone and their site of fusion
ilium
ischium
pubis
acetabulum is where they fuse, fusion of former triradiate cartilage
lunar surface of hip bone
articular surface for femur head
dx of congenital hip dysplasia, which lines on xray
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
hip joint contents
head of femur in acetabulum of hip bone
articular capsule surrounding, one of the strongest, lined by synovial membrane internally and bursa anteriorly
hip joint ligaments
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
acetabular labrum
deepens hip joint, protects rim of acetabulum
stretches across inferior aspect of lunate surface, forms transverse acetabular ligament
transverse acetabular ligament attachment to femur
ligament of the head- attaches to femoral head at the fovea
contains artery of the head to vascularize the femoral head
4 arteries vascularizing head of the femur
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
“hip fracture”
truly a femoral neck fractur or inter trochanteric fractures
femoral neck fracture complication
often assoc w/ osteoporosis- high incidence of AVN of femoral head after damage to vessels
intertrochanteric fracture
usually in elderly, usually from a fall
dont need replacement as much, lower AVN risk
joints of the pelvic girdle
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
2 strong posterior ligaments of the sacrum/hip
sacrotuberous
sacrospinous
4 openings in pelvis
greater sciatic foramen- above sacrospinous ligament
lesser sciatic- under sacrospinous
obturator
beneath inguinal ligament
5 things exiting greater sciatic foramen
piriformis muscle
sciatic nerve
superior/inferior gluteal nerves/vessels
posterior femoral cutaneous nerve
pudendal nerve and internal pudendal artery
lesser sciatic foramen contents
pudendal nerve and internal pudendal artery go back in the LSF
obturator internus tendon
gluteus maximus
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)
gluteus medius and minimus
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)
trendelenburg gait
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
trendelenburg test
patient stands on each leg, checking strenght of hip abductors
5 lateral rotators of hip joint
obturator internus superior gemellus inferior gemellus quadratus femoris piriformis
piriformis
pear shaped muscle, exits GSF attaches greater trochanter
sacral plexus on anterior surface
nerves to lateral rotators of hip
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
3 hamstrings and innervation
semimembranosis
semitendinosis (these two are medial)
biceps femoris (lateral, most commonly injured)
sciatic nerve (L5, S1,2)
origin insertion and blood supply of hamstrings
arise from ischial tuberosity, insert distal to knee joint
vascularized by perforating arteries from deep femoral artery(anterior artery)
hamstring fn, risk of injury
flexors of knee and extensors of hip
two joints! risk of tearing
popliteus muscle
unlocks the knee when in full extension, initiates flexion of the knee
pulled hamstring
sudden acceleration of muscles, can tear proximal tendinous attachment or avulse small fragment of ischial tuberosity
often have hematomas as big arteries ruptured
sciatic nerves is actually 2 nerves:
tibial nerve
common fibular or peroneal nerve
sciatic exits…
GSF below piriformis
exceptions w/ fibular portion going through or over piriformis
track of sciatic nerve
along posterior thigh innervating hamstrings
divides into tibial and common fibular in the popliteal region
safe zone for gluteal injections (antibiotics)
upper outer placement
want to avoid sciatic nerve and superior gluteal nerve
posterior hip dislocation cause, complicaitons
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
leg presentation of hip fracture vs hip dislocation
both shortened
fractures- externally rotated
dislocation- internally rotated
cutaneous innervation to posterior thigh
posterior femoral cutanous nerve (S1,2,3)
obturator internus muscle
covers lateral wall of pelvis (obturatur foramen)
exits pelvis via LSF, tendon inserts into greater trochanter
gemelli muscles
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
quadratus femoris
short flat quadrangular msucle, inferior to gemelli and obturator internus
attaches posterior ischium and inserts trochanteric crest of femur
contents of GSF above piriformis
superior gluteal nerve, artery, vein
LSF contents
obturator internus muscle/tendon
pudendal nerve and internal pudendal artery (coming from GSF, towards perineum)
GSF contents below piriformis
sciatic nerve
inferior gluteal nerve, artery, vein
pudendal nerve and internal pudendal vessels (exiting only to reenter via LSF)
posterior femoral cutaneous nerve
