gluteal region and posterior thigh Flashcards
longest bone in body
femur
hip bone if formed by fusion of three bones
ilium, ischium, pubis
Lunate surface
is the articular surface where the head of femur articulates
In youngsters- the 3 hip bones are separated by a Y-shaped cartilage
tri radiate cartilage
at what age do the primary bones fuse together in the hip?
20-25
The fusion site is the _____ the large cup-shaped socket that articulates with the head of the femur
acetabulum
the articular surface where the head of femur articulates
Lunate surface
attachment site for the lesser trochanter
iliopsoas muscle
functions mainly to extend and laterally rotate the thigh/hip
gluteus maximus
innervation of gluetus maximus
inferior gluteal nerve L5, S1, S2
innervation of hamstrings
sciatic nerve L5, S1, S2
most commonly injured hamstring muscle
biceps femoris
muscles of hamstring
semitendinosus
semimembranosus
biceps femoris (lateral)
linea aspera
rough prominent ridges (lips) located along the posterior shaft of femur
located posteriorly between the femoral condyles- cruciate ligaments attach here
intercondylar fossa
congenital hip dysplasia/dislocation CHD
the head of the femur is not positioned within the developing acetabulum
prevalence of CHD and demographic
1:1000 births
girls
how can CHD be determined?
utilize the position of the tri-radiate cartilgae and femur to determine angles
quadrants about the developing acetabulum and hip joint
formed by hilgenreiner’s horizontal line and perkins’ vertical line
Acetabular index should be about ____ in a normal hip
30º or less
denoted by a continuous and symmetrical line between the obturator foramen and the medial aspect of the femur
Shenton’s line (S)
x ray findings of congenital hip dislocation
shenton’s line is broken
proximal displacement of femoral neck
acetabular index >30
delayed ossification of the femoral head
hip joint type
ball and socket
ossification center for the developing femoral head should be found within the
lower inner quadrant N
hip joint capsule
strong and dense fibrous capsule that surround the joint
articular capsule is strengthened by 3 intrinsic ligaments
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
(or the Y ligament of Bigelow)- strongest and located on anterior aspect of joint- prevents hyperextension of the joint
iliofemoral ligament
anterior/inferior aspect of the joint capsule (prevents hyperabduction)
Pubofemoral Ligament
(ligament of Bertin) -a strong triangular ligament located posteriorly
ishiofemoral ligament
Fibers of all three hip ligaments are oriented in a ____ fashion around the hip so as to become tight in extension
spiral
This stabilizes the joint and reduces muscular energy when standing
The rim of the acetabulum is surrounded by a strong fibrocartilagenoustissue called the
acetabular labrum
(helps protect and deepen the joint cavity)
The labrum stretches across the inferior aspect of the lunate surface forming the
transverse Acetabular Ligament
attaches to this transverse acetabular ligament and to the femoral head at the fovea
ligament of the head
ligament teres or ligamentum captis femoris
artery of the head
small branch of the obturator artery that courses within the transvere acetabular ligament and helps vascularize the femoral head
artereies that vascularize the head of the femur
medial circumflex artery (major contributor)
lateral circumflex artery
retinacular arteries (aka femoral neck vessels)
artery of the head
major contributor of vascular supply to the head of femur
medial circumflex artery
proximal femoral fractures often referred to as
hip fractures
femoral neck fractures are often associated with
osteoporosis
.. avascular necrosis of the femoral head due to rupture of reintacular arteries
hip fractures common in elderly patients that usually result from a fall
intertrochanteric fractures
strong synovial joints between the sacrum and the hip bones
sacroiliac joints
sacroiliac ligaments
include both dorsal and ventral sacroiliac ligaments which strengthen and help stabilize the sacroiliac joints
a cartilaginous joint in the anterior midline that joins the pubic portions of the hip bones with an intervening fibrocartilaginous disk
pubic symphysis
originates from the sacrum and inserts onto the ischial tuberosity
Sacrotuberous ligament
originates on the sacrum and inserts on the ischial spine
Sacrospinous ligament
pelvic ligaments help prevent
upward tilting of sacrum
foramens of the pelvis
- Greater sciatic foramen
- Lesser sciatic foramen
- Obturator canal
- Beneath the inguinal ligament
- Greater sciatic foramen
- Lesser sciatic foramen
- Obturator canal
- Beneath the inguinal ligament
structures that traverse the greater sciatic foramen GSF
- Piriformis muscle
- Sciatic nerve
- Superior & inferior gluteal nerves & vessels
- Posterior femoral cutaneous nerve
- Pudendal nerve and the Internal pudendal artery exit the GSF
structures that traverse the lesser sciatic foramen
- After exiting the GSF…the Pudendal nerve and the Internal pudendal artery then enter the LSF and travel to the perineum (external genitalia)
- Obturator internus tendon
Large-heavy muscle overlying other gluteal muscles
gluteal maximus
innervation of gluteal maximus
innervated by the inferior gluteal nerve (L5,S1, S2)
mainly used when “raising up” from a sitting position
gluteaus maximus
Fibers course inferolaterally at 45º inserting into the gluteal tuberosity and the iliotibial tract
gluteus maximus
smaller fan shaped muscles deep to the gluteus maximus, arise from the lateral aspect of the ilium and insert onto the greater trochanter
gluteus medius and minimus
abductors of the hip and tensor fascia lata
gluteus medius and minimus
These muscles play essential role during ambulation by stabilizing the opposite side of the pelvis
gluteus medius and minimus
helps us stay parallel to ground when walking
innervation of gluetus minimus and medius
superior gluteal nerve L4, L5, S1
a “compensatory” gait… where an individual shifts their body weight over the weakened side to swing the contralateral limb through the gait cycle
Trendelenburg Gait
mechanism of trendelenburg gait and nerve involved
secondary to weakness of the medius/minimus or damage to the superior gluteal nerve
Trendelenburg test
when a patient is asked to stand on one leg to check the strength of these hip abductors…positive test is when the pelvis sags on the contralateral side which indicates weak hip abductors on the stance leg side
Lateral Rotators of the Hip Joint
- Obturator Internus
- Superior Gemellus
- Inferior Gemellus
- Quadratus Femoris
- Piriformis
all deep to glueteus maximus
sacral plexus lies on the anterior surface of what muscle
piriformis
pear shaped muscle that exits the great sciatic foramen and attaches to the greater trochanter
Piriformis muscle
covers most of the lateral wall of the pelvis
obturator internus muscle
the “twin” muscles assist the obturator internus
Gemelli Muscles
most powerful lateral rotator of the hip
quadratus femoris
piriformis innervation
nerve to piriformis (off sciatic)
Obturator internus & superior gemellus are both innervated by
nerve to obturator internus
Quadratus femoris & gemellus inferior are both innervated by the
“nerve to quadratus femoris”
posterior thigh muscles
The Hamstrings
- Semitendinosus
- Semimembranosus
- Biceps Femoris
most commonly injured of the hamstring muscles
biceps femoris
innervation of hamstrings
sciatic nerve L5, S1, S2
vascular supply of hamstrings
the perforating arteries that arise from the deep (profundus) femoral artery
they are flexors of the knee joint and extensors of the hip joint (thigh)
hamstrings
muscles that cross 2 joints
more prone to injury
a small flexor of the knee joint…helps to “unlock” the knee from an extended position
popliteus
mechanism of pulled hamstring
- Common sports related injury seen in football (i.e. punting), track (sprinters, jumping hurdles), and soccer
- Often a result of inadequate “warming” of the muscles prior to athletic events
- Sudden acceleration of hamstring muscles can tear the proximal tendinous attachments OR avulse a small fragment of the tuberosity
- can be accompanied by hematomas
contains two nerves within a common sheath
tibial nerve and common fibular (peroneal) nerve
larget nerve in body
sciatic nerve L4, L5, S1, S2, S3
gluteal injections
Intramuscularly injection are common sites for antibiotic administration
how to avoid large sciatic and superior gluteal nerve in a gluteal injection
- glueteus is separated into quadrants
- Upper outer injection placement ensures safety and a large muscle mass for the IM (intramuscular) medication
posterior hip dislocations often result from
motor vehicle accidents when the femur is flexed and adducted (sitting)
medical emergency! could result in AVN due to torn/damaged femoral neck vessels
posterior hip dislocations can fracture the posterior acetabulum and cause
sciatic nerve injury (10%)
presentation of posterior hip dislocation
characteristic shortened, adducted, flexed, and internally rotated position of the affected extremity
posterior femoral cutaneous nerve
S1, S2, S3
innervates the gluteus medius, minimus, and tensor fascia latamuscles after exiting the greater sciatic foramen
The superior gluteal nerve (L4, L5 & S1)
major vascular contributor to the femoral head
Medial circumflex artery
Which of the following anatomical structures is located within the femoral canal?
A. Femoral Nerve
B. Femoral Artery
C. Femoral Vein
D. Lymph node(s)
E. Great saphenous Vein
lymph nodes
what nerve is damaged here?
right superior gluteal
The superior gluteal nerve innervates the hip abductors (gluteus medius & minimus). These muscle stabilize the pelvis during single leg stance and during ambulation. When they are weak…or the superiorgluteal nerve is damaged…the contralateral hip sags (tilts) during single leg stance and/or while ambulating
hypertrophy of the piriformis can
compress the accompanying sciatic nerve
