Gluteal Region and Thigh

Question 1

What is the main function of the lower limb

Answer 1

Main function of lower limb is to bear the weight of the body through the sacroiliac joint and down the legs whilst standing with minimal energy input – achieved by knee and hip locking into place.

Question 2

Which two ligaments help fix the ilium to the sacrum?

Answer 2

Sacrotuberous and sacrospinous ligaments help fix the ilium to the sacrum.

Question 3

Which three bones form the pelvis?

Answer 3

Pelvis made of three bones – ilium, ischium and pubis.

Question 4

Describe the hip joint

Answer 4

The hip joint is ball and socket, head of femur sits 50% encompassed by the acetabulum lunate surface (very stable), all is covered in hyaline cartilage except acetabulum fossa and fovea. Acetabulum labrum (fibrocartilaginous collar deepens the acetabulum further; it also forms into the acetabulum transverse ligament. Ligament of head of femur carries the obturator artery from the acetabulum foramen to the fovea. Synovial membrane covers all including ligament of head of femur.

Question 5

What are the 3 main ligaments supporting the hip joint

Answer 5

3 main ligaments support the joint: Iliofemoral, Pubofemoral and Ischiofemoral.

Question 6

Describe the sacroiliac joint

Answer 6

Sacroiliac joint interlocks to reduce movement and is supported by 3 ligaments: anterior and posterior sacro-iliac ligament and the interosseous sacro-iliac ligament.

Question 7

What are the 4 main gateways to the lower limb and what passes through each?

Answer 7

1. Obturator Canal – all obturator nerves and vessels pass through this hole
2. Greater sciatic foramen – The piriformis muscles separates this foramen into two holes
   • A hole superior to the muscle which carries the superior gluteal nerve and vessels
   • A hole inferior to the muscle which carries the sciatic nerve, inferior gluteal nerve and vessels as well as the posterior cutaneous nerve of the thigh, and nerves to the obturator internus and gemellus superior and nerve to the quadratus femoris and gemellus inferior.
3. Lesser sciatic foramen - this is separated from the greater sciatic foramen by the sacrospinous ligament, the tendon of obturator internus, pudental nerve and internal pudental vessels pass through here
4. Gap between the inguinal ligament and pelvic bone – contains psoas major, iliacus, pectineus as well as the femoral artery, nerve and lymphatics of the lower limb.

Question 8

Describe the main lymph nodes of the lower limb

Answer 8

Lymphatics: superficial and deep inguinal nodes drain most areas, popliteal nodes drain around the knee and the external iliac nodes drain all of these.

Question 9

What is the femoral triangle

Answer 9

Femoral triangle borders: base inguinal ligament, medial border – medial side of adductor longus, lateral border – medial border of Sartorius, floor – pectineus and adductor longus.

Question 10

What passes through the femoral triangle

Answer 10

The triangle continues as a small canal called the adductor canal. Femoral nerve, artery, vein and then lymphatics pass through the triangle in that order from lateral to medial (the final three are all within their own sheath).

Question 11

Describe the types of fracture of the pelvis

Answer 11

Fracture of the pelvis – significant risk of haematoma and soft tissue damage. Type 1 iliac crest, Type 2 singe break in pelvic ring, Type 3 double break in the pubic ring (urethral damage) and Type 4 around the acetabulum.

Question 12

What issues can be associated with fracture of the femoral neck

Answer 12

Risk of necrosis of head of femur.

Question 13

What is Trendelenberg’s sign

Answer 13

Trendelenburg’s sign hip drop due to weak paralysed gluteal muscles (superior gluteal nerve).

Question 14

Where is the safest place to give intramusuclar injections to the gluteal region

Answer 14

Intramuscular injections must be done safely in the upper lateral quadrant.

Question 15

What are varicose veins?

Answer 15

Varicose veins – damaged venous valves put pressure on other valves causing twisted and dilated superficial veins. These can become ulcerated requiring removal.

Question 16

Where does the thigh begin?

Answer 16

Thigh starts after the inguinal ligament and gluteal fold.

Question 17

What type of bone is the patella and how is it held in place?

Answer 17

Patella is sesamoid and forms in quadriceps femoris tendon, held in place by patellar ligament onto tibial tuberosity.

Question 18

What does the common peroneal nerve pass arpund as it passes into the lower leg?

Answer 18

Common peroneal nerve curves around the lateral neck of the fibular.

Question 19

Where does the fibular articulate with the tibia?

Answer 19

Fibular articulates with the inferior border of the lateral tibial condyle.

Question 20

What is the fascia covering the thigh and gluteal region called

Answer 20

Fascia Lata

Question 21

Waht important structue passes through an opening in the fascia lata?

Answer 21

The great saphenous veins passes through the saphenous opening

Question 22

What is the iliotibial tract

Answer 22

The iliotibial tract is continuous with the fascia lata and has roles in stabilising the joint preventing lateral dislocation.

Question 23

Describe some different examples of bursitis that can occur in the gluteal region

Answer 23

Bursitis of the trochanteric bursa can occur if you use Gluteus medius a lot i.e. running. Also the ischiogluteal bursa can become inflamed from sitting down on uncomfortable surfaces for too long.

Question 24

What is the femoral canal and ring and what are its borders?

Answer 24

The femoral canal is an empty space between the femoral vein and femoral lymphatics which a femoral hernia can pass down. The femoral ring is the opening into the femoral canal which has the borders: Lateral = femoral vein, medial = lacunar ligament, posterior = the pectineus muscle and anterior = inguinal ligament.

Question 25

What is hip dysphasia

Answer 25

Hip dysphasia – grows wrong meaning the acetabulum too shallow or head of femoral not at right angle this predisposes to congenital dislocation basically meaning the femoral head develops outside of the acetabulum and presents with Trendelenburg’s sign. Boys > Girls.

Question 26

How does an acquired hip dislocation present?

Answer 26

Acquired Dislocation – trauma causing posterior dislocation due to ischiofemoral ligament being the weakest. The leg will be shorter and medially rotated due to gluteal muscles and there may be sciatic nerve damage.

Question 27

Discuss Femoral midshaft fractures

Answer 27

Mid Shaft fractures of the femur are rare and take a long time to heal. There is a risk of femoral artery damage and the leg may still appear shortened.

Question 28

Describe the differences between intracapsular and extracapsular fracture of the femur.

Answer 28

Intrascapular fracture of the femur – generally occur in the elderly female population and can damage the medial circumflex artery. This will make the leg shorter and it will laterally rotate due to the iliopsoas muscle.

Extracapsular fracture of the femur – is more common in the young and there is little risk of avascular necrosis but the leg is still shortened an laterally rotated.