Gluteal Region & Hip Flashcards
What is the pelvic girdle?
a bony ring formed by the left and right innominate bones and the sacrum
What are the articulations of the innominate bones?
each innominate bone articulates with the sacrum posteriorly at the sacroiliac joint
the innominate bones articulate with each other anteriorly at the pubic symphysis
What does the innominate bone develop as in the embryo?
What happens after development?
- ilium
- ischium
- pubic bone
The area which the innominate bones fuse together is the acetabulum
What are the 2 major functions of the pelvis?
- locomotion
- supporting the body weight
Label the features of the pelvis
Label the features of pelvis from a lateral view
Label the features of the medial aspect of the pelvis
what is the pubic symphysis?
what is the articular surface covered by?
a secondary cartilagenous joint between the 2 pubic bones
the articular surfaces of the pubic bones are covered by a layer of hyaline cartilage
they are connected by a fibrocartilagenous disc
What happens to the pelvis during the later stages of pregnancy and why?
the hormone relaxin helps to soften and relax the ligaments to make the pelvis more elastic
this allows the pelvic bones to stretch and open more easily for birth
What types of pelvic fractures are common in elderly people?
How are they managed?
fractures of the pubic rami are common after falls
they are managed conservatively
What causes major pelvic fractures?
Why can they be fatal?
considerable traumatic force e.g. falling from a height or road traffic accidents
the pelvic bones are in close proximity to major blood vessels so fracture can cause extensive bleeding
What are the ligaments between the sacrum and innominate bone?
Why are they important?
sacrotuberous and sacrospinous ligaments
they provide stability
they transform the greater and lesser sciatic notches of the ischium into the greater and lesser sciatic foramen
Label the ligaments and features of the pelvis
sacrotuberous attaches to the ischial tuberosity
What are the 2 articulations of the femur?
it articulates proximally with the acetabulum to form the hip joint
it artculates distally with the tibia to form the knee joint
label the features of the proximal femur
label the features of the femur
What type of joint is the hip joint?
What is it formed by?
it is a “ball and socket” synovial joint
it is formed by the articulation between the acetabulum of the innominate bone and the head of the femur
What are the movements possible at the hip joint?
- flexion
- extension
- adduction
- abduction
- lateral rotation
- medial rotation
label the components of the hip joint
What is the pain like in osteoarthritis of the hip?
there is pain in the hip that is exacerbated with activity and eased with rest
What are the three ligaments of the hip joint?
What is their function?
they surround the joint capsule and stabilise the hip joint
- iliofemoral
- pubofemoral
- ischiofemoral
label the ligaments of the hip joint
What is the fascia lata and the iliotibial tract?
the fascia lata is the deep fascia of the thigh
it is thickened laterally into a longitudinal band - the iliotibial tract
How does the superior aspect of the fascia lata split?
the superior aspect of the fascia lata in the gluteal region splits anteriorly to enclose the tensor fasciae latae muscle and posteriorly to enclose the gluteus maximus muscle
How do the tensor fasciae latae and gluteus maximus muscles work together?
they work through their attachments to the iliotibial tract to hold the leg in extension once other muscles have extended the leg at the knee joint
How do the iliotibial tract and its associated muscles stabilise the hip joint?
they prevent lateral displacement of the proximal end of the femur away from the acetabulum
What are the 3 superficial muscles of the hip?
What is their main function?
- gluteus maximus
- gluteus medius
- gluteus minimus
they mainly abduct and extend the hip
label the superficial muscles of the hip
What is the origin and insertion of gluteus maximus?
origin:
ilium - posterior to the posterior gluteal line
insertion:
greater trochanter of femur
innervation:
inferior gluteal nerve (L5, S1, S2)
What are the actions of gluteus maximus?
- extends flexed femur at hip joint
- lateral stabiliser of hip joint and knee joint
- laterally rotates and abducts the thigh
What is the origin and insertion of gluteus medius?
What is its innervation?
origin:
external surface of ilium between anterior and posterior glutea; lines
insertion:
greater trochanter of femur
innervation:
superior gluteal nerve (L4, L5 and S1)
What is the insertion and origin of gluteus minimus?
What is its innervation?
origin:
external surface of ilium between inferior and anterior gluteal lines
insertion:
greater trochanter of femur
innervation:
superior gluteal nerve (L4, L4, S1)
What are the functions of gluteus minimus and gluteus maximus?
- abduction of the femur at the hip joint
- medial rotation of the thigh
What is the role of the gluteus minimus and gluteus medius during walking?
they hold the pelvis secure over stance leg to prevent pelvic drop on the opposite swing side when walking
when standing on one leg, the muscles on that side coontract
this prevents the pelvis from tilting over to the other side
What are the 2 arteries that enter the gluteal region from the pelvic cavity via the greater sciatic foramen?
- superior gluteal artery
- inferior gluteal artery
Where do the gluteal arteries originate from?
inferior gluteal artery:
- originates from anterior trunk of internal iliac artery
superior gluteal artery:
- originates from posterior trunk of internal iliac artery
- divides into superficial and deep branches in the gluteal region
What 4 structures does the superior gluteal artery supply blood to?
- all 3 gluteal muscles
- tensor fasciae latae
- piriformis
- the hip joint
label the vessels
Which structures does the inferior gluteal artery supply blood to?
- gluteus maximus
- piriformis
- internal obturatorius
- gemellus superior and inferior
- quadratus femoris
What is the passage of the superior and inferior gluteal veins like?
they follow the superior and inferior gluteal arteries into the pelvis
they join the pelvic plexus of veins
peripherally the veins anastomose with superficial gluteal veins, which drain anteriorly into the femoral vein
What are the 5 deep muscles of the gluteal region?
What is their main function?
- piriformis
- obturator internus
- quadratus femoris
- superior gemellus
- inferior gemellus
they are mainly involved in lateral rotation of the femur at the hip joint
label the gluteal muscles
What is the origin and insertion of piriformis?
What is its innervation?
origin:
anterior surface of sacrum between anterior sacral foramina
insertion:
greater trochanter of femur
innervation:
nerve to the piriformis
this originates as branches from S2 and S1 of the sacral plexus
What are the actions of piriformis?
- laterally rotates extended femur at the hip joint
- abducts flexed femur at the hip joint
Where does the sciatic nerve emerge from?
What are its nerve roots?
it emerges from the greater sciatic foramen inferior to the lower border of piriformis
it is formed from spinal nerves L4 - S3
Which 3 structures arise superior to piriformis?
- superior gluteal nerve
- superior gluteal artery
- superior gluteal vein
Which 4 structures emerge inferior to the piriformis?
- inferior gluteal nerve
- inferior gluteal artery
- inferior gluteal vein
- sciatic nerve
label the deep gluteal muscles
What is the origin and insertion of quadratus femoris?
origin:
lateral aspect of ischium just anterior to ischial tuberosity
insertion:
quadrate tubercle on proximal femur
What is the origin and insertion of obturator internus?
origin:
deep surface of obturator membrane and surrounding bone on the anterolateral wall of pelvis
insertion:
greater trochanter of femur
What are the origins and insertions of the gemelli?
origin:
- superior - ischial spine
- inferior - ischial tuberosity
insertion:
greater trochanter of femur
What are the common actions of quadratus femoris, obturator internus and the gemelli?
- lateral rotation of the extended femur at the hip joint
- abduction of the flexed femur at the hip joint
Label the blood supply to the hip
What actually is a ‘hip fracture’?
it is actually a fracture of the femoral neck
How does the leg appear in a hip fracture?
the leg appears in external rotation and abduction, with shortening
How do hip fractures differ in young and old people?
they can occur with very low energy trauma in elderly people with osteoporosis
they are uncommon in young people and are associated with high energy trauma
