Lower limb 1: Gluteal region, hip and thigh

Question 1

What are the 4 phases of walking?

Answer 1

Heel strike
Support
Toe-off
Swing / carry through

Question 2

The ball and socket joint of the hip is made up of which structures?

Answer 2

Femoral head - ball

Acetabulum - socket

Question 3

What position is the limb in with a posterior hip dislocation?

Answer 3

Limb shortened, adducted, and internally rotated

Question 4

What position is the limb in with an anterior hip dislocation?

Answer 4

Limb abducted and externally rotated

Question 5

Is anterior or posterior hip dislocation more common?

Answer 5

Posterior

Question 6

Which nerve is most at risk of injury with a posterior hip dislocation?

Answer 6

Sciatic nerve

Question 7

Which nerve is most at risk of injury with an anterior hip dislocation?

Answer 7

Femoral nerve

Question 8

Which joints transmit axial body weight to the hip bones?

Answer 8

Sacroiliac joints

Question 9

Sacroiliac joints are classed as secondary cartilaginous joints - what does this mean?

Answer 9

They are synovial joints, but share characteristics with cartilaginous joints - presence of hyaline cartilage on the sacral side and fibrocartilage on the iliac side of the joint

Question 10

Which 3 bones comprise each hip bone?

Answer 10

Ilium
Ischium
Pubis

Question 11

Which 2 ligaments form the greater and lesser sciatic foramen?

Answer 11

Sacrospinous ligament
Sacrotuberous ligament

Question 12

What are the attachment points of the sacrospinous ligament?

Answer 12

Sacrum and ischial spine

Question 13

What are the attachment points of the sacrotuberous ligament?

Answer 13

Sacrum and ischial tuberosity

Question 14

Which part of the femur usually breaks when older or osteoporotic patients fall?

Answer 14

Neck

Question 15

Which ridge runs down the posterior side of the femur and is the attachment point of the 3 intermuscular septa?

Answer 15

Linea aspera

Question 16

What does Wolff’s Law state?

Answer 16

Bone is deposited and reabsorbed in accordance with the stresses placed upon it (it is able to remodel)

Question 17

Is the sacrospinous ligament or sacrotuberous ligament more superficial?

Answer 17

Sacrotuberous

Question 18

Which fibrocartilaginous ring supports and deepens the hip joint?

Answer 18

Acetabular labrum

Question 19

What are the 2 membrane layers of the hip joint capsule? Which one is more superficial?

Answer 19

Synovial membrane, which lines the inside of the fibrous membrane

Question 20

Which 3 ligaments stabilise the hip joint?

Answer 20

Iliofemoral
Pubofemoral
Ischiofemoral

Question 21

Describe the directionality of blood supply / flow to the hip joint.

Answer 21

Blood supply to the hip joint is unidirectional - blood flows from the base of the femoral neck up to the joint capsule

Question 22

Describe the blood supply to the femoral head.

Answer 22

Medial femoral circumflex and lateral femoral circumflex arteries, which are branches of the deep femoral artery.
They give off circumflex arteries that supply the hip joint directly

Question 23

Which specific type of injury can disrupt blood supply to the femoral head?

Answer 23

Intra-capsular femoral neck fractures

Question 24

In what way could an intra-capsular femoral neck fracture affect the femoral head?

Answer 24

Lead to avascular necrosis of the femoral head

Question 25

What is the name of the ligament of the head of the femur?

Answer 25

Ligamentum Teres

Question 26

Describe the position of Shenton's line when drawn on an X-ray.

Answer 26

Drawn along the inferior border of the femoral neck and the superior border of the obturator foramen

Question 27

What are the 2 main types of deformity of the hip joints?

Answer 27

Coxa valga Coxa vara

Question 28

What is the innervation of gluteus maximus?

Answer 28

Inferior gluteal nerve (L5 - S2)

Question 29

What is the innervation of gluteus medius?

Answer 29

Superior gluteal nerve (L4 - S1)

Question 30

What is the innervation of gluteus minimus?

Answer 30

Superior gluteal nerve (L4 - S1)

Question 31

What effect does gluteus maximus have on the trunk when walking?

Answer 31

Prevents trunk from tipping forward

Question 32

Weakness of gluteus maximus will cause which sign when walking? Which limb will be on the floor?

Answer 32

Patient will lurch backwards when walking Lurch back when weak limb is on the floor

Question 33

Describe the action of gluteus medius and minimus on pelvic stabilisation when walking.

Answer 33

When one leg lifts off the ground, gluteus medius and minimus will contract on the opposite side to prevent the pelvis from tilting towards the unsupported leg

Question 34

Damage or paralysis of gluteus medius and minimus can lead to which sign?

Answer 34

Trendelenburg sign

Question 35

What are the 5 lateral rotators of the hip?

Answer 35

Piriformis Superior gemelli Inferior gemelli Quadratus femoris Obturator internus

Question 36

What spinal nerves contribute to the sciatic nerve?

Answer 36

L4 - S3

Question 37

What are the 2 approaches for gluteal intramuscular injections?

Answer 37

Ventrogluteal approach Dorsogluteal approach

Question 38

In the ventrogluteal approach for intramuscular injections, the hand is placed over what, and what does the index finger point to?

Answer 38

Hand placed over the greater trochanter Index finger points to ASIS

Question 39

What are the 2 dorsogluteal approaches to intramuscular injections?

Answer 39

1. Vertical line through highest point of iliac crest. Horizontal line midway between ischial tuberosity and highest point of iliac crest 2. Vertical line through highest point of iliac crest. Line from PSIS to greater trochanter

Question 40

What are the compartments of the thigh?

Answer 40

Anterior Posterior Medial

Question 41

What are the compartments of the leg?

Answer 41

Anterior Posterior Lateral

Question 42

Give the function, innervation, and blood supply of the anterior thigh compartment.

Answer 42

Hip flexor / knee extension Femoral nerve (L2 - L4) Femoral artery

Question 43

Give the function, innervation, and blood supply of the medial thigh compartment.

Answer 43

Hip adductors Obturator nerve (L2 - L4) Obturator artery

Question 44

Give the function, innervation, and blood supply of the posterior thigh compartment.

Answer 44

Hip extension / knee flexion Sciatic nerve (L4 - S3) Branches of deep femoral (profunda femoris)

Question 45

Which deep fascia covers the thigh?

Answer 45

Fascia lata

Question 46

Which deep fascia covers the leg?

Answer 46

Crural fascia

Question 47

The IT band is the aponeurosis of what?

Answer 47

Gluteus maximus and tensor fascia latae

Question 48

The tensor fascia latae is innervated by which nerve?

Answer 48

Superior gluteal nerve (L4 - S1)

Question 49

The iliopsoas muscle group has what function?

Answer 49

Hip flexion

Question 50

The iliopsoas muscle group is made up of which 2 muscles?

Answer 50

Psoas major Iliacus

Question 51

What is the innervation of the iliopsoas?

Answer 51

L1 - L3

Question 52

What is the insertion of the iliopsoas?

Answer 52

Lesser trochanter of femur

Question 53

Which pathology could mimic a femoral hernia?

Answer 53

Psoas abscess

Question 54

What are the 5 main muscles of the anterior thigh compartment?

Answer 54

Rectus femoris Vastus intermedius Vastus lateralis Vastus medialis Sartorius

Question 55

What symptoms would a patient have with loss of function to the quadriceps?

Answer 55

Weak / absent knee extension Difficulty getting out of a chair

Question 56

What are the 5 main muscles of the medial thigh compartment?

Answer 56

Pectineus Adductor longus Gracilis Adductor brevis Adductor magnus

Question 57

Which muscle of the medial thigh compartment is not innervated by the obturator nerve? What is it innervated by?

Answer 57

Pectineus - innervated by femoral nerve

Question 58

What is the dual function of the gracilis muscle?

Answer 58

Adducts hip and flexes knee

Question 59

What does the femoral artery pass through to become the popliteal artery?

Answer 59

Adductor hiatus

Question 60

What are the 3 main muscles of the posterior thigh compartment?

Answer 60

Semitendinosus Semimembranosus Biceps femoris

Question 61

What is the common point of origin for the hamstring muscles?

Answer 61

Ischial tuberosity

Question 62

Which vessels emerge above and below the piriformis?

Answer 62

Above - superior gluteal artery + nerve Below - inferior gluteal artery + nerve

Question 63

From a posterior view, which nerve emerges medial to the sciatic nerve?

Answer 63

Posterior cutaneous nerve of the thigh

Question 64

The acetabulum is part of which bone?

Answer 64

Ilium