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Block 4: Anatomy + Physiology > Gluteal region, hip and thigh anatomy > Flashcards

Gluteal region, hip and thigh anatomy Flashcards

1
Q

What are the regions and boundaries of the lower limbs?

A

Gluteal region
Thigh (hip joint to knee joint)
Leg (knee joint to ankle joint)
Foot (distal to ankle joint)

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2
Q

What are the functions of the lower limbs?

A 
Low mobility, high stability 
Support body weight 
Maintain upright posture
Locomotion (gait)
Accomodate shock loading
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3
Q

What are the 4 phases of walking?

A

Phase 1: Heel strike
Phase 2: Support (foot down, other foot lifted)
Phase 3: Toe off (big toe last)
Phase 4: Swing/ carry through

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4
Q

What bones form the pelvic girdle?

A 
Sacral spine (axial skeleton) 
2 x hip bones
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5
Q

What are the functions of the pelvic girdle?

A

Distributes weight of the axial skeleton to lower limbs

Enables locomotion and standing

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6
Q

What makes up the hip joint?

A 
Acetabulum (socket - part of hip bone) 
Femoral head (ball)

[Synovial joint]

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7
Q

What type of joints are the knee and ankle?

A

Hinge joints

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8
Q

How would a patient with a posterior pelvic dislocation present?

A

Limb shortened
Hip flexed
Leg adducted/ internally rotated

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9
Q

How would a patient with an anterior pelvic dislocation present?

A

Limb abducted/ externally rotated

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10
Q

What type of pelvic dislocation is more common?

A

Posterior dislocation

Ligaments surrounding hip joints loosest when sitting down making posterior dislocations more common

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11
Q

What might happen if you injure the sacroiliac joints?

A

Pain radiating into lower back, glutes and perineal region

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12
Q

What type of joint is the pubic symphysis?

A

Secondary cartilaginous type joint

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13
Q

Where is the sacrospinous ligament found?

A

Sacrum to ischial spine

Forms lower border of the greater sciatic foramen

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14
Q

Where is the sacrotuberous ligament found?

A

Sacrum to ischial tubercle

Forms medial border of both the greater and lesser sciatic foramen

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15
Q

What are the greater and lesser sciatic foramen?

A

Route for nerves, vessels and tendons

Found in the pelvic girdle

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16
Q

What are the hip bones comprised of?

A

3 bones: Ilium, Ischium and Pubis

Fuse as you age - fully fused normally by young adulthood

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17
Q

Which parts of the hip bone are palpable?

A 
Iliac crest
Posterior superior iliac spine 
Anterior superior iliac spine 
Ischial spine 
Ischial tuberosity 
Pubic tubercle
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18
Q

What can be used to orient hip bone?

A

Anterior - pubic tubercle

Lateral - acetabulum

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19
Q

What is the acetabulum?

A

Point of union of the ilium, ischium and pubis

Forms the hip socket

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20
Q

What part of the femoral bone is prone to break (particularly in the elderly)?

A

Neck of femur

Area of weakness/ stress (due to angulation of joint)

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21
Q

What is the greater trochanter?

A

Point on anterior femur to which the gluteus medius and gluteus minimus attach - stabilise the pelvis on the lower limb when walking

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22
Q

What is the lesser trochanter?

A

Point on posterior femur to which the iliopsoas attach - powerful hip flexor

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23
Q

What is the linea aspera?

A

Line running down posterior aspect of femur which is an attachment point for powerful thigh muscles and the 3 intermuscular septa (compartmental fascia)

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24
Q

What are the condyles?

A

Point at posterior/ inferior aspect of femur

J-shaped articular region for the knee

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25
Q

What is the acetabular labrum?

A

Horseshoe shaped fibrocartilage rim of tissue that surrounds the acetabulum
Stabilises hip joint

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26
Q

What can go wrong with the acetabular labrum?

A

Can get impinged within the hip joint causing pain on movement - common in gymnasts

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27
Q

What membranes surround the hip joint?

A

Synovial membrane - attaches to the margins of the articular surfaces of the femur and the acetabulum and forms a tubular covering which lines the inside of the fibrous membrane
Fibrous membrane - more superficial

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28
Q

What ligaments surround the membranes of the hip joint?

A

Iliofemoral (iliac bone to femur)
Pubofemoral (pubic bone to femur)
Ischiofemoral (ischium to femur)

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29
Q

How do the ligaments differ when standing compared to sitting down?

A

Ligaments wind around the hip joint - tightest when standing to provide stability
Ligaments ‘untwist’ / relax when sitting down

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30
Q

What is the blood supply to the femoral head?

A

Circumflex femoral arteries (branch from femoral artery and deep femoral artery)
Artery of ligament of head of femur (tiny artery that only supplies region of joint articular surface - DOES NOT COMPENSATE FOR LOSS OF CIRCUMFLEX)

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31
Q

What type of fracture can cause necrosis of the femoral head?

A

Intra-capsular fracture can cause avascular necrosis as circumflex artery is cut off

32
Q

How can gender be identified on pelvic X-ray?

A

Women have softer angles between sacrum and ilium around pelvic inlet
Wider base in females (men have more vertical iliums)
Genitalia (soft tissue shadows will show penis and scrotum in males)

33
Q

What in Shenton’s line?

A

Imaginary curved line between inferior body of neck of femur and inferior body of pubic ramus.
Used to identify subtle fractures if line is displaced

34
Q

What is a valga deformity of joints?

A

Increased angle of joint

Distal part of limb directed away from midline

35
Q

What is a vara deformity of joints?

A

Decreased angle of joint

Distal part of limb directed towards midline

36
Q

What are the compartments of the thigh?

A

Anterior, medial, posterior

37
Q

What is the iliotibial tract?

A

Lateral thickening of the fascia lata (fascia surrounding compartments of thigh)
Acts as a muscle attachment point (e.g. for much of gluteus maximus)
Assists in knee extension and stability

38
Q

How would iliotibial tract inflammation present?

A

Lateral knee pain

39
Q

Which veins run superficial to the fascia lata?

A

Saphenous veins

40
Q

Which nerve innervates the anterior compartment of the thigh?

A

Femoral (L2-L4)

41
Q

Which nerve innervates the medial compartment of the thigh?

A

Obturator (L2-L4)

42
Q

Which nerve innervates the posterior compartment of the thigh?

A

Sciatic (L4-S3)

43
Q

Which artery supplies the anterior compartment of the thigh?

A

Femoral artery

44
Q

Which artery supplies the middle compartment of the thigh?

A

Obturator artery

45
Q

Which artery supplies the posterior compartment of the thigh?

A

Branches of the deep femoral artery (profunda femoris)

46
Q

What are the functions of the muscles in the anterior compartment of the thigh?

A

Hip flexor

Knee extension

47
Q

What are the functions of the muscles in the medial compartment of the thigh?

A

Hip adductors

48
Q

What are the functions of the muscles in the posterior compartment of the thigh?

A

Hip extension

Knee flexion

49
Q

What are the functions of the gluteal muscles?

A

Hip/ trunk extension

Pelvic stabilisation

50
Q

What nerves supply the gluteal muscles?

A

Gluteus maximus = inferior gluteal nerve (L5-S2)

Gluteus medius and gluteus minimus = superior gluteal nerve (L4-S1)

51
Q

What are the attachment points of the gluteus maximus?

A 
Proximal = ilium, sacrum and sacral ligaments 
Distal = femur, iliotibial tract
52
Q

How do the gluteus medius and gluteus minimus function?

A

Contract on the contralateral side to the leg that is off the ground when walking - this prevents the pelvis from tilting towards the unsupported side

53
Q

What is the Trendelenburg sign?

A

Caused by deinnervation to the gluteus medius and the gluteus minimus
Hip drop and lurch when walking

54
Q

What does deinnervation to the gluteus maximus cause?

A

Patient will lurch backwards when the weaker limb (side of lesion) is on the floor.
Difficulty standing up from seated position

55
Q

What makes up the sacral plexus?

A 
Lumbosacral trunk (L4, L5) 
Superior gluteal nerve (L4-S1) 
Inferior gluteal nerve (L5-S2) 
Sciatic nerve (L4-S3) 
Pudendal nerve (S2-S4)
56
Q

What is the function of the lateral rotator muscles?

A

Support and laterally rotate the hip

57
Q

What nerves innervate the lateral rotator muscles?

A

L4-S2

58
Q

What muscles make up the lateral rotator group?

A

Piriformis
Gemelli (superior and inferior)
Quadratus femoris
Obturator internus

59
Q

Where are the safe zones to give intermuscular injections in the gluteal region?

A

Method 1: mark a vertical line through highest point of iliac crest and a horizontal line midway between ischial tuberosity and the highest point of the iliac crest - inject laterally to iliac bone

Method 2: mark a vertical line through highest point of iliac crest and a diagonal line from the PSIS to the greater trochanter - inject laterally to iliac bone

60
Q

What muscles make up the powerful hip flexors?

A 
Psoas major (attaches to lumbar vertebrae and the lesser trochanter via the iliopsoas tendon) 
Iliacus (runs along the inside of the iliac bone and attaches to the lesser trochanter via the iliopsoas tendon)
61
Q

How can inflammation of the iliopsoas tendon present?

A

Groin pain

62
Q

How can a psoas abscess present?

A

Femoral triangle swelling (mimicking femoral hernia) due to tracking down fibrous sheath covering the psoas major

63
Q

What muscles make up the adductor muscle group of the hips?

A

Pectineus
Adductor longus
Adductor magnus
Adductor brevis

64
Q

What nerve innervates the adductor muscle group of the hips?

A

Obturator nerve (L2-L4)

65
Q

At what point does the femoral artery become the popliteal artery?

A

Passes through the adductor hiatus and continues behind the knee as the popliteal artery

66
Q

What muscles make up the anterior compartment of the thigh?

A

Sartorius
Tensor fascia lata
Rectus femoris (attaches to the hip bone)
Vastus intermedius (lies under the rectus femoris)
Vastus lateralis
Vastus medialis

67
Q

What is the function of the anterior compartment of the thigh?

A

Hip flexion

Knee extension

68
Q

What is the nerve supply to the anterior compartment of the thigh?

A

Femoral nerve (L2-L4) - all muscles execpt the tensor fascia lata which is innervated by the superior gluteal nerve (L4-S1)

69
Q

What would loss of function to the anterior compartment of the thigh result in?

A

Weak or absent knee extension

Difficulty standing out of chair

70
Q

What would muscle or tendon rupture result in?

A

Pain

Palpable sulcus

71
Q

What is the function of the posterior compartment of the thigh?

A

Hamstring muscle group - hip extension and knee flexion

72
Q

What nerve innervates the posterior compartment of the thigh?

A

Tibial part of the sciatic nerve (L5-S2) - all muscles except the biceps short head which is innervated by the common fibular nerve supply (L5-S1)

73
Q

What muscles make up the posterior compartment of the thigh?

A

Semimembranosus
Semitendinosus
Biceps femoris (which has a long head and a short head)

74
Q

Where do the muscles of the posterior compartment of the thigh attach to?

A

Ischial tuberosity at superior end and tibia and fibula at inferior end

75
Q

How would rupture of the hamstrings present?

A

Pain

Bruising

76
Q

What is the Pens Anserinus?

A

“Goose foot” tendon referring to the conjoined tendons of the Sartorius, Gracilis and Semitendinosus at the proximal tibia

Block 4: Anatomy + Physiology (12 decks)

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