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Block 4 > Gluteal Region, Hip and Thigh Anatomy > Flashcards

Gluteal Region, Hip and Thigh Anatomy Flashcards

1
Q

What are the 4 phases of walking?

A

Heel strike,

Support,

Toe off (collectively stance phase)

Swing/carry through (and back to heel strike = swing phase)

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2
Q

What are the differences in mobility and stability between the upper and lower limbs?

A

Upper limbs: highly mobile, lower stability

Lower limbs: highly stable, lower mobility

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3
Q

What bones make up the pelvic girdle?

A
  • Sacrum
  • Coccyx
  • Ileum (x2)
  • Ischeum (x2)
  • Pubis
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4
Q

What are the visible characteristics of a posterior hip dislocation?

A

Limb is shortened, flexed and adducted, can be internally rotated

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5
Q

What are the visible characteristics of an anterior hip dislocation?

A

Limb is abducted and externally rotated

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6
Q

What is the acetabular labrum and what are its roles?

A

Fibrocartilage ring surrounding the acetabulum. Increases depth and stability of the hip joint

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7
Q

Working from deep to superior, what are the layers of membrane and ligaments covering the hip joint?

A
  • Synovial membrane
  • Fibrous membrane
  • Ileofemoral, pubofemoral, ischeofemoral ligaments
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8
Q

Where does the synovial membrane of the hip joint attach?

A

Margins of the articular surfaces of the femur and acetabulum

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9
Q

What bones make up the bony pelvis?

A

Sacrum and 2 hip bones (composed of ileum, ischeum and pubis)

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10
Q

What are the sacroiliac joints and what is their role? What symptoms can damage to these joints cause?

A

Connect sacrum to hip bones and transmit weight of body to hip bones.

Damage can induce pain in lower back, perineal and gluteal areas.

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11
Q

What forms the borders of the greater and lesser sciatic foramen?

A

Sacrospinous and sacrotuberous ligaments

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12
Q

The acetabulum is the point of union of which bones?

A

Ischeum, ileum and pubis

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13
Q

The greater trochanter is the attachment point for which muscles?

A
  • Gluteus medius and minimus
  • Gemellus superior and inferior
  • Obturator internus
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14
Q

The lesser trochanter of the femur is the attachment point for which muscles?

A

Iliopsoas

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15
Q

The linea aspera of the femur is the attachment point for which muscles?

A

3 intermuscular septa

Thigh muscles

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16
Q

Describe the blood supply to the hip

A

Blood supply to the hip is unidirectional: flows from the base of the femoral neck via the circumflex arteries which surround the femoral neck and pass through retinacular fibres of the joint capsule to the femoral head.

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17
Q

What is the ligamentum teres? What does it contain?

A

Ligament connecting the head of femur to the acetabulum, supporting the hip joint. Contains very small artery which supplies a small region of the articular surface, not big enough to provide blood supply to the femoral head if circumflex arteries are lost.

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18
Q

What is a valgus joint deformity?

A

The distal part of the limb is directed away from the midline as the angle of the joint is greater than usual.

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19
Q

What is a varus joint deformity?

A

The distal part of the limb is directed towards the midline as the angle of the joint is smaller than usual.

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20
Q

What is the nerve and arterial supply of the anterior compartment of the thigh? What are the muscles in this group responsible for?

A

Femoral nerve (L2-L4)

Femoral artery

Hip flexion and knee extension

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21
Q

What is the nerve and arterial supply of the medial compartment of the thigh?

What are the muscles in this group responsible for?

A
  • Obturator nerve (L2-L4)
  • Obturator artery
  • Hip adduction
22
Q

What are the arterial and nerve supply to the posterior compartment of the thigh?

What are the muscles in this group responsible for?

A

Sciatic nerve (L4-S3)–> Tibial nerve (L5 and S1)

Branches of deep femoral artery (profunda femoris)

Hip extension and knee flexion

23
Q

What is the iliotibial tract?

What is its role?

A

Thickening of the fascia lata

Acts as a muscle attachment point

Assists in knee extension and stability

Insertion point for a large portion of the gluteus maximus

24
Q

What are the muscles of the gluteal region?

What are their roles and innervation?

A

Gluteus Maximus:

  • Thigh extension
  • Assists with lateral rotation of the thigh
  • Stabilisation of the pelvis during walking -
  • Innervated by inferior gluteal nerve (L5-S2)

Gluteus Medius and Minimus:

  • Abducts and medially rotates lower limb
  • Contracts during walking to prevent pelvis drop when opposite leg is off the ground.
  • Superior gluteal nerve (L4-S1)

Tensor Fascia Lata:

  • Assists gluteus medius and minimus in abduction and medial rotation as well as pelvis support during walking.
  • Superior gluteal nerve (L4-S1)
25
Q

What are the attachment points of the gluteal muscles?

A

Gluteus Maximus: Ileum, sacrum and sacral ligaments→ femur and IT tract

26
Q

How would a patient present with damage to the gluteus maximus?

A

May lurch backwards when weaker limb is on the floor during walking to maintain balance.

27
Q

How may damage/loss of innervation to the gluteus medius and minimus present?

A

Trendelenberg’s sign: hip drop on the limb that is off the floor during walking (indicates problem with the gluteus medius and minimus on the opposite side to hip drop)

28
Q

Where is the sacral plexus located?

A

Posterior lateral pelvic wall

29
Q

What type of joint is the hip joint?

A

Synovial ball and socket

30
Q

What are the roles of the lower limb?

A
  • Support body weight
  • Maintain upright posture
  • Locomotion (gait)
  • Accommodate shock loading
31
Q

What type of joints are the knee and ankle?

A

Synovial hinge joints

32
Q

Which of the sacrospinous and sacrotuberous ligaments is more superficial?

A

Sacrotuberous

33
Q

What regions do the greater and lesser sciatic foramen connect with?

A

Greater: pelvic cavity and gluteal region

Lesser: Perineal and gluteal regions

34
Q

Which structures of the hip bone are palpable?

A
  • ASIS
  • Pubic tubercle
  • Ischeal spine
  • Ischeal tuberosity
  • Iliac crest
  • PSIS
35
Q

When are the ligaments of the hip tightest?

In what position is the hip most prone to posterior dislocation?

A

Tightest when standing

Loosest when sitting (deep hip flexion) so are most prone to posterior dislocation when sitting.

36
Q

Is the blood supply to the femoral head most at risk in an intracapsular or extracapsular fracture?

What can be caused if the blood supply is disrupted?

A

Intracapsular as this disturbs the blood supply from the circumflex arteries to the femoral head.

  • Risk of avascular necrosis
37
Q

What are the lateral rotator muscles?

What is their role and nerve supply?

A

Lateral rotators support and laterally rotate the hip.

All innervated by L4-S2

Piriformis:

  • Divides greater sciatic foramen into supra and infra piriform parts

Gemelli (superior and inferior)

Obturator Internus (sits between gemelli)

Quadratus femoris

38
Q

Where does the neurovasculature leave the greater sciatic foramen in relation to the piriformis?

A
  • Superior gluteal nerve and artery: above piriformis
  • Inferior gluteal artery and nerve: below piriformis
39
Q

What is the sciatic nerve vulnerable to damage from?

A
  • Compression
  • IM injection
  • Posterior hip dislocation
  • Hip replacement surgery
40
Q

Where is the safe zone for IM injections in the gluteal region?

A

Imagine line through highest point of iliac crest and another from the PSIS to the greater trochanter.

The safe zone is the most superior and lateral area

41
Q

What is the iliopsoas muscle comprised of?

What is its innervation?

What is its role?

A

Comprised of the iliacus and psoas major muscles which join together and attach to lesser trochanter

42
Q

Where can a psoas abscess track to?

A

Can track down the fibrous sheath coering psoas major producing femoral triangle swelling which can mimic a femoral hernia

43
Q

What muscles are in the medial compartment of the thigh?

What are their innervations and movements?

What are their insertion points?

A

Superficial:

  • Pectineus (femoral nerve)
  • Adductor longus (obturator nerve)

Deep:

  • Adductor Magnus (obturator nerve)
  • Adductor Brevis (obturator nerve)

Originate from medial pelvis and inserts into midline

44
Q

What does the femoral artery pass through in the medial compartment of the thigh?

A

Adductor hiatus (to get behind knee and continue as popliteal artery)

45
Q

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

What are their innervation and movements?

A

Femoral nerve (L2,3,4)

  • Rectus femoris: Hip flexion and knee extension (attaches to hip bone)
  • Vastus Intermedius: knee extension(lies deep to rectus femoris)
  • Vastus Lateralis: Knee extension
  • Vastus Medialis: Knee extension
  • Sartorius

Tensor fascia lata (superior gluteal nerve)

46
Q

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

What are their innervations and movements?

A

(Hamstrings)

Hip extension and knee flexion

Tibial division of sciatic nerve (L5, S1-2)

  • Semimembranosus
  • Semitendinosus
  • Biceps femoris (long and short heads)
    • Short head has common fibular nerve supply.
47
Q

How would damage to the femoral nerve present?

A

Weak/absent knee extension

  • e.g. difficulty getting out of chair
48
Q

What signs and symptoms would a muscle/tendon rupture of anterior compartment muscles display?

A

Pain

Proximal rupture:

  • Palpable sulcus above knee
49
Q

What can a patellar tendon rupture cause?

A

Patella is pulled superiorly by quadriceps

Quadriceps no longer have an anchor point, causes compromised knee flexion

Can also cause avulsion fracture of tibial tuberosity

50
Q

What is the attachment point for many of the muscles of the posterior compartment of the thigh?

What in this region could cause pain on hip extension/knee flexion if inflamed?

A

Ischeal tuberosity

Ischeal bursa

Block 4 (20 decks)

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