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MSK Lower Limb > Hip > Flashcards

Hip Flashcards

1
Q

Fully classify the hip joint

A

-Synovial: it possess a joint cavity, articular cartilage and a capsule /synovial membrane. It allows movement between two bones
-Simple: it is the joint between only two bony surfaces the femur and the innominate bone of
the pelvis and has no intervening structures bet ween these surfaces
-Multi-axial: the hip joint is a very mobile joint. It is capable of moving in 3 planes of movement
(6 individual movements in pairs Flexion/extension, Abduction/adduction, Medial/Lateral rotation)
-Ball and socket: it is formed of the hollow, concave acetabulum and the rounded, convex head
of femur . This arrangement looks like a ball and socket joint and moves like one too.

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2
Q

Identify the bones in articulation at the hip joint

A

The acetabulum: Hemispherical socket deficient inferiorly on the lateral surface of the innominate at the site of fusion of the ilium, pubis and ischium, depened by the fibrocartilaginous acetabular labrum. The semilunar articular surface is covered with hyaline cartilage: the central part of the acetabulum is the thin walled non-articular acetabular fossa formed mainly by the ischium.
Head of femur: Approx. 2/3 sphere, slightly compressed anteroposterior, covered by hyaline cartilage except for a small area superolaterally adjacent to the neck and at the fovea capitis.

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3
Q

Describe the shape and extent of the articulating surfaces.

A

Although reciprocally curved the articulating surfaces are incongruent. Articular surfaces have limited surface area contact at low loads, increasing as load increases; distributing load and protecting the underlying cartilage and bone from stress.
The superior surfaces of the femoral head and acetabulum sustain the greatest pressures and have the thickest cartilage. Only when the hip is weight bearing and flexed does the anteromedial area of the acetabulum articulate with the inferior part of the femoral head.

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4
Q

Describe the arrangement of articular cartilage at the hip joint

A

Articular cartilage lines the femoral head and acetabulum for lubricated movement between the bones. When the femoral head rotates in the acetabulum, the articular cartilage allows the two surfaces to glide against each other. In the hip joint the articular cartilage is almost 1cm thick.

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5
Q

Describe the attachments of the fibrous capsule of the hip joint

A

Extends from the rim of the acetabulum to the neck of the femur. It attaches to the acetabulum superiorly and posteriorly. Distally the capsule attaches to the intertrochanteric line and junction between the neck and trochanters of the femur anteriorly.

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6
Q

Identify areas where the capsule is thickest

A

The capsule surrounds the hip joint, being thicker anteriorly and superiorly.

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7
Q

Describe the special features of the direction of the fibres of the capsule.

A

Longitudinal and circular fibres pass from acetabulum to femur. Circular fibres form a collar around the neck of the femur. On reaching the femoral neck some deeper longitudinal fibres turn upwards towards the articular margin as retinacula fibres and convey blood vessels to the head and the neck.

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8
Q

Describe the synovial membrane of the hip joint

A

Lines and covers all non-articular surfaces, extending like a sleeve around the ligamentum teres, attaching to the margins of the fovea capitis. At the femoral attachment of the capsule the synovial membrane is reflected towards the head attaching to the articular margin. An extension of the membrane below the posterior capsule serves as a bursa for obturator externus

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9
Q

List the 3 main capsular ligaments of the hip

A

Ileofemoral ligament
Pubofemoral ligamemt
Ischiofemoral ligament

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10
Q

Describe the location of the ileofemoral ligament

A

Thick, very strong, triangular (Y-shaped)
Runs between AIIS, acetabulum rim, and intertrochanteric line of the femur.

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11
Q

Give the role of the ileofemoral ligament

A

Limits extension, lateral rotation, adduction (upper fibres) and abduction (lower fibres)

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12
Q

Describe the location of the pubofemoral ligament

A

Strong, narrow ligament
Runs between iliopubic eminence, superior pubic ramus, and the lower intertrochanteric line of the femur

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13
Q

Give the role of the pubofemoral ligament

A

Limits extension, lateral rotation, and abduction

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14
Q

Describe the location of the ischiofemoral ligament

A

Less well defined spiral ligament
Situated on the posterior hip
Runs between the body of the ischium and superior part of the neck of femur and root of the greater trochanter

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15
Q

Give the role of the ischeofemoral ligament

A

Strongly resists medial rotation
Fibres “twist” as they pass from posterior to anterior. Therefore, despite posterior position, this ligament also resists extension and adduction

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16
Q

List intracapsular structures in the hip joint

A
  • The Transverse Ligament
  • The Acetabular Labrum
  • The Ligamentum Teres
  • The Acetabular Fat Pad
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17
Q

Describe the structure and function of the transverse acetabular ligament

A

Strong bands of fibres bridging the acetabular notch, the superficial edge being level with the acetabular rim.
FUNCTION: Supports part of the acetabular labrum and is connected with the ligament of the head of the femur and the articular capsule. Bridges the notch inferiorly – completes the socket of the hip

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18
Q

Describe the structure and function of the acetabular labrum

A

Triangular fibrocartilaginous ring attached to the acetabulum and transverse ligament. The apex is narrower than the maximum diameter of the femoral head which it cups.
FUNCTION: Enhances depth of the acetabulum, so dislocation of the femur is rare.

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19
Q

Describe the structure and function of the ligamentum teres

A

Weak flattened triangular band of connective tissue between the margins of the acetabular notch and transverse ligament, and the fovea capitis of the head of the femur.
FUNCTION: Contains a small artery that supplies the head of the femur with blood (mainly in children)

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20
Q

Describe the structure and function of the acetabular fat pad

A

Fibroelastic pad containing proprioceptive nerve endings lying within the acetabular fossa. The main capsular longitudinal fibres form thickened bands named after their regional attachment around the acetabulum.
FUNCTION: Nerve endings to control movement of the joint, helps with lubrication. Occupies the non-articular floor of the acetabulum

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21
Q

Describe the closed pack position of the hip joint

A

Extension, abduction, medial rotation.
Taut ischiofemoral ligament from extension and medial rotation
Taut pubofemoral ligament from extension and abduction
Taut iliofemoral ligament from extension

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22
Q

Describe the loose pack position of the hip joint

A

lexion, adduction, lateral rotation
Loose ligaments.

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23
Q

Describe the normal ROM of hip flexion

A

Free

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24
Q

Give limitations of hip flexion

A

Limited by the anterior surface of the thigh coming into contact with anterior abdominal wall when the knee is flexed and tension of the hamstring muscles when the knee is extended.
Extensor muscles: Gluteus maximus, Hamstrings, Adductor magnus

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25
Q

Describe the normal ROM of hip extension

A

Restricted

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26
Q

Give limitations of hip extension

A

Limited by the tension of the iliofemoral, pubofemoral and ischofemoral ligaments.
Flexor muscles, e.g. iliacus, psoas major.

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27
Q

Describe the normal ROM of hip abduction

A

Greatest with hip flexed

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28
Q

Give limitations of hip abduction

A

Limited by the tension of the pubofemoral ligament.
Adductor muscles, e.g.Adductor magnus, Adductor longus, Adductor brevis, Gracilis

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29
Q

Describe the normal ROM of hip adduction

A

Greatest with hip flexed

30
Q

Give limitations of hip adduction

A

Limited by the contact with the opposite limb and tension of the ligamentum teres.
Abductor muscles, e.g. Gluteus maximus, Gluteus medius, Tensor Fascia Lata

31
Q

Describe the normal ROM of lateral rotation

A

Shaft of the femur moves posteriorly. Rotation in both medial and lateral is freer when the hip is flexed small amount of hip rotation occurs automatically in the terminal phase of knee extension and at the beginning of knee flexion.

32
Q

Give limitations of lateral rotation

A

Limited by tension in the iliofemoral and pubofemoral ligaments.

33
Q

Describe the normal ROM of medial rotation

A

Shaft of the femur moves anteriorly

34
Q

Give limitations of medial rotation

A

Limited by tension of the ischiofemoral ligament

35
Q

Briefly analyse the mechanisms of the hit joint during sit to stand

A

Horizontal/acceleration- Start position – Flexion (depends upon level of recline)
Increase in hip flexion (to move upper body forwards and generate momentum)
Vertical/extension- Change from position of significant flexion to neutral
Movement in the direction of extension without entering extension

36
Q

Identify the blood supply to the head of femur

A

The femoral head is supplied by three groups of blood vessels: the superior, inferior, and anterior retinacular arteries. Small ‘artery of the head of the femur’ supplies the head of the femur in the ligamentum teres.

37
Q

Consider why a fracture to the neck of femur may disrupt this blood supply

A

When femoral neck fractures occur, some of the blood vessels are usually damaged, which leads to avascular necrosis of the femoral head.
Avascular necrosis is the death of bone tissue. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years. A broken bone or dislocated joint can stop the blood flow to a section of bone.

38
Q

What does the stability of the hip joint depend on?

A
  • shape and angle of the bones;
  • strong reinforcing ligaments;
  • acetabular labrum
  • muscles crossing the joint
    The direction of the femoral neck is also important in maintaining stability.
39
Q

Describe the term ‘Angle of inclination’

A

The angle resulting from the intersection of a line down the long shaft of the femur and a line drawn through the neck of the femur.
Typically, the normal adult has an angle of inclination between 120 and 125 degrees, it usually is closer to 125 in the elderly.

40
Q

Describe the term ‘Angle of antervention’

A

Femoral neck anteversion (FNA) is the angle between the femoral neck and femoral shaft, which affects the biomechanics of the hip. FNA changes substantially throughout growth, which may relate to motor development, and varies by up to 30° within adults.

41
Q

Which muscles in the hip are resposible for flexion?

A

Psoas major, Iliacus, Pectineus, Sartorius,

42
Q

Which muscles in the hip are resposible for extension?

A

Gluteus maximus, Hamstrings, Adductor magnus

43
Q

Which muscles in the hip are responsible for abduction?

A

Gluteus maximus, Gluteus medius, Tensor Fascia Lata

44
Q

Which muscles in the hip are responsible for adduction?

A

Adductor magnus, Adductor longus, Adductor brevis, Gracilis

45
Q

Which muscles in the hip are responsible for lateral rotation?

A

Gluteus maximus, Piriformis, Quadratus femoris, Gemellus superior and inferior, Obturator externus

46
Q

Which muscles in the hip are responsible for medial rotation?

A

Gluteus medius, Gluteus minimus, Tensor fascia lata

47
Q

Where are hip muscles situated?

A

Muscles surround the anterior, posterior and lateral aspects of the hip.

48
Q

Where are the hip flexors situated?

A

Although flexers situated on anterior of hip, usually connect from posterior, travel anterior to posterior to allow a larger lever for wider ROM.

49
Q

Fully classify the gluteus maximus

A
  • Position/Shape/Special features- Posterior hip, thick fleshy muscle with a quadrangular shape, pennate.
  • Origin- Gluteal surface and border of ileum, ileac crest, posterior aspect sacrum, side of coccyx, sacrotuberous ligament and fascia covering erector spinae.
  • Insertion- Deep part to gluteal tuberosity of femur; superficial three-quarters to iliotibial tract.
  • Nerve supply and root value- Inferior gluteal nerve
  • Action(s)- Powerfully extends the flexed hip, laterally rotates, assists abduction, help locks knee in extension, extends torso
  • Function(s)- Through attachment to the iliotibial tract it can stabilise the knee, reverse origin raises flexed trunk to upright position, running, climbing.
50
Q

Fully classify the gluteus medius

A
  • Position/Shape/Special features- Posterior hip, large fan-shaped muscle
  • Origin- Gluteal surface of ileum and covering fascia
  • Insertion- Superolateral side of greater trochanter
  • Nerve supply and root value- Superior gluteal nerve
  • Action(s)- Abducts and medially rotates hip
  • Function(s)- Work with reverse origin maintains level of pelvis in walking
51
Q

Fully classify the gluteus minimus

A
  • Position/Shape/Special features- Posterior hip, fan-shaped muscle
  • Origin- Gluteal surface of ileum deep and anterior to medius
  • Insertion- Anterosuperior aspect greater trochanter
  • Nerve supply and root value- Superior gluteal nerve
  • Action(s)- Abducts and medially rotates hip
  • Function(s)- Work with reverse origin maintains level of pelvis in walking
52
Q

Fully classify the psoas major

A
  • Position/Shape/Special features-Anterior hip, Flattened thin ribbon
  • Origin- Bodies of adjacent vertebrae and discs T12-L5; front of all lumbar transverse processes and tendinous arches over lumbar bodies.
  • Insertion- With iliacus into lesser trochanter of femur.
  • Nerve supply and root value- Anterior rami of L1,2,3,4
  • Action(s)- Flexes hip and laterally flexes trunk
  • Function(s) – Strong trunk flexer as in sitting up from lying. Action pulls lumbar spine forwards, increasing lordosis, psosas major working on one side can laterally flex the trunk to the same side.
53
Q

Fully classify the iliacus

A
  • Position/Shape/Special features- Anterior hip, triangle, flat and an exact fit of the iliac fossa
  • Origin Upper and posterior two thirds of iliac fossa, ala of sacrum and anterior sacroiliac ligament
  • Insertion Into lesser trochanter of femur with psosas major
  • Nerve supply and root value Femoral nerve L2,3
  • Action(s)- Flexes thigh at hip joint
  • Function(s) Sitting up from lying
54
Q

Fully classify the pectineus

A
  • Position/Shape/Special features: Anterior hip, Flat, quadrangular muscle
  • Origin: Superior pubic ramus, iliopubic eminence and pubic tubercle
  • Insertion: Pectineal line on upper posterior part of femur
  • Nerve supply and root value: Femoral nerve L2,3, obturator nerve L2,L3,L4
  • Action(s)L Flexes and abducts hip
  • Function(s) Moves leg towards body upon flexion
55
Q

Fully classify the pectineus

A
  • Position/Shape/Special features: Anterior hip, Flat, quadrangular muscle
  • Origin: Superior pubic ramus, iliopubic eminence and pubic tubercle
  • Insertion: Pectineal line on upper posterior part of femur
  • Nerve supply and root value: Femoral nerve L2,3, obturator nerve L2,L3,L4
  • Action(s)L Flexes and abducts hip
  • Function(s) Moves leg towards body upon flexion
56
Q

Fully classify the adductor magnus

A
  • Position/Shape/Special features: Anterior medial thigh, Triangular/anchor shaped
  • Origin: Femoral surface of ischiopubic ramus, interior surface of ischial tuberosity
  • Insertion: Whole length of linea aspera and medial supracondylar ridge, with hamstring part attaching to the adductor tubercle.
  • Nerve supply and root value: obturator nerve L2, L3, L4 , hamstring part sciatic nerve L5, S1, S2
  • Action(s): Adduction and extension of hip
  • Function(s): Adductors work with other muscles during gait, e.g. adductors on left side contract to move body weight over the left foot, allowing right leg to step forward. Maintain level pelvis during gait. Well developed in speed skaters and horse riders for adduction (bringing the lower extremity toward the midline).
57
Q

Fully classify the adductor longus

A
  • Position/Shape/Special features: Anterior medial thigh, triangular
  • Origin: Anterior aspect body of pubis
  • Insertion: Middle half linea aspera of femur
  • Nerve supply and root value Obturator nerve
  • Action(s): Adducts hip
  • Function(s): Adductors work with other muscles during gait, e.g. adductors on left side contract to move body weight over the left foot, allowing right leg to step forward. Maintain level pelvis during gait. Well developed in speed skaters and horse riders for adduction (bringing the lower extremity toward the midline).
58
Q

Fully classify the gracillis

A
  • Position/Shape/Special features: Anterior medial thigh, thin and flattened, broad above, narrow and tapering below.
  • Origin: Body and inferior pubic ramus
  • Insertion: Medial surface shaft of tibia between Sartorius and semitendinosus
  • Nerve supply and root value: Obturator nerve L2,3
  • Action(s) Adducts hip and flexes knee
  • Function(s) Adductors work with other muscles during gait, e.g. adductors on left side contract to move body weight over the left foot, allowing right leg to step forward. Maintain level pelvis during gait. Well developed in speed skaters and horse riders for adduction (bringing the lower extremity toward the midline).
59
Q

Give the function of the lateral rotators

A

Thigh external rotator. Hold head of femur in acetabulum acting as ‘contractile ligaments’. So can shorten and lengthen no matter what femur is doing: can hold it firmly in acetabulum. Important stabilising muscles as very deep muscles. Complex movements such as transferring weight in sitting position, e.g. chair to wheelchair, utilise medial and lateral rotation when feet are fixed on ground.

60
Q

Fully classify the piriformis

A
  • Position/Shape/Special features: Pyramidal shape, lateral of hip
  • Origin: 2nd/3rd/4th sacral segments lateral to sacral foramina, gluteal surface ileum and sacrotuberous ligament.
  • Insertion: Upper border and medial side greater trochanter femur
  • Nerve supply and root value: Anterior rami sacral plexus L5,S1,S2
    Action: Lateral rotator
61
Q

Where are quadratus femoris located? (LR)

A

Gluteal region

62
Q

Where are obturator internus located? (LR)

A

Muscle situated deep within both the pelvic and gluteal regions

63
Q

Where are the obturator externus located?

A

Located in the outer side of obturator membrane in lateral wall of pelvis

64
Q

What is fascia and give its function

A
  • Dense connective tissue – mature collagen
  • Encloses, separates, connects and stabilises other structures
  • Has some limited extensibility and incredible tensile strength
  • Present throughout the body; particularly evident in the lower limb
65
Q

Give the boundaries of the femoral triangle

A
  • Laterally – Medial border of Sartorius
  • Medially – Medial border of Adductor Longus
  • Superior – Inguinal Ligament
66
Q

What structures are found in the femoral triangle?

A

Neurovascular bundle and psoas tendon

67
Q

What type of lever is hip abductors?

A

First order lever

68
Q

Give the main role of hip abductors duiring gait

A

Hip abductors work on the standing leg with reversed origin insertion to maintain the level of the pelvis.

69
Q

What common pathology is caused by abductor weakness?

A

Trendelenburg gait. Causes drooping of the pelvis on the opposite/unsupported side.

70
Q

What may compromise the function of hip abductors, consequentially causing trendelenburg gait?

A
  • Paralysis or weakness of the Gluteal muscles (particularly gluteus medius) often due to atrophy associated with pathology
  • Inhibition of Gluteal muscles due to pain from the hip joint (for example, in osteoarthritis)
71
Q

What is the primary hip abductor muscle?

A

Glut medius

72
Q

Describe the muscle action in sit-to-stand movement analysis

A

Horizontal Flexion: Hip flexors (iliacus, pectineus, psoas major, sartorius) contract concentrically working in reversed origin insertion to pull the trunk towards the femur
Vertical Extension: Hip extensors (glut max, adductor magnus) contract concentrically with reversed origin insertion to pull the trunk backwards onto the femur.

MSK Lower Limb (5 decks)

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