Hip and Gluteal Region Flashcards by Sneha Shah

What is the acetabulum?

An incomplete ring of bone formed by the intersection of the ilium, ishium, and pubis at the triradiate cartilage

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What completes the circle created by the acetabulum?

The transverse acetabular ligament

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What is the acetabular foramen?

An opening formed between the ligament and the central acetabular fossa

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The acetabular fossa houses a

Fat pad

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The weight of the body is borne by articular cartilage on the ___ surface of the acetabulum

Lunate

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What is the acetabular labrum and what does it do?

It is a ring of fibrocartilage that projects beyond the bony rim of the acetabulum

It helps improve the fit of the femoral head into the acetabulum

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What is the structure of the synovial membrane?

It attaches around the head of the femur and extends down the neck of the femur and then reflects back to the rim of the acetabulum

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What is the function of the synovial membrane?

It can bunch up and stretch out to accomodate the large range of movement of the femur

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What is the structure and function of the zona orbicularis?

It is located in the fibrous joint capsule of the femur and wraps around the neck of the femur

It is smaller in diameter than the head of the femur, so it promotes joint stability

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What accomodates the movement of the femoral head within the acetabulum?

Synovial folds

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

It limits the range of motion of the hip joint, but NOT through tension

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What is the consequence of the ligament of the head of the feur being too thick to fit between the femoral head and acetabulum?

The range of motion of the hip joint is limited to the area defined by the central fat pad

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What elements of the pelvis is the femur bound to?

Ilium

Ishium

Pubis

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What ligaments attach the femur to the bones of the pelvis?

Iliofemoral

Pubofemoral

Ishiofemoral

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The iliofemoral ligament attaches on the

anterior surface of the femur, along the intertrochanteric line

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The pubofemoral ligament attaches on the

inferior aspect of the femoral neck

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The ischiofemoral ligament attaches on the

Superior aspect of the femoral neck, continuing to the upper part of the intertrochanteric line

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What happens to the femur-pelvis ligaments when a person is standing?

The ligaments are twisted, which exerts a force that pulls the head of the femur firmly into the socket formed by the acetabulum

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What happens to the head of the femur when standing?

How is this corrected?

Part of the articular cartilage on the head of the femur is exposed on the anterior and superior aspect of the articular ball

To bring the articular surface into contact with the acetabulum requires flexing and abducting the femur

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What is the true physiological position of the hip?

When the femur is flexed and abducted

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The ligaments around the head of the femur are laxed when the hip is

Flexed

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What happens to the ligaments of the hip when someone is in the seated position?

The ligaments are lax, which makes the hip joint particularly susceptible to posterior dislocations

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Dislocations of the femur are prevalent ANTERIORLY between the

Iliofemoral and pubofemoral ligaments

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Dislocations of the femur are prevalent POSTERIOLY between the

Iliofemoral and ishiofemoral ligaments

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Parts of the femur/hip joint from deep to superficial

Acetabular membrane (located inside the synovial membrane) Synovial membrane is inside the fibrous capsule of the joint (contains the zona orbicularis) Fibrous capsule of joint is inside the tube of ligaments that bind the femur to the hip (iliofemoral, ischiofemoral, and pubofemoral ligaments) These ligaments are surrounded by the muscles of the hip The muscles of the hip are covered by fascia lata Fascia lata is covered by subcutaenous fat and skin

What supplies the acetabulum?

Obturator atery- anterior and posterior branches

Blood is supplied to the femoral head by

Lateral femoral circumflex artery Medial femoral circumflex artery

Both the lateral and medial femoral circumflex arteries branch from or near the

Profunda femoris artery

What are the two anastomoses of the lateral and femoral circumflex arteries

Circulate anastomosis that occur around the femur, below the greater troachanter Both also give off ascending branches that anastomose around the femoral neck

What supplies the acetabulum?

Acetabular branches of the posterior obturator artery

What is fascia lata?

Outer layer of the deep fascia over the thigh

Fascia lata is anchored superiority in a ring that includes

Inguinal ligament Iliac crest Sacrum Coccyx Sacrotuberous ligament Pubis

Fascia lata is inferiorly continuous with

Deep fascia of the leg (fascia cruris)

What is the iliotibial tract/band?

It is the thickened, lateral aspect of the fascia lata

The iliotibial tract/band is attached superiorly to

The tubercle of the crest of the ilium

The iliotibial tract/band is attached inferiorly to

The proximal part of the tibia

What is the function of the iliotibial tract?

To reduce bending load on the femur

Function of tensor fasciae lata

Stabilizes knee in extension

The obturator externus is innervated by

Obturator nerve, posterior division

Tensor fascia lata is innervated by

Superior gluteal nerve

Gluteus maximus is innervated by

Inferior gluteal nerve

Gleuteus medius and gluteus minimus are innervated by

Superior gluteal nerve

Piriformis muscle is innervated by

Nerve to piriformis

Obturator internuis is innervated by

Nerve to obturator internus

Superior gemellus is innervated by

Nerve to obturator internus

Inferior gemellus is innervated by

Nerve to quadratus femoris

Quadratus femoris is innervated by

Nerve to quadratus femoris

Femoral nerve and its sidekicks innervated

Iliacus and psoas

Common fibular sidekicks are

Gluteal nerves

Tibial nerve and its sidekicks innervate

Lateral rotators

Posterior division of obutrator nerve comes from

L3-L4

Superior gluteal nerve that innervates tensor fascia lata comes off

L4-S1

Inferior gluteal nerve that innervates gluteus maximus comes off

L5-S2

Superior gluteal nerve that innervates gluteus medius and minimus comes off

L5-S1

Nerve to piriformis comess off

S1-S2

Nerve to obturator internus comes off

L5-S2

Nerve to quadraus femoris comes off

L4-S1

Sidekicks to common fibular nerve include

Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis

Sidekicks of tibial nerve include

Nerve to obturator internus Nerve to quadratus femoris

Dorsiflexion (extension) of upper foot is done by

L4-S1 (common fibular)

Extension of upper leg is done by

L2-L4 (Femoral nerve)

Flexion of upper thigh done by

L1-L2 (Femoral nerve)

Flantarflexion (flexion) of bottom foot is done by

L4-S5, S1-S2 (Tibial nerve)

Flexion of bottom of leg done by

L5-S2 (Tibial nerve)

Extension of bottom thigh done by

L5-S2 (Common fibular)

What defines the inferior border of the buttock

Gluteal/natal fold

The most superficial muscle in the superior-lateral region of the buttock is the

Gluteus medius

Where does the gluteus maximus insert?

Deep distal 1/4 inserts on the femus Remainder inserts on IT tract

Function of the gluteus maximus

Powerful extensor of flexed thigh Laterally stabilizes hip and knee via IT tract Laterally rotates and abducts thigh

Overall function of small glutes

Abduct femur Pervents pelvic tilt

What do the anterior part of small glutes do?

Flex and internally rotate thigh

What do the posterior parts of the small glutes do?

Extend and laterally rotate thigh

What runs above the piriformis?

Superior gluteal artery, vein, and nerve

What runs below the piriformis?

Inferior gluteal artery, vein, and nerve Sciatic nerve Posterior femoral cutaneous nerve

Arterial supply to the pirifromis may include

Superior and inferior gluteal arteries Lateral sacral artery

Circulate anastomosis involves ___ superiorly

Inferior gluteal artery

Circulate anastomosis invovles __ mediolaterally

Lateral and medial femoral circumflex arteries

Circulate anastomosis invovles ____ inferiorly

First perforating branch of the profunda femoris artery

What are the bursae of the hip?

Ischial bursae Trochanteric burase Gluteofemoral bursa

Ischial bursae separates

gluteus maximus from ischial tuberosity

Trochanteric burase separates

gluteus maximus from greater trochanter

Gluteofemoral bursa separates

IT tract from proximal attachment of hamstrings

What are the lateral rotators of the hip?

Piriformis Obturator internus Gemellus superior Gemellus inferior Quadratus femoris

Origin of piriformis

Anterior surface of sacrum

Origin of obturator internus

Deep surface of obutrator membrane and surrounding bone

Gemellus inferior origin

upper aspect of ischial tuberosity

Gemellus superior origin

External surface of ischial spine

Where do the piriformis, obutrator internus, gemellus supeior, and gemellus inferior insert

On greater trochanter of femur

What is the overall function of the piriformis, obturator internus, gemellus supeior, and gemellus inferior?

Laterally rotate extended femur Abduct flexed femur

Origin of quadratus femoris

Lateral aspect of ischium

Insertion of quadratus femoris

Quadrate tubercle on intertrochanteric crest

Action of quadratus femoris

Strong lateral rotator of femur

Fibers of the obturator internus exit the pelvis through

Lesser sciatic foramen

What forms the lesser sciatic foramen?

Lesser sciatic notch Sacrospinous ligament Sacrotuberus ligament

Obutrator externus originates from

External surface of obturator membrane

Obturator externus inserts into

Trochanteric fossa

What is the function of obturator internus?

Laterally rotates thigh

What innervates the obturator externus

Obturator nerve

Sensory innervation of the buttock is done by

Cluneal nerves Lateral branch of iliohypogastic nerve

What is the source of the superior and middle cluneal nerves?

Dorsal rami of the lumbar and sacral vertebrae

What is the source of the inferior cluneal nerve

Posterior femoral cutaneous nerve

Perforating cutaneous nerve overlaps with the

Posterior cutaneous nerve of the thigh

Perforating cutaneous nerve innervates

Skin over the medial aspect of the gluteal fold

Perforating cutaneous nerve is derived from

S2-S3

Perforating cutaneous nerve leaves the pelvic cavity by

Penetrating directly through the sacrotuberous ligament, after which it passes inferiorly around the lower border of the gluteus maximus

What is sciatica?

Symptoms of pain in the lower back, gluteal region, thigh, or leg It caused by compression/irritation of sciatic nerve

What is piriformis syndrome?

Irritation of sciatic nerve by piriformis muscle

What are the extensors of the hip?

Gluteus maximus

What are the abductors of the hip?

Small glutes

What are the lateral rotators of the hip

Piriformis Obturator internus Gemelli Quadratus femoris