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Hip And Pelvis Flashcards

1
Q

Primary functions of hip and pelvis

A

Anchors axial and appendicular skeleton
Supports body weight
Locomotion - 3 degrees of motion and functional movements

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2
Q

Structures within the
Pelvis -
Hip joint -

A

Pelvis - ilium ischium and pubis make up hemi pelvis
Also comprised of sacrum and coccyx
Hip joint - acetabulum and femoral head

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3
Q

Bones of the pelvis:

A

Ilium which is the largest
Inferiorly to ilium is the ischium
Ischium sits posterior to pubis.
Three bones form articular surface for proximal part of hip joint
Sacrum is five fused vertebrae - no movement in between
Coccyx - distal to sacrum

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4
Q

Posterior bony landmarks -
Sacrum bony landmarks -

A

Posterior - PSIS and PIIS
Ischial tuberosity - proximal attachment site for hamstrings
Pubic rami ( inferior )

Sacrum - anterior sacral foramina - holes allow sacral spinal nerves through
Posterior - spinus processes of each vertebrae of the sacrum.
Lateral view - articular facet for hip bone.

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5
Q

Bony landmarks of proximal femur -

A

Femoral head
Femoral neck - connects head and shaft of femur. This is vulnerable to fractures, especially in the elderly.
Greater trochanter - lateral
Lesser trochanter - found on intertrochanteric line. This line is important attachment site for stabilising ligaments of hip joint.

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6
Q

Linea aspera -

A

Raised ridge that descends down to the distal end of the femur and serves as a site for muscle attachments.

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7
Q

Hip joint
Femeroacetabular joint classification and movements -

A

Synovial polyaxial(3 degrees movement) ball and socket joint
Flexion/extension
Abduction/adduction
Medial/lateral rotation

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8
Q

Hip joint surfaces
Acetabulum -

A

Surface of hip bone
Lunate surface hyaline cartilage - horse shoe shaped
Thickest above and centrally for weight bearing
Cartilage in half moo shape, connects at bottom by transverse acetabular ligament.
On the ridge of the acetabulum is the acetabulum labrum - formed by fibrous-cartilaginous rim and deepens the socket which improves stability

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9
Q

Ligaments and membranes at the hip joint
Superficially:
synovial membrane -
Fibrous membrane -

A

Synovial - Attaches to margins of the articular surfaces of femur and acetabulum
Covers neck of femur before reflecting onto the fibrous membrane

Fibrous - encloses hip joint, strong and thick. Attaches from margin of acetabulum, the transverse acetabular ligament and the adjacent margin of the obturator foramen. Goes up to intertrochanteric line

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10
Q

Ligaments at the hip
Iliofemoral ligament -

A

Iliofemoral ligament - formed by two bands (superior and inferior)
Triangular shaped
Attaches from AIIS to intertrochanteric line
Superior band limits - extension and adduction
Inferior band limits - extension and abduction

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11
Q

Ligaments at hip
Pubofemoral ligament -

A

From pubic eminence onto the femur - intertrochanteric line
Also intertwine with capsule and medial band of iliofemoral ligament
Limits - extension and abduction

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12
Q

Ligaments at the hip
Ischiofemoral ligament -

A

From inferior aspect of ischium to capsule and anterior part of greater trochanter
Sits deeps to iliofemoral ligament
Limits - extension and medial/lateral rotation

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13
Q

Ligaments at hip
Ligamentum trees -
Inguinal ligament -

A

Ligamentum trees- Ligament at femur head from fovea in head of femur to acetabular notch and transverse acetabular ligament

Inguinal - attaches from ASIS to pubic tubercle

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14
Q

Morphology and stability of hip joint
Sexual differences -

A

Pelvis flatter and wider in females and more circular pelvic inlet therefore can child bear
Females have a greater Q angle - imaginary line connecting ASIS to midpoint of patella and another running from tibial tubercle to patella centre (angle between two lines)

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15
Q

Morphology and stability of hip joint
Anatomical variance -

A

Femoral neck inclination - angle at which neck sits. Meaning movements and stances will vary.
Femoral neck version - anteversion - internally rotate femur adopting a narrow stance
Retroversion - larger angle, externally rotate so wider stance adopted.

Acetabulum orientation and depth also varies between individuals and infulences biomechanics

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16
Q

Stability of hip joint:

A

Strong surrounding ligament - capsule and internal ligament
Cup shaped acetabulum - deepend by acetabular labrum
Strong capsule
Vacuum effect with ball and socket joint
Oblique angle of femoral neck
Arrangement of powerful surrounding muscles

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17
Q

Scaro - iliac joint:
Classification -

What is nutation?

A

Between sacrum and ilium
Synovial plane joint
Ridged articular surfaces
Limited movement - nutation and counter mutation can only occur
Transmits forces
With age may become ossified

Nutation - ilium movement rotating posteriorly
Counter nutation is the opposite

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18
Q

Ligaments of sacro-iliac joint:
Anterior sacro-iliac ligament -
Interosseous sacro-iliac ligament -

A

Anterior - thickening of fibrous membrane of joint capsule
Interosseous - strongest of the three, attaches to adjacent areas of ilium and sacrum

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19
Q

Ligaments of sacro-iliac joint:
Posterior sacro-iliac joint -
Sacrotuberous ligament -

A

Posterior - superficial to interosseous ligament

Sacrotuberous - from PSIS, sacral tubercles and attaches to ischial tuberosity and ischial ramus. Limits nutation of sacrum and posterior rotation of ilium

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20
Q

Sacrospinous ligament -

A

Apex from spine of ischium to lateral margin of sacrum and coccyx
Limits nutation of sacrum and posterior rotation of ilium

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21
Q

Iliolumbar ligaments -
Lumbosacral ligaments -

A

Iliolumbar - from transverse processes of L5 to posterior aspect of iliac crest. Provides stability between lumbar spine and pelvis.

Lumbosacral - transverse processes of L5 to anterior sacrum and anterior sacro-iliac ligament.

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22
Q

Pubic symphysis classification -

A

Secondary cartilaginous joint
Fitted with interpubic disc
Superior pubic ligament (sits above) and inferior pubic ligament (sits below). Both provide stability.
Minimal recorded movement - can give problems post pregnancy

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23
Q

Active movements and degrees of movement at the hip:

A

Flexion - 120-130 degrees
Extension - 10-15 degrees
Abduction - 45 degrees
Adduction - 20-30 degrees
External rotation - 40-50 degrees
Internal rotation - 30-40 degrees

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24
Q

ROM limitations:

A

Tension in antagonist eg hip flexion - tension in glute max/hamstring
Soft tissue apposition - excess fat limits movement
Tension of ligaments limits range
Relative congruency of the articular surfaces - contact of surfaces on each other eg. Shape of femoral head influences movements.

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25
Closed pack position -
Joint in most contact with articular surfaces. Increased tension For the hip - joint is in Max extension - iliofemoral ligament is taught Internal rotation Abduction
26
Open packed position -
Less surface contact Slight flexion of hip Abduction External rotation
27
Muscles of the hip - hip flexors Iliopsoas -
Made up of psoas major and iliacus as they have a conjoined tendon Proximal attachment: Psoas major - lumbar transverse processes, invertebral discs and adjacent bodies from T12 - L5 Iliacus - iliac fossa Distal attachment: Lesser trochanter of the femur Nerve supply - anterior rami (L1-L3) Action - hip flexion/trunk flexion at hip (legs in fixed position eg doing sit up)
28
Muscles of the hip - hip flexors: Pectineus _
Proximal attachment - pecten pubis and adjacent bone of pelvis Distal attachment - oblique line extending from base of lesser trochanter to line aspera Nerve supply - femoral nerve (L2-L3) Action - hip flexion and adduction (pulls on femur)
29
Muscles of the hip - hip flexors: Rectus femoris -
Part of quads - passes hip and knee joints Proximal attachment: Long/straight head originates from AIIS Short/reflected head originates from ilium just superior to acetabulum Distal attachment: Quadriceps femoris tendon Nerve supply - femoral nerve (L2-L4) Action - flexes thigh and knee
30
Muscles of the hip - hip flexors: Sartorius -
S shaped muscle Proximal attachment: ASIS Distal attachment: medial surface of tibia just inferno medial to tibial tuberosity Nerve supply - femoral nerve (L2-L3) Action - flexes thigh at hip and flexes leg
31
Muscles of the hip - hip extensors: Gluteus maximus -
Proximal attachment - sit medially, outer surface of posterior ilium sacrum and coccyx Distal - posterior aspect of iliotibial tract of fascia Lara and gluteal tuberosity of proximal femur. Nerve supply - inferior gluteal nerve (L5,S1,S2) Action - extends femur at hip, lateral stabiliser of hip joint and knee joint. Laterally rotates and abducts thigh. Prime mover for hip extension
32
Muscles of the hip - hip extensors: Bicep femoris -
Most lateral hamstring muscle Passes hip and knee therefore subject to passive/active insufficiency Proximal - long head: inferno medial part of upper area of ischial tuberosity Short head: lateral lip of linea aspera Distal - head of fibula, lateral tibial condyle Nerve supply - sciatic nerve (L5,S1,S2) Action - extends and laterally rotates hip joint. Flexes and laterally rotates leg at knee.
33
Muscles of hip - hip extensors: Semitendinosus -
Hamstring muscle - sits superficially to semimembranosus Crosses knee and hip Proximal - inferomedial part of upper area of ischial tuberosity Distal - medial surface of proximal tibia Nerve supply - sciatic nerve (L5,S1,S2) Action - extends thigh at hip, medially rotates thigh at hip joint and leg at knee Flexes knee joint
34
Muscles of hip joint - hip extensors: Semimembranosus -
Proximal - superolateral impression on the ischial tuberosity Distal - groove and adjacent bone on medial and posterior surface of medial tibial condyle Nerve supply - sciatic nerve (L5,S1,S2) Action - extends thigh at hip joint and medially rotates thigh at hip joint. Flexes leg at knee.
35
Muscles of the hip - hip abductors: Glute medius -
Prime mover Proximal: external surface of ilium between ant. And pot. Gluteal lines Distal: facet on lateral surface of greater trochanter Nerve supply - superior gluteal nerve (L4,L5,S1) Action - abducts femur and holds pelvis secure over stance leg and prevents pelvic drop on opposite swing side during walking, medially rotates thigh
36
Muscles of the hip - hip abductors: Glute minimus -
Proximal attachment: external surface of ilium and inf. and ant. Gluteal lines Distal: facet on anterolateral aspect of greater trochanter Nerve supply- superior gluteal never (L4,L5,S1) Action - abducts femur at hip, holds pelvis secure over stance leg and prevents pelvic drop on opposite swing side during walking. Medially rotates Thigh
37
Muscles of the hip - hip abductors: Tensor fascia Lata -
Proximal - lateral aspect of crest of ilium between ASIS and tubercle of crest Distal: iliotibial tract of fascia lata (Gerdys tubercle) - proximal aspect of tibia Nerve supply - superior gluteal nerve (L4,L5,S1) Action - stabilises knee joint, weak abductor and internal rotator
38
Muscles of the hip - hip abductors: Piriformis -
Proximal - anterior surface of sacrum between anterior sacral foramina Distal - medial side of superior boarder of greater trochanter of femur Nerve supply - branches from S1 and S2 Action - laterally rotates extended femur at hip joint and abducts flexed femur at hip joint
39
What are the deep lateral rotators to be aware of ?
Obturator internus Obturator external Gamellus superior Gemellus inferior Quadratus femoris
40
Muscles of the hip - hip adductors: Adductor Magnus - (adductor part)
Proximal attachment: adductor part - ischiopubic ramus Distal: posterior surface of proximal femur, linea aspera and medial supracondylar line. Nerve supply - obturator nerves (L2,L3,L4)
41
Muscles of the hip - hip adductors: Adductor Magnus - (hamstring part)
Proximal: ischial tuberosity Distal: adductor tubercle and supracondylar line Nerve supply - sciatic nerve (L4) Action - adducts and medially rotates thigh at hip joint.
42
Muscles of the hip - hip adductors: Adductor longus -
Proximal: external surface of body of pubis Distal: linea aspera on middle one-third of shaft of femur Nerve supply - obturator nerve (L2,L3,L4) Action - adducts and medially rotates thigh at hip joint
43
Muscles of the hip - hip adductors Adductor brevis -
Shorter smaller version on longus Proximal: external surface body of pubsiand inferior pubic ramus Distal: posterior surface of proximal femur and upper one third of linea aspera Nerve supply - obturator nerve (L2,L3) Action - adducts and medially rotates thigh at hip joint
44
Muscles of the hip - hip adductors - Gracilis -
Sits most medially out of the adductors Proximal attachment: line on external surfaces of body of pubis, the inferior pubic ramus and ramus of the ischium Distal: medial surface of proximal shaft of tibia Nerve supply - obturator nerve (L2,L3) Action - adducts thigh at hip joint and acts as a weak hip flexor at knee joint.
45
The femoral triangle, borders and contents -
The femoral triangle is a body space at the joint Borders: Base - Inguinal ligament (from ASIS to pubic symphasis) Medial border - medial margin of adductor longus Lateral border - medial margin of sartorius in anterior thigh compartment Contents: lateral - medial Femoral nerve, femoral artery, femoral vein and lymphatic vessels *we can palpate the femoral nerve
46
Hip flexion is produced by- And limited by -
Psoas major, sartorius, iliacus, pectineus, rectus femoris and gracilis Limited by tension in antagonists eg hamstrings
47
Hip extension produced by - And limited by -
Gluteus maximus, adductor Magnus, bicep femoris, semimembranosus and semitendinosus Limited by all ligaments and close pack position
48
Hip abduction produced by - Limited by -
Gluteus med and min, sartorius, tensor fascia lata, piriformis ( flexed thigh ) Limited by pubofemoral ligament and iliofemoral medial band
49
Hip adduction produced by - Limited by -
Adductor longus, adductor brevis, adductor Magnus, pectineus and gracilis ( very weak) Limited by iliofemoral lateral band and Ligamentum teres
50
Hip internal rotation produced by - Limited by -
Gluteus med and min, tensor fascia lata and adductor Magnus Limited by ischiofemoral ligament and posterior capsule
51
Hip external rotation produced by - Limited by -
Glute max, piriformis, obturator interior and exterior, gemellus superior and inferior, quadratus femoris and sartorius Limited by iliofemoral lateral band
52
Close-pack position at hip - Open-pack position at hip -
Close - max extension Medial rotation and abduction Open - slight flexion Abduction and lateral rotation
53
Flexion and extension occur in… Abduction and adduction occur in… Lateral and medial rotation occur in…
Sagittal plane and frontal axis Frontal plane and sagittal axis Transverse plane and vertical axis
54
Accessory movements available at the hip:
Longitudinal caudad - slight rotation and leg down from calf Distraction - separation of joint surfaces. Knee and hip flexion and pull leg against body AP - gliding backwards PA- gliding forwards Place hand on hip and greater trochanter for both
55
Main bony points of the femur-
Greater/lesser trochanter Femoral head and neck Intertrochanteric line Linea aspera Gluteal tuberosity
56
Term given to dropping of pelvis on the opposite side to standing leg -
Trendelenburg sign
57
Three components of innominate bone-
Ilium Ischium Pubis
58
What muscles attaches to ASIS? What muscle and head of that muscle attaches to AIIS?
Sartorius Long/straight head of rectus femoris
59
Which muscles attach to ischial tuberosity ? “. “. Attach to lesser trochanter ? And which attach to greater trochanter ?
Ischial - semitendinosus, semimembranosus and bicep femoris Lesser - psoas major and iliacus Greater - glute med and min and piriformis
60
Which muscle attaches to gluteal tuberosity ? Which attaches to the pectineal line ?
Glute max Pectineus

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