Hip and Pelvis Flashcards
The upper medial quadrant is supplied by
Posterior rami of upper three lumbar nerves and upper three sacral nerves
The upper lateral quadrant is supplied by
Lateral branches of the iliohypogastric (L1) and 12th thoracic nerves (anterior rami)
The lower lateral quadrant is supplied by
Branches from the lateral cutaneous nerve of the thigh (L2 and 3, anterior rami)
The lower medial quadrant is supplied by
Branches from the posterior cutaneous nerve of the thigh (S1, 2, and 3 and anterior rami)
Contains a lot of fat and thicker in women. It contributes to the prominence of the buttocks
Superficial Fascia
Continuous below with the deep fascia of the thigh
Deep Fascia
Continuation of the deep fascia on the lateral surface of the thigh and it is thickened to form a strong, wide band that is attached above to the tubercle of the iliac crest and below to the lateral condyle of the tibia
Iliotibial tract or Iliotibial band
Drains the medial end of the dorsal venous arch of the foot and passes upward directly in front of the medial malleolus
Great Saphenous Vein
The blood and nerve supply of anterior fascial compartments of the thigh
Femoral artery and nerve
Muscles located in Anterior Fascial compartments of thigh
Sartorius, iliacus, psoas, pectineus, and quadriceps femoris
The components of quadriceps femoris muscle
Rectus Femoris
Vastus Lateralis
Vastus Medialis
Vastus intermedius
An intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the sartorius muscle
Adductor Canal
Blood and nerve supply of medial fascial compartments of the thigh
Profunda femoris and obturator artery
Obturator nerve
Muscles of medial fascial compartments of the thigh
Gracilis Adductor longus Adductor brevis Adductor magnus Obturator externus
Blood and nerve supply of posterior fascial compartments of thigh
Branches of the profunda femoris artery
Sciatic nerve
Muscle of posterior fascial compartment of the thigh
Biceps femoris
Semitendinosus
Semimembranosus
Adductor magnus (hamstring portion)
What kind of joint is the hip joint
Synovial ball-and-socket joint
A strong inverted Y-shaped ligament and prevents overextension during standing
Iliofemoral ligament
A triangular ligament that limits extension and abduction
Pubofemoral ligament
A spiral shaped ligament that limits extension
Ischiofemoral ligament
This ligament is formed by the acetabular labrum as it bridges the acetabular notch
Transverse acetabular ligament
This ligament is flat and triangular which is unsheathed by synovial membrane
Ligament of the head of the femur
When the knee is flexed, flexion is limited by the
Anterior surface of the thigh coming into contact with the anterior abdominal wall
When the knee is extended, flexion is limited by
The tension of the hamstring group of muscles
What ligament limits the tension of abduction
Pubofemoral ligament
What ligaments limit the tension of lateral rotation
Iliofemoral and pubofemoral ligament
What ligament limits the tension of medial rotation
Ischiofemoral ligament
When the hip is extended, these ligaments limit the tension
Iliofemoral
Pubofemoral
Ischiofemoral
Muscles whose action is flexion
Iliopsoas
Rectus Femoris
Sartorius
Adductor Muscles
Muscles whose action is extension
Gluteus Maximus
Hamstrings
Muscles whose action is abduction
Gluteus Medius & Minimus
assisted by sartorius, tensor fascia latae, piriformis
Muscles whose action is adduction
Adductor longus and brevis Adductor magnus (fibers) assisted by pectineus and gracilis
Muscles whose action is lateral rotation
Piriformis
Obturator internus and externus
Superior and Inferior Gemelli
Quadratus Femoris
Muscles whose action is medial rotation
Gluteus medius and minimus (anterior fibers)
Tensor Fascia Latae
The extensor group of muscles is powerful than the
Flexor group
The lateral rotators are more powerful than the
Medial rotators
Pelvic Inlet (Ante, Poste, Late)
Anteriorly: Symphysis Pubis
Posteriorly: Promontory of sacrum, ala of sacrum
Laterally: Iliopectineal (arcuate) lines
Pelvic Oulet (Ante, Poste, Late)
Anteriorly: Symphysis Pubis
Posteriorly: Coccyx
Anterolaterally: ischiopubic ramus
Posterolaterally: Sacrotuberous ligament
Shallowest wall and is formed by the posterior surfaces of the bodies of the pubic bones, the pubic rami, and the symphysis pubis
Anterior Pelvic Wall
Large wall and formed by sacrum, coccyx, and piriformis muscles. Covered by the parietal pelvic fascia
Posterior Pelvic Wall
Lateral rotator of hip joint and it is inserted into the upper border of the greater trochanter of the femur
Piriformis Muscle
Formed by part of the hip bone, obturator membrane, sacrotuberous and sacrospinous ligaments, and obturator internus muscle
Lateral Pelvic Wall
These two ligaments form the greater and lesser sciatic foramina
Sacrospinous and Sacrotuberous ligament
This muscle is a lateral rotator of the femur at the hip joint
Obturator Internus
A basin-like structure wall which supports the pelvic viscera and is formed by the pelvic diaphragm. It stretches across the true pelvis and divides it into true pelvic and perineum.
Inferior Pelvic Wall
Pelvic Diaphragm consists of
Levator ani & coccygeus muscles
A wide thin sheet originating from the back of the body of the pubis and divided into anterior, intermediate, and posterior fibers
Levator Ani Muscles
The origin of this muscle is in the back of the body of the pubis, tendinous arch of the obturator fascia and spine of ischium
Levator Ani Muscle
The anterior fibers of the Levator Ani
Levator Prostate
Sphincter Vaginae
The intermediate fibers of Levator Ani
Puborectalis- important in fecal continence
Pubococcygeaus
The posterior fibers of Levator Ani
Iliococcygeus
Coccygeus
Nerve supply of Levator Ani
Perineal branch of the 4th sacral and pudendal nerve
A small but limited amount of movement is possible at these joints
Sacroiliac joints
The counternutation of sacrum & coccyx
Coccyx moves anteriorly
The nutation of ischial tuberosities
move apart
The counternutation of iliac crest
Approximately
The nutation of sacral promontory
Moves inferiorly & anteriorly
There is almost no movement possible at this joint
Symphysis pubis joint
Extensive flexion and extension are possible at this joint
Sacrococcygeal joint
Provides motor and sensory nerves for the posterior thigh, most of the lower leg, the entire foot and part of the pelvis
Sacral Plexus
Anterior contents of Pelvic Cavity
UB
male & female internal organs
Posterior contents
Sigmoid colon
Rectum
A diamond-shaped region positioned inferiorly to the pelvic floor between the thighs
Perineum
Perineum is bounded laterally by
Ischial Tuberosity
Perineum is bounded posterolaterally by
Sacrotuberous ligament
Anterior Pelvic Tilt
Pelvis moves anteriorly
ASIS is forward
Pubic Symphysis moves backward
Shearing stress on L5-S1 joint
Posterior Pelvic Tilt
Pelvis tilted posteriorly
ASIS is backward
Pubic symphysis moves forward
Compression on L5-S1 joint
Characterized by a neck-shaft angle greater than 125 degrees. The angle is “straighter”. Tends to make the limb longer, thus placing the hip in an adducted position during weight-bearing
Coxa Valga
A deformity in which the neck-shaft angle is less than the normal 125 degrees. It is “more bent” it tends to make the involved limb shorter, dropping the pelvis on that side during weight bearing
Coxa Vara
The angle between the shaft and the neck of the femur in the transverse plane
Angle of Torsion
Increase in angle which forces the hip joint into a more medially rotated position. This causes a person to walk more “toed in”
Anteversion
A decrease in the angle of torsion and forces the hip joint into a more laterally rotated position causing the person to walk more “toed out”
Retroversion
Pelvic surface of symphysis pubis faces
Upward and backward
Pelvic surface of anterior surface of sacrum
Forward and downward
A gap in the deep fascia in the front of thigh just below the inguinal ligament
Saphenous opening
Lower lateral border of the opening, which lies anterior to the femoral vessels
Falciform margin
The saphenous opening is filled with loose connective tissue
Cribrifrom fascia
False Pelvis is bounded by
Poste: Lumbar Vertebrae
Laterally: Iliac fossae and the iliacus
Ante: Lower part of the anterior abdominal wall (supports the abdominal contents)
Posterior Pelvic Wall is formed by
Sacrum
Coccyx
Piriformis
Actions of Levator Ani
- Muscles of the two sides form an efficient muscular sling that supports and maintains the pelvic viscera in position
- They resist the rise in intra pelvic pressure during the straining and expulsive efforts of the abdominal muscles (as in coughing)
- They have a very important role in maintaining the fecal continence
- They serve as a vaginal sphincter in the female
Stretches between the two sides of the pubic arch and covers the anterior part of the outlet
Perineal membrane
Irregular fibromuscular mass located between the anal canal and the perineal membrane
Perineal body
If there is right forward rotation of the pelvis, there is
left hip medial rotation
With right backward rotation of the pelvis, there is
left hip lateral rotation