Hip and Thigh

Question 1

What are the movements around the transfers, AP and vertical axis?

Answer 1

transverse: flexion and extension
AP: abduction and adduction
Vertical: medial and lateral rotation

Question 2

How does the structure of the hip joint compare to the should joint?

Answer 2

hip joint is much more stable than the shoulder joint as it has a larger articular surface and a deeper joint cavity

Question 3

What is the acetabular labrum?

Answer 3

a semi circle of fibrocartilage that adds to the stability of the hip joint, the gap in its lunate surface (acetabular notch) is spanned by the transverse acetabular ligament

Question 4

What is particular about the lunate surface?

Answer 4

it is the articular surface that is covered in hyaline cartilage for a smooth joint surface

Question 5

What/where is the fovea of the hip joint?

Answer 5

the attachment on the head of the femur for the round ligament of the femur which attaches to the pelvis at the acetabular ligament (round ligament is not a stabilizing ligament of the hip joint)

Question 6

Name the three hip joint ligaments and their attachments.

Answer 6

iliofemoral (ilum- femur), pubofemoral (pubic bone - femur) and ischiofemoral (ischium- femur)

Question 7

What are structural attributes of the hip ligaments that help to stabilize the joint?

Answer 7

spiral arrange meant of the collagen fibers allows the tendons to loosen during flexion and tighten during extension (limited to 15 deg)

Question 8

Identify the movement of the knee about a transverse and vertical axis.

Answer 8

flexion and extension around the transverse axis

rotation around the vertical axis due to the difference in the lengths in the articular surfaces of the lateral and medial condyle (longer)

Question 9

Name the two joints that comprise the articulation at the knee.

Answer 9

tibiofemoral joint and patellofemoral joint (fibula articulates with the tibia only)

Question 10

Describe two extreme variations of the Q-angle.

Answer 10

Q-angle (angle between vertical axis and axis of the femoral shaft) if exaggerated is genu valgum (proximal tibia is medially direct- knock-kneed) or genu varus (proximal tibia is lateral directed- bow-legged)

Question 11

Synovial cavity excludes _____ ligaments and infra patellar ___ ____.

Answer 11

intracapusular ligaments and infra patellar fat pad

Question 12

Fibrous joint capsule of the knee surround the femur and tibia _____, _____ and _____ (direction) thereforearthrocenteiss should be done from what angle?

Answer 12

joint capsule posteriorly, laterally and medially, arthrocentesis from the superior-lateral joint capsule

Question 13

Name the 5 ligaments of the knee.

Answer 13

fibular (lateral) collateral
tibial (medial) collateral 
anterior cruciate  
posterior cruciate 
posterior capsular (resists hyperextension)

Note: when knee is flexed, the MCL and LCL resist rotation together

Question 14

Describe the attachments of the menisci and their role in the knee joint

Answer 14

medial meniscus is attaché to the MCL, both menisci are connected by tendons to the center joint capsule

function: increased surface area of joint (creates rounded cup for femur, disperses weight around joint), helps with synovial fluid distribution and help with rotation of the knee

Question 15

Which bone moves in relation to the other in medial rotation of the knee joint?

Answer 15

medial rotation of the femur on the fixed tibia because the foot is planted (occurs when knee is in full extension and allows ligaments to be tight and very stable)

Question 16

When is the knee most susceptible to lateral damage?

Answer 16

when it is (partially) flexed

Note: women at a greater risk because of generally larger Q-angle

Question 17

Describe the innervation of the thigh based on its divisions.

Answer 17

anterior division which is posterior (obturator and tibial nerves) and posterior division which is anterior (femoral)

Question 18

Describe the innervation of the leg based on its divisions.

Answer 18

anterior division which is posterior (deep fibular and superficial fibular and posterior division, which is anterior is supplied by the tibial nerve

Question 19

Name the two nerves that form from branches of L3-4.

Answer 19

Femoral (posterior) and obturator (anterior)

Question 20

Name the nerves that form from branches of L4-S3.

Answer 20

Sciatic nerve: tibial (anterior) and common fibular (posterior)

Question 21

Name the nerve branches the come directly off the ventral lumbar vertebra T12-L3 (5)

Answer 21

subcostal (T12)
iliohypogastric and ilioinguinal (T12-L1) a
genitofemoral (L1-2)
lateral femoral cutaneous (L2-3)

Question 22

Pudendal nerve is branches of what spinal levels?

Answer 22

S2-4

Question 23

What nerves must you avoid when giving an intramuscular injection?

Answer 23

sciatic nerve, and superior/inferior gluteal nerves (aim anterior) and superior

Question 24

What is the unhappy triad?

Answer 24

tibial collateral ligament, medial meniscus and anterior crutiate ligament injury

Question 25

What are the functions of the compartments of the lower limb?

Answer 25

compartments assist with muscle action and help with venous return, can be a problem when they cannot expand during compartment syndrome Note: iliotibial band functions as a long portion of fascia that gluteal muscles insert into

Question 26

Name the four muscles associated with the gluteal region and how they are innervated.

Answer 26

gluteus maximus (inferior gluteal nerve) gluteus medius gluteus minims tensor fascia lata (superior gluteal nerve)

Question 27

___ ___ and ____ ____ are the major abductors of the hip.

Answer 27

gluteus medius and gluteus minimus

Question 28

What is the Trendelenburg sign?

Answer 28

weakness causing contralateral side to descend (weakness in the gluteal muscles that would stabilize the pelvis while walking)

Question 29

Name the lateral rotators.

Answer 29

``` P-GOGO-Q piriformis gemellus superior obturator inturnus Gemellus inferior obturator externus quadrates femurs ``` (Action lateral rotation of the hip)

Question 30

How are the lateral rotators innervated?

Answer 30

by a nerve that includes the muscle name (nerve to the ___) except obturator externus (obturator nerve)

Question 31

What are the muscles that contribute to the iliopsoas and what is its action/innervation?

Answer 31

psoas major (ventral rami L1-L3) and iliacus muscles (femoral nerve); action: flexion at the hip

Question 32

Where does the sartorius ornate and insert? How is it innervated

Answer 32

femoral nerve innervates the sartorius, attaches at the ASIS and the medial tibia (actions at the hip and the knee)

Question 33

Name the 4 quadriceps muscles and their innervation.

Answer 33

quadriceps femoris (only of quads that crosses the hip), vastus lateralis, vastus intermedius and vast us medialis (all come together in the quadriceps over the patella; innervated by the femoral nerve

Question 34

Where does the pectinous muscle originate and insert? What innervates it?

Answer 34

pectinate line on the pubic bone to the pectinate line on the medial femur; innervated by the femoral nerve or the obturator nerve

Question 35

Name the medial thigh muscles and their innervation. (main actions to adduct and medially rotate)

Answer 35

``` adductor longus (superficial- obturator), adductor brevis (deep-obturator) adductor magnus (straddles midline- obturator/tibial nerve) gracilis (midline- obturator nerve) **pubic bone to the medial tibia ```

Question 36

Name the posterior thigh muscles and their innervation.

Answer 36

semitendinous (back of pelvis to medial tibia) tibial nerve ** round tendon semimembranosus (back of pelvis to medial tibia) tibial nerve **flat tendon long head of biceps femoris (ischium to lateral fibula) tibial nerve short head of biceps femurs (linea aspire to the lateral fibula) common fibular nerve

Question 37

Which tendons form the per anserinus (goose foot)?

Answer 37

sartorius (anterior) gracilis (medial) and semitendinosus (posterior) join at the medial knee