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AoL > Hip, buttock and thigh > Flashcards

Hip, buttock and thigh Flashcards

1
Q

What occurs during development to the lower limb

A

Twisting of the lower limb during development:

permanent pronation at the mid-thigh level

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2
Q

What are the two regions of the lower limb

A

The gluteal region (part of the trunk)
and
the “free lower limb” (thigh, leg and foot)

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3
Q

Which movements can happen at the hip

A 
flexion (L2/3), extension (L4/5) 
lateral external rotation (L5,L1), 
medial internal rotation (L123), 
Adduction (L1-4), 
Abduction (L5,S1)
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4
Q

By how many degrees can the hip laterally and medially rotate

A

Medial internal rotation: 50 degrees

Lateral external rotation: 40 degrees

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5
Q

What are the bones in this region of the lower limb

A 
The pelvis (the “hip bone”)
-Ischium
-Ilium
-pubis
The femur
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6
Q

At what age is the synostosis complete

A

This is between the ischium and the pubis…

at age 9 is completed

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7
Q

What is the name of the cartilage within the acetabulum

A

The triradiate cartilage

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8
Q

What is the name of the surface where the sacrum and the pelvic bone meet

A

Auricular surface

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9
Q

What makes up the acetabulum

A

Articular (lunate) surface and the acetabular fossa

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10
Q

What is the angle of inclination

A

Angle between the long axis of the shaft and the long axis of the head/neck of the femur

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11
Q

Which occurs more laterally, a fracture of the femoral neck, or a intertrochanteric frature

A

Intratrochanteric fracture is more lateral. This effectively marks the end of the neck of the femor

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12
Q

Which two ligaments are involved in the formation of the greater and the lesser sciatic foramina

A

Sacrotuberous and sacrospinous….

appreaciate how these work and how the lesser leads back into the pelvis

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13
Q

Which structures pass through the leser sciatic foramen

A

The pudendal nerve, the internal pudendal vessels and the tendon of obturator internus muscle

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14
Q

Which muscle is related to the greater sciatic notch

A

Piriformis… some structures pass above and others pass below it

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15
Q

What are the two types of fascia in this region

A

Superficial fascia – i.e. subcutaneous tissue

Deep fascia – in the thigh called fascia lata

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16
Q

What is the iliotibial tract

A

A lateral thickened area of the fascia lata

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17
Q

What fascia can be found in the popliteal fossa

A

popliteal fascia (deep fasia over popliteal fossa)

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18
Q

Outline the structure of the iliotibial tract

A

The fascia lata is a fibrous sheath that encircles the thigh like a subcutaneous stocking and tightly binds its muscles. On the lateral surface, it combines with the tendons of the gluteus maximus and tensor fasciae latae to form the iliotibial band

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19
Q

Where does the iliotibial tract go from/to

A

extends from the iliac crest to the lateral condyle of the tibia

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20
Q

What is the funtion of the tensor fasciae latae

A
  1. Flexion of the hip
  2. Abducts hip
  3. Medially rotates hip
  4. Stabilises hip (holds femoral head in acetabulum), especially during A/P tilting of pelvis when 1 leg supports all of the body weight
  5. Stabilises extended knee
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21
Q

Which muscle compartments are found in the region

A

Gluteal compartment
Anterior compartment of the thigh
Medial compartment of the thigh
Posterior compartment of the thigh

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22
Q

Which muscles are present in the gluteal region of the thigh

A

EXTENSORS, ABDUCTORS and EXTERNAL ROTATORS of the hip

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23
Q

State the two groups of muscles in the gluteal region and the names of the muscles in them

A

Gluteal muscles

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • (Tensor fasciae latae)

Short external (lateral) rotators of the hip

  • Piriformis
  • Obturator internus
  • The gemelli (sup. and inf.)
  • Quadratus femoris
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24
Q

Where do all of the short external rotators of the hip have their distal attachments

A

Piriformis… onto greater trochanter by round ligamnet

Obturator internus and the gemelli both onto the medial aspect of the greater trochanter by a common tendon

Quadrarus femoris on the quadrate tubercle on the intertrochanteric crest of teh femor

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25
Q

Where exactly does the iliotibial tract insert onto the tibia

A

Anterolateral (Gerdy) tubercle of tibia

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26
Q

Which is the largest muscle in the bodu

A

Gluteus maximus

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27
Q

What is the lateral intermuscular septum and where does it attach

A

fold of deep fascia in the thigh

Attaches to the iliotibial tract (laterally) and runs in a corona plane towards the lateral side of the femur

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28
Q

Outline the different parts of gluteus maximus

A

Superficial 3/4,,, which attaches to the iliotibial tract…

deep distal 1/4 which attaches to the gluteal tuberosity of the femur

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29
Q

What is the proximal attachment of gluteus maximus

A

Posterior gluteal line of ilium. dorsal surface of sacrum and coccyx and sacrotuberous ligament

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30
Q

What are the proximal and distal attachments of the gluteal muscles

A

On the diagam, from top to bottom its maximum, medius then minimus for origin

ORIGIN:
G. max from the posterior glteal line, dorsal sacrum and coccyx and sacrtuberous lig.

G med. from the external surface of ilium between anterior and posterior gluteal line

G min. external surface of iliu, between anterior and inferior gluteal line

(note that the glut. min is most deep, then medius then maximus)

EXTERNAL
max:iliotibial tract and some to the gluteal tuberosity of femur

med: greater trochanter of femur
min: greater trochanter of femur

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31
Q

What is the proximal attachment of piriformis, obturator intermus, gemelli and quadratus femoris

A

piriformis: anterior surface of 2nd-4th sacral segments adn sacrotuberous ligament

Obturator internus: pelvic aspect of obturator membrane and the bones surrounding obturator foramen

gamelli: superior, from ischial spine. inferior, from ischial tuberosity

Quad. femoris: from lateral border of ischial tuberosity

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32
Q

Which part of gluteus maximus attaches to the gluteal tuberosity

A

Inferior half of the deep part

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33
Q

Where does the sciatic nerve emerge

A

under piriformis

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34
Q

What are the names of the four bursas in this gluteal region

A

Bursa of obturator interns

Ischial bursa

Trochanteric bursa

Gluteofemoral bursa

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35
Q

Which muscle types are present in the anterioa compartment of the thigh

A

Hip Flexors and Knee Extensors

```
Pectineus
Ilio-psoas
Tensor fasciae latae
Sartorius
Quadriceps femoris
~~~

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36
Q

What are the names of the four quadriceps femoris muscles

A

Rectus femoris
Vastus medialis
Vastus intermedius
Vastus lateralis

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37
Q

Which is the longest muscle in the bod

A

The sartorius..

but it’s not particularlystrong

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38
Q

Which out of the quadriceps femoris muscles cross the hip and knee joint

A

The rectus femoris

… thus this aids ilio-psoas in hip flexion and also extends the leg at the knee via the patellar ligament

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39
Q

Which muscle in the anterior compartment of the thigh has an additional function to flexion of hip or extension of leg

A

Pectineus— adducts too

technically netters actually says this is a medial compartment muscle

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40
Q

What is odd about pectineus

A

It is part of the medial compartment, but innervated by teh femoral nerve, which is typical of anterior compartment muscles

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41
Q

T/f vastus medialis is the middle vastus muscle

A

F… it’s medial.

Behind the lateralis and medialis is the vastus intermedius

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42
Q

How are muscles from the anterior compartment of the thigh linked to the patella

A

Quadriceps femoris (the vastus muscles and rectus femoris) insert to the patella by the QUADRICEPS FEMORIS tendon.

Then to the tibia by the PATELLAR LIGAMENT

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43
Q

Differentiate the actions of the vastus muscles and rectus femoris

A

Rectus femoris attaches to ASIS and the ilium above the acetabulum,

whereas the vastus muscles originate from the femur.

SO RECTUS FEMORIS acts across knee and hip joint. Vastus just knee

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44
Q

Which is the most superifical muscle in the anterior compartment of teh thight

A

Sartorius

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45
Q

Where does sartorius attach

A

SUPERIOR portion of medial surface of the tibital shaft, anteror to insertions of semitendinosus and gracilis.

SO ON THE MEDIAL SHAFT OF TIBIA (posteriorly to anterior) it goes tendon of semitendinosus, gracilis, sartorius

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46
Q

Why is sartorius important

A

At it’s upper third, the MEDIAL border of sartorius forms the LATERAL border of teh femoral triangle

In the middle third, it forms the anterior wall of the adductor canal

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47
Q

General rules of thumb for nerves

A

ANTERIOR COMPARTMENT….

femoral nerve for all

bare in mind two come from abdomen

  1. Iliacus (also femoral)
  2. Psoas (anterior rami L1-L3)

MEDIAL COMPARTMENT:

obturator nerve

apart from

  1. pectineus (femoral)
  2. part of adductor magnus (sciatic)

POSTERIOR COMPARTMENT:

sciatic nerve (for all hamstrings)

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48
Q

What is articularis genu

A

Small muscles originating below vastus inermedius, pulls suprapatellar bursa away from patellar during extension

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49
Q

Where is the apex of the patella

A

The bottom

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50
Q

What muscles are present in the medial compartment of the thigh

A 
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
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51
Q

Funvtion of medial compartment muscles

A

All adduct the thigh, apart from obturator externus which laterally rotates the thigh at the hip.

Adductor longus and magnus also medially rotate

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52
Q

What is the significantce of adductor lingus

A

Contributes floor of and its medial border is the medial border of femoral triangle

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53
Q

Outline from anterior to posterior the adductor muscles

A

Anterior first:

pectineus and adductus longus

adductus brevis

adductus magnus and obturator externus

54
Q

What is the adductor hiatus

A

It is the gap between the ‘adductor part’ of the adductor magnus (laterally) and the ‘hamstring part’ (medially). The lateral part inserts onto the shaft of the femur whereas the medial part inserts onto the adductor tubercle.

A gap between these two insertions= adductor hiatus

55
Q

Outline the innervatn of the adductor magnus

A

Lateral/adductor part= obturator

Medial/hamstring part= tibial division of sciatic nerve

56
Q

Which muscle is supplied by the posterior branch of the obturator nerve

A

The obturator muscle

57
Q

What is present in the posterior compartment of the thigh

A

Knee flexors and hip extensors

=THE HAMSTRINGS

58
Q

What are the hamstrings

A

Semimembranosus

Semitendinosis and biceps femoris

59
Q

What is the function of the hamstring muscles

A

Flex leg at the knee, extend the thigh at the hip. Rotate at the knee and the hip

60
Q

T/F all the hamstrings cross both the knee and the hip

A

F… short head of biceps femoris does not cross the knee

61
Q

Where does biceps femoris insert

A

Long and short head join to form a tendon which inserts onto the fibular head.

Extensions from this tendon blend with fibular collateral ligament

62
Q

T/f the biceps femoris both flexes the knee and extends and laterally rotates the hip

A

T… but only the long head extends and laterally rotates the hip

(because the short head originates from the femur not the pelvis)

63
Q

Function of semitendionsus

A

Flex knee, extend hip, medially rotate knee and hip (working w semimembranosus)

64
Q

Outline the origina dn insertin of semitendinosus

A

Origin is with long head of biceps femoris at the ischial tuberosity

Insertion is on the medial condyle. The gracilis inserts anteriorly to this, and the sartorius anterior still

65
Q

T/F the semimembranosus is superficial to the biceps femoris and the semitendinosus

A

F… it is deep to these structrus

66
Q

Outline the boundaries of the femoral triangle

A

Superiorly – the inguinal ligament
Medially – adductor longus
Laterally - sartorius

67
Q

What passes through the femoral triangle

A

Femoral nerve
Femoral artery
Femoral vein

68
Q

Where does the lateral cutaneous nerve of the thigh come from

A

nerve of the lumbar plexus. It arises from the dorsal divisions of the second and third lumbar nerves (L2-L3)

69
Q

What forms the roof and base of the femoral triangle

A

Anteriorly, the roof of the femoral triangle is formed by the fascia lata.
Posteriorly, the base of the femoral triangle is formed by the pectineus, iliopsoas and adductor longus muscles.

70
Q

In which fasica is the femoral canal contained

A

Within the iliacus fascia

71
Q

What is the saphenous opening

A

The saphenous vein, which runs superficially, enters the saphenous opening (an opening in the fascia lata, which overlies the femoral canal), to join the femoral vein

72
Q

Differentiate the femoral canal, femoral sheath and fascia lata

A

Femoral canal is basically a division in the iliacus fascia through which femoral artery, vein and lymphatiucs pass.

The femoral sheath is a downward continuation of the iliacus fascia to continue surrounding the vessels (but it stops at the saphenous opening)

The fascia lata the ncovers over the iliacus fascia containing the femoral vessels.

73
Q

Where does the femoral artery lie relative to the vein in the femoral canal

A

It lies lateral. The vein, artery and lympathics are deparated by septa.

74
Q

What is the iliopectineal arch

A

thickened band of fused iliac fascia passing from the posterior aspect of the inguinal ligament anteriorly across the front of the femoral nerve to attach to the iliopubic eminence of the hip bone posteriorly

75
Q

What forms the adductor canal

A 
Vastus medialis (anteriorly)
Adductor longus and adductor magnus (posteriorly)
Sartorius (medially)
76
Q

What is contained within the adductor canal

A

Femoral artery
Femoral vein
Saphenous nerve

77
Q

Where is the femoral artery compared to the femoral vein in the adductor canal

A

Artery is medial to the vein

The nerve is anterior to bot these structures

78
Q

Generally, what do the greater and lesser sciatic foramina contain

A

Greater sciatic foramen: structures passing from the pelvis to the thigh
Lesser sciatic foramen: structures passing from the pelvis to the perineum

79
Q

State the course of the sciatic nerve

A

Passes from pelvis to buttock via greater sciatic notch/foramen

80
Q

Where does the sciatic nerve lie in the buttock

A

In the buttock, lies in the inferior and medial quadrant

81
Q

What are the divisions of the sciatic nerve

A

tibial nerve and the common peroneal nerve

82
Q

What does the sciatic nerve supply

A

Supplies all the hamstring muscles and all the muscles below the level of the knee

83
Q

Where should muscles into the buttock occur

A

use the superior and lateral quadrant

84
Q

Which other nerve should be avoided in intramuscular injectiuon into the buttocks

A

superior gluteal nerves and vessels

85
Q

Where does the superior gluteal nerve come from, and what is its course

A

dorsal divisions of the L4, L5 and S1. It leaves the pelvis through the greater sciatic foramen above the piriformis, accompanied by the superior gluteal artery and the superior gluteal vein

86
Q

What is the Trendelenberg test

A

the abductors of the thigh prevent tilting of the pelvis when a limb is raised

if thigh tilts, then these abductors are paralysed

87
Q

What type of joint is the hip joint

A

Synovial ball and socket joint

Head of the femur and the acetabulum

88
Q

What is the name of the cartilage surrounding the acetabulum

A

ring of cartilage that surrounds the acetabulum of the hip= acetabular labrum

89
Q

What are the boundaries pof the joint capsule of the hip joint

A

The capsule of the hip joint attaches to the edge of the acetabulum proximally. Distally, it attaches to the intertrochanteric line anteriorly and the femoral neck posteriorly.

90
Q

T/F the joint capsiule extends further anteriorly than posteriorly

A

T

91
Q

The ligament of the head of the femur is continuyous with which hstructure

A

Transverse acetabular ligament

92
Q

Where does the ligament of the head of femur attach to the head of the femur

A

at the fovea

93
Q

What are the three capsular ligament of the hip

A

Ilio-femoral ligament
Pubo-femoral ligament
Ischio-femoral ligament

94
Q

What is the orbicular zone

A

……..

95
Q

What us the blood supply to the head of the femur

A

The branches all come from the profunda femoris

96
Q

Outline the blood vessels supplying the head of the femur

A

Deep profundus gives rise to medial and lateral circumflex femoral artery which wrap around the greater trochanter.

From the obturator artery comes the ACETABULAR BRANCH (i.e artery to head of femur) this lies WITHIN the ligament to the head of the femur

97
Q

Why is the head of the femur more important in children?

A

……

98
Q

What can fracture of the nek of the femur cause

A

fracture at the neck can lead to avascular necrosis of the head

99
Q

Which muscles flex the hip

A 
Ilio-psoas
Sartorius
Tensor fascia lata
Rectus femoris
Adductor longus
Adductor brevis
Adductor portion of adductor magnus
gracilis
100
Q

Which muscles adduct the hip

A 
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Pectineus
Obturator externus
101
Q

Which msucles extend the hip

A

The hamstrings – semimembranosus, semitendinosus, biceps femoris
Posterior part of adductor magnus
Gluteus maximus

102
Q

Which muscles abduct the hip

A

Gluteus medius
Gluteus minimus
Tensor fascia lata

103
Q

Which musclkes externally rotate the hip

A 
Obturator internus and obturator externus
The Gemelli
Piriformis
Quadratus femoris
Gluteus maximus
104
Q

Which muscles internally rotate the hip

A

Anterior portion of gluteus medius
Anterior portion of gluteus minimus
Tensor fascia lata

105
Q

Outline the arteries supplying this regin

A

External iliac artery

Femoral artery

Profunda femoris artery

Circumflex vessels

Femoral artery continues as superficial femoral artery ad then the popliteal artery

106
Q

Where does the femoral artery lie

A

between the femoral vein (medial) and the femoral nerve (lateral)

107
Q

Where does the femoral artery begin

A

midinguinal point

108
Q

Where does the femoral artery travel around the knee medially

A

through the adductor hiatus

109
Q

Where does the femoral artery continue to at the knee

A

After passing posteriorly through the adductor hiatus it runs as the popliteal artery between the medial and lateral condyles of the femur

110
Q

What are the retinacular arteries

A

branches of the medial and lateral circumflex femoral arteries that extend to the head of the femur within the retinacular folds of synovial membrane surrounding the neck of the femur.

111
Q

When are the femoral artery and vein then called the popliteal artery and vein

A

pass from the anterior compartment to the posterior of the knee (the popliteal fossa) through the hiatus of adductor magnus muscle

112
Q

What are the superficial veins of the thigh

A

Long saphenous vein

Joins the femoral artery at the sapheno-femoral junction

Valve!

113
Q

What are the deep veins of the thigh

A

Popliteal vein

Femoral vein

External iliac vein

Sapheno-femoral junction

Venae comitantes of the profunda femoris artery

114
Q

Outline the lymphatic drainage of the thigh and buttock region

A

Lymph flows with the superficial and deep veins
Superficial inguinal lymph nodes
Deep inguinal lymph nodes
External iliac lymph nodes

115
Q

Where are the deep lymph nodes located

A

Within the opening for the great saphenous vein

116
Q

Where do exteranl iliac lymph nodes drain to

A

To common ilial lymph nodes then

To lateral lumbar (caval/aortic) lymph nodes and lubar lymphatic trunks

117
Q

Where does teh femoral nerve pass

A

From the plexus, under the inguinal ligament

118
Q

What does the sciatic nerve supply

A

Sciatic n. (or its terminal branches Tibial and Common Peroneal ns.) supply the remaining compartments (i.e. post. thigh, ant. and post. leg, foot)

119
Q

Outline the motor segmental supply…

what spinal cord levels perform the following:

hip flexors

hip extensors

knee extensors

knee flexors

A 
Hip Flexors
L23
Hip Extensors
L45
Knee Extensors
L34
Knee Flexors
L5S1
120
Q

Outline the motor peripheral supply to the anterior thigh compartment

A

Femoral nerve.

Posterior divisions of lumbar plexus L234

121
Q

Outline the motor peripheral supply to the medial thigh compartment

A

Obturator Nerve

Anterior divisions of the lumbar plexus (L234)

122
Q

Outline the motor peripheral supply to the posterior thigh compartment

A

Sciatic nerve (L345S12)

123
Q

Outline the motor peripheral supply to the gluteal compartment

A

Superior gluteal nerve (L45S1) – gluteus medius and minimus

Inferior gluteal nerve (L5S12) – gluteus maximus

124
Q

Gluteus maximus is supplied by which nerve

A

inferior gluteal nerve

125
Q

Outline the sensory segmental supply to:

Front of thigh
Back of thigh
Buttock

A

Dermatomal distribution
Front of the thigh : T12, L123
Back of the thigh : S123
Buttock S234

126
Q

Outline the sensory peripjeral supply to the lower limb

A

Subcostal nerve (T12)
Ilio-hypogastric nerve (L1)
Ilio-inguinal nerve (L1)
Genito-femoral nerve (L12)
Lateral cutaneous nerve of the thigh (L23)
Sensory branches of the femoral nerve (L234)
Sensory branches of the obturator nerve (L234)
Posterior cutaneous nerve of the thigh (S23)
Saphenous nerve (L234)
Buttock nerves from the scaral plexus (L1-S3)

127
Q

What is plantar flexion

A

(raising heel relative to toe… e.g. going on tip toes

128
Q

What is dorsiflexion adn plantar flexion

A

Plantarflexion is true flexion

Dorsiflexion is true extension

129
Q

What is the acetabular notch

A

The area at the bottom of the aetabulum which is without articular surface

130
Q

What is the acetabular notch filled with

A

The trasnverse acetbaular ligament… this gives rise ot the ligament of the head of the femur

131
Q

Note that the femral nerve has the posterior divisions from lumbo-sacral plexus even though it innervates anterior muscles (because the limb is pronated)

A

….

132
Q

Which structures pass through the greater sciatic foramen, above and below piriformis?

(from self tests)

A

Above piriformis: Superior gluteal nerve, artery and vein.

Below piriformis: Inferior gluteal nerve, artery and vein, sciatic nerve, pudendal nerve.

AoL (9 decks)

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