Hip, buttock and thigh Flashcards
What happens to the lower limb during development?
It twists, resulting in permanent pronation at mid-thigh level
What specific words are given to the flexion and extension of the foot?
Dorsiflexion (pointing toes up)
Plantarflexion (pointing toes down)
What are the 3 parts of the pelvis (hip bone)?
Ilium
Ischium
Pubis
What marks the ends of the iliac crest?
ASIS + PSIS
What is the name given to the surface of the hipbone that articulates with the sacrum?
Auricular Surface
What lies in between the greater and lesser trochanters of the femur?
Intertrochanteric line
What short ridge is found just inferior to the lesser trochanter?
Gluteal tuberosity
A longer ridge downwards along the shaft of the femur and originates from the short ridge below the lesser trochanter. What is this long ridge called?
Linea aspera
Which tubercle is found just superior to the medial epicondyle of the femur?
Adductor tubercle
What is the anterior protrusion between the ilium and the pubis called?
Iliopubic eminence
What are the two notable parts of the ischium onto which ligaments attach?
Tuberosity + spine
Which pelvic bones make up the acetabulum?
All 3 (ilium, ischium + pubis)
What notches are present on the posterior aspect of the pelvis?
Greater sciatic notch + lesser sciatic notch
What is the angle of inclination?
The angle between the long axis of the shaft + long axis of the head + neck
What determines the size of the angle between the long axis of the shaft and the vertical plane?
Width of the hips
What structures form the greater and lesser sciatic foramina?
Sacrospinous ligament
Sacrotuberous ligament
What are the two fascia found in the thigh?
Superficial fascia e.g. subcutaneous tissue
Deep fascia- fascia lata
What is the name given to the lateral thickened area of the fascia lata?
Ilio-tibial tract
What are the 4 compartments of the thigh region?
Gluteal compartment
Anterior compartment of the thigh
Medial compartment of the thigh
Posterior compartment of the thigh
What movements are the muscles of the gluteal region responsible for?
Extension, abduction + external rotation of the hip
What are the gluteal muscles?
Gluteus maximus
Gluteus medius
Gluteus minimus
(tensor fasciae latae)
What are the short external rotators of the hip?
Piriformis
Obturator internus
Quadratus femoris
Gemelli (superior + inferior)
Describe the attachments of gluteus maximus.
Proximal: posterior part of the iliac crest + thick fascia of the sacrum + coccyx
Distal: gluteal tuberosity + ilio-tibial tract
What proportion of the gluteus maximum fibres attach to the gluteal tuberosity?
~ 25% attach to the gluteal tuberosity
The rest attach to the ilio-tibial tract
What does the ilio-tibial tract insert into?
Anterolateral tubercle of the tibia
Describe the attachments of gluteus medius.
Proximal: broad attachment to the external surface of the ilium (between anterior + posterior gluteal lines)
Distal: greater trochanter
Describe the attachments of gluteus minimus.
Proximal: broad attachment to the external surface of the ilium (between anterior+ inferior gluteal lines)
Distal: greater trochanter
What movement are gluteus medius and gluteus minimus responsible for?
Abduction
What movement are the deep muscles of the gluteal region responsible for? What is their other function?
Lateral rotation
Also stabilise hip joint
Describe the attachments of tensor fasciae latae.
Proximal: ASIS
Distal: ilio-tibial tract
Which compartment is tensor fasciae latae in?
Neurologically: a gluteal compartment muscle because it is innervated by the superior gluteal nerve
Action= flexor of the hip so it functions more like an anterior compartment muscle
Describe the attachments of obturator internus.
Rim of the obturator foramen
Greater trochanter of the femur
What movement are the muscles of the anterior compartment of the thigh responsible for?
Hip flexion
Knee extension
Which muscles are in the anterior compartment of the thigh?
Pectineus Ilio-psoas (Tensor fasciae latae) Sartorius Quadriceps (rectus femoris, vastus medialis, vastus intermedius, vastus lateralis)
What is the most powerful flexor of the hip?
Ilio-psoas
Describe the attachments of Ilio-psoas.
Psoas major attaches to the lateral parts of the lumbar vertebrae + T12 + Iliacus attaches to the iliac fossa + crest
The 2 muscles converge to form a common tendon that attaches to the lesser trochanter
Describe the attachments of Sartorius. What movement is it responsible for?
Sartorius comes off ASIS, descends inferiorly + medially. It crosses the knee + attaches to the upper part of the shaft of the tibia
Describe the arrangement of the quadriceps muscles.
Rectus femoris is most superficial with vastus medialis + vastus lateralis on either side of rectus femoris
Vastus intermedius is deep to rectus femoris
Where do the quadriceps attach distally?
Join to form a quadriceps tendon, which attaches to the patella
There is a patellar tendon between the patella + the tibial tuberosity on the anterior of the tibia
The patellar tendon is part of the quadriceps tendon with the patella in between as a sesamoid bone
What small muscle is found underneath vastus intermedius?
Articularis genu
What bursa is found just above the knee joint?
Suprapatellar bursa
What movement are the muscles in the medial compartment of the thigh responsible for?
Adduction of the hip
Which muscles make up the medial compartment of the thigh?
Obturator externus Gracilis Adductor brevis Adductor longus Adductor magnus
Where do most of the muscles of the medial compartment attach proximally?
Pubic bone
Describe the structure of adductor magnus.
Broad attachment to shaft of the femur (medial lip of linea aspera) + a smaller attachment to adductor tubercle (just above medial epicondyle)
Gap inbetween= Hiatus of adductor magnus
What movements are the muscles of the posterior compartment of the thigh responsible for?
Hip extension
Knee flexion
Which muscles make up the posterior compartment of the thigh?
Semitendinosus
Semimembranosus
Biceps femoris
Where do the muscles of the posterior compartment attach proximally?
Ischial tuberosity
Describe the attachments of biceps femoris.
Long head of biceps femoris comes from the ischial tuberosity + short head comes off the shaft of the femur (lateral lip of linea aspera)
They cross over laterally to attach to the head of the fibula
What are the borders of the femoral triangle?
Superior: Inguinal Ligament
Lateral: Sartorius
Medial: Adductor Longus
What are the contents of the femoral triangle (lateral to medial)? What mnemonic can be used to remember this?
Femoral Nerve
Femoral Artery
Femoral Vein
Deep inguinal lymph nodes
NAVY
What is the name given to the opening in the fascia lata over the femoral triangle and what is its purpose?
Saphenous Opening: allows draining of the long saphenous vein into the femoral vein
Margin of saphenous opening = Falciform Margin
What structures form the Adductor Canal?
Anterior: Vastus Medialis
Posterior: Adductor Longus + Adductor Magnus
Medial: Sartorius
What are some other names for the Adductor Canal?
Hunter’s Canal
Subsartorial Canal
What are the contents of the Adductor canal?
Femoral artery
Femoral vein
Saphenous nerve (major branch of femoral nerve)
Where does the sciatic nerve lie within the gluteal region?
Inferior medial quadrant
What two nerves does the sciatic nerve divide to form?
Tibial Nerve
Common Peroneal Nerve
Where would you perform an intramuscular injection into the gluteal region?
Superior lateral quadrant
What does the sciatic nerve supply?
All hamstring muscles
All muscles below the knee (supplied by the 2 branches of the sciatic)
What test is used to assess the function of the hip abductors?
Trendelenberg test
Patient lifts 1 foot off the floor, their hip abductors (gluteus medius + minimus) should contract to keep the pelvis level despite the extra weight of the raised foot on the opposite side
Describe the structure of the acetabulum.
Acetabulum has a depression in the middle (acetabular fossa) + a lunate surface (surrounding the fossa)
The acetabular notch is filled in by the transverse acetabular ligament
What runs within the capsule of the hip joint?
Blood supply to femoral head
What are the ligaments of the hip joint?
Iliofemoral ligament (Y shaped)
Ischiofemoral ligament
Pubofemoral ligament
Transverse acetabular ligament
Describe how the arrangement of the hip ligaments changes when the hip is flexed and extended.
Flexed: ligaments relaxed
Extended (e.g. when standing): ligaments spiral, which pulls the head of the femur into the acetabulum + helps stabilise the joint when standing
Describe the blood supply to the head of the femur.
Main blood supply is via the medial + lateral circumflex femoral arteries (from profunda femoris)
Also a small blood supply from artery of the head of the femur (branch of obturator artery- more important in children)
What type of hip fracture is most likely to need a hip replacement and why?
Intracapsular: more likely to disrupt the blood supply + cause avascular necrosis of the head of the femur
When does the external iliac artery become the femoral artery?
As it passes under the inguinal ligament
What main branch does the femoral artery give off that gives rise to the medial and lateral circumflex femoral arteries?
Profunda femoris
At what point do the superficial femoral artery and the femoral vein become the popliteal artery and vein?
As they pass through the hiatus of adductor magnus from the anterior to posterior compartment
Which arteries, that supply the buttock and thigh, are branches of the internal iliac?
Superior + Inferior gluteal arteries
Obturator artery
What is the main superficial vein of the thigh?
Long saphenous vein
What other veins drain into the saphenous vein before it enters the sapheno-femoral junction?
Superficial circumflex iliac
Superficial epigastric
Superficial external pudendal
Lateral cutaneous vein of thigh
What are the deep veins of the thigh?
Popliteal vein Femoral vein External iliac vein Sapheno-femoral junction Venae comitantes of the profunda femoris artery
What are the main groups of lymph nodes in the thigh?
Deep inguinal lymph nodes
Superficial inguinal lymph nodes
External iliac lymph nodes
Which nerve supplies the anterior compartment of the thigh and which division of the lumbosacral plexus gives rise to this?
Femoral nerve: posterior division of the lumbosacral plexus (L2,3,4)
Which nerve supplies the medial compartment of the thigh and which division of the lumbosacral plexus gives rise to this?
Obturator nerve: anterior division of lumbosacral plexus (L2,3,4)
State which roots are responsible for: Hip flexion Hip extension Knee extension Knee flexion
Hip flexion: L2,3
Hip extension: L4,5
Knee extension: L3,4
Knee flexion: L5, S1
Which nerve supplies the posterior compartment of the thigh, posterior and anterior leg and foot, and which nerve roots give rise to this nerve?
Sciatic nerve (L4,5 + S1,2,3)
Which nerves supply the gluteal muscles and which nerve roots give rise to these nerves?
Superior gluteal nerve (L4,5 + S1)
Inferior gluteal nerve (L5 + S12)
Which nerve roots are responsible for the sensory segmental supply to the:
Front of the thigh
Back of the thigh
Buttock
Front of the thigh: T12, L1,2,3
Back of the thigh: S1,2,3
Buttock: S2,3,4
Which nerve roots give rise to the following sensory peripheral nerves:
Subcostal nerve: T12
Ilio-hypogastric nerve: L1
Ilio-inguinal nerve: L1
Genito-femoral nerve: L1,2
Lateral cutaneous nerve of the thigh: L2,3
Sensory branches of the femoral nerve: L2,3,4
Sensory branches of the obturator nerve: L2,3,4
Posterior cutaneous nerve of the thigh: S2,3
Saphenous nerve: L2,3,4
Buttock nerves from the sacral plexus: L1-S3
Where are the most common sites of fracture on the femur?
Femoral neck
Intertrochanteric fracture
How do the semimembranosus and semiteninosus differ in appearance?
Tendinosus: forms a more classic tendon (rope like)
Membranosus: forms a flat, membranous, strap like tendon
Where odes the sciatic nerve usually enter the gluteal region?
Inferior to piriformis, but can be superior or pierce muscle itself
Which 2 actions can adductor Magnus perform?
Anterior portion: Hip flexion
Posterior portion: Hip extension
Where do dermatomes L3 and L4 extend?
L3 to the knee
L4 to the floor (foot)
