hip, buttock and thigh

Question 1

DIAGRAM bones of pelvis and important point

Answer 1

sacrum, coccynx, and the 2 pelvic bones (ilium, ischium and pubis) image always of RIGHT PELVIC bone ALL muscles above knee attach to pelvic bone proximally

Question 2

DIAGRAM parts of pelvis

Answer 2

ded

Question 3

DIAGRAM acetabulum

Answer 3

all 3 parts of pelvic bone part of it: lunate surface, the fossa, and the notch as well

Question 4

DIAGRAM ligaments of pelvis and function

Answer 4

sacrospinous between sacrum and ischial spinous process sacrotuberous- prevent sacrum and ischial TUBEROSITY, preventing upward tilting of sacrum

Question 5

foramina of pelvis

Answer 5

greater has structures leaving pelvis to lower limb, less rather to perineum both formed by ligaments and greater/lesser sciatic notch respectively

Question 6

DIAGRAM proximal femur

Answer 6

head and neck of femur, greater and lesser trochanter, and intertrochanteric line

Question 7

DIAGRAM angle of anteversion- difference at birth+ effect

Answer 7

between axis of femoral head and transcondylar axis of knee- normally 12 degrees, but 20 at birth= intoed feet

Question 8

DIAGRAM acetabular (hip) joint- what is it + movements

Answer 8

ball and socket joint between femoral head and acetabulum= allows flexion/extension, abduction/adduction, lateral and internal rotation, circumduction

Question 9

labrum and ligament

Answer 9

rim of tissue called acetabular labrum around acetabulum, which is completed by TRANSVERSE ACETABULAR LIGAMENT

Question 10

synovium, capsule and ligaments involved

Answer 10

synovial membrane surrounds head, which is surrounded by a capsule going to neck of femur stabilised by ligament of head of femur, iliofemoral, pubo-fumoral and ischio-femoral ligament (named according to proximal and distal attachments)

Question 11

DIAGRAM intracapsular/extracapsular fractures- what’s more dangerous

Answer 11

extracapsular- at intratrochanteric line ie outside capsule intra- fracture of femoral neck ie within capsule intra more dangerous as can cause avascular necrosis of head due to circumflex arteries

Question 12

gluteal region and compartment divisions

Answer 12

divided into 2 compartments superficial- gluteus maximus, medius and minimus deep gluteal compartment (short external rotators of hip)- piriformis, obturator internis, quadratus femoris, gamellus

Question 13

compartments of thigh

Answer 13

anterior- hip flexors/knee extensors adductor (medial)- hip adductor posterior- knee flexors/hip extensors

Question 14

anterior compartment of thigh- muscles and innervation

Answer 14

iliopsoas tensor fascia latae sartorius quadriceps femoris- rectus femoris, vastus medialis, intermedius and lateralis all supplied by femoral nerve apart from tensor fascia latae, and psoas part of iliopsoas

Question 15

medial part of thigh- muscles and innervation

Answer 15

adductor longus, brevis and magnus gracilis obturator externus pectineus all supplied by obturator EXCEPT pectineus (femoral)

Question 16

posterior part of thigh- muscles+ innervation

Answer 16

biceps femoris, semitendinosus, and semimembranous sciatic nerve

Question 17

lumbar and sacral plexus- how it forms and what they supply

Answer 17

lumbar plexus formed by ventral rami of L1-4, lumbar plexus gives off branch called LUMBOSACRAL trunk, which along with ventral rami of S1-4 form sacral plexus lumbar forms femoral (from posterior division) and obturator (anterior division) nerve, sacral supplies sciatic nerve and all nerve- both L2-4 sacral also forms superior and inferior gluteal nerve

Question 18

sciatic nerve

Answer 18

biggest nerve in body (L4-S3), composed of 2 nerves: tibial and peroneal nerve supplies all of posterior compartment of thigh ie hamstrings

Question 19

safe area

Answer 19

intramuscular injection given in SUPEROLATERAL quadrant of glute to prevent damage to sciatic nerve

Question 20

innervation of gluteal region

Answer 20

superior gluteal nerve innervates gluteus medius, minimum and tensor fascia latae inferior innervates gluteus maximus

Question 21

proximal attachments of muscles

Answer 21

each compartment attaches to same parts of pelvic bone superficial gluteal muscles all attach to posterior ilium anterior compartment- hip flexors attach to medial ilium (usually ASIS), the 3 vastus muscles of quadriceps DON’T attach to pelvis adductor compartment attach to body of pubis and ischiopubic ramus posterior muscles ie hamstrings all attach to ischial tuberosity

Question 22

DIAGRAM gluteus maximus- distal attachment and function

Answer 22

deep fibres go to gluteal tuberosity in femur, superficial to iliotibial tract hip extension+ abduction+ lateral rotation

Question 23

DIAGRAM gluteus medius and minimus

Answer 23

greater trochanter hip abduction

Question 24

DIAGRAM trendelenberg test: what it tastes, how to test

Answer 24

tests for weak hip abductor- raise the good leg ie other leg, and if hip falls on side which leg is raise= loss of medius/minimus SOUND SIDE SAGS

Question 25

deep gluteal compartment: distal and function

Answer 25

attach to greater trochanter lateral rotation of hip

Question 26

DIAGRAM ilio-psoas muscle- distal and function

Answer 26

formed from iliacus and psoas major distal: attachment to lesser trochanter hip flexion

Question 27

DIAGRAM fascia of leg

Answer 27

have superficial and deep fascia deep called fascia lata: lateral THICKENED area called iliotibial tract

Question 28

tensor fascia lata- distal, function and innervation

Answer 28

iliotibial tract stability of knee during extension superior gluteal nerve

Question 29

quadriceps femoris- function of all muscles

Answer 29

rectus femoris for knee extension AND hip flexion rest for ONLY knee extension

Question 30

adductor muscles- distal and function

Answer 30

femoral shaft adduction/medial rotation of hip

Question 31

gracilis- distal

Answer 31

tibial shaft

Question 32

hamstrings- distal

Answer 32

biceps- fibula semimem/semitend- tibia

Question 33

DIAGRAM femoral triangle- borders and what it contains

Answer 33

borders are inguinal ligament (superior), adductor longus (medial) and sartorius (lateral) contains femoral artery and vein WITHIN femoral sheath, and femoral nerve OUTSIDE sheath- nerve most lateral, then artery, then vein (NAVY)

Question 34

DIAGRAM adductor canal- what it continuous with, borders and what it contains

Answer 34

femoral triangle continuous with adductor canal at apex of triangle, with sartorius muscle becoming ANTERIOR border of canal anterior- sartorius posterior- adductor longus and mangus lateral- vasutus medialis femoral artery, vein, and SAPHENOUS nerve

Question 35

where adductor canal ends and significance

Answer 35

at adductor hiatus, where femoral artery becomes popliteal artery, AND popliteal vein becomes femoral vein

Question 36

arterial supply- branches and at what levels

Answer 36

aorta forms common iliac at L4, which forms internal and external at pelvic brim external iliac becomes femoral artery as it passes under inguinal ligament and enters femoral triangle

Question 37

femoral artery- relations, and branches

Answer 37

NAVY- nerve most lateral, then artery, then vein gives off profunda femoris, then becomes SUPERFICIAL FEMORAL artery, which becomes popliteal at adductor hiatus at knee

Question 38

palpation of femoral artery and what it lies on

Answer 38

palpated at mid-ingunal point between ASIS and pubic symphysis- lies on PSOAS tendon

Question 39

branches of profunda femoris and significance

Answer 39

gives off lateral and medial femoral circumflex- if blocked can cause avascular necrosis of femoral head

Question 40

venous drainage- superficial and deep

Answer 40

superficial- femoral vein formed from popliteal vein: great saphenous vein joints femoral vein at femoral triangle deep- venae comitantes of profunda femoris joins femoral

Question 41

lymph drainage

Answer 41

inguinal nodes: superficial inguinal goes to deep inguinal nodes, which go to external iliac nodes

Question 42

DIAGRAM true and apparent leg length

Answer 42

patient lies down and ASIS at same level true leg- measure between medial malleolus and same side ASIS (FIXED) apparent leg- measure between medial malleolus and xiphisternum (NON-FIXED)

Question 43

lower limb during development

Answer 43

pronation occurs at mid thigh levels, thus dermatomes arechanges

Question 44

DIAGRAM importance of attachments of adductor magnus

Answer 44

has broad attachment to femur, then another attachment to adductor tubercle between these 2 attachments is adductor hiatus

Question 45

sciatic nerve- variation

Answer 45

enters gluteal region from pelvis, normally below piriformis, but can pierce or be superior thus care must be taken during intramuscular junction to avoid damaging of nerve