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MSK > Hip/Glutes > Flashcards

Hip/Glutes Flashcards

1
Q

The os coxae or innominate bone is _______ in newborns and children, then becomes _____ in adulthood

A
  • separated (by epithelia)
  • fused
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2
Q

These two ligaments form these two important foramina within the pelvic region for passage of structures into and out of the gluteal region:

A
  • ligaments: sacrospinous L. and sacrotuberous L.
  • foramina: greater sciatic foramen and lesser sciatic foramen
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3
Q

What contents pass through the greater sciatic foramen?

A

(all exit)

  • piriformis M.
  • sciatic N.
  • guteal neurovascular bundles
  • posterior femoral cutaneous N.
  • pudendal N. and internal pudendal A.
  • obturator internus/superior gemellus N.
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4
Q

What contents pass through the lesser sciatic foramen?

A
  • pudendal N. and internal pudendal A. (enter)
  • obturator internus/superior gemellus N. (enter)
  • obturator internus (exit)
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5
Q

What nerves supply the cutaneous and deep region of the hips/glutes?

A
  • cutaneous: cluneal (clunial) nerves
  • deep: deep nerves (sacral plexus branches, leave pelvis via greater sciatic foramen)
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6
Q

What nerves supply the superior/middle and inferior areas of the cutaneous glute/hips?

A
  • superior/middle: lateral branches of L1-3 and S1-3 dorsal (posterior) rami, supply superior 2/3, sacrum, and adjacent area
  • inferior: gluteal branches of posterior femoral cutaneous N. (S1-3 ventral (anterior) rami branches), supply inferior 1/3
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7
Q

What are the courses and innervations of the 2 deep nerves of gluteal region? (superior gluteal N. and inferior gluteal N.)

A
  • superior gluteal N. course: leaves pelvis superior to piriformis w/ superior gluteal A., runs between gluteus medius and gluteus minimus
  • superior gluteal N. innervation: gluteus medius, gluteus minimus, and tensor fasciae latae
  • inferior gluteal N. course: leaves pelvis inferior to piriformis w/ inferior gluteal A.
  • inferior gluteal N. innervation: gluteus maximus
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8
Q
  • nerve derived from L4-S3 ventral (anterior) rami
  • largest nerve in the body
  • course: leaves pelvis inferior to piriformis, runs inferiorly deep to gluteus maximus, usually divides about half way down thigh into tibial and common fibular Ns.
  • does not supply any gluteal structures
A

sciatic nerve

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9
Q

Innervates the cutaneous portion of the posterior thigh and supplies more skin than any other cutaneous nerve:

A

posterior femoral cutaneous N.

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10
Q
  • nerve that arises from anterior divisions of S2-S4 ventral rami
  • most medial structure exiting greater sciatic foramen
  • reenters pelvis via lesser sciatic foramen to supply perineal structures
A

pudendal N.

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11
Q

What are the 3 main branches arising from the internal iliac A.?

A
  • superior gluteal A.
  • inferior gluteal A.
  • internal pudendal A.
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12
Q
  • largest internal iliac A. branch
  • deep branch supplies: gluteus medius, gluteus minimus, tensor fascia lata
A

superior gluteal A.

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13
Q
  • artery that branches off the internal iliac A.
  • supplies: gluteus maximus, small lateral rotators, superior hamstrings
  • aids in cruciate anastomosis of thigh: transverse branch of the medial circumflex femoral A., terminal part of the transverse branch of the lateral circumflex femoral A., first perforating A., and this artery
A

inferior gluteal A.

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14
Q

What are the arteries that participate in cruciate anastamosis of the leg?

Why is this important?

A
  • inferior gluteal A., medial circumflex femoral A., lateral circumflex femoral A., perforating As.
  • important because they can supply blood to the leg if the femoral A. is occluded/severed
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15
Q
  • artery that branches off the internal iliac A.
  • reenters pelvis via lesser sciatic foramen w/ pudendal N.
  • supplies perineal Ms. and ext. genitalia
  • does not supply any gluteal structures
A

internal pudendal A.

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16
Q

Where should intragluteal injections be made?

A

In the supero-lateral part of the gluteal region in order to avoid the sciatic N. and other gluteal nerves and vessels

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17
Q

What are the superficial gluteal muscles?

A
  • gluteus medius
  • tensor fasciae latae
  • gluteus maximus
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18
Q

Gluteus Maximus

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Gluteus Maximus

(largest gluteus muscle)

  • Origin: lateroposterior surface of sacrum and coccyx, gluteal surface of ilium (behind posterior gluteal line), thoracolumbar fascia, sacrotuberous ligament
  • Insertion: iliotibial tract, gluteal tuberosity of femur
  • Action: chief extensor of the thigh, lateral rotation, slight extension of leg when working w/ tensor fascia lata
  • Innervation: inferior gluteal N.
19
Q

Gluteus Medius and Gluteus Minimus

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Gluteus Medius and Gluteus Minimus

(both partially covered by gluteus maximus)

  • Origin of medius: gluteal surface of ilium (between anterior and posterior gluteal lines)
  • Insertion of medius: lateral aspect of greater trochanter of femur
  • Origin of minimus: gluteal surface of ilium, (between anterior and inferior gluteal lines)
  • Insertion of minimus: anterolateral aspect of greater trochanter of femur
  • Action: thigh abduction and medial rotation (particularly minimus)
  • Innervation: superior gluteal N.
20
Q

Summarize the gait cycle:

(just memorize this shit, I literally have no idea what the %’s mean and I don’t really care)

A
  • gait sequence composed of 60% stance phase (20% double support [10% right foot forward, 10% left foot forward] and 40% single support) and 40% swing phase
  • swing phase occurs during single support stance phase (both = 40%)
  • two double support phases for a single gait cycle
21
Q

Gluteus Medius and Minimus dysfunction:

  • condition names:
  • causes:
  • effect:
A

Gluteus Medius and Minimus dysfunction:

  • condition names: gluteal gait or Duchenne’s limp (positive Trendelenburg’s sign)
  • causes: superior gluteal N. injury (or stroke that causes other underlying nerve injury)
  • effect: patient loses steadying action of gluteus medius and minimus, they lean toward effected side during stance phase of gait
22
Q

What causes the leaning gait on the stance side within gluteus dysfunction?

A
  • contraction on stance side keeps greater trochanter in proximity to the iliac blade
  • thereby keeping the pelvic level and maintaining a smooth gait
  • if dysfunctional, the pelvis tilts toward the swing side
23
Q

Tensor Fascia Lata

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Tensor Fascia Lata

(enclosed by fascia lata, has the IT band)

  • Origin: outer lip of anterior iliac crest, anterior superior iliac spine (ASIS)
  • Insertion: iliotibial tract
  • Action: abducts, medially rotates, and flexes thigh; slight extension of knee along w/ the gluteus maximus
  • Innervation: superior gluteal N.
24
Q
  • a tendon in the lateral leg that runs from iliac tubercle to tubercle (Gerdy’s) on lateral tibial condyle
  • reinforced by tendinous fibers from tensor fascia lata and gluteus maximus
  • function: assists in decelerating adduction of thigh; laterally stabilizes knee; extends leg, compensate for quadriceps paralysis via gluteus maximus flexion; pulls patella laterally, antagonist of vastus medialis, and synergist w/ flexing vastus lateralis for this action; stretch to treat chondromalacia patella
A

iliotibial band (IT band)

25
Q

Piriformis M.

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Piriformis M.

(lies deep to gluteus maximus and medial to gluteus medius, demarcates gluteal blood vessels and nerves)

  • Origin: anterior surface of the sacrum (between the S2 and S4), gluteal surface of ilium (near posterior inferior iliac spine), (sacrotuberous ligament)
  • Insertion: apex of greater trochanter of femur
  • Action: external rotation and abduction of thigh, stabilizes head of femur acetabulum
  • Innervation: nerve to piriformis (S1-2)
26
Q

Obturator Internus

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Obturator Internus

(leaves pelvis through lesser sciatic foramen)

  • Origin: posterior surface of the obturator membrane; bony boundaries of the obturator foramen
  • Insertion: medial surface of greater trochanter of femur
  • Action: external rotation of extended thigh; abduction of flexed thigh; stabilization of hip joint
  • Innervation: nerve to obturator internus (L5 and S1)
27
Q

Superior and Inferior Gemelli

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Superior and Inferior Gemelli

  • Origin: ischial tuberosity
  • Insertion: medial surface of greater trochanter of femur (via tendon of obturator internus)
  • Action: thigh external rotation, thigh abduction (from flexed hip), stabilizes head of femur in acetabulum
  • Innervation of superior: nerve to obturator internus and superior gemellus
  • Innervation of inferior: nerve to quadratus femoris and inferior gemellus
28
Q

Obturator Externus M.

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Obturator Externus M.

(deep to pectineus)

  • Origin: external margins of obturator foramen
  • Insertion: trochanteric fossa
  • Action: thigh external rotation, thigh abduction (from flexed hip); stabilizes head of femur in acetabulum
  • Innervation: obturator N.
29
Q

Quadratus Femoris M.

  • Origin:
  • Insertion:
  • Action:
  • Innervation:
A

Quadratus Femoris M.

  • Origin: ischial tuberosity
  • Insertion: intertrochanteric crest of femur
  • Action: thigh external rotation; stabilizes head of femur in acetabulum
  • Innervation: nerve to quadratus femoris (L4-S1)
30
Q

What are the vertically oriented and horizontally oriented gluteal muscles?

A
31
Q

What are the dynamics of the glutei muscles?

A
32
Q

What are the bursae of the gluteal region?

A
  • ischial bursa
  • trochanteric bursa
  • gluteofemoral bursa
33
Q

Hip joint

  • articular surfaces:
  • joint type:
  • movements:
A

Hip joint

  • articular surfaces: head of femur articulates w/ acetabulum of hip
  • joint type: diarthrotic ball and socket type of synovial joint
  • movements: flexion-extension, abduction-adduction, circumduction, medial-lateral rotation
34
Q

Hip joint: articular surfaces

  • rim of acetabulum is incomplete inferiorly (acetabular notch):
  • acetabulum has a centrally located nonarticular area (acetabular fossa):
  • acetabulum depth increased by fibrocartilaginous acetabular labrum:
A

Hip joint: articular surfaces

  • rim of acetabulum is incomplete inferiorly (acetabular notch): bridged by transverse acetabular ligament
  • acetabulum has a centrally located nonarticular area (acetabular fossa): fatpad covered by a synovial membrane occupies acetabular fossa, malleable nature permits positional changes of femoral head during hip joint movements
  • acetabulum depth increased by fibrocartilaginous acetabular labrum: deepens socket for femoral head
35
Q
  • injury that can be induced by twisting on a weight bearing hip, majority (80%) have no known direct cause
  • pain may become diffuse and difficult to pinpoint
  • not possible to see swelling, although the inflamed joint may become larger in volume because of an “effusion” due to trauma
  • if the front of the hip joint is affected there may be a pinching sensation when the person flexes the hip by bringing the knee up to the chest
  • pain may be reproduced in sport during activities that require weight bearing and twisting (i.e. kicking a football)
  • can be repaired arthroscopically
A

acetabular labrum tears

36
Q

Hip joint: articular capsule

  • proximally attached to the edge of acetabulum
  • distally attached to the neck of femur
  • some deep fibers pass circularly around neck (orbicular zone):
  • some deep longitudinal fibers form a retinaculum (L., band or halter):
A
  • some deep fibers pass circularly around neck (orbicular zone): forms a collar around neck (helps hold femoral head in acetabulum)
  • some deep longitudinal fibers form a retinaculum (L., band or halter): retinacular fibers are reflected superiorly along neck
37
Q

Hip joint: articular capsule

  • thickened parts of fibrous (articular) capsule are called:
  • three hip joint intrinsic ligaments:
A
  • thickened parts of fibrous (articular) capsule are called: instrinsic ligaments
  • three hip joint intrinsic ligaments: iliofemoral L., pubofemoral L., ischiofemoral L.
38
Q
  • intrinsic hip ligament
  • strong y-shaped band that covers anterior aspect of hip
  • anterior inferior iliac spine and acetabular rim to intertrochanteric line
  • helps prevent overextension
A

iliofemoral L.

39
Q
  • intrinsic hip ligament
  • strengthens anterior and inferior parts of fibrous capsule
  • arises from obturator crest of pubic bone and passes laterally to blend with joint capsule and iliofemoral ligament
  • helps prevent overabduction and overextension
A

pubofemoral L.

40
Q
  • intrinsic hip ligament
  • strengthens joint capsule posteriorly
  • arises from ischial part of acetabular rim
  • fibers spiral anterolaterally to attach to femoral neck
  • helps prevent overextension
A

ischiofemoral L.

41
Q
  • comprises 10-15% of traumatic hip dislocations
  • occur when knee strikes dashboard w/ thigh abducted, falls from height, or from a blow to the back in a squatted position
  • neck of femur or greater trochanter impionges on rim of acetabulum and thereby levers head of femur out of acetabulum through tear in anterior hip capsule
A

anterior hip dislocation

42
Q
  • type of hip dislocation
  • occurs when thigh is adducted, medially rotated, and flexed
  • can cause damage to the sciatic nerve
  • may result in paralysis of hamstrings and muscles distal to the knee
  • sensory change may occur in skin over the posterolateral aspects of leg and most of foot
A

posterior hip dislocation

43
Q

What is the degenerative process that may cause someone to require a hip replacement?

How is a hip replacement done generally? Lol

A
  • osteoarthritis
  • metal prosthesis anchored to femur by bone cement to replace femoral head and neck, plastic socket cemented to hip bone to replace acetabulum
44
Q

What are the differences in clinical presentation of a hip fracture vs. a hip dislocation?

A
  • fracture: injured leg is shortened and laterally rotated
  • dislocation: leg is normal length and medially rotated

MSK (33 decks)

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