Hip joint Flashcards
three parts of the hip bone
another name for the hip bone
ilium, pubis, ischium
innominate bone
What separates the 3 parts of the hip bone in the child?
tri-radiate cartilage
what is the pubic symphysis?
A joint; the articulation between the two hip bones at the pubic bodies
What shape is the internal surface of the ilium?
Which muscle originates here?
Concave; it forms the iliac fossa
Iliacus
What shape is the external surface of the ilium?
Which muscles insert here?
convex; it forms the wing of the ilium
gluteal muscles
Of the three sections, which is the most anterior portion of the hip bone?
The pubis
What is the pubic crest?
Which of the superior and inferior pubic rami is longer?
The thickening on the superior aspect of the pubic body
Superior is longer, inferior portion becomes the ischiopubic ramus along the bottom of the obturator foramen
Where is the obturator foramen?
Its in the lower portion of the hip bone. Enclosed by the inferior and superior pubic rami, plus the ischiopubic ramus.
Describe the position of the ischium in the hip bone
posterior and inferior
What part of the hip bone are you sitting on whilst sitting upright?
Describe the position of this part
The ischial tuberosities
On the posterior and inferior aspect of the ischium
Name the two ligaments attached to the ischium and sacrum
Sacrospinous ligament
Sacrotuberous ligament
Which ligament attached to the ischium creates the greater sciatic foramen?
Where does it attach?
Sacrospinous ligament
Sacrum and ischial spine
Which ligament attached to the ischium creates the lesser sciatic foramen?
Where does it attach?
Sacrotuberous ligament
Sacrum to the ischial tuberosity
What’s the purpose of the 2 ligaments between the ischium and sacrum?
Sacrospinous and sacrotuberous
- limit rotation of the inferior sacrum during standing; when the body’s weight is transmitted down the vertebral column.
Function of the hip joint
Is it a more stable or more mobile?
enable mobility of the lower limbs without weakening the ability of the lower limbs to support the weight of the body
More stable
What is the acetabular notch?
The incomplete inferior section of the acetabular labrum (the fibrocartilaginous collar around the acetabular)
What does the acetabular labrum do?
Its a fibrocartilaginous collar which encircles the acetabulum. It craetes a more secure fit for the femoral head by;
- Deepening the acetabulum - Increasing the contact between the articulating surfaces by 10%
Articulations of the femur
- acetabulum proximally (hip joint)
- patellar and tibia distally (knee joint)
Which ligament attaches to the fovea capitis?
Ligamentum teres
How are the greater and lesser trochanters of the femur connected, both anteriorly and posteriorly?
Anterior; intertrochanteric line
Posterior; intertrochanteric crest
Where is the gluteal tuberosity?
Which muscle inserts here?
Lateral ridge of the upper section of the linea aspera, below the intertrochanteric crest
Gluteus maximus
Difference between the condyles and epicondyles of the femur?
Condyles articulate with another bone
Epicondyles are projections on the condyles where muscles and ligaments attach (like a tuberosity).
What is the medial supracondylar line?
Where does it end?
One division of the inferior linea aspera along the medial aspect of the femur
The addcutor tubercle of the femur
Where does the lateral supracondylar line terminate?
Lateral condyle of the femur
There are 4 ligaments of the hip joint. Name them.
(Hint: think which bones are involved).
Which is the strongest?
Which is the weakest?
What is their shared purpose?
Intracapsular (1)
- Ligamentum teres
Extracapsular (3)
- Iliofemoral
- Pubofemoral
- Ischiofemoral
Iliofemoral is strongest ligament in whole body
Ischiofemoral is the weakest of the three
Pull the head of the femur into the acetabulum
What is the longitudinal retinacula of the femur?
Anterior fibres of the hip joint capsule which ascend the neck; they contain blood vessels for the femoral head and neck
The iliofemoral ligament is shaped like which letter?
What does it prevent?
When does it relax?
An inverted Y;
with the base at the inferior iliac spine and arms reaching to the intertrochanteric line of the femur
Hyperextension of the hip;
(Screws the femoral head into the acetabulum so that the trunk stays upright without need for muscular activity. Prevents hyperextension (the trunk falling backwards)
When sitting to allow the pelvis to tilt backwards into a sitting position
Extracapsular ligaments of the hip joint; - Iliofemoral - Pubofemoral - Ischiofemoral What does each one prevent?
- hyperextension of the hip
- hyperabduction and hyperextension
- excessive internal rotation
The pubofemoral ligament is what shape?
Is it anterior or posterior?
triangle shaped
Anterior (with iliofemoral ligament)
What shape is the ischiofemoral ligament?
Is it anterior or posterior?
What does it do?
Spiral shaped (fibres spiral superolaterally and attach to the greater trochanter) Posterior Prevents excessive internal rotation
Where is the transverse acetabular ligament?
What does it form?
Below the acetabulum, its the portion of the labrum which bridges the acetabular notch.
Creates a tunnel through nerves and vessels can enter the hip joint
Relationship between the muscles and ligaments at the hip joint
Reciprocal
- the ligaments are strongest anteriorly so the anterior muscles (medial flexors) are fewer and weaker (
3 primary innervations of the hip
femoral nerve anteriorly
sciatic nerve posteriorly
obturator nerve medially
Why can pain from the hip be referred to the knee? (And vice versa)
because the femoral and sciatic nerves (which innervate the hip) also innervate the skin around the knee
What is the main blood supply to the epiphysis in the child?
What is the main blood supply to the femoral head in the adult?
The artery of the ligamentum teres
Ascending cervical branches of the MFCA, medial femoral circumflex artery
Which larger artery does the artery of the ligamentum teres arise from?
The obturator artery
What makes up the extracapsular arterial ring at the base of the femoral neck?
Where do these vessels arise from?
A large branch of the medial femoral circumflex artery (MFCA) posteriorly and smaller branches of the lateral femoral circumflex artery (LFCA) anteriorly
The profunda femoral artery
Branches of the extracapsular ring extend to where?
What are the branches called?
into the metaphysis
ascending cervical branches of the MFCA/ retinacular arteries
How does an intracapsular fracture of the femoral neck cause avascular necrosis?
The fracture disrupts the ascending cervical branches of the MFCA which are the main blood supply to the femoral head
Where do the lumbar plexus and sacral plexus combine?
What’s this structure formed from?
the lumbosacral trunk
Anterior rami/branches of the L4 and L5 nerve roots
The peripheral nerves of the lumbar plexus innervate skin and muscle in which area on the body?
posterior abdominal wall to the lower limb
The lumbar plexus has anterior and posterior divisions. Which contribute to the lumbosacral plexus?
Anterior rami of nerve roots L1-L4
Posterior divisions of the lumbar plexus innervate which aspect of the thigh?
Why?
Anterior thigh
Internal rotation during 8th week of development (check)
What are the 5 branches of the lumbar plexus? (peripheral nerves)
Which are posterior divisions?
What are the lumbar nerve roots of each?
I get leftovers on Friday; Ilioguinal L1 Genitofemoral L1, 2 Lateral femoral cutaneous nerve L2, 3 Obturator L2, 3, 4 Femoral L2, 3, 4
Lateral femoral cutaneous nerve and the Femoral nerve are posterior
(Posterior divisions innervate the anterior thigh)
What does the ilioguinal nerve innervate?
Skin of the genitalia and the upper medial thigh
Where does the obturator nerve innervate on the leg?
Which muscles does it innervate?
Medial thigh
Adductor muscles
gracilis
Pectineus
Obturator externus
What are the branches of the sacral plexus?
Give their nerve root values
Salmon is so perfectly pink
Superior gluteal nerve (L4, L5, S1) Inferior gluteal nerve (L5, S1, S2) Sciatic nerve (L4, L5, S1, S2, S3) Posterior cutaneous- femoral nerve/ nerve of the thigh (S1, S2, S3)
Pudenal*
- don’t need to know yet
Which nerve roots contribute to the sacral plexus?
Anterior divisions of the sacral nerve roots; S1-S5
The superior and inferior gluteal nerves enter the gluteal region through the ____ foramen and _____ the piriformis muscle. They have no _____ branches.
Both enter through the greater sciatic foramen
Superior; above piriformis
Inferior; below piriformis
They have no sensory branches
Which muscles do the superior and inferior gluteal muscles innervate?
Superior; gluteus minimus, gluteus medius and the tensor fascia lata muscles
Inferior; gluteus maximus
The posterior cutaneous nerve of the thigh innervates the skin of the _____. It exits ____ the piriformis muscle.
posterior thigh and leg
below
Which nerve is the longest in the body?
Describe its route
sciatic nerve
- emerges below the piriformis muscle
- enters the posterior compartment of the thigh
- crossed by the long head of the biceps femoris muscle
- branches above the knee (superior aspect of the popliteal fossa/ knee pit)
- into the common peroneal/ fibula nerve (lateral) and the tibial nerve
What is the popliteal fossa?
knee pit
What signals do the common fibular and tibial nerves transmit?
This makes them what type of nerve?
Sensory and motor sensation- they are mixed nerves
Which muscles does the common fibular nerve supply?
Which muscles does the tibial nerve supply?
Both branches of the sciatic nerve
Fibular- Only the short head of biceps femoris
Tibial- hamstring muscles and the hamstring (ischial) part of adductor magnus
Where is the dorsogluteal site and what is it used for?
Which structure could be damaged during this process?
Upper outer quadrant of the gluteal region
(top-right part of bum)
Intramuscular injection in children under 7
Sciatic nerve
Why is the ventrogluteal site for intramuscular injections preferable?
Who is it not used on and why?
Further from neurovascular structures compared to the dorsogluteal site (E.g. sciatic nerve)
Not used on children under 7 because it requires greater compliance
What is the fascia lata?
What does it do?
Deep fascia (connective tissue) of the thigh
- Intermuscular septum attaches here which divides the thigh into 3 compartments
- Encloses the thigh muscles as a unit
Which structures enter the saphenous opening?
(Opening of the fascia lata)
- saphenous vein
- lymphatic vessels which drain into the inguinal lymph nodes
What is the iliotibial tract/ band and what does it do?
Where does the band start and finish?
Which muscle pulls on the band?
What does this pulling achieve?
Thickened fascia lata (band of connective tissue) at the lateral aspect; stabilises the knee
Begins at the iliac crest and inserts at the lateral tibial condyle
The tensor fascia lata muscle
It stabilises the hip during extension (assists gluteus maximus)
Where does the tensor fascia lata muscle originate and insert?
(On the iliotibial tract)
Originates from iliac spine, inserts between the 2 layers of ITB in the lateral upper third of the thigh
Which 2 muscles insert onto the iliotibial tract?
What effect do they both exert here?
Which sports is this useful in?
Gluteus maximus (some fibres) and tensor fascia lata
Stabilise the knee whilst standing
- During standing the muscles tighten the tract and steady the condyles of the femur on the articular surfaces of the tibia
Running, water skiing, horseriding
How does the tensor fascia lata muscle help venous return from the legs?
It hoists the tensor fasica lata (deep connective tissue) upwards which narrows the compartments of the thigh and compresses the deep veins
When is the iliotibial band shortest?
How can this cause pain?
When sitting
It can become tight easily and cause lateral knee pain and patellar instability. Treated with physiotherapy
The gluteal muscles can be divided into superfical and deep categories. Which muscles are in each?
Which category has the bigger muscles?
What action does each compartment perform?
Superficial; gluteus maximus, gluteus medius, minimus, tensor fascia lata
Deep; piriformis superior gemellus obturator internus inferior gemellus (obturator externus) medial thigh sometimes quadratus femoris
Superfical muscles are larger
They abduct and extend the thigh at the hip joint
Deep muscles laterally rotate the femur
The superior and inferior fibres of the gluteus maximus insert in different places. Where?
Where does the muscle originate?
Superior and superficial; iliotibial tract
Inferior and deep; gluteal tuberosity of femur
posterior/ gluteal surface of the ilium, sacrum and coccyx
(Iliac wing/ convex posterior surface of the ilium
Gluteus maximus and the _____ muscles extend the hip from a ____ position when moving from ____ to _____ by ____ the ____
hamstrings muscles
flexed
sitting to standing
tilting the pelvis
What shape are the gluteus medius and minimus muscles?
Where do they both insert and originate?
Fan shaped
Gluteus medius is between maximus and minimus. It riginates from the iliac wing/ gluteal surface of ilium and inserts onto the lateral aspect of the greater trochanter
Gluteus minimus originates from the ilium and inserts onto anterior aspect of the greater trochanter
Which muscles prevent Trendelenburg sign?
Damage to which nerve could cause this symptom?
The hip abductors- gluteus medius and minimus
The superior gluteal nerve (innervates both of them)
What does Trendelenburg sign occur?
When the hip abductor muscles aren’t working properly.
Usually, when standing on one leg the abductor muscles of the standing leg contract to prevent the pelvis tilting towards the unsupported side. If the standing leg is injured, then the pelvis tilts.
What do the deep gluteal muscles do?
Where do the majority insert?
Which nerve innervates the piriformis?
laterally rotate the lower limb (around the hip joint)
Onto the greater trochanter
(the gluteal muscles- superficial and deep- mostly insert here)
Nerve to piriformis
Obturator internus originates where?
Which foramen does it pass through?
Where does obturator externus originate?
obturator membrane- on the medial surface of the obturator foramen
Passes through the lesser sciatic foramen
External surface of the obturator foramen
The superior and inferior gemellus muscles are separated by __?
Where do they each originate?
What’s their innervation?
the obturator internus tendon
superior= ischial spine inferior= ischial tuberosity
superior; nerve to the obturator internus
inferior; nerve to quadratus femoris
*note; they are triangle shaped
What shape is quadratus femoris?
How does its insertion differ to the other deep gluteal muscles?
square shaped and flat
inserts onto the quadrate tubercle of the intertrochanteric crest (rather than the greater tubercle)
Which nerve innervates obturator externus?
Explain the functions of this muscle?
obturator nerve
can be classed as belonging to the deep gluteal muscles (externally rotate the leg) and the muscles of the medial compartment of the leg (adduct).
The deep muscles of the gluteal region can be called the ___ ____ muscles.
Why?
short rotator muscles because they laterally rotate the thigh at the hip joint
