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Lower Extremity Anatomy > Hip Joint > Flashcards

Hip Joint Flashcards

1
Q

Sacroiliac joint (SI)

A
  • Designed for force transmission and weight-bearing
  • Articulating bony surfaces are irregular
  • Limited motion
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2
Q

Sacroiliac joint (SI) is located between

A
  • L-shaped auricular surface of ilium and sacrum (S1-3)
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3
Q

Irregular articulating bony surfaces of sacroiliac joint

A
  • Increase friction and congruency
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4
Q

Limited motion of sacroiliac joint

A
  • 2 degrees of rotation

- 2mm of translation

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5
Q

2 parts of sacroiliac joint

A
  • Anterior planar (synovial joint)

- Posterior syndesmosis (fibrous joint)

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6
Q

Anterior planar (synovial joint)

A
  • Auricular surfaces
  • Sacral surface covered by hyaline cartilage
  • Ilium surface covered by fibrocartilage
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7
Q

Ligaments of the sacroiliac joint

A
  • Anterior (ventral) sacroiliac
  • Interosseous sacroiliac
  • Poster (dorsal) sacroiliac
  • Iliolumbar
  • Sacrotuberous
  • Sacrospinous
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8
Q

Anterior (ventral) sacroiliac ligament

A
  • Thickening of anterior joint capsule
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9
Q

Interosseous sacroiliac ligament

A
  • Connect tuberosities of sacrum/ilium

- Posterior/superior to joint

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10
Q

Posterior (dorsal) sacroiliac

A
  • Overlies interosseous ligament posteriorly

- Connects intermediate/lateral crest of sacrum of S1,2 to PSIS and internal lip of iliac crest

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11
Q

Long posterior (dorsal) sacroiliac ligament

A
  • S3,4 to PSIS
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12
Q

Iliolumbar ligament

A
  • L4,5 to iliac crest, sacral ala and anterior sacroiliac ligament
  • Primarily supports lumbosacral joint (L5/S1)
  • Also supports SI joint
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13
Q

Sacrotuberous ligament

A
  • Broad attachment to PSIS, posterior sacroiliac ligaments, dorsolateral sacrum and coccyx
  • Attaches to ischial tuberosity
    Glut max, piriformis, biceps femoris, semitendinosus muscles attach
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14
Q

Sacrospinous ligaments

A
  • Attaches from ischial spine to lateral margin of sacrum/coccyx
  • Anterior to sacrotuberous ligament
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15
Q

Ligaments that resist nutation

A
  • Sacrotuberous
  • Sacrospinous
  • Anterior and interosseous SI
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16
Q

Nutation

A
  • Anterior/inferior motion of sacral base
  • Posterior/superior motion of coccyx
  • There is concurrent superior rotation of pelvis (weight-bearing)
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17
Q

Counternutation

A
  • The opposite motion of nutation
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18
Q

Ligaments resisting counternutation

A
  • Long posterior (dorsal) sacroiliac ligament
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19
Q

Blood supply to SI joint

A
  • Superior gluteal
  • Iliolumbar
  • Lateral sacral
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20
Q

Innervation of the SI joint (variable among individuals)

A
  • Primarily dorsal rami L4-S3(4)
  • Vental rami L5-S2
  • Superior gluteal nerve
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21
Q

Pubic symphysis

A
  • Articular surfaces of pubis are covered by hyaline cartilage
  • Fibrocartilage disc connects the 2 pubic bones (symphysis joint)
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22
Q

Pubic symphysis joint functional classification

A
  • Amphiarthrosis joint
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23
Q

Superior pubic ligament

A
  • Attaches to pubic bones superiorly

- Extend out to pubic tubercles

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24
Q

Inferior pubic ligaments

A
  • Also called arcuate pubic ligament

- Extends out to inferior pubic rami

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25
Q

Hip joint

A
  • Ball and socket (spheroid)

- Synovial joint (diarthrosis)

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26
Q

Hip joint movements

A
  • Triplanar motion

- Flex/ext/ab/add/int & ext rot/circumduction

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27
Q

Hip movement from the anatomical position

A
  • Adduction is more limited than abduction

- Lateral rotation is stronger than medial rotation

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28
Q

Hip joint articulates between

A
  • Femoral head and acetabulum (lunate surface)
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29
Q

Hip joint socket

A
  • Stable
  • More than ½ of femoral head fits into “socket”
  • Anterior femoral head has less coverage of acetabulum
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30
Q

Acetabular fossa (cotyloid fossa) filled with

A
  • Fat

- Ligament of the head of the femur

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31
Q

Acetabular labrum

A
  • Fibrocartilage attached to acetabular rim
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32
Q

Acetabular labrum function

A
  • Deepens socket
  • Shock absorber
  • Decrease stress between
  • Helps create negative pressure (sealing function)
  • Distributes compressive loads
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33
Q

Joint capsule attaches proximally to

A
  • Rim of acetabulum

- Transverse acetabular ligament

34
Q

Joint capsule attaches distally to

A
  • Intertrochanteric line anteriorly
  • Extends to mid neck posteriorly (doesn’t attach firmly to bone)
  • Lateral half of neck is extracapsular posteriorly
35
Q

Muscles that attach to the hip capsule

A
  • Gluteus minimus
  • Iliocapsularis
  • Indirect head of rectus femoris
  • Obturator externus
  • Conjoint tendon of hip
36
Q

Conjoint tendon of hip

A
  • Obturator internus
  • Superior and inferior gemelli
  • Also known as the triceps coxae
37
Q

Synovium

A
  • Lines capsule and all structures within the capsule except for articular cartilage
38
Q

Ligaments of the hip joint

A
  • Extracapsular (extrinsic)
  • Iliofemoral
  • Pubofemoral
  • Ischiofemoral
39
Q

Extracapsular (extrinsic) ligaments

A
  • Reinforce joint capsule
  • Spiraling shaped fibers “screw” head into acetabulum
  • All resist hip extension and anterior translation of femoral head
40
Q

Iliofemoral (Y-ligament, ligament of Bigelow)

A
  • Strongest ligament in the hip

- Splits into 2 bands

41
Q

Iliofemoral (Y-ligament, ligament of Bigelow) proximal attachment

A
  • AIIS

- Iliac portion of acetabular rim

42
Q

Iliofemoral (Y-ligament, ligament of Bigelow) two bands

A
  • Upper (lateral) band

- Lower (medial) band

43
Q

Upper (lateral) band of iliofemoral ligament

A
  • Attaches to superior intertrochanteric line

- Resists extension and external rotation

44
Q

Lower (medial) band of iliofemoral ligament

A
  • Attaches to inferior intertrochanteric line

- Resists extension and external rotation

45
Q

Pubofemoral ligament

A
  • Attaches to pubic part of acetabular rim/obturator crest
  • Blends with joint capsule/iliofemoral ligament
  • Resists extension and abduction/external rotation
46
Q

Ischiofemoral ligament

A
  • Ischial part of acetabular rim to capsule around femoral neck
  • Resists extension and internal rotation
47
Q

Zona orbicularis

A
  • Circular fibers from the capsular ligaments for a collar around the neck
  • Not directly attached to bone
  • “Locking ring”
48
Q

Zona orbicularis function

A
  • Aids in holding femoral head into acetabulum

- Resists distraction

49
Q

Intracapsular ligaments

A
  • Ligament of head of the femur

- Transverse acetabular ligament

50
Q

Ligament of head of the femur other names

A
  • Ligamentum teres femoris
  • Round ligament of the femur
  • Ligamentum capitis femoris
  • Foveal ligament
51
Q

Intracapsular ligament

A
  • Located at the acetabular fossa
52
Q

Ligamentum capitis femoris

A
  • Secondary stabilization function of normal hip

- More important stabilizer in pathological hip

53
Q

Ligamentum capitis femoris is a conduit for

A
  • Artery to head of the femur and nerves

- Functions in proprioception

54
Q

Ligamentum capitis femoris attaches

A
  • Margin of acetabular notch/transverse acetabular ligament

- Fovea capitis on the femur

55
Q

Transverse acetabular ligament

A
  • Attaches to edges of acetabular notch

- Creates foramen for vessel passage

56
Q

Iliocapsularis origin

A
  • Anterior inferior iliac spine

- Anterior hip capsule

57
Q

Iliocapsularis insertion

A
  • Below lesser trochanter

- Sometimes iliopfemoral ligament and/or intertrochanteric line

58
Q

Iliocapsularis innervation

A
  • Femoral nerve
59
Q

Iliocapsularis function

A
  • Raise the capsule with hip flexion

- Stabilize the hip

60
Q

Iliocapsularis becomes hypertophied with

A
  • Dysplastic hips (insufficient acetabular coverage)
61
Q

Trochanteric bursa

A
  • Between gluteus maximus muscle and lateral aspect of greater trochanter
  • Associated with “hip bursitis”
62
Q

Hip bursitis

A
  • Point tenderness
  • Lateral thigh/gluteal pain
  • Pain with ext rotation and extension
63
Q

Ischial bursa

A
  • Between glut max and ischial tuberosity

- Prolonged sitting in a position that puts increased pressure on ischial tuberosity

64
Q

Gluteofemoral bursa

A
  • Between glut max (IT band) and vastus lateralis
65
Q

Gluteus medius bursa

A
  • Between gluteus medius and superior greater trochanter

- These are not the only ones

66
Q

Blood supply to the hip joint

A
  • Trochanteric anastomosis
  • Primarily from retinacular arteries from the ascending branches of medial and lateral femoral circumflex arteries
  • Medial femoral circumflex is major supplier in the adult
67
Q

Medial femoral circumflex as the major supplier in the adult

A
  • High risk of avascular necrosis with femoral neck fracture
68
Q

Hip joint blood supply in the child

A
  • Obturator is major supplier

- (Artery to the head of the femur)

69
Q

Artery to the head of the femur

A
  • Branch of acetabular artery (from posterior branch of obturator or MFC)
  • Important in younger children (< 3)
  • Not a major supplier in the adult
70
Q

Nerve supply to hip joint

A
  • Posterior division of femoral
  • Sciatic
  • Superior gluteal
  • Anterior branch of obturator nerve
  • Accessory obturator nerve can innervate if present
  • Nerve to quadratus femoris
71
Q

Avascular necrosis of femoral head

A
  • Interruption of blood supply to the femoral head resulting in ischemia
  • Osteocyte death and necrosis of the tissue (superolateral femoral head)
  • Can lead to femoral head collapse
72
Q

Traumatic causes of avascular necrosis of femoral head

A
  • Trauma resulting in hip dislocation/subluxation or femoral neck fracture
73
Q

Non-traumatic causes of vascular necrosis of femoral head

A
  • Excessive corticosteroid and alcohol use most common
  • Hematological disease
  • Many others
74
Q

Imaging modalities for detecting avascular necrosis of the femoral head

A
  • Plain radiographs

- MRI is most sensitive and specific

75
Q

Thigh/hip flexors

A
  • Flexors
  • Iliacus and psoas major (iliopsoas)
  • Rectus femoris
  • Sartorius
  • Tensor fascia latae
  • Pectineus
  • Adductor longus
  • Adductor brevis
  • Adductor magnus
76
Q

Thigh/hip extensors

A
  • Extensors
  • Gluteus maximus
  • Biceps femoris long head
  • Semitendinosus
  • Semimembranosus
  • Adductor magnus, hamstring part
77
Q

Thigh/hip abductors

A
  • Abductors
  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia latae
  • Piriformis
  • Sartorius
78
Q

Thigh/hip lateral (external) rotators

A
  • Gluteus maximus
  • Piriformis
  • Obturator internus
  • Superior gemellus
  • Inferior gemellus
  • Quadratus femoris
  • Obturator externus
  • Sartorius
  • Gluteus medius and minimus
79
Q

Thigh/hip medial (internal) rotators

A
  • Medial (internal) rotators
  • Tensor fascia latae
  • Gluteus medius
  • Gluteus minimus
  • Pectineus
80
Q

Thigh/hip adductors

A
  • Adductors
  • Pectineus
  • Adductor longus
  • Adductor brevis
  • Adductor magnus
  • Gracilis
  • Quadratus femoris
  • Obturator externus

Lower Extremity Anatomy (35 decks)

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