Hip joint Flashcards
What muscles are responsible for lateral / external rotation of the Hip ?
Where are they located ?
0 Piriformis - origin - anterior sacrum —-> travels through greater sciatic forearm —-> inserts onto greater trocanter.
( closely related to sciatic . )
0 Gemelli - 2 - superior & inferior (narrow & triangular ) - sepearted by obturator internus
1. Superior - orginates form ischial spine
2. Inferior - orginates from ischial tuberosity
( both insert onto gretaer trocanter )
0 Obturator internus
- originates from pubis & ischium at obturator forearm (posterior surface of the obturator membrane - internal (internus ) )——> leaves pelvis via lesser sciatic forearm ——> greater trocnater.
0 Quadratas femoris - flat , square shaped.
( most inferior of the deep muscles )- loacted beneath all of them.
Originates from lateral side of ischial tuberosity - inserts onto quadate tuberosity on intertrochnateric crest.
0 Obturator externus - origin from external part of obturator membrane
ACTION - Thigh abdcutuon , lateral rotation ,stabilises hip joint.
Gluteal region - deep muscles .
*All carry out abduction & insert onto greater trocanter apart from fermoris - intertrochaneric crest & only lateral rotation.
Gemelli - superior & inferior , piriformis , obturator internus ( join to form a commoon tendon - Triceps coxae - before inserting onto the medial aspect of the greater trochanter.
Muscles of the gluteal region ?
Superior muscles
Gluteus minimus
Gluteus Medius
Gluteus maximus
All cary out abduction & medial rotation & innervated by superior gluteal n. - apart from maximus ( inferior gluteal n. & lateral rotation & extension of lower limb)
- there is also the tensor fascia Lata
tightens fascia Lata —-> medially rotates lower limb & abducts. - superior gluteal N.
Deep muscles
0 Piriformis
0 Gemelli
0 Obturator internus
( located within both pelvic and gluteal regions - originates from posterior surface of obturator forearm )
(lateral rotation & abduction )
0 Quadratas femoris
(lateral rotation )
What is the Hip joint ?
PARTS
0 Acetabulum
0 Joint capsule
0 Ligaments
MOVEMENTS
0 Ball and socket synovial joint - very stable - not very mobile.
0 Articulation btw head of femur and acetabulum of pelvis.
MOVEMENTS
- Abduction
- adduction
- flexion
- extension
- lateral rotation
- medial rotation.
PARTS
- ACETABULUM
0 Acetabulum - Lunate (articular) surface
0 Acetabulum labrum - fibrocartilaginous collar around the lunate surface - deepens the acetabulum - stabilises hip joint
0 Tranverse Acetabulum Ligament - As Acetabulum labrum cross Acetabulum notch - forms Transverse Acetabulum ligament.
0 Acetabulum notch - space btw two ends of lunate surface
0 Acetabulum Fossa - Point of attachment for ( ligamentum teres ) ligament of head of femur - FOVEA
- LIGAMENTS
Intracapsular
0 Ligamentum teres -carries Acetabular branch of obturator a.
0 Transverse Acetabulum Ligament
Extracaspcular
0 Iliofemoral -strongest
0 Pubofemoral
0 Ischiofemoral - weakest.
JOINT CAPSULE
joint capsule - made up of circular ( Zona orbicularis ) & longitudinal fibres.
from acetabulum & transverse acetabulum L to neck of femur ( intertrochanteric crest)
Capsule thicker anterosuperiorly (maximal stress occurs here - especially when standing ) than posteroinferiorly
Zona Orbicularis - on neck of femur - encircles femoral neck - attaches to intertrochanteric line - BV travel underneath joint capsule , up neck to head of femur - intra - capsular fracture to neck -damage BV - lack of blood supply ——> avascular necrosis (death to tissue due to no blood ) & malunion ( fracture not healing properly )
Extracapsular fracture unlikely to damage BV
Joint capsule supported by 3 ligaments - supported and reinforced by :
0 extracapsular ligaments.
What is a synovial joint ?
Found between bones that move against each other.
0 Contains a synovial membrane - layer of cells that line joint capsule and produces synovial fluid.
Ligaments of the hip joint ?
Intracapsular -
0 Ligamentum teres - round ligament of femoral head.
* DOES NOT SUPPORT JOINT - reminant of fetal development.
Vessel & nerves travel within to supply femoral head.
e.g acetabular branch of obturator a.
0 Transverse Acetabular Ligament - located btw the 2 ends of the acetabulum labrum.
Extracaspcular
0 Iliofemoral -strongest - Y shaped - origin - anterior inferior iliac spine —-> bifurcates - inserts into intertrochanteric line of femur.
ACTION - prevents hyperextension.
0 Pubofemoral - - arises - superior pubic rami and inserts into the intertrochanteric line of femur.
ACTION - prevents excessive abduction and extension.
Reinforces joint anteriorly & extension.
0 Ischiofemoral - weakest - btw
body of the ischium and the greater trochanter of the femur
reinforce joint capscule posteriorly , prevents hyperextension , holds femoral head in acetabulum.
What muscles abduct the Hip ?
POSTERIOR
0 Gluteus Medius
0 Gluteus Maximus
ANTERIOR
0 Fasciae Latae.
0 Saritorius ( not sure )
What muscles abduct the Hip ?
G - Gracilis -
M - Magnus (adductor)
L - Longus (adductor )
B - Brevis (adductor)
P - Pectineus
Great major league Baseball Players
Map the branches of common iliac artery to popliteal a. ?
Abdominal Aorta ——–> bifurcates ——–> common iliac ———> external & internal iliac.
- Internal iliac —-> bifurcates ——-> anterior & posterior division
0 Anterior division - o Obturator a. o Inferior gluteal a. o Inferior Pudendal a. o Inferior vesical a. o Middle rectal a. o Umbilical a o Uterine a. o Vaginal a.
POSTERIOR DIVISION
o Iliolumbar a.
o Superior gluteal a.
o Lateral sacral a. (superior & inferior )
EXTERNAL ILIAC
external iliac —–> common femoral a. ——————————————> ( enters femoral triangle and gives off 4 branches.
- Superfical circumflex
- Superfical Epigastric
- Superfical external Pudendal
- Deep external Pudenal
Further down -
common femoral —— bifurcates ——-> Superficial femoral &Profunda femoris
profunda femoris ( deep femoral a. ) - branches off. -
MAIN SUPPLY TO ADDUCTOR , EXTENSOR , FLEXOR MUSCLES OF THIGH.
Profunda femoris ——————–> gives of 3 branches
- Lateral circumflex femoral - ascending & descending & transverse branch.
- Medial circumflex femoral - ascending branch (anastomes with ascending branch of lateral circumflex) & transverse branch.
MORE DISTAL
3. perforating a.
3 branches - perforate the adductor Magnus muscle .
Superficial Femoral ——- > gives off Descending genicular a. -2 branches ( saphenous & articular —————–>
REST OF FEMORAL A. ———————-> Popliteal a. ( when femoral passes through adductor hiatus ) - enters posterior compartment.
What is the blood supply of the hip ?
2/3 branches of profuna femoris (deep femoral a. )
Medial circumflex femoral
Lateral circumfex femoral
(anastomose - trochanteric anastomosis - )
Foveal a. - branch of obturator a / acetabular branch of the obturator a. . ( branch of internal iliac a. )
if damage to lateral & medial circumflex - fovea a. can prevent avascular necrosis.
Nerve supply of the Hip joint ?
Femoral n. - Hip flexors ( anterior thigh muscles )
Obturator n . - external / lateral rotators of hip (e.g Gemelli , obturator internus & externus etc . )
Superior Gluteal n. — adductors of the hip
( GMLBP)
nerve to quadratus femoris ( actually called that ) - supplies (external rotators )quadratas femoris , inferior gemelli
What imaging is used for Diagnosis of Hip fractures ?
Plain radiographs ( X -ray )
usually AP or Lateral.
Types of Hip Fracture ?
Intracapsular -
1. Subtrochanteric - lesser trochanter to 5cm distal.
- Intertrochanteric - between lesser & greater trochanter.
Intracapsular
- Subcapital - most common form - fracture line extends through junction of head and neck of femur.
- Transcervical - mid - portion of neck .
- Basicervical. - base of femoral neck
- powerpont mentioned
CAPITAL - fracture of femoral head.
Hip joint dislocations ?
Posterior more common
- lower limb will be internally rotated , adducted and flexed.
POSSIBLE CAUSES
- Dashboard injury - impact drives femoral head out of acetabulum
- associated with fracture to posterior lip of acetabulum or labrum.
0 Anterior -
Superior / pubic hip location
(femur moves up but anteriorly )
Inferior/ iliac hip dislocation
( femur moves inferiorly but anteriorly )
on radiograph shenton’ s line may be broken.
Always check sciatic nerve function - common fibular ( peroneal) and deep fibular may be damage - foot drop - weak dorsiflexion at ankle so in permanent plantarflexion - unopposed action of posterior muscles.
Urgent reduction (surgery ) needed to avoid avascular necrosis (disruption to blood supply of femoral head ) —> lead to femoral head collapse .
Imaging - radiograph of anterior hip dislocation ?
What is likely to be seen.
- lesser trochanter more visible in anterior dislocation due to external rotation
- In an anterior dislocation the femoral head will appear larger than the contralateral hip on account of geometric magnification
What are bursae ?
small fluid like sacs- reduce friction between moving parts of the body joints .
help tendons move over bony landmarks.
Bursitis - inflammation / irritation of the bursae.
