Hip joint, deep back, suboccipital, gluteal regions Flashcards
Pelvic Bones
- Illium
- ischium
- pubis
Landmarks in the pelvic
look over
Serratus Posteior Superior
Origin:
1. C7-T3 SP
Insertion:
1. Ribs 2-5 (Run out laterally)
Action:
1. elevates the ribs
Innervation:
1. ventral rami of the thoracic nerves
Serrratus posterior inferior
Origin:
1. T11-L3 SP
Insertion:
1. Ribs 9-12
Action:
1. depress the ribs
Innervation:
1. ventral rami of thoracic nerves
Splenius Capitis
Origin:
1. spinous processes of C7-T4
Insertion:
1. mastoid process
2. lateral 1/3 of superior nuchal line
Action:
1. bilateral: extend neck
2. Unilateral: ipsilateral neck rotation
Innervation:
1. dorsal rami of cervical nerves
Splenius Cervicis
Origin:
1. Spinous processes of T3-T6
Insertion:
1. Transverse processes of C1-C3
Action:
1. Bilateral: Extend neck
2. Unilateral: Ipsilateral neck rotation
Innervation:
1. Dorsal rami of cervical nerves
iliocastalis (errector spinae)
Lateral column
divisions:
- Lumborum
- Thoracis
- Cervicis
Origin:
1. Sacrum
2. lumbar spinous process
3. iliac crest
Insertion:
1. Angles of ribs
2. cervical transverse processes
Action:
1. bilateral: trunk extension
2. unilateral: ipsilateral trunk lateral flexion and rotation
Innervation:
1. dorsal rami
Longissimus
Middle column (erector spinae)
Divisions:
-thoracis
-cervicis
-capitis
Origin:
1. Thoracic and cervical TP
Insertion:
1. Thoracic and cervical TP
2. mastoid process
Action:
bilateral: trunk extension
unilateral: ipsilateral trunk lateral flexion
Innervation:
dorsal rami
Spinalis
Medial column (erector spinae)
Divisions:
- thoracis
- cervicis
- capitis
Origin:
1. thoracic and cervical spinous process
Insertion:
1. thoracic and cervical spinous process
2. blends with semispinalis capitis
Action:
1. bilateral: trunk extension
2. unilateral: ipsilateral trunk lateral flexion
Innervation:
1. dorsal rami
Tranversospinales
Origin:
1. transverse process
Insertion:
2. spinous process
-Semispinalis: spans 4-6 vertebrae (Occiput-thoracic)
-multifidus: spans 2-4 vertebrae (deep to semispinalis)
-rotatores: spans 1-2 vertebrae (deep to semispinalis thoracic)
Action:
1. Bilateral: extend trunk
2. unilateral: contralateral trunk rotation
Innervation:
1. dorsal rami
Segmental Muscles: levatores costrum
Origin:
1. Thoracic TP
Insertion:
1. Rib below
Action:
1. stabilize vertebral column
Innervation:
1. dorsal rami
Segmental Muscules: interspinales
Origin:
1. SP
Insertion:
1. SP below
Action:
1. stabilize vertebral column
Innervation:
1. dorsal rami
Segmental muscules: intetransversarrii
Origin:
1. TP
Insertion:
1. TP below
Action:
1. stabilize the vertebral column
Innervation:
1. Dorsal rami
Scalene
Anterior scalene
middle scalene
posterior scalene
Origin:
1. cervical TP
Insertion:
1. rib 1 or rib 2
Action:
1. elevation of rib 1 or 2
Innervation:
1. cervical ventral rami
Rectus Capitis Posterior minor
Origin:
1. C1 SP
Insertion:
1. medial occipital bone
Action:
1. Stabilize the head
Innervation:
1. suboccipital nerve (C1)
Rectus Capitis posterior major
Origin:
1. C2 SP
Insertion:
1. lateral occipital bone
Action
1. stabilize head and neck
Innervation:
1. suboccipital nerve (C1)
Obliquus Capitis Supeiror
Origin:
1. C1 TP
Insertion:
1. occiput
Action:
1. stabilize Head and neck
Innervation:
- suboccipital nerve C1
obliquus capitis inferior
Origin:
1. C2 SP
Insertion:
1. C1 TP
Action:
1. stabilize head and neck
Innervation:
1. suboccipital nerve C1
Gluteus Minimus
Origin:
1. ilium
2. between inferior and anterior gluteal lines
Insertion:
1. Greater trochanter
Action:
1. Hip abduction
Innveration:
1. Superior gluteal nerve L4-S1
Gluteus Medius
Origin:
1. ilium
2. between anterior and posterior gluteal lines
Insertion:
1. greater trochanter of the femur
Action:
1. Hip abduction
Innveration:
1. Superior gluteal nerve L4-S1
Gluteus Maximus
Origin:
1. ilium (posterior to gluteal line)
2. sacrum
3. coccyx
4. sacrotuberous ligament
Insertion:
1. iliotibial tract
2. Gluteal tuberosity of the femur
Action:
1. extends the thigh
2. laterally rotates the thigh
3. abducts the thigh
Innervation:
1. inferior gluteal L5-S2
Tensor fascia Latte
Origin:
1. anterior iliac crest
Insertion:
1. Anterior aspect of iliotibial tract
Action:
1. Flexes hip
2. abducts the hip
3. IR hip
4. Stabilizes knee in extension
Innervation:
1. superior gluteal L4-S1
Piriformis
Origin:
1. anterior sacrum
Insertion:
1. Greater trochanter
Action:
1. lateral hip rotation
Innervation:
1. S1, S2
Gemellus Superior
Origin:
1. Ischial spine
Insertion:
1. Greater trochanter
Action:
1. lateral hip rotation
Innervation:
1. Nerve to obturator interns L5-S2
Obturator Internus
Origin:
1. Medial surface of obturator membrane
Insertion:
1. Greater trochanter
Action:
1. lateral hip rotation
Innervation:
1. Nerve to obturator interns L5-S2
Gemellus Inferior
Origin:
1. ischial tuberosity
Insertion:
1. Greater Trochanter
Action:
1. lateral hip rotation
Innervation:
1. Nerve to quadrates femoris L4-S1
Quadratus Femoris
Origin:
1. ischium
Insertion:
1. intertrochanteric crest of the femur
Action:
1. lateral hip rotation
Innervation:
1. Nerve to quadrates femoris L4-S1
Blood Supply in this region
- Common iliac artery
- internal iliac artery and external iliac artery
- femoral artery
What supplies the femoral head
- lateral circumflex artery medial cicumflex femoral artery
- obturator artery
Deep back ligaments
- ligamentum flavum: between the lamina
- posterior longitudinal: vertebral bodies
- anterior longitudinal: vertebral bodies
- interspinous ligament: between Spinous process
- supraspinous: above spinous process
Suboccipital triangle anatomy
- rectus capitis posteriror major
- rectus capitis posterior minor
- obliquus capitis superior
- obliquus capitis inferior
Contents:
- vertebral artery
- suboccipital nerve C1
Runs over top
- greater occiptial nerve C2
Subocciptial Ligaments
nuchal ligaments
alar ligaments
transverse ligament
Gluteal Region nerves that enter through the greater sciatic forearm
- superior gluteal nerve L4-S1
- inferior gluteal nerve (L5-S2)
- sciatic nerve (L4-S3)
- Nerve to quadratus Femoris (L4-S1)
- Posterior cutaneous nerve of thigh
Gluteal region that enter through the lesser sciatic foramen
- Nerve to obturator internus (L5-S2)
- Pudendal Nerve S2-S4
Suboccipital Nerves
Suboccipital nerve C1 (motor and goes through triangle)
Greater occipital nerve C2 (sensory and goes under oblique capitus inferior
Sciatic nerve entrapment/piriformis syndrome
Causes
- muscle spasm in the piriformis muscle
- irritation in the muscule
- irritation in nearby structures such as the sacroiliac joint or hip
- tightening of the piriformis in response to injury or spasms
- swelling of the piriformis muscle
- sciatic nerve piercing the piriformis
- sciatic nerve passing superior to the piriformis
Piriformis syndrome
- Pain in the buttocks and down the leg
- chronic pain in the buttock and hip area
- pain when getting out of bed
- inability to sit for a prolonged time
- pain in the buttocks that is worsened by hip movements
Common referral pattern
sciatica
- characteristic pain in the buttocks that run down the leg
- shooting
- burning
- aching down
- numbness
- tingling
- occurs with movement or in sitting
- can extend lower over the proximal two thirds of the posterior thigh
- can be mistaken for superior hamstring or medial hamstring pain
Hip OA
- gradual erosion of cartilage which causes joint pain stiffness
- most common cause of hip pain in older adults
- diagnosis: moderate anterior/lateral pain in weight bearing, morning stiffness less than 1 hour after waking up hip internal rotation <24º and or flexion <15º
- physical examination: leg length discrpenancy, antalgic gait and trendelenburg gait
Forward head posture
- shortening of posterior cerivcal extensor muscles and tightening of anterior cervical muscles
- the weight of the head is maintained in fron of the line of gravity which then increases the flexion moment on spine