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Anatomy II Fall 2023 > Hip region > Flashcards

Hip region Flashcards

1
Q

What are similarities in the upper extremities and lower extremities?

A
  • pelvic and pectoral girdles
  • proximal segments have unpaired long bone
  • second segment has 2 parallel bones
  • 8 carpals and 7 tarsals
  • 5 metacarpals and 5 metatarsals
  • 2 bones in thumb and great toe
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2
Q

What are some differences in the upper and lower extremities?

A

LE
- more stability
- pelvic girdle complete ring
- tibia only connects to the femur
- leg cannot pronate or supinate

UE
- more mobility
- pectoral girdle incomplete ring
- both bones in forearm connect to humerus
- forearm can pronate/supinate

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3
Q

What muscles/ ligaments, fascia attach to the iliac crest?

A
  • thoracolumbar fascia
  • Tensor Fascia Lata
  • Iliacus
  • Latissimus dorsi
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4
Q

What muscles/ ligaments, fascia attach to the ASIS?

A
  • Sartorius
  • TFL
  • inguinal ligament
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5
Q

What muscles/ ligaments, fascia attach to the AIIS?

A
  • Iliofemoral ligament
  • rectus femoris
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6
Q

What muscles/ ligaments, fascia attach to the PSIS?

A
  • Posterior sacroiliac ligament
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7
Q

What muscles/ ligaments, fascia attach to the Ischial spine?

A
  • sacrospinous ligament
  • superior gemellus
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8
Q

What muscles/ ligaments, fascia attach to the ischial tuberosity?

A

-fascia lata
- quadratus femoris
- inferior gemellus
- Hamstrings (adductor magnus, semimembranosus, semitendinosus, long head of bicep femoris)

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9
Q

What ligament separates the greater and lesser sciatic foramen?

A
  • sacrospinous ligament
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10
Q

What muscles/ ligaments, fascia attach to the pubic crest?

A
  • abdominal muscles
  • adductor longus (just inferior)
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11
Q

What muscles/ ligaments, fascia attach to the Pubic tubercles?

A
  • inguinal ligament
  • Fascia Lata
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12
Q

What muscles/ ligaments, fascia attach to the greater trochanter?

A
  • obturator internus
  • gluteus medius
  • gluteus minimus
  • piriformis
  • vastus lateralis
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13
Q

What muscles/ ligaments, fascia attach to the lesser trochanter?

A
  • iliopsoas
  • psoas major
  • iliacus
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14
Q

What muscles/ ligaments, fascia attach to the trochanteric fossa?

A
  • superior and inferior gemellus
  • obturator internus
  • obturator externus
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15
Q

What muscles/ ligaments, fascia attach to the Linea aspera?

A
  • Vastus lateralis
  • vastus medialis
  • adductor brevis
  • adductor longus
  • adductor magnus
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16
Q

What muscles/ ligaments, fascia attach to the Gluteal tuberosity?

A
  • Gluteus maximus
  • adductor magnus
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17
Q

What muscles/ ligaments, fascia attach to the adductor tubercle?

A
  • adductor magnus (hamstring portion)
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18
Q

Where does the iliofemoral ligament live?

A
  • attaches to the AIIS then to the intertrochanteric line of the femur
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19
Q

Where does the pubofemoral ligament live?

A
  • attaches to obturator crest of pubic bone to merge w/ fibrous layer of joint capsule
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20
Q

Where does the ischiofemoral ligament live?

A
  • from acetabular rim to femoral neck
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21
Q

Where does the ligamentum teres ligament live?

A
  • runs through fovea of the femur from the transverse acetabular ligament
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22
Q

What does the Iliofemoral ligament do?

A
  • strongest ligament in the body
  • prevents hyperextension
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23
Q

What does the pubofemoral ligament do?

A
  • prevents hyperabduction
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24
Q

What does the ischiofemoral ligament do?

A
  • weakest of the 3 ligaments
  • taut during hip flexion
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25
Q

What does the ligamentum teres ligament do?

A
  • early life it is a passageway for blood flow to femoral head
  • does NOT aid in stability
  • obturator artery runs through
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26
Q

What is the coxafemoral joint comprised of?

A
  • femoral head
  • acetabulum
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27
Q

Why is the coxafemoral joint so stable?

A
  • most stable joint
  • depth of the ball-in-socket joint (more than half of the femoral head inside the labrum - compared to 1/3rd of humeral head in labrum w/ glenohumeral joint)
  • many muscles/ligaments runs around this joint
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28
Q

What are the boundaries of the femoral triangle?

A

Superior
- Inguinal ligament

Medial
- adductor longus

Lateral
- sartorius

Floor
- Iliopsoas & pectineus

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29
Q

What are the contents of the femoral triangle from lateral to medial?

A
  • femoral nerve
  • femoral artery
  • femoral vein
  • deep inguinal lymph nodes
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30
Q

What do the vessels of the femoral triangle run through?

A
  • vessels run through adductor canal all the way to the adductor hiatus made by the adductor magnus tendons
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31
Q

Describe the pathway of the femoral nerve

A
  • passes under the inguinal ligament through femoral triangle to the anterior thigh muscles
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32
Q

Describe the pathway of the saphenous nerve

A
  • branches off of femoral nerve and extends beyond the knee
  • passes medial malleolus to the dorsum of the foot
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33
Q

Describe the pathway of the superior gluteal nerve

A
  • leaves through greater sciatic foramen & passes superior to piriformis muscle
34
Q

Describe the pathway of the inferior gluteal, sciatic,
nerve to quatratus femoris, nerve to obturator internus, posterior femoral cutaneous, and pudendal nerves

A
  • leaves through greater sciatic foramen & passes inferior to piriformis muscle
35
Q

What muscle do the anterior and posterior divisions of the obturator nerve descend around?

A
  • adductor brevis
36
Q

Describe what the femoral nerve innervates

A
  • anterior thigh muscles
  • hip & knee joints
  • cutaneous branches to anteromedial thigh
37
Q

What muscles does the femoral nerve innervate?

A
  • iliopsoas
  • sartorius
  • pectineus
  • rectus femoris
  • Vastus intermedius
  • vastus lateralis
  • vastus medialis
38
Q

What muscles does the obturator nerve innervate?

A
  • obturator externus
  • pectineus
  • adductor brevis
  • adductor longus
  • adductor magnus (anterior head)
  • Gracilis
39
Q

What muscles does the sciatic nerve innervate?

A

Tibial portion:
- adductor magnus
- bicep femoris (long head)
- semimembranosus
- semitendinosus

Fibular portion:
- biceps femoris (short head)

40
Q

Describe what the saphenous nerve innervates

A
  • supplies skin and fascia of anteromedial aspect of the leg
  • supplies articular branches of the ankle joint
  • supplies skin of the medial side of the foot to the head of the first metatarsal
  • last cutaneous branch of the femoral nerve
41
Q

Describe what the clunial nerves innervate

A
  • supply the skin over the iliac crest, b/w PSIS’s, and over iliac tubercles
  • skin of buttock
42
Q

Describe what the superior gluteal nerve innervates

A
  • gluteus medius
  • gluteus minimus
  • tensor fasciae latae
43
Q

Describe what the inferior gluteal nerve innervates

A

gluteus maximus

44
Q

Describe what the sciatic nerve innervates

A
  • all muscles to posterior thigh, leg, & foot
  • tibial division for all except short head of biceps femoris which is supplies by common fibular division
45
Q

Describe what the nerve to quadratus femoris innervates

A
  • Quadratus femoris
  • inferior gemellus
  • hip joint
46
Q

Describe what the nerve to obturator internus innervates

A
  • obturator internus
  • superior gemellus
47
Q

Describe what the posterior femoral cutaneous nerve innervates

A
  • supplies skin of inferior half of buttocks
  • skin over posterior thigh and popliteal fossa
  • skin of lateral perineum & upper thigh
48
Q

Describe what the pudendal nerve innervates

A
  • principle nerve to perineum
49
Q

What are some key landmarks for dermatomes in the lower extremities?

A

L1: inguinal region
L3: anteromedial thigh to medial aspect of the knee
L4: top of knee down medial aspect of leg/foot
L5: lateral aspect of knee to lateral aspect of lower leg to b/w great toe and pinky toe (dorsal & plantar)
S1: posterolateral thigh to pinky toe
S2: posteromedial thigh to medial sole of foot

50
Q

What are some key myotomes for the hip?

A

Flexion: L2-L3

Extension: L4-L5

Abduction: L5-S1

Adduction: L2-L4

ER: L5-S1

IR: L4-L5

51
Q

What are some key myotomes for the knee?

A

Flexion: L5-S1

Extension: L3-L4

52
Q

What are some key myotomes for the ankle?

A

Dorsiflexion: L4-L5

Plantarflexion: S1-S2

Inversion: L4-L5

Eversion: L5-S1

53
Q

Which myotomal actions would be weak if a disc were compressing the L5 nerve root?

A

Hip Ext
Hip ER/IR
Hip abduction
Knee Flex
Dorsiflexion
Ankle eversion/inversion

54
Q

Describe the arterial branching that occurs in the hip and thigh region

A

External iliac -> Femoral -> 1) obturator artery & 2) Profunda Femoris
1) obturator artery
2) profunda femoris -> medial/lateral circumflex & perforating arteries

Internal Iliac -> superior & inferior gluteal, & internal pudendal

55
Q

What is a potential consequence of injury to the femoral artery?

A
  • death
56
Q

Which artery is most responsible for blood flow to the femoral head?

A
  • medial circumflex artery
57
Q

What is a potential consequence of injury to the medial circumflex artery?

A
  • avascular necrosis of the femoral head
58
Q

How are the great and small saphenous veins similar to the cephalic and basilic veins of the upper extremity?

A
  • both are superficial and come from venous plexuses from the distal appendages
59
Q

Describe the deep venous drainage of the lower extremities

A

1) anterior & 2) posterior -> popliteal vein -> femoral vein -> external iliac vein

1) anterior: dorsal venous arch -> anterior tibial vein

2) medial/lateral plantar veins -> posterior tibial/fibular veins

*Femoral vein receives blood from the great saphenous vein and profunda femoris vein

60
Q

Explain the gluteal region and muscles associated with the region

A
  • unique to humans for upright standing
  • angle of inclination allows for abductors to sit high in gluteal region

Muscles:
- Gluteus max, med, & min
- Tensor Fascia Latae
- piriformis
- superior gemellus
- Obturator internus
- inferior gemellus
- quadratus femoris
- obturator externus

61
Q

Explain the anterior group of muscles for the hip and the muscles associated

A
  • extensor group (knee) & hip flexion
  • innervated by the femoral nerve

Muscles:
- Iliopsoas (major, minor, iliacus)
- sartorius
- pectineus
- rectus femoris
- vastus lateralis, medialis, & intermedius

62
Q

Explain the medial group of muscles for the hip and the muscles associated

A
  • adductor group
  • innervated by obturator nerve

Muscles:
- gracilis
- adductor longus (most anterior)
- adductor brevis (shortest)
- adductor magnus (largest)
- (technically obturator externus but that performs ER)

63
Q

Explain the posterior group of muscles for the hip and the muscles associated

A
  • flexor group (knee)
  • innervated by tibial portion of sciatic nerve

Muscles:
- semitendinosus
- semimembranosus
- biceps femoris (long head)

64
Q

Which muscles are considered to be part of the “Rotator Cuff of the hip?”

A

6 ER muscles
- piriformis
- superior gemellus
- obturator internus
- inferior gemellus
- quadratus femoris
- obturator externus

Abductors
- gluteus medius
- gluteus minimus
- tensor fascia latae

65
Q

What is the triceps coxae?

A
  • “triceps of the hip:
  • 3 muscles of 2 gemelli & obturator internus

-act together to ER the hip

66
Q

List the muscles that perform hip flexion

A
  • iliopsoas
  • sartorius
  • pectineus
  • rectus femoris
  • tensor fascia latae
  • some of adductor magnus (adductor part)
67
Q

List the muscles that perform hip extension

A
  • gluteus maximus
  • semitendinosus
  • semimembranosus
  • biceps femoris (long head)
  • some of adductor magnus (hamstring part)
68
Q

List the muscles that perform hip abduction

A
  • gluteus medius
  • gluteus minimus
  • tensor fascia latae

When hip is flexed
- piriformis
- obturator internus
- superior/inferior gemelli

69
Q

List the muscles that perform hip adduction

A
  • pectineus
  • gracilis
  • adductor longus
  • adductor brevis
  • adductor magnus
70
Q

List the muscles that perform hip ER

A
  • piriformis
  • superior gemellus
  • obturator internus
  • inferior gemellus
  • quadratus femoris
  • obturator externus
  • gluteus maximus
71
Q

List the muscles that perform hip IR

A
  • gracilis (when flexed)
  • gluteus medius
  • gluteus minimus
  • tensor fasciae latae
72
Q

What can be a complication of an intrascapular fracture of the femur?

A
  • occurs inside capsule of hip joint
  • degeneration or avascular necrosis can occur due to a loss of blood supply
73
Q

What anatomical structures are replaced during a total hip arthroplasty?

A
  • acetabulum & femoral head
  • PT is important with this surgery
74
Q

What is a congenital hip dislocation?

A
  • in neonates
  • more in females than males
  • femoral head sits higher in acetabulum and the limb appears to be shorter
75
Q

What is an acquired hip dislocation?

A

Posterior dislocation (usually a car accident)
- uncommon b/c hip joint is so stable
- sitting in the car puts hip into flexion, adduction, & IR then an A -> P force tears the posterior capsule of the hip joint dislocating the hip posteriorly

Anterior dislocation
- position: extension, abduction, & ER
- acetabulum usually fractures

76
Q

How does a proximal hamstring strain differ from an ischial tuberosity avulsion fracture?

A

Hamstring strain:
- caused from muscle tearing

Ischial tuberosity avulsion fracture:
- caused from one being pulled away by the muscle

77
Q

Explain how bursitis occurs in trochanteric bursitis

A
  • pain radiates or is local
  • repetitive friction from TFL & glute max over greater trochanter
  • common in running
  • greater trochanter will be TTP
  • pain w/ resisted abduction or ER
78
Q

Explain how bursitis occurs in ischial bursitis

A
  • repetitive hip extension while seated (rowing)
  • ischial tuberosity TTP
  • pain while sitting is local
79
Q

What is the Trendelenburg Sign and why does it happen?

A
  • opposite side of pelvis drops w/ contralateral leg left

Causes:
- superior gluteal nerve injury
- spinal cord injury at L4-S1 levels
- gluteus Medius injury & weakness/atrophy
- trochanteric bursitis

80
Q

What is piriformis syndrome?

A
  • compression of sciatic nerve by piriformis

Causes:
- excessive use of gluteal muscles
- Trauma = piriformis spasm
- 12% of population the fibular division runs through the piriformis instead of under

81
Q

How does a Psoas Abscess form?

A

Causes:
- TB -> retroperitoneal pyogenic infection
- Crohn’s disease -> regional enteritis of ileum
- usually from an infected area that the psoas runs through/around

Pus usually appears on anterior superior part of thigh
- often mistaken as a femoral hernia

82
Q

What is the relationship of iliopsoas to pathology of the posterior abdominal region?

A
  • adenocarcinoma of pancreas invades surrounding muscles (iliopsoas) causing excruciating pain
  • disease of intervertebral joints or SI joints causes iliopsoas spasm & a protective reflex

if iliopsoas runs through these regions it is vulnerable to infection/disease

Anatomy II Fall 2023 (11 decks)

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