Hip region Flashcards
What is the function of the hip joint?
- connection btw pelvis and lower limb, providing mobility, weight transference and stability.
- the joint is the superior aspect of the leg, articulating with the lateral inferior aspect of the pelvis at the acetabulum - therefore all hip movements are movements of the leg.
- the acetabulofemoral joint carries the greatest load of any joint in the body.
- weight transmitted through sacrum and iliofemoral ligaments.
Give a brief explanation of the structure:
- synovium-lined ball and socket joint that plays a major role in weight bearing and locomotion. Its stability is due to the relatively deep insertion of the femoral head into the acetabulum and the strong capsule and surrounding muscles.
What are the muscles surrounding the Hip joint?
- ilipsoas
- rectus femoris
- Gluteus medius and maximus
- Adductor
- Gracilis
- TFL
- Piriformis
- Obturator
- Gamellis
Explain the function of bursae and its complications:
- are fluid-filled cavities located at tissue sites where tendons or muscles pass over bony prominences near joints.
- prevent excessive friction of soft tissue over bony prominences during motion.
- There are three bursae closely related to the hip: The trochanteric bursa, ischiogluteal bursa and the gluteus medium bursa.
What are the different injuries related to the hip bursa:
The iliotibial band and gluteus muscles pass over this area.
Falls onto the lateral hip and overuse injuries (especially common in runners and dancers) are the most common causes of trochanteric bursitis.
After passing over the greater trochanter, the iliotibial band inserts at the knee on the lateral aspect of the tibia, so patients with iliotibial band syndrome may also complain of lateral knee pain.
Steroid injection into the trochanteric bursa may be helpful in addition to icing, anti-inflammatory medication and avoidance of excessive training or overuse. Another commonly injured bursa is one overlying the ischial tuberosity a fall on the buttock is the most common cause.
The differential diagnosis includes a hamstring strain, an apophysitis or even an avulsion fracture in a skeletally immature athlete. Less commonly injured is the iliopsoas (iliopectineal) bursa, which cushions the iliopsoas hip flexor muscle as it sweeps over the femoral head and inserts on the lesser trochanter. Patients with an inflamed iliopsoas bursa usually complain of anterior groin pain, which is worse with resisted hip flexion.
What is avascular necrosis of the hip:
- poor blood circulation starves the femoral head which weaken and collapse.
- AVN, is most prevalent in younger or middle aged-adults.
- symptoms: pain after standing and walking.
- causes: alcoholism, corticosteroids, blockage blood vessels from sickle cells anaemia, dislocation and trauma.
What are the three ligaments of the hip joint connecting the femoral head to the acetabulum.
iliofemoral, pubofemoral and ischiofemoral.
What are the nerves that innervate the hip joint:
- obturator nerve
- femoral nerve
- sciatic nerve
- Superior gluteal nerve.
Cited the hip muscles and their general action and function:
Buttock muscles:
Gluteus Max: hip extension during running and walking and stabilise the hip when weight bearing, medius and minimus work eccentrically.
Adductor muscles: - Pectinous - Gracilis - Adductor magnus - Adductor brevis Responsible for external rotation of the leg as it swings forward in running.
Hip flexors
- iliacus / posts major
exerts stress on lumbar spine during walking and running which is counter ac by abdominal muscles.
Named the hip flexors, origin, insert and nerve supply
Iliacus: Iliac crest - Lesser trochanter of the femur.
N: Femoral nerve L2-L4
Psoas: TP T12-L5 - Lesser trochanter of the femur.
N: Ventral rami of L2-4
TFL: O: ASIS I: Iliotibial tract.
N Superior gluten nerves L4-S1
Sartorius:
O: anterior superior iliac spine
I: Med part of the tibia near the tibial tuberosity.
N: Femoral nerve (L2-L4)
Rectus femoris:
O: Ant. inf. iliac spine and sup. acetabulum.
I: Tibial tuberosity and the patella.
N: Femoral nerve L2-L4
Adductor longus:
O: ramus of pubis
I: Linea aspera
N: obturator nerve. L2-L4
Pectinous:
O: pubis
I: pectineal line of femur.
N: Femoral nerve L2-L4 and ant. division of obturator nerve.
Named the hip adductors, origin, insert and nerve supply
Adductor longus:
O: ramus of pubis
I: Linea aspera
N: obturator nerve. L2-L4
Pectinous:
O: pubis
I: pectineal line of femur.
N: Femoral nerve L2-L4 and ant. division of obturator nerve.
Gracilis:
O: pubic symphysis.
I: Medial surface of the tibia.
N: Ant. division of the obturator nerve L2-L4
Adductor brevis:
O: Inf. ramus of the pubis.
I: Pectineal line and medial lip of lines aspera.
N: Ant.division of the obturator nerve L2-L4
Adductor magnus:
O: ischiopubic ramus, ischial tuberosity.
I. Linea aspera of the femur.
N: Post. division of the obturator nerve and tibial nerve.
Named the hip extensors, origin, insert and nerve supply
Gluteus max:
O: thoracolumbar fascia, iliac crest, sacrum
I: TFL and gluteal tuberosity of the proximal femur.
N: Gluteal nerve L5-S2.
Biceps femoris:
O: ischial tuberosity and sacrotuberous ligament
I: head of the fibula and lateral condyle of the tibia.
N:Tibial nerve L5-S2
Semitendinosus:
O: ischial tuberosity and sacrotuberous ligament.
I: medial surface of the tibial tuberosity.
N: Tibial nerve. L5-S2
Semimembranosus:
O: Outer surface of the ischial tuberosity.
I medial tibial condyle popliteal ligament and fascia.
N:Tibial nerve L5-S2
Named the hip abductors, origin, insert and nerve supply
Gluteus medius:
O: Exter. surface of the ilium
I: greater trochanter of the femur.
N:Sup. gluteal nerve L4-S1
Gluteus minimus:
O: External surface of the ilium
I: Greater trochanter of the femur.
N: Sup. gluteal nerve. L4-S1)
TFL: O: ASIS I: Iliotibial tract.
N Superior gluten nerves L4-S
Named the hip external rotators, origin, insert and nerve supply
Gluteus max:
O: thoracolumbar fascia, iliac crest, sacrum
I: TFL and gluteal tuberosity of the proximal femur.
N: Gluteal nerve L5-S2.
Piriformis: pelvic surface of the sacrum / sup. border of the greater trochanter of the femur.
N: sacral plexus L5-S1/ ventral rami of S1-S2
Obturator interns:
Gemellus: ischial spine / greater trochanter of the femur.
N: Sacral plexus (L5-S1)
Quadrates femoris: Lateral border of the ischial tuberosity / intertochanteric crest of the femur.
N: sacral plexus L5-S1
