hip region and thigh Flashcards
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how many bones in the phalanges of the foot
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how many bones in the metatarsals of the foot
5
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how many bones in the tarsals of the foot
7
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where do superficial veins run in the lower limb?
They run in the subcutaneous tissue layer and connect with deep veins.
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Into which vein does the great saphenous vein empty?
The great saphenous vein empties into the femoral vein in the saphenous opening within the femoral triangle.
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Where does the small saphenous vein drain?
The small saphenous vein empties into the popliteal vein in the popliteal fossa.
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What is the function of perforating veins in the lower limb?
Perforating veins allow blood to flow from superficial veins to deep veins.
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What structures help regulate blood flow in the veins of the lower limb?
Venous valves regulate blood flow and prevent backflow.
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How does blood return from the lower limb to the heart?
The musculovenous pump helps push blood from the lower limb back to the heart.
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What structures supply sensory and motor innervation to the lower limb?
The lumbar plexus (L1-4) and sacral plexus (L4-S4).
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What forms the lumbar and sacral plexuses?
The ventral rami of lumbar (L1-4) and sacral (L4-S4) spinal nerves.
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What are the 4 major nerves of the lumbar plexus and their functions?
Femoral nerve (L2-4): Supplies the anterior compartment of the thigh.
Obturator nerve (L2-4): Supplies the medial compartment of the thigh.
Lumbosacral trunk (L4-5): Contributes to the formation of the sacral plexus.
Lateral cutaneous nerve of the thigh (L2-3): Supplies skin on the anterolateral surface of the thigh.
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What are the 5 major nerves of the sacral plexus and their functions?
Sciatic nerve (L4-S3): Supplies the posterior compartment of the thigh.
Superior (L4-S1) and inferior gluteal (L5-S2) nerves: Supply the gluteal muscles.
Posterior cutaneous nerve of the thigh (S1-3): Supplies skin of the posteromedial surface of the thigh.
Nerve to quadratus femoris (L5-S1), nerve to obturator internus (L5-S1), and nerve to piriformis (S1-2).
Clunial nerves: Cutaneous nerves that supply the skin of the gluteal region.
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What are the 3 primary functions of the hip joint?
Connecting the lower limb and the pelvic girdle
Stability and weight-bearing
Movement
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What are the 4 main types of movements at the hip joint?
Flexion-Extension
Abduction-Adduction
Medial (Internal) - Lateral (External) Rotation
Circumduction
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What is flexion of the hip joint?
Movement of the thigh forward, decreasing the angle between the thigh and the pelvis
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What is extension of the hip joint?
Movement of the thigh backward, increasing the angle between the thigh and the pelvis.
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What is abduction of the hip joint?
Moving the thigh away from the midline of the body.
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What is adduction of the hip joint?
Moving the thigh toward the midline of the body.
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What is medial (internal) rotation of the hip joint?
Rotating the thigh inward, bringing the toes toward the midline.
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What is lateral (external) rotation of the hip joint?
Rotating the thigh outward, moving the toes away from the midline.
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What is circumduction of the hip joint?
A circular movement combining flexion, extension, abduction, and adduction.
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What type of joint is the hip joint?
The hip joint is a synovial ball-and-socket joint.
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What 3 structures provides stability to the hip joint?
Acetabular labrum
Capsule – ligaments
Muscles – medial and lateral rotators
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What is the primary function of the ligaments of the hip joint?
They primarily prevent hyperextension and over-abduction of the hip joint.
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What are 2 common causes of hip joint dislocation?
Osteoporosis (common in elderly individuals).
High-impact trauma, such as a car accident.
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What happens in a posterior hip dislocation?
The head of the femur is driven posteriorly, out of the acetabulum.
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Why does hip joint extension affect dislocation risk?
In hip joint extension, ligaments are twisted and tightened, pushing the femoral head into the acetabulum for stability.
However, in some positions of extension, ligaments become lax, allowing a greater range of movement, which can increase dislocation risk.
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What is an intracapsular hip fracture?
A fracture that occurs proximal to the intertrochanteric line, often involving the femoral neck.
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Why are intracapsular fractures problematic?
They damage the joint capsule.
They disrupt blood supply from the femoral circumflex arteries and retinacular arteries.
The only remaining arterial supply is the artery to the head of the femur, which is often insufficient, leading to avascular necrosis.
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What is an extracapsular fracture?
A fracture outside the joint capsule, which does not disrupt blood supply, allowing for better healing.
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What 5 arteries supply blood to the femoral head?
Medial circumflex femoral artery
Lateral circumflex femoral artery
Retinacular arteries (run in synovial folds)
Acetabular branch (artery to the head of femur, runs in ligament)
Obturator artery
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What is the risk of an intracapsular fracture?
Avascular necrosis of the femoral head due to disrupted blood supply.
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What is the action of the gluteus maximus?
Extends the hip joint (especially from a flexed position).
Assists in rising from a sitting position.
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What is the nerve supply of the gluteus maximus?
Inferior gluteal nerve (L5-S2).
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What is the action of the tensor fasciae latae?
Tenses the fascia lata.
Abducts and medially rotates the hip joint.
Helps keep the pelvis level when the ipsilateral limb is weight-bearing
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What is the nerve supply of the tensor fasciae latae
Superior gluteal nerve (L4-S1).
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What is the action of the gluteus medius + minimus?
Abducts and medially rotates the hip joint.
Helps keep the pelvis level when the ipsilateral limb is weight-bearing.
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What is the nerve supply of the gluteus medius + minimus?
Superior gluteal nerve (L4-S1).
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What muscles are affected by superior gluteal nerve injury?
Gluteus medius and gluteus minimus.
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Impaired hip joint abduction and medial rotation result in what
gluteal medius (Duchenne) limp
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What is the function of gluteus medius and minimus in typical, one legged stance?
They stabilize the pelvis in the coronal plane when standing on one leg
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What 3 things happens when the superior gluteal nerve is injured?
Weakness or paralysis of gluteus medius and minimus.
Impaired hip abduction and medial rotation.
Pelvis sags toward the unaffected side (positive Trendelenburg test).
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What is a positive Trendelenburg test?
When standing on the affected limb, the pelvis sags toward the unaffected, unsupported side due to weak hip abductors.
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how does the body compensate for superior gluteal nerve injury?
Tilts the upper body toward the affected side to shift the center of gravity onto the stance side.
This helps elevate the pelvis on the swing side.
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What are the three abnormal gaits caused by this injury?
Waddling gait
Steppage gait
Swing-out gait
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what is waddling gait
Leans away from the unsupported side.
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what is steppage gait
Lifts the foot higher as it moves forward.
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what is swing out gait
Swings the foot laterally when moving forward.
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What is the main function of the deep gluteal muscles?
Lateral rotation of the hip joint and steadying the femoral head in the acetabulum.
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What is the nerve supply of the piriformis?
Nerve to piriformis (S1-S2).
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What are the attachments of the piriformis?
Proximal attachment: Anterior surface of sacrum.
Distal attachment: Superior surface of greater trochanter.
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what is the nerve supply of the obturator internus?
Nerve to obturator internus (L5-S1).
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What are the attachments of the obturator internus?
Proximal attachment: Pelvic surface of obturator membrane.
Distal attachment: Trochanteric fossa.
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What is the nerve supply of the superior gemellus?
Same as obturator internus (L5-S1).
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What are the attachments of the superior gemellus?
Proximal attachment: Ischial spine.
Distal attachment: Trochanteric fossa.
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What is the nerve supply of the inferior gemellus?
Same as quadratus femoris.
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What are the attachments of the inferior gemellus?
Proximal attachment: Ischial tuberosity.
Distal attachment: Trochanteric fossa.
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What is the nerve supply of the quadratus femoris?
Nerve to quadratus femoris (L5-S1).
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What are the attachments of the quadratus femoris?
Proximal attachment: Ischial tuberosity.
Distal attachment: Intertrochanteric crest.
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What is the anatomical significance of the piriformis muscle?
It acts as a landmark in the gluteal region, dividing the greater sciatic foramen into superior and inferior portions.
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What is the function of the greater sciatic foramen?
It allows neurovascular structures to exit the pelvic cavity and enter the gluteal region.
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What structures pass superior to the piriformis?
Superior gluteal nerve
Superior gluteal artery and vein
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What structures pass inferior to the piriformis?
Inferior gluteal nerve, artery, and vein
Pudendal nerve
Internal pudendal artery and vein
Sciatic nerve
Posterior cutaneous nerve of the thigh
Nerve to obturator internus
Nerve to quadratus femoris
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What are the ligaments associated with the piriformis?
Sacrotuberous ligament
Sacrospinous ligament
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What passes through the lesser sciatic foramen?
Pudendal nerve
Internal pudendal artery and vein
Obturator internus
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Where does the sciatic nerve usually emerge from?
Inferior to the piriformis muscle through the greater sciatic foramen.
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What are common variations in the sciatic nerve pathway?
Early splitting of the tibial and common fibular divisions.
Common fibular division piercing through the piriformis muscle.
Sciatic nerve passing superior to the piriformis.
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What is Piriformis Syndrome?
Compression of the sciatic nerve by the piriformis muscle, often affecting cyclists and ice skaters.
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How can the sciatic nerve be injured during medical procedures?
Intramuscular injections into the gluteal region can damage the sciatic nerve if not properly placed.
