Hip, Thigh, and Knee Flashcards
what type of pattern are the hip ligaments in?
spiral fiber pattern
when do hip ligaments tighten?
during hip extension to increase stability
when are hip ligaments the tightest?
end of stance phase right before you push off
what hip ligament limits natural tendency to hyperextend?
iliofemoral ligament
what is the strongest ligament in the body
iliofemoral ligament
what hip ligament limits abduction and external rotation of the hip
pubofemoral ligament
what is the weakest of the 3 hip ligaments?
ischiofemoral ligament
what hip ligament limits internal rotation?
ischiofemoral ligament
what provides vascularization for the head of the femur?
ligament of head of femur
what action do anterior thigh muscles do at the hip and knee?
hip - flex
knee - extend
pectineus
Proximal attachment – superior pubic ramus
Distal attachment – pectinate line of femur
Innervation – dual innervated – femoral and obturator nerve L2, L3
Action – flex, adduct, internal rotator of hip
iliopsoas
Proximal attachment – psoas major – body and transverse process of T12-L5, iliacus – iliac fossa – come together at level of inguinal ligament
Distal attachment – lesser trochanter
Innervation – psoas major – L1, L2, L3, iliacus – femoral nerve L2, L3
Action – flex hip, psoas major acts on vertebral column as bilateral flexor and unilateral ab/adductor and rotator
Psoas minor
Proximal attachment – T12, L1 vertebra
Distal attachment – pubic bone
Innervation – L1, L2
Action – does not cross hip, act lumbar intervertebral joint – bilateral flexor, unilateral ab/adductor, and rotator
sartorius
Proximal attachment – ileum – anterior superior iliac spine (ASIS)
Distal attachment – medial posterior tibia (pes anserinus)
Innervation – femoral nerve L2, L3
Action – flex, abductor, and external rotator of hip, flex knee
what is the longest muscle in the body
sartorius
what quadricep muscle acts on hip and knee?
rectus femoris
rectus femoris
Proximal attachment – anterior inferior iliac spine
Distal attachment – quad tendon
Innervation – femoral nerve L2, L3, L4
Action – flex at hip, extend knee
vastus lateralis
Proximal attachment – femur
Distal attachment – quad tendon
Innervation – femoral nerve L2, L3, L4
Action - extend leg at knee
what do oblique fibers of vastus lateralis do?
VLO - stabilize patella/knee
what do oblique fibers of vastus medialis do?
VMO - stabilize patella/knee
vastus medialis
Proximal attachment – femur
Distal attachment – quad tendon
Innervation – femoral nerve L2, L3, L4
Action - extend leg at knee
vastus intermedius
Proximal attachment – femur
Distal attachment – quad tendon
Innervation – femoral nerve L2, L3, L4
Action - extend leg at knee
what is the function of vastus intermedius at articularis genu
pull suprapatellar bursa up during knee extension to prevent bursa from binding between patella and femur
what is the action of muscles that cross hip inferior/medially?
adduct hip - adductor group
adductor longus
Proximal attachment – body of pubic bone
Distal attachment – linea aspera
Innervation – obturator nerve L2, L3, L4
Action – adductor, flexor, and internal rotator of hip
adductor brevis
Proximal attachment – inferior pubic body and ramus
Distal attachment – linea aspera and pectinate line
Innervation – obturator nerve L2, L3, L4
Action – adductor, flexor, and internal rotator of hip
adductor magnus anterior and posterior
Proximal attachment – anterior – ischiopubic ramus, posterior – ischial tuberosity
Distal attachment – anterior – linea aspera, posterior - adductor tubercle
Innervation – dual innervated composite muscle – anterior – obturator nerve L2, L3, L4, posterior – tibial nerve L4
Action – anterior part acts in synergist with adductor group (adductor, flexor, internal rotator of hip), posterior part acts in synergist with hamstrings (hip extensor, adduct)
adductor magnus anterior is part of what group?
hip adductor group
adductor magnus posterior is part of what group?
hamstrings
gracilis
Proximal attachment – inferior pubic ramus
Distal attachment – posterior medial tibia (pes anserinus)
Innervation – obturator nerve L2, L3
Action – flex at knee and hip
what muscles attach at the pes anserinus?
gracilis, sartorius, and semitendinosis
obturator externus
Proximal attachment – external surface of obturator membrane (obturator foramen)
Distal attachment – greater trochanter passing posterior to neck of femur
Innervation – obturator nerve L3, L4
Action - external rotator and abductor of hip
boundaries of femoral triangle
- superior: inguinal ligament running from anterior superior iliac spine to pubic tubercle.
- medially: lateral border of adductor longus muscle
- lateral/inferior: superior border of the Sartorius muscle
- floor: iliopsoas (lateral floor), and pectineus (medial floor) muscles
- roof: skin and fascia (fascia lata; cribriform) of thigh
what is the space between inguinal ligament and hip bone?
retroinguinal space
contents of femoral triangle
femoral vein, artery, and nerve
contents of adductor (femoral) canal
femoral artery/vein, saphenous vein, and cutaneous branch of femoral nerve (lower leg, medial calf)
when does femoral artery become popliteal artery?
when it passes through adductor hiatus
femoral artery comes off of what superior artery
external iliac artery at inguinal ligament
blood is shunted in what direction in venous blood flow in the lower limb
blood is shunted from superficial to deep through perforating veins
what makes up the femoral nerve
lumbar plexus, posterior divisions of ventral rami L2-L4
what makes up obturator nerve
lumbar plexus, anterior divisions of ventral rami L2-L4
articulations that form knee
medial femorotibial (medial condyle of femur and tibia), lateral femorotibial (lateral condyle of femur and tibia), and femuropatellar
what type of joint is the knee
shallow hinge synovial joint
what ligaments prevent knee hyperextension and limit rotation?
collateral ligaments
what knee ligament limits adduction or varus?
fibular collateral
what knee ligament limits abduction of valgus?
tibial collateral
what limits femur from sliding posterior and tibia from sliding anterior
anterior cruciate ligament
what knee ligament opposes hyperextension
anterior cruciate ligament
what limits the femur from sliding anterior and tibia from sliding posterior?
posterior cruciate ligament
what knee ligament limits hyperflexion?
posterior cruciate ligament
what is the Q angle?
angle between the axis of the femur and axis of the tibia to move the legs more toward the central axis of the body
what does the Q angle look for?
looks at the degree of valgus and varus
gluteus maximus
Proximal attachment – posterior iliac crest, posterior superior iliac spine, sacrum and coccyx
Distal attachment – deep – gluteal tuberosity, superficially – forms IT band and attach distally to Gerdy tubercle
Innervation – inferior gluteal nerve L5, S1, S2
Action – extends and external rotator of hip – when gluteus maximus contracts TFL together they synergize to abduct at the hip
gluteus medius and minimus
Proximal attachment – external surface of ala
Distal attachment – greater trochanter
Innervation – superior gluteal nerve L5, S1
Action – at midline they are abductors (main action), anterior medius and minimus will flex and internal rotate, posterior medius and minimus will extend and external rotate – stabilize during stance phase when you are unbalanced
Tensor fascia lata (TFL)
Proximal attachment – anterior superior iliac spine (ASIS)
Distal attachment – lateral condyle of fibula
Innervation – superior gluteal nerve L5, S1
Action – flexes at hip, synergize with gluteus max to abduct hip
piriformis
Proximal attachment – sacrum
Distal attachment – greater trochanter
Innervation – S1, S2 ventral rami
Action – abductor and lateral (external) rotator
obturator internus
Proximal attachment – internal surface of obturator membrane/foramen
Distal attachment – greater trochanter
Innervation – L5, S1 ventral rami
Action – abductor and lateral (external) rotator
superior and inferior gemelli
Proximal attachment – superior – on ischial spine inferior – ischial tuberosity
Distal attachment – merge with obturator internus to form common attachment on greater trochanter
Innervation – L5, S1 ventral rami
Action – abductor and lateral (external) rotator
quadratus femoris
Proximal attachment – ischial tuberosity
Distal attachment – intertrochanteric crest on posterior surface of femur
Innervation – nerve to quadratus femoris – lumbosacral plexus L5, S1
Action – external rotation – it will not abduct
obturator externus
Proximal attachment – obturator membrane
Distal attachment – greater trochanter of femur
Innervation – obturator nerve
Action – abduct and external rotator
semitendinosis
Proximal attachment – ischial tuberosity
Distal attachment – pes anserinus
Innervation – tibial nerve L5, S1, S2
Action – extend hip, flex knee, internally rotate foot
semimembranosis
Proximal attachment – ischial tuberosity
Distal attachment – medial plateau of the tibia
Innervation – tibial nerve L5, S1, S2
Action – extend hip, flex knee, internally rotate foot
Biceps femoris
Proximal attachment – long head – ischial tuberosity, short head – linea aspera
Distal attachment – lateral plateau of tibia and fibula, short head - fibula
Innervation – long head – tibial nerve, short head – fibular nerve – both are L5, S1, S2 ventral rami
Action – long head extend hip, long and short – flex knee, external rotator of foot mostly at knee but some at hip joint
