Joints 1 - Glenohumeral and Hip Joints Flashcards
What are the movements of the GH joint?
+ Flexion and extension
+ Abduction and adduction
+ Medial and lateral rotation
+ Circumduction
What are the movements of the hip joint?
+ Flexion and extension
+ Abduction and adduction
+ Medial and lateral rotation
+ Circumduction
What are the intrinsic, anterior ligaments of the GH joint?
+ Glenohumeral - weak
+ Transverse humeral - supports biceps tendon
What are the extrinsic, superior ligaments of the GH joint?
+ Coracoacromial - strong
+ Coracohumeral - strong
What does the coraco- acromial arch consist of?
+ Coracoid process
+ Acromion
+ Coraco-acromial ligament
What does the coraco-acromial arch do?
Prevents superior displacement of the humerus
Where does the GH joint capsule attach?
+ Medially to glenoid fossa margin and labrum
+ Laterally to anatomical neck of humerus
Where does the GH joint capsule enclose?
Proximal attachment of long head of biceps
What structures pass through the GH capsule?
+ Biceps tendon
+ Synovial membrane (anteriorly)
What does the synovial membrane form upon passing through the GH capsule anteriorly?
Subscapularis bursa
What does the subscapularis bursa do?
Protects the subscapularis tendon from being damaged by the edge of the glenoid
Where does dislocation of the GH joint most commonly occur, and during which movement?
Subcoracoid dislocation (anterior), usually during abduction
What structures are at risk during dislocation of the GH joint?
Axillary nerve and circumflex humeral artery
What are bursae?
Sac-like cavities containing synovial fluid which also helps facilitate movement
What can bursitis lead to?
Degenerative changes in the associated tendons resulting in difficulty initiating certain movements
What would degenerative changes in the supraspinatus tendon result in?
The inability to initiate abduction
What are the superficial muscles of the scapular region?
+ Latissimus dorsi
+ Trapezius
What are the deep muscles of the scapular region?
+ Rhomboids
+ Levator scapulae
What are scapular (intrinsic shoulder) muscles?
\+ Deltoid \+ Teres major \+ Supraspinatus \+ Infraspinatus \+ Teres minor \+ Subscapularis
What muscles form the rotator cuff muscles?
SITS \+ Supraspinatus \+ Infraspinatus \+ Teres minor \+ Subscapularis
What do the rotator cuff muscles do?
They are short, powerful muscles that stabilise the GH joint by pulling the head of the humerus into the glenoid fossa
What movement is supraspinatus involved with?
First 15° of abduction (deltoid takes over up to 90°)
What movement is infraspinatus involved in?
Lateral rotation
What movement is teres minor involved in?
Lateral rotation
What movement is subscapularis involved in?
Medial roation
What are features of the first 3 muscles of SITS, supraspinatus, infraspinatus and teres minor?
Posterior scapular muscles that attach on posterior aspect of scapula (supra/infraspinus fossa) and attach to the greater tuberosity of the humerus
What nerve supplies supraspinatus and infraspinatus?
Suprascapular nerve
What nerve is teres minor supplied by?
Axillary nerve
What are features of subscapularis muscle?
Anterior scapular muscle that attached to the subscapular fossa and the lesser tuberosity of the humerus
What nerve supplies subscapularis?
Supscapular nerves (posterior cord)
Which muscles attach the UL to the scapula (scapulohumeral muscles)?
+ Deltoid
+ Teres major
+ Triceps
+ Rotator cuff muscles (SITS)
What are the landmarks of teres major?
Divides the axilla from arm
What is teres major?
A muscle of the posterior wall of the axilla
What are the attachments of teres major?
+ Lateral margin of scapula
+ Medial lip of bicipital groove of humerus
What nerve is teres major supplied by?
Lower subscapular nerve
What movement is teres major involved in?
It adducts and medially rotates the humerus
What are the attachments of the deltoid?
+ Clavicle
+ Acromion
+ Spine of scapula
+ Deltoid tuberosity of humerus
What nerve is the deltoid supplied by?
Axillary nerve
What movements are the deltoids involved in?
+ Abducting the arm (supraspinatus initiates first 15°)
+ Flexes and medially rotates arm (clavicular head)
+ Extends and laterally rotates the arm (spinal part)
Where does triceps brachii (long head) attach?
Infraglenoid tubercle of the scapula to the ulna
What is the role of triceps brachii (long head)?
Assists in stabilising the adducted GH joint
What are the attachments of the coracobrachialis?
Attached to coracoid process of scapula to middle 1/3 of humerus
What is the role of the coracobrachialis?
Resists dislocation of shoulder joint
What are the movements of the GH joint?
Flexion: pec. major + deltoid
Lat. rotation: infraspinatus
Med. rotation: subscapularis
Extension: deltoid
Adduction: pec. major + lat. dorsi
Abduction: deltoid
What are the gateways to the scapular region?
+ Suprascapular notch
+ Quadrangular space
+ Upper triangular space
+ Lower triangular (triangular interval)
What structures pass through the suprascapular notch?
+ Suprascapular nerve
+ Suprascapular artery
+ Branch of subclavian artery
What structures pass through the quadrangular space?
+ Axillary nerve
+ Posterior circumflex humeral artery
What structures pass through the upper triangular space?
+ Circumflex scapular artery
What structures pass through the lower triangular space?
+ Radial nerve
+ Profunda brachii artery
How is the acetabulum formed?
Fusion of ilium, pubis and ischium
What lines the rim of the acetabulum, and what can happen to it?
Acetabular labrum, may tear and cause pain
What are features of the acetabulum?
+ Deep socket
+ Weight bearing
+ Stable
+ Lunate lined articular surface
What are features of the femoral head?
+ Large, approx. 2/3 of sphere
+ Covered in hyaline cartilage except for fovea ligament
What are the features of the proximal femur?
\+ Head, fovea \+ Neck \+ Greater trochanter \+ Intertrochanteric crest \+ Intertrochanteric line (capsular attachment) \+ Lesser trochanter
Why is the femoral shaft offset from the head by the femoral neck?
To enable movement
What is the femoral neck particularly susceptible to in osteoporotic women?
Fracture (avascular necrosis of femoral head)
What is the role of the trochanters?
For muscle attachment
What is the role of the intertrochanteric line?
Hip joint capsule and ligaments insert anteriorly into the line
When do the epiphyses of the two trochanters and the femoral head fuse?
By 18/19 years
What is the connection between the synovial layers of the capsule and retinacular fibres?
The synovial layers of the capsule sends retinacular fibres medially along the femoral neck towards the head
What are the 3 ligaments that reinforce the fibrous capsule of the hip joint?
+ Iliofemoral
- anterior and superior
- strongest
+ Pubofemoral
- anterior and inferior
+ Ischiofemoral
- posterior
- weakest
Where does the iliofemoral ligament attach?
From ant. iliac spine to intertrochanteric line
What does the iliofemoral ligament prevent?
Hyperextension of hip joint during standing
Where does the pubofemoral ligament attach?
Blends with iliofemoral; attaches from obturator crest of pubic bone to merge with fibrous capsule
What does the pubofemoral ligament prevent?
Overabduction of hip joint; tightens during abduction and extension of hip
Where does the ischiofemoral ligament attach?
From acetabular rim (ischialO to medial part of greater trochanter
Where are the ligaments of the hip joint weaker?
Posteriorly where the muscles (medial rotators of the hip) are placed to reinforce the joint
Where are the ligaments of the hip joint stronger?
Anteriorly where the muscles (medial flexors of the hip) are fewer and weaker than the rotators posteriorly
Where is the great trochanter in relation to the acetabulum
Opposite the middle of the acetabulum
Which part of the acetabulum is often the first part to radiologically show the changes of osteoarthritis?
Superolateral part
What does abnormal growth or movement of the epiphysis of the hip joint do?
Causes the femoral neck to move slightly anteriorly and into external rotation
Where are retinacular arteries derived from?
Circumflex femoral and the obturator arteries
In the hip joint, which structures are located laterally?
+ Gluteus med
+ TFL - tensor fascia latae
+ Iliotibial tract
In the hip joint, which structures are located anteriorly?
Femoral nerve and vessels
In the hip joint, which structures are located medially?
Branches of the obturator nerve and vessels
In the hip joint, which structures are located posteriorly?
Sciatic nerve (with post. fem. cutaneous nerve and inf. gluteal vessels adjacent)
What are the flexors (anterior thigh) of the hip joint?
+ Pectineus
+ Iliopsoas
+ Sartorius
What are the adductors (medial thigh) of the hip joint?
\+ Adductor longus \+ Adductor brevis \+ Adductor magnus \+ Gracilis \+ Obturator externus
What are the extensors (posterior thigh - also flex knee) of the hip joint?
+ Semitendinosus
+ Semimembranosus
+ Biceps femoris
What are the abductors and rotators of the thigh (gluteal region)?
\+ Gluteus maximus, medius, minimus \+ TFL - tensor fascia latae \+ Piriformis \+ Obturator internus \+ Superior and inferior gemelli \+ Quadratus femoris
Where does the flexor, pectineus attach?
From the pubis to the femur (pectineal line)
What movement is pectineus also involved in?
Adducts and assists with medial rotation of thigh
What nerve supplies pectineus?
Femoral nerve
What structures combine to form the flexor, iliopsoas?
Psoas major, psoas minor and iliacus
Where does iliopsoas attach to?
The vertebrae (psoas major and minor) OR iliac crest and SI ligaments (illiacus) where it attaches the femur (lesser trochanter - psoas major and iliacus or pectineal line psoas minor)
What is iliopsoas supplied by?
Femoral nerve or ant. rami L1-L3
What are the attachments of the flexor, sartorius?
From the ant. sup. iliac spine to sup. med. tibia
What movement is sartorius also involved in?
+ Abducts and laterally rotates thigh
+ Flexes legs at knees
What is sartorius supplied by?
Femoral nerve
Where does adductor longus attach?
From the pubis (body inf. to pubic crest) to the femur (mid 1/3 of linea aspera)
What is adductor longus supplied by?
Obturator nerve
Where does adductor brevis attach?
From the pubis (body and inf. ramus) to the femur (pectineal line and prox. linea aspera)
What is adductor brevis supplied by?
Obturator nerve
Where does adductor gracilis attach?
From the pubis ( bodya ndinf. ramus) to the sup. medial tibia
What movement is gracilis also associated with?
Flexes and partially medially rotates leg
What is adductor gracilis supplied by?
Obturator nerve
What are the two parts of adductor magnus?
+ Adductor
+ Hamstring
Where does adductor magnus attach for the hamstring part?
From ischial tuberosity attaching to the femur (adductor tubercle)
Where does adductor magnus attach for the adductor part?
From the inf. ramus of pubis and ischial ramus to femur (gluteal tuberosity, linea aspera med supracondylar line)
Post division/for the adductor part, what is adductor magnus supplied by?
Obturator nerve
What is the hamstring part of adductor magnus supplied by?
Sciatic nerve
Where does obturator externus attach to?
From the obturator foramen and membrane to femur (trochanteric fossa)
What movement is obturator externus also involved in?
+ Laterally rotates thigh
+ Steadies head of femur
What is obturator externus supplied by?
Obturator nerve
What are the flexors of the hip joint?
+ Pectineus
+ Iliopsoas
+ Sartorius
What are the adductors of the hip joint?
\+ Adductor longus \+ Adductor brevis \+ Adductor magnus \+ Gracilis \+ Obturator externus
What are the extensors of the hip joint?
+ Semitendinosus
+ Semimembranosus
+ Biceps femoris
Where does semitendinosus attach?
From the ischial tuberosity to sup. medial tibia
Where does semimembranosus attach?
From ischial tuberosity to post medial condyle of tibia
What movements are semitendinosus and semimembranosus also involved in?
+ Flex leg
+ Medially rotate when knee flexed
+ When thigh flexed, they extend trunk
What is semitendinosus and semimembranosus supplied by?
Sciatic nerve
Where does the long head of biceps femoris attach?
From the ischial tuberosity to the fibula
Where does the short head of biceps femoris attach?
From the femur (linea aspera and lat. supracondylar line) to the fibula
What movement is biceps femoris also involved in?
Partially flexes leg when knee flexed
What is biceps femoris supplied by?
Sciatic nerve
What are the abductors and medial rotators of the thigh?
+ Gluteus maximus
+ Gluteus medius, minimus and tensor fascia latae
+ Piriformis, obturator internus, superior and inferior gemelli
+ Quadratus femoris
What is a dashboard injury?
Sitting with hips flexed - blow to the knee sends force proximally through the femur and dislocated the hip posteriorly
What structure is at risk in a dashboard injury/posterior dislocation?
Sciatic nerve
