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MD2002 > Joints 1 - Glenohumeral and Hip Joints > Flashcards

Joints 1 - Glenohumeral and Hip Joints Flashcards

1
Q

What are the movements of the GH joint?

A

+ Flexion and extension
+ Abduction and adduction
+ Medial and lateral rotation
+ Circumduction

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2
Q

What are the movements of the hip joint?

A

+ Flexion and extension
+ Abduction and adduction
+ Medial and lateral rotation
+ Circumduction

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3
Q

What are the intrinsic, anterior ligaments of the GH joint?

A

+ Glenohumeral - weak

+ Transverse humeral - supports biceps tendon

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4
Q

What are the extrinsic, superior ligaments of the GH joint?

A

+ Coracoacromial - strong

+ Coracohumeral - strong

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5
Q

What does the coraco- acromial arch consist of?

A

+ Coracoid process
+ Acromion
+ Coraco-acromial ligament

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6
Q

What does the coraco-acromial arch do?

A

Prevents superior displacement of the humerus

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7
Q

Where does the GH joint capsule attach?

A

+ Medially to glenoid fossa margin and labrum

+ Laterally to anatomical neck of humerus

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8
Q

Where does the GH joint capsule enclose?

A

Proximal attachment of long head of biceps

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9
Q

What structures pass through the GH capsule?

A

+ Biceps tendon

+ Synovial membrane (anteriorly)

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10
Q

What does the synovial membrane form upon passing through the GH capsule anteriorly?

A

Subscapularis bursa

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11
Q

What does the subscapularis bursa do?

A

Protects the subscapularis tendon from being damaged by the edge of the glenoid

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12
Q

Where does dislocation of the GH joint most commonly occur, and during which movement?

A

Subcoracoid dislocation (anterior), usually during abduction

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13
Q

What structures are at risk during dislocation of the GH joint?

A

Axillary nerve and circumflex humeral artery

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14
Q

What are bursae?

A

Sac-like cavities containing synovial fluid which also helps facilitate movement

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15
Q

What can bursitis lead to?

A

Degenerative changes in the associated tendons resulting in difficulty initiating certain movements

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16
Q

What would degenerative changes in the supraspinatus tendon result in?

A

The inability to initiate abduction

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17
Q

What are the superficial muscles of the scapular region?

A

+ Latissimus dorsi

+ Trapezius

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18
Q

What are the deep muscles of the scapular region?

A

+ Rhomboids

+ Levator scapulae

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19
Q

What are scapular (intrinsic shoulder) muscles?

A 
\+ Deltoid
\+ Teres major
\+ Supraspinatus
\+ Infraspinatus
\+ Teres minor
\+ Subscapularis
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20
Q

What muscles form the rotator cuff muscles?

A 
SITS
\+ Supraspinatus
\+ Infraspinatus
\+ Teres minor
\+ Subscapularis
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21
Q

What do the rotator cuff muscles do?

A

They are short, powerful muscles that stabilise the GH joint by pulling the head of the humerus into the glenoid fossa

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22
Q

What movement is supraspinatus involved with?

A

First 15° of abduction (deltoid takes over up to 90°)

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23
Q

What movement is infraspinatus involved in?

A

Lateral rotation

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24
Q

What movement is teres minor involved in?

A

Lateral rotation

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25
Q

What movement is subscapularis involved in?

A

Medial roation

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26
Q

What are features of the first 3 muscles of SITS, supraspinatus, infraspinatus and teres minor?

A

Posterior scapular muscles that attach on posterior aspect of scapula (supra/infraspinus fossa) and attach to the greater tuberosity of the humerus

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27
Q

What nerve supplies supraspinatus and infraspinatus?

A

Suprascapular nerve

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28
Q

What nerve is teres minor supplied by?

A

Axillary nerve

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29
Q

What are features of subscapularis muscle?

A

Anterior scapular muscle that attached to the subscapular fossa and the lesser tuberosity of the humerus

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30
Q

What nerve supplies subscapularis?

A

Supscapular nerves (posterior cord)

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31
Q

Which muscles attach the UL to the scapula (scapulohumeral muscles)?

A

+ Deltoid
+ Teres major
+ Triceps
+ Rotator cuff muscles (SITS)

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32
Q

What are the landmarks of teres major?

A

Divides the axilla from arm

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33
Q

What is teres major?

A

A muscle of the posterior wall of the axilla

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34
Q

What are the attachments of teres major?

A

+ Lateral margin of scapula

+ Medial lip of bicipital groove of humerus

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35
Q

What nerve is teres major supplied by?

A

Lower subscapular nerve

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36
Q

What movement is teres major involved in?

A

It adducts and medially rotates the humerus

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37
Q

What are the attachments of the deltoid?

A

+ Clavicle
+ Acromion
+ Spine of scapula
+ Deltoid tuberosity of humerus

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38
Q

What nerve is the deltoid supplied by?

A

Axillary nerve

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39
Q

What movements are the deltoids involved in?

A

+ Abducting the arm (supraspinatus initiates first 15°)

+ Flexes and medially rotates arm (clavicular head)

+ Extends and laterally rotates the arm (spinal part)

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40
Q

Where does triceps brachii (long head) attach?

A

Infraglenoid tubercle of the scapula to the ulna

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41
Q

What is the role of triceps brachii (long head)?

A

Assists in stabilising the adducted GH joint

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42
Q

What are the attachments of the coracobrachialis?

A

Attached to coracoid process of scapula to middle 1/3 of humerus

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43
Q

What is the role of the coracobrachialis?

A

Resists dislocation of shoulder joint

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44
Q

What are the movements of the GH joint?

A

Flexion: pec. major + deltoid

Lat. rotation: infraspinatus

Med. rotation: subscapularis

Extension: deltoid

Adduction: pec. major + lat. dorsi

Abduction: deltoid

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45
Q

What are the gateways to the scapular region?

A

+ Suprascapular notch
+ Quadrangular space
+ Upper triangular space
+ Lower triangular (triangular interval)

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46
Q

What structures pass through the suprascapular notch?

A

+ Suprascapular nerve
+ Suprascapular artery
+ Branch of subclavian artery

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47
Q

What structures pass through the quadrangular space?

A

+ Axillary nerve

+ Posterior circumflex humeral artery

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48
Q

What structures pass through the upper triangular space?

A

+ Circumflex scapular artery

49
Q

What structures pass through the lower triangular space?

A

+ Radial nerve

+ Profunda brachii artery

50
Q

How is the acetabulum formed?

A

Fusion of ilium, pubis and ischium

51
Q

What lines the rim of the acetabulum, and what can happen to it?

A

Acetabular labrum, may tear and cause pain

52
Q

What are features of the acetabulum?

A

+ Deep socket
+ Weight bearing
+ Stable
+ Lunate lined articular surface

53
Q

What are features of the femoral head?

A

+ Large, approx. 2/3 of sphere

+ Covered in hyaline cartilage except for fovea ligament

54
Q

What are the features of the proximal femur?

A 
\+ Head, fovea
\+ Neck
\+ Greater trochanter
\+ Intertrochanteric crest
\+ Intertrochanteric line (capsular attachment)
\+ Lesser trochanter
55
Q

Why is the femoral shaft offset from the head by the femoral neck?

A

To enable movement

56
Q

What is the femoral neck particularly susceptible to in osteoporotic women?

A

Fracture (avascular necrosis of femoral head)

57
Q

What is the role of the trochanters?

A

For muscle attachment

58
Q

What is the role of the intertrochanteric line?

A

Hip joint capsule and ligaments insert anteriorly into the line

59
Q

When do the epiphyses of the two trochanters and the femoral head fuse?

A

By 18/19 years

60
Q

What is the connection between the synovial layers of the capsule and retinacular fibres?

A

The synovial layers of the capsule sends retinacular fibres medially along the femoral neck towards the head

61
Q

What are the 3 ligaments that reinforce the fibrous capsule of the hip joint?

A

+ Iliofemoral

  • anterior and superior
  • strongest

+ Pubofemoral
- anterior and inferior

+ Ischiofemoral

  • posterior
  • weakest
62
Q

Where does the iliofemoral ligament attach?

A

From ant. iliac spine to intertrochanteric line

63
Q

What does the iliofemoral ligament prevent?

A

Hyperextension of hip joint during standing

64
Q

Where does the pubofemoral ligament attach?

A

Blends with iliofemoral; attaches from obturator crest of pubic bone to merge with fibrous capsule

65
Q

What does the pubofemoral ligament prevent?

A

Overabduction of hip joint; tightens during abduction and extension of hip

66
Q

Where does the ischiofemoral ligament attach?

A

From acetabular rim (ischialO to medial part of greater trochanter

67
Q

Where are the ligaments of the hip joint weaker?

A

Posteriorly where the muscles (medial rotators of the hip) are placed to reinforce the joint

68
Q

Where are the ligaments of the hip joint stronger?

A

Anteriorly where the muscles (medial flexors of the hip) are fewer and weaker than the rotators posteriorly

69
Q

Where is the great trochanter in relation to the acetabulum

A

Opposite the middle of the acetabulum

70
Q

Which part of the acetabulum is often the first part to radiologically show the changes of osteoarthritis?

A

Superolateral part

71
Q

What does abnormal growth or movement of the epiphysis of the hip joint do?

A

Causes the femoral neck to move slightly anteriorly and into external rotation

72
Q

Where are retinacular arteries derived from?

A

Circumflex femoral and the obturator arteries

73
Q

In the hip joint, which structures are located laterally?

A

+ Gluteus med
+ TFL - tensor fascia latae
+ Iliotibial tract

74
Q

In the hip joint, which structures are located anteriorly?

A

Femoral nerve and vessels

75
Q

In the hip joint, which structures are located medially?

A

Branches of the obturator nerve and vessels

76
Q

In the hip joint, which structures are located posteriorly?

A

Sciatic nerve (with post. fem. cutaneous nerve and inf. gluteal vessels adjacent)

77
Q

What are the flexors (anterior thigh) of the hip joint?

A

+ Pectineus
+ Iliopsoas
+ Sartorius

78
Q

What are the adductors (medial thigh) of the hip joint?

A 
\+ Adductor longus
\+ Adductor brevis
\+ Adductor magnus
\+ Gracilis
\+ Obturator externus
79
Q

What are the extensors (posterior thigh - also flex knee) of the hip joint?

A

+ Semitendinosus
+ Semimembranosus
+ Biceps femoris

80
Q

What are the abductors and rotators of the thigh (gluteal region)?

A 
\+ Gluteus maximus, medius, minimus
\+ TFL - tensor fascia latae
\+ Piriformis
\+ Obturator internus
\+ Superior and inferior gemelli
\+ Quadratus femoris
81
Q

Where does the flexor, pectineus attach?

A

From the pubis to the femur (pectineal line)

82
Q

What movement is pectineus also involved in?

A

Adducts and assists with medial rotation of thigh

83
Q

What nerve supplies pectineus?

A

Femoral nerve

84
Q

What structures combine to form the flexor, iliopsoas?

A

Psoas major, psoas minor and iliacus

85
Q

Where does iliopsoas attach to?

A

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)

86
Q

What is iliopsoas supplied by?

A

Femoral nerve or ant. rami L1-L3

87
Q

What are the attachments of the flexor, sartorius?

A

From the ant. sup. iliac spine to sup. med. tibia

88
Q

What movement is sartorius also involved in?

A

+ Abducts and laterally rotates thigh

+ Flexes legs at knees

89
Q

What is sartorius supplied by?

A

Femoral nerve

90
Q

Where does adductor longus attach?

A

From the pubis (body inf. to pubic crest) to the femur (mid 1/3 of linea aspera)

91
Q

What is adductor longus supplied by?

A

Obturator nerve

92
Q

Where does adductor brevis attach?

A

From the pubis (body and inf. ramus) to the femur (pectineal line and prox. linea aspera)

93
Q

What is adductor brevis supplied by?

A

Obturator nerve

94
Q

Where does adductor gracilis attach?

A

From the pubis ( bodya ndinf. ramus) to the sup. medial tibia

95
Q

What movement is gracilis also associated with?

A

Flexes and partially medially rotates leg

96
Q

What is adductor gracilis supplied by?

A

Obturator nerve

97
Q

What are the two parts of adductor magnus?

A

+ Adductor

+ Hamstring

98
Q

Where does adductor magnus attach for the hamstring part?

A

From ischial tuberosity attaching to the femur (adductor tubercle)

99
Q

Where does adductor magnus attach for the adductor part?

A

From the inf. ramus of pubis and ischial ramus to femur (gluteal tuberosity, linea aspera med supracondylar line)

100
Q

Post division/for the adductor part, what is adductor magnus supplied by?

A

Obturator nerve

101
Q

What is the hamstring part of adductor magnus supplied by?

A

Sciatic nerve

102
Q

Where does obturator externus attach to?

A

From the obturator foramen and membrane to femur (trochanteric fossa)

103
Q

What movement is obturator externus also involved in?

A

+ Laterally rotates thigh

+ Steadies head of femur

104
Q

What is obturator externus supplied by?

A

Obturator nerve

105
Q

What are the flexors of the hip joint?

A

+ Pectineus
+ Iliopsoas
+ Sartorius

106
Q

What are the adductors of the hip joint?

A 
\+ Adductor longus
\+ Adductor brevis
\+ Adductor magnus
\+ Gracilis
\+ Obturator externus
107
Q

What are the extensors of the hip joint?

A

+ Semitendinosus
+ Semimembranosus
+ Biceps femoris

108
Q

Where does semitendinosus attach?

A

From the ischial tuberosity to sup. medial tibia

109
Q

Where does semimembranosus attach?

A

From ischial tuberosity to post medial condyle of tibia

110
Q

What movements are semitendinosus and semimembranosus also involved in?

A

+ Flex leg
+ Medially rotate when knee flexed
+ When thigh flexed, they extend trunk

111
Q

What is semitendinosus and semimembranosus supplied by?

A

Sciatic nerve

112
Q

Where does the long head of biceps femoris attach?

A

From the ischial tuberosity to the fibula

113
Q

Where does the short head of biceps femoris attach?

A

From the femur (linea aspera and lat. supracondylar line) to the fibula

114
Q

What movement is biceps femoris also involved in?

A

Partially flexes leg when knee flexed

115
Q

What is biceps femoris supplied by?

A

Sciatic nerve

116
Q

What are the abductors and medial rotators of the thigh?

A

+ Gluteus maximus
+ Gluteus medius, minimus and tensor fascia latae
+ Piriformis, obturator internus, superior and inferior gemelli
+ Quadratus femoris

117
Q

What is a dashboard injury?

A

Sitting with hips flexed - blow to the knee sends force proximally through the femur and dislocated the hip posteriorly

118
Q

What structure is at risk in a dashboard injury/posterior dislocation?

A

Sciatic nerve

MD2002 (85 decks)

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