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Gabe's Metabolism > Joints of the Hip Complex > Flashcards

Joints of the Hip Complex Flashcards

1
Q

What does each component of hip bone help form?

A

The acetabulum

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2
Q

Which 3 bones comprise the hip bone?

A

Ischium, ileum and pubis

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3
Q

How is the congruence of the hip joint?

A

Good

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4
Q

Which parts of the acetabulum are not articular?

A

Lunate surface is weight-bearing, acetabular notch & fossa are non-articular.

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5
Q

What is the anatomical neck of the femur the site of?

A

The epiphysis

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6
Q

What attaches around the site of the growth plate at the epiphysis?

A

Joint capsule

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7
Q

What structures sit within the hip joint?

A

Fat pads, labrum and synovial fluid.

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8
Q

What is the non-articular site on the head of the femur?

A

Fovea

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9
Q

What inserts to the fovea?

A

Ligamentum teres

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10
Q

What types of epiphyses are the greater and lesser trochanters?

A

Traction epiphyses

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11
Q

What is the intertrochanteric line/crest?

A

The crest/line between the greater and lesser trochanters. Intertrochanteric line on anterior side, crest on posterior side.

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12
Q

What is a traction epiphysis?

A

A secondary center of ossification forming at the attachment site of a tendon.

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13
Q

What is a pressure epiphysis?

A

A secondary center of ossification that forms at the articular end of a long bone.

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14
Q

What shape is the head of the femur?

A

2/3 of a sphere.

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15
Q

How is the head of the femur directed?

A

Upwards, medially & forwards

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16
Q

Which part of the femoral head lies outside of the acetabulum and joint?

A

Anterior part

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17
Q

What is exposed anterior part of the femoral head protected by?

A

Psoas bursa – sits just below tendon of psoas major

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18
Q

What does the head of the femur articulate with?

A

Roof of acetabulum (thickest cartilage)

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19
Q

What does the neck of the femur do to allow a greater RoM?

A

The mid-region of the femoral neck is narrower than circumference of the head - greater ROM w/o contacting rim of acetabulum.

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20
Q

What are the 2 intra-articular structures of the hip joint?

A

Labrum and ligament of head of femur.

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21
Q

What does the labrum do?

A

Bridges acetabular notch, deepens cup & increases surface area - often torn in hip injury

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22
Q

What does the ligament of the head of femur do?

A

Has no supporting role
 - directs branch of obturator artery to femoral head (regresses after puberty)

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23
Q

What are the 2 systems of trabeculae that interesect in the femur?

A

Super and inferior.

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24
Q

What are the superior trabecula?

A

Vertical and articulate trabeculae formed due to compression through the head and neck.

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25
Q

What are the infeerior trabeculae?

A

Medial and lateral trabeculae that form in response to muscle pulls on greater and lesser trochanters.

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26
Q

Where does the line of gravity pass in relation to the hip joint?

A

Posterior

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27
Q

Where does the line of gravity pass in relation to the knee joint?

A

Anterior

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28
Q

Where does the line of gravity pass in relation to the ankle joint?

A

Anterior

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29
Q

What is the position of greatest stability at the hip joint?

A

Close packed position: extension, abduction & medial rotation

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30
Q

Where does the hip joint capsule attach?

A

At base of the long neck

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31
Q

What are the 3 ligaments of the hip joint?

A

Strong iliofemoral ligament in front, weaker behind (pubofemoral & ischiofemoral ligaments – blend with capsule with no direct attachment to femur)

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32
Q

When is the hip joint at maximum stability?

A

In extension

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33
Q

What is the hip joints maximum stability at extension primarily due to?

A

Iliofemoral ligament - spirals & tightens with hip extension

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34
Q

Do the ligaments of the hip joint attach to the femur?

A

No, they blend with the joint capsule.

35
Q

What is the hip joint capsule lined internally by?

A

Ring of fibres – ‘zona orbicularis’

36
Q

How is the posterior hip joint capsule different to the rest?

A

Does not extend as far distally –no limit to extension

37
Q

What are the retinacular fibres of the hip joint?

A

Reflections of fibrous tissue from capsule to femoral neck contain ‘retinacular’ vessels

38
Q

What do the retinacular vessels do?

A

Critical blood supply to head of femur.

39
Q

Which movements occur at the hip joint?

A
  • Flexion/extension (F – 120 deg; E – 10-20 deg)
  • Abduction/adduction
  • Medial/lateral rotation
  • Medial rotation occurs with extension (‘screw- home’) – joint ‘locked’. Reverse in flexion
  • Medial rotation in stance, lateral rotation in swing
40
Q

What is the hip joint surrounded by?

A

Cuff of ‘fixator’ muscles to stabilise head of femur in acetabulum.

41
Q

What are all fixator muscles of the hip?

A

External/lateral/outward rotators of the hip

42
Q

What is the principle role of the fixator muscles of the hip?

A

To pull head of femur into socket

43
Q

How do the tendons and fibres of the hip joint fixator muscles run?

A

Parallel to the neck of the femur

44
Q

When is gluteus maximus recruited?

A

Only recruited for extreme contractions/power.

45
Q

What is the role of gluteus medius and minimus?

A

Abduct the hip but primarily maintain position of pelvis in coronal plane (i.e. act from below)

46
Q

What is gluteus medius capable of?

A

Both flexion & extension

47
Q

What is the Trendelenberg gait?

A

Injury to gluteus medius and minimus results in failure to abduct the hip that’s involved in the swing phase.

48
Q

When are the adductor muscles of the hip most powerful?

A

When adducting from an abducted position.

49
Q

Where is groin pain and pathology related to the adductor muscles common?

A

At the bony attachment (osteitis pubis)

50
Q

Which adductor muscle is especially known as a common source of groin pain and pathology?

A

Adductor longus

51
Q

What is Hilton’s law?

A

Joint receives pain & proprioceptive fibres from branches to muscles that move the joint – also pass to overlying skin

52
Q

What is the hip joint innervated by?

A

Articular branches of femoral & obturator nerves

53
Q

What does referred pain from hip travel via?

A

Obturator nerve

54
Q

Where does referred pain to the hip travel from?

A

Lumbar spine and sacroiliac joint.

55
Q

Which spinal cord segments flex the hip?

A

L2/L3

56
Q

Which spinal cord segments extend the hip?

A

L4/L5

57
Q

Which spinal cord segments flex the knee?

A

L5/S1

58
Q

Which spinal cord segments extend the knee?

A

L3/L4

59
Q

Which spinal cord segments extend the ankle joint?

A

L4/L5

60
Q

Which spinal cord segments flex the ankle joint?

A

L1/L2

61
Q

Which spinal cord segments flex the toes?

A

L1/L2

62
Q

Which spinal cord segments extend the toes?

A

L5/S1

63
Q

Where does the hip joint get its blood supply?

A

Via anastomoses between branches of medial (primarily) & lateral femoral circumflex arteries (normally off profunda femoris)

64
Q

Where does a small amount of blood supply to the hip joint come from?

A

Artery of head of femur (regresses after puberty)

65
Q

Where do retinacular vessels pass?

A

Across femoral neck, bound down by ‘retinacular’ fibres (from capsule)

66
Q

When are vessels supplying the hip joint susceptible to fracture?

A

In a fractured neck of femur

67
Q

Where does the sciatic nerve pass?

A

Beneath piriformis and through greater sciatic foramen.

68
Q

What is dislocation of the hip joint often associated with?

A

Fractured posterior lip of acetabulum

69
Q

What is endangered in a dislocation of the hip joint?

A

Sciatic nerve

70
Q

What is important in dislocation of the hip joint?

A

Early re-articulation

71
Q

When is the hip joint most susceptible to dislocation?

A

When the joint is adducted, internally rotated and flexed.

72
Q

What happens tot he neck-shaft angle (angle of inclination) with development?

A

Angle greater in newborn (≥150°) reduces to approx. 135° in adult

73
Q

Why is the female angle of inclination smaller?

A

Due to width of pelvis

74
Q

What does the angle of inclination enable?

A

Enables femur to swing free of the pelvis in locomotion.

75
Q

What does the stability of the hip override?

A

Other joints of the lower limb

76
Q

What is coxa valga?

A

A pathological increase in the angle of inclination

77
Q

What is coxa vara?

A

A pathological decrease in the angle of inclination

78
Q

Which pathology will result in the leg being further away from the midline?

A

Coxa valga (valga = outwards)

79
Q

Which pathology will result in the leg being closer to the midline?

A

Coxa vara

80
Q

What does coxa vara in adolescence result in?

A
  • Increased stress on femoral neck.
  • Increased shear forces on femoral head may cause proximal femoral epiphysis to ‘slip’ – ‘slipped capital femoral epiphysis’
81
Q

In a fractured neck of the femur, what will muscle spasm cause?

A

External rotation & shortening of limb

82
Q

What are the 2 different causes of dislocation of the hip joint?

A

Congenital or traumatic

83
Q

What strengthens the anterior aspect of the hip joint?

A

Iliofemoral ligament

Gabe's Metabolism (5 decks)

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