Joints Of The Lower Limb And Glutes Flashcards
Type of joint for the hip?
- ball and socket synovial joint
- head of the femur articulates with the acetabulum of the hip bone
Acetabulum rim
-has elevated rim (incomplete in vicinity of the obturator foramen)
Acetabulum articular cartilage
- depression within the bony rim is smooth and covered with articulate cartilage
- no articular cartilage at the acetabular notch where the rim is incomplete and extends to the center (acetabular fossa)
Labrum of the acetabulum
-acetabulum is deepened by the addition of a cartilaginous lip-the labrum on the bony rim, which continues across the acetabular notch as the transverse ligament
Ligament of the head of the femur (round ligament)
- between the acetabular notch and the pit (fovea) in the head of the femur
- transmits vessels and nerves to the head of the femur
Capsule of the joint (acetabulum)
-attaches to the bone around the rim of the acetabulum except at the notch where it attaches to the transverse ligament
Capsule of the joint (femur)
- attaches laterally to the medical side of the greater trochanter, anteriorly to the intertrochanteric line, and medially just above the lesser trochanter
- posteriorly it attaches to the neck of the femur so that the lower posterior part of the neck is extra capsular
Rentinacular folds
- synovial membrane lining the capsule reflects off the capsule onto the neck of the femur in little folds
- contain blood vessels which serve the neck and head of the femur
Iliopsoas muscle
- capsule is frequently perforated/incomplete so that it communicates with a bursa under the iliopsoas muscle
- has three thickenings which extend from the hip bone to the femur in a spiral fashion
- iliofemoral lig, pubofemoral lig, ischiofemoral lig
Iliofemoral ligament
- attaches to the ilium adjacent to the anterior inferior iliac spine as it goes toward the femur
- divides into two limbs which attach high and low, respectively, to the intertrochanteric line, giving it a “Y” shape
Pubofemoral ligament
- attaches to the pubis near the obturator canal and to the femur at the lower part of the neck
- blends with the lower limb of the iliofemoral ligament
Ischiofemoral ligament
- attaches to the ischium behind and below the acetabulum
- spirals up and over the back of the capsule to attach to the greater trochanter
- some fibers blend with the upper limb of the iliofemoral ligament and other fibers become circular to form the zona orbicularis
What can you palate in the gluteal region?
- iliac crest (whole length)
- posterior superior iliac spine and the dimple over it at the level of S3
- natal cleft, 3rd sacral spine, and tip of coccyx
- gluteal fold, ischial tuberosity, and sacrotuberous ligament
Hip/innomianate bones
- two hip bones
- result of the fusion of three separate bones (ilium, pubis, and ischium)
Acetabulum
- place of union of the three parts of the hip bone
- articulates with the head of femur
Acetabular notch
-prominent open area of the acetabular margin
Acetabular fossa
-circular depression in floor of acetabulum which is continuous with the acetabular notch
Ilium What are all the structures?
- iliac crest
- tubercle of the crest
- ASIS/PSIS
- AIIS/PIIS
- greater sciatic notch
- iliac fossa
- inferior, anterior, posterior gluteal lines
Pubis What are the structures?
- body
- superior ramus and inferior ramus
- pubic crest
- pubic tubercle
- pectineal line
- obturator foramen
Ischium What are the structures?
- body
- ischial ramus
- ischial tuberosity
- ischial spine
- lesser sciatic notch
Head of femur
-articulates proximally with the hip bone at the acetabulum
Fovea
- pit on the medial surface
- attachment for ligament of the head which carries blood supply to the head of the femur
Neck of femur
-connects head to the shaft of the femur
Shaft of femur
- proximally has a greater trochanter and lesser trochanter
- important landmarks for muscle attachments
- note trochanteric fossa and intertrochanteric line
Mid-shaft
- numerous lines for muscle attachments
- posterior aspect- gluteal tuberosity, pectineal line, Linda as-era
Medial and lateral condyles of femur
-articulate with the tibia distally as well as with the patella anteriorly
Superior cluneal nerves
- from posterior primary rami of L1, 2 & 3
- supplies upper buttock
Middle cluneal nerves
- from posterior primary rami of S1, 2, 3
- supplies medial buttock
Inferior cluneal nerves
- branching from the posterior femoral cutaneous nerve and anterior primary rami of S1, 2, 3
- supplies lower buttock
Superficial fascia of the gluteal region
-is a little thicker and tougher than other areas of the body
Deep fascia of the gluteal region
- encloses the gluteus maximus and tensor fascia lata muscles between two layers
- very tough above the gluteus maximus superficial to the gluteus medius, gives partial origin for gluteus medius
Muscles of the gluteal region innervation
- four largest muscles are referred to as the gluteal muscles
- gluteus maximus, tensor fascia lata, gluteus medius, gluteus minimus
- all are innervated by the gluteal nerves
Gluteus maximus muscle Origin? Insertion? Innervation? Function?
O: from the back of the pelvis, erector spinae tendon, and sacrotuberous ligament
I: into the iliotibial tract and gluteal tuberosity of the femur
I: inferior gluteal nerve
F: extends and laterally rotates the thigh at the hip
-abductor-upper fibers
-adductor-lower fibers of the thigh at the hip joint
Tensor fascia lata Arises? Inserts? Innervation? Function?
A: anterior part of the crest of the ilium
I: into the iliotibial tract and lateral condolences of the tibia
I: superior gluteal nerve
F: flexes and medially rotates the thigh at the hip and helps stabilize both hip and knee joints
Gluteus medius Arises Inserts Innervation Function
A: below the iliac crest and between the anterior and posterior gluteal lines
I: greater trochanter
I superior gluteal nerve
F: strong abductor and rotator of the thigh
-anterior fibers-medial rotator
-posterior fibers-lateral rotator
Gluteus minimus Arises Inserts Innervation Function
A: ilium beneath the gluteus medius
I: on the greater trochanter of the femur
I: superior gluteal nerve
F: strong abductor of the thigh at the hip
Piriformis
Arises
Inserts
Function
A: front of the sacrum inside the pelvis, passes through the greater sciatic notch
I: greater trochanter of the femur
F: a lateral rotator of the thigh at the hip
Obturator internus
Arises
Inserts
Function
A: inside the pelvis off the obturator membrane and surrounding bone–goes through the lesser sciatic notch, makes a 90* turn
I: greater trochanter
F: lateral rotator of the thigh at the hip
Superior and inferior gemelli
Arises
Inserts
Function
A: superior and inferior margins of the lesser sciatic notch, respectively
I: the tendon of the obturator internus muscle
F: aid in lateral rotation
Quadratus femoris
Origin
Inserts
Function
O: lateral side of the ischial tuberosity
I: intertrochanteric crest of the femur
F: laterally rotates the thigh
Small lateral rotators
-of the hip and lie in a plane with the gluteus minimus above and the adductor magnus below
Nerves of the gluteal region
- branches of the sacral plexus
- all branches pass through the greater sciatic foramen
Superior gluteal nerve
- posterior branches of L4, 5, S1
- emerges from greater sciatic foramen above the piriformis muscle in company with the superior gluteal vessels
- supplies the gluteus medius, gluteus minimus, and tensor fascia lata muscles
Inferior gluteal nerve
- posterior branches of L5, S1, 2
- appears below the piriformis muscle
- supplies the gluteus maximus muscle
- accompanied by the inferior gluteal vessels
Posterior femoral cutaneous nerve
- anterior branches S2, 3; and posterior branches S1, 2
- overlies the sciatic nerve
- gives off the inferior cluneal nerves and the perineal branch
- continues down the back of the thigh under the deep fascia as far as the popliteal fossa
Sciatic nerve
- makes up tibial nerve: anterior branches L4, 5, S1, 2, 3
- makes up common perineal/fibular nerve: posterior branches L4, 5, S1, 2
- appears below the piriformis muscle
- crosses the quadratus femoris muscle
Pudendal nerve
- crosses the sacrospinous ligament and re-enters the pelvis through the lesser sciatic foramen
- lateral to the nerve are the internal pudendal vessels
Nerve to the obturator internus muscle
- anterior L5, S1, 2
- appears lateral to the internal pudendal vessels
- supplies the superior gemellus muscle
- enters the pelvis through the lesser sciatic foramen to supply the obturator internus muscle
Nerve to the quadratus femoris
- anterior branches L4, 5, S1
- lateral to the nerve to the obturator internus and passes deep to the gemelli and obturator internus muscles to reach the anaterior surface of the quadratus femoris muscle
- innervates the inferior gemellus along its way, as well as the hip joint
Nerve to the piriformis
- posterior branches S1, 2
- given off in pelvis and appears in the gluteal region
Nerves pelvic diaphragm (levator ani & coccygeus) (anterior branches)
- Levator ani is innervated S3 and S4; coccygeus muscle by S4 and S5
- given off in the pelvis and never appear in the gluteal region
Pelvic spanchnic nerves
- parasympathetic-preganglionic
- remain in the pelvis
Superior gluteal vessels
-appears above the piriformis muscle in company with the superior gluteal nerve
Inferior gluteal vessels
-appear below the piriformis muscle with the inferior gluteal nerve
Medial femoral circumflex vessels
-appear between the quadratus femoris and adductor magnus near the hamstring muscles
First perforating vessels
-pierce the adductor magnus muscle adjacent to the linea aspera
Lateral femoral circumflex vessels
-appear above the neck of the femur and lateral to the shaft below the greater trochanter
Which blood vessels anastomose in gluteal region?
- inferior gluteal
- superior gluteal
- medial femoral circumflex
- first perforating
- lateral femoral circumflex
Which blood vessels form the cruciate anastomosis?
-inferior gluteal, medial femoral circumflex, first perforating, lateral femoral circumflex
