L16_The Pelvis and the Gluteal Region Flashcards
Name the structures indicated by the numbers
- Femoral head
- Femoral Neck
- Greater trochanter
- Intertrochanteric line
- Lesser Trochanter
- Lesser Trochanter
- Intertrochanteric Crest
- Gluteal Tuberosity
- Greater Trochanter
Name the structures of the acetabulum joint
- Fovea (direct linkage between the head of the femur and the acetabulum)
- Ligament of the head of the femur
- Lunate surface (articular surface)
- Acetabular labrum (hold the head of the femur)
- Transverse Acetabular Ligament
- Acetabular fossa
Describe the hip hoint (articulation, classification, reinforcing structures and ligaments, movements)
Articulation: between the head of the femur and the lunate surface of acetabulum
Classification: ball and socket joint , multiaxial joint
Reinforcing structures: Involved in deepening the socket and stabilizing the joint
- Deepen acetabulum or within acetabulum
° acetabular labrum (fibrocartilagenous ring)
° Transverse acetabular ligament
° Ligament of head of the femur
- Stabilize and limit movement at the hip
° Iliofemoral ligament: prevent hyperextension and limits lateral rotation
° Pubofemoral ligament: limit abduction
° Ischiofemoral ligament: limits medial rotation
Movements: flexion/extension, abduction/adduction, circumduction
Name the ligaments indicated by the numbers and tell me what movement they limit
1, 4. Iliofemoral Ligament (extending from the ilium to the femur)
*Prevents hyperextension during standing and limits lateral rotation
- Pubofemoral ligament (extending from the pubic bone to the femur)
*Prevents over-abduction
- Ischiofemoral Ligament (extending from the ischium and the femur)
* Limits medial rotation
Describe the blood supply to the lower extremity
Describe the blood supply to the head and neck of the femur
- the medial circumflex femoral artery (primary supply) and the lateral circumflex femoral artery will gove blood supply into the retinacular arteries that will then give blood supply to the neck of the femur (primarly) and the head of the femur by smaller branches in the bone.
- the obturator artery will pass inside of the fovea and become the foveal artery that will give blood supply to the head of the femur
If there’s a hip dislocations, femoral neck fractures the blood supply coming from the femoral neck won’t be able to get to the head of the femur. To prevent the bone to die of, due to lack of blood - avascular necrosis of femoral head-, the foveal artery will still provide blood to the head of the femur since it won’t be affected by the injury.
Identify the ligaments of the pelvis and tell me their function
- Sacrospinous ligament (SS) - attaches to the ischial spine
- Sacrotuberous ligament (ST) - attaches to the sacral tuberosity
Function: prevent upward tilting of distal sacrum, pulls the pelvis down (anchors sacrum to hip bones)
- The ligaments created the greater sciatic foramina
- The ligaments created the lesser sciatic foramina
- Inguinal ligament
Describe the gluteus maximus muscle (origin, insertion, function, innervation)
Origin: ilium ans sacrum, sacrotuberus and posterior sacroiliac ligaments
Insertion: Gluteal tuberosity, iliotibial tract/band (fascia lata)
Function: Hip extension and lateral (external) rotation of the thigh
Innervation: Inferior gluteal nerve (L5-S2)
Describe the gluteus medius (origin, insertion, function, innervation)
Origin: external/posterior ilium
Insertion: Lateral surface of greater trochanter
function: hip abduction, medial rotation (anterior), lateral rotation (posterior)
Innervation: superior gluteal nerve (L4-S1)
Describe the gluteus minimus (origin, insertion, function, innervation)
Origin: external/ posterior ilium
Insertion: anterior surface of greater trochanter
Function: hip abduction and medial rotation
Innervation: superior gluteal nerve (L4-S1)
Describe the tensor fascia lata (origin, insertion, function, innervation)
Origin: ASIS
Insertion: lateral tibial condyle via IT band
function: abducts and medially rotates the thigh at the hip, stabilizes pelvis whil standing, tenses IT band
Innervation: superior gluteal nerve and artery
Describe the Iliotibial band (origin, insertion, function)
NOT A MUSCLE
Origin: Tensor fascia lata
Insertion: lateral tibial condyle
Function: lateral thickening of the fascia lata of the thigh
Describe the piriformis (origin, insertion, function, innervation)
Origin: anterior sacrum
Insertion: upper medial aspect of greater trochanter
function: lateral rotation of the thigh at the hip
Innervation: nerve to piriformis (anterior rami S1-S2)
Describe the Obturator internus (origin, insertion, function, innervation)
Origin: internal margins of surface of obturator foramen and membrane
Insertion: greater trochanter
Functions: lateral rotation of the thigh at the hip
Innervation: nerve to obturator internus (L5-S2)
Describe the Gemellus superior (origin, insertion, function, innervation)
Origin: Ischial spine
Insertion: greater trochanter
Function: lateral rotation of the thigh at the hip
Innervation: nerve to obturator internus (L5-S2)
Describe the gemellus inferior (origin, insertion, function, innervation)
origin: ischial tuberosity
insertion: greater trochanter
function: lateral rotation of the thigh at the hip
Innervation: nerve to quadratus femoris (L4-S1)
Describe the quadratus femoris (origin, insertion, function, innervation)
origin: ischial tuberosity
insertion: intertrochanteric crest
function: lateral rotation of the thigh at the hip
innervation: nerve to quadratus femoris (L4-S1)
Describe the obturator externus (origin, insertion, function, innervation)
origin: external margins of surface of obturator foramen and membrane
insertion: intertrochanteric crest
function: lateral rotation of the thigh at the hip
Innervation: obturator nerve (L2-L4)
Identify and describe the neurovascular supply to the gluteal region
Motor innervation
Obturator nerve (L2-L4) -> gives innervation to obturator externus (passes through the obturator foramen)
Superior gluteal nerve (L4-S1) -> gives innervation to gluteus medius and minimus and tensor fascia lata (exits pelvis via greater sciatic foramen above piriformis)
Inferior gluteal nerve (L5-S2) -> gives innervation to gluteus maximus (exits pelvis via greater sciatic foramen below piriformis)
Sciatic nerve (L4-S3) -> gives motor innervation to the lower extremity (exits below piriformis -normal- or one branch can pierce piriformis and joint the other one after or one branch can pass superior to piriformis and join the other one after below piriformis
Nerve to obturator Internus (L5-S2) -> gives innervation to obturator internus and gemellus superior (exits below piriformis)
Nerve to piriformis (S1-S2) -> gives innervation to pirirformis (exits below piriformis)
Nerve to quadratus femoris (L4-S1) -> gives innervation to gemellus inferior and quadratus femoris (exits below piriformis)
Sensory innervation
Superior cluneal nerve
Middle cluneal nerve
Inferior cluneal nerve (S1-S3)
Posterior Femoral Cutaneous nerve (S1-S3) -> gives cutaneous innervation to the posterior thigh
Identify and describe the neurovascular supply to the gluteal region (ARTERY)
Exact same as the vasculature to the head and neck of the femur ++
Superior gluteal artery : exit the pelvis via the greater sciatic foramen on either side of the piriformis muscle. The superior gluteal artery travels with the nerve. Provides bllod supply and innervation to gluteus medius and minimus muscle
Inferior gluteal nerve: exits below the level or piriformis. the inferior gluteal artery travels with the nerve. Provide blood supply and innervation to gluteus maximus muscle
Describe the significance of the cruciate anastomosis
Important vascuar anastomosis to help re-direct blood to the distak lower limb in the event of a blockage between the femoral and external iliac arteries.
In the event of an injury, the blood flow will be backwards because the blood will come from the inferior gluteal artery to the medial circumflex femoral artery to the deep femoral artery, 1st perforating artery and Lateral circumflex femoral artery. The lateral circumflex femoral artery and the 1st perforating artery will then also go to the deep femoral artery that will then go to the femoral artery
