L5: Anantomy of the Hip Flashcards
What are the three main articulations at the hip bone?
Sacroilliac joint: Posterior between hips and sacrum
Pubic symphysis: anterior, between L and R hips bone
Hip joint: articulation with head of the femur
What are the three parts of the hip bone?
Ilium
Pubis
Ischium
What is the name of the socket in which they all form? What articulates there?
Acetabulum
Head of the femur
What cartilage separates the bones during childhood?At what age do they being to and complete fusion?
Triradiate cartilage
Beings 15-17 years
Completed 20-25 years
What is the anatomy of the ilium?
Largest
Forms superior part of acetabulum
Two surfaces–>
internal surface: concave shape, iliac fossa
external surface: convex shape, attachment of gluteal muscles
Superior: iliac crest–> thickened wing, extends for ASIS to PSIS (anterior/posterior superior iliac spine)
Notches: AIIS and PIIS (anterior/ posterior inferior iliac spine)
Posterior: greater sciatic notch –> indentation
Describe the anatomy of the pubis?
Anterior portion of hip
Pubic body: medial portion,
–> articulates with opposite at pubic symphysis(cartilagenous joint)
–> pubic crest- round thickening
–> pubic tubercle- (rounded projection) marks end of pubic crest
Superior pubic ramus–> extends laterally form pubic symphysis to acetabulum
Inferior pubic ramus–> extends laterally, joins with inferior ischial ramus at ischiopubic ramus
What is the obturator foramen? What forms it?
Hole Formed by: - Superior pubic ramus - Inferior pubic ramus - Superior ischial ramus - Inferior ischial ramus
Describe the anatomy of the ischium?
Posterioinferior hip
Supeiror ischial ramus, body and inferior ischial ramus
Ischial tuberosity: posterior inferior part, bit you sit on
Ischial spine: projection of bone between superio ischial ramus and body (posteromedial projection of bone)
What important ligaments are attached to the ischium?
Sacrospinous ligament: anterior side, lateral, between ischial spine to sacrum
–> creates greater sciatic foramen
Sacrotuberous ligament: posterior side, longitudinal between sacrum to ischial tuberosity
–> creates lesser sciatic foramen
Limit rotatior of inferior part of sacrum
What forms the hip joint? Type of joint?
Acetabulum and head of femur
Ball and socket
What is the main function of the hip joint?
Enable movement of the lower limbs
Support weight of the body
What is the acetabulum? What structure helps stabilise it?
Cup like socket
inferiorlateral aspect
Acetabulum labrum–> fibrocartilagenous, encircles and deepens socket, more secure fit
–> ↑contact area by 10% so > 50% femoral head is in contact
What cartilage covers the surface of the head of femur and lines the acetabulum?
Hyaline cartilage
Acetabulum–> hyaline incomplete inferiorly–> acetabular notch–> contains fibroelastic fat with synovial membrane
What is the osteology of the femur? (label diagram)
Head–> covered hyaline cartilage, fovea capitis (depression for attachment of ligamentum teres)
Neck –> inferiorly, posteriorly and laterally, 125 degree angle with shaft
Greater and lesser trochanter–> bony prominence attachment site
Anterior–> Intertrochanteric line –> connect GT and LT
Posterior–> Intertrochanteric crest –> conntect GT and LT
Shaft –> linea aspera (posterior surface) –> intermuscular septa and muscles of thigh attach
Gluteal tuberosity –> between superior aspect of linear aspera and intertrochanteric crest
Lateral and medial supraconylar lines–>linear aspera diverges
Medial supraconylar ends on adductor tubercle (superior to medial epicondyle)
end of femur–> Medial and femoral condyles,
posterior –> separated by intercondylar notch
anterior–> trochlear groove
Medial and lateral epicondyle –> protuberance superior to condyle
What does the capsule of the hip attach to?
Proximally –> edge of acetabulum 5-6mm outside acetabulum labrum
Distally –> anterior - intertrochanteric line
–> posterior - neck of femur
What ligaments are associated with the hip joint?
Intracapsular –> ligamentum teres (contain artery)
Extracapsular - 3 ligaments- pull head into joint
–> Iliofemoral
–> Pubofemoral
–> Ischiofemoral
What are the features of the iliofemoral ligament?
- strongest
- superior and anterior joint capsule, blends with it
- anterior inferior iliac spine to intertrochanteric line (Y shaped insertion)
- Prevents hyperextension
- Screw head into acetabulum (standing)
What are the features of the pubofemoral ligament?
- inferior and anterior
- superior pubic ramus to inferior part of intertrochanteric line
- prevents excessive abduction and extension of hip
What are the features of the ischiofemoral ligament?
- posterior surface
- spiral shaped
- body of ischium to spirals superiolaterally to superior lateral intertrochanteric line and anteriormedial apsect of greater trochanter
- prevents excessive internal (medial) rotation of hip
What are the features of the ischiofemoral ligament?
- posterior surface
- spiral shaped
- body of ischium to spirals superiolaterally to superior lateral intertrochanteric line and anteriormedial apsect of greater trochanter
- prevents excessive internal (medial) rotation of hip
What ligament bridges the acetabular notch?
Transverse acetabular ligament
Where is the synovial membrane located?
Under the ligaments
attached to the margins of the articular surfaces
Ensheathes the ligamentum teres and covers the pad of fat contained within
What helps to stabilise the hip joint?
- C-shaped acetabulum
- Acetabulum labrum
- Capsule
- Ligaments intra and extracapsular
- Muscles
How do they muscles and ligaments work in the hip joint?
Reciprocal fashion
Anteriorly–> ligaments strongest, muscles weakest
Posteriorly –> ligaments weakest, muscles strongest
What movements are possible at the hip joint?
Flexion, extension, abduction, adduction, lateral rotation, medial rotation
What is the blood supply to the femoral head and neck?
-Extracaspular arterial ring
–> posteriorly- medial femoral circumflex artery
–> anteriorly- lateral femoral circumflex artery
branches of profunda femoris artery (femoral artery- external iliac artery)
-Ascending cervical arteries aka retinacular (branches of lateral circumflex arteries)–> metaphysis of femoral neck
-Artery of ligamentum teres –> femoral head (major in children, minor in adults)
- Ascending cervcial arteries (retinacular) of medial femoral circumflex artery –> head of femur
Why are adults more at risk of avascular necrosis to the head of the femur than children?
Fracture cut of blood supply from ascending cerival arteries of MFCA
Children major blood supply by artery of the ligamentum teres
What is the lumbosacral plexus?
Nerve supply to the lower limb
What nerve roots contribute the the lumbar plexus?
Anterior rami of L1-4
Divide into cords–> combine to form peripheral nerves
Descends on posterior abdominal wall
What contributes to the lumbosacral trunk?
L4 anterior ramus combines with the L5 anterior ramus
Contribute axons to sacral plexus hence lumbosacral plexus
What nerve root contribute to the sacral plexus?
S1- S5 and L4 and L5 (lumbosacral trunk)
Main destination= lower limb and pelvis, muscles, organs and perineum
What does ‘I get leftovers on Friday’ stand for?
Branches of the lumbar plexus I--> Ilioinguinal (L1) Get--> Genitofemoral (L1 and L2) Leftovers--> Lateral femoral cutaneous (L2 and L3) On--> Obturator (L2, L3 and L4) Friday--> Femoral (L2, L3 and L4)
Where does the ilioinguinal nerve innervate?
L1
Skin of genitalia and upper medial thigh (very upper!!)
Where does the genitofemoral nerve innervate?
L1 and L2
Genital branch (not this unit)
Femoral branch–> skin on upper anterior thigh
Where does the lateral cutaneous nerve innervate?
Posterior divisions of L2 and L3
Cutaneous sensation to anterolateral thigh inferiorly as knee