L6: The Pelvis and Hip Flashcards
Identify the anatomical regions of the lower limb.
The regions:
- Gluteal region
- Thigh
- Leg
- Foot
The neurovascular regions:
- The femoral triangle (groin)
- The popliteal fossa (behind the knee)
- Tarsal tunnel (posterior to the medial ankle)
The joints:
- Hip
- Knee
- Ankle
Describe the bony hip.
The pelvis is made up of the sacrum, the innominate bones on the left and the right, The pelvis connects the body connects our body from the lower limb, transmits weight of the hips and lower limbs and is protective.
The head of the femur articulates with the acetabulum forming the hub joint.
The innominate bones articulate with each other at the cartilaginous pubic symphysis. They articulate with the sacrum at the sacroiliac joint.
What are the movements of the hip joint?
- Extension - move leg back
- Flexion - move leg forward
- Abduction - move leg out laterally
- Adduction - bring leg in medially
- Internal rotation
- External rotation
What factors stabilise the pelvis and hip joint?
The hip joint is very stable, the acetabular labrum. The strong joint capsule is reinforced by surrounding ligaments.
- There is a fibrous capsule around the acetabulum to the intertrochanteric line of the proximal femur.
- Under the fibrous capsule is the synovial membrane which does not extend as far.
What are the 2 pelvic ligaments?
- Sacrospinous ligament - attaches from the ischial spine on the sacrum and forms the greater sciatic foramen - the sciatic nerve passes through the G. sciatic foremen into the gluteal regional and into the lower limb.
- Sacrotuberous ligaments - spans from the sacrum to the ischial tuberosity and converts the lesser sciatic notch on the lesser sciatic foreman.
What are the hip ligaments?
These stabilise the joints:
- Pubofemoral ligament - Anterior inferior ligament that prevents excessive abduction.
- Iliofemoral ligament - This is the strongest of the ligaments. It is superior and anterior. It prevents hyperextension. It is an anterior ligament.
- Ischiofemoral ligament - Posterior ligament. It is the weakest of the ligaments.
These ligaments pull the head of the femur into the acetabulum.
What are the flexors of the hip? What are there origins and insertions?
Prime flexor - psoas major. This is made of the psoas major and ilacus and inserts on the lesser trochanter. It travels under the inguinal ligament.
Other flexors include:
- Pectineus - attaches from the superior pubic ramus to the femur.
- Rectus femoris - attaches from the ASIS to the tibial tuberosity.
- Sartorius - attaches from the ASIS to the medial tibia.
- Tensor fascia latae - attaches from the ASIS to the iliotibial tract.
Most are innervated by the femora nerve (L2-L4).
What are the abductors of the hip? What are there origins and insertions?
Lie posterior lateral to the joint. Innervated by the superior gluteal. Main muscles:
• Gluteus medius
• Gluteus minimus
Both inert on the greater trochanter. Gluteus medius – comes down on the anterolateral part. Gluteus minimus inserts laterally on the greater trochanter. They are helpful in contraction when walking. They make sure the pelvis remains stable when walking. When we stand on one leg, the pelvis stays level as the abductors on the leg on eth ground contact and pull on the pelvis to keep it stable.
What are the adductors of the hip? What are there origins and insertions?
Lie mostly medial to the joint (thigh). Mostly innervated by the obturator nerve (L2-4).
Adductor group:
Have origins form the pelvic bone and insert on the posterior femur:
• Adductor brevis
• Adductor longs
• Adductor magnus (2 parts)
Others include:
• Gracillus
• Pectineus (femoral nerve) -
Obtruator externus
What are the lateral rotators of the hip? What are there origins and insertions?
Lie deep in the gluteal region, posterior aspect. Insert on the posterior aspect of the femur. When they rotate, the laterally rotate and stabilize. They are small muscle’s that lie deep to the gluteal muscles. They are small short muscles. These include:
• Piriformis – attached to the anterior aspect of the sacrum, and travels through the greater foramen and attaches to the superior greater trochanter. It can also contribute to abduction of the hip.
• Paired gemelli – superior and inferior gemelli. Superior originates on the ischial spine and inserts on the trochanteric fossa. The inferior gemelli originates form the ischial tuberosity.
• Between these is the obturator interuns – arises from the obturator foreman. It travels between them and inserts of the trochanteric fossa. The tendon travels through the lesser sciatic foramen
• Quadratus femoris – attached to the ischial tuberosity and the proximal femur on the intertrochanteric crest.
• The gluteus maximus also is a lateral rotator.
What are the medial rotators of the hip? What are there origins and insertions?
- Pectineus – originates from the superior pubic ramus and inserts on the proximal femur on the pectineal line on the posterior aspect of the proximal femur. Just inferior to the lesser trochanter.
- Gluteus Medius and minimus – anterior parts – which insert on the greater trochanter. Originate from the posterior aspect of the innominate bone and insert on eth lateral and slight anterior part of the greater trochanter.
What are the major vessels and nerves of the anterior joint?
- Obturator artery from internal iliac travels through obturator foramen into medial thigh.
- Femoral artery is continuation of the external iliac after it passes under the inguinal ligament > thigh.
- Travels in femoral triangle with the femoral vein and femoral nerve.
What are the major vessels and nerves of the gluteal region?
Internal iliac artery (and vein) in the pelvis give rise to the superior and inferior gluteal arteries > into gluteal region through greater sciatic foramen. They travel above and below, respectively, of the pirifromis. The sciatic nerve exits G. sciatic foramen below piriformis.
What is the blood supply to the hip?
Blood supply usually arises from the profunda femoris. This is the deep artery of the thigh, a large branch of the femoral. It gives rise to the medial circumflex artery and the lateral circumflex artery. These wrap around the joint and anastomose. The greater portion of the supply so from the medial circumflex. There is also a contribution form the obturator artery to the hip joint. Fractures to the neck of the femur can mean blood vessels coming distally can become torn. This can lead to avascular necrosis so of the femoral head.
What is congenital hip dysplasia?
The acetabulum is not deep enough for the developing femoral head. In movement the femoral head moves out of the acetabulum. Once it has moved out, the acetabulum does not continue to develop properly. There is laxity of ligaments that allows this.
