L9.2 - Hip Joints Flashcards
4 Joints of Pelvis
1) Lumbosacral - Secondary cartilaginous IV joint. Synovial zygoapophyseal joints (b/w inferior facets of L5 and superior facets of S1)
2) Sacroiliac - Partly Synovial and syndesmosis, b/w auricular surface of sacrum and ilium. Strong weight-bearing joint
3) Pubic symphyseal - Secondary cartilaginous b/w pubic bones
4) Sacrococcygeal - secondary cartilagnious joint b/w apex of sacrum and base of coccyx
Lumbosacral Joints - L1-4 superior articular facets are orientated ____, inf. art. facets are orientated ____ - allowing F/E in the ____ plane. L5/S1 however, have inf. facet of L5 orientated ______ and sup. facet of S1 orientated ____ which plays a role in ____
Lumbosacral Joints - L1-4 superior articular facets are orientated medially, inf. art. facets are orientated laterally - allowing F/E in the sagittal plane. L5/S1 however, have inf. facet of L5 orientated anterolaterally and sup. facet of S1 orientated internally (posteromedial) which plays a role in prevention of anterior gliding of spine.
Lumbosacral Joints - Ligaments (3)
1) Anterior Longtitudinal Lig.
2) Iliolumbar Lig (trans. pro. to ilium)
3) Lumbosacral (trans. pro. to ant. fossa of ilium)
Sacroiliac Joint - 2 types of joints present. The sacral tuberosity is ____ to the auricular surface. They are __ and ____, respectively.
Sacroiliac Joint - 2 types of joints present. The sacral tuberosity is posterior to the auricular surface. They are syndesmosis and synovial joint, respectively.
What can be found at syndesmosis joints? e.g. sacral tuberosity
Interosseous membrane (one of the strongest ligaments)
Sacroiliac Joint - Body weight is transferred onto the anterior surface of S1 then displaced medially/laterally - where weight is taken up by the iliac crest.
Laterally
Sacroiliac Joint - Ligaments and accessory lig.
Ant sacroiliac, Post sacroiliac, interosseous
Accessory lig - sacrospinous (sacrum to ischial spine), sacrotuberous (sacrum to ischial tuberosity)
Sacroiliac Joint - Evolutionary history: in primates, and some apes, _____ attach on sacrotuberous lig. On the sacrospinal lig., for animals with a tail, there is a ____ that attaches to it
Both lig. are accessory lig. that aid in preventing the ___
Hamstrings, Ischial coccygeus, anterior gliding of spine
The angle for the sacrum is ____ to the line of gravity
Oblique
The pubic bone forms the ____ of the pelvic cavity
Floor
Sacrum takes up a lot of weight when transitioning from ___ to __
Sitting to standing
Rotation occurs at S_ while S_ tilts inward (into pelvic cavity) - this action is aka ____. Hence ___ end tilts outwards aka ___.
2, 1, Nutation/nodding, Coccygeal, Counter-nutation
Sacroiliac joint transfers forces ____ and pubic symphysis takes up compressive forces going ___ from the ground. Hence the head and neck of femur takes up a lot of these forces, where the trabeculae in the middle of the head is orientated ___ in order to take up compressive forces. Compared to the inferior head of femur which are _____ orientated, where it goes till the neck of the femur and towards the greater trochanter - allowing the formation of criss-cross lines to take up weight.
Downwards, upwards, vertically (going to medial side of shaft of femur), transversely
Trabeculae in femur is least dense at ____ hence leading to fractures
Surgical neck
Reverse keystone effect
The sacrum sinks fowards and downwards into the pelvis. Post. lig. tighten and draw iliac bones together. Stability is therefore due to the ligs. (particularly the interosseous sacroiliac ligs.) - the bones (sacrum and ilium) tend to “open” the joint up.
Ligaments are lax during pregnancy. Head of infant engages pelvic inlet by ___, opening it up. As infant head goes through inlet - it rotates so that face rubs against pubic symphysis (aka anterior presentation - it is a posterior presenation when face rubs against sacrum with back of head rubbing pubic symphysis) . Head goes through pelvic outlet by the process of ___
Counter-nutation, nutation
Joints of Pubic symphysis
1) Type of joint
2) Lig.
3) Movements
4) Reinforced by?
It acts as a ‘tie-beam’, preventing separation laterally and resisting compression forces via femora
1) Secondary cartilaginous
2) Superior pubic lig., inferior arcuate, anterior lig
3) Small gliding movements during movements at Sacroiliac Joint
4) Reinforced by criss-crossing fibres from abdominal muscles (+adductor longus)
Sacrococcygeal Joint
1) Type of Joint
2) Where is it found?
3) Lig.
*Not weightbearing in humans
1) Secondary cart.
2) Apex of sacrum and base of coccyx
3) Ant and post sacrococcygeal lig.
Pelvic and lumbosacral fractures
1) What tends to lead to a fracture?
2) What is fractured?
3) Structures that could be damaged?
4) How is the L5/S1 affected?
5) Pretzel concept
1) Head on collision
2) Four pubic rami (anterior region), acetabulum, Joint of sacrum
3) Bladder, femoral artery (anteriorly), femoral nerve (ant), inf and sup gluteal artery (post), sciatic nerve (posterior)
4) Could have breakage, fracturing pars interarticularis aka spondylolysis or bilateral fracture aka spondylolythesis
5) Breaking one side leads to break in another side
Difference between spondylolysis and spondylolythesis
1) Slight slipping of L5 anteriorly
2) Entire L5 slips anteriorly into pelvic cavity
Hip Joint
1) Type of Joint
2) Location
3) Margins of capsule
4) Lig. - Origin and insertions, prevents what actions
1) Synovial ball and socket
2) B/w acetabulum and head of femur
3) Acetabular labrum, intertrochanteric line and above intertrochanteric crest (femoral neck: intracapsular)
4) a) Iliofemoral (‘Y’) lig. of Bigelow (AIIS to intertrochanteric line) It is considered the STRONGEST LIG in the body. Prevents hyperextension.
b) Pubofemoral - from lateral aspect of pubic bone to intertrochanteric line. Prevents hyperextension and hyperabduction.
c) Ischiofemoral - from ischial aspect of acetabulm and spirals from posterior side to insert on superior aspect of intertrochanteric crest and blend with the other ligaments on the anterior side. Fixes head of femur, prevents hyperextension and excessive lateral rotation.
* All 3 tighten in hip internal rotation and extension
What cartilage covers head of femur?
Avascular hyaline cartilage - it is also present in acetabulum
Ligamentum teres is aka ___, starts at ___ and inserts on ___.
Ligament of head of femur, fovea capitis, transverse acetabular lig.
What is found in between the two heads of the iliofemoral ligament of Bigelow?
Iliopectineal bursa
Fat pad in ______ - extrasynovial, provides cushioning
acetabular fossa
Hip Joint - Position of max stability
Lower leg is 10 to 20 degrees of extension, internal rotation and slight abduction
2 Bursae in hip joint
psoas, trochanteric
Hip Joint - Muscle support
psoas (ant), rectus femoris (lat), 6 ext rotators (post)
Femoral neck fracture - More like in what type of people? How is fractured hip presented? Longer or shorter than unfractured side?
Older women with osteoporosis, leg is positioned laterally rotated, shorter,
Posterior dislocation - how does this occur? What structures are compromised?
Sitting in a car cross-legged and getting into an collision anteriorly (Knee and hip flexed, internal rotation, adduction). Sciatic nerve, femoral circumflex arteries (mostly medial one is compromised)
Anterior dislocation - how does this occur
When leg is laterally rotated, abducted, slight extension
Congenital dislocation -what is it? More often in F or M? Treatment?
Infant born with coxa vara (110 degrees angle of inclination). More often in female infants. Put babies in thick nappies.
Medial rotators of hip
Glut medius and minimus, to some extent (tensor fascia lata) - not glut max
NS of Hip Joint
1) Anteriorly
2) Inferiorly
3) Posteriorly
NS of Hip Joint
1) Anteriorly - femoral
2) Inferiorly - obturator (anterior division)
3) Posteriorly - superior gluteal, nerve to quadratus femoris, sciatic
Hip pain may refer pain from uterus to ___
Knee (as it is more superficial)
BS of Hip Joint
1) Hip Joint
2) Head of femur - Diff b/w child and adult
Anastomoses b/w medial and lateral circumflex femoral arteries.
Head of femur - obturator artery. In child (artery to head of femur) In adult (capsular blood vessels obturator artery.
