L9.2 - Hip Joints

Question 1

4 Joints of Pelvis

Answer 1

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

Question 2

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 ____

Answer 2

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.

Question 3

Lumbosacral Joints - Ligaments (3)

Answer 3

1) Anterior Longtitudinal Lig.
2) Iliolumbar Lig (trans. pro. to ilium)
3) Lumbosacral (trans. pro. to ant. fossa of ilium)

Question 4

Sacroiliac Joint - 2 types of joints present. The sacral tuberosity is ____ to the auricular surface. They are __ and ____, respectively.

Answer 4

Sacroiliac Joint - 2 types of joints present. The sacral tuberosity is posterior to the auricular surface. They are syndesmosis and synovial joint, respectively.

Question 5

What can be found at syndesmosis joints? e.g. sacral tuberosity

Answer 5

Interosseous membrane (one of the strongest ligaments)

Question 6

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.

Answer 6

Laterally

Question 7

Sacroiliac Joint - Ligaments and accessory lig.

Answer 7

Ant sacroiliac, Post sacroiliac, interosseous

Accessory lig - sacrospinous (sacrum to ischial spine), sacrotuberous (sacrum to ischial tuberosity)

Question 8

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 ___

Answer 8

Hamstrings, Ischial coccygeus, anterior gliding of spine

Question 9

The angle for the sacrum is ____ to the line of gravity

Answer 9

Oblique

Question 10

The pubic bone forms the ____ of the pelvic cavity

Answer 10

Floor

Question 11

Sacrum takes up a lot of weight when transitioning from ___ to __

Answer 11

Sitting to standing

Question 12

Rotation occurs at S_ while S_ tilts inward (into pelvic cavity) - this action is aka ____. Hence ___ end tilts outwards aka ___.

Answer 12

2, 1, Nutation/nodding, Coccygeal, Counter-nutation

Question 13

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.

Answer 13

Downwards, upwards, vertically (going to medial side of shaft of femur), transversely

Question 14

Trabeculae in femur is least dense at ____ hence leading to fractures

Answer 14

Surgical neck

Question 15

Reverse keystone effect

Answer 15

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.

Question 16

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 ___

Answer 16

Counter-nutation, nutation

Question 17

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

Answer 17

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)

Question 18

Sacrococcygeal Joint

1) Type of Joint
2) Where is it found?
3) Lig.

*Not weightbearing in humans

Answer 18

1) Secondary cart.
2) Apex of sacrum and base of coccyx
3) Ant and post sacrococcygeal lig.

Question 19

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

Answer 19

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

Question 20

Difference between spondylolysis and spondylolythesis

Answer 20

1) Slight slipping of L5 anteriorly

2) Entire L5 slips anteriorly into pelvic cavity

Question 21

Hip Joint

1) Type of Joint
2) Location
3) Margins of capsule
4) Lig. - Origin and insertions, prevents what actions

Answer 21

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

Question 22

What cartilage covers head of femur?

Answer 22

Avascular hyaline cartilage - it is also present in acetabulum

Question 23

Ligamentum teres is aka ___, starts at ___ and inserts on ___.

Answer 23

Ligament of head of femur, fovea capitis, transverse acetabular lig.

Question 24

What is found in between the two heads of the iliofemoral ligament of Bigelow?

Answer 24

Iliopectineal bursa

Question 25

Fat pad in ______ - extrasynovial, provides cushioning

Answer 25

acetabular fossa

Question 26

Hip Joint - Position of max stability

Answer 26

Lower leg is 10 to 20 degrees of extension, internal rotation and slight abduction

Question 27

2 Bursae in hip joint

Answer 27

psoas, trochanteric

Question 28

Hip Joint - Muscle support

Answer 28

psoas (ant), rectus femoris (lat), 6 ext rotators (post)

Question 29

Femoral neck fracture - More like in what type of people? How is fractured hip presented? Longer or shorter than unfractured side?

Answer 29

Older women with osteoporosis, leg is positioned laterally rotated, shorter,

Question 30

Posterior dislocation - how does this occur? What structures are compromised?

Answer 30

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)

Question 31

Anterior dislocation - how does this occur

Answer 31

When leg is laterally rotated, abducted, slight extension

Question 32

Congenital dislocation -what is it? More often in F or M? Treatment?

Answer 32

Infant born with coxa vara (110 degrees angle of inclination). More often in female infants. Put babies in thick nappies.

Question 33

Medial rotators of hip

Answer 33

Glut medius and minimus, to some extent (tensor fascia lata) - not glut max

Question 34

NS of Hip Joint

1) Anteriorly
2) Inferiorly
3) Posteriorly

Answer 34

NS of Hip Joint

1) Anteriorly - femoral
2) Inferiorly - obturator (anterior division)
3) Posteriorly - superior gluteal, nerve to quadratus femoris, sciatic

Question 35

Hip pain may refer pain from uterus to ___

Answer 35

Knee (as it is more superficial)

Question 36

BS of Hip Joint

1) Hip Joint
2) Head of femur - Diff b/w child and adult

Answer 36

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.