Lecture 1 Flashcards
What are the motions of the hip
Medial and lateral rotation turn the foot in and out respectively, abduction/adduction move the leg from and to the midline, respectively, and flexion/extension moves the leg anteriorly and posteriorly, respectively
What are the Latin names for the hip bone?
Os coxae and innominate bone
What are the parts of the coxal bone
ilium, ischium, and pubis
What is the acetabulum?
literally ‘vinegar cup’ it is the where the ilium. ischium, and pubis fuse
What is the obturator foramen
Hole formed by the fusion of the ischium and pubis bone
What is the pelvis
The pelvis is the bony ring made up of 2 os coxae and the sacrum
What are the articulations in the pelvis
2 sacroiliac joints and the pubic symphysis
What forms the sacroiliac joint
auricular surfaces of the ilium and sacrum for the synovial part of the joint, and the ventral and dorsal sacroiliac ligaments form the syndesmosis part
What is a common pathology of the sacroiliac joint
It is not uncommon for the SI joint to undergo stenosis with age. There is back pain for 3 years, and then the body adjusts and it goes away
What are the ventral and dorsal sacroiliac ligaments
Thickened regions of the SI joint capsule
Where is the iliolumbar ligaments and what is its role
Spans from iliac crest to TVP of L5. It limits rotation and anterior gliding of L5 relative to the sacrum and limits side-bending of L5 in relation to the pelvis
Where is the interosseus sacroiliac ligament
between the iliac tuberosity and sacrum (forms a syndesmosis)
Where is the sacrospinous ligament
From the sacrum to the ischial spine to form the greater and lesser sciatic foramina
What gives the sacrum stability
The downward compression of the sacrum from the weight of the upper body causes the interosseus ligaments to pull the ilium bones together thus tightening the iliosacral joint
What limits anterior sacral rotation
Sacrotuberous, sacrospinal, and interosseus sacroiliac ligaments
What is nutation of the sacroiliac joint
Rotation or tilting of the sacrum around a horizontal axis through the interosseus ligaments
What is anterior nutation
When the promontory moves anterior and inferior and the coccyx moves superior and posterior
What is counter nutation
The opposite of anterior nutation. The promontory moves superior and posterior, and the coccyx moves anterior and inferior
What roll does nutation play in birthing
Nutation brings the iliac crests closer together and the ischial tuberosities further apart, increasing the size of the pelvic outlet, making a bigger birth canal
What is a common fracture site on the femur
The neck
What is the hip joint
The hip joint is a ball-and-socket synovial joint between the head of the femur and the acetabulum of the coxal bone
What ligaments form the hip joint
Transverse acetabular, acetabular ligament, ligamentum teres
What are the stabilizing ligaments of the hip joint
iliofemoral, ischiofemoral, pubofemoral ligaments
What is the role of the iliofemoral ligament
limits hyperextension of the femur
What is the role of the ischiofemoral ligament
reinforces hip capsule posteriorly
What is the role of the pubofemoral ligament
reinforces hip capsule inferiorly
What is an alternative name for the iliofemoral ligament
The Y-ligament of Bigelow
How do the hip stabilizers maintain tension
They are positioned in a spiral so that no matter how the femur moves, there is tension
What is the blood supply to the femoral neck
Medial and lateral circumflex femoral aa
What is the blood supply to the femoral head
medial and lateral epiphyseal aa
<p>
| What is interesting about the lateral epiphyseal artery</p>
<p>
| It is easy disrupted by fracture, dislocations, etc which can lead to necrosis</p>
What is the origin and insertion of the gluteus maximus
O: iliac crest and sacrum/coccyx
I: Gluteal tuberosity and iliotibial tract
What is the action of the gluteus maximus
extend, lateral rotate femur
What is origin and insertion of the Psoas major
O: bodies and tvps of T12-L5
I: Lesser trochanter of femur
What is the innervation of the psoas major
N: L1-4
What is the action of the psoas major
Laterally flex vertebral column and flex femur at hip
What is the origin and insertion of the psoas minor
O: Bodies of T12-L5
I: Pectineal line of the pubis
What is the innervation of the psoas minor
L1
What is the action of the psoas minor
Weaker flexor of the lumbar spine
What is the origin and insertion of the iliacus
O: iliac fossa
I: lesser trochanter
What is the innervation the iliacus
Femoral N.
What is origin and insertion of the gluteus medius
O: Dorsum ilium
I: greater trochanter
What is the action of the gluteus medius
Abduct, medially rotate femur; during gait, supports body on one leg while the other leg swings forward
What is the innervation of the glut max
Inferior gluteal N (L5, S1,2)
What is the innervation of the glut med and min
Superior gluteal n (L5, S1)
What is the origin and insertion of the gluteus minimus
O: Dorsal ilium
I: greater trochanter
What is the action of the gluteus minimus
Abduct, medially rotate the femur; assists the glut med in supporting the body during gait
What is the origin and insertion of the tensor fascia lata
O: ASIS, anterior iliac crest
I: iliotibial tract
What is the innervation of the tensor fascia lata
Superior gluteal N (L4,5)
What is the action of the tensor fascia lata
Abduct, medially rotate, flex femur; keep knee extended
<p>
| What muscles laterally rotate the femur</p>
<p>
| Obturators internus and externus, superior and inferior gemelli, piriformis, quadratus femoris, and gluteus maximus</p>
What muscles medially rotate the femur
Tensor fascia lata, gluteus medius, and gluteus minimus
What muscles abduct the femur
Tensor fascia lata, gluteus medius, gluteus minimus, and piriformis
What hip/gluteal muscles extend the femur
Gluteus maximus
What hip/gluteal muscles flex the femur
Iliacus and psoas
What is the origin and insertion of the obturators internus and externus
O: Obturator membrane
I: Greater trochanter
What is the innervation of the obturator internus
Nerve to obturator internus (L5,S1)
What is the innervation of the obturator externus
Obturator N (L3,4)
What is the action of the obturators internus and externus
Laterally rotate the femur
What is the origin and insertion of the superior and inferior gemelli
O: ischium
I: greater trochanter
What is the innervation of the superior and inferior gemelli
Nerve to obturator internus and quadratus femoris
What is the action of the superior and inferior gemelli
Laterally rotate the femur
What is the origin and insertion of the quadratus femoris
O: ischial tuberosity
I: quadrate tubercle
What is the innervation of the quadratus femoris
Nerve to the quadrates femoris
What is the action of the quadrates femoris
Laterally rotate femur
What is the origin and insertion of the piriformis
O: anterior sacrum
I: greater trochanter
What in the innervation of the piriformis
S 1,2
What is the action of the piriformis
Abduct, laterally rotate femur
What happens if the lateral cutaneous nerve is irritated
Burning, electric pain in lateral side of thigh
What are the major branches from the Lumbar plexus
Femoral, obturator, muscular branches, illiohypogastric, ilioinguinal, genitofemoral, lateral cutaneous nerve to the thigh
What connects the lumbar and sacral plexi
Lumbosacral trunk
What are the main branches in the sacral plexus
Sciatic, superior gluteal nerve, inferior gluteal nerve, pudendal
Where is the sciatic nerve located
L4,5 S1,2,3 rami exit through the greater sciatic foramen with the piriformis to travel down the thigh between the hamstrings and adductor magnus before branching in the common fibular and tibial branches
What does the sciatic nerve innervate
Hamstrings, 1/2 adductor magnus, foot and leg muscles
What is a variation found in the sciatic nerve
The common fibular portion usually exits below the piriformis but may exit through or above
What does the superior gluteal nerve innervate
Gluteus minimus, medius, and tensor fascia lata
What does the inferior gluteal nerve innervate
Gluteus maximus
<p>
| What is of interest concerning the medial circumfex artery (artery of the ligamentum teres)</p>
<p>
| it is also called the artery of the ligamentum teres and not everyone has one.</p>
