Lecture 10: Hip and Gluteal region Flashcards
Where does buttocks end/begin
Thigh/gluteal fold —> level top of iliac crest
Buttcrack
Intergluteal cleft
What is gluteal fold
Marks lowest point of gluteal region
Describe hip joint
Femoral head = ball
Socket = acetabulum = cup
Ball and socket = multi axial joint = most mobile
Describe femoral head
Lined with articular cartilage
Describe ligament of head of femur
Intracapsular ligament = within fibrous capsule but outside synovial space
Anchors femoral head to fossa (acetabulum)
Describe fovea of femoral head
Depress where ligament of head of the femoral attaches to head
Describe acetabular fossa
Lined with articular Cartilage = socket
Describe acetabular labrum
Rim of fibrocartilage extending slightly beyond bony edge of fossa = deepens socket
Extends, provides even more stability
Compare femoral neck to head
Femoral neck = 48 degrees to shaft (has greater and lesser trochanter)
Then femoral head = ball part
for what are the attachment sites of femur
Hip abductors, lateral rotators and extensors
Many hip and gluteal muscles
Name attachment sites of femur
Greater trochanter
Lesser trochanter (iliopsoas)
Inter trochanteric crest/ridge
Gluteal tuberosity = elevated, rough spot
Describe flexion/extension of hip joint
Sagittal plane
Transverse axis
Like kick ball with toe
Describe add/abduction of hip joint
Coronal plane
Sagittal acis
Like starfish
When sitting = like get out of car, abd when straddle, add when cross legs
Describe axial rotation of hip joint
Transverse plane
Longitudinal axis
Medial = internal rotation, greater trochanter moves anteriorly (charleston)
Lateral = external rotation
Motion to cross legs, like stand up and wiggly knee
Describe circumduction of hip joint
Combo flex/ext + add/abd
Link arm circles but for legs
How is hip joint stabilized
Reinforced by 3 extracapsular ligaments = when standing prevent excessive motion and force femoral head firmly into acetabular fosssa
Name ligaments of hip joint
Iliofemoral
Pubofemoral
Ischiofemoral
Describe iliofemoral ligament
Prevents hyper extension and limits lateral rotation
Describe pubofemoral ligament
Prevents over abduction
Describe ischiofemoral ligament
Limits medial rotation
Name and describe the weak spots in ligaments of hip joint
Anterior = between iliofemoral and pubofemoral
Posterior = between iliofemoral and ischiofemoral
Exposure of joint = weak spot
Describe ligaments when hip extended
Spiralling and taught ligaments move femoral head closer into fossa
Most stable, spiral like wringing towel
Describe ligaments when hip flexed
When sitting
Slack ligaments make femoral head and fossa less tightly packed
Describe clinical correlate - hip joint ligaments
Impact to Knee with flexed hip = like when sitting in car = may cause posterior hip dislocation through weak spots in hip joint ligaments
Clinical sign = leg position = flexed, adducted and medially rotated
Force out through gap between iliofemoral and ischiofemoral = weak spot, so muscles on post side cannot function anymore= hip extensors, abductors, lateral rotators = opposites of these muscles are unbalanced bc stretched = leg position odd
Describe blood supply of hip joint
Hip joint, femoral head and neck = supplied by arterial ring
What forms arterial ring
Formed by medial and lateral circumflex femoral arteries (branches of deep femoral a)
Describe whole branching pattern
Ext iliac —> femoral —> first branch = deep femoral —> medial and lateral circumflex arteries
Internal ilaic —> ant division—> Obturator artery —>Foveal a
Describe medial and lateral circumflex arteries
Medial = on posterior neck
Lateral = on anterior neck
Forms ring = anastomose and gives out Little branches = blood to trochanter and femoral head and neck
Describe foveal artery
Within ligament of head of femur
Form obturator artery
= where fovea is (ligament of head of femur)
Name most superficial gluteal muscles
Gluteus Maximus
Tensor fascia lata
Describe iliotibial band/tract
Lateral thickening of fascia lata
Inserts onto lateral tibial condole (crosses hip and knee joints, ilium —> lateral condyle)
Aka IT BAND
Describe gluteus Maximus attachments
From posterior sacroiliac ligament and sacrotuberous ligament to gluteal tuberosit y and IT BAND
Describe gluteus Maximus fucntions
Extension and lateral rotation of hip
Describe tensor fascia lata attachments
From Asis to lateral tibial condyle via it band (continuous with it band)
Smaller, embedded in it band
Describe tensor fascia lata functions
Weak hip medial rotation, flexion and abduction
Stabilized hip and knee joints by tensing it band (coordination between hip and knee joint)
Name hip abductor muscles
Gluteus medium
Gluteus minimus
Under gluteus Maximus
Describe gluteus medius attachments
Prox= posterior surface of ilium
Distal = superior aspect of greater trochanter
Describe gluteus medius Main function
Hip abduction
Describe gluteus minimus attachments
Prox= posterior surface of ilium (minimus deep to medius)
Distal = anterior aspect of greater trochanter
Describe gluteus minimus Main function
Hip abduction
Describe gluteus minimus Accessory functions
Hip medial rotation and flexion
Can also do - weak - bc anterior to hip joint
Why hip abductors important muscles
In controlling pelvic drop - during one legged phase in walking and running
Hip would fall - to counter and keep center of gravity = need these muscles
Would have opposite abductors active to compensate
= pelvic drop
Name hip lateral rotators
Piriformis
Obturator internus
Superior and inferior gemelli
Qudaratus femoris
Obturator externus
Describe piriformis attachments
From anterior sacrum - on inside
To greater trochanter (exit pelvis via greater sciatic foramen)
Describe piriformis accessory functions
Abduction
Describe piriformis main function
Hip lateral rotation
Describe obturator internus attachment
From bony borders of obturator foramen inside pelvis
To greater trochanter (exit pelvis via lessser sciatic foramen)
Describe obturator internus main function
Hip lateral rotation
Describe superior gemellus attachment
From ischial spin e
To greater trochanter
Describe inferior gemellus attachment
From ischium
To greater trochanter
Describe superior gemellus main function
Hip lateral rotation
Describe inferior gemellus main function
Hip lateral rotation
What is between gemelli
Tendon of obturator internus =
Gemellus sanwhichc
Describe qudartus femoris attachment
From ischium
To inter trochanteric crest
Describe qudartus femoris main function
Hip lateral rotation
Describe obturator externus attachment
From bony rim of obturator foramen external to pelvic cavity
To inter trochanteric crest
ON ANTERIOR side, still behind hip joint tho
Describe obturator externus function
Lateral rotation of hip
What levels is superior gluteal nerve
L4-s1
Describe what superior gluteal nerve innervates
Gluteus medius and minimus (runs between these)
Tensor fascia lata
Where does superior gluteal nerve exit pelvis
Exits pelvis via greater sciatic foramen ABOVE piriformis
What levels is inferior gluteal nerve
L5-s2
Describe what inferior gluteal nerve innervates
Gluteus Maximus
How does inferior gluteal nerve exit pelvis
Exits pelvis via greater sciatic foramen BELOW piriformis
What does piriformis serve as
Landmark for neurovasculature scturtrues
Name spinal levels sciatic nerve
L4-s3
How does sciatic nerve exit
BELOW piriformis
With inf gluteal nerve
But not Motor to gluteal region
Describe posterior femoral cutaneous nerve
S1-s3
Part of gluteal region and mainly posterior thigh
Name the divisions of sciatic nerve
Tibial and common fibular nerves
How are lateral rotators innervated - gen
Most = innervated directly from Sacral nerves (like nerve to… piriformis, gemelli, obturator internus, quadratus femoris)
ONE Exception
How are lateral rotators innervated - EXCEPTION
Obturator externus = innervated by obturator nerve
DOES Sciatic nerve always emerge inferior to piriformis
NAWWWWW - normally emerges inferior piriformis, runs posterior to other lateral rotators, with variations
Most of time =80-90% branches under
Sometimes = 8-10% of Time, tibial under and common fibular through piriformis
Rarely = 1-2% tibial under, and common fibular Above piriformis
Describe clinical correlate of sciatic nerve
Sciatic nerve entrapment = piriformis syndrome
Piriformis impinges on sciatic nerves = causes pain down leg and in gluteal region
Describe sensory innervation of gluteal region = generally
Cute angus area innervated by a spinal nerve (dermatome) DOES NOT MAP 1-1 with area innervated by peripheral nerve = bc peripheral nerves usually receive contributions from multiple spinal levels
= mix and matches
Name nerves that provide sensory to gluteal region
Cluneal nerve = superior, medial, inferior, mostly posterior rami - but soem from ant rami, areas covered do not map onto dermatomes
Posterior femoral cutaneous
Describe posterior femoral cutaneous - sensory
PFC
S1-s3
Anterior/posterior rami
Runs with sciatic
Sensory to posterior thigh
Describe inferior cluneal nerve
Branch of posterior femoral cutaneous
Innervates upper thigh and inferior buttocks
Is sciatic sensory to gluteal region
NOOOOO
Not sensory in gluteal region
Do spinal nerves cover the same areas as named nerves
Noooooo
Describe blood supply to gluteal region
Mainly from inferior and superior gluteal arteries = branches of internal illaic arteries
Follow gluteal nerves in relation to piriformis muscle
Veins accompany muscles
Describe pathway of blood supply to gluteal region
Internal ilaic —>
Posterior division —> superior gluteal artery (exit above piriformis)
Anterior division —> inferior gluteal artery (exits below piriformis)
