Lecture 17 - Pelvic Girdle and Hip Flashcards
1
Q
Function of the lower limb
A
Movement & bipedal locomotion
Weight bearing
Force transmission i.e. kicking
2
Q
Gluteal
A
Pelvis area
3
Q
Thigh
A
Between hip and knee
4
Q
Leg
A
Between knee and ankle
5
Q
Foot
A
Below ankle
6
Q
Movements of the limb
A
Flexion and extension
Abduction and adduction
Rotation (internal/medial and external/lateral)
Circumduction
7
Q
Plane of flexion and extension in limbs
A
Sagittal
8
Q
Plane of abduction and adduction in the limbs
A
Front/coronal
9
Q
Plane of rotation (internal/medial and external/lateral) in the limbs
A
Transverse
10
Q
abduction
A
away
11
Q
adduction
A
towards
12
Q
Note that bending of the knee =
A
flexion
13
Q
Plane of circumduction in the limbs
A
occurs in multiple planes
14
Q
Tissue layers
A
Bone
Deep fascia - within is bone, muscle, blood vessels, arteries and deep veins
Skin
Superficial fascia - mostly fat but also some blood supply, will find some superficial veins
Muscles
15
Q
Muscle compartments
A
Musculoskeletal system are compartmentalized, separated by fascia
Muscles in each compartment share a
• Common function
• Common blood and nerve supply
(supply structures shared i.e. VAN)
16
Q
VAN means
A
vein
artery
nerve
17
Q
Nervous system
A
three plexuses in the body = cervical plexus, brachial plexus, lumbosacral plexus
18
Q
Three plexuses in the body
A
Cervical – supplying the neck Brachial – supplying upper limb
Lumbosacral – supplying lower limb ( formed by the anterior rami of L1-S4) (nerve comes from lumbar and sacral nerves)
19
Q
Ramus =
A
branch (of blood vessels of nerves for example)
20
Q
All muscles need a
A
nerve
21
Q
Three main nerves for the lower limb
A
- Sciatic (tibial & common fibular)
- Femoral
- Obturator
Plus gluteal nerves (superior and inferior gluteal nerves)
Nerves supply muscles also supply joints over which they pass, and other tissues such as skin
22
Q
Sciatic nerve
A
Large nerve, posterior side of the thigh
23
Q
Femoral nerve
A
supplies anterior thigh and medial (and anterior) leg skin
located in the pelvis, anterior to hip
helps the muscles move the hip and straighten the leg
24
Q
Obturator
A
supplies medial thigh
25
Skin innervation
* Each nerve has branches that supply a specific area of skin
* Important when diagnosing nerve injuries
For examples:
• Femoral supplies anterior thigh and
medial leg skin
• Obturator supplies medial thigh
26
Arterial supply
Abdominal aorta (arterial supply comes from here) splits into two to form the common iliac artery which splits to form the internal and external iliac artery. External iliac artery eventually becomes the femoral artery
Note: Deep veins of the same name accompany the arteries.
Joints and skin also receive vascular supplies.
27
Pulse location
Femoral pulse
Popliteal pulse
Dorsalis pedis pulse
Posterior tibial pulse (behind medial malleolus)
People with peripheral arterial disease may have
weak or no pulse in the periphery - important diagnostic tool
28
Function of veins
to return deoxygenated blood back towards the heart
29
Features of veins
Veins have low blood pressure
Venous blood in the lower limb needs to move against gravity
These veins have valves to prevent back-flow against gravity
30
Two mechanisms help venous blood movement
Arteriovenous pump – arterial pulse helps warm and push blood in accompanying veins
Musculovenous pump – when skeletal muscles contract, muscle bellies expansion helps propel venous blood
31
The limbs has two venous systems
Superficial (outside to the deep fascia)
Deep (inside the muscle
compartment) venous systems
32
Pathway of veins of the lower limb
Great saphenous vein empties into/joins the femoral vein and the small saphenous vein empties into/joins the popliteal vein in the popliteal fossa. Then enters into the inferior vena cava
33
Deep veins follow their arteries as
venae comitantes (accompanying vein)
34
Two major superficial veins in the lower limb are
Great saphenous vein (empties into the femoral vein)
Small saphenous vein (empties into the popliteal vein)
35
Valve failure
Valve failure in the superficial veins can lead to varicose vein
36
Fossa =
shallow depression or hollow
37
Pelvis girdle
2 X pelvis and 1 x Sacrum
Osteoligamentous ring connected by sacroiliac joint (SIJ) and pubic symphysis
38
Joints in the pelvic girdle
Pubic symphysis = usually not mobile but is in child birth via a hormone to allow movement
Sacroiliac joint (SIJ) (x2)
39
Pelvic girdle consists of
Sacrum
Hip bones
Many ligaments
40
Pelvic girdle articulates with
Laterally: Femora x 2
Inferiorly: Coccyx
Superiorly: L5 (disc & vertebral body)
41
Sacroiliac ligaments
Sacroiliac ligaments help stabilize the SIJs. (stabilise the pelvic girdle)
They consist of:
Anterior
Interosseous (”between bone”) - deep, span between tuberosities of ilium and sacrum, inbetween pelvis and sacrum
Posterior
42
Pelvic girdle functions
Protects and supports pelvic organs (bladder, rectum, anal canal, reproductive tracts)
Transmits body weight from trunk to lower extremities
• Essential for standing and gait
Bony prominences for attachment of muscles and ligaments
43
Transmission of weight
down vertebral column, around ilium and wight eventually travels down through the femurs
44
Sacrum
5 fused vertebrae, contributes to the sacroiliac joint
It has sacral canal (superior), sacral hiatus (inferior)
Continuation of vertebral canal, contain sacral spinal nerves (spinal cord ends at L1/L2 level).
anterior formina and posterior foramina for spinal nerves
sacral canal connects down to the sacral hiatus
45
Gluteal lines
Muscles attach in this area, lines on the hip bone
46
Acetabulum provides
a socket for hip joint
47
Pelvis consists of 3 bones fused in late teens approx what age
16 - 18
48
Pelvis consists of 3 bones ...
Ilium
Ischium
Pubis
49
Pelvis forms a joint at the
acetabulum - Ball-and-socket joint
50
Ischial tuberosity
Important landmark, attachment of the hamstrings
51
Hamstrings
Extend thigh, flex knee
52
Obturator foramen
Covered by obturator membrane
| Obturator nerve and vessels pass through it (obturator canal)
53
Iliac fossa
For muscle illiacus
54
Anterior superior iliac spine
Attaches inguinal ligament and sartorius
55
Anterior inferior iliac spine
Attachs rectus femoris
56
Inguinal ligament
Anterior superior iliac spine to the pubic tubercle
57
What's near the inguinal ligament?
Inguinal canal - superior to the inguinal ligament. Relevance to inguinal hernia.
Femoral artery - under the inguinal ligament. Location for catheterization.
58
Function of sacrospinous and sacrotuberous ligaments
Resist rotation of sacrum between hip bones
Form boundaries of greater and lesser sciatic foramina
59
Sacrospinous ligament
Ischial spine to the outer edge of the sacrum and coccyx
thin triangular ligament in the human pelvis
60
Sacrotuberous ligament
slender fan shaped ligament of the posterior pelvis located on either side of the body
outer edge of scarum and coccyx to the ischial tuberosity
61
Greater sciatic foramen
opening (foramen) in the posterior human pelvis. It is formed by the sacrotuberous and sacrospinous ligaments. The piriformis muscle passes through the foramen and occupies most of its volume.
62
What structures exit through the greater sciatic foramen ?
Piriformis muscle
Superior and inferior gluteal nerves (supplying gluteal muscles) and associated blood vessels
Sciatic nerve (supplies posterior muscles of the thigh, all leg and foot muscles)
63
Lesser sciatic foramen
The lesser sciatic foramen is an opening (foramen) between the pelvis and the back of the thigh. The foramen is formed by the sacrotuberous ligament which runs between the sacrum and the ischial tuberosity and the sacrospinous ligament which runs between the sacrum and the ischial spine.
64
Superior and inferior gluteal nerves supplies...
supplying gluteal muscles
65
Sciatic nerve supplies...
(supplies posterior muscles of the thigh, all leg and foot muscles)
66
Muscles that attach to the greater trochanter?
Hip abductor muscles = gluteus medius, gluteus minimus
67
Greater trochanter
proximal and lateral side of the femur
68
Lesser trochanter
bony protuberance that projects from the posterior aspect of the femor inferomedially at the base of the femur neck
69
What muscles attach to the lesser trochanter
Iliopsoas = psoas major and iliacus
70
Gluteal tuberosity for
gluteus maximus
71
The hip joint is a
synovial joint - ball and socket, multiaxial
72
Hip joint bony components
Acetubulum and head of the femur
ball and socket joint = socket within the pelvis and ball is head of the femur
73
Functions of the hip joint
Links lower limb to pelvis
Transmit upper body weight to lower limb
Designed for stability (most stable joint)
2nd most movable joint in the body
74
Hip joint is multiaxial ...
a rounded head fits into a concavity, permitting movement on several axes
75
Hip joint - capsule
Joint capsule (two layers):
• Outer, fibrous layer
• Inner, synovial membrane
Attaches around margin of acetabulum and to femoral neck
Reinforced by ligaments.
76
Pelvic bones =
ilium
Ischium
Pubis
77
Capsular ligament names
iliofemoral (Y shaped, strongest)
ischiofemoral (at back)
pubofemoral
78
Hip joint - capsular ligaments
Difficult to distinguish from capsule
Functions:
• Stabilizes and strengthen the joint
• All ligaments are tight with hip extension (e.g., in standing)
• This position is energy efficient (don’t need to rely on muscles for support)
79
Acetabular labrum
Labrum = lips
Fibrocartilage structure, attached to the rim of the acetabulum
It increases the articular area (of the hip joint socket) by ~10%, help to fit the femoral head to acetabulum. - increases concavity
