Lecture 19 Flashcards
What are the features of the pelvic girdle?
Base of sacrum Sacroiliac joint Pelvic surface of sacrum Pelvic brim Pelvic inlet Coccyx Acetabulum – where the ilium, ischium and pubis fuse (21-25 years old).
What are the features of the ilium?
Crest
Iliac fossa
Anterior superior iliac spine (ASIS)
Anterior inferior iliac spine (AIIS)
What are the features of the ischium?
Body
Ramus
What are the features of the os coxa?
Gluteal lines (posterior, anterior, inferior) - where gluteal muscles originate, can be more exaggerated in males. Anterior superior iliac spine (ASIS) Anterior inferior iliac spine (AIIS) Posterior superior iliac spine (PSIS) Posterior inferior iliac spine (PIIS) Greater sciatic notch Ischial spine Lesser sciatic notch Ischial tuberosity Obturator foramen Pelvic fractures – a result of direct anterior trauma, if you break one side the other side will also break.
What are the features of the sacrum?
Transverse ridges – fusion of vertebra
Holds the midline of the two os coxa together.
Lateral sacral crest – where transverse processes fuse.
Median sacral crest – where spinous processes fuse.
Intermediate sacral crest – where articular facets fuse.
Sacral cornu – where spinal cord exits.
Sacral promontory – takes body weight in horizontal orientation rather than vertical orientation.
Greatest amount of lordosis occurs at the lumbosacral angle (L5 – S1 joint).
Coccyx – begin with 6, 2 fall off leaves 4.
What are the features of the femur?
Greater trochanter Lesser trochanter Intertrochanteric line Head – sphere like Fovea (pit) for ligament of head Anterior surface of body Long, robust Lateral epicondyle Lateral condyle Adductor tubercle Medial epicondyle Medial condyle Patella surface Trochanteric fossa Intertrochanter crest Pectineal line Gluteal tuberosity Linea aspera Medial lip of linea aspera Lateral lip of linea aspera Nutrient foramen Lateral surface of body Medial surface of body Medial supracondylar line Lateral supracondylar line Popliteal surface Intercondylar line Intercondylar fossa – takes up tibeal eminence
What is is the angle of inclination/angulation?
The angle of the head and neck of the femur relative to the shaft.
~125 deg in adults
Females > Males – due to F having a more valgus position of the distal condyles relative to the head of femur (under hips).
~160 deg in newborns – can get dislocated during birth, congenital or swaddled.
Coxa vara (110 deg) can cause slipped capital femoral epiphysis.
Where is the femur most likely to fracture?
The neck.
Vulnerable to avascular necrosis due to compromised blood supply.
Medial and lateral femoral circumflex and retinacular branches go around neck of femur.
Medial femoral circumflex provides most of the blood supply.
When are avulsion fractures most likely to occur?
Typically seen in parts of the bone that has epiphyses that have not fused.
Occurs in older individuals who exert their bones a lot.
Occurs typically in the region of the pelvis.
Avulsions at the musculotendinous junction and tendon are more likely in older people.
What is deep fascia?
tight stocking, holds muscles together, surrounds thigh (fascia lata), thickens laterally to form the iliotibial band (ITB), begins at the iliac crest at the iliac tubercle, encloses muscles at proximal end, inserts on lateral side of tibia, provides lateral support, important in sending weight to the midline, gluteus muscle inserts onto it.
What is superficial fascia?
(subcutaneous tissue layer) - layers of fat, subcutaneous veins (greater/lesser saphenous), cutaneous nerves and lymph nodes.
What are the features of the iliopsoas muscle?
What is it’s origin and insertion?
What nerve is it innervated by?
Lateral ends and bodies T12-L5 to lesser trochanter (psoas bursa intervening).
Covered by fascia (psoas and iliacus).
Hip flexor.
Trunk flexor when the pelvis is fixed eg. Sit ups however this contraction also compresses lumbar vertebrae and causes shear at L5/S1 = degenerative changes at IVD and vertebral bodies - consequence of a prime mover acting as a stabiliser.
Innervated by femoral nerve.
What are the features of the pectineus muscle?
What movements does it assist with?
What nerve is it innervated by?
Between anterior and posterior compartments.
Assists in flexion of the thigh, medial rotation and adduction.
Innervated by femoral and obturator nerve.
What are the features of the sartorius muscle?
What is it’s origin and insertion?
Tailor muscle Crosses hip joint and knee joint. Originates ASIS Inserts superior aspect of tibia. Allows you to sit cross legged.
What are the 4 anterior compartment quadriceps femoris muscles and what nerve are they innervated by?
Rectus femoris Vastus medialis Vastus lateralis Vastus intermedius Femoral nerve
What are the features of the rectus femoris muscle?
What is it’s origin and insertion?
Crosses the hip and knee joint.
Originates ASIS.
Inserts patella tendon.
Hip flexion is limited by knee extension.
Insufficient in it’s action.
Depends if role is as a prime mover (active insufficient) or antagonistic (passive insufficient).
What are the 4 muscles of the lateral compartment?
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia lata
Where do gluteal intramuscular injections take place?
Top lateral section
Beware of sciatic nerve
What is the role of gluteus maximus?
Postural muscle
Recruited in power extension eg. climbing up stairs, standing up.
What is the role of gluteus medius and gluteus minimus?
Maintain the position of the pelvis during locomotion.
What is the role of tensor fascia lata?
Extensor at knee
Also maintains tension at ITB and relieves femur of some of the tensile forces of weight bearing.
What is the role of the lateral rotators?
Short muscles run in line with the femoral neck.
Form the rotator cuff muscles
Act as stabilisers/fixators of the hip joint
Prime mover action as external rotators of the hip.
What are the 5 lateral rotator muscles?
Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris
What is gluteus maximus innervated by?
Superior gluteal nerve and artery
Inferior gluteal nerve
What is gluteus medius innervated by?
Superior gluteal nerve and artery
What are the extensor muscles (hamstrings)?
Biceps femoris
Semitendinosus
Semimembranosus
Hamstring fibres of adductor magnus
All are two joint muscles – hamstrings are all less efficient as hip extensors when knee is also flexed.
