Lecture 4: Lower Limb Pt. 1 Hip/Gluteal Thigh Flashcards
Femoral Triangle Borders (3)
- superior: inguinal ligament
- Lateral: medial border of the sartorius
- Medial: medial border of adductor longus muscle
Femoral Triangle
wedge shaped area located within superiomedial aspect of the anterior thigh that acts as a channel for structures entering and leaving anterior thigh
Contents of Femoral Triangle (5)
NAVEL (pneumonic device)
- femoral Nerve
- femoral Artery
- femoral Vein
- Empty space- for veins and lymph vessels to distend to accommodate different levels of flow
- Lymph nodes
- nerve and vessles pass beneath inguinal ligament and gain access to anterior thigh + femoral sheath of fascile sleeve
- femoral canal and ring are weak point and site for femoral hernias
Femoral Sheath
fascial sleeve within femoral triangle
Femoral hernias occur where?
femoral canal and ring are weak site
Femoral Hernia
definition
clinical manifestation
treat
Hernia: part of an organ is displaced and protruding through the wall of the cavity containing it
Femoral Hernia: part of bowel pushes into femoral canal underneath inguinal ligament
- clinically presents as lump or buldge in femoral triangle
- req. sx intervention to treat
Bones of the Thigh (6)
- Sacrum
- coccycx
- Ilium
- Ischium
- Pubis
- femur
Sacrum
large bone located at end of vertebral comumn and forms posterior aspect of pelvis
Coccyx
terminal part of vertebral columns, compromized of 4 vertebra which fuse to produce traingular shape
Ilium
widest and largest bone, superior
anterior iliac spine ASIS: true leg lenth is measures from ASIS to medial mallelolus
Pubis
most anterior portion of pevlic girdle
femur
only bone in the thigh, longest bone in body
Bones of the Hip (3)
**note
- Ilium : upper margin characterized by iliac crest
- lateral surface exhibits 3 gluteal lines for attachment of gluteal muscles - Ischium contributes to acetabulum and forms the ischial spine and ischial tuberosity
- ischial tuberosity-= sits bone - Pubis- formes anterior and medial aspects of each hip bone
- forms “c” upper limb being the superior pubic ramus and lower limb being inferior pubic ramus
*all three contribute to site of articulation with the femoral head
Hip Joint and Ligaments (3)
type joint
3 ligaments involved
*ball and socket
-ball=head of femur
-socket=acetabulum of hip
~~both covered in articular cartilege
- Iliofemoral ligament
- pubofemoral ligament
- Ischiofemoral ligament
Ilio femoral ligament
shape
location
purpose
Y-shaped
spans from anterior inferior iliac spine to intertrochanteric line
prevents hyperestension of hip joint
*anterior
Pubofemoral ligament
location
purpose
spans from inferior pubic ramus to blend with capsule of the hip joint
prevents excessive abduction of joint
*medial
Ischiofemoral ligament
arises from acetabular rim poertiorly and attaches laterally to greater trochanter
*posterior
ROM of hip (6) and the muscles that cause the movement ** (starred slide)
- Flexion
- Extension
- Abduction
- Adduction
- External Rotation
- internal rotation
Congenital/developmental hip dislocation
special pop.
how does this occur?
2 tests/what they do
10 in 10,000 infants born with developmental dislocation
girls > boys
when acetabulum is shallow as result or failure to fevelop properly in utero
ortolani’s test of hib adbcution confirms dx
barlow pops hip out
early detection lead to 96% children gaining normal hip function
Brusitis - three main
2 types
treatments of each type
- sciatic
- trochanteric **most common cause hip pain, causes tenderness on the outer hip
- iliopectineal
tx: ice, medicaion for inflammation and pain
tensor fascia latae
I
2 movements
inserts on iliotibial tract, attached to lateral condyle of tibia
internal rotation, abduction
Iliopsoas (2)
Origin
movement
1) psoas major- originates from T12-L4 -> medial, inner aspect of femur
2) Iliacus- originates form iliac fossa and blends with tendon of psoas major -> medial, inner aspect femur
flexion of hip
Hamstring (3 muscles)
- semitendinosis
- Biceps femoris
- Semimebranosis
Quadriceps femoris (4 musces)
- Rectus femoris
- Vastus lateralis
- Vastus Medialis
- Vastus intermedius
* all quadricep muscles unite at quadriceps tendon, which attaches to the patella
Satroius
O
I
M
O: from the anterior superior iliac spine
I:onto the medial tibia as part of pes anseriunus
M: flexor
Gracillis
O: body of pubis
I: medial tibia
M: adductor
also part of pes snseriunus
Lumbar Plexus
- lumbar formed by spinal nerves L1-L4
Nerves of Thigh ** (4)
- Femoral Nerve
- Obturator Nerve
- Sciatic Nerve
- Pudendal Nerve
Sciatic Nerve: clinical correlation
IM must be given where?
- must be considered when admistering intramuscular innjections onto gluteal region **
a. one line descends vertically from the highest point on the iliac crest
b. the other horizontal line passes through the vertical line halfway between the highest point on the iliac crest and ischial tuberosity
nerve passes through the lower medial quandrant
- to avoid damaging the sciatic nerve, IM injections given only in UPPER LATERAL QUADRANT OF THE GLUTEAL REGION
Sciatica
- Pain the radiates along path of sciatic nerve
- herniated disc may compress nerve on one side, causing symptoms in one leg
- OR disc may bulge or herniate from both sides, causing symptoms in both legs
- DD, Spinal stenosis, sponfylolitheses, OA, traumra, tumprs, piriformis syndrom
burnign sennsation or sharp, shooting pain- can be constant or intermittent
leg pain commonly occurs more in calf region below the knee
Blood Supply/ Lymph
2 arteries
nodes where?
- femoral artery
- Obtruator artery: branch of internal iliac artery
- descends via obtruator canal to enter medial thigh
a. anterior branch
b. posterior branch - inguinal nodes in femoral triangle
Femoral artery gives rise to… (3) arteries
- superficial epigastric
- superifical cirumflex iliac
- external pudental
Landmarks of Femur (4)
- head of femur: articulares with acetabulum of hip bone
- neck of femur extends to intertrochanteric line
- intertrocanteric line: between greater and lesser trochanters and it site where neck and shaft of femur join
- Medial and lateral condyles: articulates with meiscis and tibial condyles to form knee joint
Flexion of Hip (4 muscles)
*starred slide
- iliopsoas
- rectus femorus
- sartorius
- pectineus
Extension of Hip (4 muscles)
*starred slide
- gluteus maximus
- semimembranosus
- semitendinosus
- biceps femoris (hamstrings)
Abduction of the Hip (4 muscles)
*starred slide
- gluteus medius
- gluteus minimus
- piriformis
- tensor fascia latae
Adduction of the Hip (5 muscles)
*starred slide
- adductor longus
- adductor brevis
- adductor magnus
- prectineus
- gracilis
External Rotaton of the Hip (6 muscles)
*stared slide
- biceps femoris
- gluteus maximus
- piriformis
- Asst. obtruators
- asst. gemeli
- asst. quadrates femoris
Internal rotation fo the hip (3)
- anterior fibers gluteus medius
- anterior fibers gluteus minimus
- tensor fascia latae
Barlow’s test
hip displocation of infants
- examiner adducts the hip while applying posterior force on the knee to promote dislocation
Ortolani
hip dislocation of infants
- examiner abducts the hip while applying an anterior force on the femur to reduce the hip joint
infectious bursitis
tx(3)
- uncommon
- if it does occur, tx with abx, aspirin, sx
semitinosus muscle
origin
insertion
movement
Member of hamstring
O: ischial tuberosity
I: upper media tibia
M: extension hip
+ inserts with sartorial and gracilis for four pes anserinus
pes anserinus (3 muscles)
semitendinosus + sartorius + gracillis
Biceps femoris
Origin
inserition
Member of hamstring
O: ischial tuberosity
(long head)
-linea aspera and supracondylar line femur (short head)
I: lateral aspect fibular head
M: extension hip
Semimembranosus
Origin
Insertion
member of hamstring
O: ischial tuberosity
I: posterior side of medial tibial condyle
M: extension hip
Rectus femoris
origin
insertion
member of quadriceps
O: anterior inferior iliac spine
M: flexion hip
Attached to other quadriceps muscles -> unite as quadriceps tendon -> attach to patella
Vastus Lateralis
origin
insertion
member of quadriceps
O: greater tochanter
Attached to other quadriceps muscles -> unite as quadriceps tendon -> attach to patella
Vastus Medialis
origin
insertion
member of quadricepts
O: intertrochanteric line
Attached to other quadriceps muscles -> unite as quadriceps tendon -> attach to patella
Vastus intermedius
origin
insertion
movement
member of quadriceps
O: anterolateral shaft of femur
Attached to other quadriceps muscles -> unite as quadriceps tendon -> attach to patella
adductors of the hip/thigh (3)
- adductor longus
- adductor brevis
- adductor magnus
Sacral Plexus
from by anterior rami of S1, S2, S3, S4
-received contribution form lumbar and spinal nerved L4 and L5
Plexus of the thigh (2)
- lumbar
2. sacral
Femoral nerve
roots
innvervation
*stared
R: L2-L4
I: hip flexors and knee extensors
Obturator nerve
roots
innervation
*stared
r: L2-L4
I: all muscles in the medial compartment of the thigh
Sciatic Nerve
roots
*stared
r: L4-S3
* combination of tibial and common fibular nerve
* largest nerve in the body
Pudental Nerve
Roots
Innvervation
R: S2-S4
I: internal genitalia, skin around anus, anal canal, perineum
Femoral Artery
gives rise to (3)
largest branch
continuation of external iliac artery distal to the inguinal ligament
- gives rise to
1. superficial apigastric
2. superficial circumflex iliac
3. external pudendal arteries
*largest branch is profunda femoris artery (branches from femoral artery posteriorly)
Obtruator Artery
2 branches
- branch of internal iliac artery
- descends via obtruator canal to enter medial thigh
a. anterior branch:
b. posterior branch
Anterior Branch obturator artery
supplies (4)
Supplies
- pectinous
- obtruator externes
- adductor muscles
- gracilis
Posterior branch obturator artery
supplies
supplies some of deep gluteal muscles
