Lecture: Posterior Hip and Thigh Flashcards
What is a palpable landmark that divides the junction between the hip and the thigh?
Greater trochanter divides the:
Hip region
Femoral region
Recognize the inguinal ligament on imaging
“v line”
Where does the inguinal ligament pass to and from?
What is its importance?
passes from anterior superior iliac spine (laterally) and pubic tubercle (medially)
Acts as a retinaculum to pin structures down as it passes to thigh
Sacroiliac joint
* joint type
* bones that comprise joint
* function
* ligaments that reinforce it
- diarthrodial synovial joint
- sacrum and ilium
- permits very little movement; transfers force from pelvis to sacrum
- anterior and posterior sacroiliac ligaments
When does the SI joint permit lots of movement?
Pregnancy (due to hormone release)
What is one cause for pelvic girdle pain in women who are pregnant and post-partum?
Sacroiliac joint laxity
Another name for os coxa
innominate
What is the longest and strongest bone in the body?
Femur
How can you differentiate between the anterior and posterior side of the femur?
linea aspera on the posterior side
How many degrees of freedom does the hip joint have?
What is the general range of motion in the hip?
3 degrees
* flexion/extension
* abduction/adduction
* external rotation/internal rotation
Flexion: 110-120 degrees
Extension: 10-15 degrees
Abduction: 30-50 degrees
Adduction: 25-30 degrees
External rotation: 40-60 degrees
Internal rotation: 30-40 degrees
What is the accompanying pelvic movements associated with extreme hip flexion and extreme hip extension?
Extreme hip flexion: posterior pelvic tilt
Extreme hip extension: anterior pelvic tilt
What is the name for the angle between the femoral shaft and the neck?
What is the normal range?
What would cause variation in the range?
What is the importance of this angle?
Collum/inclination angle
- 125-130
- height; taller people have a larger angle
- increase in angle causes the femoral head to be directed more superiorly in the acetabulum (coxa valga)
- decrease in angle causes the femoral head to be more inferior in the acetabulum (coxa vara)
What is the name for the angle that the femoral neck makes with the acetabulum
- what is the normal angle?
- what would be optimal angle?
- what angle is an infant typically born with? When will it assume normal angle?
*what do you call an abnormally small angle?
angle of anteversion or femoral torsion
- 5-15 degrees
- 15 degrees for optimal alignment
- 30 degrees (excessive anteversion) –> 15 by 6 years of age
pigeon walking and w sitting seen with excessive anteversion
- retroversion (less than 5 degrees)
Hip joint
* joint type
* how is the hip joint enhanced for stability?
- ball and socket
- deep socket (acetabulum) over femoral head; surrounded by many muscles; reinforced by multiple intrinsic ligaments
What are the dynamic and static stabilizers of the hip?
dynamic: lateral and medial rotators
static: extracapsular ligaments - iliofemoral, pubofemoral, ischiofemoral
Describe the foveal ligament/ligamentum teres/ligament of the head of the femur
* where does it attach
* function
- intracapsular ligament made of two bands that originate on the ischial and pubic side of the acetabular notch and insert on the fovea capitis of the femoral head
- contribute to hip mechanics and involved in joint pain in hip (nociceptors are here)
identify the following on the hips:
* anterior longitudinal ligament
* iliolumbar ligaments
* anterior sacroiiliac ligament
* inguinal ligament
* sacrospinous ligament
* sacrotuberous ligament
* symphysis pubic joint
* obturator membrane
What is the importance of the sacrospinous and sacrotuberous ligaments? What are their attachments?
In addition to contributing pelvic stability, they help define the apertures (openings) between the pelvic cavity and adjacent regions through which structures pass.
sacrospinous ligament divides the greater and lesser sciatic foramen. attaches from ischial spine to lateral sacrum and coccyx
sacrotuberous ligament walls them off. Y shaped. Extends from PSIS and dorsolateral sacrum and coccyx to the ischial tuberosity
Describe the contents of the greater and lesser sciatic foramen
Greater sciatic foramen: piriformis and superior gluteal artery, sciatic nerve, lumbosacral plexus
inferior sciatic foremen: tendon and nerve of obturator internus as well as the pudendal nerve and vessels
Identify the following on surface anatomy
* tensor fascia lata
* gluteus maximus
* site of greater trochanter
* vastus lateralis
* biceps femoris (long head and tendon)
* iliotibial tract
* patellar ligament
* anterolateral tibial tubercle
* head of fibula
* gastrocnemius
* semimembranosus
* semitendinosus
What is TFL a synergist with? and during what movement?
Gluteus maximus during abduction of the thigh
What insertion point does TFL and gluteus maximus share?
iliotibial tract/band
What is the fascia of the thigh and leg
What does the thigh fascia become?
- thigh: fascia lata (becomes iliotibial tract)
- leg: crural fascia
Describe: iliotibial tract/band syndrome
common cause of lateral knee pain in endurance athletes
friction of the IT tract against the lateral epicondyle of the femur with flexion and extension of the knee
results in inflammation of IT tract over lateral aspect of the knee or its attachment to the dorsolateral tibia (Gerdy’s tubercle). can also occur in the hip region (esp in older adults)
What muscles in the gluteal region are superficial vs deep?
Superficial gluteal muscles: Gluteus maximus, gluteus medius, gluteus minimus and the tensor fasciae latae
Deep gluteal muscles:
Piriformis, obturator internus, superior and inferior gemelli, quadratus femoris
Sacral plexus
* what are its roots
* what are its branches
- L4-S4
- superior gluteal nerve, inferior gluteal nerve, nerve to piriformis, sciatic nerve
The femoral and obturator nerves arise from ?
Lumbar plexus (L2-L4)
What nerve roots make up the pudendal nerve? What is the function of the pudendal nerve?
What can pudendal nerve neuralgia/dysfunction cause?
S2-S4
sensory nerve for pelvic organs including genitals, rectum, and anus
crucial for continence and sexual function
dysfunction can cause pain, incontinence, impaired sexual function
What does the sciatic nerve branch off into? describe their path down the leg
branch into common fibular/peroneal nerve and tibial nerve above the knee
common fibular/peroneal nerve travels laterally to innervate the shin
tibial nerve travels inferiorly and down the middle of the leg to innervate the posterior leg muscles
Identify the following posterior surface structures
* vastus lateralis
* semimbranosus
* semitendinosus
* semitendinosus tendon
* biceps femoris tendon
* popliteal fossa
* gastrocnemius, medial and lateral head
* head of fibula
* fibularis longus
* soleus
* fibularis brevis
* calcaneal tendon
* fibularis longus tendon
* lateral malleolus
* gluteus maximus
* adductor magnus
* gracilis
* biceps femoris
Why doesn’t the short head of biceps femoris contribute to hip extension?
originates more distally on the femur @ linea aspera
What hamstring is not innervated by the tibial nerve? and what is it innervated by?
biceps femoris short head - common peroneal nerve
Draw a cross section of the leg. Compare it to the one listed in the lecture video