Lecture: Posterior Hip and Thigh

Question 1

What is a palpable landmark that divides the junction between the hip and the thigh?

Answer 1

Greater trochanter divides the:
Hip region
Femoral region

Question 2

Recognize the inguinal ligament on imaging

Answer 2

“v line”

Question 3

Where does the inguinal ligament pass to and from?

What is its importance?

Answer 3

passes from anterior superior iliac spine (laterally) and pubic tubercle (medially)

Acts as a retinaculum to pin structures down as it passes to thigh

Question 4

Sacroiliac joint
* joint type
* bones that comprise joint
* function
* ligaments that reinforce it

Answer 4

• diarthrodial synovial joint
• sacrum and ilium
• permits very little movement; transfers force from pelvis to sacrum
• anterior and posterior sacroiliac ligaments

Question 5

When does the SI joint permit lots of movement?

Answer 5

Pregnancy (due to hormone release)

Question 6

What is one cause for pelvic girdle pain in women who are pregnant and post-partum?

Answer 6

Sacroiliac joint laxity

Question 7

Another name for os coxa

Answer 7

innominate

Question 8

What is the longest and strongest bone in the body?

Answer 8

Femur

Question 9

How can you differentiate between the anterior and posterior side of the femur?

Answer 9

linea aspera on the posterior side

Question 10

How many degrees of freedom does the hip joint have?

What is the general range of motion in the hip?

Answer 10

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

Question 11

What is the accompanying pelvic movements associated with extreme hip flexion and extreme hip extension?

Answer 11

Extreme hip flexion: posterior pelvic tilt

Extreme hip extension: anterior pelvic tilt

Question 12

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?

Answer 12

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)

Question 13

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?

Answer 13

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)

Question 14

Hip joint
* joint type
* how is the hip joint enhanced for stability?

Answer 14

• ball and socket
• deep socket (acetabulum) over femoral head; surrounded by many muscles; reinforced by multiple intrinsic ligaments

Question 15

What are the dynamic and static stabilizers of the hip?

Answer 15

dynamic: lateral and medial rotators

static: extracapsular ligaments - iliofemoral, pubofemoral, ischiofemoral

Question 16

Describe the foveal ligament/ligamentum teres/ligament of the head of the femur
* where does it attach
* function

Answer 16

• 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)

Question 17

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

Question 18

What is the importance of the sacrospinous and sacrotuberous ligaments? What are their attachments?

Answer 18

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

Question 19

Describe the contents of the greater and lesser sciatic foramen

Answer 19

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

Question 20

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

Question 21

What is TFL a synergist with? and during what movement?

Answer 21

Gluteus maximus during abduction of the thigh

Question 22

What insertion point does TFL and gluteus maximus share?

Answer 22

iliotibial tract/band

Question 23

What is the fascia of the thigh and leg

What does the thigh fascia become?

Answer 23

• thigh: fascia lata (becomes iliotibial tract)
• leg: crural fascia

Question 24

Describe: iliotibial tract/band syndrome

Answer 24

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)

Question 25

What muscles in the gluteal region are superficial vs deep?

Answer 25

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

Question 26

Sacral plexus
* what are its roots
* what are its branches

Answer 26

• L4-S4
• superior gluteal nerve, inferior gluteal nerve, nerve to piriformis, sciatic nerve

Question 27

The femoral and obturator nerves arise from ?

Answer 27

Lumbar plexus (L2-L4)

Question 28

What nerve roots make up the pudendal nerve? What is the function of the pudendal nerve?

What can pudendal nerve neuralgia/dysfunction cause?

Answer 28

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

Question 29

What does the sciatic nerve branch off into? describe their path down the leg

Answer 29

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

Question 30

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

Question 31

Why doesn’t the short head of biceps femoris contribute to hip extension?

Answer 31

originates more distally on the femur @ linea aspera

Question 32

What hamstring is not innervated by the tibial nerve? and what is it innervated by?

Answer 32

biceps femoris short head - common peroneal nerve

Question 33

Draw a cross section of the leg. Compare it to the one listed in the lecture video