Lower Limb 1: The Gluteal Region and Hip Joint

Question 1

Give a description of the osteology of the pelvic girdle

Answer 1

2 hip (innominate bones) and the sacrum
Innominate articulate with the sacrum posteriorly at the sacroiliac joints
Articulate anteriorly with each other at the pubic symphysis
Innominate bone derived from 3 separate bones: Ilium, Ischium and Pubic

Question 2

List the main differences between the male and female pelvis

Answer 2

Male:

• heart shaped pelvic inlet
• narrow + deep
• acetabula closer together
• pelvic inlet is smaller, more obstructed
• Pubic arch is V-shaped

Female:

• pelvic inlet larger and more rounded
• pubic arch is U-shaped
• bones lighter, thinner, smoother

Question 3

Functions of the pelvis?

Answer 3

bear weight - transfer from upper skeleton to lower skeleton
provide attachment for muscles of posture and movement
attachment form external reproductive organs and muscles
contain and protect pelvic and abdominal viscera

Question 4

Which ligaments form important foramen at the hip joint?

Answer 4

Sacrotuberous - inserts onto ischial tuberosity
Sacrospinous - inserts onto ischial spine

firmly attach sacrum to ischium and creates to greater and lesser sciatic foramen

Question 5

Movements possible at the hip joint?

Answer 5

Flexion
Extension
Abduction
Adduction
Medial and Lateral rotation
Circumduction

Question 6

Features strengthening the hip joint?

Answer 6

Fibrous capsule surrounding whole joint - covers whole joint to femoral neck - tough but loose to allow full range of movements
Ligaments
Acetabular anatomy - good congruency in ball and socket joint

Question 7

Ligaments involved in strengthening the hip joint?

Answer 7

Iliofemoral
Pubofemoral
Ischiofemoral

Question 8

Describe the iliofemoral ligament

Answer 8

covers joint anteriorly and superiorly
Y shaped
Strongest one
Extends from ilium to intertrochanteric line of the femur
Prevents hyperextension

Question 9

Describe the pubofemoral ligament

Answer 9

Covers joint anteriorly and inferiorly

Prevents abduction

Question 10

Describe the Ischiofemoral ligament

Answer 10

Covers joint posteriorly
attached to ischium and ischial tuberosity to greater trochanter of femur
the weakest one

Question 11

Decribe the blood supply to the hip joint

Answer 11

Femoral artery - major supply, most thigh and all of the leg

Gluteal arteries - superior and inferior, superior divides into superficial and deep branch

Obturator artery - supplies medial thigh

Question 12

Describe the origin of the gluteal arteries

Answer 12

Gluteal arteries:

sup+inf originate in pelvic cavity as branches of internal iliac

Question 13

Describe the superior gluteal artery

Answer 13

Originates from posterior trunk of internal iliac
leaves pelvic cavity with superior gluteal nerve through greater sciatic foramen ABOVE piriformis
Divides into superficial and deep

Superficial Branch - passes onto deep surface of gluteus maximus muscles
Deep branch - passes between gluteus medius and minimus muscles

Question 14

Describe the inferior gluteal artery

Answer 14

Originates from anterior trunk of internal iliac
leaves pelvis with inferior gluteal nerve through greater sciatic foramen BELOW piriformis

Descends through gluteal region into post. thigh and supplies adjacent structures
Anastamoses with perforating branches of the femoral artery

Question 15

Innervation of Gluteus Maximus?

Answer 15

Inferior gluteal nerve, L5,S1,S2

Question 16

Origin of Gluteus maximus?

Answer 16

Posterior gluteal line (ilium)
Sacrum, coccyx,
Sacrotuberous ligament

Question 17

Insertion of Gluteus Maximus?

Answer 17

Posterior iliotibial tract of facia lata

Gluteal tuberosity of femur

Question 18

Function of Gluteus Maximus?

Answer 18

Extends flexed femur at hip
Extends knee
Lateral stabiliser of hip + knee joint
Laterally rotates and abducts thight

Question 19

Innervation of Gluteus Medius + Minimus?

Answer 19

Superior Gluteal Nerve

L4, L5, S1

Question 20

Origin of Gluteus Medius?

Answer 20

External ilium, between anterior + posterior gluteal lines

Question 21

Insertion of Gluteus Medius?

Answer 21

Lateral superior surface of greater trochanter

Question 22

Action of Gluteus Medius?

Answer 22

Abducts femur at hip
Keeps pelvis level when walking
Medially rotate anterior thigh

Question 23

Origin of Gluteus Minimus?

Answer 23

External surface of ilium between anterior + Inferior gluteal lines

Question 24

Insertion of Gluteus Minimus?

Answer 24

Linear facet on anterolateral aspect of the greater trochanter

Question 25

Function of Gluteus Minimus?

Answer 25

Abducts thigh
keeps pelvis level
medially rotates anterior thigh

Question 26

What is the iliotibial tract?

Answer 26

Thickened band of fascia lata descending the lateral margin of the leg
extends from tubercle of iliac crest to attach just below the knee
the band is crucial to stabilising the knee during running

Question 27

what are the chief abductors at the hip joint

Answer 27

Gluteus Medius

Gluteus Minimus

Question 28

Describe the attachments, course and function of Piriformis?

Answer 28

Origin - anterior surface of sacrum
Insertion - medial, posterior, superior border of greater trochanter
Innervation - L5, S1 and S2
Function - Laterally rotates extended femur, abducts flexed femur

Exits pelvis through the greater sciatic foramen

Question 29

Where does the sciatic nerve leave the pelvis?

Answer 29

Emerges from the lower border of piriformis

Question 30

What passes superior to piriformis?

Answer 30

Superior gluteal nerve
superior gluteal artery
superior gluteal vein

Question 31

What passes inferior to piriformis?

Answer 31

Sciatic Nerve (L4 - S3)
nerve to quadrator femoris
nerve to obturator internus
posterior cutaneous nerve to thigh
pudendal nerve
Inferior gluteal N/A/V

Question 32

What passes through the lesser sciatic foramen?

Answer 32

Tendon of obturator internus
Pudendal nerve
Internal pudendal vessels
Nerve to obturator internus

Question 33

What is the origin of obturator internus?

Answer 33

anterolateral wall of pelvis,

deep surface of obturator membrane and bone

Question 34

What is the origin of the Gemelli muscles?

Answer 34

Gemellus Superior - external surface of ischial spine

Gemellus Inferior - Upper ischial tuberosity

Question 35

What is the common insertion of Piriformis, Obturator Internus and the Gemelli?

Answer 35

Medial side of the greater trochanter

Question 36

What is the common function of Piriformis, Obturator Internus, quadratus femoris and the Gemelli?

Answer 36

Laterally rotate the extended femur

pirformis abducts the flexed femur

Question 37

What are the attachments of Quadratus Femoris?

Answer 37

Origin - lateral ischium anterior to ischial tuberosity

Insertion - quadrate tubercle on intertrochanteric crest of proximal femur

Question 38

What is the nerve supply of Obturator Internus and Gemellus superior?

Answer 38

Nerve to Obturator Internus

L5, S1

Question 39

What is the nerve supply to Gemellus Inferior and Quadratus Femoris?

Answer 39

Nerve to Quadratus Femoris

L5, S1

Question 40

Where is it safe to give an intramuscular injection in the gluteal region?

Answer 40

Upper outer quadrant of gluteal region

Question 41

What is the Tensor Fascia Latae Muscle

Answer 41

extends from lateral crest of ilium to insert onto iliotibial tract
laterally rotates the extended femur

Question 42

nerve roots of the sciatic nerve?

Answer 42

L4-S3