Lower Limb 1: The Gluteal Region and Hip Joint Flashcards
Give a description of the osteology of the pelvic girdle
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
List the main differences between the male and female pelvis
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
Functions of the pelvis?
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
Which ligaments form important foramen at the hip joint?
Sacrotuberous - inserts onto ischial tuberosity
Sacrospinous - inserts onto ischial spine
firmly attach sacrum to ischium and creates to greater and lesser sciatic foramen
Movements possible at the hip joint?
Flexion Extension Abduction Adduction Medial and Lateral rotation Circumduction
Features strengthening the hip joint?
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
Ligaments involved in strengthening the hip joint?
Iliofemoral
Pubofemoral
Ischiofemoral
Describe the iliofemoral ligament
covers joint anteriorly and superiorly Y shaped Strongest one Extends from ilium to intertrochanteric line of the femur Prevents hyperextension
Describe the pubofemoral ligament
Covers joint anteriorly and inferiorly
Prevents abduction
Describe the Ischiofemoral ligament
Covers joint posteriorly
attached to ischium and ischial tuberosity to greater trochanter of femur
the weakest one
Decribe the blood supply to the hip joint
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
Describe the origin of the gluteal arteries
Gluteal arteries:
sup+inf originate in pelvic cavity as branches of internal iliac
Describe the superior gluteal artery
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
Describe the inferior gluteal artery
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
Innervation of Gluteus Maximus?
Inferior gluteal nerve, L5,S1,S2
Origin of Gluteus maximus?
Posterior gluteal line (ilium)
Sacrum, coccyx,
Sacrotuberous ligament
Insertion of Gluteus Maximus?
Posterior iliotibial tract of facia lata
Gluteal tuberosity of femur
Function of Gluteus Maximus?
Extends flexed femur at hip
Extends knee
Lateral stabiliser of hip + knee joint
Laterally rotates and abducts thight
Innervation of Gluteus Medius + Minimus?
Superior Gluteal Nerve
L4, L5, S1
Origin of Gluteus Medius?
External ilium, between anterior + posterior gluteal lines
Insertion of Gluteus Medius?
Lateral superior surface of greater trochanter
Action of Gluteus Medius?
Abducts femur at hip
Keeps pelvis level when walking
Medially rotate anterior thigh
Origin of Gluteus Minimus?
External surface of ilium between anterior + Inferior gluteal lines
Insertion of Gluteus Minimus?
Linear facet on anterolateral aspect of the greater trochanter
Function of Gluteus Minimus?
Abducts thigh
keeps pelvis level
medially rotates anterior thigh
What is the iliotibial tract?
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
what are the chief abductors at the hip joint
Gluteus Medius
Gluteus Minimus
Describe the attachments, course and function of Piriformis?
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
Where does the sciatic nerve leave the pelvis?
Emerges from the lower border of piriformis
What passes superior to piriformis?
Superior gluteal nerve
superior gluteal artery
superior gluteal vein
What passes inferior to piriformis?
Sciatic Nerve (L4 - S3) nerve to quadrator femoris nerve to obturator internus posterior cutaneous nerve to thigh pudendal nerve Inferior gluteal N/A/V
What passes through the lesser sciatic foramen?
Tendon of obturator internus
Pudendal nerve
Internal pudendal vessels
Nerve to obturator internus
What is the origin of obturator internus?
anterolateral wall of pelvis,
deep surface of obturator membrane and bone
What is the origin of the Gemelli muscles?
Gemellus Superior - external surface of ischial spine
Gemellus Inferior - Upper ischial tuberosity
What is the common insertion of Piriformis, Obturator Internus and the Gemelli?
Medial side of the greater trochanter
What is the common function of Piriformis, Obturator Internus, quadratus femoris and the Gemelli?
Laterally rotate the extended femur
pirformis abducts the flexed femur
What are the attachments of Quadratus Femoris?
Origin - lateral ischium anterior to ischial tuberosity
Insertion - quadrate tubercle on intertrochanteric crest of proximal femur
What is the nerve supply of Obturator Internus and Gemellus superior?
Nerve to Obturator Internus
L5, S1
What is the nerve supply to Gemellus Inferior and Quadratus Femoris?
Nerve to Quadratus Femoris
L5, S1
Where is it safe to give an intramuscular injection in the gluteal region?
Upper outer quadrant of gluteal region
What is the Tensor Fascia Latae Muscle
extends from lateral crest of ilium to insert onto iliotibial tract
laterally rotates the extended femur
nerve roots of the sciatic nerve?
L4-S3
