Lower Limb Flashcards
Also known as the pelvic bone
Hip bone
Hip bone is formed by the fusion of 3 primary bones, what are these 3 primary bones?
Ilium
Ischium
Pubis
Provide attachment for ligaments and tendons of lower limb structures
Anterior inferior iliac spine
Serves as attachment points for muscles and ligaments that support sacroiliac joint
Posterior inferior iliac spine
Marks the superior end of the greater sciatic notch
Posterior inferior iliac spine
“Wing”. Posterolateral portions of the ilium. Provides broad surfaces for the fleshy attachment
Ala
The curved and thickened superior border of the ala of the ilium. Serves as a protective bumper. An important site of aponeurotic attachment for thin, sheet like muscle and deep fascia
Iliac crest
Iliac crest begins at
Anterior superior iliac spine
Iliac crest terminates at
Posterior superior iliac spine
A prominence on the external lip of the crest
Iliac tubercle
Lies 5-6cm posterior to the ASIS
Iliac tubercle
widest portion of the iliac crest
Iliac tubercle
Gluteal lines and Gluteal muscles between the anterior and posterior lines
Gluteus medius
Gluteal lines and Gluteal muscles between the anterior and inferior lines
Gluteus minimus
A large, smooth depression on the ala
Iliac fossa
Relating to or denoting a type of joint which is surrounded by a thick flexible membrane forming a sac into which is secreted a viscous fluid that lubricates the joint
Synovial joint
Fibrous joint in which two adjacent bones are linked by a strong membrane or ligaments
Syndesmotic joint
Iliac fossa provides proximal attachement for the ___
iliacus muscle
A bar of bone formed by the union of the ramus of the ischium and the inferior ramus of the pubis. Constitutes the inferomedial boundary of the obturator foramen
Ischiopubic ramus
Forms the postero-inferior aspect of the hip bone
Ischium
Triangular. Found at the inferior margin of the greater sciatic notch which provides ligamentous attachment. Separated the greater sciatic notch from the lesser sciatic notch.
ISCHIAL SPINE
Serves as a trochlea or pulley for muscles that emerge from the bony pelvis
Lesser sciatic notch
Bony projection at the junction of the inferior end of the body of the ischium and its ramus. Provides the proximal, tendinous attachment of posterior thigh muscles. The body’s weight rests on this tuberosity when sitting
Ischial Tubeerosity
Concavity found on top of the ischial spine
Greater sciatic notch
Forms the anteromedial part of the hip bone. Contributes to the anterior part of the acetabulum. Provides proximal attachment for muscles of the medial thigh divided into a flattened medially placed body and superior and inferior rami
PUBIS
Formed by the articulation or joining of symphysial surfaces of the bodies of the two pubes
Pubic symphysis
Small projections at the lateral ends of the pubic crest. Provide attachment for the main part of the inguinal ligament
Pubic tubercle
Formed by the anterosuperior border of the bodies and the symphysis pubis. Provides attachment for abdominal muscles
PUBIC CREST
Connects the pelvic girdle and the lower limb. Transmits weight of the upper body to the heads and necks of the femora. Multiaxial ball and socket type of synovial joint
Hip joint
A sharp raised edge at the posterior margin of the superior ramus of the pubis. Forms part of the pelvic brim
Pecten pubis
Approximately 2/3 of a sphere. Covered with articular cartilage except in the fovea
Head of the femur
____ is the depression for the ligament of the femoral head
Fovea
A hemispherical hollow on the lateral of the hip bone
Acetabulum
Acetabulum, formed by the fusion of three bony parts: ___, ___, ___
Ilium, Ischium, & Pubis
A deep nonarticular part formed mainly by the ischium. This fossa is thin walled (often translucent) and continuous inferior with the acetabular notch
Acetabular fossa
Consists of a semilunar articular part covered with articular cartilage (lunate surface of the acetabulum) approximately three quarters of a circle
ACETABULAR RIM
A continuation of the acetabular labrum (coronal section)
Transverse acetabular ligament
LINES AND CURVATURES ARE USED IN THE DETECTION OF HIP ABNORMALITIES
Kohler line
Iliofemoral line
Shenton line
A fibrocartilaginous rim attached to the margin of the acetabulum which increases the acetabular articular area
Acetabular labrum
____ are located anteriorly. fewer. weaker. less mechanically advantaged. anterior ligaments are strongest
Medial flexors
Should appear in a normal AP radiograph as smooth, continous lines. Is a radiographic indication of the angle of inclination (ASIS)
Iliofemoral line
Shenton line
____ are weaker posteriorly. medial rotators are abundant, stronger, and more mechanically advantaged.
Ligaments
Normally tangential to the pelvic inlet and the obturator foramen. This line medial to the acetabular fossa. Note: A fossa that crosses the line suggests an acetabular fracture with inward displacement
Kohler line
Iliofemoral ligament, attaches to the _____ and the ____. Attaches ____ distally
- anterior inferior iliac spine and the acetabular rim proximally
- intertrochanteric line
Anterior and superior. Y shaped. The body’s strongest ligament. Specifically prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum via the mechanism described above
Iliofemoral ligament
3 INTRINSIC LIGAMENTS OF THE JOINT CAPSULE
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Anterior and inferior. Arises from the obturator crest of the pubic bone and passes laterally and inferiorly to merge with the fibrous layer of the joint capsule. Blends with the medial part of the iliofemoral ligament and tightens during both extension and abduction of the hip joint. Prevents overabduction of the hip joint
Pubofemoral ligament
States that the nerves supplying the muscles extending directly across and acting at a given joint also innervate the joint. Knowledge of the nerve supply of the muscles and their relationship to the joint is needed to deduce the nerve supply of the joint
Hilton’s law
Posterior. Arises from the ischial part of the acetabular rim. It spirals superolaterally to the femoral neck, medial to the base of the greater trochanter. Weakest of the three ligaments
Ischiofemoral ligament
Supplies the anterior aspect of the hip joint. Flexor muscles innervated by the nerve pass anterior to the hip joint
Femoral nerve
Supplies the inferior aspect of the hip joint. Lateral rotator muscles that pass inferior to the hip joint are innervated by the ____
Obturator nerve
Supplies the posterior aspect of the hip joint. Lateral rotator muscles that pass posterior to the joint are innervated by the _____
nerve to the quadratus femurs
Supplies the superior aspect of the joint. Abductors muscles that pass to the superior aspect of the hip joint are innervated by the _____
Superior gluteal nerve
The strongest flexor of the hip
Iliopsoas
Primary extensor from the flexed to the straight (standing) position; also, a lateral rotator
Gluteus maximus
Functions as an adductor also serves as a flexor (anterior or aponeurotic part) and an extensor (posterior or harmstrings part)
Adductor magnus
serve as abductors and medial rotators
anterior portions of the gluteus medius and gluteus minimus
May injure the urinary bladder and urethra
Pubo-obturator area
WEAK AREAS OF THE HIP BONES PRONE TO FRACTURE
1)Pubic rami
2)Acetabula (or the area immediately surrounding them)
3)Region of the sacro-iliac joints
4)Alae of the ilium
_____ means to tear away
A small part of bone with a piece of a tendon or ligament attached is included in the avulsed part
Avulse
Avulsion fraactures occur:
Where muscles are attached
Where ligaments are attached
Apophyses (bony projections that lack secondary ossification centers)
_______ may slip away from the femoral neck because of a weakened epiphyseal plate. Older children and adolescents (10-17y/o). Caused by acute trauma or repetitive microtraumas that place increased shearing stress on the epiphysis (especially with abduction and lateral rotation of the thigh). Common initial symptom of the injuiry is hip discomfort that may be referred to the knee
Dislocated Epiphysis of the femoral head
Common areas for avulsion fracture of the hip bone
1)Anterior superior iliac spines
2)Anterior inferior iliac spines
3)Ischial tuberosities
4)Ischiopubic rami
Neck of the femur is most frequently fractured because it is the narrowest and weakest part of the bone. It lies at a marked angle to the line of weight bearing or pull of gravity. Increasingly vulnerability with age, especially in females, secondary to osteoporosis
Femoral fractures
Fractures of the proximal femur occur at severral locations:
1.Transcervical (middle of the neck)
2.Intertrochanteric
____ are often intracapsular, and realignment of the neck fragments requires internal skeletal fixation. Cause lateral rotation of the lower limb. Often disrupt the blood supply to the head of the femur. Most of the blood to the head and neck of the femur is supplied by the medial circumflex femoral artery
Fractures of the femoral neck
Most common. Head on collision that causes the knee to strike the dashboard may dislocate the hip when the femoral head is forced out of the acetabulum. The joint capsule ruptures inferiorly and posteriorly, allowing the femoral head to pass through the tear in the capsule, and over the posterior margin of the acetabulum onto the lateral surface of the ilium, shortening and medial rotating the limb. Because of the close relationship of the sciatic nerve to the hip joint, it may be injured during posterior dislocations or fractures - dislocations of the hip joint. This kind of injuiry may result in paralysis of the hamstrings and muscles distal to the knee supplied by the sciatic nerve. Sensory changes may also occur in the skin over the posterolateral aspects of the leg and over much of the foot because of injuiry to sensory branches of the sciatic nerve
Posterior dislocations of the hip joint
Results from a violent injury that forces the hip into extension, abduction, and lateral rotation. In these cases, the femoral head is inferior to the acetabulum. Often, the acetabular margin fracture, producing a fracture - dislocation of the hip joint. When the femoral head dislocates, it usually carries the acetabular bone fragment and acetabular labrum with it. These injuries also occur with posterior dislocations.
Anterior dislocations of the hip joint
Inferior to the level of the iliac crests. Extending laterally to the posterior margin of the greater trochanter
Buttocks
Groove that separates the buttocks from each other
Intergluteal cleft
Demarcates the inferior boundary of the buttocks & the superior boundary of the thigh
Gluteal fold
The line joining the highest point of the iliac crests - crosses the _____ and is a useful landmark when a lumbar spinal puncture is perfomed
L4-L5 intervertebral (IV) disc
Intergluteal cleft - begins inferior to the apex of the sacrum & extends as far superiorly as the _____.
S3 or S4 segment
The ___is palpable in the superior part of the intergluteal cleft
coccyx
Indicated by dimples that exist because the skin and underlying fascia are attached, It
coincides with the termination of the iliac crests from which bone marrow and pieces of bone for grafts can be obtained
Posterior superior iliac spine
PSIS, ine joining these dimples pass through the ____, indicating the level of the lowest limit of the dural sac and the lowest limit of the dural sac and the bifurcation of the common iliac arteries
S2 spinous process
____, may be felt on the lateral aspect of the hip, especially its inferior part. The prominence of the are normally responsible for the width of the adult pelvis
Greater trochanter
Top of the greater trochanter - lies approximately a hand’s breadth inferior to the tubercle of the iliac crest (____ posterior to the ASIS)
5-6cm
_____, is indicated by a line joining the skin dimple formed by the posterior superior iliac spine to the superior border of the greater trochanter of the femur
Superior border of the piriformis
____, a line drawn over the lateral hip region from the ASIS to the ischial tuberosity normally passes over or near the top of the greater trochanter. Trochanter can be felt superior to this line in a person with a dislocated hip or a fractured femoral neck
Nelaton line
_____ continuous with the sacrotuberous ligament
Posterior sacro-iliac ligament
GLUTEAL LIGAMENTS
Posterior sacroiliac ligaments
Sacrotuberous ligament
Sacrospinous ligament
To avoid injury to the underlying sciatic nerve, the injection should be given well forward on the _____ of the buttock
upper outer quadrant
_____ converts the sciatic notch into a foramen
Sacrotuberous ligament
_____ together with the ischial spine, the ligament subdivides the sciatic foramen into the greater and lesser sciatic foramina
Sacrospinous ligaments
Structures that exit the Greater sciatic foramen (PSPSNPSI)
- Piriformis
- Sciatic nerve
- Posterior cutaneous nerve of the thigh
- Superior and inferior gluteal nerves
- Nerves to the obturator internus and quadratus femoris
- Pudendal nerve
- Superior and inferior gluteal arteries and veins
- Internal pudendal artery and vein
Structures that exit the Lesser sciatic foramen (TNPI)
- Tendon of obturator internus muscle
- Nerve to obturator internus
- Pudendal nerve
- Internal pudendal artery and vein
Three layer overlapping glutei (maximus, medius, and minimus) and the tensor fasciae latae
Superficial layer of muscle
Smaller muscles (piriformis, obturator internus, superior and inferior gemelli, and quadratus femoris)
Deep layer of muscle
The most superficial gluteal muscle
Gluteus maximus
Main actions of Gluteus Maximus:
Extension and lateral rotation of the thigh
Membranous sacs lined by a synovial membrane
Purpose: To reduce friction and permit free movement
Bursae
Separates the inferior part of the gluteus maximus from the ischial tuberosity; it is often absent
Ischial tuberosity
3 bursae are associated with the gluteus maximus:
Trochanteric bursa
Ischial bursa
Gluteofemoral bursa
Separates superior fibers of the gluteus maximus from the greater trochanter. commonly the largest of the bursae formed in relation to bony prominences and is present at birth
Trochanteric bursa
Separates the iliotibial tract from the superior part of the proximal attachment of the vastus lateralis
Gluteofemoral fossa
Inflammation of the trochanteric bursa may result from repetitive actions such as climbing stairs on a deeply elevated treadmill. These movements involve the gluteus maximus and move the superior tendinous fibers repeatedly back and forth over the bursae of the greater trochanter - causes deep diffuse pain in the lateral thigh region the pain radiates along the iliotibial tract that extends from the iliac tubercle to the tibia - pain posterior to the greater trochanter - elicited by manually resisting abduction and lateral rotation of the thigh while the person is lying on the unaffected side - characterized by point tenderness over the greater trochanter
Trochanteric bursitis
Inflammation of the ischial bursa - resulting from excessive friction between the ischial bursae and the ischial tuberosities - repeated stress from activities like cycling, rowing, or other activities involving repetitive hip extension while seated - localized pain occurs over the bursa - pain increases with movement of the gluteus maximus
Ischial bursitis
A fusiform muscle approximately 15cm long that is enclosed between two layers of fascia lata - Innervated by the superior gluteal nerve (L5, S1) - Primarily a flexor of the thigh because of its anterior location - To produce flexion, acts in concert with the iliopsoas and rectus femoris - It is also an abductor and medial rotator of the thigh
Tensor fascia latae
Tensor fascia latae, a fusiform muscle approximately ___ long that is enclosed between two layers of fascia lata - Innervated by the superior gluteal nerve (____) - Primarily a flexor of the thigh because of its anterior location - To produce flexion, the tensor fasciae latae acts in concert with the iliopsoas and rectus femoris - It is also an abductor and medial rotator of the thigh
15cm - L5, S1
Originated from the latin word “pirum” which means “pear. Leaves the pelvis through the greater sciatic foramen, almost filling it, to reach its attachment to the superior border of the greater trochanter. Landmark of the gluteal region
Piriformis
Occupies the gap between the piriformis and the quadratus femoris - common tendon of these muscles lies horizontally in the buttocks as it passes to the greater trochanter of the femur
Triceps coxae
3 head muscle of Triceps coxae
Obturator interns
Superior gemelli
Inferior gemelli
____ continuous below with the deep fascia of the thigh or fascia lata. encloses the gluteus maximus muscle - above the gluteus maximus, it continues as a single layer that covers the outer surface of the gluteus medius and is attached to the iliac crest - on the lateral surface of the thigh, the fascia is thickened to form a strong, wide band, the iliotibial tract
Deep fascia
Posterior to the pectineus and the superior ends of the adductor muscles, innervated by the obturator nerve. Functions as a lateral rotator of the thigh
Obturator externus
______ thick, especially in women, and is impregnated with large quantities of fat
Superficial fascia
Major branches of the internal iliac artery that supply or traverse the gluteal regiom are the;
superior gluteal artery
inferior gluteal artery
internal pudendal artery
