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Structure and Function > Lower Limb, Gluteal Region, Hip Joint > Flashcards

Lower Limb, Gluteal Region, Hip Joint Flashcards

1
Q

Lower Extremities vs Upper Extremities

A
  • Upper extremity
    • Non-weight bearing
    • Highly mobile
  • Lower extremities
    • Weight bearing
    • Standing/walking = locomotion
    • Anti-gravity
      • Ie Gravity causes excess flexion at the knee > quadriceps (extensor) resist
    • Very stable > strong ligaments and muscles
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2
Q

Lower Limb Rotation and Compartments

A
  • All limbs same position > palms/soles anterior, thumbs/toes superior
  • 6-8th week > rotation
    • Upper limbs rotate laterally > elbow posterior, thumbs lateral
    • Lower limbs rrotate medially >.knees anterior, toes medial
  • Muscle mass
    • Muscle masses migrate with innervation into the limb
    • Ventral muscle mass = flexors
      • Upper limbs: ventral muscle mass > anatomically anterior
      • Lower limbs: ventral muscles mass > anatomically posterior
    • Dorsal muscle mass = extensors
      • Upper limbs: dorsal muscle mass > anatomically posterior
      • Lower limbs: dorsal muscle mass > anatomically anterior
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3
Q

Innervation of the Lower Limb

Collateral Nerves

Terminal Nerves

A
  • Lumbosacral plexus > innervation to the lower limb
  • Union of lumbar plexus and sacral plexus by lumbosacral trunk
  • L2-L3 ventral rami > anterior/posterior divisions > collateral/terminal nerves
    • Posterior division nerve fibers innervate anterior compartment muscles
    • Anterior division nerve fibers innervate posterior compartment muscles
  • Sciatic > splits at knee > tibial and common fibular
  • Proximo-distal gradient
    • Superior rami innervate proximal muscles
    • Interior rami innervate distal muscles
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4
Q

Innervation of the Lower Limb

Collateral Nerves

Terminal Nerves

A
  • Lumbosacral plexus > innervation to the lower limb
  • Union of lumbar plexus and sacral plexus by lumbosacral trunk
  • L2-L3 ventral rami > anterior/posterior divisions > collateral/terminal nerves
    • Posterior division nerve fibers innervate anterior compartment muscles
    • Anterior division nerve fibers innervate posterior compartment muscles
  • Sciatic > splits at knee > tibial and common fibular
  • Proximo-distal gradient
    • Superior rami innervate proximal muscles
    • Interior rami innervate distal muscles
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5
Q

Innervation of the Lower Limb: Dermatomes

A
  • Lumbosacral plexus > innervation to the lower limb
  • Union of lumbar plexus and sacral plexus by lumbosacral trunk
  • L2-L3 ventral rami > anterior/posterior divisions > collateral/terminal nerves
    • Posterior division nerve fibers innervate anterior compartment muscles
    • Anterior division nerve fibers innervate posterior compartment muscles
  • Sciatic > splits at knee > tibial and common fibular
  • Proximo-distal gradient
    • Superior rami innervate proximal muscles
    • Interior rami innervate distal muscles
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6
Q

Arteries of the Lower Limb

A
  • Internal iliac > gluteal region
  • Femoral artery > rest of lower limb
  • Internal iliac and femoral artery anastomose at the cruciate anastomosis (cross-shaped)
    • Inferior gluteal artery
    • Medial femoral circumflex artery
    • Lateral femoral circumflex artery
    • 1st perforating artery
  • Know:
    • Hip – femoral and internal iliac
    • Thigh – deep femoral (like produnda brachii)
    • Knee – popliteal
    • Leg – anterior/posterior tibial
    • Foot – plantar arches
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7
Q

Venous Drainage of the Lower Limb

A
  • All veins drain into:
    • Femoral vein
    • Iliac vein
  • Muscular venous pump system
    • Relaxation > superficial > perforating veins (no backflow) > deep veins > contraction > superiorly
    • Great saphenous vein (analogous to the great saphenous)
      • Superficial vein
      • Used as a graft in CABG > invert bc of valves
      • Distally: anterior to the medial malleolus
    • DVT
      • Forms in deep vein (usually calf or thigh)
      • Can lead to pulmonary emboli
      • IVC filter for PE prevention
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8
Q

Lymphatic Drainage of the Lower Limb

A
  • Superficial (vertical) inguinal node
  • Deep inguinal node
  • Popliteal node
  • Superficial lymphatics > superficial inguinal node or popliteal node > deep inguinal node > external iliac node
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9
Q

Hip: Pelvis Bone

A
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10
Q

Hip: Pelvis Bone Ligaments

A

Ischial spine= landmark

Obturator canal > obturator AVN

Sacrotuberous Ligament

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11
Q

Hip: Femur Bone

A
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12
Q

Gluteal Region

  • 4 functional groups
    • Hip abductors (Superior gluteal nerve)
    • Medial rotators (Superior gluteal nerve)
    • Lateral rotators (Superior gluteal nerve)
    • Extensors (Inferior gluteal nerve)
A
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13
Q

Gluteal Region

  • 4 functional groups
    • Hip abductors (Superior gluteal nerve)
    • Medial rotators (Superior gluteal nerve)
    • Lateral rotators (Superior gluteal nerve)
    • Extensors (Inferior gluteal nerve)
A
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14
Q

Gluteal Region

  • 4 functional groups
    • Hip abductors (Superior gluteal nerve)
    • Medial rotators (Superior gluteal nerve)
    • Lateral rotators (Superior gluteal nerve)
    • Extensors (Inferior gluteal nerve)
A
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15
Q

Gluteal Region

  • 4 functional groups
    • Hip abductors (Superior gluteal nerve)
    • Medial rotators (Superior gluteal nerve)
    • Lateral rotators (Superior gluteal nerve)
    • Extensors (Inferior gluteal nerve)
A
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16
Q

Gluteal Region: Blood supply

A
  • Superior gluteal artery
  • Inferior gluteal artery
  • Branches of the internal iliac
  • At hip > cruciate anastomosis
    • Femoral artery and iliac artery anastomose
    • Medial circumflex femoral artery
    • Lateral circumflex femoral artery
    • 1st perforating artery
    • Inferior gluteal artery
17
Q

Gluteal Region: Clinical considerations

A
  • Sciatic nerve variations
    • Piriformis syndrome
      • Piriformis compresses sciatic nerve at the greater sciatic foramen
      • Normal: Common fibular nerve inferior to piriformis
      • Abnormal: Common fibular nerve through/superior to piriformis
      • Pain radiating down the limb > muscle weakness
    • Intragluteal injections risk
18
Q

Hip Joint

A
  • Ball and socket
  • Synovial
  • Head of femur and acetabulum of coxal bone (bony pelvis)
  • Stabilized by:
    • Deep bony socket
    • Fibrocartilagenous acetabular labrum
    • Extrascapular ligaments (resist hyperextention)
      • Iliofemoral - strongest
      • Ischiofemoral
      • Pubofemoral
      • Round ligament of the femus = intrascapular
        • Contains foveal artery
  • Strong muscles
19
Q

Hip: Center of Gravity

A
20
Q

Hip Blood Supply

A
21
Q

Hip Movements

A
  • Flexion/extension
    • Around transverse axis
    • In sagittal plane
  • Abduction/adduction
    • Around anteroposterior axis
    • In coronal plane
  • Medial/lateral rotation
    • Around vertical axis
    • In transverse plane
  • Circumduction
  • Pelvic tilt
    • Tilts around anteroposterior axis toward the unsupported limb
    • Controlled by hip abductors
    • Gait
      • Line of gravity shifts anterior/posterior to the transverse axis > pelvis tilts in flexion and extension
      • Controlled by gluteus maximus and tensor fascia lata
22
Q

Hip Clinical Considerations

Hip Fracture

Hip Dislocation

A
  • Hip Fractures
    • Post-menopausal women with osteoporosis > femoral neck fracture
    • Sometimes tear:
      • Round periosteum
      • Branches of the medial femoral circumflex artery
        • Bone tissue can become necrotic
        • Avascular necrosis
23
Q

Hip Clinical Considerations

Hip Fracture

Hip Dislocation

A
  • Congenital hip dislocation
    • Result of lax ligaments or acetabular dysplasia
    • More in girls
    • Unilateral left 70%
    • Associated with
      • Family history
      • Breech delivery
    • S/S
      • Unable to abduct hip
      • Affected limb appears shorter
  • Acquired hip dislocation
    • Uncommon
    • Traumatic injury (car accident)
    • Usually posterior in direction > fractures femoral head and acetabulum
24
Q

Hip Surgery

A

Fracture Repair

Total Hip Replacement

Hip Resurfacing

Structure and Function (15 decks)

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