m7: pelvis and hip Flashcards
(Posterior) Right and left pelvic bones ↔ sacrum and fifth lumbar
(Anterior) Left and right hemipelvis ↔ pubis symphysis
Pelvic Girdle
Femoral head ↔ Acetabulum
Very stable structurally + Very mobile
Hip abductor muscles on the weight-bearing leg must create a force to counterbalance about _% of body’s weight during each step taken.
Hip joint
85%
Latin word, “bowl”/ “basin”
A bridge between the lower extremities and the entire head, arm, and trunk complex (HAT).
Pelvis
Providing a stable base for HAT
Containing and supporting the visceral contents
Transmitting and absorbing forces to and from both HAT superiorly and the lower extremities inferiorly.
Functions of the Pelvis
Major role in elevating and lowering the body:
Climbing
Rising from a chair
Lifting the limb, as when the foot is elevated to tie a shoelace.
Hip muscles may function by:
moving the femur on the pelvis (e.g., flexing the hip to step up onto a step)
by moving the pelvis over the femur (e.g.,leaning over to pick up an object from the floor).
Supporting and transferring the weight of the HAT to the femurs in standing or to the ischial tuberosities in sitting.
Rotating during walking to create a rhythmic pelvic swing so a smooth translation of both the trunk and the lower extremities occurs.
Providing a broad area for muscular attachment.
Pelvis
3 Innominate bones (R) and (L)
Ilium
Ischium
Pubis
“wing/ear”
Largest, superior
Iliac crest (_) highest point of the pelvis
Iliac tubercle ()
Ilium
Iliac crest (L4)
Iliac Tubercle (L5)
▪ (Origin of Sartorius, Inguinal Ligament/ poupart’s/ aponeurosis of external oblique)
▪ Measurement landmark of:
1.
2.
ANTERIOIR SUPERIOR ILIAC SPINE (ASIS)
- LLD, Q-angle
- Fulcrum for hip abduction, adduction
▪ (Origin of rectus femoris straight head)
ANTERIOIR INFERIOR ILIAC SPINE (AIIS)
▪ S2
▪ Dimples of Venus
▪ Measurement landmark of: _ Test
POSTERIOR SUPERIOR ILIAC SPINE (PSIS)
Schober’s Test
Fracture of the iliac wing
Duverney’s Fracture
▪ “fish”
▪ Posterior
▪ Ischial tuberosity
▪ Ischiogluteal bursa
Ischium
▪ “sit bone”
▪ For weightbearing in sitting
▪ Origin of hamstrings
Ischial Tuberosity
▪ Prolonged sitting causes bursitis; Tailor’s/weaver’s/ boatman’s bottom
Ischiogluteal bursa
▪ “crotch”
▪ Common site of adductor origin
Pubis
- _ _ = origin of pectineus
Superior Ramus
- _ /= origin of adductor longus
Pubic Tubercle/ Body
- Inferior Ramus
a.
b.
c.
a. Adductor Magnus
b. Gracilis
c. Adductor Brevis
- Obturator foramen
a.
b.
a. Lumbar and sacral nerves
b. Blood vessels
▪ Triradiate ligament connects ilium, ischium, pubis (Fused after birth)
▪ Covered by fibrous cartilage: glenoid labrum
▪ Orientation: (LIA) Lateral, Inferior, Anterior
Acetabulum
▪ Sacral promontory
▪ Sacral body
Sacrum
▪ “tail bone”
▪ Painful coccyx “_”
MOI: falling in seated position
Coccyx
coccygodynia
▪ Carries abdominal organs
▪ Male: Heart, smaller
▪ Female: Oval, larger
▪ Borders:
1.
2.
3.
Pelvis Inlet/Pelvic Brim
- Ant: Symphysis pubis
- Post: Sacral promontory
- Lat: Iliopectineal line
▪ Carries reproductive organs
▪ Borders:
1.
2.
3.
Pelvis Outlet
- Ant: Pubic arch
- Post: Coccyx
- Lat: Ischial tuberosity
▪ (N) ASIS = PSIS
▪ APT = ASIS < PSIS
▪ PPT = ASIS > PSIS
Pelvic Tilt
▪ ASIS = PSIS
XXX:
Pelvic tilt
▪ Iliac crest (L) = (R)
XXX:
Pelvic obliquity/list
▪ Pubic tubercle = Greater trochanter
XXX: _, _, _
True LLD, coxa vara, dislocation
▪ 25% of the general height
Femur
Neck Shaft Angle
▪ Adult=
▪ Child=
▪ Increased =
▪ Decreased =
125 degrees
160 degrees
coxa valga > 135 degrees
coxa vara < 120 degress
▪ (N) 8-15 degrees
▪ Increased – _ (in-toe, patellar
squinting, knocked knees)
▪ Decreased – _ (out-toe, frog eyes/
grasshopper, bowleg)
Femoral Torsion
Anteversion
Retroversion
▪ “Angle of Wiberg”
▪ (N) 20-30
▪ ↑ angle = more stable
▪ ↓ angle = less stable
▪ Aging increases center edge angle
Center Edge Angle
▪ Covered by hyaline and fibrous cartilage
▪ Orientation: _ , _ , _
▪ Blood supply:
- 20% obturator artery
- 80% Medial circumflex arter
Femoral head
(SAM) Superior, Anterior and Medial
▪ G. Med/Min
▪ Red carpet muscles
Greater Trochanter
POOSIQ (Sup to inf)
● Piriformis
● Obturator internus
● Obturator externus
● Superior gemellus
● Inferior gemellus
● Quadratus femoris
Iliopsoas
Lesser Trochanter
▪ Ligaments: weakened by relaxin, aldosterone
▪ Movement: Nutation/Counternutation
Sacroiliac Joint (SI)
▪ Multiaxial ball-and-socket joint that has
maximum stability because of the deep insertion of the head of the femur into the acetabulum
Acetabulofemoral Joint
Hip Joint
Resting position:
30° flexion, 300 abduction, slight lateral rotation
Hip joint
Closed Packed Position:
Full extension, medial rotation, and abduction
Hip joint
Capsular Pattern:
Flexion, abduction, medial rotation (but in some cases, medial rotation is limited)
▪ AKA: Y ligament of bigelow
▪ Strongest ligament of the body
▪ Restricts: Extension, ER small amount AD
Iliofemoral ligament
▪ Restricts extension
▪ Weakest
Ischiofemoral Ligament
▪ Restricts AB, Extension
Pubofemoral ligament
FACTORS AFFECTING HIP STABILITY
●
●
●
● Architecture/stability
● Ligaments – Y ligament
● Atmospheric pressure is negative, creates a suction
BOUNDARIES
→ SUPERIOR: _ _ (forms the base the femoral triangle)
→ MEDIAL: _ _
→ LATERAL: _
inguinal ligament
adductor longus
sartorius
→ LATERAL: sartorius
→ Contents (lat.to med.):
Femoral nerve
Femoral artery
Femoral vein
Lymph nodes
▪ MC direction of Hip
▪ D/L: posterior
▪ MOI: dashboard injury, FAddIR + PCL injury
Hip dislocation
▪ A metal prosthesis anchored to the person’s _ by bone cement replaces the femoral _ and _
▪ A plastic socket cemented to the hip bone replaces the _.
Hip replacement
▪ A metal prosthesis anchored to the person’s femur by bone cement replaces the femoral head and neck
▪ A plastic socket cemented to the hip bone replaces the acetabulum.
Gluteal region
MUSCLE:
ORIGIN: Outer surface of ilium (1), sacrum, coccyx, sacrotuberous ligament
INSERTION: Iliotibial and gluteal tuberosity of femur
NERVE: INFERIOR Gluteal Nerve - L5, S1, S2
ACTIONS:
● Extends and laterally rotates the thigh at the hip joint
● The upper fibers abduct and the lower fibers adduct the thigh at the hip joint
● Posteriorly tilts the pelvis at the hip joint
● Extends the leg at the knee joint
GLUTEUS MAXIMUS
Gluteal region
MUSCLE:
ORIGIN: Outer surface of ilium (2)
INSERTION: LATERAL surface of greater trochanter of femur
NERVE: Superior gluteal nerve (1)
ACTIONS: (1)
● Abducts thigh at hip joint
● Tilts pelvis when walking to permit
opposite leg to clear ground
GLUTEUS MEDIUS
Gluteal region
MUSCLE:
ORIGIN: Outer surface of ilium (3)
INSERTION: ANTERIOR surface of greater trochanter of femur
NERVE: Superior gluteal nerve (2)
ACTIONS: (2)
● Abducts thigh at hip joint
● Tilts pelvis when walking to permit
opposite leg to clear ground
GLUTEUS MINIMUS
Gluteal region
MUSCLE:
ORIGIN: Iliac crest
INSERTION: Iliotibial tract
NERVE: Superior Gluteal Nerve (3)
ACTIONS: Assists gluteus maximus in extending the knee joint
TENSOR FASCIA LATAE
Gluteal region
MUSCLE:
ORIGIN: Anterior surface of sacrum
INSERTION: UPPER border of greater trochanter of femur (1)
NERVE: 1st and 2nd sacral nerves
ACTIONS: Lateral rotator of thigh at hip joint (1)
PIRIFORMIS
Gluteal region
MUSCLE:
ORIGIN: Inner surface of obturator membrane
INSERTION: UPPER border of greater trochanter of femur (2)
NERVE: Sacral plexus (1)
ACTIONS: Lateral rotator of thigh at hip (2) joint
OBTURATOR INTERNUS
Gluteal region
MUSCLE:
ORIGIN: Spine of ischium
INSERTION: UPPER border of greater trochanter of femur (3)
NERVE: Sacral plexus (2)
ACTIONS: Lateral rotator of thigh at hip joint (3)
GEMELLUS SUPERIOR
Gluteal region
MUSCLE:
ORIGIN: Ischial tuberosity
INSERTION: UPPER border of greater trochanter of femur (4)
NERVE: Sacral plexus (3)
ACTIONS: Lateral rotator of thigh at hip joint (4)
GEMELLUS INFERIOR
Gluteal region
MUSCLE:
ORIGIN: Lateral border of ischial tuberosity
INSERTION: Quadrate tubercle of femur
NERVE: Sacral plexus (4)
ACTIONS: Lateral rotator of thigh at hip joint (5)
QUADRATUS FEMORIS
Anterior
MUSCLE:
ORIGIN: Anterior superior iliac spine (ASIS)
INSERTION: Upper medial surface of shaft of tibia
NERVE: Femoral nerve (1)
ACTIONS:
● Flexes, abducts, laterally rotates thigh at hip joint
● Flexes and medially rotates leg at the knee join
SARTORIUS
Anterior
MUSCLE:
ORIGIN: Iliac fossa of hip bone
INSERTION: With psoas into lesser trochanter of femur
NERVE: Femoral nerve (2)
ACTIONS: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on thigh as in sitting up from lying down (1)
ILIACUS
Anterior
MUSCLE:
ORIGIN: Superior ramus of pubis
INSERTION: Upper end of linea aspera of shaft of femur
NERVE: Femoral nerve (3)
ACTIONS: Flexes and adducts thigh at hip joint
PECTINEUS
Anterior
MUSCLE:
ORIGIN: Transverse processes, bodies and intervertebral discs of the 12th thoracic and five lumbar vertebrae
INSERTION: With iliacus into lesser trochanter of femur
NERVE: Lumbar plexus
ACTIONS: Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on thigh as in sitting up from lying down (2)
PSOAS
Medial
MUSCLE:
ORIGIN: Inferior ramus of the pubic bone
INSERTION: Upper part of shaft of tibia on medial surface
NERVE: Obturator Nerve - L2, L3
ACTIONS: Adducts thigh at hip joint (1); Flexes leg at KNEE joint
GRACILIS
Medial
MUSCLE:
ORIGIN: Body of pubis, medial to pubic tubercle
INSERTION: Posterior surface of shaft of femur (linea aspera) (1)
NERVE: Obturator Nerve - L2, L3, AND L4
ACTIONS: Adducts thigh at hip joint and assists in lateral rotation (1)
ADDUCTOR LONGUS
Medial
MUSCLE
ORIGIN: Inferior ramus of pubis ONLY
INSERTION: Posterior surface of shaft of femur (2)
NERVE: Obturator Nerve - L2, L3 ONLY
ACTIONS: Adducts thigh at hip joint and assists lateral rotation (2)
ADDUCTOR BREVIS
Medial
MUSCLE:
ORIGIN: Inferior ramus of pubis, ramus of ischium, ischial tuberosity
INSERTION: Posterior surface of shaft of femur (3); adductor of tubercle of femur
NERVE:
● Adductor portion: obturator nerve
● Hamstring portion: sciatic nerve
ACTIONS: Adducts thigh at hip joint and assists in lateral rotation (3); hamstring portion extends thigh at hip joint
ADDUCTOR MAGNUS
Medial
MUSCLE:
ORIGIN: Outer surface of obturator membrane and pubic and ischial rami
INSERTION: Medial surface of greater trochanter
NERVE: Obturator Nerve - L2, L3 ONLY (2)
ACTIONS: Laterally rotates thigh at hip joint
OBTURATOR EXTERNUS
