May30 M3-Anatomy LL 1 Flashcards
3 hip bones (forming ‘‘the hip bone’’)
- ilium (top until mid acetabulum)
- ischium (mid acetabulum to the bottom, posteriorly)
- pubis (mid acetabulum to bottom anteriorly) (anterior branch)
landmarks on the ilium
- sacroiliac joint
- ala of the ilium
- iliac crest
- AIIS and ASIS
- iliac fossa (anterior ala of the ilium, the fossa)
- articular surface in the back medially to articulate with the sacrum
landmark to know on the sacrum
coccyx (last bone in the bottom)
what’s the hip joint
joint between hip bone and femur
structure associated to the pubis
pubic symphysis
landmarks of the ischium
- ischial spine in the back
- ischial tuberosity in the bottom (the hamstrings spread from there)
- greater and lesser sciatic notches (above and below the ischial spine). the greater sciatic notch is mostly ilium superiorly
hole in the hip bone
obturator foramen (hole formed by ischium and pubis, below acetabulum)
regions of the femur
head, neck and shaft
landmarks on the femur (4)
- greater trochanter (laterally ant)
- lesser trochanter (medially post)
- intertrochanteric line (between trochanters anteriorly)
- intertrochanteric crest (between trochanters posteriorly)
- gluteal tuberosity (below intertrochanteric crest POSTERIORLY)
what muscle goes to the lesser trochanter of the femur
iliopsoas
bones forming the acetabulum (hip bone articular surface for femur)
all 3 hip bones
structures at the acetabulum to support the joint (5)
- acetabular labrum (ring around the joint)
- lunate surface (cartilage forming valley in the labrum)
- acetabular fossa (hole in middle of valley formed by lunate surface)
- ligament of the head of the femur (attaching fossa of femur head (the fovea) to acetabular fossa)
- ligaments and joint capsule (around the labrum)
name of hole in femur head
fovea
characteristics of hip joint
- ball and socket joint
- multi-axial
- synovial
movements the hip can do
- flexion (lift leg in front) and extension (lift leg in back)
- ABDuction and ADDuction
- medial and lateral rotation
when is it that the hip flexion angle is 0 and that lateral balancing of the hip is due to ADDuction and ABDuction
- standing (angle of 0)
- sitting (angle of 90 flexion but you’re working on ABDuction and ADDuciton if moving leg to the side or medially)
- ABDuction and ADDuction is balancing, not rotating the leg*
when is it that hip flexion angle is 90 and that lateral and medial balancing of the hip is due to medial and lateral rotation
standing and lifting leg (hip) 90 degrees and rotating thigh ROTATING is turning the leg on its own axis not balancing it
3 ligaments supporting the hip joint
- iliofemoral lig. (ant lat, on top)
- pubofemoral lig. (ant med)
- ischiofemoral lig. (posterior)
2 weak spots of the hip joint ligaments
- in the front, between iliofemoral and pubofemoral lig.
- in the back between iliofemoral (bc is on top) and ischiofemoral lig. (in back)
clinical significance of 2 weak spots of hip joint ligaments
possible dislocation bc there, the joint can come apart
% of post vs ant hip dislocations
90% posterior (femur to back, not in acetabulum, and leg a bit shorter)
10% to front (leg bit longer)
posterior vs anterior hip dislocation characteristics
-post = hip flexed, ADDucted, medial rot
-ant = hip slightly flexed, ABDucted, lat rot
(think post leg goes back so want to put leg as close to the body axis as possible)
ligaments at the sacroiliac joint
- anterior sacroiliac ligaments in front
- posterior sacroiliac ligaments in the back
inguinal ligament from where to where
ASIS to pubic symphysis, running on ilium and pubis
ligament attaching from L5 vertebrae’s transverse processes to the ilium and associated muscle
iliolumbar ligament
-quadratus lomburum was attaching there
2 important ligaments linking the sacrum to the ischium
- sacrospinous ligament (sacrum to ischial spine)
- sacrotuberous (sacrum to ischial tuberosity)
important function of the sacrospinous and sacrotuberous ligaments
prevent upward tilting of the lower end of the sacrum (sacral spine) by anchoring it to the ischium
what are the greater and lesser sciatic foramens
on each side of the hip bone, holes formed by
- greater sciatic notch ant, ST lig. post and SS lig. inf (for greater sciatic foramen)
- lesser sciatic notch ant, ST lig post and SS lig sup
muscle crossing through greater sciatic foramen and almost filling it + O and I + function
piriforms m
- O: sacrum
- I: greater trochanter of femur
- fct: lat rot of the hip
trick for distinguishing lat and med rot of the hip
- medial = turn toes medially
- lateral = turn toes laterally
6 lateral rotators of the femur at the hip
sup to inf (order in which you find them)
- piriformis
- superior gemellus
- obturator internus
- inferior gemellus
- quadratus femoris
- obturator externus (inn. by obturator n.)
- are posterior except obturator externus*
gemellus superior O and I
ischial spine to greater trochanter
obturator internus O and I and trajectory
- O: bone around the obturator foramen in the back (so starts more medially than the gemellus muscles bc this foramen is more medial than ischial spine)
- passes through the lesser sciatic foramen (then turns into a tendon)
- I: greater trochanter of femur
gemellus inferior O and I
ischium (below ischial spine) to greater trochanter
quadratus femoris O and I
ischium (below gemellus inf) to intertrochanteric crest (in the back)
obturator externus O and I
O: bone around obturator foramen in the front (so outside the pelvis) to greater trochanter
muscles for ABDuction of the femur and name of the group
small gluteals
- gluteus minimus
- gluteus medius
gluteus minimus and medius O and I
posterior surface of the ilium to greater trochanter of the femur
note: gluteus minimus is under (more ant) medius in the back
gluteus minimus two functions
medial rotation of the femur
ABDuction of the femur
how small gluteals help when we walk (function)
- allow the body not to bend in the side opposite to the stance leg and the swing leg not to sag
- this would appear as moving the hip out on the lateral side (on side of the stance leg) bc swing leg sagging
name of test where you check if swing leg sagging and stance leg side has the hip lat rotated + body tilted on swing leg side
Trendelenburg’s test
gluteus maximus O, I and F
- O: ilium, sacrotuberous lig and posterior sacroiliac lig
- I: gluteal tuberosity (back of femur) and iliotibial tract (it kind of starts the IT tract/band)
what’s the fascia lata
deep fascia surrounding the whole thigh (muscle, bone, etc.)
what’s the iliotibial band or tract (+ O and I)
thickening of the fascia lata on the lateral side forming a band
- O: gluteus maximus
- I: lateral side of the tibia
tensor fascia lata O, I and F
- O: iliac crest and ASIS
- I: IT tract
- F: tense the fascia lata and helps the use of the gluteus maximus to stabilize the hip and knee
gait cycle def
once cycle of swing and stance by one limb (= taking 2 steps)
2 phases of the gait cycle and their start and end
- stance phase (60%). begins with heel strike. ends with push-off from the forefoot
- swing phase: begins after push off (with forefoot) and ends with the heel striking the groud
- while one limb is in the stance phase, the other limb is in the swing phase*
steps of the stance phase
- foot strike
- drop the foot and other foot takes off
- reversal of the fore-aft shear (pied déposé becomes the back foot as the other limb swings forward)
- opposite foot strike (other limb was swinging and does a foot strike to touch the ground forward) (as this limb takes off with a push from the forefoot)
steps of the swing phase
- take the forefoot off
- foot clearance (foot off ground, phase of swinging
- tibia vertical in front of your body (swinging forward but not completely)
- foot strike (heel to ground after swung forward)
functions of gluteus maximus, medius and minimus in the gait cycle
- gluteus maximus: stance phase foot ground opposite toe off step + reversal of fore-aft shear step. to push forward (hip extension)
- small gluteals (medius and minimus): stance phase: ABDuction to keep body straight and not let swinging leg sag
5 important nerves to lower limb (all come off the pelvis under the inguinal lig)
- obturator n (L2,3,4)
- femoral n (L2,3,4)
- superior gluteal n (dnm level)
- inferior glutela n (dnm level)
- sciatic n (L4 to S3)
obturator n does what muscles
- ADDuctors
- obturator externus
obturator n does what skin
skin of medial thigh between legs proximally
obturator n trajectory
comes out of pelvis via obturator foramen
femoral n covers what region
anterior thigh
superior gluteal n inn. what + location
- small gluteals (medius and minimus)
- tensor fascia lata
- above piriformis
inferior gluteal n inn. what + location
gluteus maximus
*below piriformis
sciatic n. location (comes off where)
under piriformis
other n than sciatic and inferior gluteal n coming off under piriformis
posterior cutaneous n of the ghigh (on side of scatic n.): goes to the skin
what nerves innervate the lateral rotators of the hip (5 of the 6, all except obturator externus)
sacral nerves (there are 5, one to each of these muscles (branches of lumbosacral plexus from L4 to S2) (to piriformus, gem sup, obt internus, gem inf, quadratus femoris)
blood supply to the gluteal region
- common iliac a gives internal iliac a
- internal iliac a gives superior and inferior gluteal a.
location of sup and inf gluteal a
above and below piriformis
so superior gluteal a with superior gluteal n. and inf glut a with inf glut n.
blood supply to the hip joint
- common iliac a. gives external iliac a.
- external iliac a. becomes the femoral a. after passes inguinal lig
- femoral a. gives lateral and medial femoral circumflex a. (ring around femur neck)
- femoral a. gives deep femoral a.
- internal iliac a. also gave obturator a.
- posterior branch of obturator a. gives foveal a
blood supply to head of femur
- medial circumflex femoral artery
- foveal a.
hip fracture means what, how many types + can be divided
- fractures of the femur (near the hip bone)
- 6 types
- can be divided in 3 above intertrochanteric line and 3 under it
6 hip fracture types
- subcapital neck fracture (right under the head)
- transcervical neck fracture
- intertrochanteric fracture
- subtrochanteric fracture
- fracture of the greater trochanter
- fracture of the lesser trochanter
worst hip fracture and why
transcervical neck fracture
- ring of blood vessels (medial and lateral circumflex femoral a) around the lower part of the neck stops supplying the femoral head
- left with only foveal a supply to head of femur (not enough)
- avascular necrosis of femoral head (which causes many problems)
consequence of avascular necrosis of femoral head
femoral head ischemia leads to:
- death of marrow
- death of osteocytes
- collapse of the necrotic segment
3 bursae in the hip + function
- trochanter bursa (reduce friction between IT band and greater trochanter)
- iliopsoas bursa (on iliopsoas m anteriorly)
- ischial bursa (on gluteal tuberosity in the back of the femur)
clinical relevance of the bursae in the hip
- can get infected, inflamed or irritated. = bursitis
- inflammation of the trochanteric bursa is called greater trochanteric pain syndrome (GTPS) or trochanteric bursitis
