Mod 3: Lecture 2 - Gluteal Region and Hip Joint Flashcards
1
Q
Pelvic Bone/ Innominant Bone
A
- Fusion of three bones
- — ilium
- — ischium
- — pubis
- — fusion occurs between 15-17 years of age
- Acetabulum
- — where the 3 bones unite
- — the circle at the bottom of the pelvis
- — location of femoral head articulation
2
Q
Ilium
A
- big round flat top part
- Iliac Crest: top curve of the bone
- — at the L4 vertebral level
- ASIS: anterior superior iliac spine
- — the front end of the iliac curve
- AIIS: anterior inferior iliac spine
- —- below the iliac curve, the bump after the inward curve
- PSIS: posterior superior iliac spine
3
Q
Ischium
A
- bottom and back of the inferior circle
- Ischial Tuberosity: a bump at the posterior inferior part
- — supports you when you sit
- Ischial Spine: a pointy projection at the back of the pelvis
- Ramus of Ischium: extends from the ischial tuberosity to inferior pubic ramus
- — contributes to the ischiopubic ramus
4
Q
Pubis
A
- top and center of the inferior circle
- Infer Pubic Ramus: contributes to the ischiopubic ramus
- Super Pubic Ramus: the top part of the inferior circle
- Pubic Tubercle: a little jutting out right before the pubic symphysis
5
Q
Pelvis/ Pelvic Girdle
A
- formed by two pelvic bones and the sacrum
- — each pelvic bone consists of three fused bones
- — the sacrum is five fused bones
- False Pelvis/ Pelvis Major: contains abdominal viscera
- — the space between the ilium
- True Pelvis/ Pelvis Minor: contains pelvic viscera
- — the stuff in the giant circle below the ilium
- Pelvic Brim: separates true from false pelvis
6
Q
Joints within the Pelvis
A
- Pubic Symphysis: syndesmosis
- — a cartilaginous disc between the right and left pubis
- —- anterior
- Sacroiliac (SI) Joint: synovial joint
- — between the sacrum and the ilium
- — posterior
7
Q
Obturator Foramen
A
- formed by the ischium and pubis
- — inferior circle
- — directly below the acetabulum
- nearly closed by the obturator membrane
8
Q
Greater Sciatic Notch
A
- superior to ischial spine
- — curved indent in the ilium, right above the ischium
- — seen in a lateral view
- converted to a foramen by the sacrospinous ligament
9
Q
Lesser Sciatic Notch
A
- inferior to the ischial spine
- — curved indent in the ischium
- — seen in a lateral view
- converted to a foramen by the sacrospinous and sacrotuberous ligaments
10
Q
Ligament Attachments
- Sacrospinous
- Sacrotuberous
A
- sacrum and coccyx to ischial spine
2. PSIS and sacrum to ischial spine
11
Q
Greater Sciatic Foramen
A
- further divided by piriformis muscle
- Above piriformis: superior gluteal nerves
- Below piriformis:
- — inferior gluteal nerves
- — sciatic and pudendal nerves
- — cutaneous nerves
- — nerves to lateral rotators
12
Q
Lesser Sciatic Foramen
A
- tendon of obturator internus
- pudendal nerves to perineum
13
Q
Obturator Canal
A
- obturator nerve and vessels
14
Q
Proximal Femur
A
- Femoral Head: fits deep within the acetabulum
- Femoral Neck: frequent site of fractures
- Greater and Lesser Trochanter: both are the site of multiple muscle attachments
- Intertrochanteric Line: located anteriorly between the greater and lesser trochanters, the site of ligaments support the hip joint (iliofemoral)
15
Q
Proximal/Body of the Femur
A
- Linea Aspera: vertical ridge of bone which serves as an area for multiple muscle attachments
- Gluteal Tuberosity: ridge of bone between greater trochanter and linea aspera
- — bumps out more than the linea aspera
- Pectineal Line (posterior): ridge of bone between the lesser trochanter and linea aspera
- — kind of diagonal
16
Q
Distal Femur
A
- Linea Aspera: vertical ridge of bone which serves as an area for multiple muscle attachments
- Medial and Lateral Supracondylar Ridge: posterior, extend down from the aspera to the medial and lateral condyles
- Adductor Tubercle: site of muscle attachment
- — found above the medial condyle
17
Q
Hip Joint
A
- formed by the acetabulum of the pelvic bone and head of the femur
- ball and socket joint
18
Q
Acetabulum (bony)
A
- formed by ilium, pubis, and ischium right above the obturator foramen
- bony cup does not extend inferiorly
- — this area is closed by the transverse acetabular ligament (which is important for stability)
- — this is where the acetabulum runs into the obturator foramen
19
Q
Acetabular Labrum
A
- fibrocartilagenous structure
- attaches to bony rim of acetabulum
- — continuous with the transverse acetabular ligament
- deepens the acetabulum and contributes to joint stability
- Lunate Surface: acetabular hyaline cartilage on the ridge of the labrum
- — horseshoe shaped, does not cover the ligament
- — fat is located centrally
20
Q
Movements of the Femur
A
- Flexion/Extension
- Abduction/Adduction
- Medial/Lateral Rotation
21
Q
Pelvic Motion
A
- Anterior and Posterior Tilt
- — sagittal plane around coronal axis
- — anterior: hip flexion, pubic symphysis forward, ilium back
- — posterior: hip extension, pubic symphysis back, ilium forward
- Lateral Tilt
- — frontal plane around sagittal axis
- — produces hip abduction: ilium tilts down
- — produces hip adduction: ilium tilts up
22
Q
Ligaments of the Hip
A
- Anterior and Posterior Sacroiliac Ligament
- Iliofemoral
- Pubofemoral
- Ischiofemoral
23
Q
Anterior and Posterior Sacroiliac Ligament
A
- support sacroiliac joint
- — in between the ilium and sacrum
- synovial plane
- one in the front (anterior) and one in the back (posterior) per side
- — so there is a left set and a right set
24
Q
- Iliofemoral Ligament
- Pubofemoral Ligament
- Ischiofemoral Ligament
A
1, 2, 3. - connect the femur to the pelvis
- wrap around the femur head and the hip by the acetabulum
- reinforce and stabilize the hip joint
- fibers are oriented in a spiral and are taut in extension
1. anterior - seen from the front
2. anteroinferior - same spot as 1, just lower, also seen from the front
3. posterior - seen from the back
25
Q
A. Iliacus Muscle B. Psoas Major 1. Attachments 2. Action 3. Innervation
A
A ,B. - posterior abdominal wall - paired - often referred to as the iliopsoas 1 A. - top of ilium, - proximal femur 1 B. - lumbar spine, - proximal femur 2 A, B. - together, they are the strongest flexors in the hip 3 A, B. femoral nerve
26
Q
A. Psoas Minor B. Quadratus Lumborum 1. Attachments 2. Action 3. Innervation
A
A, B. - posterior abdominal wall - paired - does not cross the hip joint 1 A. - lumbar spine, - ilium 1 B. - lower rib, - ilium 2. 3 A, B. ventral rami of upper lumbar levels
27
Q
Gluteal Muscles
A
- Gluteus Maximus
- Gluteus Medius
- Gluteus Minimus
- Tensor Fascia Latae
28
Q
Gluteus Maximus
- Attachments
- Action
- Innervation
A
- superficial
1. - butt cheek
2.
3. inferior gluteal nerve
29
Q
A. Gluteus Medius B. Gluteus Minimus 1. Attachments 2. Action 3. Innervation
A
A. deep
B. deepest, directly under A
1 A, B. superior and lateral diagonal of butt cheek
2 A, B. when walking, constriction on stance side of the hip prevents excessive pelvic tilt during swing phase of the leg on the opposite side of the hip
3 A, B. superior gluteal nerve
30
Q
Tensor Fascia Latae
- Attachments
- Action
- Innervation
A
- small muscle in the gluteal region
1. - the connective tissue on the lateral side of the thigh
2.
3.
31
Q
Hip Lateral Rotators
- Attachments
- Action
- Innervation
A
- From superior to inferior:
- —- Priformis - Gemellus Superior - Obturator Internus - Gemellus Inferior - Obturator Externus - Quadratus Femoris
1. - anterior sacrum, ischium - greater trochanter of femur
2. lateral rotation of hip
3. sacral plexus
32
Q
Nerves to the Lower Extremity from the Lumbar Plexus
A
- Femoral Nerve
- — Saphenous Nerve
- Obturator Nerve
- Lumbosacral Trunk
33
Q
Femoral Nerve
A
- emerges from the lateral border of the psoas major
- —- innervates the iliacus
- passes deep to the inguinal ligament/iliopubic tract to the anterior thigh
- — supplies the flexors of the hip and extensors of the knee
34
Q
Saphenous Nerve
A
- branches from the femoral nerve
- supplies the skin on the medial side of the ankle and foot
35
Q
Obturator Nerve
A
- emerges from the medial border of the psoas major and passes into the pelvis
- — passes through the obturator foramen, inferior to the superior pubic ramus
- goes to the medial thigh
- — supplies the adductor muscles
36
Q
Lumbosacral Trunk
A
- associated with the sacral plexus
- formed by the ventral rami of L4 and L5
- participates in the formation of the sacral plexus with the anterior rami of the S1-S4 nerves
37
Q
Nerves to the Lower Extremity from the sacral plexus
A
- Sciatic Nerve
- —- Tibial Nerve
- — Common Fibular (Common Peroneal) Nerves
- Posterior Cutaneous Nerve of the Thigh
- Superior and Inferior Gluteal Nerves
- Nerve to the Quadratus Femoris
- Nerve to the Obturator Internus
38
Q
Sciatic Nerve
A
- largest nerve in the body
- gives rise to the Tibial nerve and the common fibular nerves
39
Q
Tibial Nerve
A
- innervates all but one muscle of the posterior compartment of the thigh
- — not the short head of the biceps femoris
- innervates all muscles of the posterior compartment of the lower leg
- — deep and superficial
- the sural nerve arises from the tibial nerve
40
Q
Sural Nerve
A
- arises from the tibial nerve
- — though sometimes with a contribution from the common peroneal (common fibular) nerve
- supplies the skin on the posterior and lateral aspects of the leg
41
Q
Common Fibular (Common Peroneal) Nerve
A
- innervates only the short head of the biceps femoris muscle in the thigh
- divides into the superficial and deep fibular nerves around the head of the fibula
- — superficial: muscles in the lateral leg compartment
- —- deep: muscles in the anterior leg compartment
42
Q
Clinical Correlation: Total Hip Replacement (THR)
A
- Indications: done for arthritis or a fractured femur
- Surgical Approach: the head of the femur is replaced with a prosthetic and a disk is put around the acetabulum
- Post-Op Precautions
- — don’t move the hip into extreme positions, such as extreme hip flexion or abduction
- — OTs work with the patients to prevent dislocation of the new hip prosthesis
- — OTs give adaptive equipment to prevent hip movements
43
Q
Adaptive Equipment for a Total Hip Replacement
A
- Reacher
- Long Handled Shoehorn
- Dressing Stick
- Sock-Aid
- Long Handled Sponge
- Elastic Shoelaces
- help with dressing and washing of the lower extremity without excessive movement
