Pelvis/Hip/Thigh Flashcards
psoas major origin and insertion
O: T12-L5
I: Lesser trochanter
psoas major innervation
femoral nerve
psoas major action
flex hip
what muscle covers the lumbar plexus
psoas major
psoas minor origin and insertion
O: T12-L1
I: iliopubic eminence
innervation for psoas minor
L1 ventral ramus
psoas minor action
assist with hip flexion
iliacus origin and insertion
O: iliac fossa/sacral ala
I: lesser trochanter
iliacus innervation
femoral nerve
iliacus action
flex hip
name the pelvic hip flexors
psoas major
psoas minor
iliacus
tensor fasciae lata origin and insertion
O: iliac crest/ASIS
I: IT band, proximal tibial tuberosity
tensor fasciae lata innervation
superior gluteal
tensor fasciae lata action
abduct, flex, IR thigh
gluteus medius origin and insertion
O: ilium b/w anterior and posterior gluteal lines
I: greater trochanter (posterior)
gluteus medius innervation
superior gluteal
gluteus medius action
abduct and IR thigh
if _____ muscle is out, patient will have a trendelenburg gate
gluteus medius
gluteus minimus origin and insertion
O: ilium between anterior and inferior gluteal lines
I: greater trochanter (anterior)
gluteus minimus innervation
superior gluteal
gluteus minimus action
abduct and IR thigh
gluteus maximus origin and insertion
O: ilium, dorsal sacrum
I: ITB and gluteal tuberosity
gluteus maximus innervation
inferior gluteal
gluteus maximus action
extend and ER thigh
obturator externus origin and insertion
O: ischiopubic rami, obturator membrane
I: trochanteric/piriformis fossa
obturator externus innervation
obturator nerve
obturator externus action
ER thigh
pirformis origin and insertion
O: anterior sacrum
I: superior greater trochanter
pirformis innervation
nerve to piriformis
pirformis action
ER thigh
superior gemellus origin and insertion
O: ischial spine
I: medial greater trochanter
superior gemellus innervation
nerve to obturator internus
superior gemellus action
ER thigh
obturator internus origin and insertion
O: ischiopubic rami/obturator membrane
I: medial greater trochanter
obturator internus innervation
nerve to obturator internus
obturator internus action
ER and abduct thigh
inferior gemellus origin and insertion
O: ischial tuberosity
I: medial greater trochanter
inferior gemellus innervation
nerve to quadratus femoris
inferior gemellus action
ER thigh
quadratus femoris origin and insertion
O: ischial tuberosity
I: intertrochanteric crest
quadratus femoris innervation
nerve to quadratus femoris
quadratus femoris action
ER thigh
what muscle can be used as a landmark for the sciatic nerve
piriformis
what comprises the lumbar plexus?
L1-L4 ventral rami
what is the labrums function?
deeps socket
increases femoral head coverage
- along the acetabular rim except inferiorly
which ligament provides strong anterior support to the hip and resists extension
Iliofemoral ligament (Y ligament of Bigelow
small artery to femoral head is within which ligament?
ligamentum teres/ligament to head of femur/foveal ligament
what are the attachments for the iliofemoral ligament?
Superior: ASIS/Ilium to greater trochanter
Inferior: ilium to intertrochanteric line/lesser trochanter
which ligament prevents hyperextension of the hip and provides inferior joint support?
pubofemoral ligament
attachments for pubofemoral ligament
Anterior pubic ramus to intertrochantic line
broad, relatively weak ligament that provides minimal posterior hip support
ischiofemoral ligament
which part of hip is extracapsular (due to inadequate coverage from ischiofemoral ligament)?
lateral posterior neck
in femoral neck fracture or intertrochanteric fracture how will the leg be positioned?
shortened and ER
Trendelenburg gate?
lean laterally to WB side
what can Trendelenburg gate indicate?
gluteus medius weakness
what can Lurch gait indication?
gluteus maximus weakness
Lurch gate?
lean posterior (keeping hip extended)
numbness and dysesthesias in lateral thigh can indicate entrapment of which nerve?
lateral femoral cutaneous nerve
what does genitofemoral nerve (L1-L2) provided sensory to?
proximal anteriomedial thigh
what does obturator nerve (L2-L4) provide sensory to?
inferomedial thigh
what does lateral femoral cutaneous nerve (L2-L3) provide sensory to?
lateral thigh
what does femoral nerve provide sensory to?
anteromedial thigh
what does posterior femoral cutaneous n (S1-S3) provide sensory to?
posterior thigh
what nerve innervates muscles that do thigh/hip adduction?
obturator nerve (L2-L4)
what nerve innervates muscles that do thigh abduction?
superior gluteal (L5)
what nerve innervates muscles that do hip flexion/knee extension
femoral nerve (L2-L4)
what nerve innervates muscles that do hip extension
Inferior gluteal (L5-S2)
what nerve innervates muscles that do knee flexion
Sciatic
articularis genus origin and insertion?
O: distal anterior fermoral shaft
I: synovial capsule
articularis genus innervation
femoral
articularis genus action
pulls capsule superiorly in extension
sartorius origin and insertion
O: ASIS
I: proximal medial tibia (pes anserinus)
sartorius innervation
femoral nerve
sartorius action
flex, ER hip
vastus lateralis origin and insertion
O: greater trochanter, lateral linea aspera
I: lateral patella, tibia tubercle
vastus lateralis innervation
femoral
vastus lateralis action
extend leg
vastus intermedius origin and insertion
O: proximal femoral shaft
I: patella, tibia tubercle
vastus intermedius innervation
femoral nerve
vastus intermedius action
extend leg
vastus medialis origin and insertion
O: intertrochanteric line, medial linea aspera
I: medial patella, tibia tubercle
vastus medialis innervation
femoral
vastus medialis action
extend leg
rectus femoris origin and insertion
O: AIIS, superior acetabular rim
I: patella, tibia tubercle
rectus femoris innervation
femoral
rectus femoris action
flex thigh, extend leg
adductor longus origin and insertion
O: body of pubis (inferior)
I: linea aspera (mid 1/3)
adductor longus innervation
obturator
adductor longus action
adducts thigh
adductor brevis origin and insertion
O: body and inferior pubic ramus
I: pectineal line, linea aspera
adductor brevis innervation
obturator
adductor brevis action
adduct thigh
adductor magnus origin and insertion
O: 1. pubic ramus. 2. ischial tuberosity
I: linea aspera, adductor tubercle on medial condyle
adductor magnus innervation
- obturator
2. sciatic
adductor magnus action
adduct and flex/extend thigh
Gracilis origin and insertion
O: body and inferior pubic ramus
I: proximal medial tibia (pes anserinus)
Gracilis innervation
obturator
Gracilis action
adduct thigh
flex leg
IR leg
Pectineus origin and insertion
O: pectineal line of pubis
I: pectineal line of femur
Pectineus innervation
femoral n
Pectineus action
flex and adducts thigh
what hip adductor muscle can be used in ligament reconstruction
gracilis
what are the hamstring muscles?
semitendinosus
semimembranosus
biceps femoris - long head and short head
semitendinosus origin and insertion
O: ischial tuberosity
I: proximal medial tibia (pes anserinus)
semitendinosus innervation
sciatic n. (tibial)
semitendinosus action
extend thigh, flex leg
semimembranosus origin and insertion
O: ischial tuberosity
I: posterior medial tibial condyle
semimembranosus innervation
sciatic (tibial)
semimembranosus action
extend thigh, flex leg
biceps femoris long head origin and insertion
O: ischial tuberosity
I: fibular head
biceps femoris long head innervation
sciatic n (tibial)
biceps femoris long head action
extend thigh, flex leg
biceps femoris short head origin and insertion
O: linea aspera, supracondylar line
I: Fibula, lateral tibia
what landmark is used to measure the Q angle of the knee?
ASIS
what muscles insert on pes anserinus?
sartorius, gracilis, semitendinosus
how many vertebra make up the sacrum?
5 fused vertebra
how many vertebra make up the coccyx?
4 fused vertebra
Iliac crest is a common site for both tricortical and cancellous _______
bone graft harvest
where does snapping hip occur?
tendons (psoas/iliacus) can snap over the lesser trochanter
nerves/arteries/muscles that exit the greater sciatic foramen?
Piriformis muscle
POP’S IQ
- Pudendal n (and artery)
- (nerve to) Obturator internus
- Posterior cutaneous n of thigh
- Sciatic nerve
- Inferior gluteal nerve (and artery)
- nerve to (quadratus femoris)
Also superior gluteal nerve and artery
what muscle is a reference point for the greater sciatic foramen?
piriformis
where do most nerves exit the greater sciatic foramen relative to the piriformis?
inferiorly
Superior gluteal nerve and artery exit superior
Sciatic nerve may exit above or through
what muscle is the landmark for posterior column of the pelvis?
obturator internus – you will not see externus in posterior approach
what are the acetabular zones?
- Anterior superior
- Anterior inferior
- Posterior superior
- Posterior inferior
what are the 2 lines that define the acetabular zones?
- ASIS to center of acetabulum
2. perpendicular to line 1
what acetabular zone is considered the “safe zone” for putting screws?
Posterior superior
Posterior inferior is the secondary safe zone
in the anterior superior acetabular zone what structures do you need to be aware of?
external iliac artery and vein
in the anterior inferior zone acetabular zone what structures do you need to be aware of?
obturator nerve, artery, vein
in the posterior superior acetabular zone what structures do you need to be aware of?
sciatic nerve
superior gluteal nerve, artery, vein
in the posterior inferior acetabular zone what structures do you need to be aware of?
sciatic nerve
inferior gluteal artery, nerve, vein
internal pudendal nerve, artery, vein
types of joints
ball and socket saddle hinge condyloid pivot gliding.
body weight is transmitted through which joint
sacroiliac
which ligament is strongest in the pelvis and is key to vertical stability
posterior sacroiliac
what ventral rami comprise the lumbosacral plexus?
L4-S3(S4)
where does the lumbosacral plexus lie?
anterior piriformis muscle
blood supply to head/neck of femur
primarily the medial femoral circumflex artery (branch from profunda femoris)
(also lateral FCA and ligamentum teres artery)
blood supply to shaft of femur
nutrient artery from profunda femoral artery
which axis? - line drawn along the axis of the femur
anatomic
which axis? - line drawn between center of femoral head and intercondylar notch
mechanical
primary blood supply to the thigh
profunda femoris (branch from femoral artery)
what would be seen on Xray if there is loosening of total hip arthoplasty?
radiolucent lines most often caused by osteolysis
which muscle is the medial femoral circumflex artery located under?
quadratus femoris
which vessels are located under the transverse acetabular ligament and may be injured by retractors/anterior inferior quad screws in total hip arthoplasty?
obturator vessels
what is done if there is a periprosthetic fx?
Stable implant: ORIF
Unstable: replace w/ longer stem the passes fx site
for total hip what structures are in danger of injury with the anterolateral approach?
descending branch of LFCA and femoral nerve (due to vigorous medial retraction)
