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2b_Y1 - LEA-Exam 1 > Quiz 2- Lec 7-8 > Flashcards

Quiz 2- Lec 7-8 Flashcards

Joints and Ligaments of Pelvis

1
Q

lumbosacral junction: joint type

A

anteriorly: 2º cartilaginous joint “symphysis”
posteriorly: zygapophyseal joint

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2
Q

how is lumbosacral junction similar/different from other joints of the spine?

A

similar to other joints of the spine/vertebral column in terms of basic parts

UNIQUE in that the sacral base and the disc between L5/S1 are tilted forward off the horizontal by 30 degrees, (sacral inclination)

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3
Q

sacral inclination: what is is, how much, and M/F

A

angle between sacral base& disc from the horizontal;

usually about 30 degrees

Females (sacral inclination) > male

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4
Q

typical lumbosacral angle (value)

A

140 degrees

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5
Q

effects of increased lumbar LORDOSIS on the:

  1. sacral inclination and,
  2. lumbosacral angle
A

In increase in lumbar LORDOSIS, the

  1. sacral inclination: increases
  2. lumbosacral angle: decreases
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6
Q

movements and plantes at LUMBOSACRAL JOINT

(4 pairs)

A
  1. Flexion (lmtd)/extension - Sagittal plane
  2. Some side-bending - Coronal/frontal plane
  3. Some rotation - horizontal plane
    • *side-bending cannot occur w/o rotation (& vice versa) - called joint coupling
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7
Q

Why can flexion (lmtd)/extension at the LUMBOSACRAL joint occur in the Sagittal plane?

A

bc inferior articular facts of L5 are not oriented in sagittal plane –> rather, they are oriented in frontal/coronal plane

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8
Q

Why is there some side-bending at the LUMBOSACRAL joint in the Coronal/frontal plane?

A

due to facets being oriented in CORONAL plane –> so less flexion

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9
Q

sacroiliac joint: articulation and function

A

articulation between axial and appendicular skeleton

fxn: the upper body weight above the pelvis is transferred across the SI joint to the lower limbs

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10
Q

Sacroiliac joint: classification and movement

A

classification: plane synovial joint (articulation between auricular surfaces of sacrum & ilium) and syndesmosis (b/w sacral & iliac tuberosities)
*very little movement occurs here (atypical for synovial joints)

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11
Q

what are the adaptations that the Sacroiliac joint developed? what is the purpose?

A

Adaptations:

  • rough interlocking articular surfaces (sacral cartilage is hyaline; iliac cartilage is fibrous
  • interosseous ligaments (part of syndesmosis)
  • accessory ligaments

Purpose: to LIMIT MOVEMENT and FACILITATE WEIGHT TRANSFER

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12
Q

what is the movement at the sacroiliac (SI) joint?

A

small amount of rotation (1-8º); some mvmt of sacrum, more in females/pregnancy

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13
Q

CC: what can occur to the SI (sacroiliac joint) in old age?

A

subject to degenerative changes

can become completely fused in old age

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14
Q

CC: what is fusion of the sacroiliac joint called?

A

anklyosis: when bony growth has obliterated the separation between ilium and sacrum

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15
Q

how do the interlocking auricular surfaces of the sacrum & iliac assist in the function of the SI joint?

A
  • surfaces are virtually flat in infants –> become irregular (adulthood)
  • reciprocal surface feat. consist of transverse oriented ridges and furrows (covered in cartilage) –> contributes to stability & strength of the joint in transmitting weight from the spine to the lower limbs –> limiting movement
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16
Q

where is the syndesmosis (fibrous) part of SI joint?

where is the synovial plant part of the SI joint?

A
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17
Q

what aspec of the ILIUM can help determine the age of a pelvis?

A

the ridges and furrous of the AURICULAR surface of the ILIUM undergoes age-related changes

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18
Q

sacroiliac fibrous joint capsule: anterior composition

A

comprised of bands of capsular ligaments (thickenings of fibrous capsule)

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19
Q

ventral sacroiliac ligament: attachments

A

medial: at base and pelvic surfaces of sacral segments S1-S3
lateral: to medial edge of the iliac fossa (thick at arcuate line and preauricular sulcus)

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20
Q

interosseous sacroiliac ligament: attachments

A
  • medial: at sacral tuberosity
  • lateral: at iliac tuberosity
  • (may develop from dorsal part of fibrous capsule)
  • *STRONGEST LINK BETWEEN ILIUM AND SACROM; abundant fibers
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21
Q

extracapsular ligaments include SHORT and LONG DORSAL SACROILIAC LIGAMENTS:

location

A

posterior to interosseous sacroiliac ligament

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22
Q

SHORT dorsal sacroiliac ligament: attachments

A

nearly horizontal in direction (Seen in red)

  • sacral base and prox. 1/2 of intermediate sacral crest
  • iliac tuberosity
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23
Q

LONG dorsal sacroiliac ligament: attachments

A
  • oblique in direction;
  • it is attached by one extremity to the lateral sacral crest (S3/S4)
  • the other to the posterior superior spine of the ilium (PSIS).
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24
Q

list the ACCRSSORY ligaments of the SI joint

A
  1. Iliolumbar ligament
  2. Sacrotuberous
  3. Sacrospinous ligament
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25
Q

iliolumbar ligament:

type of ligament, attachments

A
  • accessory ligament of SI joint
  • series of bands from L4/L5 body & transverse process to
  • iliac crest, iliac tuberosity, upper surface of sacral ALA, and ventral sacroiliac ligament
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26
Q

sacrotuberous ligament:

type and attachments

A
  • accessory ligament of SI joint
  • from: medial edge of ischial tuberosity
  • to: PSIS adn PIIS (and between), lateral sacral crest (S3-S5) & coccyx

Remember:

  • PSIS: Posterior superior iliac spine*
  • PIIS: posterior inferior iliac spine*
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27
Q

sacrospinous ligament:

type and attachments

A

deep to sacrotuberous lig

  • from: ischial spine
  • to: lateral edge of S4/S5 and coccyx
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28
Q

function of sacrotuberous and sacrospinous ligaments?

A

to RESIST/LIMIT upward movement of sacral apex

29
Q

pubic symphysis: classification and movements

A
  • classification: 2º cartilaginous type of joint; symphysis w/ fibrocartinaginous interpubic disc; thin hyaline cartilage on symphyseal surfaces
  • movements: very little
30
Q

ligaments of pubic symphysis

A
  1. arcuate pubic lig
  2. superior pubic lig
  3. anterior pubic lig
  4. posterior lig

(no inferior pubic ligament)

31
Q

hip joint: between….and articulation

A
  • lower limb and pelvic girdle
  • involves articulation between acetabulum of the os coxae, & the head of the femur
32
Q

ID the following features:

(femur) head, neck, greater trochanter, lesser trochanter; and know acetabulum of os coxae

A
33
Q

hip joint: classification and complexity

A

classification: synovial / ball&socket (spheroid joint)

complexity: compound joint (3+ articular surfaces, by counting acetabulum as comprised of 3 bones and femoral head)

34
Q

motions of hip joint

A

Femur can move about 3 cardinal axes and in 3 different planes

35
Q

ABduction/ADduction @ hip joint: plane and axis

A
  • plane: coronal (frontal)
  • axis: anterior-posterior
36
Q

FLEXION/EXTENSION @ hip joint: plane and axis

A
  • plane: sagittal
  • axis: medial-lateral
37
Q

MEDIAL/LATERAL rotation @ hip joint: plane and axis

A
  • plane: transverse
  • axis: longitudinal (vertical/superoinferior)
38
Q

bony components of hip joint (features of acetabulum)

A
  1. lunate surface
  2. acetabular fossa
  3. acetabular notch
39
Q

hyaline cartilage in hip joint?

A

yes. the Hyaline cartilage over LUNATE is thickest anterosuperiorly (where weight transfer is greatest, and lunate is widest)

Hyaline cartilage also covers most of femoral head, except for fovea

40
Q

where is the hyaline cartilage in the lunate surface thickest?

A

anterosuperiorly (where lunate is thickest)

41
Q

what are the 3 special “intracapsular” structures of the hip joint?

A
  1. Ligament of head and femur
  2. Acetabular labrum (rim)
  3. TAL - transverse acetabular ligament
42
Q

what is the difference between the TAL (transverse acetabular ligament) and the acetabular labrum?

A

the TAL is part of the labrum, BUT IT LACKS CARTILAGE CELLS

(NO CARTILAGE CELLS IN TAL, BUT YES IN LABRUM)

43
Q

ligament of head of the femur: attachments

A

from fovea capitus (in head of femur)

to TAL and acetabular fossa

44
Q

joint capsule: characteristics

A
  • capsule is strong, dense, but loose
  • encloses the joint completely, and most of the femoral neck (except posterior 1/3)
45
Q

joint capsule attachments

A

distal: femur
anteriorly: greater trochanter, intertrochanteric line, tubercle of femur, femoral neck
posteriorly: covers the femoral neck 1 cm medial to the intertrochanteric crest (no real bony attachment here that allows retinacular branches of medial circumflex femoral artery to pass under)

46
Q

retinacula of hip joint capsule: description

A

deep fibers of capsule that are reflected onto femoral neck (along w/ reflection of synovium) and transmit blood vessels (from medial & lateral circumflex femoral arteries) to head and neck of femur

47
Q

clinical importance: retinacula of hip joint capsule

A
  • typical hip fx –> along the femoral neck –> disrupts the blood supply (tears) –> the femoral head and part of the neck can become necrotic
    • may still be able to get some blood supply to some of the humerus
    • If not –> can cause nonunion –> the options for tx include hip replacement
48
Q

what are the 3 capsular ligaments? which is strongest?

A

thickenings of the joint capsule

  1. ILIOFEMORAL is strongest
  2. ISCHIOfemoral
  3. PUBOfemoral
49
Q

iliofemoral

capsular ligament attachments

A

strongest capsular ligament

  • from iliac part of acetabular rim & AIIS
  • TO greater trochanter, intertrochanteric line & femoral tubercle
50
Q

ischiofemoral

capsular ligament attachments

A
  • from ischial part of acetabular rim
  • to superomedial aspect of greater trochanter and upper band of iliofemoral ligament (iliotrochanteric band)
51
Q

pubofemoral

capsular ligament attachements

A
  • from: pubic portion of acetabular rim, obturator crest, iliopubic eminence & obturator membrane
  • to: femur anterior to lesser trochanter, neck, and iliofemoral ligament
52
Q

which capsular ligament is also called “Y ligament of Bigelow”?

A

iliofemoral ligament

it is a weak area anteriorly that is strengthened by psoas major tendon

53
Q

how to the 3 capsular ligaments respond to:

  • flexion?
  • extension?
A

the ligaments….

  • SLACK in flexion
  • TENSE in extension; so the hip joint is most stable in EXTENSION
54
Q

hip joint is more stable in (FLEXION/EXTENSION)? why?

A

EXTENSION; because the 3 capsular ligaments are TENSE in extension, providng more stability and support

55
Q

what motions do the iliofemoral (3), ischiofemoral (3), and pubofemoral (2) ligaments resist?

A
56
Q

external iliac artery changes name as it passes inferior to inguinal ligament –> becomes known as what?

A

femoral artery

57
Q

at what point does the EXTERNAL ILIAC ARTERY become renamed as the femoral artery?

A

as it passes deep to the inguinal ligament

58
Q

what is the MOST important blood supply to the hip?

A

medial circumflex femoral artery

(branches off of deep femoral, close to origin)

provides oxygenated blood to the femoral neck and damage to the artery or involvement in pathological processes may result in decreased flow and avascular necrosis of the femoral head

59
Q

sources of blood to head and neck of femur?

A
  1. *MAJOR is medial circumflex femoral artery
  2. acetabular branch of obturator artery
60
Q

ID the joint structures on the hip

A
61
Q

what innervates the hip joint capsule and the ligaments?

A
  1. Femoral
  2. Obturator
  3. Nerve to quadratus femoris & superior gluteal nerves
62
Q

CC: what is a better way to describe hip fractures?

What occurs as a result?

A

they are most commonly femoral neck fractures (osteoporosis or osteoarthritis) –> branches of medial circumflex femoral artery are frequently torn –> can cause aseptic vascular necrosis of femoral head

63
Q

CC: what is the procedure to correct hip fx?

A

take away part of head of femur –> now using bone grafts

OR Hip replacement

64
Q

CC: Frog leg lateral projection

A

w/ pt supine, thigh is ABducted at 45º & externally rotated w/ knee flexed at 30-40º and foot placed against the contralateral knee –> allowing good view of hip joint and femoral neck

*IMPORTANT FOR ASSESSING SLIPPED CAPITAL FEMORAL EPIPHYSIS AND PERTHES DISEASE

65
Q

cc: Perthes disease

A

if head of the femur is eroding in childhood

  • rare childhood condition that affects the hip
  • occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, –> bone cells die (avascular necrosis)
66
Q

CC: Slipped capital femoral epiphysis

A
  • causes head of femur to displace posteriorly; can also be treated with braces
67
Q

CC: osteoarthritis/ remodeling of femoral head

A
  • the cartilage in the hip joint gradually wears away –> cartilage becomes frayed and rough, and the protective joint space between the bones decreases –> bone rubbing on bone –> bones may form bone spurs
  • occurs with aging, worsens over time
  • can cause joint pain and stiffness
68
Q

posterior hip dislocation:

occurs when? what is the position?

A

most often caused during a car accident

the hip is:

  1. flexed
  2. adducted
  3. medially rotated

2b_Y1 - LEA-Exam 1 (9 decks)

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