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MSK Mine > S3) The Hip > Flashcards

S3) The Hip Flashcards

1
Q

Identify the superficial gluteal muscles (4)

A
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia lata
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2
Q

Describe the structure, action and innervation of the gluteus maximus muscle

A
  • Structure: largest & most superficial of the gluteal muscles
  • Function: The main muscles involved in hip extension, assists with lateral rotation, only used when force is required, such as running or climbing.)
  • Innervation: inferior gluteal nerve
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3
Q

State the origin and attachment of the gluteus maximus muscle

A
  • Origin: gluteal (Posterior) surface of the ilium, sacrum and coccyx
  • Attachment: iliotibial tract and the gluteal tuberosity of femur
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4
Q

Identify the gluteus Maximus in this image

A

Structure A (it its reflected backwards)

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5
Q

Describe the structure, action and innervation of the gluteus medius muscle

A
  • Structure: fan-shaped, lies between the gluteus maximus and minimus

- Action: abduction and medial rotation of the lower limb and secures the pelvis in a horizontal alignment, preventing a downward tilt towards the unsupported limb

- Innervation: superior gluteal nerve

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6
Q

State the origin and attachment of the gluteus medius muscle

A
  • Origin: gluteal surface of the ilium
  • Attachment: lateral surface of the greater trochanter
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7
Q

Identify the gluteus medius in this image

A

Structure B(1)

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8
Q

Describe the structure, function and innervation of the gluteus minimus muscle

A
  • Structure: deepest and smallest of the superficial gluteal muscles
  • Function: abduction and medial rotation of the lower limb and secures the pelvis in a horizontal alignment, preventing a downward tilt towards the unsupported limb
  • Innervation: superior gluteal nerve
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9
Q

State the origin and attachment of the gluteus minimus muscle

A
  • Origin: Originates to form the ilium and converges to form a tendon, inserting to the…
  • Attachment: anterior side of the greater trochanter
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10
Q

Identify the gluteus minimius in this image

A

Structure B(1) - It sits deep to the gluteus medius, so it is not visible in this dissection

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11
Q

What do the gluteus medius and minimus have in common?

A
  • The same:
  • Nerve innervation
  • Blood supply
  • Action
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12
Q
  1. What do the inferior and superior gluteal neuromuscular bundles consist of?
  2. Label them in this image: (see actual structures in DR session)
A

Superior gluteal artery, vein and nerve

Inferior gluteal artery, vein and nerve

  • j in image = superior gluteal neuromuscular bundle
  • i in image = inferior gluteal neuromuscular bundle
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13
Q

What is the tensor fascia lata?

A

The tensor fascia lata is a small superficial gluteal muscle that lies towards the anterior edge of the iliac crest. involved in hip flexion, abduction, internal rotation

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14
Q

State the origin and attachment of the tensor fascia lata?

A
  • Origin: iliac crest (descends down superolateral thigh)
  • Attachment: anterior aspect of ITT
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15
Q

Describe the arterial supply of the hip joint

A

Arterial supply via the medial and lateral circumflex femoral arteries which are branches of the profunda femoris artery

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16
Q

Describe the structure, function and innervation of the tensor fascia lata muscle

A
  • Structure: small superficial muscle, lies towards anterior edge of the iliac crest

- Function: abduction, medial rotation (tightens fascia lata)

- Innervation: superior gluteal nerve

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17
Q

Describe the articulating surfaces of the hip joint

A
  • Head of femur articulates with the acetabulum of the pelvis
  • Acetabular labrum is a fibrocartilaginous collar which deepens the concavity
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18
Q

The fascia lata is also continuous with regions of deep and superficial fascia at its superior aspect.

Explain this.

A
  • The deep iliac fascia from the thoracic region covers the iliopsoas and blends with the fascia lata superiorly
  • Superficial fascia from the inferior abdominal wall and perineal region both blend with the fascia lata just below the inguinal ligament
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19
Q

What is the hip joint?

A

The hip joint is a ball and socket synovial joint which connects the lower limb to the pelvic girdle

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20
Q

State the origin and attachment of the tensor fascia lata muscle

A
  • Origin: anterior iliac crest & ASIS
  • Attachment: ITT (lateral condyle of tibia indirectly)
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21
Q

What is the clinical significance of the medial circumflex artery?

A
  • Medial circumflex femoral artery is responsible for the majority of the arterial supply (lateral artery has to penetrate through the thick iliofemoral ligament)
  • Damage to the medial circumflex femoral artery can result in avascular necrosis of the femoral head
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22
Q

Describe the innervation of the hip joint

A

The hip joint is innervated by the femoral nerve, obturator nerve, superior gluteal nerve, and nerve to quadratus femoris

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23
Q

The only intracapsular ligament of the hip is the ligament of the head of the femur.

Describe its structure, function and anatomical location

A
  • Structure: relatively small ligament
  • Function: increases stability, encloses a branch of the obturator artery (artery to head of femur)
  • Location: runs from the acetabular fossa to the fovea of the femur
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24
Q

Identify the 3 extracapsular ligaments of the hip joint

A
  • Iliofemoral ligament
  • Pubofemoral ligament
  • Ischiofemoral ligament
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25
Q

Describe the structure, function and location of the iliofemoral ligament

A
  • Structure: ‘Y’ shaped appearance
  • Function: prevents hyperextension of the hip joint
  • Location: spans between the anterior inferior iliac spine and the intertrochanteric line of the femur
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26
Q

Describe the structure, function and location of the pubofemoral ligament

A
  • Structure: triangular shape
  • Function: prevents excessive abduction and extension
  • Location: spans between the superior pubic rami and the intertrochanteric line of the femur
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27
Q

Describe the structure, function and anatomical location of the ischiofemoral ligament

A
  • Structure: spiral orientation
  • Function: prevents excessive extension
  • Location: spans between the body of the ischium and the greater trochanter of the femur
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28
Q

Identify and describe the factors that stabilise the hip joint

A
  • Acetabulum – encompasses nearly all of the femoral head (decreases chance of dislocation)
  • Acetabular labrum – increases depth provides a larger articular surface
  • Intracapsular & extracapsular ligaments
  • Joint capsule
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29
Q

Explain how the muscles and ligaments work in a reciprocal fashion at the hip joint

A
  • Anteriorly, where the ligaments are strongest, the medial flexors are fewer and weaker

- Posteriorly, where the ligaments are weakest, the medial rotators are greater in number and stronger

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30
Q

Identify the possible movements at the hip joint as well as the muscles involved

A

- Flexion: iliopsoas, rectus femoris, sartorius

- Extension: gluteus maximus, semimembranosus, semitendinosus, biceps femoris

- Abduction: gluteus medius, gluteus minimus and deep gluteals

- Adduction: adductors longus, brevis & magnus, pectineus, gracillis

- Lateral rotation: biceps femoris, gluteus maximus, deep gluteals

- Medial rotation: gluteus medius & minimus, semitendinosus, semimembranosus

31
Q

Identify and describe the three articulations of the hip bone

A
  • Sacroiliac joint – articulation with sacrum
  • Pubic symphysis – articulation with the corresponding hip bone
  • Hip joint – articulation with the head of femur
32
Q

Which three parts compose the hip bone?

A
33
Q

How do the bones composing the hip joint vary before and after puberty?

A
  • Prior to puberty, the triradiate cartilage separates these constituents
  • After age 15-17 the three parts begin to fuse (forms acetabulum)
34
Q

The superior part of the hip bone is formed by the ilium, the widest and largest of the three parts.

Describe its structure

A
  • Body: forms the superior part of the acetabulum
  • Wing: expansion above the acetabulum
  • Iliac fossa: concave inner surface
  • Gluteal surface: convex external surface
  • Iliac crest: thickened superior margin (extends from ASIS to PSIS)
35
Q

Which muscles attach to the ilium?

A
  • Gluteal muscles attach to the gluteal surface of the Ilium (at anterior, posterior and inferior gluteal lines)
  • Iliacus muscle attaches medially at the iliac fossa
36
Q

Why is the anterior superior iliac spine clinically relevant?

A

The ASIS serves as the attachment site of the inguinal ligament, which runs from the ASIS to the pubic tubercle

37
Q

The most anterior portion of the hip bone is formed by the pubis

Describe its structure

A
  • Body – located medially & articulates with opposite pubic body at the pubic symphysis
  • Superior ramus – extends laterally from the body, forming part of the acetabulum (encloses the obturator foramen)
  • Inferior ramus – projects towards and joins the ischium (encloses the obturator foramen)
38
Q

The posterioinferior part of the hip bone is formed by the ischium.

Describe its structure

A
  • Inferior ischial ramus – combines with inferior pubic ramus to form the ischiopubic ramus (encloses part of obturator foramen)
  • Ischial tuberosities – found on posterorinferior aspect of the ischium (carries body weight when sitting)
  • Greater sciatic notch – found on the posterior aspect of the ischium
39
Q

Which ligaments attach to the ischium and what do they do?

A
  • Sacrospinous ligament which runs from the ischial spine to the sacrum, forming the greater sciatic foramen
  • Sacrotuberous ligament which runs from the sacrum to the ischial tuberosity, forming the lesser sciatic foramen
40
Q

What is fascia?

A

Fascia is defined as a sheet or band of fibrous tissue lying deep to the skin that lines, invests and separates structures within the body

41
Q

The fascia lata is a deep fascial investment of the whole thigh musculature.

Describe its structure and location

A
  • Structure: strong, extensible and elasticated
  • Location: begins around the iliac crest and inguinal ligament, ends at the bony prominences of the tibia (becomes crural fascia)
42
Q

Identify and describe the 3 types of fascia

A
  • Superficial fascia: blends with the reticular layer beneath the dermis
  • Deep fascia: envelopes muscles, bones and neurovascular structures
  • Visceral fascia: provides membranous investments that suspend organs within their cavities
43
Q

The width of the fascia lata varies considerably at different regions of the thigh.

Where is it thinnest and where is it thickest?

A
  • Thickest: superolateral aspect of the thigh
  • Thinnest: adductor muscles of the medial thigh
44
Q

Describe the divisions of the fascia lata in the leg

A
  • The deepest aspect of fascia lata gives rise to three intermuscular septa that attach centrally to the femur
  • This divides the thigh musculature into three compartments: anterior, medial lateral
45
Q

Which of the intermuscular septa is strongest?

A

The lateral intermuscular septum is the strongest of the three due to reinforcement from the iliotibial tract

46
Q

What is the saphenous opening and what does it do?

A
  • The saphenous opening is an ovoid hiatus which is found in the fascia lata inferior to the inguinal ligament
  • It is an entry point for efferent lymphatic vessels and the great saphenous vein, draining into superficial inguinal lymph nodes and the femoral vein respectively
47
Q

Describe the structure and location of the Iliotibial Tract (ITT)

A
  • Structure: a longitudinal thickening of fascia lata, strengthened posteriorly by fibres from the gluteus maximus
  • Location: lies laterally in the thigh, extending from the iliac tubercle to the lateral tibial condyle
48
Q

Describe the three functions of the Iliotibial Tract (ITT)

A
  • Acts as an extensor, abductor and lateral rotator of the hip
  • ITT extends centrally to form the lateral intermuscular septum
  • Forms a muscular sheath for the tensor fascia lata
49
Q

When stimulated, the tensor fasciae lata tightens the iliotibial band and braces the knee.

Why is this clinically important?

A
  • When the fascia lata is pulled taut, it forces muscle groups closer together within their intermuscular septa towards the femur
  • This centralises muscle weight and limits outward expansion, which reduces the overall force required for movement at the hip joint
50
Q

What effect does tensing the fascia lata have on veins?

A
  • Makes muscle contraction more efficient in compressing deep veins
  • Ensures adequate venous return to the heart from the lower limbs
51
Q

What are the superior attachments of the fascia lata?

A

- Posterior: sacrum, coccyx

  • Lateral: iliac crest
  • Anterior: inguinal ligament, superior pubic rami
  • Medial: inferior ischiopubic rami, ischial tuberosity, sacrotuberous ligament
52
Q

Describe the inferior attachments of the fascia lata

A

The fascia lata atttaches at bony prominences around the knee joint (femoral & tibial condyles, patella, head of fibula, tibial tuberosity) then becomes the deep fascia of the leg (crural fascia)

53
Q

Describe the lateral attachments of the fascia lata

A

The lateral thickening of fascia lata forms the iliotibial tract which descends the lateral thigh and attaches to the lateral tibial condyle

54
Q

Describe the central attachments of the fascia lata

A

The deep aspect of fascia lata produces three intermuscular septa which attach centrally to the femur

55
Q

Identify the deep gluteal muscles

A
  • Piriformis
  • Obturator internus
  • Superior & inferior gemelli
  • Quadrator femoris
56
Q

Describe the structure, function and innervation of the piriformis muscle

A
  • Structure: most superior of the deep muscles
  • Function: lateral rotation, abduction
  • Innervation: nerve to piriformis
57
Q

State the origin and attachment of the piriformis muscle

A
  • Origin: anterior surface of the sacrum (travels through greater sciatic foramen)
  • Attachment: greater trochanter of the femur
58
Q

Describe the structure, function and innervation of the obturator internus muscle

A
  • Structure: forms the lateral walls of the pelvic cavity
  • Function: lateral rotation, abduction
  • Innervation: nerve to obturator internus
59
Q

State the origin and attachment of the obturator internus muscle

A
  • Origin: pubis and ischium at the obturator foramen (travels through lesser sciatic foramen)
  • Attachment: greater trochanter of the femur
60
Q

Describe the structure, function and innervation of the gemelli muscles

A
  • Structure: superior and inferior gemelli are two narrow triangular muscles, separated by the obturator internus tendon
  • Function: lateral rotation, abduction
  • Innervation: superior – nerve to obturator internus, inferior – nerve to quadratus femoris
61
Q

State the origin and attachment of the gemelli muscles

A
  • Origin: superior – ischial spine, inferior – ischial tuberosity
  • Attachment: greater trochanter of the femur
62
Q

Describe the structure, function and innervation of the quadrator femoris muscle

A
  • Structure: flat, square-shaped muscle, most inferior of the deep gluteal muscles

- Function: lateral rotation

- Innervation: nerve to quadratus femoris

63
Q

Describe the arterial supply of the gluteal region

A

Arterial supply via superior and inferior gluteal arteries (arise from internal iliac artery) which enter the gluteal region via the greater sciatic foramen

64
Q

Describe the venous drainage of the gluteal region

A

Venous drainage via inferior and superior gluteal veins (empty into the internal iliac vein)

65
Q

State the origin and attachment of the quadrator femoris muscle

A
  • Origin: lateral side of the ischial tuberosity
  • Attachment: quadrate tuberosity on the intertrochanteric crest
66
Q

What is osteoarthritis?

A
  • Osteoarthritis is a non-inflammatory chronic disease of the synovial joints in the musculoskeletal system (no systemic involvement)
  • No joint ankylosis is observed in the course of the disease
67
Q

Compare and contrast the aetiology of primary and secondary osteoarthritis

A
  • Primary OA: aetiology is unknown
  • Secondary OA: trauma, infection (septic arthritis), inflammation (RA), metabolic (gout), endocrine (DM)
68
Q

Describe how articular cartilage changes in osteoarthritis

A
  • Increased tissue swelling
  • Cartilage fibrillation
  • Cartilage erosion down to subchondral bone
69
Q

What are the risk factors for arthritis?

A
  • Obesity
  • Past injury in a joint
  • Occupational factors
  • Genetics
  • Age
70
Q

What are the signs and symptoms of arthritis?

A
  • Joint pain
  • Crepitis (grinding)
  • Joint deformity
  • Osteophytes
  • Joint stiffness
71
Q

Outline the investigation of osteoarthritis in terms of bloods, imaging and radiological findings.

A

- Bloods – FBC, U&Es , LFTs, CRP

- Imaging – look for subchondrial sclerosis, osteophytes, narrowing of joint space, subchondrial cysts

72
Q

What is a pelvic bone fracture?

A
  • Pelvic bone fractures are fractures which result from direct trauma to the pelvic bones or indirectly through forces transmitted from the lower limb
  • Fractures often occur at the weaker points of the bones (pubic rami, acetabulum, region of sacroiliac joint)
73
Q

A common complication of pelvic fractures is soft tissue injury.

Which structures are at high risk?

A
  • Bladder
  • Urethra

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