SACRUM / PELVIS / HIP Flashcards
OS COXAE (bones)
-ilium
-ischium
-pubis
Triradiate Cartilage
“Y” shaped epiphyseal plate that forms acetabulum at junction of ischium, ilium, pubis
-fuses at 12-13yrs (female), 14-15yrs (male)
what bones make up the greater sciatic notch?
ilium & ischium
what divides the greater & lesser sciatic notch?
ischial spine
sit bones
ischial tuberosity
what forms the iliopectineal line?
arcuate line of ilium & pectineal line of pubic bone
6 types of joints
-L5-S1 facet joint
-L5-S1 intervertebral joint
-sacroiliac joint
-sacrococcygeal joint
-pubic symphysis
-acetabulofemoral (hip) joint
L5-S1 FACET JOINT
-type: synovial, plane, diarthrosis, uniaxial
-articular surfaces: inferior condylar facet of L5 vertebrae, superior condylar facet of sacrum
-ligaments: articular capsule, supraspinous, interspinous, ligamentum flavum, intertransverse, iliolumbar
-movements: gliding, flexion & extension, some lateral flexion with rotation
L5-S1 INTERVERTEBRAL JOINTS (lumbosacral joint)
-type: cartilaginous, symphysis, amphiarthrosis, triaxial
-articular surfaces: inferior body of superior vertebra, superior body of inferior vertebra, IVD
-ligaments: ALL, PLL, iliolumbar ligament
-movements: flexion, extension, lateral flexion & some rotation
SACROILIAC JOINTS
-type: synovial, plane (also fibrous, syndesmosis), diarthrosis, amphiarthrosis
-articular surfaces: C-shaped auricular surface, concave sacral surface (covered in hyaline cartilage) on sacrum
-articular surfaces: C-shaped auricular surface, convex ilial surface (covered in fibrocartilage) on ilium
-ligaments: joint capsule, iliolumbar, anterior sacroiliac, interosseous, posterior; long & short sacroiliac, sacrotuberous, sacrospinous
-movements: gliding (slight), nutation & counternutation
SACROCOCCYGEAL JOINT
-type: cartilaginous, symphysis, amphiarthrosis, uniaxial
-articular surfaces: inferior surface of apex of sacrum
-articular surfaces: superior surface of base of coccyx
-ligaments: has fibrocartilaginous disc, sacrococcygeal ligaments (anterior, lateral, superficial & deep posterior), intercornual
-movements: small amount of flexion & extension, especially during defecation & childbirth
PUBIC JOINT / INTERPUBIC/ PUBIC SYMPHYSIS
-type: cartilaginous, symphysis, amphiarthrosis, uniaxial
-articular surfaces: symphyseal surfaces covered by hyaline of two pubic bones with a fibrocartilaginous disc in between
-ligaments: superior pubic ligaments, inferior (arcuate) pubic ligament
-movements: gliding, very little motion
ACETABULOFEMORAL JOINT (hip joint)
-type: synovial, ball & socket (spheroid), diarthrosis, triaxial
-articular surfaces: head of femur with lunate surface of acetabulum on labrum
-ligaments: fibrous capsule, labrum, zona orbicularis, ligamentum capitis femoris (ligamentum teres), transverse acetabular, iliofemoral, pubofemoral, ischiofemoral
-movements: flexion, extension, ADD, ABD, medial/ internal rotation, lateral/ external rotation, circumduction
SACROILIAC JOINT - LIGAMENTS
-sacroiliac ligaments: anterior, posterior (long & short), interosseous
-sacrospinous ligaments (sacrum to spine of ischium)
-sacrotuberous ligaments (sacrum to ischial tuberosity)
-iliolumbar ligaments
PUBIC JOINTS - LIGAMENTS
-superior pubic ligament
-inferior pubic ligament (arcuate pubic ligament)
COUNTER NUTATION
-base of sacrum moves superiorly & posteriorly
-enlarges pelvic INLET
-ischial tuberosities approximate
-pubic symphysis separates
-iliac crests separate
-PSIS approximates
-ASIS flares OUT
NUTATION
-base of sacrum moves inferiorly & anteriorly
-enlarges pelvic OUTLET
-ischial tuberosities move apart
-symphysis pubis approximates
-iliac crests approximate
-PSIS separates
-ASIS flares IN
ACETABULOFEMRAL (hip) AROM
flexion: 110-120
extension: 10-15
internal/ medial rotation: 30-40
external/ lateral rotation: 40-60
ABD: 30-50
ADD: 30
3 main bursae
-trochanteric bursa
-ischial bursa
-gluteofemoral bursa
NORMAL end feels
-flexion & ADD: elastic / tissue approximation
-straight leg raise: elastic
-extension & ABD: elastic / firm
-internal & external rotation: elastic / firm
ABNORMAL end feels
-bony: osteoarthritis
-late myospasm: instability
hip joint forces
standing: 0.3x body weight
standing on 1 leg: 2.5x body weight
walking: 3x body weight
running: 4.5x body weight
Q angle
-line drawn from ASIS through center of patella
-another line drawn from center of patella to center of tibial tuberosity
-term “Q” used to represent main pull of quadriceps muscle
-women’s Q angle: 4.5 degrees larger due to wider pelvis
*a large “Q” angle may predispose to osteoarthritis of knee / patellar dislocation
GENU VARUM
“bow-legged”, outward bowing of knees
GENA VALGUM
“knock-kneed”, inward bowing of knees
GENA RECURVATUM
knee hyperextension, excessive extension
lumbopelvic rhythm
describes a combined movement of lumbar spine & pelvis when bending forward
anterior pelvic tilt (muscles)
TIGHT: erector spinae, hip flexors, quadriceps
WEAK: hamstrings, glutes, abdominals
posterior pelvic tilt (muscles)
TIGHT: abdominal muscles, hamstrings, gluteus maximus
WEAK: erector spinae, hip flexors
purpose for male & female pelvis
FEMALE: designed for childbirth & mobility
MALE: designed for strength & stability
CAUDA EQUINA
adult spinal cord ends at L1/L2 -> becomes cauda equina
the end of vertebral column
L5 is last intervertebral disc & facet articulation with sacrum
psoas major & iliacus combine to form what muscle?
iliospoas muscle
external rotator muscles
-piriformis
-superior gemellus
-inferior gemellus
-obturator internus
-obturator externus
-quadratus femoris
pelvic floor muscles
-ischiocavernosus muscle
-bulbospongiosis (bulbocavernosus) muscle
-transverse perineal muscles
-levator ani muscles
MALE pelvic muscles
CREMASTER (connected to internal oblique muscle): surrounds each testicle, contracts to raise/ lower testicles (raising them -> closer to body & warms them up)
DARTOS: surrounds penis, foreskin & scrotum -> contracts to wrinkle scrotal skin to reduce heat loss, relaxes them does the opposite
ILIOCOSTALIS LUMBORUM
O: sacrum, iliac crest, SP T11, T12, supraspinous ligament, lateral crest of sacrum
I: angle of ribs 7-12
A: B - extension of spine, eccentric stabilization during trunk flexion
A: U - lateral flexion of spine
N: dorsal rami (spinal nerve)
LONGISSIMUS THORACIS
O: TVP L1-L5, thoracolumbar fascia
I: TVP T1-T12, angle of ribs 4-12
A: B - extension of spine, draws ribs down
A: U - lateral flexion of spine
N: dorsal rami (spinal nerve)
DIAPHRAGM
O: sternal part: two slips of dorsum of xiphoid process
O: costal part: lower 6 ribs & their costal cartilages
O: lumbar part: bodies of L1-L3
I: into central tendon (aponeurosis)
A: separates abdominal & thoracic cavities, contracts during inspiration (dome descends), relaxes during expiration (dome ascends)
N: Phrenic nerve
PSOAS MAJOR
O: TVP L1-L5, sides of bodies, corresponding discs of T12-L5
I: lesser trochanter of femur
A: flexion & lateral rotation of hip; flexion & lateral flexion of trunk, anterior pelvic tilt
N: lumbar plexus
PSOAS MINOR
O: sides of bodies T12, L1 & disc in between
I: iliopectineal eminence, arcuate line of ilium & iliac fascia
A: flexion of pelvis on lumbar spine
N: lumbar plexus
*absent in ~50% of people
ILIACUS
O: superior 2/3 of iliac fossa, internal lip of iliac crest, iliolumbar & ventral sacroiliac ligaments, ala of sacrum
I: lateral side of tendon of psoas major & just distal to lesser trochanter
A: flexion & lateral rotation of hip, anterior pelvic tilit
N: femoral nerve
QUADRATUS LUMBORUM
O: iliolumbar ligament, iliac crest
I: inferior border of 12th rib, TVP L1-L4
A: B - extensions of lumbar spine
A: U - elevation of pelvis, lateral flexion of trunk, depression of 12th rib
N: lumbar plexus
LATISSIMUS DORSI
O: SP T7-T12, last 3-4 ribs, through thoracolumbar fascia, posterior 1/3 of external lip of iliac crest, slip from inferior angle of scapula
I: intertubercular groove of humerus
A: B - hyperextends spine
A: U - lateral flexion of trunk, shoulder joint, assists in tilting pelvis
N: thoracodorsal nerve
GLUTEUS MAXIMUS
O: posterior gluteal line of ilium, portion of iliac crest, posterior surface of lower part of sacrum, side of coccyx, aponeurosis of erector spinae, sacrotuberous ligament, gluteal aponeurosis
I: iliotibial tract of tensor fascia lata
I: gluteal tuberosity of femur
A: extends & laterally rotates hip joint, helps to stabilize knee in extension (via its insertion to IT band)
A: upper fibers - assist in ABD of hip
A: lower fibers - assist in ADD of hip
N: inferior gluteal nerve
GLUTEUS MEDIUS
O: external surface of ilium between iliac crest & posterior gluteal line dorsally & anterior gluteal line ventrally & gluteal aponeurosis
I: oblique ridge on lateral surface of greater trochanter of femur
A: ABD of hip
A: anterior fibers - medially rotate & may assist in flexion of hip joint
A: posterior fibers - laterally rotate & may assist in extension of hip joint
N: superior gluteal nerve
GLUTEUS MINIMUS
O: external surface of ilium between anterior & inferior gluteal line, margin of greater sciatic notch
I: anterior border of greater trochanter of femur & hip joint capsule
A: ABD, medially rotates, may assist in flexion of hip joint
N: superior gluteal nerve
PIRIFORMIS
O: pelvic surface of sacrum close to S1-S4 sacral foramina, margin of greater sciatic foramen & pelvic surface of sacrotuberous ligament
I: superior border of greater trochanter of femur
A: lateral rotation of hip, ABD of thigh when hip is flexed
N: nerve to piriformis
SUPERIOR GEMELLUS
O: external surface of spine of ischium
I: with tendon of obturator internus into medial surface of greater trochanter of femur
A: lateral rotation of hip, ABD thigh when hip is flexed
N: nerve to obturator internus
INFERIOR GEMELLUS
O: proximal part of tuberosity of ischium
I: with tendon of obturator internus into medial surface of greater trochanter of femur
A: lateral rotation of hip, ABD of thigh when hip is flexed
N: nerve to quadratus femoris
OBTURATOR INTERNUS
O: internal/ pelvic surface of obturator membrane & margin of obturator foramen, pelvic surface of ischium posterior & proximal to obturator foramen
I: medial surface of greater trochanter of femur, proximal to trochanteric fossa
A: lateral rotation of hip joint, ABD of thigh when hip is flexed
N: nerve to obturator internus
OBTURATOR EXTERNUS
O: rami of pubis & ischium & external surface of obturator membrane
I: trochanteric fossa of femur
A: lateral rotation of hip joint, weak ADD of thigh
N: obturator nerve
QUADRATUS FEMORIS
O: proximal part of lateral border of tuberosity of ischium
I: proximal part of quadrate line, extends distally from intertrochanteric crest
A: lateral rotation of hip joint, ADD of thigh (weak action)
N: nerve to quadratus femoris
