Sem 2 - H - Gluteal region & hip joint (articulation, capsule, ligaments, arteries)- Hip bone, femur, gluteal muscles/nerves/vessels Flashcards
What are two other names for the hip bone? Which bones make up the hip bone?
Hip bone - innominate bone and os coxae Ilium, ischium and pubic bone make up the hip bone
What muscle attaches in the iliac fossa? What does the iliac crest connect? Which two bones surround the obturator foramen?
Iliacus arises in the iliac fossa Pubic crest connects anterior superior iliac spine (ASIS) to posterior superior iliac spine (PSIS) Ischium and pubic bone surround the obturator foramen
What lies immediately below the auricular surface of the ilium? What does the auricular surface of the ilium articulate with?
Just below the auricular surface of the ilium is the greater sciatic notch
The auricular surface of the ilium articulates with the sacrum to form the SI joint
What are the gluteal lines and which surface of the ilium do these lines lie on? What does the meeting point of the three hip bones form?
The gluteal lines are on the lateral surface of the ilium and divide up the ilial surface
- Posterior gluteal line
- Anterior gluteal line
- Inferior gluteal line
The meeting point of the three hip bones forms the acetabulum
What forms the greater and lesser sciatic foramen?
The greater and lesser sciatic foramen are formed by sacrospinous and sacrotuberous ligaments
Sacrospinous ligament - ischial spine to sacum
Sacrotuberous ligament - ischial tuberosity to sacrum
Hip joints lie more lateral than the knee joint Femur therefore needs to angle inwards as it moves downwards What is this angle known as and what is the measurement of this angle?
The femur needs to angle inward as it moves downwards - this angle is known as the angle of inclination
Angle of inclination is the angle between the long axis of the femoral shaft and long axis of the femoral head/neck - 125 degrees
So that the femoral head is able to insert into the acetabulum, there is a torsion of the femoral neck This torsion is known as femoral neck antversion (antversion means rotated forwards) What direction does the femoral neck anteversion cause the femoral head to face? What is the angle of anteversion (torison)?
Because of the femoral neck anteversion, the femoral head will face medially, anteriorly and superiorly
Angle of antversion is the angle between the transverse axis of the femoral condyles and axis of the femoral head and neck - the angle is approximately 12 degrees
What is the tuberosity that lies on the lateral aspect of the superior part of the linea aspera and what muscle forms part of its attachment here?
The gluteal tuberosity is at the lateral aspect of the superior linea aspera - gluteus maximus forms part of its insertion here
What are the muscles of the superficial and deep gluteal regions?
Superficial gluteal muscles -Gluteus maximus, gluteus medius and minimus, tensor fasci latae Deep gluteal muscles - piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris
What is the attachments of the gluteus maximus muscle?
The gluteus maximus attaches at the posterior sacrum, sacrotuberous ligament and ilium behind the posterior gluteal line and 3/4 of its fibres insert into the iliotibial tract, and 1/4 of its fibres - the deep fibres - insert into the gluteal tuberosity
What is the function of the gluteus maximus? What is its nerve supply?
The gluteus maximus is the main extensor of the hip and assists in lateral rotation of the hip Its is innervated by the inferior gluteal nerve (L5,S1,2)
State the attachment, function and nerve supply of the gluteus maximus
Attachment - Posterior sacrum, sacrotuberous ligament &ilium behind the posterior gluteal line into the iliotibial tract (3/4 of fibres) and the deep fibres into the gluteal tuberosity of femur (1/4 of fibres)
Function - Main extensor of the hip and assists in lateral rotation of the hip
Innervation - Inferior gluteal nerve (L5,S1,2)
What is the attachment of the tensor fascia latae?
Attaches from the anterior iiac crest and anterior superior iliac spine (ASIS) and inserts into the iliotibial tract
What is the function and nerve supply to the tensor fascia latae?
Function Tenses the iliotibial tract and fascia latae as well as supporting the femur on tibia during standing Innervation - Superior gluteal nerve (L4,5,S1)
State the attachments, function and nerve supply of the tensor fascia latae
Attachment - Anterior iliac crest and ASIS to the iliotibial tract Function - Tenses the iliotibial tract and fascia latae and supports femur on tibia whilst standing Innervation - Superior gluteal nerve (L4,5,S1)
If completely reflecting the gluteus maximus, what muscle will be seen and what muscle lies deep to this?
If reflecting gluteus maximus, will see the gluteus medius with the gluteus minimus lieing deep to the medius
What is the function and innervation of the gluteus medius and minimus?
Gluteus medius and minimus abduct the hip and medially rotate the hip Innervation - Superior gluteal nerve (L4,5,S1)
What is the attachment of the gluteus medius?
Gluteus medius attaches to the ilium between the posterior and anterior gluteal lines to the lateral aspect of the greater trochanter of the femur
What is the attachment of the gluteus minimus?
The gluteus minimus attaches between the anterior and inferior gluteal lines to the anterior surface of the greater trochanter of the femur
State the attachments, function and nerve supply of gluteus medius and minimus
Gluteus medius - ilium between posterior and anterior gluteal lines to the lateral surface of the greater trochanter
Gluteus minimus - ilium between anterior and inferior gluteal lines to the anterior surface of the greater trochanter
- Function - abduct & medially rotate hip joint
- Innervation - Superior gluteal nerve (L4,5,S1)
How does the superior gluteal nerve reach the tensor fascia latae?
Superior gluteal nerve exits the pelvis superior to the pifiromis before coursing between gluteus medius and minimus before coming anterior to innervate the tensor fascia latae
What is the attachment, function and nerve supply of the piriformis?
Attachment - arises at the anterior surface of the sacrum and sacrotuberous ligament before passing through the greater sciatic foramen to the superior border of the greater trochanter of the femur
Function - lateral rotation of hip joint
Innervation - Nerve to pifiromis (anterior rami S1,2)
What is the attachment, function and nerve supply of the obturator internus?
Attachment- Arises form the pelvic surface of the membrane and margins of the obturator foramen before passing through the lesser sciatic foramen to the trochanteric fossa
Function - laterally rotates the hip
Innervation - Nevre to obturator internus (L5,S1)
What is the attachment, function and nerve supply of the superior and inferior gemellus muscles
Superior gemellus - ischial spine (nerve to obturator intenrus (L5,S1))
Inferior gemellus - ischial tuberosity (nerve to quadratus femoris (L5,S1))
- They blend with the tendon of the obturator internus to insert into the trochanteric fossa
- Function - lateral rotation of the hip
Where does the main muscular bulk of the obturator internus lie?
The main muscular bulk of the obturator internus lies in the pelvis and therefore mainly the tendon is visible when looking from the gluteal compartment
What is the attachment of the quadratus femoris?
The quadratus femoris attaches from the ischial tuberosity to the quadrate tubercle on the intertrochanteric crest of the femur
State the attachment function and nerve supply of the quadratus femoris?
Attachment Ischial tuberosity to the quadrate tubercle on the intertrochanteric crest of the femur Function - lateral rotation of the hip Innervation - nerve to quadratus femoris (L5,S1)
State the attachment function and nerve supply of the only muscle of the medial compartment of the hip that does not adduct the hip?
Obturator externus
Attachment - outer surface of obturator membrane and margins of obturator foramen behind the neck of the femur to the trochanteric fossa Function - lateral rotation of the hip Innervation - Obturator nerve (L3,4 roots)
What are the superior gemellus, obturator internus and inferior gemellus collectively known as?
These three muscles together are collectively known as the triceps coxae
In terms of walking, you plant one limb and swing the other forward In order to be able to do this we twist the pelvis Describe how the planted limb and advancing limb twist during walking?
Medial rotation of the planted limb occurs whilst lateral rotation of the advancing limb happens to keep the distal lower limb from pointing inwards
As well as medial rotation of the planted limb, there is also abduction of the planted limb to support the pelvis on the opposite side
What are the nerve roots of the sciatic nerve? What are the ways in which it leaves the pelvis?
Nerve roots - L4,5,S1,2,3
Usually the sciatic nerve leaves the pelvis inferior to the pirfiormis
- The tibial division almost always is inferior to the pifiromis
- The common fibular divsion can leave inferior, directly through or superior to the piriformis
What muscle are the superior and inferior gluteal vessels/nerve relative to? What do the nerves supply?
The gluteal nerves and vessels are relative to the piriformis Superior gluteal nerve - gluteus medius, minimus and tensor fascia latae Inferior gluteal nerve - gluteus maxiimus
What does the inferior gluteal artery give branches to once leaving the pelvis?
Inferior gluteal artery - mainly supplies the gluteus maximus and comes towards the cruciate anastamosis at the femoral neck area
What does the superior gluteal artery give branches to once leaving the pelvis?
Superior gluteal artery - gives off a superficial and deep branch Superficial branch enters the deep surface of the gluteus maximus Deep branch splits into superior and inferior division with the inferior dvision continuing to travel with the superior gluteal nerve
What is the nerve that runs very closely associated with the sciatic nerve? What are its nerve roots? What branches does this nerve give to supply the skin of the lower half of the buttocks?
This nerve would be the posterior cutaneous nerve of the thigh (S1,2,3) The posterior cutaneous nerve of the thigh gives the inferior clunial nerves to supply the skin of the lower half of the buttocks
Where do all the clunial nerves arise?
The superior clunial nerves arise from the posterior ami of L1,2,3 lumbar nerves The middle clunial nerves arise from the posterior rami of S1,2,3 sacral nerves The inferior clunial nerves arise from the posterior cutaneous nerve of the thigh (anterior rami S1,2,3)
What type of joint is the hip joint?
The hip joint is a synovial ball and socket joint
Inferiorly there is a gap in the acetabulum known as the acetabular notch Which ligament bridges this notch? What is the fat pad in the acetabular fossa covered by?
The transverse acetabular ligament bridges the acetabular notch The fat pad in the acetabular fossa is covered by the synovial membrane and is therefore not part of the hip joint articular surface
Describe the capsule attachments of the hip joint? (acetabulum and femur)
The capsule aessentially attaches around the acetabulum and cuts across at the acetabular notch
On the femur, anteriorly the capsule comes across the intertrochanteric line and posteriorly, the capsule extends to the distal end of the neck of the femur
Restate the iliofemoral ligament attachments and its function? Remember it has upper and lower bands
Iliofemoral ligament
Attachment - AIIS to the intertrochanteric line
Function - fibres become taight during certain movement at hip joint
Limits -
- * Extension
- * Lateral rotation
- * Upper band limits adduction
- * Lower band limits abduction
Restate the pubofemoral ligament attachments What is the function of the pubofemoral ligament?
Attachment - from iliopubic eminence to the lower part of the intertrochanteric line Function
- To limit
- * Extension
- * Lateral rotation
- * Abduction
Due to the spiralling of the fibres, the ischiofemoral ligament is special in the movements it limits- usually posterior to the joint ligament would limit flexion for example
- What movements does the ischiofemoral ligament limit?
- Limits - Extension due to the fibres becoming taught when extending the hip because of the spiralling
- Limits - Medial rotation as this will stretch the fibres
- Limits - Adduction because the tilt of the greater trochanter away from the midline will stretch the fibres
Restate the movements limited by all the hip joint ligaments The ligaments deal with all the movements except flexion as this is limited by the presence of the trunk
Iliofemoral limits-
- Extension &lateral rotation Upper band limits adduction Lower band limits abduction
Pubofemoral limits -
- Extension, lateral rotation and abduction
Ischiofemoral limits -
- Extension, medial rotation and adduction
What are the main arteries supplying the hip joint?
Medial and lateral circumflex femoral arteries mainly
As well as superior/inferior gluteal arteries and the artery to the head of the femur (from obturator artery)
Where do the medial and lateral circumflex femoral arteries arise? What branches are given and from which one to supply the head and neck of the femur? What can fracture of the neck of the femur do to this circumflex artery?
Medial and lateral circumflex femoral arteries arise from the profunda femoris branch of the femoral artery
Medial circumflex femoral arteries give retinacular branches which supply the head and neck of the femur
The neck of the femur can fracture tearing the medial circumflex femoral artery causing avascular necorsis of the femoral head
