Session 3 - Hip Flashcards
What is an alternative name of hip bones?
Innominate bones
What are the 3 main articulations/joints in hip bones?
Sacroiliac joint
Pubic symphysis
Hip joint
What does the sacroiliac joint articulate with?
Sacrum
What does the pubic symphysis articulate with?
Between left and right hip bones
What does the hip joint articulate with?
Head of femur
What are the 3 parts of the hip bone?
Ilium
Pubis
Ischium
What are the ilium, pubis and ischium separated by in a child?
Triradiate cartilage
What is the acetabulum?
Cup shaped socket formed by the ilium, pubis and ischium
How does the ilium look like?
Widest and largest of the 3 parts
Located superiorly
What are the 2 surfaces of the wing of the ilium?
Internal and external
What is the shape of the internal surface of the ilium?
Concave shape
What is the shape of the external surface of the wing of the ilium?
Convex shape
What is the iliac crest?
Superior thickened margin of the wing from anterior superior iliac spine to posterior superior iliac spine
What is the greater sciatic notch?
Indentation on posterior aspect of the ilium
How does the pubis look like?
Most anterior portion of the hip bone
What are the 3 parts of the pubis?
Body
Superior ramus
Inferior ramus
What is the pubic body of the pubis?
Located medially, articulates with opposite pubic body at pubic symphysis
Where is the superior pubic ramus?
Extends laterally from pubic body to acetabulum
Where is the inferior pubic ramus?
Extends laterally from pubic body to the inferior ischial ramus
What is the ischiopubic ramus?
The point where inferior pubic ramus meets the inferior ischial ramus
Where is the obturator foramen?
Hole enclosed by superior and inferior rami
What passes through the obturator foramen?
Obturator nerve, artery and vein
Where is the ischium?
Posteroinferior part of the hip bone
What are the 3 parts of the ischium?
Body
Inferior ramus
Superior ramus
What is the ischial tuberosity?
Posteroinferior aspect of ischium
What is the ischial spine?
Posteromedial projection of bone, near junction of the superior ramus and body
What are 2 important ligaments that attach to the ischium?
Sacrospinous
Sacrotuberous
Where is the sacrospinous ligament located?
From ischial spine to sacrum
Where is the sacrotuberous ligament?
Runs from sacrum to ischial tuberosity
What is the function of the sacrospinous and sacrotuberous ligaments?
Limit rotation of the inferior part of sacrum, during transmission of body weight down the vertebral column in erect position
What is the structure of the hip joint?
Ball and socket synovial joint consisting of an articulation between head of femur and pelvic acetabulum
What is the function of the hip joint?
Enable mobility of lower limbs without weakening its ability to support body weight
What is the structure of the acetabulum?
Cup-like socket
What is the acetabular labrum?
Fibrocartilaginous collar encircling the acetabulum
What is the function of the acetabular labrum?
Encircles acetabulum, deepening it and providing more secure fir for femoral head, increases articular contact area
How stable and mobile is the hip joint?
Very stable but not very mobile
What is the acetabular notch?
Incomplete inferior part of the acetabulum
What is the fovea capitis?
Small depression on centre of femoral head where ligamentum teres attaches
What does the ligamentum teres do?
Contain artery of ligamentum teres
What are the greater and lesser trochanters?
Large bony prominences at proximal end of femoral shaft
What is the intertrochanteric line?
Line that connects the greater and lesser trochanters on anterior aspect
What is the intertrochanteric crest?
A ridge that connects the greater and lesser trochanters on posterior aspect
What is the linea aspera?
Where intermuscular septa and many thigh muscles attach
Where is the gluteal tuberosity?
Ridge between upper end of the linea aspera and intertrochanteric chest
What is the gluteal tuberosity?
Site of insertion of gluteus Maximus
What does the linea aspera diverge to become inferiorly?
Lateral and medial supracondylar lines
Where does the medial supracondylar line terminate?
Medial condyle of femur
Where does the lateral supracondylar line terminate?
Lateral femoral condyle
What is the intercondylar notch?
Separation of condyles posteriorly
What is the trochlear or patellofemoral groove?
Articular surface for the patella between the 2 condyles
Where does the capsule of the hip joint attach to?
Acetabulum edge and intertrochanteric line of femur
What are longitudinal retinacula?
Capsular fibres that ascend down the neck anteriorly
What is the only intracellular ligament of the hip joint?
Ligament teres
What are the 3 major extracapsular ligaments in the hip joint?
Iliofemoral
Pubofemoral
Ischiofemoral
How does the iliofemoral ligament look like?
Inverted Y-shaped attached to anterior inferior iliac spine of ilium and intertrochanteric line of femur
What is the function of iliofemoral ligament?
Prevents hyperextension of hip
How does the pubofemoral ligament look like?
Triangular, base attached to superior pubic ramus and apex attached to inferior part of intertrochanteric line anteriorly
What are 2 functions of pubofemoral ligament?
Prevent excessive abduction
Prevent excessive extension
How does the ischiofemoral ligament look like?
Spiral shaped, attached to body of ischium posteriorly and intertrochanteric line of femur
What is the function of ischiofemoral ligament?
Prevent excessive internal rotation of hip joint
What does the transverse acetabular ligament look like?
Bridges through acetabular notch
What are 6 factors that act to increase stability of the hip joint?
Cup shaped acetabulum Acetabular labrum that deepens the acetabulum Capsule Ligament teres Extracapsular ligaments Muscles surrounding the joint
What are the 3 nerves that innervate the hip joint and from which direction?
Sciatic nerve posteriorly
Femoral nerve anteriorly
Obturator nerve inferiorly
What are the 2 arteries that make up the extracapsular arterial ring?
Medial femoral circumflex artery and lateral femoral circumflex artery
What artery does the ligamentum teres contain?
Artery of ligamentum teres
What plexus does the lower limb receive its nerve supply from?
Lumbosacral plexus
What spinal nerves make up the lumbar component of the lumbosacral plexus?
Anterior rami of L1-4 spinal nerves
What are the 5 branches of the lumbar plexus and their root values?
Ilioinguinal L1 Genitofemoral L1 L2 Lateral femoral cutaneous L2 L3 Obturator L2 L3 L4 Femoral L2 L3 L4
What root value is the ilioinguinal nerve?
L1
Where does the ilioinguinal nerve innervate?
Skin of genitalia and upper medial thigh
What roots does genitofemoral nerve have?
L1 and L2
What 2 branches does the genitofemoral nerve divide into?
Genital and femoral
Where does the femoral branch innervate?
Skin on upper anterior thigh
What roots does the lateral femoral cutaneous nerve have?
Posterior divisions of L2 and L3
What kind of function does the lateral cutaneous nerve have?
Sensory
Where does the lateral cutaneous nerve provide sensation to?
Anterolateral thigh as far inferiorly as the knee
What roots does the obturator nerve have?
Anterior divisions of L2 L3 and L4
Where does the obturator nerve innervate?
Medial thigh
What roots does the femoral nerve have?
Posterior divisions of L2 L3 and L4
Where does the femoral nerve innervate?
Anterior compartment
What roots is the sacral plexus made up of?
Anterior rami of S1 S2 S3 S4 S5 and a contribution from lumbosacral trunk
What is the lumbosacral trunk?
L4 anterior ramus combines with L5 anterior ramus that goes into the sacral plexus
What are the 5 branches of the sacral plexus and their root values?
Superior gluteal - L4 L5 S1 Inferior gluteal - L5 S1 S2 Sciatic - L4 L4 S1 S2 S3 Posterior femoral - S1 S2 S3 Pudendal - S2 S3 S4
What root values does the superior gluteal nerve have?
L4
L5
S1
What are the 3 areas that the superior gluteal nerve innervates?
Gluteus medius
Gluteus minimus
Tensor fascia lata
What root values does the inferior gluteal nerve have?
L5 S1 S2
What muscle does the inferior gluteal nerve innervate?
Gluteus Maximus
What root values does the posterior cutaneous nerve of the thigh have?
S1
S2
S3
Where does the posterior cutaneous nerve of the thigh innervate?
Skin of posterior thigh and leg
What is the nerve and vessel that exits the pelvis through the greater sciatic foramen superior to the piriformis muscle?
Superior gluteal nerve
What are 5 nerves that exit the pelvis via the greater sciatic foramen inferior to the piriformis muscle?
Sciatic Inferior gluteal Posterior femoral cutaneous Nerve to quadratic femoris Nerve to obturator internus
What are the 4 structures that pass through the lesser sciatic foramen?
Tendon of obturator internus
Nerve to obturator internus
Pudendal nerve
Internal pudendal vessels
What are the 5 root values of the sciatic nerve?
L4 L5 S1 S2 S3
What are the 2 divisions of the sciatic nerve?
Tibial nerve
Common fibular nerve
What kind of muscle does the tibial nerve supply?
Hamstring
What does the common fibular nerve supply?
Short head of biceps femoris in the posterior thigh
How do you find the ventrogluteal injection site?
Palm of hand on greater trochanter, thumb toward inguinal region and index toward anterior superior iliac spine, form V with index and middle finger and inject between
Where is the dorsogluteal injection site?
Upper outer quadrant of gluteal region
What is fascia lata?
Deep fascia of the thigh
What is the function of the saphenous opening in the fascia lata?
Entry point for saphenous vein and lymphatic vessels draining into superficial inguinal lymph nodes
What is the iliotibial tract?
Thickened fascia lata at its lateral aspect running from iliac crest to lateral tibial condyle
What is the tensor fascia lata?
Muscle originating from anterior superior iliac spine between the 2 layers of iliotibial band of fascia lata
What is the tensor fascia lata innervated by?
Superior gluteal nerve
What is the function of tensor fascia lata?
Stabilizes hip in extension by pulling on iliotibial tract
What are the 2 main groups of muscles in gluteal region?
Superficial
Deep
What is the function of superficial gluteal muscles?
Large muscles that abduct and extend the thigh
What are the 4 superficial gluteal muscles?
Gluteus Maximus
Gluteus minimus
Gluteus medius
Tensor fascia lata
What is the function of deep gluteal muscles?
Smaller muscles acting to laterally rotate the femur
What are the 5 deep gluteal muscles?
Piriformis Gemellus superior Obturator internus Gemellus inferior Quadratus femoris
What are the 2 arteries that supply gluteal muscles?
Superior and inferior gluteal arteries
Where does the gluteus maximus originate from?
Posterior surface of ilium, sacrum and coccyx
What are the 2 functions of the gluteus Maximus?
Main Extensor and assists with lateral rotation
What is the gluteus maximus innervated by?
Inferior gluteal nerve
Where is the gluteus Maximus located?
Most superficial part of buttock
Where is the gluteus medius located?
Between gluteus Maximus and minimus
Where does the gluteus medius originate from?
Posterior surface of ilium
Where does the gluteus medius insert into?
Lateral surface of greater trochanter
Where does the gluteus Maximus insert into?
Iliotibial tract and gluteal tuberosity of femur
What is the function of gluteus medius?
Abducts and medially rotates lower limb
What is the gluteus medius innervated by?
Superior gluteal nerve
Where does the gluteus minimus originate?
Ilium
Where does the gluteus minimus insert?
Anterior aspect of greater trochanter
What is the function of the gluteus minimus?
Abducts and medially rotates lower limb
What is the gluteus minimus innervated by?
Superior gluteal nerve
What happens when the superior gluteal nerve is injured?
Gluteus medius and minimus affected, weakness in abducting thigh at hip
What are 4 possible causes of superior gluteal nerve injury?
Surgery complication
Injections to buttocks
Fracture of greater trochanter
Dislocation of hip joint
How do you test for superior gluteal nerve injury?
Standing erect, patient to lift one foot off ground, but supporting limb doesn’t contract to prevent tilting so tilts towards other side = Positive Trendelenburg sign
What is the general action of deep gluteal muscles?
Laterally or externally rotate lower limb
Why is piriformis a landmark?
Sciatic nerve emerges from pelvis inferior to it
Where does the piriformis originate?
Anterior surface of sacrum
Where does the piriformis travel through?
Greater sciatic foramen
Where does the piriformis insert?
Superior aspect of greater trochanter of femur
What are 2 actions of the piriformis?
Lateral rotation and abduction
What nerve innervates the piriformis?
Nerve to piriformis
What does the obturator internus originate from?
Medial surface of obturator membrane in obturator foramen
Where does the obturator internus travel through?
Lesser sciatic foramen
Where does the obturator internus insert?
Posterior aspect of greater trochanter, below piriformis and superior gemellus
What is the actions of the obturator internus?
Lateral rotation and abduction
Which nerve innervates the obturator internus?
Nerve to obturator internus?
What is the structure that separates the superior and inferior gemellus?
Obturator internus tendon
Where does the superior gemellus originate from?
Ischial spine
Wherre does the inferior gemellus originate from?
Ischial tuberosity
Where does the superior gemellus insert?
Posterior aspect of greater trochanter, above obturator internus
Where does the inferior gemellus insert?
Below obturator internus
What are the actions of the superior and inferior gemellus?
Lateral rotation and abduction
What is the superior gemellus innervated by?
Nerve to obturator internus
What is the inferior gemellus innervated by?
Nerve to quadratus femoris
Where does the quadratus femoris originate from?
Lateral aspect of ischial tuberosity
Where does the quadratus femoris insert?
Quadratus tubercle on the intertrochanteric crest
What is the function of the quadratus femoris?
Lateral rotation
What is the quadratus femoris innervated by?
Nerve to quadratus femoris
Where does the obturator externus originate from?
External surface of obturator membrane
Where does the obturator externus insert?
Posterior aspect of greater trochanter
What are the 2 functions of obturator externus?
Abduction and lateral rotation
What is the obturator externus innervated by?
Obturator nerve
What are hamstrings?
Muscles in posterior compartment of thigh
What are the 3 muscles of hamstrings?
Biceps femoris
Semitendinosus
Semimembranosus
What are the functions of hamstrings?
Extend lower limb at the hip and flex it at the knee
What are hamstrings innervated by?
Tibial part of sciatic nerve except short head of biceps femoris
What are the 2 heads of the biceps femoris?
Long and short heads
Where does the long head of biceps femoris originate from?
Ischial tuberosity of pelvis
Where does the short head of biceps femoris originate from?
Linea aspera on posterior surface of femur
What are the 3 functions of biceps femoris?
Flex knee
Extends thigh at hip
Laterally rotate hip and knee
What is the long head innervated by?
Tibial part of sciatic nerve
What is the short head innervated by?
Common fibular part of sciatic nerve
Where is the semitendinous located?
Medial to biceps femoris and superficial to semimembranosus
Where does the semitendinosus originate from?
Ischial tuberosity
Where does the semitendinosus insert on?
Upper medial aspect of tibia
What are the 4 functions of semitendinosus?
Flex leg at knee
Extend thigh at hip
Medially rotate thigh at hip
Medially rotate leg at knee
What is the semitendinosus innervated by?
Tibial part of sciatic nerve
Where is the semimembranosus located?
Deep to semitendinosus
Where does semimembranosus originate from?
Ischial tuberosity
Where does semimembranosus insert?
Medial tibial condyle
What are the 4 functions of semimembranosus?
Flex leg at knee
Extent thigh at hip
Internally rotate thigh at hip
Internally rotate leg at knee
What is the semimembranosus innervated by?
Tibial part of sciatic nerve
What is osteoarthritis?
Degenerative disorder arising from breakdown of articular hyaline cartilage
What are 5 risk factors of primary osteoarthritis?
Age Female sex Ethnicity Genetics Nutrition - lack of vit C and E
What are 5 symptoms of osteoarthritis in a joint?
Joint stiffness Pain in hip, gluteal and groin radiating to knee Mechanical pain Crepitus Reduced mobility
What are 4 limitations placed on daily living activities for patients with osteoarthritis?
Difficulty walking
Difficulty putting on socks and shoes
Difficulty getting in and out of car
Difficulty getting out of the bath
What are the 4 signs of OA on X-rays?
Reduced joint space
Subchondral sclerosis
Bone cysts
Osteophytes
Why does hyaline cartilage initially swell during osteoarthritis?
Increased proteoglycan synthesis by chondrocytes, with increased number of chondrocytes differentiating from chondroprogenitor cells
Why is there loss of joint space during osteoarthritis?
Proteoglycan content falls, cartilage softens and loses elasticity, flaking and fibrillation develops, cartilage becomes eroded down to subchondral bone, resulting in loss of joint space
How does subchondral sclerosis occur in osteoarthritis?
Subchondral bone gets vascular invasion and increased cellular Katy, becoming thickened and denser at areas of pressure
How does subchondral bone cysts form during osteoarthritis?
Traumatized subchondral bone undergoes cystic degeneration to form subchondral bone cysts
How do osteophytes form during osteoarthritis?
Irregular outgrowth of new bone
What is the definition of fractured neck of femur?
Fracture of proximal femur, up to 5cm below the lesser trochanter
What are the 2 types of #NOF?
Intracapsular
Extracapsular
What kind of neck of femur fracture is more likely to have implications on blood supply of femoral head?
Intracapsular fracture
Why is intracapular fracture more likely to affect blood supply of femoral head?
More likely to disrupt the ascending cervical branches of medial femoral circumflex artery. Artery of the Ligamentum Teres cannot sustain metabolic demand of femoral head, higher risk of avascular necrosis of bone
What are 3 symptoms of #NOF?
Reduced mobility
Sudden inability to bear weight on limb
Pain in hip, groin or knee
How does a displaced NOF fracture look like upon examination?
Affected leg is shortened, abducted and externally rotated
What is the definition of a hip dislocation?
Head of femur fully displaced out of acetabulum
What is the most common type of hip dislocation?
Posterior
How does a posterior dislocation of the hip look like upon examination?
Shortened, flexion, addiction and internal rotation
