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Musculoskeletal System > Session 3 - Hip > Flashcards

Session 3 - Hip Flashcards

1
Q

What is an alternative name of hip bones?

A

Innominate bones

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2
Q

What are the 3 main articulations/joints in hip bones?

A

Sacroiliac joint
Pubic symphysis
Hip joint

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3
Q

What does the sacroiliac joint articulate with?

A

Sacrum

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4
Q

What does the pubic symphysis articulate with?

A

Between left and right hip bones

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5
Q

What does the hip joint articulate with?

A

Head of femur

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6
Q

What are the 3 parts of the hip bone?

A

Ilium
Pubis
Ischium

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7
Q

What are the ilium, pubis and ischium separated by in a child?

A

Triradiate cartilage

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8
Q

What is the acetabulum?

A

Cup shaped socket formed by the ilium, pubis and ischium

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9
Q

How does the ilium look like?

A

Widest and largest of the 3 parts

Located superiorly

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10
Q

What are the 2 surfaces of the wing of the ilium?

A

Internal and external

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11
Q

What is the shape of the internal surface of the ilium?

A

Concave shape

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12
Q

What is the shape of the external surface of the wing of the ilium?

A

Convex shape

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13
Q

What is the iliac crest?

A

Superior thickened margin of the wing from anterior superior iliac spine to posterior superior iliac spine

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14
Q

What is the greater sciatic notch?

A

Indentation on posterior aspect of the ilium

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15
Q

How does the pubis look like?

A

Most anterior portion of the hip bone

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16
Q

What are the 3 parts of the pubis?

A

Body
Superior ramus
Inferior ramus

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17
Q

What is the pubic body of the pubis?

A

Located medially, articulates with opposite pubic body at pubic symphysis

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18
Q

Where is the superior pubic ramus?

A

Extends laterally from pubic body to acetabulum

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19
Q

Where is the inferior pubic ramus?

A

Extends laterally from pubic body to the inferior ischial ramus

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20
Q

What is the ischiopubic ramus?

A

The point where inferior pubic ramus meets the inferior ischial ramus

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21
Q

Where is the obturator foramen?

A

Hole enclosed by superior and inferior rami

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22
Q

What passes through the obturator foramen?

A

Obturator nerve, artery and vein

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23
Q

Where is the ischium?

A

Posteroinferior part of the hip bone

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24
Q

What are the 3 parts of the ischium?

A

Body
Inferior ramus
Superior ramus

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25
Q

What is the ischial tuberosity?

A

Posteroinferior aspect of ischium

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26
Q

What is the ischial spine?

A

Posteromedial projection of bone, near junction of the superior ramus and body

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27
Q

What are 2 important ligaments that attach to the ischium?

A

Sacrospinous

Sacrotuberous

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28
Q

Where is the sacrospinous ligament located?

A

From ischial spine to sacrum

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29
Q

Where is the sacrotuberous ligament?

A

Runs from sacrum to ischial tuberosity

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30
Q

What is the function of the sacrospinous and sacrotuberous ligaments?

A

Limit rotation of the inferior part of sacrum, during transmission of body weight down the vertebral column in erect position

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31
Q

What is the structure of the hip joint?

A

Ball and socket synovial joint consisting of an articulation between head of femur and pelvic acetabulum

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32
Q

What is the function of the hip joint?

A

Enable mobility of lower limbs without weakening its ability to support body weight

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33
Q

What is the structure of the acetabulum?

A

Cup-like socket

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34
Q

What is the acetabular labrum?

A

Fibrocartilaginous collar encircling the acetabulum

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35
Q

What is the function of the acetabular labrum?

A

Encircles acetabulum, deepening it and providing more secure fir for femoral head, increases articular contact area

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36
Q

How stable and mobile is the hip joint?

A

Very stable but not very mobile

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37
Q

What is the acetabular notch?

A

Incomplete inferior part of the acetabulum

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38
Q

What is the fovea capitis?

A

Small depression on centre of femoral head where ligamentum teres attaches

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39
Q

What does the ligamentum teres do?

A

Contain artery of ligamentum teres

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40
Q

What are the greater and lesser trochanters?

A

Large bony prominences at proximal end of femoral shaft

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41
Q

What is the intertrochanteric line?

A

Line that connects the greater and lesser trochanters on anterior aspect

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42
Q

What is the intertrochanteric crest?

A

A ridge that connects the greater and lesser trochanters on posterior aspect

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43
Q

What is the linea aspera?

A

Where intermuscular septa and many thigh muscles attach

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44
Q

Where is the gluteal tuberosity?

A

Ridge between upper end of the linea aspera and intertrochanteric chest

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45
Q

What is the gluteal tuberosity?

A

Site of insertion of gluteus Maximus

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46
Q

What does the linea aspera diverge to become inferiorly?

A

Lateral and medial supracondylar lines

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47
Q

Where does the medial supracondylar line terminate?

A

Medial condyle of femur

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48
Q

Where does the lateral supracondylar line terminate?

A

Lateral femoral condyle

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49
Q

What is the intercondylar notch?

A

Separation of condyles posteriorly

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50
Q

What is the trochlear or patellofemoral groove?

A

Articular surface for the patella between the 2 condyles

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51
Q

Where does the capsule of the hip joint attach to?

A

Acetabulum edge and intertrochanteric line of femur

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52
Q

What are longitudinal retinacula?

A

Capsular fibres that ascend down the neck anteriorly

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53
Q

What is the only intracellular ligament of the hip joint?

A

Ligament teres

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54
Q

What are the 3 major extracapsular ligaments in the hip joint?

A

Iliofemoral
Pubofemoral
Ischiofemoral

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55
Q

How does the iliofemoral ligament look like?

A

Inverted Y-shaped attached to anterior inferior iliac spine of ilium and intertrochanteric line of femur

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56
Q

What is the function of iliofemoral ligament?

A

Prevents hyperextension of hip

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57
Q

How does the pubofemoral ligament look like?

A

Triangular, base attached to superior pubic ramus and apex attached to inferior part of intertrochanteric line anteriorly

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58
Q

What are 2 functions of pubofemoral ligament?

A

Prevent excessive abduction

Prevent excessive extension

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59
Q

How does the ischiofemoral ligament look like?

A

Spiral shaped, attached to body of ischium posteriorly and intertrochanteric line of femur

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60
Q

What is the function of ischiofemoral ligament?

A

Prevent excessive internal rotation of hip joint

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61
Q

What does the transverse acetabular ligament look like?

A

Bridges through acetabular notch

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62
Q

What are 6 factors that act to increase stability of the hip joint?

A 
Cup shaped acetabulum
Acetabular labrum that deepens the acetabulum 
Capsule 
Ligament teres 
Extracapsular ligaments 
Muscles surrounding the joint
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63
Q

What are the 3 nerves that innervate the hip joint and from which direction?

A

Sciatic nerve posteriorly
Femoral nerve anteriorly
Obturator nerve inferiorly

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64
Q

What are the 2 arteries that make up the extracapsular arterial ring?

A

Medial femoral circumflex artery and lateral femoral circumflex artery

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65
Q

What artery does the ligamentum teres contain?

A

Artery of ligamentum teres

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66
Q

What plexus does the lower limb receive its nerve supply from?

A

Lumbosacral plexus

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67
Q

What spinal nerves make up the lumbar component of the lumbosacral plexus?

A

Anterior rami of L1-4 spinal nerves

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68
Q

What are the 5 branches of the lumbar plexus and their root values?

A 
Ilioinguinal L1 
Genitofemoral L1 L2 
Lateral femoral cutaneous L2 L3 
Obturator L2 L3 L4 
Femoral L2 L3 L4
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69
Q

What root value is the ilioinguinal nerve?

A

L1

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70
Q

Where does the ilioinguinal nerve innervate?

A

Skin of genitalia and upper medial thigh

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71
Q

What roots does genitofemoral nerve have?

A

L1 and L2

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72
Q

What 2 branches does the genitofemoral nerve divide into?

A

Genital and femoral

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73
Q

Where does the femoral branch innervate?

A

Skin on upper anterior thigh

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74
Q

What roots does the lateral femoral cutaneous nerve have?

A

Posterior divisions of L2 and L3

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75
Q

What kind of function does the lateral cutaneous nerve have?

A

Sensory

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76
Q

Where does the lateral cutaneous nerve provide sensation to?

A

Anterolateral thigh as far inferiorly as the knee

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77
Q

What roots does the obturator nerve have?

A

Anterior divisions of L2 L3 and L4

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78
Q

Where does the obturator nerve innervate?

A

Medial thigh

79
Q

What roots does the femoral nerve have?

A

Posterior divisions of L2 L3 and L4

80
Q

Where does the femoral nerve innervate?

A

Anterior compartment

81
Q

What roots is the sacral plexus made up of?

A

Anterior rami of S1 S2 S3 S4 S5 and a contribution from lumbosacral trunk

82
Q

What is the lumbosacral trunk?

A

L4 anterior ramus combines with L5 anterior ramus that goes into the sacral plexus

83
Q

What are the 5 branches of the sacral plexus and their root values?

A 
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
84
Q

What root values does the superior gluteal nerve have?

A

L4
L5
S1

85
Q

What are the 3 areas that the superior gluteal nerve innervates?

A

Gluteus medius
Gluteus minimus
Tensor fascia lata

86
Q

What root values does the inferior gluteal nerve have?

A

L5 S1 S2

87
Q

What muscle does the inferior gluteal nerve innervate?

A

Gluteus Maximus

88
Q

What root values does the posterior cutaneous nerve of the thigh have?

A

S1
S2
S3

89
Q

Where does the posterior cutaneous nerve of the thigh innervate?

A

Skin of posterior thigh and leg

90
Q

What is the nerve and vessel that exits the pelvis through the greater sciatic foramen superior to the piriformis muscle?

A

Superior gluteal nerve

91
Q

What are 5 nerves that exit the pelvis via the greater sciatic foramen inferior to the piriformis muscle?

A 
Sciatic 
Inferior gluteal 
Posterior femoral cutaneous 
Nerve to quadratic femoris 
Nerve to obturator internus
92
Q

What are the 4 structures that pass through the lesser sciatic foramen?

A

Tendon of obturator internus
Nerve to obturator internus
Pudendal nerve
Internal pudendal vessels

93
Q

What are the 5 root values of the sciatic nerve?

A 
L4
L5
S1
S2
S3
94
Q

What are the 2 divisions of the sciatic nerve?

A

Tibial nerve

Common fibular nerve

95
Q

What kind of muscle does the tibial nerve supply?

A

Hamstring

96
Q

What does the common fibular nerve supply?

A

Short head of biceps femoris in the posterior thigh

97
Q

How do you find the ventrogluteal injection site?

A

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

98
Q

Where is the dorsogluteal injection site?

A

Upper outer quadrant of gluteal region

99
Q

What is fascia lata?

A

Deep fascia of the thigh

100
Q

What is the function of the saphenous opening in the fascia lata?

A

Entry point for saphenous vein and lymphatic vessels draining into superficial inguinal lymph nodes

101
Q

What is the iliotibial tract?

A

Thickened fascia lata at its lateral aspect running from iliac crest to lateral tibial condyle

102
Q

What is the tensor fascia lata?

A

Muscle originating from anterior superior iliac spine between the 2 layers of iliotibial band of fascia lata

103
Q

What is the tensor fascia lata innervated by?

A

Superior gluteal nerve

104
Q

What is the function of tensor fascia lata?

A

Stabilizes hip in extension by pulling on iliotibial tract

105
Q

What are the 2 main groups of muscles in gluteal region?

A

Superficial

Deep

106
Q

What is the function of superficial gluteal muscles?

A

Large muscles that abduct and extend the thigh

107
Q

What are the 4 superficial gluteal muscles?

A

Gluteus Maximus
Gluteus minimus
Gluteus medius
Tensor fascia lata

108
Q

What is the function of deep gluteal muscles?

A

Smaller muscles acting to laterally rotate the femur

109
Q

What are the 5 deep gluteal muscles?

A 
Piriformis 
Gemellus superior 
Obturator internus 
Gemellus inferior 
Quadratus femoris
110
Q

What are the 2 arteries that supply gluteal muscles?

A

Superior and inferior gluteal arteries

111
Q

Where does the gluteus maximus originate from?

A

Posterior surface of ilium, sacrum and coccyx

112
Q

What are the 2 functions of the gluteus Maximus?

A

Main Extensor and assists with lateral rotation

113
Q

What is the gluteus maximus innervated by?

A

Inferior gluteal nerve

114
Q

Where is the gluteus Maximus located?

A

Most superficial part of buttock

115
Q

Where is the gluteus medius located?

A

Between gluteus Maximus and minimus

116
Q

Where does the gluteus medius originate from?

A

Posterior surface of ilium

117
Q

Where does the gluteus medius insert into?

A

Lateral surface of greater trochanter

118
Q

Where does the gluteus Maximus insert into?

A

Iliotibial tract and gluteal tuberosity of femur

119
Q

What is the function of gluteus medius?

A

Abducts and medially rotates lower limb

120
Q

What is the gluteus medius innervated by?

A

Superior gluteal nerve

121
Q

Where does the gluteus minimus originate?

A

Ilium

122
Q

Where does the gluteus minimus insert?

A

Anterior aspect of greater trochanter

123
Q

What is the function of the gluteus minimus?

A

Abducts and medially rotates lower limb

124
Q

What is the gluteus minimus innervated by?

A

Superior gluteal nerve

125
Q

What happens when the superior gluteal nerve is injured?

A

Gluteus medius and minimus affected, weakness in abducting thigh at hip

126
Q

What are 4 possible causes of superior gluteal nerve injury?

A

Surgery complication
Injections to buttocks
Fracture of greater trochanter
Dislocation of hip joint

127
Q

How do you test for superior gluteal nerve injury?

A

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

128
Q

What is the general action of deep gluteal muscles?

A

Laterally or externally rotate lower limb

129
Q

Why is piriformis a landmark?

A

Sciatic nerve emerges from pelvis inferior to it

130
Q

Where does the piriformis originate?

A

Anterior surface of sacrum

131
Q

Where does the piriformis travel through?

A

Greater sciatic foramen

132
Q

Where does the piriformis insert?

A

Superior aspect of greater trochanter of femur

133
Q

What are 2 actions of the piriformis?

A

Lateral rotation and abduction

134
Q

What nerve innervates the piriformis?

A

Nerve to piriformis

135
Q

What does the obturator internus originate from?

A

Medial surface of obturator membrane in obturator foramen

136
Q

Where does the obturator internus travel through?

A

Lesser sciatic foramen

137
Q

Where does the obturator internus insert?

A

Posterior aspect of greater trochanter, below piriformis and superior gemellus

138
Q

What is the actions of the obturator internus?

A

Lateral rotation and abduction

139
Q

Which nerve innervates the obturator internus?

A

Nerve to obturator internus?

140
Q

What is the structure that separates the superior and inferior gemellus?

A

Obturator internus tendon

141
Q

Where does the superior gemellus originate from?

A

Ischial spine

142
Q

Wherre does the inferior gemellus originate from?

A

Ischial tuberosity

143
Q

Where does the superior gemellus insert?

A

Posterior aspect of greater trochanter, above obturator internus

144
Q

Where does the inferior gemellus insert?

A

Below obturator internus

145
Q

What are the actions of the superior and inferior gemellus?

A

Lateral rotation and abduction

146
Q

What is the superior gemellus innervated by?

A

Nerve to obturator internus

147
Q

What is the inferior gemellus innervated by?

A

Nerve to quadratus femoris

148
Q

Where does the quadratus femoris originate from?

A

Lateral aspect of ischial tuberosity

149
Q

Where does the quadratus femoris insert?

A

Quadratus tubercle on the intertrochanteric crest

150
Q

What is the function of the quadratus femoris?

A

Lateral rotation

151
Q

What is the quadratus femoris innervated by?

A

Nerve to quadratus femoris

152
Q

Where does the obturator externus originate from?

A

External surface of obturator membrane

153
Q

Where does the obturator externus insert?

A

Posterior aspect of greater trochanter

154
Q

What are the 2 functions of obturator externus?

A

Abduction and lateral rotation

155
Q

What is the obturator externus innervated by?

A

Obturator nerve

156
Q

What are hamstrings?

A

Muscles in posterior compartment of thigh

157
Q

What are the 3 muscles of hamstrings?

A

Biceps femoris
Semitendinosus
Semimembranosus

158
Q

What are the functions of hamstrings?

A

Extend lower limb at the hip and flex it at the knee

159
Q

What are hamstrings innervated by?

A

Tibial part of sciatic nerve except short head of biceps femoris

160
Q

What are the 2 heads of the biceps femoris?

A

Long and short heads

161
Q

Where does the long head of biceps femoris originate from?

A

Ischial tuberosity of pelvis

162
Q

Where does the short head of biceps femoris originate from?

A

Linea aspera on posterior surface of femur

163
Q

What are the 3 functions of biceps femoris?

A

Flex knee
Extends thigh at hip
Laterally rotate hip and knee

164
Q

What is the long head innervated by?

A

Tibial part of sciatic nerve

165
Q

What is the short head innervated by?

A

Common fibular part of sciatic nerve

166
Q

Where is the semitendinous located?

A

Medial to biceps femoris and superficial to semimembranosus

167
Q

Where does the semitendinosus originate from?

A

Ischial tuberosity

168
Q

Where does the semitendinosus insert on?

A

Upper medial aspect of tibia

169
Q

What are the 4 functions of semitendinosus?

A

Flex leg at knee
Extend thigh at hip
Medially rotate thigh at hip
Medially rotate leg at knee

170
Q

What is the semitendinosus innervated by?

A

Tibial part of sciatic nerve

171
Q

Where is the semimembranosus located?

A

Deep to semitendinosus

172
Q

Where does semimembranosus originate from?

A

Ischial tuberosity

173
Q

Where does semimembranosus insert?

A

Medial tibial condyle

174
Q

What are the 4 functions of semimembranosus?

A

Flex leg at knee
Extent thigh at hip
Internally rotate thigh at hip
Internally rotate leg at knee

175
Q

What is the semimembranosus innervated by?

A

Tibial part of sciatic nerve

176
Q

What is osteoarthritis?

A

Degenerative disorder arising from breakdown of articular hyaline cartilage

177
Q

What are 5 risk factors of primary osteoarthritis?

A 
Age 
Female sex
Ethnicity
Genetics
Nutrition - lack of vit C and E
178
Q

What are 5 symptoms of osteoarthritis in a joint?

A 
Joint stiffness
Pain in hip, gluteal and groin radiating to knee 
Mechanical pain 
Crepitus
Reduced mobility
179
Q

What are 4 limitations placed on daily living activities for patients with osteoarthritis?

A

Difficulty walking
Difficulty putting on socks and shoes
Difficulty getting in and out of car
Difficulty getting out of the bath

180
Q

What are the 4 signs of OA on X-rays?

A

Reduced joint space
Subchondral sclerosis
Bone cysts
Osteophytes

181
Q

Why does hyaline cartilage initially swell during osteoarthritis?

A

Increased proteoglycan synthesis by chondrocytes, with increased number of chondrocytes differentiating from chondroprogenitor cells

182
Q

Why is there loss of joint space during osteoarthritis?

A

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

183
Q

How does subchondral sclerosis occur in osteoarthritis?

A

Subchondral bone gets vascular invasion and increased cellular Katy, becoming thickened and denser at areas of pressure

184
Q

How does subchondral bone cysts form during osteoarthritis?

A

Traumatized subchondral bone undergoes cystic degeneration to form subchondral bone cysts

185
Q

How do osteophytes form during osteoarthritis?

A

Irregular outgrowth of new bone

186
Q

What is the definition of fractured neck of femur?

A

Fracture of proximal femur, up to 5cm below the lesser trochanter

187
Q

What are the 2 types of #NOF?

A

Intracapsular

Extracapsular

188
Q

What kind of neck of femur fracture is more likely to have implications on blood supply of femoral head?

A

Intracapsular fracture

189
Q

Why is intracapular fracture more likely to affect blood supply of femoral head?

A

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

190
Q

What are 3 symptoms of #NOF?

A

Reduced mobility
Sudden inability to bear weight on limb
Pain in hip, groin or knee

191
Q

How does a displaced NOF fracture look like upon examination?

A

Affected leg is shortened, abducted and externally rotated

192
Q

What is the definition of a hip dislocation?

A

Head of femur fully displaced out of acetabulum

193
Q

What is the most common type of hip dislocation?

A

Posterior

194
Q

How does a posterior dislocation of the hip look like upon examination?

A

Shortened, flexion, addiction and internal rotation

Musculoskeletal System (9 decks)

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