The Hip - Anatomy, Arthritis and Trauma Flashcards
What makes up the sacrum?
The lower, sacral vertebrae and a bit of the ilium.
What makes up the acetabulum and the Obturator foramen of the pelvis?
The acetabulum is formed by the ilium, ischium and pubis and the Obturator foramen is made by just the ischium and pubis.
What can you see looking at the femur posteriorly?
A posterior view of the femur shows the head, then neck then greater and lesser trochanter separated by the intertrochanteric crest (intertrochanteric line anteriorly). The gluteal tuberosity, from the greater trochanter runs down to make the linear aspera with medial and lateral lips.
Name some bony landmarks of the ilium.
Iliac crest, anterior superior iliac spine, posterior superior iliac spine, posterior inferior iliac spine and anterior inferior iliac spine and the iliac fossa (medial).
Where is the ischial tuberosity, in relation to the lesser sciatic notch and the ischial spine?
The ischial tuberosity is later,a posterior. Superior to the ischial tuberosity is the lesser sciatic notch and then the ischial spine. The ischium is generally posterior to the pubis.
The inferior and superior pubic rami are either side of what?
Either side of the pubic tubercule (pubic symphysis when viewed medially).
Where is there articulation of the pelvis?
Articulation at the pubic symphysis at interpubic disk with some movement. Also articulation at the sacroiliac joint and the hip joint (deepened by acetabular labrum).
Blood supply:
The external iliac artery becomes the femoral vein when it passes under the _________ ________ then has which branches (?) before going passing through the adductor hiatus in adductor ________. The _______ saphenous vein is medial and the ______ saphenous vein is lateral. The great saphenous vein is outside the _______ _____ before it drains into the femoral vein. Tibial veins go to ___________vein which goes to the femoral vein (joined by internal deep femoral vein).
Inguinal ligament Branches: deep artery of thigh/profundus femoris, medial (supplies head and neck of femur) and lateral circumflex arteries and then various perforating arteries Magnus Great Small Fascia lata Popliteal
Where do the 3 main nerves pass in the thigh?
The femoral nerve (L2-4 knee extension), passes under the inguinal ligament and is lateral in the femoral triangle.
The Obturator nerve (L2-4 hip adduction) passes through the Obturator foramen.
The Sciatic nerve (L4-S3) is big and passes medial and posterior.
The ball and socket hip joint has a great range of movement, but needs to be stabilised by ligaments, which ones (intracapsular and extracapsular)?
Intracapsular: ligament of the head of the femur (acetabular fossa to fovea of femur), which encloses a branch of Obturator artery (artery to the head of the femur).
Extracapsular (continuous with capsule) 3: Iliofemoral ligament (anterior iliac spine to intertrochanteric line, Y shaped, prevents hyperextension), Ischiofemoral (posterior body of ischium to greater trochanter, spiral, prevents excessive extension) and Pubofemoral (superior pubic rami to intertrochanteric line, triangular, prevents excessive abduction and extension).
Bearing in mind that the hip joint is stabilised by the 3 thickenings of the capsule and ligamentum Teres (intracapsular), what are the ranges of motion possible?
Flexion: 70-140 degrees, Extension: 4-15 degrees, Adduction: 20 degrees, Abduction: 30 degrees, Internal rotation: 70 degrees and External rotation: 90 degrees.
What are the 2 primary hip flexors? Describe them.
Psoas major - lumbar vertebrae to lesser trochanter - anterior rami of L1-3.
Iliacus - iliac fossa to lesser trochanter - femoral nerve.
Iliopsoas assists in lateral rotation.
Name and describe 2 assisting hip flexors (assisting Iliopsoas) that start with p and r.
Pectineus - base of femoral triangle - pectineal line on anterior pelvis to pectineal line on posterior - femoral nerve (and branch from Obturator) - also adducts.
Rectus femoris - one of the quadriceps - ilium just superior to acetabulum to patella by quadriceps femoris tendon (runs straight down) - also extends the knee - femoral nerve.
Name and describe 2 assisting hip flexors (assisting Iliopsoas) that start with s and t.
Sartorius - longest muscle, runs inferomedially and is superficial from anterior superior iliac spine to medial surface of tibia - femoral nerve.
Tensor fascia lata - gluteal muscle - also abducts and internally, rotates (and tenses fascia lata) - from the iliac crest it inserts into the anterior aspect of the iliotibial tract (1/3 down thigh) and gluteal tuberosity of femur (longitudinal thickening of fascia) - superior gluteal nerve.
Describe the gluteal muscle that is used for hip extension.
Gluteus maximus starts at the gluteal/posterior surface of the ilium, sacrum and coccyx then slopes down at a 45 degree angle to insert into the iliotibial tract and gluteal tuberosity of the femur - inferior gluteal nerve - only used when force is required e.g. In running or climbing - and can laterally rotate.
Hamstrings:
Innervated by _______ N. _________ ________ is the most lateral from ischial tuberosity of pelvis and linea aspera of femur and inserts onto the head of fibula - flexes at the knee. The _____ head innervated by the ______ N. and the _____ head by the ______ _______ N.
Sciatic
Biceps femoris
Long - tibial
Short - common fibular
Semitendinosus and semimembranosus are both hamstring muscles which flex the knee, medially rotate and are innervated by the tibial nerve, what’s the difference?
Semitendinosus runs from the ischial tuberosity to the medial surface of the tibia. It covers the more medial semimembranosus , which comes more superiorly from the ischial tuberosity and runs to the medial condyle of the tibia.
Describe the 2 hip abductors.
Gluteus medius is fan shaped and runs from the gluteal surface of the ileum to the lateral surface of the greater trochanter; it also medially rotates and during locomotion, secures the pelvis to prevent a drop in the contralateral limb.
Gluteus minimus originates from the ilium and converges to form a tendon attaching to the anterior greater trochanter. It has the same movements and they’re both innervated by the superior gluteal nerve.
Name 2 muscles in the thigh that adduct it, excluding the ‘adductor’ muscles.
Pectineus and gracillis.
Explain the adductor muscle with a dual function.
Adductor Magnus lies to the posterior of the medial compartment. The half of it that’s a hamstring part goes from the ischial tuberosity to the adductor tubercule and medial supracondylar line of the femur, is innervated by the tibial nerve and also extends the thigh. The adductor half comes from the inferior rami of the pubis and rami of the ischium to the linea aspera and is innervated by the Obturator nerve and also flexes. Both adduct.
Both the Adductor longus and the adductor brevis adduct and are innervated by the Obturator nerve, how can you distinguish between them?
The Adductor longus partially covers the others and makes up the medial border of the femoral triangle. It comes from the pubis, fans and then inserts into the linea aspera and medially rotates.
The adductor brevis lies between the anterior posterior divisions of the Obturator nerve, coming from the body of the pubis and inferior pubic rami to the linea aspera, proximal to Adductor longus.
