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anatomy of the limbs > the hip buttock and thigh > Flashcards

the hip buttock and thigh Flashcards

1
Q

describe the twisting of the knee joint during development *

A

there is permenant pronatoion mid thigh

everything below is back to front

nerve supply is what it would be if the posterior compartment was the anterior compartment ie before rotation

it means flexion and extension are differnt

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2
Q

what are the 2 major compartments of the lower limb *

A

gluteal regon - part of trunk

free lowr limb = thigh, leg and foot

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3
Q

which direction and what roots is extension and flexion of the hip *

A

flexion forward - l2, 3

extension l4 5 backward

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4
Q

what roots control lateral and medial rotation of the hip *

A

medial - l1 2 3

lateral = l1 5

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5
Q

what are the bones of the hip, buttock and thigh *

A

pelvis - hip bone (ishium, ilium, pubis)

the femer

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6
Q

what is the leg

A

region between knee and ankle

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7
Q

describe the hip bone *

A

ileum is the flat bone - ala of ileum is the posterior part, iliac fossa is the anterior part

pubis is anterior - body is in the midline, and have superiuor and nerior ramus

ishium is posterior

ishium has ishial spine an dischial tuberosity for attachment of the bony ligaments - boundary between anterior and posterior pelvsi

acetabulum is the hip joint, made of all 3 bones - articulation with the femer - fossa in middle not part of teh artiiculation

ileum has articulation for the sacrum - sacroiliac joint

identify: ASIS, AIIS, PISI, PIIS, iliac crest, iliac fossa, iliac part of acetabulum, body of ishium, ishial tuberosity, ramus of ishium, obturator foramen, greater sciatic notch, lesser sciatic notch, ischial spine, ischial part of acetabulum, superior pubic ramus, inferior pubic ramus, pubic crest, pubic tubercle, pubic portion of acetabulum, acetabular notch, acetabular fossa, lunate fossa

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8
Q

how can you tell which part of the bone ossificated separately

A

the cartilage during development

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9
Q

describe the femer bone *

A

long straight shaft

head is hemisherical covered in hyaline cartilage - articulates with acetabulum

greater and lesser trochanter (proterbances) and intertrochanteric line anteriorly, and intertrochanteric crest posteriorly

on back of shaft is linea aspera formed from the ridges of the epicondyles

anterior surface is smooth and concave

patella articulates the intercondylar region - is a sesamoid bone - formed within tendon where muscle is going to move over the surface of the bone to minimise friction

medial and lateral epicondyles

medal and lateral conduyles that articulate with the tibia plateau - hagve intercondylar fossa

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10
Q

common places for head of femer fracture *

A

most common at femoral neck

intertrochanteric fracture

(fractures becoming more important with aging population )

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11
Q

describe the ligamentous anatomy of the pelvis *

A

sacrotuberous ligament goes from sacrum to ishial tuberosity - forms the greater sciatic foramen

sacrospinous ligament goes from the the sacrum to ischia spine - forms lesser sciatic foramen

the foramen formed allow structures to pass between anterior and posterior

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12
Q

describe the fascia of the buttock, thigh *

A

there are 2 layers

  • superficial - subcut tissue
  • deep - called fascia lata (holds all the muscle compartments in it)

the fascia lata has a thickened area called the ilio-tibial tract - this merges with fascia across the knee

fibres from glut max merge with the fascia lata

distal attachement of tensor fascia latea os fascia lata

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13
Q

what are the muscular compartments of the hip, buttock and thigh *

A

gluteal compartment

anterior compartment of the thigh

medial ‘’

posterior ‘’

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14
Q

what are the muscles of the gluteal region and what are their overall functions *

A

func - extensors, abductors, external rotators of the hip

gluteal muscles

  • gluteus maximus
  • gluteus medius
  • gluteus minimus
  • (tensor fascia lata) - neurologically gluteal, but function more anterior

short lateral rotators of the hip - hold head of femer into acetabulum to stabalise joint (also lateral rotation)

  • piriformis
  • obturator internus
  • the gemelli (superior and inferior)
  • quadratus formis
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15
Q

describe gluteus maximus *

A

biggest muscle in body

course fibres - not involved in fine movement

most superficial muscle in the gluteal region

origin - fascia covering gluteus medius, ileum behind posterior gluteal line, fascia of erector spinae, dorsal surface of lower sacrum, coccyx and sacrotuberous ligament

superficial 3/4 attachs to ilio-tibial tract

deep distal 1/4 attaches to gluetal tuberosity of femer

extensor of hip joint, laterally rotates thigh, adductor of thigh

fibres of the iliotibial tract stabalise a fully extended knee

blood - unferior and superior gluteal artery

nerve - inferior gluteal nerve - L5 s1 2

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16
Q

describe teh tesnor fasciae latae *

A

tense fascia

stabalise knee as it acts across it

origin - lateral aspect of crest of ileum between ASIS and tubercle of crest

insertion - iliotibial tract below greater trochanteur

action - hip flexion, medial rotate and abduct a flexed thigh, tense iliotibial tract to support femer on tibia in standing

blood - superior gluteal a, lateral femoral circumflex a

nerve - superior gluteal l4 5 s1

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17
Q

describe the gluteus medius and minimus *

A

originate from ileum and gluteal aponeurosis, the fibres cross laterally and attach at the greater trochanter of the humerus (minimis also attaches to anterior capsule of hip joint)

abduct - important in stabalising gait

adduct and medially rotate the thigh, posterior fibres may laterally rotate the thigh

blood - superior gluteal artery

nerve - superior gluteal nerve l4 5 s1

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18
Q

describe the piriformis *

A

comes off the anterior surface of sacrum

attaches to the medial side of the superior greater trochanter

lateral rotation of extended thigh, abducts a flexed thigh

blood - superior and inferior gluteal a

nerve - nerve to piriformis

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19
Q

describe the lateral rotators of the hip *

A

attacg around the hip joint

lateral rotation

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20
Q

describe obturator internus (lateral rotator) *

A

comes form the obturator foramen and membrane then moves at an angle

attach to medial side greater trochanter through lesser sciatic foramen

laterally rotates femer, abducts thigh when flexed

blood - inf gluteal a

nerve - nerve to obturator internus l5l s1 2

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21
Q

image of superficial gluteal muscles *

A
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22
Q

image of deep gluteal muscles *

A
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23
Q

what are the muscles of the anterior compartment of the thigh and their generic function *

A

hip flexors and knee extensors

pectineus

ilio-psoas

(tensor fasciae latae)

sartorius

guadiceps femoris

  • rectus femoris
  • vastus medialis
  • vastus intermedius
  • vastus lateralis
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24
Q

describe pectineus *

A

muscle of the groin

attach to superior ramus of pubic bone and superior part of pectineal line fo femer

flexor and adduction

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25
Q

describe iliopsoas *

A

muscle from pelvis

psoas major which attachs to lumbar spine from T12-L5, and iliacus which attaches to iliac fossa come together, pass under inguinal ligament and attach to lesser trochanter as the iliopsoas tendon

they are flexors - hip flexion and lateral rotation

blood - muscular branch of medial femoral circumflex artery

nerve - femoral - psoas major - L1 2 3, iliacus - l3 4

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26
Q

describe sartorius *

A

flex knee and abduct thigh

go from ASIS to medial side of knee - attach below knee at shaft of the tibia inferomedial to the tibial tuberosity

course is anterior and medial

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27
Q

describe the quadriceps femoris *

A

extensors of knee,

rectus femoris can flex hip

rectus femorus attaches across hip joint

vastus lateralis can abnormally displace patella

vastus stay within the thigh

at knee the fibres converge and attach at the patella (patella embedded in ligament that they form) - ligement continues to tibial tuberosity as the patella ligament attach at the tibial tuberosity

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28
Q

identify muscles on a cross sectoion through the thigh

A
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29
Q

describe the bursas of the knee joint *

A

little sacs

some continuous wit the joint cavity nd others are separate

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30
Q

what are the muscles and their functoion fo the medial compartment of the thigh *

A

hip adductors

adductor longus

adductor brevis

adductor magnus

gracilis

obturator externus

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31
Q

describe the attachments of the medial compartment of the thigh *

A

attach around the pubiuc bone

distal attachment on posterior shaft of femer - to linea aspera

adductor longus - comes of crest of pubis to femur

gracilis - strap muscle from inferior ramus of pubis, external surface of body of pubis and ramus of ishium; and attaches to medial surface of shaft of the tibia across the knee

adductor magnus has 2 compartments - medial is an adductor, posterior is a hamstring

  • adductor attaches to ischiopubic ramus to posterior surface of the prox femer, linea aspera and medial supracondylar line
  • hamstring - ischial tuberosity to adductor tubercle and supracondylar line

adductor magnus has a broad attachment on femer’s linea aspera, then there is a gap called the adductor hiatus, then small attachment at adductor tubercle

adductor brevis - external surface of body of pubis and inferior pubic ramus to posterior surface of femur and linea aspera

obturator externus - external surface of obturator foramen and membrane to greater trochanter(trochanteric fossa)

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32
Q

what is teh importance of teh addductor hiatus *

A

for structures to pas through

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33
Q

what are the muscles of the posterior compartment of the thigh, and what is the function *

A

knee flexors and hip extensors

the hamstrings:

semimembranosus

semitendinosus

biceps femoris

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34
Q

describe the attachment of teh posterior thigh muscles *

A

from ishial tuberosity

except short head of biceps - comes off posterior of femer (linea aspera)

semitendinosis and semimembrinosis stay medial - course is across knee - attach to medial epicondylar region of the tibia, semimembranous attach to medial condyle

long head of the biceps femoris - runs laterally and is joined by fibres from the short head coming from the inferior linea aspera and supracondylar ridge of femer - they form a common tendon that cross knee joint to insert into head of fibula

biceps femoris attaches to head of fibula

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35
Q

how can you tell the difference between the semimembranosus and semitendinosus

A

tendonosus has a rope like tendon

membranosus - strap

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36
Q

what is the outline of the femoral triangle *

A

superior - inguinal ligament

medial - lateral edge of teh adductor longus

laterally - medial edge of sartorius

(covered by the fascia lata)

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37
Q

what does the femoral triangle contain *

A

femoral nerve

femroal artery

femoral vein

important lymph nodes

(order is NAVY Y being y fronts)

(the femoral sheath encloses teh femoral artery and vein - a portion of it medially forms the femoral canal

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38
Q

what is the saphenous opening *

A

where the long saphenous vein pierces the fascia lata nad drains into the femoral vein

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39
Q

alternative names for the adductor canal

A

hunter’s canal

subsartorial canal

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40
Q

where does the adductor canal run and what is it lined by *

A

extends along the medial aspect of the thigh from apex of femoral triangle and at adducter hiatus

formed by:

  • vastus medialis anteriorly
  • adductor longus nd adductor magnus posteriorly
  • sartorius medially
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41
Q

what does the adductor canal contain *

A

the femoral artery

femoral vein

saphenus nerve (this is a terminal branch of the femoral nerve which gives off branches, not long after entering the femoral triangle)

they run under satorius

they pass through the adducter meatus and enter the politeal fossa

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42
Q

what are the features of the gluteal region *

A

greater and lesser sciatic notches (parts of the ishial bone)

greater foramen and lesser sciatic foramen

sacrotuberus ligament

sacrospinous ligament

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43
Q

purpose of the greater and lesser sciatic foramen *

A

greator - structures pass from pelvis to thigh

lesser - from pelvis to perineum

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44
Q

describe the path of the sciatic nerve *

A

pass from pelvis to buttock through the greater sciatic notch/foramen

usually enters gluteal region inferiorly to the piriformis muscle but can be supperior/pierce the muscle

in buttock lies in inferior and medial quadrant

pass along posterior aspect of thigh

divides into tibial and common perineal nerve (this is at an inconsistant level)

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45
Q

what does the sciatic nerve supply *

A

hamstring muscles

its divisions supply all muscles below the level of the knee

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46
Q

what goes superior ro the pirmormis when entering the gluteal region *

A

superior gluteal nerves and vessles

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47
Q

describe the safe area for IM injections*

A

to avoid hitting the sciatic nerve (and superior gluteal nerve and vessels) during IM injection

inject into upper lateral quadrant of buttox - into the gluteus mediaus muscle

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48
Q

describe the trendelenburg test *

A

the abductors of the thigh prevent the tilting of the pelvis when a limb is raised so you dont fall

when there is paralysis of a thigh abductor - the pelvis tilts and pt waddles

subject asked to stand on both legs - R and L pelvis should remain at the same level w/o any tilt - examiner should stand behind and feel pelvis

then pt should raise 1 leg - pelvis should remain horizontal

if pelvis on raised leg drops down - the test is positive - shows weakness of motor fuction of abductor muscles - glut max and med in leg standing on

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49
Q

describe the hip joint *

A

it is a synovial ball and scoket joint

between head of femer and acetabulum

all 3 bones of pelvis contribute

the acetabular labrum is a im of cartilage that deepens the socket

the deficiency in bone of the acetabulum is made up for by the transverse acetabular ligament - it is continuous with the acetabular labrum and attaches to the head of the femer

the ligament of the head of the femer attaches to the head of the femur at the fovea

teh acetabular fossa is full of fibro-fatty tissue - not actually involved in the joint

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50
Q

describe the capsule of the hip joint *

A

extends down the neck of the femur it extends further anteriorly than posteriorly

within the capsule runs the blood supply of the femer head

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51
Q

classification of hip fractures *

A

intracapslar

extracapsular

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52
Q

what are the ligaments of the hip joint *

A

ilio-femoral ligament - coming off the ileum and fans to attach to the intertrochanteric line

pubo-femoral ligament off pubis then attach to intertrochanteric line

ischio-femoral ligament - from ischium to intertrochanteric line

the ligament of the head of the femer - not most important for the stabalisation of the joint

the ligaments are arranged spirally - when extend the hip the ligaments tightn up spiral and bring the 2 parts together - pull hip into the pelvis and stabalise the hip

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53
Q

what is the blood supply for the head of the femer *

A

medial and lateral circumflex arteries tehy come distally to supply the head

the artery of the head pof the femer - more important in children

obturator artery is a branch through ligament to head of femur - small supply

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54
Q

what is the consequence pof intracapsular fractures *

A

because main blood supply is coming distally - when fracture only get blood supply form the obturator artery = avascular necrosis of teh femoral head

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55
Q

what are the hip-flexors *

A

–Ilio-psoas

–Sartorius

–Tensor fascia lata

–Rectus femoris

–Adductor longus

–Adductor brevis

–Adductor portion of adductor magnus

–gracilis

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56
Q

what are the hip adductors *

A

–Adductor longus

–Adductor brevis

–Adductor magnus

–Gracilis

–Pectineus

Obturator externus

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57
Q

what are the hip extensors *

A

–The hamstrings – semimembranosus, semitendinosus, biceps femoris

–Posterior part of adductor magnus

–Gluteus maximus

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58
Q

what are the hip abductors *

A

–Gluteus medius

–Gluteus minimus

–Tensor fascia lata

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59
Q

what are teh external hip rotators *

A

–Obturator internus and obturator externus

–The Gemelli

–Piriformis

–Quadratus femoris

Gluteus maximus

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60
Q

what are the hip internal rotators *

A

–Anterior portion of gluteus medius

–Anterior portion of gluteus minimus

–Tensor fascia lata

61
Q

what are the blood vessels of the buttock, hip and thigh *

A

external iliac

femoral - at midinguinal point

(femoral artery lies between femoral nerve which is medial and vein)

profunda femoris artery

circumflex vessles

femoral artery continues as superficial femoral artery and then popliteal artery

62
Q

describe the path of the arteries *

A

abdominal aorta divides into internal and external iliac

external iliac pasess under inguinal ligamnent and becomes femoral - at inguial ligament it is at the mid-inguinal point, ie half way between the ASIS and pubic symphisis

internal iliac branches into obturator artery - supplies some of buttock and medial thigh

femoral gives off profunda femoris artey - deep branch of thigh

both femoral and profunda give off circumflex arteries that supply the hip joint

femoral artey continus behind knee to become the popliteal artery

63
Q

how do the femoral artey and vein pass from the anterior to posterior compartment *

A

through the hiatus of the adductor magnus muscle

64
Q

what are the superficial veins *

A

long saphrenous - runs from the medial border fo the foot - pass up posterior and medial at knee, mediual side of thigh then anterior

joins teh femoral vein at sapheno-femoral junction in saphenous opening of fascia lata in the femoral triangle

there is a valve at the sapheno-femoral junction that prevents blood passing from the deep to superficial system - this valve can be faulty or incompetent in varicose veins

65
Q

what are the deep veins *

A

popliteal

femoral

external iliac

spheno-femoral junction

vanae comitantes of the profunda femoris artery

66
Q

descrieb teh lymph drainage of the region *

A

lymph flows woith the superficial veins

there are superficial inguinal and knee nodes they drain into the deep inguinal lymph nodes and the external iliac nodes

the deep system of lymphatic drainage drains alongside the deep veins to the deep inguinal nodes - these drain into the external iliac nodes

important because they drain the iliac region

67
Q

what is motor nerve supply of anterior compartment of thigh *

A

femoral nerve which is derived from the posterior divisions of lumbar plexus l2 3 4

68
Q

what is the motor nerve supply of the median compartment of thigh *

A

obturator nerve through obturator foramenwhich is derived from the

anterior divisoon of lumbar plexus l2 3 4

69
Q

what supplies posterior thigh, anterior and posterior leg and foot motor*

A

sciatic/ its branchs ie tibial or common perineal which is derived from the lumbo-sacral plexus l3 4 5 s1 2

also supply a lot of superficial cutaneous supply in foot and leg

70
Q

what roots are knee extensors

A

l3 4

71
Q

what root are knee flexors

A

l5 s1

72
Q

what is the motor nerve supply of the gluteal compartment of the thigh *

A

superior gluteal nerve l4 5 s1 - gluteus mediuus and minimus

inferior gluteal nerve l5 s1 2 - gluteus maximus

73
Q

describe teh sensory segmental supply of the region *

A

front of thigh t12 l1 2 3

back of thigh s1 2 3

buttock s2 3 4

74
Q

map the dermatomes of the leg *

A

l3 to knee

l4 to floor

s1 and 2 are posterior

75
Q

ewhat are the nerves for the sensory peripheral supply *

A
  • Subcostal nerve (T12)
  • Ilio-hypogastric nerve (L1)
  • Ilio-inguinal nerve (L1)
  • Genito-femoral nerve (L12)
  • Lateral cutaneous nerve of the thigh (L23)
  • Sensory branches of the femoral nerve (L234)
  • Sensory branches of the obturator nerve (L234)
  • Posterior cutaneous nerve of the thigh (S23)
  • Saphenous nerve (L234)
  • Buttock nerves from the scaral plexus (L1-S3)
76
Q

describe the path of the deep veins *

A

flow into the popliteal vein at the level of the knee

popliteal vein runs along the popliteal and femoral arteries to form the femoral vein

the femoral vein lies medial to femoral artery in groin and then passes beneath the inguinal ligament to form external iliac vein

the femoral vein recieve sthe long saphrenous vein at the sapheno-femoral junction in the groin

proximal to this is recieves the venae comitantes of the profunda femoris artery

77
Q

attachments of gluteus medius *

A

origin - external surface of ileum between anterior and posterior gluteal lines

insertion - lateral surface of greater trochanter

78
Q

attachments of the gamellus superior *

A

external surface of ishial spine

along length of obturator internus tendon and into medial side of greater trochanter with obturator internus tendon

79
Q

attachments of gamellus inferior *

A

ischial tuberosity

along length of obturatir internus tendon and medial side of greater trochanter

80
Q

attachments of quadratus femoris *

A

ishium - anterior to ischila tuberosity

intertrochanteric crest of prox femer

81
Q

attachments of vastus medialis *

A

femur - medial part of intertrochanteric line, pectinal line, linea aspera, medial supracondylar line

quadriceps femoris tendon and medial border of patella

profunda femoris artery, genicular artery

82
Q

attachments of vastas intermedius *

A

femur anterior and lateral surfaces

quadriceps femoris tendon and lateral margin of patella and lateral condyle of tibia

femoral circumflex artery

83
Q

attachments of vastus lateralis *

A

femur - interotrocahnteric line, greater trochanter, gluteal tuberosity, linea aspera, intermuscular septum

quadriceps femoris tendon and lateral margin of patella

femoral circumflex a

84
Q

attachments of rectus femoris *

A

straight head from ASIS, reflected head from ileum superior to acetabulum

quadriceps femoris tendon into patella - tibial tuberosity via the patella tendon

blood femoral circumflex

85
Q

what can be affected in a fracture of the head of the femur *

A

because of the force needed to break the bone it causes damage to the soft tissue ie the musclular compartments and the structures they contain

86
Q

what provides stability for the hip joint *

A

the ligaments of the hip joint

teh acetabulum encompasses the hemi-spherical head of the femer and contributes substantially to stability

the rim of the acetabulum is raised by a fibro-cartilaginous collar - the acetabular labrum

the fibrous membrane that encloses the the hip joint is strong and thick

87
Q

identify the major ligaments of the hip and buttock *

A

pic from dissection

88
Q

where are the superior and inferior gluteal nerves and vessels *

A

pass between the pelvis and buttock

superior - above the piriformis

inferior - below the piriformis

89
Q

where does the posterior cutaneous nerve of the thigh run *

A

on top of the sciatic nerve

90
Q
A
91
Q

describe anteversion of the femoral neck *

A

it is teh angular difference between the axis of the femoral neck and the transcondylar axis of the knee

in adults it is 12degrees

at birth it is around 30-40 degrees

it reduces a degree a year until age 20

a high angle = intoed feet - normal in young children

92
Q

palpate the iliac crest

A

where place hands on top of hips

l4 5

93
Q

palpate ASIS

A

-

94
Q

palpate femoral head

A

at midpoint between ASIS and pubic symphisis/site of femoral artery palpation

95
Q

what level is the iliac tubercle

A

l5

96
Q

palpate PSIS

A

indicated by skin dimple at S2

97
Q

palpate the greater trochanter of the femer

A

bony prominence on the lateral side of the upper thigh about 10cm below iliac crest

98
Q

palpate body of pubis

A

a hands width below umbilicus

99
Q

palpate pubic symphisis and superior pubic ramus

A

-

100
Q

palpate pubic tubercle

A

2cm lateral to pubic symphysis

101
Q

palpate ischial tuberosity

A

on inferior part of buttock when thigh is flexed

102
Q

palpate inferior pubic ramus

A

follow body of pubis inferiorly then continue infero-laterally

103
Q

surface mark the inguinal ligamentr

A

between ASIS and pubic tubercle

104
Q

palpate femoral artery

A

mid inguinal point - between ASIS and pubic symphysis

105
Q

surface mark femoral vein

A

on medial side of femoral artery

106
Q

surface mark femoral nerve

A

on lateral side of femoral artery

107
Q

palpate the gluteal fold

A

the inferior border of the gluteus maximus

extend thigh at hip joint and feel muscle contracting and producing rounded contour of buttock

108
Q

surface mark the gluteal sulcus

A

the visible skin crease separating the buttock and thigh which crosses the true gluteal fold obliquely

109
Q

test the gluteus maximus

A

inferior gluteal nerve - l5 s1 s2

subject lies prone (on front) with knee flexed

ask subject to extend their thigh at hip joint while applying resistance at distal end of thigh

examiner palpates rounded countour of buttock for muscle contraction

110
Q

test the gluteus medius and minimus

A

superior gluteal nerve l5 s1

subject lies on side with lower limb fully extended

ask subject to abduct limb at hip joint while applying resistance at distal end of thigh

examiner palpates contraction of the gluteus medius inferior to the iliac crest

111
Q

test the tensor fascia lata

A

superior gluteal nerve l5 s1

subject lies on side - slightly towards supine

pts legs are extended

ask to abduct and place finger tip on tensor fascia lata muscle and ilio-tibial band

112
Q

test the hamstrings

A

nerve - tibial division of sciatic l5 s1 s2 except for biceps which is common fibular division - l5 s1 s2

subject lies prone with knee flexed to 30degrees

examiner places opposing force just above posterior side of ankle while subject attempts to flex knee further

hamstring tendons will be visible around the popliteal region and muscle contraction is palpable on posterior side of midthigh

113
Q

test the quadriceps

A

femoral nerve l2 3 4

subject sits on couch with knees bent to 90degrees over the edge

the examiner applies pressure over distal part of the leg while subject attempts to extend it

the contracting quadriceps can be palpated on anterior thigh

114
Q

draw the course of the sciatic nerve

A

the nerve leaves teh greater sciatic notch and enters the gluteal region at midpoint between PSIS and ischial tuberosity

it forms a downward curve to pass under the thigh around the midpoint between the greater trochanter and ischial tuberosity before reaching the popliteal fossa

115
Q

identify the safe area for intragluteal injections

A

place index finger on ASIS and middle finger on iliac tubercle - safe area is the area in between

116
Q

joints that do flexion (or plantar flexion(

A

hip

knee

ankle

toes - MCP and IP

117
Q

joints that do extension (dorsi flexion)

A

hip

knee

ankle

toes - MTP and IP

118
Q

joints that do abduction

A

hip

toes - MTP (midline is 2nd toe)

119
Q

joinst that do adduction

A

hip

toes

120
Q

joints that do rotaion

A

hip

in knee there is some passive medial rotation - 5 degrees of the femer on tibia during full extension and active lateral rotation of 5degrees during flexion from a fully extended position

121
Q

joints that do circumduction

A

hip

122
Q

things that can do eversion and inversion

A

foot at subatlar and transverse tarsal joints

eversion - move foot away from median plane - face laterally

inversion - moving sole of foot towards median plane - ie face medially

123
Q

what is true leg length

A

measure the distance between the medial malleolus of ankle and bony fixed part of pelvis eg ASIS on both legs

if discrepancy >1.5cm = discrepancy in true leg length

eg by fractures, congenital, injury

124
Q

how do you measure apparent leg length

A

measure distance between the medial malleolus of ankle and non-fixed landmark eg xiphisternum

measure length on both sides

if difference >1.5cm - discrepancy in apparent (functional)

can be caused by pelvic tilt/rotation, hip joint or sacroiliac abnormalities

125
Q

describe the lunate surface of the acetabulum

A

half moon shape

articulates surface for head of femer

covered in hyaline cartilage

126
Q

significance of the ishial spine

A

pudendal nerve passes over it

127
Q

what type of joint is the pubic symphisis

A

seconadary cartilaginous - there is a fibrocartilage disk

128
Q

what type of joint is the sacro-iliac joint

A

synovial - but doesnt move

129
Q

what is the false and true pelvis

A

above and below the pelvic inlet respectively

130
Q

describe the femoral canal

A

in femoral triangle the artery, vein and lymphatics afre in the femoral sheath

each of the structures surrounded by the sheath is contained in a separate fascial compartment

the medial most is the femoral canal and contains the lymphatics

the opening is weak and is a site for hernias

131
Q

effect of disslocation of the hip joint *

A

damage trhe structures around - labrum, ligaments, muscles, soft tissue, nerves and bv can be damaged

damage to bv = avascular necrosis - can lead to arthritis

patients are unable to move leg and if there is nerve damage - wont have sensation

damage sciatic nerve - loss of mobility of leg and sensation of back of leg

132
Q

attachments of gluteal minimus *

A

external surface of ileum between inferior and posterior gluteal lines

greater trochanter

133
Q

attachments of teh gluteus minimis *

A

external surface of the ileum between inferior and anterior gluteal lines

anterolateral aspect of greater trochanter

134
Q

attachments of the tensor fascia latae *

A

lateral aspect of crest of ileum between ASIS and crest

iliotibial tract

135
Q

attachment of vastus intermedius *

A

femer - anterior and lateral surfaces

quadriceps femoris tendon, lateral margin of patella, lateral condyle of tibia

136
Q

innervation of the posterior compartment of the thigh *

A

sciatic nerve

l5 s1 2

137
Q

what are the nerves for the rotator muscles of the hip joint *

A

nerve to piriformis, nerve to obturator internus, nerve to quadratus femoris

138
Q

innervation of the medial compartment of thigh *

A

obturator nerve

(except pectineus - femoral, and part of adductor magnus - sciatic [tibial])

139
Q

blood supply to the thigh *

A

mainly the profunda femoris artery

140
Q

describe the adductor longus *

A

origin - anterior surface of pubis insert to medial lip of linea aspera on middle half of femur

adducts thigh, flexes thigh, may laterally rotate thigh at hip

blood - muscular branches of femoral a

nerve- obturator L2 3 4

141
Q

action and blood supply of the adductor magnus *

A

adducts thigh, posterior fibres adduct and laterally rotate the thigh

blood - profunda femoris

142
Q

action and blood of adductor brevis *

A

action - adducts thigh, aids in flexion of thigh, may laterally rotate at hip

femoral artery

143
Q

describe the superior gemellus *

A

origin - ischial spine

insertion - medial asoect of greater trochanteur via upper tendon of obturator internus

action - laterally rotates the femer, abducts thigh when flexed

blood - inferior glut a

nerve - nerve to obturator internus l5 s1 2

144
Q

function and blood of obturator externus *

A

laterally rotates thigh, assists in flexion of hip joint

obturator a

145
Q

describe the inferior gemellus *

A

origin - ischial tuberosity

insertion - medial aspect of greater trochanteur via lower tendon of obturator internus

action - laterally rotates femer

inferior glut a

nerve to quadratus femoris - l4 5 s1

146
Q

describe the quadratus femorus *

A

origin - lateral aspect of the ischial tuberosity

insertion - quadrate line - along posterior aspect of femur and interotrochanteuric crest

laterally rotates femer

inferior gluteal a

nerve to quadratus l4 5 s1

147
Q

action and blood of biceps femoris *

A

flexor at knee, laterally rotates thigh if flexed at knee, extends hip

profunda femoris, inferior gluteal a

148
Q

action and blood of semimembrinosis *

A

flex knee, extends hip, medially rotates tibia, pulls medial meniscus posterior during flexion

profunda femoris and inferior gluteal a

149
Q

action and blood of semitendinosis *

A

extends hip, flexes knee, medial rotates tibia

profunda femoris, inferior gluteal a

anatomy of the limbs (14 decks)

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