The Hip, Buttock + Thigh Flashcards
1
Q
Sacroiliac Joint
A
articulation with sacrum
2
Q
Hip
A
Ilium+ ischium +pubis
3
Q
Pubic symphysis
A
articulation with the corresponding hip bone
4
Q
Hip joint
A
Articulation with the head of the femur
5
Q
At what age does the hip bones begin to fuse?
A
Age 15-17yrs
6
Q
At what age does complete fusion of the hip bone takes place?
A
20-25 years
7
Q
Ilium
A
- superior part of hip bone
- largest
8
Q
Wing of the ilium
A
- iliac fossa surface(superior-concave)
- ala
- superior
9
Q
Attachement/ origin of the iliac muscle
A
iliac fossa
10
Q
Attachment of the gluteal muscles
A
- External surface of ilia fossa
- convex
- gluteal surface
11
Q
What is the name of the superior margin of the wind of the ilium called ?
A
iliac crest
-extends from the ASIS to the PSIS
12
Q
Muscles attaching to the ilium
A
- gluteal muscles
- iliacus muscle
13
Q
Palpation of the femoral artery
A
- mid-inguinal point
- halfway between the ASIS and the pibic symphysis
14
Q
Location of the Mid-point of the inguinal ligament
A
halfway between the ASIS and the pubic
15
Q
Pubis
A
- anterior portion of the hip bone
- body+superior rami+inferior rami
16
Q
Obturator foramen
A
obturator nerve , artery and vein passes through
17
Q
superior ramus
A
- extends laterally from the body
- forms part of the acetabulum
18
Q
inferior ramus
A
projects towards and joins the ischium
19
Q
Ischium
A
- posterioinferior part of hip bone
- inferior rams +superior ramus
20
Q
What is the part of the hip bone we sit on ?
A
ischial tuberosity
21
Q
Greater Sciatic Notch
A
nerve + vessels running from the pelvis to the thigh
22
Q
Sacrospinous ligament
A
- runs from the ischial spine to the sacrum
- creates the sciatic foramen
23
Q
Sacrotuberous Ligament
A
- runs from the sacrum to ischial tuberosity
- lesser sciatic foramen
24
Q
Direct trauma
A
fracture to the pelvic bones from or example vehicular accident
25
Forces transmitted from the lower limb
example a heavy fall on the feet
26
What are common sites of fracture of the hip bone
| i.eweaker points of the bones.
- pubic rami
- acetabulm
- sacroiliac joint
27
What is the site of attach,emt for the inguinal ligament?
Anterior Superior Iliac spine
28
What is the arcuate line?
A ridge projected anteriorly and inferiorly form the articular surface
29
Pubis symphysis
a joint between the two pubes of the hip bone which consist of a disc of fibrocartilage .
30
Acetabulum
along with the femoral head it forms the hip joint
31
Acetabular Notch
- forms a foramen through which blood vessels and nerves pass
- point of attachment for ligaments of the femur
32
Femur
- long bone
- longest bone in the body
- transmits forces from the tibia to the hip joint
33
Head of the femur
-articulates with the acetabulum of the pelvis
34
Neck of the femur
connects the head of the femur with the shaft
35
Greater Trochanter
originates from the anterior aspect just lateral to the neck
| -site of attachment for the gluteus medium , gluteus minimum and piriformis
36
Lesser trochanter
-projects from the posteromedial side of the femur
| site of attachment for the posts major and iliac muscles
37
intertrochanteric line
- connects the two trochanters together
| - site of attachment for the iliofemoral ligament
38
intertrochanteric crest
-located on the posterior surface of the femur
39
At what point does the intertrochanteric line becomes the pectineal line?
Afters ot passes the lesser trochanter of the posterior surface
40
Quadrate tubercle
- rounded tubercle on the superior half of the femur
| - attachment of the quadrates femoris
41
Intracapsular Fracture
- elderly women
- minor trip or stumble
- occurs within the capsule
- medial femoral circumflex artery
- avascular necrosis of femoral head
- shorter leg, toes pointing lateral
42
Extra- capsular Fracture
- Common in young and middle age
- blood supply to the head of the femur is intact
- leg shortened and laterally rotated .
43
Linea aspera
- posterior surface of the femoral shaft
| - roughened ridges of bone
44
which border of the line aspera becomes the pectineal line?
medial
45
When the line aspera widens , what does it become?
-forms the floor of the popliteal fossa
46
Fracture of the femoral shaft
- e.g. vehicular accident
- spiral fracture--> leg shortening
- ma have possible disruption of neuromuscular supply.
47
Medial and lateral condyles
- the posterior and inferior surface articulates with the tibia and menisci of the knee
- anterior surface articulates with the patella
48
Medial and lateral epicondyles
- Bony elevations
| - attachment of some muscles and collateral ligaments of the knee joint
49
Intercondylar fossa
- depression on the posterior surface
| - lies between the two condyles
50
Facet for attachment of the posterior cruciate ligament
-medial wall of the intercondylar fossa
51
Facet for attachment of anterior cruciate ligament
-Lateral Wall of the intercondylar fossa
52
To which part of the femur do the lateral rotators of the lower limb attach to?
Greater trochanter
53
Which strong ligament attaches to the intertrochanteric line?
Iliofemoral
54
On which part of the femur can you find the intertrochanteric crest?
Posterior aspect
55
What is the name of the structure to which adductor magnus attaches?
Adductor tubercle
56
Which two structures at the distal end of the femur articulate with the tibia to create the knee joint?
Condyles
57
what is the safest place for giving inter muscular injection in the buttock from the stand point of safe guarding the sciatic nerve ?
-upper left quadrant of buttock
58
Which gluteal muscle is a medial rotator of the femur?
Gluteus medius
59
The sciatic nerve can get irritated and or compressed by which muscle in the gluteal region in certain pathological situation and produce a syndrome with the same name?
Piriformis
60
Which structure in the hip joint helps to increase the depth of the acetabulum and increases its stability ?
Acetabular Labrum
61
A trans-cervica; fracture of femoral neck. What is the most likely complication in the hip?
avascular necrosis of femoral head
62
Which of the following thigh anterior compartment muscle has a dual nerve supply and therefore dual function?
Pectineus
63
Which thigh medial compartment muscle forms the immediate posterior wall of adductor canal?
adductor longus
64
where does the femoral artery become the popliteal artery ?
at the end of the adductor canal
65
Which ligament of the knee joint is a flat band and is attached at its middle to the capsule of knee joint and one of th menisci of the knee joint?
Tibial Collateral Ligament
66
Clergyman's knee refers to what inflammation of which bursa of the knee?
subcutaneous infra-patellar bursa
67
Fovea Capitis
Site of attachment of ligament of head of femur
68
Greater and lesser trochanter
-points of attachment for the tendons of some of the thigh and buttock muscles
69
What is the prominence felt on the widest part of your hip and its function(clinical) ?
- greater trochanter
| - used to locate the site of attachment for IM injection
70
What is supplied by the medial femoral circumflex artery ?
Femoral neck
71
Femoral neck fractures
- intracpauslar
- avascular necrosis
- hemiarthroplasty
- total hip replacment
72
Intertrochanteric Fracture
- does not involve the femoral head
- blood supply preserved
- does not render femoral head ishaemic
- repair usually a femoral plate and pin
73
What type of joint is the hip joint ?
Ball & socket synovial joint
74
Describe the hip joint.
Articulation between the pelvis acetabulum and the head of the femur.
75
What fibrocartilaginous collar is the acetabulum deepened by ?
Acetabular Labrum
76
What is covered in articular cartilage ?
Acetabulum and head of femur
77
Ligament of head of femur
- runs from acetabular fossa to the fovea of the femur
- encloses a branch of the obturator artery
- Intracapsular
78
Iliofemoral Ligament
- Y-shaped
| - prevents hyperextension of hip joint
79
Pubofemoral
- Triangular shape
| - prevents excessive abduction and extension
80
Ischiofemoral
- spiral orientation
| - prevents excessive extension
81
Arterial supply to the hip joint
-medial and lateral circumflex femoral arteries
82
Damage to the medial circumflex artery causes what ?
-Avascular necrosis
83
What is the hip joint innervated by ?
Femoral Nerve, Obturator nerve , Superior Gluteal nerve and nerve to quadrates femoris
84
What are the Flexors of the hip ?
-Iliopsoas ,rectus femoris ,sartorius
85
What are the extensors of the hip?
gluteus maximus, semimembranosus, semitendinosus and biceps femoris
86
What are the abductors of the hip?
gluteus medius, gluteus minimus and the deep gluteals (piriformis, gemelli etc.)
87
What are the adductors of the hip?
adductors longus, brevis and magnus, pectineus and gracillis
88
What muscles laterally rotates the hip?
biceps femoris, gluteus maximus, and the deep gluteals (piriformis, gemelli etc.)
89
What muscles medially rotate the hip?
gluteus medius and minimus, semitendinosus and semimembranosus
90
Posterior Dislocation of the hip
- femoral head moved posteriorly
- tearing of the inferior and posterior joint capsule
- limb shortened and medially rotated
- sciatic nerve at risk
91
Anterior dislocation of the hip
- traumatic extension , abduction and lateral rotation
- femoral head displaced anteriorly
- fractures of the femoral head
92
Superficial Fascia
Blends with the reticular layer beneath the dermis
93
Deep fascia
envelops muscles , bones and neuromuscular structures
94
Visceral fascia
Provides membranous investments that suspend organs within their cavities
95
Where does the fascia lata become the deep fascia of the leg ?
bony prominences of the tibia
96
where is the fascia lata thickest ?
- Along the superolateral aspect of the thigh
| - Around the knee
97
Where is the fascial investment thinnest?
-Where it covers the adductor muscles of the medial thigh
98
What does the deepest aspect of fascia lata give rise to ?
Intermusclar Septa
99
What is the function of the Intermuscular Septa ?
Divides the thigh musculature into three compartment :
1) anterior
2) medial
3) lateral
100
Which is the strongest compartment and why ?
- Lateral compartment
| - receives reinforcement from the iliotibial tract
101
Saphenous opening
An ovoid hiatus present in the fascia lata just inferior to the inguinal ligament
102
What is the purpose of the saphenous opening ?
An entry point for lymphatic vessels and the great saphenous vein
103
What covers the hiatus ?
Cribriform Fascia
104
Iliotibial Tract
-Longitdinal thickening of the fascia lata
105
What strengthens the ITT?
Posteriorly by fibers of the gluteus maximus
106
Location of the ITT
Located laterally in the thigh extending from the iliac tubercle to the lateral tibial condyle
107
Functions of the ITT
- acts as an extensor, abductor and lateral rotator of the hip
- form the lateral intermuscular septum of the thigh and attaches to the femur.
- forms a sheath for the tensor fascia lata muscle.
108
Tensor Fascia Lata
- Gluteal muscle
| - acts as a flexor, abductors and internal rotator of the hip
109
Functions of the tensor fascia lata muscle.
autens the iliotibial band and braces the knee, especially when the opposite foot is lifted.
110
Proximal Attachments of the Fascia lata
- Posterior: sacrum and coccyx
- Lateral: iliac crest
- Anterior: inguinal ligament, superior pubic rami
- Medial: inferior ischiopubic rami, ischial tuberosity, sacrotuberous ligament
111
What does the widen band of fibers of the Fascia aa attach to ?
The widened band of fibres descends the lateral thigh and attaches to the lateral tibial condyle on the anterolateral (Gerdy) tubercle.
112
Inferior Attachment
The fascia lata ends at the knee joint where it then becomes the deep fascia of the leg (the Crural fascia).
113
Superficial abductors and extenders of the gluteal region
gluteus maximus, gluteus medius, gluteus minimus and tensor fascia lata.
114
Deep lateral rotators of the gluteal region
quadratus femoris, piriformis, gemellus superior, gemellus inferior and obturator internus.
115
Gluteus maximus
- Largest gluteal muscle
- most superficial
- produces the shape of the buttocks
116
Actions of the gluteus maximus
- Main extensor of the thigh
- assist with lateral rotation
- Used when running or climbing
117
Innervation of the Gluteus Maximus
Inferior gluteal nerve
118
Gluteus medius
- fan-shaped
| - lies between the G.maximus and minimus
119
Actions of the gluteus medius
abducts and medially rotates the lower limb
120
Innervation of the gluteus medius
superior gluteal nerve
121
Gluteus Minimus
-deepest and the smallest
122
Actions of the gluteus minimus
Abduct and medially rotates the lower limb
123
Innervation of the gluteus minimus
superior gluteal nerve
124
Actions of the tensor fascia lata
Assists the gluteus medius and minimus in abduction and medial rotation of the lower limb.
125
Innervation of the tensor fascia lata
superior gluteal nerve
126
Damage to the superior gluteal nerve
- paralysis of the g.medius and minimus
- stabilizing the pelvis
- steady pelvis
127
Trendelenburg sign
- pt asked to stand on unassisted on each leg in turn
| - pelvic drop will occur on unsupported side
128
Deep muscles of the gluteal region
Piriformis, gemelli, obturator interns , quadrates femoris
129
Piriformis
- landmark in the gluteal region
| - can be used to locate the sciatic nerve
130
Actions of the piriformis
Lateral rotation and abduction
131
Innervation of the piriformis
Nerve to piriformis
132
Obturator Internus
forms the lateral walls of the pelvic cavity
133
Action of obturator internus
lateral rotation and abduction
134
Innervation of the obturator interns
Nerve to obturator internus
135
Superior Gemelli
-triangular muscle
-lateral rotation and -abduction
nerve to obturator internus
136
Inferior Gemelli
- triangular muscle
- lateral rotation nd abduction
- nerve to quadrates femoris
137
Quadratus femoris
- flat, square shaped muscle
- lateral rotation
- nerve to quadrates femoris
138
Whatives the insertion of gluteus maximus?
Gluteal Tuberosity
139
Damage to which nerve gives a positive Trendelenburg sign?
Superior gluteal
140
Which muscle lies between the gemilli?
Obturator internus
141
Which of these muscles is innervated by nerve to obturator internus?
Superior Gemellus
142
What is a positive trendelenburg sign when standing on the right leg?
Drop of left hip
143
The sciatic nerve normally runs directly beneath which deep gluteal muscle?
Piriformis
144
Innervation of the anterior thigh
femoral nerve (L2-L4)
145
Major muscles in the anterior thigh
Pectineus, sartorial and quadriceps femoris
146
Iliopsoas
-made up of two muscles the poses major and the iliacus
147
Actions of the iliopsoas
Flexes the lower limb at the hip joint and assists in lateral rotation at the hip joint.
148
Innervation of the Iliopsoas
The psoas major is innervated by anterior rami of L1-3, while the iliacus is innervated by the femoral nerve.
149
Quadriceps Femoris
-consist of three muscles vastus muscles and the rectus femoris
150
Vastus muscles
Vastus lateralis , vastus intermedius , vastus medialis
151
Vastus lateralis
-extends the knee joint and stabilizes the patella
152
Innervation of the Vastus Lateralis
Femoral nerve
153
Vastus intermedius
- extends the knee joint and stabilizes the patella
| - femoral nerve
154
Vastus medialis
- extends the knee joint and stabilizes the patella
| - femoral nerve
155
Rectus Femoris
- cross both the hip and knee joints
- flexes the leg at the hip joint
- extends at the knee joint
- femoral nerve
156
Sartorius
- longestest muscle in the body
- runs across the thigh in a inferomedial direction
- At the hip joint, it is a flexor, abductor and lateral rotator. At the knee joint, it is also a flexor.
- femoral nerve
157
Pectineus
- dual innervation
- adduction and flexion at the hip joint
- Femoral nerve . May receive a branch from the obturator nerve
158
Testing the quadriceps
- position the pt supine with knee slightly flexed
- ask pt to extend knee against resistance
- if femoral nerve is damaged, contractions of quadriceps femoris will era absent
159
Which muscle of the quadriceps crosses both the hip and the knee joint?
Rectus Femoris
160
Which of the following best describes the function of sartorius at the hip?
Flexion-abduction-lateral rotation
161
Damage to which of these nerve roots would affect the function of the femoral nerve?
L3
162
What are the nerve roots of the nerve which innervates the quadriceps muscles
L2-L4
163
What muscle lays directly on top of the iliac fossa?
iliacus
164
Hamstrings
- posterior compartment of the thigh
| - biceps femoris, semitendinous and semi membranous
165
sciatic nerve
L4-L3
166
Biceps femoris
- two head( long and short)
- flexion at the knee
- extends the keg at the hip
- laterally rotates at the hip and knee
- long head= tibial part of sciatic nerve
- short head =common fibular
167
Semitendinous
- Flexion of the leg at the knee joint. Extension of thigh at the hip. Medially rotates the thigh at the hip joint and the leg at the knee joint.
- Tibial part of the sciatic nerve
168
Semimembranous
- underneath the semitendinous
- Flexion of the leg at the knee joint. Extension of thigh at the hip. Medially rotates the thigh at the hip joint and the leg at the knee joint
- tibial part of the sciatic nerve
169
Damage to the hamstrings
-excessive stretch
-tearing or muscle fibers
-athletes involved in running or kicking
haematoma
170
Avulsion fracture of the ischial tuberosity
- hamstrings tendons 'tear off'
| - sprinting , football and hurdling
171
Which is the most medial muscle of the hamstrings?
Semimembranosus
172
Which of these is the correct function of ALL the hamstrings at the knee?
Flexion
173
Which muscle of the hamstrings causes lateral rotation at the hip and knee?
Biceps femoris
174
From which nerve plexus does the obturator nerve arise?
Lumbar
175
Which two nerves innervate adductor magnus?
Tibial and obturator
176
Which of these is the most superior of the muscles of the medial thigh?
Obturator externus
177
Which of the following muscles has a role in adducting at the hip?
Gracilis , obturator externes, adductor brebis , adductor longs, adductor magnus
178
Adductor Magnus
- largest muscle
- lies posteriorly to the other msucles
- adductor part and hamstring part
- adduct the thigh
- adductor component flexes the thigh, with the hamstring portion extending the thigh.
179
Innervation of adductor magnus
Adductor part is innervated by the obturator nerve (L2-L4), the hamstring part is innervated by the tibial nerve (L4-S3).
180
Adductor longus
- medial border of femoral triangle
- adduction and medial rotation of thigh
- obturator nerve (L2-L4)
181
Adductor brevis
- short muscle
- lies in between the anterior and posterior divisions of the obturator nerve.
- adduction of thigh
- Obturator nerve (L2-L4
182
Obturator Externus
- laterally rotates the thigh
| - obturator nerve (L2-L4)
183
Gracilis
- crosses at both the hip and the knee joints
- -adduction of the thigh at the hip and flexion of the leg at the knee
- obturator nerve (L2-L4)
184
Which muscle is sometimes transplanted into the hand or the forearm to replace damage muscles ?
Gracilis
185
Injury to the adductor Muscles
- Groin strain
- proximal part of muscle affected
- extreme stretching sports etc
186
Femoral triangle superior border
Inguinal Ligament
187
Femoral Triangle lateral border
Medial border of the sartorius muscle
188
Femoral triangle medial border
medial border of the adductor longs muscle
189
Roof of the femoral triangle
fascia lata
190
Base of the femoral triangle
Pectineus , iliopsoas and adductor longs muscles
191
Contents of the Femoral triangle (Lateral to medial )
NAVeL
| Nerve . Artery , vein,Lymphatic canal
192
Femoral vein
The great saphenous vein drains into the femoral vein within the triangle.
193
Femoral pulse
Just inferior to where the femoral artery crosses the inguinal ligament
194
Femoral Hernia
- part of the bowel pushes into the femoral canal underneath the inguinal ligament
- lump of budge in the area of the femoral triangle
195
function of the inguinal ligament?
Acts as a flexor retinaculum
196
Where would you place a needle to draw blood from the femoral artery?
Midway between ASIS and pubic symphysis (mid inguinal point)
197
What is the main function of the empty space in the femoral triangle?
Allow the femoral vein to distend when venous return is high
198
What can be found at the mid-point of the inguinal ligament
Femoral nerve
199
What structure exits the femoral triangle through the saphenous opening?
Saphenous vein
200
Medial border of the femoral canal
Lacunar ligament
201
Lateral border of the femoral canal
femoral vein
202
Anterior border of the femoral canal
inguinal ligament
203
Posterior border of the femoral Canal
Pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle
204
Femoral ring
opening to the femoral canal
205
Contents of the femoral canal
lymphatic vessels , deep lymph node, empty space , loose connective tissue
206
explain why femoral hernias can become strangulated
- Lucnar ligament is relatively firm
- The rigid structure does not allow for distension or movement and does not allow for easy return to the abdominal cavity. This increases the risk for strangulation of the hernia.
207
What superficial vein enters the femoral canal to drain into the femoral vein?
Long saphenous vein
208
Where is the femoral ring found in relation to the canal?
Superiorly
209
Adductor Canal
- Hunter's canal
| - passageway from structures moving between the anterior thigh and the posterior leg
210
Borders of the adductor canal
- Anterior: Sartorius.
- Lateral: Vastus medialis.
- Posterior: Adductor longus and adductor magnus.
211
Adductor hiatus
- Apex of the adductor canal
| - gap between the adductor and hamstring attachments of the adductor Magnus
212
Contents of the adductor canal
femoral artery , femoral vein , nerve to vastus medialis , saphenous nerve
