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Msk > The Hip Joint > Flashcards

The Hip Joint Flashcards

1
Q

What does the hip joint consist of and what are its properties?

A

• Joint consists of:
– Ball (femoral head)
– Socket (acetabulum of hip bone)

• Large range of movement

• Strong joint
– Takes a lot to disrupt
– Very stable joint

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2
Q

Label the proximal part of the femur

A

See slide for image
See app

Femoral head
Femoral neck
Greater trochanter
Lesser trochanter
Intertrochanteric line (anterior)
Intertrochanteric crest (posterior)
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3
Q

Name the 3 bones which fuse to form the hipbone. What are they separated by and when do they fuse?

A

• Formed by fusion of 3 bones
– Ilium
– Ischium
– Pubis

• Separated by Tri-radiate cartilage
– Begins to fuse at 15-17 years
– Fusion complete by 20-25 years

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4
Q

What is the acetabulum?

A

• Socket of joint
• Where hip bones converge
• Margin of acetabulum is incomplete inferiorly
– Acetabular notch

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5
Q

What strengthens the joint?

A
  • Labrum
  • Joint capsule
  • Ligaments
  • Muscles
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6
Q

What are the acetabular labrum and transverse acetabular ligament?

A

• Fibrocartilaginous rim attached to margin of acetabulum
• Increases the articular contact area by 10% – More than 50% of head of femur fits in
• Transverse acetabular ligament strengthens inferior portion of acetabulum
– Where acetabular notch is

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7
Q

What is the joint capsule?

A 
• Capsular fibres take a spiral course 
• Anterior
– Attaches at intertrochanteric line
– In extension capsule helps pull femoral head into acetabulum
• Posteriorly
– Lateral part of neck is extra-capsular

Back of the neck of the femurs is extracapsullar
Fibres run in spiral - extending hip twists the fibres to pull joint together

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8
Q

What are the 3 strong ligaments which strengthen the capsule?

A
  • Capsule is strengthened by 3 strong ligaments

* Iliofemoral • Pubofemoral • Ischiofemoral

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9
Q

What are the accessory ligaments?

A
  • Accessory ligaments
  • Ligament of head of femur
  • Transverse acetabular ligament
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10
Q

What are the properties of the iliofemoral ligament?

A
  • Y shaped ligament
  • Bodies strongest ligament
  • Protects hip joint superiorly & anteriorly
  • Prevents hyperextension
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11
Q

What are the properties of the pubofemoral ligament?

A
  • Protects anteriorly and inferiorly

* Prevents over abduction

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12
Q

What are the properties of the ischiofemoral ligament?

A

– Weakest of the three
– Positioned posteriorly (attaches to greater trochanter)
– Limits extension

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13
Q

What are the muscles that move the hip joint?

A
  • iliopsoas
  • rectus femorus
  • sartorius

Must cross the joint to move it

Iliopsoas is the most powerful flexor - 2 muscles with a common insertion - psoas major and iliacus
Reclusive femoral is the only quad muscle to cross the hip joint

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14
Q

What are the hip adductors?

A 
Hip Adductors 
• Adductor
– Magnus
– Brevis
– Longus 
• Pectineus 
• Gracilius 
• Obturator externus

See slide for image

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15
Q

Name the hip extensors

A
  • Gluteus maximus
  • Long head of Biceps femoris
  • Semimebranosus
  • Semitendinosus

See slide for image

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16
Q

Name the hip abductors

A
  • Gluteus medius
  • Gluteus minimus
  • Tensor fasciae latae

Medius and minimus supplied by Superior gluteal nerve
Medius and minimus make sure pelvis doesnt droop down on one side so you can walk

17
Q

Name the lateral rotators of the hip joint

A
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quadratus femoris
18
Q

Describe the nerve supply to the hip joint

A 
• Hiltons law
– “the nerves supplying the muscles extending directly across and acting at a given joint also innervate the joint”
• Femoral nerve (anterior) 
• Obturator nerve (inferior) 
• Superior Gluteal nerve (superior) 
• Nerve to Quadratus femoris (posterior)
19
Q

Describe the blood supply to the hip joint

A

• Major source (deep femoral artery)
– Medial circumflex femoral artery
– Lateral circumflex femoral artery
• Minor source (adult)
– Obturator artery (via ligament of head of femur)
• Blood supply from ligament of the head of femur is often not adequate if only supply
• If you get a femoral neck # you can tear Retinacula arteries
• Result can be AVN of femoral head
Blood supply come from branches of the profunda femoris - deep femoral artery
2 branches - Lateral has smaller branches
Synovial membrane doubles back on itself forming folds
Arteries come very close to the bone - if you break that bone the vessels can be damages (retinacular aretereis)

20
Q

What happens if the superior gluteal nerve is damaged?

A 
Superior gluteal nerve damage 
• Supplies hip abductors 
• Damage to SGN leads to:
– weakened abduction 
– Changes to stance phase of gait cycle
• Trendelenberg sign
– Pelvis droops on the unaffected side
Hip adductors keep pelvis level - if not - trendelenburg sign (drooping on one side) - CONTRALATERL side to injury, e.g. “right sided positive trendelenburg sign” means damage on left side, droop on right side
21
Q

Where are the 2 innominate bones connected?

A

Anteriorly at pubic symphysis

Posteriorly at the sacrum

22
Q

Describe the muscles of the gluteal region

A

• Located posteriorly to the pelvic girdle at the proximal end of the femur.
• The muscles in this region move the lower limb at the hip joint.
• Muscles divided into 2 groups:
- Superficial
- Deep
Collectively abduct, extend, and laterally rotate the femur at the hip joint.

23
Q

What are the 3 superficial gluteal muscles?

A 
ACTION: 
Gluteus Maximus 
• Main extensor of the thigh 
• Assists with lateral rotation.
- Used when force is required, such as running or climbing.

Gluteus Medius and Minimus
• Abducts and medially rotates thigh
• Stabilises pelvis during walking, preventing pelvis drop on the opposite limb

INNERVATION AND BLOOD SUPPLY:
Gluteus Maximus = Inferior Gluteal Nerve and Artery
Gluteus Medius and Gluteus Minimus = Superior Gluteal Nerve and Artery

24
Q

What are the 5 deep muscles

A

See slide for diagram

INNERVATION:
Piriformis = Nerve to Piriformis
Gemellus Superior = Nerve to Obturator internus
Obturator Internus = Nerve to Obturator Internus.
Gemellus Inferior = Nerve to Quadratus Femoris
Quadratus Femoris = Nerve to Quadratus Femoris.

25
Q

Why is the pirformis an important anatomical landmark?

A
  • Divides up the gluteal region into an superior and inferior part.
  • The sciatic nerve usually enters the gluteal region directly inferior to the piriformis, and is visible as a flat band, approximately 2cm wide
26
Q

What are the “safe areas” for injection of the gluteal region?

A
  • Dorsogluteal safe to use from 3 years old
  • Ventrogluteal site preferred in children over 7 and adults but requires compliance

Se slide for position

27
Q

What are the muscles of the posterior thigh?

A

See side for diagram

• Biceps femoris 
– Long head 
– Short head
• Semitendinosus 
• Semimembranosus

• All originate from ischial tuberosity
– Except short head of biceps (linea aspera)
• All innervated by tibial part of sciatic nerve
– Except short head of biceps (common fibular division of sciatic nerve)

Msk (15 decks)

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