The Lower Limb (1)- Hip, Gluteal and posterior thigh Flashcards
what dos a joint consist of
ball-femoral head
socket- acetabulum of hip bone
what do raised area of bone indicate
muscle attatchment
what 3 bones make up the hip bone
ilium
ischium
pubis
what strengthens the hip joint
labrum
-fibrocartilaginous rim attached to margin of acetabulum
transverse acetabular ligament- strengthens inferior portion of acetabulum- where the acetabular notch is
what does the labrum allow
increases articular contact area by 10%
-more than 50% of head of femur fits in
how does the joint capsule strengthen the joint
capsular fibres take a spiral course
in extension capsule helps pull femoral head into acetabulum
anterior- attaches at intertrochanteric line
posterior- lateral part of neck is extra-capsular
what are the three capsule joint ligaments
iliofemoral
pubofemoral
ischiofemoral
what are the accessory ligaments
ligament of head of femur
ligamentes teres
transverse acetabular ligament
iliofemoral ligaments
inverted Y shaped ligament
bodys strongest ligament
protects hip joint superiorly and anteriorly
prevents hyperextension
pubofemoral
protects anteriorly and inferiorly
prevents over-abduction and hyperextension
ischiofemoral ligament
weakest
positioned posteriorly- attaches to great trochanter
prevents excessive internal medial rotation
what is the main flexor of the hip
iliopsoas (iliacus + psoas major)
- two separate muscles that merge
- insert into lesser trochanter
which muscles assist the main flexor of the hip
rectus femoris
sartorius
pectieus
rectus femoris
one of 4 quadriceps muscles
only one to cross the hip joint (only hip flexor)
also crosses knee joint (knee extender)
sartorius
crosses both hip and knee
synergist muscle
pectinus
hip flexor but also thigh adductor
nerve supply to muscles that move the joint
femoral nerve
what muscles allow hip adductors
magnus
- 2 portions (adductor and hamstring)
- Gap in muscle fibres (adductor hiatus)
- transmits femoral vessels (to poplitea fossa)
brevis
longus
what muscles assist adduction of the hip
pectineus
gracilis
obturator externus
gracilis
medial thigh muscle
inserts into pes anserinus
obturator externus
originates anteriorly but passes behind neck of femur
synergist muscle
pectineus
hip flexor also adducts thigh
nerve supply to muscles that adduct the thigh
obturator nerve
muscles that allow hip extension
gluteus maximus
- long head of biceps fermoris
- semimembranosus
- semitendinosus
biceps femoris
long head
short head
-common origin is ishial tuberosity
semitendinosus
on Top of long Tendon
semimembranosus
Most Medial
what nerve innervates the hip extensors
tibial part of the sciatic nerve except the short head of biceps- common fibular division of sciatic nerve
what muscles abduct the hip
gluteus medius
gluteus minimus
assisted by tensor fascia late and sartorius
The gluteal region
gluteus maxiums
- main extensor of teh thigh
- 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 of gluteal region
gluteus maximus- inferior gluteal nerve and artery
gluteus medias and minimus- superior gluteal nerve and artery
muscles and their innervation in the gluteal region
piriformis- nerve to piriformis
gemellus superior- nerve to obturator internus
obturator internus- nerve to obturator infernus
gemellus inferior- nerve to quadratus femoris
quadratus femoris- nerve to quadratus femoris
main actions of the gluteal region
external (lateral) rotation of thigh
abduction of thigh
how is the piriformis an imprtant anatomical landmark
piriformis divides up the 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
what is the safe area for intramuscular injections
dorsogluteal site for use from 3 years old
ventrogluteal site preferred in children over 7 and adults
what is the major source of blood to the hip joint
deep femoral/ profunda femoris artery
- medial circumflex femoral artery
- lateral circumflex femoral artery
what is the minor source of blood to the hip
artery of the ligamentum teres= branch of obturator artery
what does damage to the superior gluteal nerve cause
weakened abduction of lower limb
abnormal stance phase of gait cycle
trendelenburg sign
-when weightbearing on the affected limb, the pelvis droops on the undamaged unsupported side
How do you locate the correct site for a gluteal intramuscular injection?
Place the palm of one hand over the greater trochanter of the femur, point your thumb
towards the inguinal region and your index finger towards the anterior superior iliac crest.
Spread the index and middle fingers to make a V and inject between the proximal
interphalangeal joints of your fingers into the gluteus medius muscle.
What are the typical symptoms experienced by a patient with osteoarthritis in their hip?
Give three
Joint stiffness that occurs getting out of bed
• Joint stiffness after sitting for a long time
• Pain in the hip joint (may be referred to the knee)
• Crepitus: A sound or feeling (“crunching”) of bone rubbing against bone
• Reduced mobility e.g. difficulty walking, difficulty putting on socks and shoes, getting in
and out of a car / the bath etc
What are the four cardinal signs of osteoarthritis on an X-ray?
ROBS
- reduction in Joint space
- Osteophyte formation
- Subchondral sclerosis
- Subchondral bone cysts
State two typical symptoms experienced by a patient with a fractured neck of femur.
Reduced mobility / sudden inability to bear weight on the limb
Pain, which may be felt in the hip, groin and/or knee
From beneath which muscle does the sciatic nerve emerge as it exits the pelvis?
piriformis
What are the two components of the sciatic nerve?
Tibial and common peroneal (also called common fibular).
Which component supplies the
hamstring muscles of the posterior thigh?
tibialis
common origin of hamstring muscles
ischial tuberosity
