The Lower Limb (1)- Hip, Gluteal and posterior thigh

Question 1

what dos a joint consist of

Answer 1

ball-femoral head

socket- acetabulum of hip bone

Question 2

what do raised area of bone indicate

Answer 2

muscle attatchment

Question 3

what 3 bones make up the hip bone

Answer 3

ilium
ischium
pubis

Question 4

what strengthens the hip joint

Answer 4

labrum
-fibrocartilaginous rim attached to margin of acetabulum

transverse acetabular ligament- strengthens inferior portion of acetabulum- where the acetabular notch is

Question 5

what does the labrum allow

Answer 5

increases articular contact area by 10%

-more than 50% of head of femur fits in

Question 6

how does the joint capsule strengthen the joint

Answer 6

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

Question 7

what are the three capsule joint ligaments

Answer 7

iliofemoral
pubofemoral
ischiofemoral

Question 8

what are the accessory ligaments

Answer 8

ligament of head of femur
ligamentes teres
transverse acetabular ligament

Question 9

iliofemoral ligaments

Answer 9

inverted Y shaped ligament
bodys strongest ligament
protects hip joint superiorly and anteriorly
prevents hyperextension

Question 10

pubofemoral

Answer 10

protects anteriorly and inferiorly

prevents over-abduction and hyperextension

Question 11

ischiofemoral ligament

Answer 11

weakest
positioned posteriorly- attaches to great trochanter
prevents excessive internal medial rotation

Question 12

what is the main flexor of the hip

Answer 12

iliopsoas (iliacus + psoas major)

• two separate muscles that merge
• insert into lesser trochanter

Question 13

which muscles assist the main flexor of the hip

Answer 13

rectus femoris
sartorius
pectieus

Question 14

rectus femoris

Answer 14

one of 4 quadriceps muscles
only one to cross the hip joint (only hip flexor)
also crosses knee joint (knee extender)

Question 15

sartorius

Answer 15

crosses both hip and knee

synergist muscle

Question 16

pectinus

Answer 16

hip flexor but also thigh adductor

Question 17

nerve supply to muscles that move the joint

Answer 17

femoral nerve

Question 18

what muscles allow hip adductors

Answer 18

magnus

• 2 portions (adductor and hamstring)
• Gap in muscle fibres (adductor hiatus)
• transmits femoral vessels (to poplitea fossa)

brevis

longus

Question 19

what muscles assist adduction of the hip

Answer 19

pectineus
gracilis
obturator externus

Question 20

gracilis

Answer 20

medial thigh muscle

inserts into pes anserinus

Question 21

obturator externus

Answer 21

originates anteriorly but passes behind neck of femur

synergist muscle

Question 22

pectineus

Answer 22

hip flexor also adducts thigh

Question 23

nerve supply to muscles that adduct the thigh

Answer 23

obturator nerve

Question 24

muscles that allow hip extension

Answer 24

gluteus maximus

• long head of biceps fermoris
• semimembranosus
• semitendinosus

Question 25

biceps femoris

Answer 25

long head short head -common origin is ishial tuberosity

Question 26

semitendinosus

Answer 26

on Top of long Tendon

Question 27

semimembranosus

Answer 27

Most Medial

Question 28

what nerve innervates the hip extensors

Answer 28

tibial part of the sciatic nerve except the short head of biceps- common fibular division of sciatic nerve

Question 29

what muscles abduct the hip

Answer 29

gluteus medius gluteus minimus assisted by tensor fascia late and sartorius

Question 30

The gluteal region

Answer 30

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

Question 31

innervation of gluteal region

Answer 31

gluteus maximus- inferior gluteal nerve and artery gluteus medias and minimus- superior gluteal nerve and artery

Question 32

muscles and their innervation in the gluteal region

Answer 32

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

Question 33

main actions of the gluteal region

Answer 33

external (lateral) rotation of thigh | abduction of thigh

Question 34

how is the piriformis an imprtant anatomical landmark

Answer 34

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

Question 35

what is the safe area for intramuscular injections

Answer 35

dorsogluteal site for use from 3 years old ventrogluteal site preferred in children over 7 and adults

Question 36

what is the major source of blood to the hip joint

Answer 36

deep femoral/ profunda femoris artery - medial circumflex femoral artery - lateral circumflex femoral artery

Question 37

what is the minor source of blood to the hip

Answer 37

artery of the ligamentum teres= branch of obturator artery

Question 38

what does damage to the superior gluteal nerve cause

Answer 38

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

Question 39

How do you locate the correct site for a gluteal intramuscular injection?

Answer 39

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.

Question 40

What are the typical symptoms experienced by a patient with osteoarthritis in their hip? Give three

Answer 40

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

Question 41

What are the four cardinal signs of osteoarthritis on an X-ray? ROBS

Answer 41

* reduction in Joint space * Osteophyte formation * Subchondral sclerosis * Subchondral bone cysts

Question 42

State two typical symptoms experienced by a patient with a fractured neck of femur.

Answer 42

Reduced mobility / sudden inability to bear weight on the limb Pain, which may be felt in the hip, groin and/or knee

Question 43

From beneath which muscle does the sciatic nerve emerge as it exits the pelvis?

Answer 43

piriformis

Question 44

What are the two components of the sciatic nerve?

Answer 44

Tibial and common peroneal (also called common fibular).

Question 45

Which component supplies the | hamstring muscles of the posterior thigh?

Answer 45

tibialis

Question 46

common origin of hamstring muscles

Answer 46

ischial tuberosity