the pelvis and gluteal region Flashcards
what is the name of the boney structure that can be observed on the proximal head of the femur on the posterior side that projects medially?
lesser trochanter
what is the name of the small ridge of boney bumps found between the greater and lesser trochanter on the anterior side?
intertrochanteric line
what is the name of the small ridge of boney bumps found between the greater and lesser trochanter on the posterior side?
intertrochanteric crest
what is the function of the gluteal tuberosity?
attachement for gluteal muscle
describe the structure of the acetablum
- acetabular labrum deepens the fossa
- lunate surface: articulate with the femoral head
- acetabular fossa: is a deep fossa found inside the acetabulum (think of hot tub)
what is the ligament that closes off the lunate surface?
transverse acetabular ligament
what ligament serves to keep the femoral head inside the acetabulum?
ligament of the head of the femur
onto what does the ligament to head of femur attach to?
fovea
what type of joint is the hip joint?
ball and socket
synovial
multiaxial
what movement is occurs during flexion of the hip joint?
leg advances forward
what type of movement causes the leg to move back (take a step back)
extension about the hip joint
while sitting, if you move your leg outwards what movement is that?
abduction about the hip joint
if sitting with both legs close to one another, what movement is that?
adduction about the hip joint
how could medial rotation about the hip joint be described?
heel of foot points outwards, hence femur rotates internally about hip joint
how could lateral rotation about the hip joint be described?
heel of foot points inwards, femur rotates externally about the hipojoint
what stabilizes the hip joint?
- iliofemoral
- pubofemoral
- ischiofemoral
which stabilizer prevents hyperextension when standing and will limit lateral rotation?
-iliofemoral
which stabilizer prevents over-abduction of the hip joint?
-pubofemoral
which stabilizer limits medial rotation of the hip joint?
-ischiofemoral
what is the most common type of hip dislocation?
posterior hip dislocation
identifying the following dislocation based on symptoms
femur will be shortened, flexed, adducted and medially rotated about the hip joint?
posterior hip dislocation
identifying the following dislocation based on symptoms
femur is slightly flexed, abducted, and laterally rotated about the hip joint
anterior hip dislocation
what A. pierces through the obturator membrane?
obtrurator A
what A. wraps around the front of the femur?
lateral circumflex femoral A.
what A. anastomoses to the lateral circumflex femoral A.?
where does this A travel?
medial circumflex femoral A.
it travels posterior to the femur
the external illiac artery bifurcates into what branches inferior to the hip joint?
femoral and deep femoral A.
where do the medial and lateral circumflex A. originate from?
from the deep femoral A.
what may occur to the blood supply during a femoral neck fracture?
blood supply could possibly be cut off leading to avascular necrosis of the femoral head
in order to avoid necrosis of the head due to lack of blood supply how is the vascular system arranged?
the head an neck of the femur obtains its blood supply by multiple arteries that originate from different major arteries.
what may be the cause for the femoral neck to fracture?
hip dislocations
where does the obturator A. originate from?
internal iliac A.
what arteries supply the femoral head and neck
medial circumflex femoral A.
lateral circumflex femoral A.
Obturator A.
what arteries arise from the medial Circumflex femoral A?
retinacular (nutrient) arteries
what Artery arises from the obturator A.?
foveal A.
where is the foveal A. located?
it travels within the ligament of the head of femur
the majority of the blood supply comes from which A?
from the medial circumflex femoral A.
what ligaments function to prevent upward tilting of the distal sacrum and pulls the pelvis down? (anchors sacrum to hipbones)
sacrotuberous ligament (ST) sacrospinous ligament (SS)
what do the ST and SS ligaments form?
the greater and lesser sciatic foramina
what is the function of the greater and lesser foramina?
it allows for structures that originate from inside to make their way out.
what is the largest, most external muscles of the gluteal region?
gluteus maximus
gluteus maximus
origin
insertion
function
origin: posterior sacroiliac ligament and sacrotuberous ligament
insertion: gluteal tuberosity and IT band
function: extends thigh at hip, lateral rotation
what is the primary extensor?
gluteus maximus
Tensor Facia Lata
origin
insertion
function
origin: ASIS
insertion: lateral tibial condyle via IT band
function: abducts and medially rotates thigh at the hip
stabilizes pelvis while standing
tenses IT band
what is the IT band?
name: iliotibial band
its a lateral thickening of the fascia lata of the thigh
what are the abductor muscles of the hip?
Gluteus medius
Gluteus minimus
what is the common origin and insertion of the abductors of the hip?
stretch between the posterior surface of the ilium and the greater trochanter (the region will differ)
which of the abductors inserts on the superior aspect of the greater trochanter?
gluteus medius
which of the abductors inserts on the anterior aspect of the greater trochanter?
gluteus minimus
which abductor is also involved in medial rotation, abduction and serves as an accessory hip flexor?
gluteus minimus
what are the lateral rotators of the thigh?
piriformis superior gemellus inferior gemellus quadratus femoris obturator internus obturator externus
piriformis
origin
insertion
particularity?
origin: anterior sacrum
insertion: greater trochanter
particularity: exits through the greater sciatic foramen
superior gemellus
origin
insertion
origin: iscial spine
insertion: greater trochanter
inferior gemellus
origin
insertion
origin: ischium
insertion: greater trochanter
what is known as the gemellus sandwich?
the tendon of obturator internus lays in between both gemellus muscles
quadratus femoris
origin
insertion
origin: ischium
insertion: intertrochanteric crest
what muscles share the common origin of ischium
- quadratus femoris
- inferior gemellus
what lateral rotator muscles commonly insert on the greater trochanter
- piriformis
- superior gemellus
- inferior gemellus
- -obturator internus
obturator internus
origin
insertion
particularity?
origin: internal boney border of the obturator foramen inside the pelvis
insertion: greater trochanter
particularity: exits the pelvis through the lesser sciatic foramen
obturator externus
origin
insertion
function
origin: bone of obturator forament external to the pelvis
insertion: intertrochanteric crest
function: lateral rotation of the thigh
what nerve innervates the obturator externus?
what spinal levels are involved?
where does it travel?
obturator N.
L2-L4
travels inside of the pelvis
what gluteal muscle serves as a landmark for neurovascular structures?
piriformis
which nerve exits via the greater sciatic foramen above piriformis?
superior gluteal N.
what nerve exits pelvis via the greater sciatic forament below piriformis?
inferior gluteal N.
what nerve innervates the gluteus maximus?
inferior gluteal N.
what does the superior gluteal N. innervate?
gluteus medius and gluteus minimus, tensor fascia lata
what nerve innervates most of the lower limbs and is also the biggest nerve in our bodies?
sciatic nerve
L4-S3
which nerve is responsible for the sensory innervation of the posterior thigh?
posterior femoral cutaneous n.
what nerves innervates the lateral rotators?
sacral nerve
what nerve will innervate gemellus superior and obturator internus?
nerve to obturator internus
what nerve innervates piriformis?
nerve to piriformis
what muscle pair does the nerve to quadratus femoris innervate?
gamellus inferior and quadratus femoris
what is the common orientation of the sciatic N.
both components of the nerve pass below the piriformis
what are some possible abnormal orientations for the sciatic N.
the tibial and common fibular N. split causing for the tibial N. to split the piriformis or pass above before joining the common fibular N.
what spinal levels are involved in the posterior femoral cutaneous N.?
S1-S3
what region of the skin is innervated by the inferior clundeal N.
what spinal levels are involved?
the lower part of the butt cheek and part of the lateral posterior thigh
S1-S3
what nerve is responsible for the sensory innervation of the medial quarter of the butt cheek?
middle cluneal nerve
what region does the superior cluneal N. innervate?
from the medial 1/4 to the lateral 1/4 of the but check from the top until the bottom part of the butt cheek covered by the inferior cluneal N.
what branches originate from the interal illiac A.?
superior gluteal A.
inferior Gluteal A.
what is the important vascular anastomosis that helps redirect blood of the lower limb in case of blockage between femoral and external Iliac A?
cruciate anastomosis
how does the deep femoral A. terminate as?
4th perforating A
what A are involved in the cruciate anastomosis?
Medial Cx. femoral A.
lateral Cx. femoral A.
1st perforating A
how should gluteal intramuscular injections be administered?
- superior lateral quadrant
- allign middle finger and thumb to quadrant and inject between index and middle finger
why is it important to properly inject in the gluteal region?
avoids damaging the neuromuscular structures that are deep to gluteus maximus
what is the cause of greater throchanteric pain syndrome?
inflammation of the trochanteric bursa
what bursae(s) can be found in the gluteal region?
- iliotibial bursa
- trochanter bursa
- ischial bursa
