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C&M Lower Limb > Week 1 L1: The Pelvis and Hip > Flashcards

Week 1 L1: The Pelvis and Hip Flashcards

1
Q

What are the two bones in the leg?

A

tibia and fibula

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2
Q

What are the 3 neurovascular regions in the lower limb?

A
  1. Femoral triangle (groin)
  2. Popliteal fossa (behind the knee)
  3. Tarsal tunnel (posterior to medial ankle)
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3
Q

Which joint is the most commonly replaced joint in the body?

A

the hip

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4
Q

Which 3 bones make up the pelvis?

A
  • the sacrum

- left and right innominate bones (‘hip’ bones)

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5
Q

How does the pelvis remain anchored to the axial skeleton?

A

via strong and stable joints between the sacrum and each innominate bone = the sacroilliac joint

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6
Q

What structure articulates with the acetabulum of the pelvis at the hip joint?

A

head of the femur

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7
Q

Where do the inomminate bones articulate with eachother?

A

anteriorly at the pubic symphysis

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8
Q

Which patent structure has the superior pubic ramus above, and the inferior pubic ramus below?

A

obturator foramen

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9
Q

What is the most distal part of the vertebral column?

A

sacrum

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10
Q

How is the inomminate bone formed in a foetus?

A

3 separate bones fuse at the acetabulum:

  1. The ilium (superior)
  2. The ischium (posterior)
  3. The pubis (anterior)
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11
Q

What is the acetabulum?

A

the socket for the head of the femur

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12
Q

What does the inguinal ligament attach to on the pelvis?

A

Anterior superior iliac spine

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13
Q

What is the line between the trochanters called?

A

intertrochanteric line

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14
Q

What bony landmarks are seen in the posterior aspect of the femur?

A
  • trochanteric fossa
  • gluteal tuberosity
  • intertrochanteric crest
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15
Q

What is the acetabular labrum?

A

a ring of cartilage that surrounds the acetabulum of the hip

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16
Q

What are the two pelvic ligaments?

A
  1. Sacrospinous ligament

2. Sacrotuberous ligament

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17
Q

Which two structures does the sacrospinous ligament sit between?

A

sacrum and ischial spine

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18
Q

Which two structures does the sacrotuberous ligament sit between?

A

sacrum to the ischial tuberosity

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19
Q

Which foramen does the sacrospinous ligament extend over?

A

greater sciatic foramen

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20
Q

Which foramen does the sacrotuberous ligament

A

lesser sciatic foramen

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21
Q

What are the 3 hip ligaments?

A
  1. Pubofemoral
  2. Iliofemoral
  3. Ischiofemoral
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22
Q

What is the function of the pubofemoral ligament?

A

prevents excessive abduction

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23
Q

What is the function of the iliofemoral ligament?

A

prevents hyperextension of the hip during standing - ‘screws’ in the femoral head

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24
Q

Which is the strongest hip ligament, and which is the weakest?

A

iliofemoral - strongest

ischiofemoral - weakest

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25
Q

Which movements are possible at the hip joint?

A
  • flexion and extension
  • abduction and adduction
  • medial and lateral rotation
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26
Q

What is the prime hip flexor?

A

iliopsoas

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27
Q

Other than the iliopsoas, what are the other flexors in the hip and where do they lie?

A
  • lie anterior to the joint
    1. Pectineus
    2. Sartorius
    3. Rectus femoris
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28
Q

What is the iliopsoas made up of?

A

psoas major + iliacus

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29
Q

Where does the iliopsoas insert

A

lesser trochanter

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30
Q

Which nerve also travels with the iliacus and psoas major, deep to the inguinal ligament, and inserts onto the lesser trochanter?

A

the femoral nerve

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31
Q

Where do the rest of the flexor muscles in the anterior thigh insert?

  1. Pectineus
  2. Rectus femoris
  3. Sartorius
  4. Tensor fascia latte
A
  1. superior pubic ramus
  2. AIIS –> tibial tuberosity
  3. ASIS –> medial tibia
  4. ASIS –> Iliotibial tract
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32
Q

Which nerve are the flexors of the hip innervated by?

A

femoral nerve

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33
Q

What are the two extensors of the hip?

A
  1. Gluteus maximus

2. Hamstrings

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34
Q

Where does the gluteus maximus insert?

A

gluteal tuberosity and iliotibial tract

35
Q

Which nerve are the extensors of the hip innervated by?

A

inferior gluteal nerve

36
Q

Where are the extensors of the hip located?

A

posterior to the joint/ posterior thigh

37
Q

Where do the hamstrings originate?

A

ischial tuberosity

38
Q

What are the two abductors of the hip?

A

gluteus medius

gluteus minimus

39
Q

Which nerve innervates the abductors of the hip?

A

superior gluteal nerve

40
Q

Where do the abductors of the hip insert?

A

onto the greater trochanter

41
Q

Where do the adductors of the hip lie?

A

medial to the joint

42
Q

Which nerve innervates the adductors of the hip?

A

obturator nerve

43
Q

Which 3 muscles make up the adductor group? (3 of the adductors of the hip)

A
  • adductor brevis
  • adductor longus
  • adductor magnus
44
Q

Where do the muscles in the adductor group insert?

A

posteriorly on the femur

45
Q

What are the other adductors of the hip?

A
  • gracilis
  • pectineus (femoral nerve)
  • obturator externus
46
Q

What are the 5 muscles that are able to laterally rotate the hip?

A
  1. Piriformis
  2. Superior and inferior gemelli
  3. obturator internus
  4. quadratus femoris
  5. gluteus maximus
47
Q

Explain the location of the piriformis?

A
  • attached to the sacrum
  • travels through the greater sciatic foramen
  • inserts on the superior aspect of the greater trochanter
48
Q

Where do the superior and inferior gemelli, and obturator internus insert?

A

trochanteric fossa

49
Q

Where is the obturator internus located?

A

in between the superior and inferior gemelli

50
Q

which muscles can medially rotate the hip?

A
  • pectineus

- gluteus medius and minimus

51
Q

Which two vessels supply the anterior thigh and hip joint?

A

obturator and femoral artery

52
Q

Explain the pathway of the obturator artery?

A

internal iliac travels through obturator foramen into medial thigh

53
Q

Explain the pathway of the femoral artery?

A
  • continuation of the external iliac after it passes under the inguinal ligament
  • femoral nerve travels in the femoral triangle with the femoral vein and femoral nerve
54
Q

Which arteries supply the posterior thigh?

A

internal iliac artery in the pelvis give rise to the superior and inferior gluteal arteries into gluteal region through greater sciatic foramen

55
Q

Which nerve supplies the posterior thigh?

A

sciatic nerve

56
Q

Which artery supplies the majority of the hip?

A

medial circumflex artery

57
Q

Which nerve may be at risk if there is a femoral nerve fracture?

A

medial circumflex artery

58
Q

Other than the medial circumflex, what other arteries supply the hip?

A
  • lateral circumflex artery
  • profunda femoris
  • medial circumflex artery
59
Q

Which artery gives off the lateral circumflex artery and the medial circumflex artery?

A

profunda femoris

60
Q

What is DDH?

A

Developmental dysplasia of the hip
-in children, ligaments around the hip joint are loose allowing the hip to subluxate –> this is when the ball is no longer centred in the socket

61
Q

Which nerve network innervates the lower limb?

A

lumbosacral plexus

62
Q

What are the 3 major branches of the lumbosacral plexus that innervates the lower limb?

A
  • femoral - travels under inguinal ligament
  • obturator
  • sciatic
63
Q

What is avascular necrosis?

A

complication of hip fracture whereby the hip joint as no blood supply so the bone dies

64
Q

What is the definition of a hip fracture?

A

fracture of the femur distal to the femoral head and proximal to a level 5cm below the lesser trochanter

65
Q

How are hip fractures classified?

A
  1. Intracapsular (within the capsule)
  2. Extracapsular (outside the hip capsule)
    - intertrochanteric
    - subtrochanteric
66
Q

What are the risk factors a hip fracture?

A
  • osteoporosis/osteopenia
  • age over 65 years
  • falls
  • low BMI
  • female
  • high energy trauma
67
Q

What is the maximum angle at which:

  1. The hip can flex
  2. the hip can abduct
  3. the hip can adduct
  4. the hip can internally or externally rotate
A
  1. Max 120
  2. max 45
  3. max 30
  4. max 45
68
Q

What are the complications of a hip fracture?

A
  • reduction in mobility
  • thrombosis
  • pneumonia
  • respiratory failure
  • delirium
  • pressure sores
  • avascular necrosis
  • failure of fixation
69
Q

Ideally how long should surgery be performed following the diagnosis of a hip fracture?

A

36 hours

70
Q

What is the pubic symphysis?

A

Secondary cartilaginous joint between the two pubic bones. the articular surfaces are covered by a layer of hyaline cartilage and are connected by a fibrocarilaginous disc

71
Q

What are the 3 superficial gluteal muscles?

A
  • gluteus maximus
  • gluteus medius
  • gluteus minimus
72
Q

What is the trendenlenburg sign?

A
  • ‘waddling gait’
  • if the hip abductors (gluteus medius and minimus) are paralysed on one side
  • the pelvis will tilt to one side
73
Q

Where does the tensor fascia lata originate and insert?

A

originates: ASIS
inserts: iliotibial tract

74
Q

What is the function of the tensor fascia lata?

A

extension of knee and contribution to flexion of the hip

75
Q

For the piriformis, what is:

  1. Its origin
  2. Its insertion
  3. Its action
  4. Its innervation
A
  1. sacrum
  2. greater trochanter
  3. lateral rotator of hip
  4. superior gluteal nerve
76
Q

Why, when giving an intramuscular injection into the buttock, must you always place it in the upper, lateral quadrant of the buttock?

A

away from the sciatic nerve and superior gluteal artery

77
Q

What is the obturator canal?

A

small gap in the obturator foramen that is not covered by muscle / membrane

78
Q

What is a callous?

A

on an X-ray, when a broken bone heals and starts to reform, we see a cloudy region

79
Q

What is an open book fracture?

A

fracture at the pubic symphisis

80
Q

Which deep gluteal muscle travels through the greater sciatic foramen?

A

piriformis

81
Q

Which nerve might be injured as a result of an acetabular fracture?

A

sciatic nerve

82
Q

Which muscle is most superior in the group fo small lateral rotators?

A

piriformis

83
Q

Which spinal nerves form the sciatic nerve?

A

L4 - S3

84
Q

How does the obturator internus enter the gluteal region?

A

lesser sciatic foramen

C&M Lower Limb (4 decks)

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