Week 13 Anatomy - Hip and Lower Limb Vasculature Flashcards
What bones compose pelvic part of the hip?
Ilium
Ischium
Pubis
How is the hip and acetabulum formed from childhood –> adulthood?
At birth, bones are separated by hyaline cartilage
By puberty, bones begin to fuse
Acetabulum is a tri-radiated ‘Y’ shaped structure, with each of the bones contributing 1/3 to the structure of the acetabulum
Describe bony landmarks of the ilium:
ASIS + AIIS
Tubercle of iliac crest (5cm posterior to ASIS on crest)
PSIS + PIIS
What bony landmark forms the superior aspect of greater sciatic notch?
Posterior inferior iliac spine
Describe bony landmarks of the ischium:
Body: part that contributes to acetabulum
Ramus: joins inferior ramus of pubis to form ischio-pubic ramus
Ischial tuberosity: the bony bit you sit on
Ischial spine: spinous process which separates the greater and lesser sciatic notches
Describes bony landmarks of the pubis:
Medial ‘body’ with superior and inferior rami which connect it to the hip
What is the obturator foramen?
The foramen formed by the junction of the inferior and superior rami of pubis and ischium to the acetabulum and ilium
What are the contents of the obturator foramen?
Obturator nerve and vessels via obturator canal
Describe the bony features of the proximal femur:
Head: articulates with acetabulum, has ‘fovea’ which is site of attachment of ligament of the head
Neck
Greater trochanter (anterior, lateral)
Lesser trochanter (posterior)
What is the linea aspera?
broad ridge on the posterior aspect of the femur, longitudinally, which is the site of attachment for adductors of the hip
What is the ‘angle of inclination’?
Angle formed by the junction of the axis of the femoral neck and the diaphysis of the femur, usually 115-140 degrees in adulthood, more in males than females
Generally, what action do muscles that attach to greater trochanter do?
Hip abduction and lateral rotation
Action of muscles that insert onto lesser trochanter?
Hip flexion
Muscle that insert onto linea asperia/proximal femur?
Hip adduction
What is the trochanteric crest? What notable bony landmarks sits along the crest?
Ridge between trochanters posteriorly
Quadrate tuberosity sits in the middle of this crest, attachment site for quadratus femoris
What type of joint is the hip?
Ball and socket synovial joint
What contributes to the stability of the hip?
Acetabulum
Labrum (Extra cartilage which gives more surface area/contact)
Intrinsic Ligaments of the hip
Joint capsule
Muscles (external and internal rotators of the hip)
What are the intrinsic ligaments of the hip that provide extra joint stability?
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
What nerves supply the hip joint?
Anteriorly = femoral nerve
Inferiorly = obturator
Posteriorly = nerve to quadratus femoris
Superiorly = superior gluteal nerve
What are the borders of the femoral triangle?
Superior = inguinal ligament
Medial = adductor longus
Lateral = sartorius
What are the contents of the femoral triangle? (lateral to medial)
Femoral nerve
Femoral artery
Femoral Vein
Deep inguinal lymph nodes
What is the adductor canal/what purpose does it serve?
Extends from apex of femoral triangle to adductor hiatus, providing intermuscular passage of the femoral vessels to the popliteal fossa
What are the contents of the adductor canal?
Femoral artery
Femoral vein
Nerve to vastus medialis
What are the major hip flexors?
Iliacus
Psoas major
What is the origin and insertion of the psoas major muscle?
Origin = Lumbar vertebrae
Insertion = Lesser trochanter
What muscles participate in hip extension?
Gluteus maximus
Biceps femoris
Semi-membranosus
Semi-tendinosus
What bony landmark do hip extensors originate from?
Ischial tuberosity
What muscles participate in hip abduction?
Gluteus medius
Gluteus minimus
Tensor fascia lata
Broadly speaking, what nerve is responsible for hip abduction?
Superior gluteal nerve
What bony landmarks do hip abductors originate form, and insert onto?
Origin: External ilium
Insertion: Greater trochanter/trochanteric fossa
What bony landmark do hip extensors originate from and insert onto?
Origin: Ischial tuberosity
Insertion: diverse
What is the most important landmark muscle of the external rotator muscles of the hip, and why?
Piriformis, ‘Pear shaped’. It is covered by the lumbosacral plexus.
It is the muscle which attaches from anterior surface of sacrum to greater trochanter. Inferior to piriformis, exits the sciatic nerve from greater sciatic foramen.
Superiorly, exits the superior gluteal nerve and artery.
Inferiorly, exits the inferior gluteal nerve and artery.
What are the muscles that participate in external rotation of hip? (from superior to inferior)
Piriformis
Gemellus superior
Obturator internus
Gemellus inferior
Quadratus femoris
Obturator externus
What muscles participate in ADduction of the hip?
Gracilis
Adductor longus
Adductor brevis
Adductor magnus
Pectineus
In general, what is the origin of adductor muscles?
Where do they insert?
Origin: Body of pubis, Inferior rami of pubis and ischium
Insertion: Linea aspera of femur
What nerve is responsible for the medial compartment of the thigh/adductors?
Obturator nerve
What structures pass through the adductor magnus?
Femoral artery + vein
Become popliteal artery and vein after crossing through the muscle
What muscles cross both the hip causing hip flexion AND knee extension?
Sartorius
Gracilis
Describe the arterial supply of the lower limb? (Anterior and medial thigh)
Common iliac arteries divide into external and internal iliac arteries.
External iliac arteries cross under the inguinal ligament and become femoral artery.
Femoral artery crosses medially and through adductor canal to enter posterior compartment , becoming popliteal artery.
Popliteal artery divides into the anterior and posterior tibial arteries.
Anterior tibial become dorsalis pedis, and posterior tibial artery ends as medial and lateral plantar arteries.
Describe the arterial supply of the lower limb? (Gluteal and posterior thigh)
All blood supply from INTERNAL iliac artery, with three major branches: (All traverse pelvis into gluteal region via greater sciatic foramen)
1. Superior gluteal artery (largest branch) –> superior to piriformis
2. Inferior gluteal artery –> inferior to piriformis
3. Inferior pudendal artery – > inferior to piriformis, anterior to inferior gluteal artery
Describe superficial venous supply of lower limb, starting at the foot:
- Great Saphenous Vein
- Dorsal vein great toe + dorsal venous arch of foot –> GSV
- Anterior to medial malleolus
- Posterior to medial condyle femur
- Empties into femoral vein - Small Saphenous vein
- Dorsal vein little toe with dorsal venous arch –> SSV
- Posterior to lateral malleolus
- Penetrates deep fascia and ascends between heads gastrocnemius
- Empties into popliteal vein
Describe the deep veins of the lower limb:
Again, starting at dorsal venous arch, some empties into deeper veins:
- Anterior tibial
- Posterior tibial
- Fibular
These then travel along with their respective arteries before uniting in the popliteal fossa to form toe popliteal vein
Once entering the thigh, known as femoral vein, which becomes external iliac vein when passing above inguinal ligament
