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Musculoskeletal System > Week 8 - The Hip Joint and Gluteal Region > Flashcards

Week 8 - The Hip Joint and Gluteal Region Flashcards

1
Q

What is the primary function of the hip joint?

A

To bear weight

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2
Q

What are the articulating surfaces of the hip joint?

A

Head of femur and acetabulum of the pelvis

- Both are covered in articular cartilage

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3
Q

What is the acetabulum?

A

A cup-like depression in the lateral side of the pelvis

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4
Q

What is the role of ligaments within the hip joint?

A

They act in increase stability

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5
Q

What is the intracapsular ligament within the hip joint?

A

Ligament of head of femur

  • A relatively small ligament that runs from the acetabular fossa to the fovea of the femur
  • It encloses a branch of the obturator artery
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6
Q

What are the extracapsular ligaments within the hip joint?

A
  • Iliofemoral
  • Pubofemoral
  • Ischiofemoral
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7
Q

Describe the iliofemoral ligament

A
  • Located anteriorly
  • Originates from the ilium, immediately inferior to the anterior inferior iliac spine
  • Attaches to the intertrochanteric line in 2 places, giving the ligament a Y-shape
  • Prevents hyperextension of the hip joint
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8
Q

Describe the pubofemoral ligament

A
  • Located anteriorly and inferiorly
  • Attaches at the pelvis to the iliopubic eminence and obturator membrane
  • It then blends with the articular capsule
  • It prevents excessive abduction and extension
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9
Q

Describe the ischiofemoral ligament

A
  • Located posteriorly
  • Originates from the ischium of the pelvis
  • Attaches to the greater trochanter of the femur
  • Prevents excessive extension of the femur at the hip joint
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10
Q

Describe the vascular supply to the hip joint

A
  • Medial and lateral circumflex femoral arteries
  • – Circumflex arteries are branches of the profound femoris artery
  • – They anastomose at the base of the femoral neck to form a ring, from which smaller arteries arise to supply the joint itself
  • – The medial circumflex femoral artery is responsible for the majority of the arterial supply
  • – The lateral circumflex femoral artery has to penetrate through the thick iliofemoral ligament to reach the hip joint
  • Artery to head of femur
  • – Branch of the obturator artery
  • – Minor supply
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11
Q

What happens if the medial circumflex femoral artery is damaged?

A

Can result in avascular necrosis of the femoral head

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12
Q

What is the innervation to the hip joint?

A
  • Femoral nerve
  • Obturator nerve
  • Superior gluteal nerve
  • Nerve to quadratus femoris
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13
Q

What are the stabilising factors of the hip joint?

A
  • Acetabulum
  • Acetabular labrum
  • Extracapsular ligaments
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14
Q

How does the acetabulum act as a stabilising factor in the hip joint?

A
  • Deep
  • Encompasses nearly all of the head of the femur
  • – This decreases the probability of the head slipping out of the acetabulum and causing a dislocation
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15
Q

How does the acetabular labrum act as a stabilising factor in the hip joint?

A
  • Fibrocartilaginous collar around the acetabulum
  • Increases the depth of the acetabulum
  • – This provides a large articular surface
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16
Q

How do the extracapsular ligaments act as a stabilising factor in the hip joint?

A
  • Very strong
  • They have a unique spiral orientation
  • – Causes them to become tighter when the joint is extended
  • – It also means less energy is needed to maintain a standing position
  • Muscles and ligaments work in a reciprocal fashion
  • – Anteriorly, where the ligaments are strongest, the medial flexors are fewer and weaker
  • – Posteriorly, where the ligaments are weakest, the medial rotators are greater in number and stronger
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17
Q

Which muscles cause flexion at the hip joint?

A
  • Iliosoas
  • Rectus femoris
  • Sartorius
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18
Q

What determines the degree to which flexion occurs at the hip joint?

A

Depends on whether the knee is flexed

- If it is, this relaxes the hamstrings so increases the range of flexion

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19
Q

Which muscles cause extension at the hip joint?

A
  • Gluteus maximus
  • Semimembranosus
  • Semitendinosus
  • Biceps femoris
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20
Q

What limits extension at the hip joint?

A
  • The joint capsule
  • The iliofemoral ligament
    They become taut during extension to limit further movement
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21
Q

Which muscles cause abduction at the hip joint?

A
  • Gluteus maximus
  • Gluteus minimus
  • The deep gluteals (performs, gemelli, etc.)
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22
Q

Which muscles cause adduction at the hip joint?

A
  • Adductors longus, brevis and magnus
  • Pectineus
  • Gracilis
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23
Q

Which muscles cause lateral rotation at the hip joint?

A
  • Biceps femoris
  • Gluteus maximus
  • Deep gluteals
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24
Q

Which muscles cause medial rotation at the hip joint?

A
  • Gluteus medius
  • Gluteus minimus
  • Semitendinosus
  • Semimembranosus
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25
Q

What causes a fracture to the neck of the femur?

A
  • In 40 year olds, they are more likely to occur from falls
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26
Q

What happens in a fracture to the neck of the femur?

A
  • Affected limb is laterally rotated
  • The arteries arising from the medial circumflex femoral artery are usually torn, disrupting blood supply
  • – This can cause avascular necrosis of the femoral head and neck
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27
Q

What happens in a surgical hip replacement?

A
  • A plastic socket is cemented to the hip none to replace the acetabulum
  • A stainless steel femoral stem and head replaces the femur
28
Q

Why are surgical hip replacements performed?

A

Following:

  • Traumatic injury
  • Degenerative disease of the joint
29
Q

What are the 2 types of hip dislocations?

A
  • Acquired

- Congenital

30
Q

Describe congenital hip dislocations

A
  • More common in girls
  • Occurs in ~1.5 per 1000 births, so it is a relatively common abnormality
  • During development the femoral head is not placed within the acetabulum, resulting in a dislocated joint
  • Common symptoms:
  • – Inability to abduct at the hip joint
  • – Affected limb is shorter
  • – Positive Trendelenburg sign
  • Predisposes the patient to arthritis of the hip in later life
31
Q

Describe acquired hip dislocations

A
  • Quite uncommon, due to the strength and stability of the joint
  • Usually occurs during traumatic accidents
  • Can be anterior or posterior
  • Posterior dislocations:
  • – More common type
  • – The femoral head is forced posteriorly and tears through the inferior and posterior part of the joint capsule (the weakest part)
  • – The affected limb becomes shortened and medially rotated
  • – The sciatic nerve can be damaged, which would cause paralysis of the hamstrings and the muscles distal to the knee
  • Anterior dislocations
  • – A consequence of extension, abduction and lateral rotation
  • – The femoral head ends up anterior and inferior to the acetabulum
32
Q

What can be a consequence of a traumatic hip dislocation in children?

A

Can disrupt the artery to the head of the femur

  • Fractures that result in separation of the superior femoral epiphysis are also likely to result in an inadequate blood supply to the femoral head
  • Can cause avascular necrosis of the head of the femur
  • Growth at the epiphysis is retarded
  • Produces hip pain that may radiate to the knee
33
Q

What is the route of the sciatic nerve?

A
  • It leaves the pelvis and enters the gluteal region via the greater sciatic foramen
  • It leaves the greater sciatic foramen inferior to the piriformis muscle
  • It then descends in the plane between the superficial and deep groups of gluteal muscles
  • – Posteriorly to the deep gluteal muscles
  • – Anteriorly to gluteus maximus and the superficial group of gluteal muscles
  • It continues down the posterior thigh, giving rise to motor branches for the hamstring muscles
  • When it reaches the apex of the popliteal fossa, it terminates by bifurcating into the tibial and common fibular nerves
34
Q

Describe how intramuscular injections into the gluteal region are given

A
  • The gluteal region can be divided into quadrants using 2 lines, marked by bony landmarks
  • – 1 line descends vertically from the highest point on the iliac crest
  • – The other horizontal line passes through the vertical line halfway between the highest point on the iliac crest and ischial tuberosity
  • The sciatic nerve passes through the lower medial quadrant
  • To avoid damaging the sciatic nerve therefore, intramuscular injections are given only in the upper lateral quadrant of the gluteal region
35
Q

How are measurements of the lower limb done?

A

Real shortening = due to actual loss of bone length
- Put both limbs into exactly the same position, where there is no joint fixation
- The length of each limb is then measured from the anterior superior iliac spine to the medial malleolus
Apparent shortening = due to a fixed deformity of the limb
- Patient lies with their legs parallel
- The distance from umbilicus to each medial malleolus

36
Q

What bursae are there in the hip and where are they found?

A
  • Trochanteric bursa (situated between the gluteus maximus and greater trochanter)
  • Iliopsoas bursa (lies deep to iliopsoas)
  • Ischiogluteal bursa (situated near ischial tuberosity)
37
Q

How can the bursae present clinically/become inflamed?

A

They can be inflamed by repetitive strain or direct trauma

  • Trochanteric: inflammation occurs in disorders such as rheumatoid arthritis and in patients with gait disturbances)
  • Iliopsoas: may present as swelling below inguinal ligament
  • Ischiogluteal: can be inflamed by sitting down
  • May result in pain in movement and pain on direct pressure
38
Q

Describe arthritis to the hip

A

Inflammation of the joint in the synovium

  • Damage to cartilage
  • Usually pain early on is due to inflammation
39
Q

Describe osteoarthritis

A
  • Mainly cartilaginous damage
  • Pain is from mechanical grinding
  • Previous joint injuries may predispose to this condition
  • Increased mechanical load makes things worse
  • Hip is commonly affected
40
Q

Describe rheumatoid arthritis

A
  • Problem starts in synovium
  • Essentially inflammatory
  • Joint cartilage is destroyed
  • Problem then becomes mechanical
41
Q

What is the gluteal region?

A

An anatomical area located posteriorly to the pelvic girdle at the proximal end of the femur

42
Q

What are the 2 groups of muscles found in the gluteal region?

A

Superficial abductors and extenders
- A group of large muscles that abduct and extend the femur
- It includes the gluteus maximus, gluteus medius and gluteus minimus
Deep lateral rotators
- A group of smaller muscles that mainly act to laterally rotate the femur
- Includes the quadratus femoris, performs, gemellus superior, gemellus inferior and obturator internus

43
Q

Where is the gluteus maximus found?

A
  • Originates from the posterior surface of the ilium, sacrum and coccyx
  • Slopes across the buttock at a 45 degree angle
  • Inserts into the iliotibial tract and gluteal trochanter
44
Q

What are the actions of the gluteus maximus?

A
  • Main extensor of the thigh
  • Assists with lateral rotation
  • Only used when force is required (such as running or climbing)
45
Q

What is the innervation of the gluteus maximus?

A

Inferior gluteal nerve

46
Q

Where is the gluteus medius found?

A
  • Lies between the gluteus maximus and minimus
  • Originates from the gluteal surface of the ilium
  • Inserts into the lateral surface of the greater trochanter
47
Q

What are the actions of the gluteus medius?

A
  • Abducts and medially rotates the lower limb

- During locomotion it secures the pelvis, preventing pelvic drop of the opposite limb

48
Q

What is the innervation of the gluteus medius?

A

Superior gluteal nerve

49
Q

Where is the gluteus minimus found?

A
  • The deepest and smallest of the superficial gluteal muscles
  • Originates from the ilium and converges to form a tend
  • Inserts to the anterior side of the greater trochanter
50
Q

What are the actions of the gluteus minimus?

A
  • Abducts and medially rotates the lower limb

- During locomotion it secures the pelvis, preventing pelvic drop of the opposite limb

51
Q

What is the innervation of the gluteus minimus?

A

Superior gluteal nerve

52
Q

What is the main action of the deep gluteal muscles?

A

Laterally rotate the lower limb

- Also stabilise the hip joint by ‘pulling’ the femoral head into the acetabulum of the pelvis

53
Q

Where is the piriformis found?

A
  • Originates from the anterior surface of the sacrum
  • Then travels infero-laterally through the greater sciatic foramen
  • Inserts into the greater trochanter of the femur
54
Q

What are the actions of the piriformis?

A
  • Lateral rotation

- Abduction

55
Q

What is the innervation of the piriformis?

A

Nerve to piriformis

56
Q

Where is the obturator internus found?

A
  • Forms the lateral walls of the pelvic cavity
  • Originates from the pubis and ischium at the obturator foramen
  • Travels through the lesser sciatic foramen
  • Attaches to the greater trochanter of the femur
57
Q

What are the actions of the obturator internus?

A
  • Lateral rotation

- Abduction

58
Q

What is the innervation of the obturator internus?

A

Nerve to obturator internus

59
Q

Where are the gemelli found?

A
  • The superior gemellus muscle originates from the ischial spine
  • The inferior originates from the ischial tuberosity
60
Q

What are the gemelli?

A

2 narrow and triangular muscles

- They are separated by the obturator internus tendon

61
Q

What are the actions of the gemelli?

A
  • Lateral rotation

- Abduction

62
Q

What innervates the gemelli?

A
  • Superior: nerve to obturator internus

- Inferior: nerve to quadratus femoris

63
Q

What are the actions of the quadratus femoris?

A

Lateral rotation

64
Q

Where is the quadratus femoris found?

A
  • Originates from the lateral side of the ischial tuberosity

- Attaches to the quadrate tuberosity on the intertrochanteric crest

65
Q

What innervates the quadratus femoris?

A

Nerve to quadratus femoris

Musculoskeletal System (12 decks)

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