Hip

Question 1

what are the hip bones called

and alongside x they form what?

Answer 1

inominate bones

x = sacrum

the pelvic girdle

Question 2

what are the articulations of the hip bones

Answer 2

• sacroiliac joint : articulation with the sacrum
• pubic symphysis : ​articulation between the right and left inominte bone
  
  • hip joint: articulation with the head of the femur

Question 3

describe the inominate bone

Answer 3

• its composed of three bones: ilium, ischium and pubic
• as a child they are seperate adn only begin fusing at the ages of 15-17
• once they fuse they form a triradiate cartilage
• they also form the acetabulum ; cup socket for the femoral head to articulate with the hip

Question 4

label this

Answer 4

Question 5

describe the ilium

what are the surfaces?

describe its key features and names of parts?

Answer 5

• widest part and its the top
• has two surfaces:
  
  • external surface: which is convex and provides attatchment for gluteal muscles
  • internal surface : which is concave and produces the iliac fossa
• the superior margin is the iliac crest which extends :
  
  • anteriorly into the anterior superior iliac spine and anterior inferior iliac spine
  • posteriorly into the posterior superior iliac spine and posterior iliac spine
  • the posterior aspect creates the greater sciatic notch

Question 6

describe the ischium

what are its key features?

what are points of attatchment?

Answer 6

• forms the posterior inferior asect of the innominate bone
• composed of a ramus of ischium
• posterior aspect forms a ischial tuberosity (which you sit on when sitting in a chair)
• on the posteriomedial aspect of the innominate bone is the ischial spine
• important attatchments of the ischium are:
  
  • sacrospinous ligament : this goes from the ischial spine to the sacrum and creates the greater sciatic notch
  • ​sacrotuberous ligament : this goes from the sacrum to the ischial tubersity forming the lesser sciatic notch

Question 7

what are the ligaments associated with the ischium and whats their function?

Answer 7

• sacrospinous ligament
• sacrotuberous ligament

limit the rotationof the inferior part of the sacrum upon transmission of weight of the body down the vertebral coloumn in the erect position

Question 8

describe the hip joint

whats the points of articulation

whats its functions

Answer 8

• ball and socket synovial joint
• the head of the femur articulates with the pelvis acetabulum
• function is to enable mobility to lower limbs without weakening the ability of the lower limbs to support the weight of the body

Question 9

whats the acetebulum and where is it (anatomical words)

describe the whole structure (what is it associated with )

Answer 9

inferolateral aspects of the pelvis

surrounded by a fibrocartilaginous collar = acetabular labrum providing it with a more secure fit for the hemispheric femoral head

the acetabulum its self is covered in hyaline cartilage except a small part known as the acetabular notch which contins fibroelastic fat covered with synovial membrane

Question 10

whats the function of the acetabular labrum

Answer 10

increases the articular contact by 10% so that more than 50% of the femoral head is in contact with socket at any given one time

this increases the stability of the joint but sacrifices some mobility (however more stable than the shoulder joint)

Question 11

describe the femoral head

Answer 11

• articulates with the acetabulum of the pelvis
• covered in hyaline cartilage
• has a small depression known as the fovae capitis where the ligamentum teres attaches
• this ligament contains the artery to the femoral head

Question 12

describe the femoral shaft

Answer 12

• belwo the femoral head
  
  • passes inferiorly and posteriorly and laterally making a 125 degree angle (with the long axis of femoral shaft)
• this angle is smaller in females

Question 13

label this

Answer 13

image

Question 14

how are the greater and lesser trochanters connected anteriorly and posteriorly

Answer 14

anteriorly = intertrochanteric line

posteriorly = intertrochanteric crest

Question 15

what is on the posterior aspect of the femoral shaft and what attaches to it?

Answer 15

linea aspera

intermusula speta and…..

Question 16

whats above the linae aspera

Answer 16

gluteal tubersity

this is insertion of the gluteal maximus

Question 17

inferiorly to the linea aspera what does the linea aspera divide into

Answer 17

• lateral and medial supracondylar lines
• medial margin continues inferiorly and terminates at the adductor tubercule of the medial formal condyle
• lateral marginof the linea aspera contunies inferirly to form the lateralsupracondyular line and terminares at the lateral formal condyle

Question 18

describe the condyles of the femor

Answer 18

• medial margin of linea aspera continues inferiorly and terminates at the adductor condyle of the medial formal condyle
• lateral margin of linea aspera continues inferiorly and forms the lateral formal condyle
• seperating the two condyles is intercondylar noch POSTERIORLY
• ANTERIORLY the patella covers the space trochlear (patellofemoral groove) between the lateral and medial condyles
• ths

Question 19

what covers the hip joint? describe it

Answer 19

the capsule

it sits 5-6mm outside the acetabular labrum proximally (closer to the pelvis)

and

distally it attatcehs to the intertrochanteric line anteriorly and neck of femur posteriorly

capsule fibres ascend anteriorly as logntindal retincula containing blood vessels for the femoral head and neck

Question 20

describe the 2 parts of the capusle and name the ligaments

Answer 20

• intracapsular; ligamentum teres (carries blood supply to the femoral head, attatches from the fovae capitis to the trochlear notch)
• extracapsular; iliofemoral. pubofemoral and ischiofemoral ligaments

Question 21

label this

Answer 21

iliofemoral (from the iliac to the femoral head)

ischiofemoral ( from ischium to the femoral head)

pubofemoral (from pubis to the femoral head)

Question 22

iliofemoral ligament

Answer 22

from iliac to the femoral head

storngest ligamatn in the body

inverted Y shape,

lies superior+anterior to the hip joint and blends in with the capsule

the baseof the Y shape is attatches to the anterior inferior iliac spine of the femur.

in the stadnign positionit ‘scrws the head of the femour inot the acetabulum’ and prevents the trunk from falling backward without the need for muscules = PREVETNS HYPEREXTENSION OF THE HiP

when sitting it become relaxed and allows the pelvis to tilt backwards into its sittign position

Question 23

pubofemoral ligament

Answer 23

lies inferior and anterior to the hip joint

triangular shaped

base is attatched to the superior pubic ramus

its apex is the intertrochanteric line anteriorly

function is to prevent excessive abduction and extension of the hip joint

Question 24

ischiofemoral ligaments

Answer 24

spiral shaped and attaches to the body of ischium posterioly

its inferior fibres spiral superolaterally from the body of the ischium to attacth tot he superolateral end of the intertrochanteric line of the femur, anteromedial. ot the base of the greater trochanter

it wraps all the way aroudn the back of the femoral head and neck and iserts anteriorly , deep to the lateral fibres of the iliofemoral ligament

weakest of the 3 ligaments

prevents excessive interal (medial rotation

Question 25

transverse ligament

Answer 25

bridges the acetabular notch creates a tunnel where b vessels and nerves enter the hip joint

Question 26

is there a synovial membrane in the hip joint?

Answer 26

yes

Question 27

describe the synovial membrane of hip joint

Answer 27

lines the capsule and is attatched to the margins of the articular sufarces ensheathes the ligamentum teres covers the pad of fat contained in the acetabular fossa

Question 28

what are the stabalising factors of the hip joint

Answer 28

cup shaped acetabulum acetabular labrum - deepen the acetabulum capsule ligamentum teres extracapsular ligaments muscles surrounding the hip joint

Question 29

where are the muscles of the hip joint in association to the ligaments

Answer 29

anteriorly where ligaments are stronget = medial flexors (located anteriorly) are fewer adn weaker posterirly where the ligaments are weaker = lateral rotators (extensors) are greater in munber and stronger - they pull the head of the femur into the acetabulum

Question 30

muslces groups involved in the hip joint

Answer 30

superfical muscles deep muscles posterior thigh

Question 31

superifical muscles

Answer 31

gluteal maximus / medius/ minimus + tensor fascia lata muscle abductors of the hip and extend the lower limb at the hip joint

Question 32

tensor fascia lata

Answer 32

O = ASIS i= between two layers of iliotiial band of fascia lata between the upper and middle two thirds of the thigh N= superior gluteal nerve f = * stabalise the hip in extesnion (assists g. maximus) + soem fibres insert into the iliotibial tract in the standing position and so help stabalise the kneeby steadying the condyles of femur on articular surfaces of the tibia * used in water sking and horse riding * minor function is to hoist the foscia lataupwards which c tightening of the compartments of the thigh and compressing the lower limbs

Question 33

fascia of the thigh

Answer 33

* enclosed the thigh musles and seperates them into anterior, medial and posterior * superiorly it is contininous witht he fascia of the abdominal wall and perineal region * inferiroly it is contious with the fascia of the lower limb * it is thinnest medially over the adductor muscles * theres a saphenous opening in the fascia lata between the below the inguinal ligament and is entry point for the saphenous vein wc trains into femoral vein and fr the llympathic vessels wc drain inot the superficial inguinal lymph nodes * thickest on the lateral aspect wher it forms the iliotibial tract/band and runs from the iliac crest to the lateral tibial condyle

Question 34

iliotibila tract

Answer 34

O = iliac crest I= lateral epicondyle of the femur F = stabilised the knee shortened when sit down becoems tight easily casuing lateralkne pain, patellar instbaility and other issues B treated with physio

Question 35

gluteus maximus

Answer 35

largest gluteal muscle O= posterior surface of ilium, sacrum and coccyx and crosses the buttock at a 45 degreee angle I = superior fibres insert into iliotibial tract and inferior fibres insert into gluteal tuberosity of the femur F = extend lower limb at hip oint, main extensor of thigh, and lateral (external) rotation of the hip used in stepping and walking superior fibres help with extension of hte knee since they are attatched to the iliotibila tract IN= inferior gluteal nerve (L5S1S2)

Question 36

gluteus medius

Answer 36

inbetween mini and maxi O= gluteal (posteior) surface of ilium I = lateral surface of greater trochanter F= abducts and medially rtate the lower limb at the hip joint whilst walking it secures the pelvis in the horisontal alignment, oreventing downward tilt towrds unsupported limb IN = superiro gluteal nerve L4 L5 S1

Question 37

gluteus minimu

Answer 37

O = ilium I= anterior asepct of the greater trochanter F = abducts and medial rotationof lower limb at hip joint and maintains the pevlis horisozonatl allignemtn wehn walking IN= superior gluteal nerve L4 L5S1

Question 38

deep muscles of the gluteus

Answer 38

function is to laterally rotate the lowerl limb + stabilise the hip joint by pulling the femoral head deep into the acetabulum piriformis obturator internus obturator externus superior gemellus inferior gemellus quadratus femroris

Question 39

piriformis

Answer 39

key landmark because sciatic nerve emerges from the levis inferior to it O = anterior surface of sacrum travels inferiorlaterally through greater sicatic foramen I= superior aspectof the greater trochanter of femur F = lateral rotation and abduction N = nerve to piriformis

Question 40

obturator internus

Answer 40

lateral wall of the pelvis cavity O = medial surface of the obturator membrane adn from the adjascent pubis and ischium , travels through the lesser sciatic foramen I = posterior aspect of the greater trochanter below the insertionof the piriformis and superior gemellus F = lateral rotation adn abduction of lower limb N = nerve to obturator

Question 41

superior gemellus

Answer 41

O = ischial spine I = posterior aspect of the greater trochanter IN = nerve to obstrator F. =lateral rotation adn abduction

Question 42

inferior gemellus

Answer 42

O= ischial tuberosity I = posterior aspect of the greater trochanter IN= nerve to quadratus femoris

Question 43

what seperates the superior and inferior gemelli and what des this mean in terms. of IN?

Answer 43

obturator internus tendon superior = nerve to obturator internus inferior = nerve to quadratus femoris

Question 44

quadratus femoris

Answer 44

most infeirr of the deep gluteal muscles O = lteral aspect o the ischial tuberosity I= lateral aspect of the greatertrochanter F = abduct adn lateral rotation IN+nerve to quadratus femoris

Question 45

obturator externus

Answer 45

aka medial compartment of the thigh O= external surface of the ob. membrane , I= passes posterior to neck of femur and inserts onto posteiror aspect of the greater trochanter F. = Abd. and lat. rot IN+ obtruator nerve L2 L3L4

Question 46

nerve supply to the hip

Answer 46

sciatic nerve posteirorly obtruator nerve inferiorly femoral nerve anteriorly

Question 47

bloos dupply to the femoral head

Answer 47

extracpsular aterial ring that is formed posteriorly by large branch of medial formal circumflux artery adn lateral femoral circulflex artery they give retinalculars whc are small b vessels into the metaphysis of the of the femoal neck ligamentumteres also intracapsualr wc comes from the obturator artery

Question 48

what artery t femoral head is important in kids

Answer 48

ligamentum teres because it is major blood supply to the femoral epiphysis (head) in adults after epiphysial fusion only small amont of head near fovia is nurished by b supply from it, most b supply is from MCFA branches and so distrubing the reticlars (Ascenidng cervial branhces) of the MFCA in an intracapsular fracture would result in avacualr necrosis because most b supply cut off to femoral head cut off

Question 49

describe the lumbar sacral plexus

Answer 49

formed by anterior ramiof L1 2 4 - they combine to form peripheral nerveswc descend from the posterior abdominal wall to the lower limbs where they innervate their target structures L4 anterior ramigves off a rbanch wc combinse with the L5 anterior ramus to from the lumbosacral trunk posteiror divios of the lumbar plexus form the nerves that supply the anterior thigh d to the 90 rotation teh exensors are anterior

Question 50

describe the roots of the lumbar plexus

Answer 50

L1 = **ilioinguinal nerve** root = In skin of genitalia and upper media thigh L1 + L2 = **genitofemoral** wc divies into the femoral adn genital branch . f**emoral branch** innervates the upper anterior thigh ksin L2 + L3 = l**ateral cutanoeus nerve** of tigh (lateral femoral cutanoeus nerve) formed from the posterior divisions of L2 and L3 = IN the anterolateral thigh as far inferirly as the knee * anterior deivisons* L2 L3 L4 = **obturator nerve** = IN medial thigh and is nerve of the medial compartment of the thigh (so adductors) * postieor divisions* L2 L3 L4 = **femoral nerve** anteriot thigh via **anterior femoral cutanoeus nbranch** via its **saphenous branch** innervates the medial aslect of thigh skin

Question 51

sacral plexus describe it

Answer 51

frmed y anrterior rami of S1 S2 S3 S4 S5 adn infor from L4 AND L5 2 desitnations is the lowerl limb and lelvis msicles

Question 52

nerves of the sacral plexus

Answer 52

L4 L5 S1 **superior gluteal nerve** = leaves via greater sciatic foramenn above the piriformis muscle alongside the superior gluteal arteru and vin , no sensory branches important in injury L5 S1 S2 = **inferior gluteal nerve** = leavs via the greater sciatic fromaen but entes the gluteal region below the piriformis muscle along side the infeiro gluteal arty adn veinonly inervates the glu. maximus scaitic nerve = L4 L5 S1 S2 S3 S1 S2 S3 = **posteiror cutanoeus nerve of the thigh / posterior femroal cutaenous nerve =** anterior divisions of S1 S2 S3 leavesvia the greater sciatic belwo the priformis muscles and innervates skin of posteior thigh and leg

Question 53

nerves thatleavebelow the prifiroms

Answer 53

post. femoral cut. nerve S1 S2S3 / sciaticL4L5S1S2S3 / inferior gluteal nerveL5S1S2

Question 54

nerves that leave aboe the piriformis

Answer 54

superior gluteal nerve(L4 L5 S1)

Question 55

how are the greater and lesser sciatic fromaen creater

Answer 55

graterdue tot sacrospinatous lessre due oto the sacrotubersous

Question 56

what geos through thegreater sciatic foreamen

Answer 56

* piriformis * sciatic nerve * inferiorGN and A nad V * posteiro femoral cutanoue nerve= * nerve to obruator * nere to quadratus femoris \ * pudenal nerve

Question 57

what goes through the lesser sciatic foraemn

Answer 57

tendon of obtruator intebus nerve toobtruator intetbus pudenal nerve

Question 58

posterior thigh compartment? what is it also knownas? what does it include? fucntion of these muscles?innervation?

Answer 58

hamstrings includes ; semitendinosus semimembranosus bicep femoris long head F = extednt he lower limb at the hip joint IN = sciatic nerve

Question 59

bicep femoris

Answer 59

2 heads logn head and short head O= long head) ischial tuberosity I = (long head) head of fibula O= short head ) linea aspera I= ischial tuberosity IN=long head) tibial part of sciatic nerve IN= short head = common peroneal part of sciatic nerve F. = extend lower limb at hip joint ad externally rotate the leg (below knee) and knee joint

Question 60

semitendinosis

Answer 60

medial to bicep femoris and superficial to semimembranosus F = flex leg at knee joint, extend lowelr limb at hip joint and medially rotate the thigh at hip joint adn externally rotate the leg at knee joint IN= tibial part of sciatic nerve

Question 61

semimembranosus

Answer 61

medial to the bicep femoris and deep to semitendinosus O = ischial tuberosity I= medial tibial condyle F = flex leg at knee joint and externally roate theleg at knee joint but interally roate the thigh at hip joint and extend the thigh at hip joint IN= tibial part of sciaic nerve