Anatomy Block 2: Gluteal Region & Hip Joint

Front 1

The acetabular fossa is made deeper by the..

Back 1

acetabular labrum

Front 2

What ligament bridges the acetabular notch?

Back 2

transverse acetabular ligament

Front 3

The ____________________ attaches to the margins of the acetabular notch and to the transverse acetabular ligament.

Back 3

ligamentum capitis femoris

Front 4

The main function of the ligamentum capitis femoris is to...

Back 4

carry the artery to the head of the femur, a branch of the obturator artery

Front 5

The head of the femur is covered by hyaline cartilage except for the small central depression called the ________________, in which you can find the _________________.

Back 5

-fovea capitis femoris

-ligamentum capitis femoris

Front 6

The normal angle of inclination between the femoral neck and shaft is...

Back 6

about 126 degrees (from 115 to 140)

Front 7

Abnormal femoral angle of inclination: coxa vara...

Back 7

is a decrease in the angle (less than 120 degrees, looks like an "r")

Front 8

Abnormal femoral angle of inclination: coxa valga...

Back 8

is an increase in the angle (more than 135 degrees, looks like an "l")

Front 9

shortened leg, limp; pain free gait abnormality; congenital or acquired (infection, tumor, post-traumatic fracture, metabolic)--coxa vara or coxa valga?

Back 9

coxa vara

Front 10

slipped epiphysis of femoral head; genu varum (bow legged)--coxa vara of coxa valga?

Back 10

coxa valga

Front 11

The angle of torsion/declination is normally ____ in females and ____ in males.

Back 11

12 degrees females
7 degrees males

Front 12

_______________ is an abnormal increase in the angle of torsion; equals _________________.

Back 12

-anteversion
-internal femoral torsion

Front 13

_______________ is an abnormal decrease in angle of torsion; equals ______________

Back 13

-retroversion (retro - decrease)
-external femoral torsion (ER - external:retro)

Front 14

What is the main blood supply to the head of the femur?

Back 14

retinacular branches of the medial femoral circumflex artery

Front 15

What is the secondary blood supply to the head of the femur?

Back 15

retinacular branches of the lateral femoral circumflex artery

Front 16

What artery supplies blood to the head of the femur and is important in children, but not so much in adults?

Back 16

artery to the head of the femur (remember, it's enclosed in the ligamentum capitis femoris)

Front 17

What are the trochanteric anastomoses?

Back 17

Lat. fem. circumflex a.
Inferior gluteal a.
Medial fem. circumflex a.
Superior gluteal a.

(LIMS)

Front 18

What is a consequence of a femoral neck fracture?

Back 18

torn retinacular branches of femoral circumflex arteries, causing avascular necrosis of the femoral head

Front 19

What are the 4 causes of avascular necrosis to the femoral head?

Back 19

-chronic alcohol
-steroid use
-femoral neck fracture
-posterior hip dislocation

Front 20

The _______________ fracture runs from the greater trochanter of the femur to the lesser trochanter and (does/does not) involve the femoral neck. It (does/does not) cause avascular necrosis of the femoral head.

Back 20

-intertrochanteric
-does not involve neck
-does not cause avascular necrosis

Front 21

_______________ is a line drawn from the neck of the femur through the _______________ and is important in monitoring changes in the head/neck of the femur (ex. femoral neck fracture).

Back 21

-Shenton's line
-lower margin of the superior pubic ramus

Front 22

What three ligaments form the fibrous capsule around the hip joint?

Back 22

-iliofemoral ligament ("ilYofemoral")
-pubofemoral ligament
-ischiofemoral ligament

Front 23

Where does the iliofemoral ligament attach?
What action does it prevent?

Back 23

-anterior inferior ilaic spine and acetabular rim to the intertrochanteric line
-prevent hyperextension

Front 24

Where does the pubofemoral ligament insert?
What action does it prevent?

Back 24

-obturator crest and blends with iliofemoral ligament
-limits extension and abduction

Front 25

What separates the pubofemoral ligament and the iliofemoral ligament?

Back 25

-gap covered by the iliopsoas muscle and iliopsoas bursa

Front 26

Where does the ischiofemoral ligament attach?
What action does it prevent?

Back 26

-spirals from the ischial part of the acetabular rim to the neck of the femur medial to base of greater trochanter
-prevents hyperextension (NOTE: Both the ischiofemoral and iliofemoral ligaments prevent hyperextension. Pubofemoral prevents extension and abduction).

Front 27

Posterior hip luxation (dislocation) is easiest in what position?

Back 27

-during flexion and adduction of thigh (ligaments prevent extension, so they are relaxed when thigh is flexed)

Front 28

90% of hip dislocations is in what direction?

Back 28

posterior

Front 29

Anterior dislocation of hip joint are caused by what action?
This accounts for what percent of hip dislocations?

Back 29

-forceful abduction and external rotation
-5%

Front 30

Congenital hip dislocation/developmental dysplasia of the hip occurs in 1.5/1000 live births and is more common in ____
Some of the risk factors include:

Back 30

-girls

Risk factors:
-family history
-generalized ligamentous laxity
-breech birth

Front 31

This dislocation, which is occurs prior to skeletal maturity, causes the head and neck to separate where they are located at the epiphyseal plate

Back 31

slipped capital femoral epiphysis

Front 32

The trochanteric bursa is between what two structures?

Back 32

gluteus maximus and the greater trochanter

Front 33

A person with trochanteric bursitis may produce pain where?

Back 33

pain usually radiates distally along iliotibial tract

Front 34

What bursa is found under the iliopsoas muscle

Back 34

iliopsoas bursa

Front 35

The iliopsoas bursa may be inflamed (iliopsoas bursitis) in cases of ____, causing pain in the ____ area

Back 35

-rheumatoid arthritis or overuse injury
-anteromedial thigh pain

Front 36

Branches of what two nerves innervate both the hip and knee joints, allowing hip pain to be referred to the knee and vertebral/sacroiliac/prostate pain to the hip?

Back 36

femoral and obturator nerves

Front 37

Hip pain is often referred to the ____

Back 37

knee

Front 38

Vertebral column, sacroiliac joint, or prostate pain may be referred to the ____

Back 38

hip

Front 39

The gluteus maximus does what actions?

Back 39

-powerful extensor
-laterally rotates thigh
-abducts thigh

Front 40

What muscles are innervated by the superior gluteal nerve?

Back 40

-tensor fascia lata
-gluteus medius
-gluteus minimus
(everything except the gluteus maximus)

Front 41

What muscles are innervated by the inferior gluteal nerve?

Back 41

gluteus maximus

Front 42

What is the function of the tensor fascia lata?

Back 42

stabilizes knee during extension

Front 43

What is the function of the gluteus medius and gluteus minimus?

Back 43

-most important action - stabilize pelvis
-abducts and medially rotates femur at hip joint

Front 44

What are the deep muscles of the gluteal region that cause lateral rotation?

Back 44

-Piriformis (+abd)
-Gemellus superior (+abd)
-Obturator internus (+abd)
-Gemellus inferior (+abd)
-Obturator externus (not abd)
-Quadratus femoris (not abd)
The attachments of the last two muscles are a bit more distal on the femur--does not cause abduction. However, all muscle laterally rotate the thigh as they attach on the posterior surface of the femur

Front 45

Clarify slide about nerve

Back 45

slide 27

Front 46

What are the two arteries of the gluteal region?

Back 46

-superior gluteal artery
-inferior gluteal artery

Front 47

The superior and inferior gluteal arteries are a branch of _____

Back 47

internal iliac artery

Front 48

The superior gluteal artery enters the gluteal region through the _____ and is ____ to the piriformis muscle

Back 48

-upper part of the greater sciatic foramen
-superior

Front 49

The inferior gluteal artery enters the gluteal region through the ____ and is _____ to the piriformis muscle

Back 49

-lower part of the greater sciatic foramen
-inferior

Front 50

The cruciate anastomoses provide alternate blood supply to the lower limbs due to occlusion of the ______________.

Back 50

femoral artery

Front 51

The cruciate anastomoses are:

Back 51

Inferior gluteal artery
Medial femoral circumflex artery
Lateral femoral circumflex artery
First perforating branch of profunda femoris artery

"I Got My First and Last Chia Pet"

Front 52

The pudendal canal is formed by the _____ in the _____

Back 52

-obturator interus fascia
-ischioanal fossa

Front 53

What are the nerves of the gluteal muscles?

Back 53

-superior gluteal nerve
-inferior gluteal nerve
-nerve to piriformis
-nerve to obturator internus
-nerve to quadratus femoris

Front 54

A patient has a hard time rising from a seated position, climbing stairs, and running and jumping. What nerve may be damaged? What muscles does this nerve innervate?

Back 54

-inferior gluteal nerve (L5-S2)
-gluteus maximus

Front 55

A patient comes in with weakness in abducting his thigh. Tests show trendelenburg sign and gluteus medius gait. What nerve may be damaged? What muscle does this innervate?

Back 55

-Superior gluteal nerve (L4-S1)
-gluteus medius and minimus

Front 56

Paralysis of the gluteus medius and minimus result in a positive ____ test

Back 56

Tredelenburg

Front 57

Describe the trendelenburg sign

Back 57

-patient is asked to raise knee
-the "normal side" drops when its knee is lifted and "affected side" supports the body
*when standing with both feet, patient leans towards affected side

Front 58

Sciatic nerve damage may be due to:

Back 58

-badly placed gluteal intramuscular injection
-posterior hip dislocation
-traction on baby's legs during difficult childbirth

Front 59

Damage to sciatic nerve can cause:

Back 59

-hamstring muscle paralyzed
-all muscles below the knee paralyzed
-flail foot

Front 60

One or more roots of the sciatic nerve may be damaged in the vertebral canal due to:
This can cause damage to what nerve?

Back 60

-protruding or herniated intervertebral disc
-common fibular (peroneal) nerve - foot drop

Front 61

Damage to the common fibular nerve can cause:

Back 61

-FOOTDROP
-paralysis of muscles in anterior and lateral leg compartments

Front 62

Sciatic nerve may be compressed by what muscle, resulting in...
This may cause:

Back 62

-piriformis muscle
-pain and/or paresthesia in gluteal region and posterior thigh

Front 63

Piriformis syndrome is more likely to happen if:

Back 63

-if the common fibular nerve pierces the piriformis

Front 64

What are the actions of the semimembranosus and semitendinosus muscles?

Back 64

-flex knee
-extend hip
-medially rotate lower limb

seMi's are Medial rotators

Front 65

What are the actions of the biceps femoris muscles?

Back 65

-flex leg at knee
-extend thigh at hip (only long head)
-laterally rotate lower limb (remember, the seMi's Medially rotate)

Front 66

What are the hamstring muscles?
Where do the originate?
What never innervates them?

Back 66

-Semitendinosus
-Semimembranosus
-Biceps femoris long head
-Adductor magnus, hamstring part

-Ischial tuberosity

-tibial nerve of sciatic nerve (except short head of bicep femoris)
-short head of bicep femoris - common fibular nerve

Front 67

What artery supplies the posterior thigh?

Back 67

profunda femoris artery (Posterior = Profunda)
*also largest branch of femoral artery

Front 68

The posterior thigh muscles (biceps femoris, semitendinosus, semimembranosus) divide into what two divisions in the distal thigh (popliteal fossa)?

Back 68

-tibial division
-common fibular division

Front 69

Trochanteric anastomoses provide collateral circulation to the head of the femur when the _________________ are blocked.

Back 69

femoral or medial femoral circumflex arteries