AP - gluteal region and posterior thigh

what is the hip joint?

articulation of femoral head with acetabulum

what is the femur made up of?

cancellous bone and cortical bone

the ____ of the femur provides the greatest resistance to bending and torsion → strength

shaft

condyle

large prominence

knee joint

femur ends in a medial and lateral condyle which articulates with the tibial medial and lateral condyle

patella

along the anterior aspect of femur and tibia with supporting attachments from the quadriceps tendon superiorly and patellar tendon inferiorly

tibia

the larger part of the “lower leg” bone that provides weight bearing support

the distal MEDIAL prominence of the tibia is called what?

medial malleous

fibula

smaller more lateral leg bone that supports/creates ankle joint

what is the distal LATERAL prominence of fibula?

lateral malleolus

what is cancellous bone?

• spongy bone that is porous in appearance

• has weight bearing properties but less than cortical bone

• high surface area and high metabolic activity (incl cell prod and mineral exchange)

what makes up 20% of bone in body?

cancellous bone

what is cortical bone?

• highly dense bone bearing majority of weight

• forms protective barrier around cancellous bone

periosteum

nutrient rich outer membrane surrounding shaft of femur

contributes to bone elongation and modeling including when injured

what are the 2 layers of periosteum?

has an outer fibrous layer for structural integrity and inner layer with osteogenic potential

what bones do not have periosteum?

sesamoid bones and the intra-articular ends of bones (joint)

list of sesamoid bones

patella, hands, feet, wrist

what joint formed by the acetabulum and head of femur allows multi-directional movement and stability?

synovial ball-and-socket joint

what are accessory structures of the hip joint structure?

• acetabular labrum

• iliofemoral ligament

• medial and lateral rotator muscles

what is the acetabular labrum?

fibrocartilaginous lip that deepens socket for better fit

what ish te iliofemoral ligament?

prevents HYPEREXTENSION of the hip joint

the iliofemoral (ligament) is more anteriorly or posteriorly placed?

anteriorly (altho can extend posterior aspect)

medial and lateral rotator muscles

assist in hip stability and movement

what are examples of hip joint movement?

1. flexion and extension

2. abduction and adduction

3. medial (internal) rotation and lateral (external) rotation

4. circumduction (all movements together, it’s like a circle)

what are some important anatomic points of the femur?

• femoral head

• femoral neck

• greater and lesser trochanter

• intertrochanteric line

• intertrochanteric crest

• linea aspera

what is the femoral head?

articulates with the acetabulum

what is the interotrochanteric crest?

the ridge between greater/lesser trochanter

what is a hip fracture?

fracture of the proximal femur between the femoral head and no more than 5 cm distal to lesser trochanter

what is a risk of proximal femur fracture?

avascular necrosis due to retrograde blood supply, can compromise blood supply to femoral head

what is the most common MOA of hip fractures?

fall

what are the RFs for hip fractures?

age, previous history of fall, gait imbalances combined with poor bone quality

tx of hip fractures?

surgery/immobilization

what is the most common post procedural complications for hip fractures?

MI/HF - 35-42% (d/t lack of blood flow to the heart from the anemia from surgery/fracture)

anemia - 24-44% (bleeding can accumulate in the thigh or the glute, incl. bruising, edema, discoloration post surgery)

hip fractures

what are the 4 portions of the ischium?

• superior ischial ramus

• ischial body

• ischial tuberosity

• inferior ischial ramus

what is the connection point between pubis bone and ischial bone?

ischiopubic ramus

ischiopubic ramus is created by what?

inferior ischial ramus and inferior pubic ramus

ischial spine is an important attachment point for what?

sacrospinous ligament

what allows passage of the sciatic nerve, piriformis muscle, and the lesser sciatic notch?

greater sciatic notch

what are the three portions of the innominate bone?

ilium, ischium, and pubis

what is acetabulum?

concave surface surface where femoral head articulates

ball and socket joint that allows for full movement

what are stabilizing ligaments for the pelvis?

sacrospinous ligaments and sacrotuberous ligament

where does the sacrotuberous ligament extend from?

sacrum to ischial tuberosity

what is medial to sacrotuberous ligament?

the sacrospinous ligament

the crossing of sacrotuberous ligament and sacrospinous ligament creates what two openings?

greater and lesser sciatic foramen

what is the greater sciatic foramen mostly filed with?

piriformis muscle (suprapiriform and infrapiriform)

what is in the lesser sciatic foramen? (PINTO)

• pudendal nerve

• internal pudendal artery/vein

• nerve to obturator internus

• TO tendon of obturator internus

where does piriformis muscle arise from/origin?

sacrum → greater sciatic foramen laterally

what is the role of the piriformis muscle?

lateral hip rotator along with obturator internus

where does piriformis muscle insert into?

greater trochanter

what is piriformis syndrome?

inflammation/scarring of piriformis muscle → compression of sciatic nerve → unilateral pain or numbness on buttock/leg

what is in the suprapiriform foramen (of the greater sciatic foramen?)

• superior gluteal a/v

• superior gluteal n

what is in the infrapiriform foramen (of the greater sciatic foramen?)

• inferior gluteal vessels a/v

• inferior pudendal a/v

• nerves of sacral plexus

• inferior gluteal nerve

• pudendal nerve

• sciatic nerve

• posterior femoral cutaneous nerve

• nerve to obturator internus

• nerve to guadratus femoris

greater sciatic foramen

what covers the obturator foramen?

obturator internus muscle

what are the 6 muscle groups of short hip rotator muscles?

1. piriformis m

2. obturator externus m

3. obturator internus m

4. superior gemellus m

5. inferior gemellus m

6. quadratus femoris m

where do all short hip rotator muscles converge?

area back of femur medial to greater trochanter

what rotation is your short hip rotator muscles responsible for?

produce lateral rotation of hip when foot is not on the ground

when foot is on ground, rotation of trunk to opposite side

where is obturator externus arise and insert?

• arise from lateral edge of ischiopubic ramus

• travels bckward under femoral neck

• inserts into greater trochanter

obturator internus muscle arise and inserts?

• starts in pelvic cavity on ilium and ischium and travels through lesser sciatic foramen

• inserts into greater trochanter

(it looks kind of fan shaped)

what is gemelli muscles?

pair of triangular muscles arising from ischium and overlaps with obturator internus muscle (inserts into greater trochanter)

what is role of gemelli muscles?

externally rotates thigh and extends hip

what is role of quadratus femoris muscle?

short and rectangular muscle, acts as external rotator and adductor

what are the 5 muscle groups of adductor muscles medially?

1. adductor longus m

2. adductor brevis m

3. adductor magnus m

4. pectineus m

5. gracilis m

(these also make up obturator externus)

what is adductor longus location?

arise: pubic crest

extends to femur, lower than brevis

where does the most distal aspect of adductor longus end?

edge of adductor hiatus

the adductor brevis m is ____ to longus m

deep

what is the largest of the adductor muscles and most posterior?

adductor magnus

where does the adductor magnus extend?

from outer border of pubis and ischium and extends to attach on POSTERIOR aspect of femur along linea aspera

what is the adductor hiatus?

large gap toward the distal end of femur?

what is pectineus muscle role?

adducts and flexes thigh

what is the gracilis muscle?

most medial muscle in thigh region

extends from hip joint and knee joint so affects both

adducts thigh and medially rotates and flexes knee

what are the abductor muscles?

• gluteus minimus m

• gluteus medius m

• tensor fascia

• also quadratus femoris, obturator internis, gemelli bundle, piriformis

gluteus minimus m

extends from ilium to front of greater trochanter

gluteus medium m

overlies gluteus minimus and extends from ilium to outer aspect of trochanter

tensor fascia lata m arise and extend

arise: iliac crest

extend: iliotibial tract

what is the fascia lata?

thick fibrous plane that surrounds tissue of thigh (like a casing)

iliotibial band

thickening of fascia lata and acts as area of insertion for gluteus maximus and tensor fascia lata m

what makes up the iliopsoas m?

psoas major, ilacus m, and psoas minor = primary hip flexor

what are the 3 muscles of posterior compartment of thigh?

• semitendinous m

• semimembranosus m

• biceps femoris

what are the actions of the posterior compartment of thigh?

1. extend hip

2. flex knee

what is semitendinosus m?

MEDIAL, superficial, rope like tendon at distal attachment

sits on top of semimembranosus m

what is semimembranosus m?

MEDIAL, deeper, more membranous/flatter/wider tendon

what is biceps femoris m?

LATERAL, has two heads, long and short

what are all the hip extensor muscles/hamstring muscles?

• semitendinosus m

• semimembranosus m

• bicep formis

what is role of gluteus maximus m?

extension when rising from squatting/seating