Gluteal, Hip and Thigh

What are some anatomical landmarks of the pelvis

ASIS, Iliac crest, pubic tubercle, ischiopubic ramus

What landmark is used for pudendal nerve block

Ischial spine

What is fovea

The hole at the head of the femur → Where the artery of the ligament of the head of the femur is

What is the strongest ligament in the body

iliofemoral ligament (Y ligament); attached from the ASIS to the intertrochanteric crest of femur

What nerves innervate the anterior compartment

Femoral nerve

What nerves innervate the medial compartment

Obturator nerve

What nerves innervate the posterior compartment

Sciatic nerve

What is Trendelenburg sign

Pelvis of the patient drops to opposite side when standing on the affected limb

What causes the Trendelenburg sign

Weak paralyzed abductor muscle (gluteus medius and minimus) caused by superior gluteal nerve injury

What is the gait (walk) like for patients with positive Trendelenburg sign

Trunk of the body leans to the affected side to balance the center of gravity of the patient

Piriformis action

Lateral rotation of extended femur at hip joint; abduction of flexed femur at hip joint

What muscle is innervated by the superior gluteal nerve and abduct the femur at the hip joint

Gluteus medius, gluteus minimus and tensor fasciae latae

Function of gluteus medius and minimus

Abduct femus at hip joint, stabilization of pelvis, medial rotation

Gluteus maximus action and innervation

Extensor of flexed femur at hip joint; lateral rotation and abduction of thigh; inferior gluteal nerve

What is the shared action of obturator internus, gemellus superior and inferior and quadratus femoris

Lateral rotation of extended femur at hip joint; abduction of flexed femur at hip joint

Which muscles are innervated by the nerve to obturator internus

Obturator internus, gemellus superior

Which muscles are innervated by the nerve to quadratus femoris

Gemellus inferior, quadratus femoris

Muscles in the anterior compartment

Iliopsoas, vastus medialis, vastus lateralis, vastus intermedius, rectus femoris, sartorius

Quadricep muscles

Vastus intermedialis/medialis/lateralis, rectus femoris

Which muscle in the anterior compartment is NOT innervated by the femoral nerve and what nerve is it innervated by

Psoas major → Innervate by the anterior rami

Anterior muscles that extend leg at knee joint

Vastus intermedius, lateralis, medialis

Anterior muscles that flex thigh at hip joint

Psoas major, iliacus, rectus femoris, sartorius

Rectus femoris action

Flex thigh at hip joint + extend leg at knee joint

Sartorius action

Flex thigh at hip joint + flex leg at knee joint

Muscles in the medial compartment

Gracillis, pectineus, Adductor brevis, adductor longus, adductor magnus, obturator externus

Which muscles of the medial compartment are NOT innervated by the obturator nerve

Hamstring part of adductor magnus → Sciatic nerve; Pectineus → Femoral nerve

Which medial compartment muscle adduct and medially rotate thigh at hip joint

Pectineus, adductor brevis, adductor longus, adductor magnus

Gracilis action

Adduct thigh at hip joint and flex leg at knee joint

Obturator externus action

Lateral rotation of thigh at hip joint

Posterior/hamstring muscles

Bicep femoris, semitendinosus, semimembranosus

Muscles that flex leg at hip join, extend thigh at hip joint, medially rotate thigh at hip joint and leg at knee joint

Semitendinosus, semimembranosus

Bicep femoralis action

Flex leg at knee joint; extend and lateral rotation of thigh at hip joint, leg at knee joint

Common origin of posterior compartment muscle + Hamstring part of adductor magnus

Ischial tuberosity

What is pes anserinus

Group of 3 muscle attached at the superior tubercle (pes anserinus) from all 3 compartment that are all 2 joint muscles that flex the knee

What muscles are part of the pes anserinus

Sartorius, gracilis, semitendinosus

What nerve passes through the piriformis muscle

Sciatic nerve, superior and inferior gluteal nerves

What does the sciatic nerve branch into

Common fibular nerve and tibial nerve

Sensory nerves of the hip and thigh

Anterior cutaneous and saphenous nerve

Which is the safest area of the gluteus to do an injection

Upper lateral quadrant; lower medial has the sciatic nerve, upper medial has the superior gluteal

What are the branches of the aorta in the hip and thigh

Aorta → Common iliac artery → Internal and external iliac artery → External iliac becomes the femoral artery at inguinal ligament → Popliteal artery at adductor hiatus

What are the arteries that supply the head of the femur

Lateral and medial circumflex + artery of ligament of head of femur

What is the origin of the gluteal artery

Internal iliac artery

What structures are in the femoral triangle

Femoral nerve artery and vein

What structures are in the popliteal fossa

Popliteal artery and vein, tibial nerve, common fibular nerve

What is Shenton line used for

Find dislocation of the of hip

What does this image indicate

Hip dislocation

What does this image indicate

Normal hip and femur of a child

Lateral view femur

AP view femur

Genu varus

Genu valgus (knock knee)

<120 degree

Coxa vara

120-135 degree

Normal head of femur

>135 degree

Coxa valga

What is this image indicate

Intertrochanteric fracture

What does this image indicate

Femoral neck fracture

What artery would be affected in femoral neck fracture

Lateral and medial circumflex artery → High risk of avascular necrosis

Dislocation of femur

Which type of hip dislocation is more common and what is the most vulnerable position

Posterior; found in car accidents where the leg is shortened, adducted and internally rotated (sitting); posterior part of the acetabulum also breaks with it