Gluteal Region, Hip, Posterior Thigh

What is the two function of the lower extremety? What are the five joints of the lower extremity?

1. Support body weight

   1. Articular surfaces are shaped to “lock”

   2. This reduces muscular energy
      

2. Locomotion

   1. Combination of several movements across multiple joints

• Joints:

  • Hip joint

  • Knee joint

    • Tibiofemoral joint

    • Patellofemoral joint

  • Tibiofibular joint

  • Ankle joint

  • Joints of the foot

Describe the superficial and deep fascia of lower limb. What is the Fascia Lata? What is the IT Band?

• Superficial Fascia

  • Delicate over the gluteal region

  • Contains fat and cutaneous nerves & vessels
    

• Deep Fascia

  • Deep gluteal fascia

  • Fascia Lata

    • A thick, stocking-like fascia that surrounds the thigh

    • Iliotibial Band - a thickened portion of the fascia lata

Describe the hip joint

(Articulation? Joint? AKA? Consists of?)

• Articulation: head of femur + acetabulum of pelvic bone

• Ball-socket Synovial joint

• Aka Os Coxae

• Consists of 3 fused bones: Ilium, Ischium, Pubis

Describe the acetabular labrum. Where is the transverse acetabular ligament and why is this important?

• Acetabular Labrum: fibrocartilage collar that surrounds and Deepens the acetabulum

• Transverse acetabular ligament has vessels passing through it
  

Differentiate between the sacrospinous and sacrotuberous ligaments

• Sacrospinous Ligament

  • Attachments: Anterior surface of sacrum + Ischial Spine

  • Forms greater sciatic foramen
    

• Sacrotuberous Ligament

  • Attachments: Lateral margin of sacrum + Ischial tuberosity

  • Sacrospinous + Sacrotuberous = lesser sciatic foramen

Describe what goes through the Greater sciatic foramen (above and below piriformis) and lesser sciatic foramen

Describe the SI joint’s function and sources of pain. Describe what the pain feels like

• Sacro-Iliac Joint

  • small and very strong

  • Transmits forces of upper body → pelvis (hips) and legs

  • shock-absorbing structure
    

• Source of Pain

  • Too much movement — hypermobility or
    instability

  • Too little movement — hypomobility or
    fixation.

  • typically felt on one side of the low back or buttocks, and can radiate down the leg

What are the hip flexors muscles (Origin/insertion/innervation)? What is the tensor fascia lata (function/innervation)?

• Hip Flexors

  • Iliacus
    • Iliac fossa
    • Lesser trochanter
    • Femoral nerve

  • Psoas
    • T12-L5
    • Lesser trochanter
    • Anterior rami
    

• Tensor fascia lata

  • stabilization of both knee and hip joints

  • innervated by superior gluteal n.

Differentiate between the gluteus maximus, medius, and minimus

• Gluteus maximus

  • extension of the femur at the hip

  • Inferior gluteal n.
    

• Gluteus medius

  • abducts & medially rotates femur at the hip

  • Superior gluteal n.

• Gluteus minimus

  • abducts and medially rotates femur

  • Superior gluteal n.

What are the deep muscles of the gluteal region? Function?

Deep Muscle:

• Piriformis

• Obturator internus

• Superior & Inferior Gemelli

• Quadratus femoris
  

Function:

• laterally rotate extended femur or abduct flexed femur

Describe the biomechanic of the hip joint during gait

Describe the Trendelenberg sign/gait

• Paralysis of Gluteus Medius + Minimus = (+) Trendelenburg sign

• Sign: pelvis opposite the affected side drops when the affected side is supporting the body

• patient will leans her trunk toward the affected side to maintain balance

What are the nerves to lower limb?

Nerves to lower limb:

• Obturator

• Femoral

• Sciatic

• Superior/Inferior gluteal nerves

• Cutaneous nerves

What are the nerves to gluteal region? How do you inject into the gluteal region?

• Superior gluteal nerve

• Inferior gluteal nerve

• Sciatic nerve

Safe = Upper lateral quadrant

What is piriformis syndrom? What occurs in 12% of the population? What plays a role in this disease? What type of occupation could lead to this?

• Sciatic nerve can become irritated or compressed by the piriformis muscle → pain and/or paresthesia in the gluteal region and posterior thigh

• An early division of the sciatic n. occurs in about 12% of the population and may predispose a person to this condition
  

• Hypertrophy of the piriformis plays a role as well

  • Dancers, ice skaters, cyclists, etc.

Describe the vasculature of the head of femur

• Extracapsular arterial network around head and neck of femur

• Branch from medial & lateral circumflex arteries

• Only one small artery to the head of the femur (branch of obturator)

How does avascular necrosis could happen to the head of the femus?

Medial circumflex artery feeds epiphyseal arteries (posterio-lateral aspect of femoral neck

Disruption of this blood supply leads to avascular necrosis of femoral head

What are the anterior ligaments of the hip? Compare and contrast them

(Shape? Attachments? tightened when…?)

Iliofemoral Ligament

• Y shaped ligament located anterior to hip joint

• Attachments: ilium btw AIIS / margin of acetabulum + femur along intertrochanteric line

• tightened by extension of femur

  • helps reduce muscular energy required to maintain a standing position
    

Pubofemoral Ligament

• triangular shaped ligament located anteroinferior to hip joint

• Attachments: Pubic bone + iliofemoral ligament

  • (Exact attachments vary from text to text)

• Tightens w/ extension and abduction of the femur

Describe the ischiofemoral ligament?

(Location? Attachments? Function?)

• Location: posterior to hip joint

• Attachments: Ischium + neck/greater trochanter of femur

• Function: similar to Iliofemoral and pubofemoral but not as strong

Describe Hip Replacement Surgery

(procedure? type? common problem post op?)

• Removes damaged cartilage and bone → replaces w/ artificial parts
  

• Types:

  • Joint resurfacing

  • Hemiarthroplasty

  • Total joint replacement

• common problem post-op: hip dislocation because artificial hip is smaller than the original joint

What are the Posterior Thigh Muscles (action? Innervation? Attachment?)

• Semimembranosus & Semitendinosus

  • Flex leg at knee

  • Extend thigh at hip

  • Medially rotate lower limb
    

• Biceps Femoris

  • Flexes leg at knee

  • Extends thigh at hip

  • Laterally rotates lower limb
    

• All supplied by sciatic nerve
  

• Note proximal attachment on ischial tuberocity (2 joint muscle)

Describe the divisions of the sciatic nerve

• Divides into two divisions in distal thigh (Sometimes divided within pelvis)
  

• Tibial Division
  

  • Medial thigh: Adductor magnus, hamstring part
    

  • Posterior thigh: Long head of biceps femoris, Semitendinosus, Semimembranosus
    

• Common Fibular Division

  • Posterior thigh: Short head of biceps femoris

    • Divides into deep and superficial fibular nerves

    • Old name “peroneal nerve”

Describe the boundaries and content of the popliteal fossa?

What is the difference between between Gluteals and Hamstring?

Gluteal: extends hip getting up

Hamstring: Exten hip when standing

Describe how hamstrings could cause Low Back Pain.

• Hamstring muscles are tight → pull on their attachment at the bottom of the pelvis → backwards tilting of
  the pelvis →rounding out the natural inward lower back arch and causing slouching

• If your muscles have tightened up then blood has been squeezed out of them therefore your muscles are working at less than 100 % of capacity and your performance will be down as a result