Lower Extremity Anatomy > Hip Joint > Flashcards

Hip Joint Flashcards

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1
Q

Sacroiliac joint (SI)

A
  • Designed for force transmission and weight-bearing
  • Articulating bony surfaces are irregular
  • Limited motion
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2
Q

Sacroiliac joint (SI) is located between

A
  • L-shaped auricular surface of ilium and sacrum (S1-3)
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3
Q

Irregular articulating bony surfaces of sacroiliac joint

A
  • Increase friction and congruency
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4
Q

Limited motion of sacroiliac joint

A
  • 2 degrees of rotation

- 2mm of translation

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5
Q

2 parts of sacroiliac joint

A
  • Anterior planar (synovial joint)

- Posterior syndesmosis (fibrous joint)

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6
Q

Anterior planar (synovial joint)

A
  • Auricular surfaces
  • Sacral surface covered by hyaline cartilage
  • Ilium surface covered by fibrocartilage
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7
Q

Ligaments of the sacroiliac joint

A
  • Anterior (ventral) sacroiliac
  • Interosseous sacroiliac
  • Poster (dorsal) sacroiliac
  • Iliolumbar
  • Sacrotuberous
  • Sacrospinous
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8
Q

Anterior (ventral) sacroiliac ligament

A
  • Thickening of anterior joint capsule
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9
Q

Interosseous sacroiliac ligament

A
  • Connect tuberosities of sacrum/ilium

- Posterior/superior to joint

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10
Q

Posterior (dorsal) sacroiliac

A
  • Overlies interosseous ligament posteriorly

- Connects intermediate/lateral crest of sacrum of S1,2 to PSIS and internal lip of iliac crest

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11
Q

Long posterior (dorsal) sacroiliac ligament

A
  • S3,4 to PSIS
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12
Q

Iliolumbar ligament

A
  • L4,5 to iliac crest, sacral ala and anterior sacroiliac ligament
  • Primarily supports lumbosacral joint (L5/S1)
  • Also supports SI joint
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13
Q

Sacrotuberous ligament

A
  • Broad attachment to PSIS, posterior sacroiliac ligaments, dorsolateral sacrum and coccyx
  • Attaches to ischial tuberosity
    Glut max, piriformis, biceps femoris, semitendinosus muscles attach
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14
Q

Sacrospinous ligaments

A
  • Attaches from ischial spine to lateral margin of sacrum/coccyx
  • Anterior to sacrotuberous ligament
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15
Q

Ligaments that resist nutation

A
  • Sacrotuberous
  • Sacrospinous
  • Anterior and interosseous SI
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16
Q

Nutation

A
  • Anterior/inferior motion of sacral base
  • Posterior/superior motion of coccyx
  • There is concurrent superior rotation of pelvis (weight-bearing)
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17
Q

Counternutation

A
  • The opposite motion of nutation
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18
Q

Ligaments resisting counternutation

A
  • Long posterior (dorsal) sacroiliac ligament
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19
Q

Blood supply to SI joint

A
  • Superior gluteal
  • Iliolumbar
  • Lateral sacral
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20
Q

Innervation of the SI joint (variable among individuals)

A
  • Primarily dorsal rami L4-S3(4)
  • Vental rami L5-S2
  • Superior gluteal nerve
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21
Q

Pubic symphysis

A
  • Articular surfaces of pubis are covered by hyaline cartilage
  • Fibrocartilage disc connects the 2 pubic bones (symphysis joint)
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22
Q

Pubic symphysis joint functional classification

A
  • Amphiarthrosis joint
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23
Q

Superior pubic ligament

A
  • Attaches to pubic bones superiorly

- Extend out to pubic tubercles

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24
Q

Inferior pubic ligaments

A
  • Also called arcuate pubic ligament

- Extends out to inferior pubic rami

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25
Hip joint
- Ball and socket (spheroid) | - Synovial joint (diarthrosis)
26
Hip joint movements
- Triplanar motion | - Flex/ext/ab/add/int & ext rot/circumduction
27
Hip movement from the anatomical position
- Adduction is more limited than abduction | - Lateral rotation is stronger than medial rotation
28
Hip joint articulates between
- Femoral head and acetabulum (lunate surface)
29
Hip joint socket
- Stable - More than ½ of femoral head fits into “socket” - Anterior femoral head has less coverage of acetabulum
30
Acetabular fossa (cotyloid fossa) filled with
- Fat | - Ligament of the head of the femur
31
Acetabular labrum
- Fibrocartilage attached to acetabular rim
32
Acetabular labrum function
- Deepens socket - Shock absorber - Decrease stress between - Helps create negative pressure (sealing function) - Distributes compressive loads
33
Joint capsule attaches proximally to
- Rim of acetabulum | - Transverse acetabular ligament
34
Joint capsule attaches distally to
- Intertrochanteric line anteriorly - Extends to mid neck posteriorly (doesn’t attach firmly to bone) - Lateral half of neck is extracapsular posteriorly
35
Muscles that attach to the hip capsule
- Gluteus minimus - Iliocapsularis - Indirect head of rectus femoris - Obturator externus - Conjoint tendon of hip
36
Conjoint tendon of hip
- Obturator internus - Superior and inferior gemelli - Also known as the triceps coxae
37
Synovium
- Lines capsule and all structures within the capsule except for articular cartilage
38
Ligaments of the hip joint
- Extracapsular (extrinsic) - Iliofemoral - Pubofemoral - Ischiofemoral
39
Extracapsular (extrinsic) ligaments
- Reinforce joint capsule - Spiraling shaped fibers “screw” head into acetabulum - All resist hip extension and anterior translation of femoral head
40
Iliofemoral (Y-ligament, ligament of Bigelow)
- *Strongest ligament in the hip* | - Splits into 2 bands
41
Iliofemoral (Y-ligament, ligament of Bigelow) proximal attachment
- AIIS | - Iliac portion of acetabular rim
42
Iliofemoral (Y-ligament, ligament of Bigelow) two bands
- Upper (lateral) band | - Lower (medial) band
43
Upper (lateral) band of iliofemoral ligament
- Attaches to superior intertrochanteric line | - Resists extension and external rotation
44
Lower (medial) band of iliofemoral ligament
- Attaches to inferior intertrochanteric line | - Resists extension and external rotation
45
Pubofemoral ligament
- Attaches to pubic part of acetabular rim/obturator crest - Blends with joint capsule/iliofemoral ligament - Resists extension and abduction/external rotation
46
Ischiofemoral ligament
- Ischial part of acetabular rim to capsule around femoral neck - Resists extension and internal rotation
47
Zona orbicularis
- Circular fibers from the capsular ligaments for a collar around the neck - Not directly attached to bone - "Locking ring"
48
Zona orbicularis function
- Aids in holding femoral head into acetabulum | - Resists distraction
49
Intracapsular ligaments
- Ligament of head of the femur | - Transverse acetabular ligament
50
Ligament of head of the femur other names
- Ligamentum teres femoris - Round ligament of the femur - Ligamentum capitis femoris - Foveal ligament
51
Intracapsular ligament
- Located at the acetabular fossa
52
Ligamentum capitis femoris
- Secondary stabilization function of normal hip | - More important stabilizer in pathological hip
53
Ligamentum capitis femoris is a conduit for
- Artery to head of the femur and nerves | - Functions in proprioception
54
Ligamentum capitis femoris attaches
- Margin of acetabular notch/transverse acetabular ligament | - Fovea capitis on the femur
55
Transverse acetabular ligament
- Attaches to edges of acetabular notch | - Creates foramen for vessel passage
56
Iliocapsularis origin
- Anterior inferior iliac spine | - Anterior hip capsule
57
Iliocapsularis insertion
- Below lesser trochanter | - Sometimes iliopfemoral ligament and/or intertrochanteric line
58
Iliocapsularis innervation
- Femoral nerve
59
Iliocapsularis function
- Raise the capsule with hip flexion | - Stabilize the hip
60
Iliocapsularis becomes hypertophied with
- Dysplastic hips (insufficient acetabular coverage)
61
Trochanteric bursa
- Between gluteus maximus muscle and lateral aspect of greater trochanter - Associated with “hip bursitis”
62
Hip bursitis
- Point tenderness - Lateral thigh/gluteal pain - Pain with ext rotation and extension
63
Ischial bursa
- Between glut max and ischial tuberosity | - Prolonged sitting in a position that puts increased pressure on ischial tuberosity
64
Gluteofemoral bursa
- Between glut max (IT band) and vastus lateralis
65
Gluteus medius bursa
- Between gluteus medius and superior greater trochanter | - These are not the only ones
66
Blood supply to the hip joint
- Trochanteric anastomosis - Primarily from retinacular arteries from the ascending branches of medial and lateral femoral circumflex arteries - Medial femoral circumflex is major supplier in the adult
67
Medial femoral circumflex as the major supplier in the adult
- High risk of avascular necrosis with femoral neck fracture
68
Hip joint blood supply in the child
- Obturator is major supplier | - (Artery to the head of the femur)
69
Artery to the head of the femur
- Branch of acetabular artery (from posterior branch of obturator or MFC) - Important in younger children (< 3) - Not a major supplier in the adult
70
Nerve supply to hip joint
- Posterior division of femoral - Sciatic - Superior gluteal - Anterior branch of obturator nerve - Accessory obturator nerve can innervate if present - Nerve to quadratus femoris
71
Avascular necrosis of femoral head
- Interruption of blood supply to the femoral head resulting in ischemia - Osteocyte death and necrosis of the tissue (superolateral femoral head) - Can lead to femoral head collapse
72
Traumatic causes of avascular necrosis of femoral head
- Trauma resulting in hip dislocation/subluxation or femoral neck fracture
73
Non-traumatic causes of vascular necrosis of femoral head
- Excessive corticosteroid and alcohol use most common - Hematological disease - Many others
74
Imaging modalities for detecting avascular necrosis of the femoral head
- Plain radiographs | - MRI is most sensitive and specific
75
Thigh/hip flexors
- Flexors - Iliacus and psoas major (iliopsoas) - Rectus femoris - Sartorius - Tensor fascia latae - Pectineus - Adductor longus - Adductor brevis - Adductor magnus
76
Thigh/hip extensors
- Extensors - Gluteus maximus - Biceps femoris long head - Semitendinosus - Semimembranosus - Adductor magnus, hamstring part
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Thigh/hip abductors
- Abductors - Gluteus medius - Gluteus minimus - Tensor fascia latae - Piriformis - Sartorius
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Thigh/hip lateral (external) rotators
- Gluteus maximus - Piriformis - Obturator internus - Superior gemellus - Inferior gemellus - Quadratus femoris - Obturator externus - Sartorius - Gluteus medius and minimus
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Thigh/hip medial (internal) rotators
- Medial (internal) rotators - Tensor fascia latae - Gluteus medius - Gluteus minimus - Pectineus
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Thigh/hip adductors
- Adductors - Pectineus - Adductor longus - Adductor brevis - Adductor magnus - Gracilis - Quadratus femoris - Obturator externus
Lower Extremity Anatomy
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