How is the pelvic girdle formed and what does it articulate with?
•2 hip bones joint by pubic symphysis
•Each articulates with sacrum (axial skeleton) via sacro-iliac joint
What are the the deep fascias of the lower limb
1. Deep gluteal fascia 2. Fascia lata •Iliotibial Band = a thickened portion of the fascia lata •Saphenous opening (passage of neurovascular structures) –Where superficial vein enters the femoral vein 3. Popliteal fascia 4. Deep fascia of the leg (crural) intermuscular septa that define leg compartments------thick bands at ankle (extensor & fibular retinacula) 5. Deep fascia of the foot
What is the area of the leg
Between the knee and the ankle
What does the internal iliac artery branch into?
•superior & inferior gluteal aa. > gluteal region
•obturator a. > medial thigh
Internal pudendal a. is passing through
What does the external iliac artery become?
Bleeds profusely when lacerated and can cause fetal hemorrhage
What does the femoral artery branch into
•Deep artery of thigh
Descending genicular artery
What does the deep artery of the thigh feed?
Thigh and Hip
Also the = lateral and medial femoral circumflex artery and the perforating branches
What does the Descending genicular artery feed?
what does the popliteal artery feed?
Knee, leg and foot
ALSO = •Genicular arteries •Anterior tibial artery •Dorsalis pedis a. •Posterior tibial artery •Fibular a. •Medial & lateral plantar aa.
Which artery is the continuation of the femoral artery
What are the superficial veins of the lower limb
Great saphenous vein - empties into the femoral vein on the medial side
Small saphenous vein - joins the popliteal vein in knee to become the femoral vein on the lateral side
What deep vein drains into the external iliac vein and where does it receive its blood from?
Receives from: •Deep vein of the thigh (perforating & circumflex veins) •Genicular veins •Popliteal vein –Anterior and posterior tibial veins
Which veins drain into the internal iliac vein
Sup. & Inf. gluteal veins
How do you get varicose veins?
•Occur in superficial veins when either the deep fascia or valves of perforating veins are incompetent •Blood flow slows, go from deep to superficial veins and collects in the superficial vein, causing a bulge
What are some treatment options for varicose veins
•Sclerotherapy: injecting a sclerosing agent to cause vein to shrink and close
•Surgery: vein stripping or removal, or ligation of great saphenous v. at entrance to femoral v. in femoral triangle/ small sephanous v. at popliteal fossa
Where do vessels along the great saphenous drain into?
Superficial inguinal nodes
Where do vessels along the small sapheneous drain into?
Where do Superficial inguinal & popliteal nodes drain into?
•deep inguinal and then external iliac nodes
What is indicative of enlarged nodes
infection or malignancies
What are the spinal nerves of the lower limb?
•Lumbar plexus (L1 to L4) •Sacral plexus (L4 to S3) •exception:lat. cut. br. of subcostal n.(T12)
•Body •Ischial ramus •Ischial spine •Greater & Lesser sciatic notch •Ischial tuberosity** Repetitive movement can inflame the bursa covering the ischial tuberosity (ischial bursitis) / pressures sores common over tuberosity in debilitated or sensory-impaired patients
Articulating surface of the hip joint are covered with which articulating cartilage?
–head of the femur minus fovea
–lunate surface of the acetabulum
What is the acetabulum deepened by?
–acetabular labrum, a fibrocartilage collar which surrounds the acetabulum
–transverse acetabular ligament that bridge notch
Which ligament prevent hyperextension of the hip and where does it attach? Location?
Iliofemoral ligament (Y shaped)
Attaches = ilium and femur
Location = anterior and superior to the hip joint
Which ligament prevents over-abduction and helps limit extension? What is the attachment site and location?
Pubofemoral ligament (triangular shaped)
Attaches = pubic bone to the iliofemoral ligament
Location = anterior and inferior to the hip joint
Which ligament has a weak role in limiting extension & medial rotation of the hip? What are the attachment sites and Location?
Attaches = Ischium and Femur
Location = posterior to the joint
What is the normal angle of inclination of adults?
What happens when there is a decrease in the angle of inclination?
Coxa Vara mild passive abduction of the hip
Coxa Valga risk of osteoarthritis, subluxation of femur head
In the transverse plane between the axis of the femoral neck and the axis of the femoral condyles,
What does anterversion mean?
increased angle of torsion > 15 degrees
What does retroversion mean?
Decreased angle of torsion < 15 degrees
Which nerve supplies the hip joint anteriorly?
Which nerve supplies the hip joint inferiorly?
Which nerve supplies the hip joint superiorly?
Superior gluteal nerve
Which nerve supplies the hip joint posteriorly?
nerve to quadratus femoris
Which artery is the most important main supply to the head and neck of the femur?
Medial circumflex femoral artery (supplies most of the blood to the head and neck of the femur)
What arteries supply the Hip Joint
•Medial circumflex femoral artery –Lateral circumflex femoral artery –Artery to head of femur –Superior & Inferior gluteal –1st perforating branch of deep artery of the thigh
What complications arise with femoral fractures?
–retinacular branches of the medial femoral circumflex artery may be torn, resulting in avascular necrosis of the femoral head (bone dies)
–Risk of deep vein thrombosis & pulmonary embolism
What can cause Avascular necrosis of femoral head:
–Sickle cell disease –alcoholics or long-term use of corticosteroids
What is Legg-Calvé-Perthes
Epiphyseal ossification centers of the femoral head in children
What can cause an avulsion fracture of lesser trochanter
–pull of iliopsoas are frequent in adolescent
–adult > sign of metastatic carcinoma
What results form a posterior hip dislocation
Damage of the sciatic nerve & cause paralysis of muscles of posterior thigh and muscles below knee
–Most frequent and can damage your sciatic nerve
While you are walking, what minimizes the drop in center of gravity by lengthening the limbs?
Pelvic rotation in the transverse plane
What minimizes the rise in center of gravity
pelvic tilt (drop) on the swing side
What are the superficial gluteal muscle
•Tensor fasciae latae
•Gluteus medius & Gluteus minimus
–lateral rotation of thigh –Extension of thigh between flexed and standing position –stabilization of hip joint(keep femoral head in acetabulum)
– Medial rotation of thigh – Helps Flex thigh – stabilization of hip joint – stabilization of knee joint > supports femur on tibia by tensing fascia lata
What is the function of the Gluteus medius & Gluteus minimus
– Abduct & medially rotate thigh – Keep pelvis level when opposite limb is raised during walking – stabilization of hip joint (keep femoral head in acetabulum)
What can result from a Positive Trendelenburg Sign
•Results from paralysis or weakness of the gluteus medius and mimimus •Pelvis drops on opposite side when the affected side is supporting the body •the patient leans trunk toward the affected side to maintain balance may lead to an altered gait pattern:
What are the Deep Muscles of Gluteal Region? Function?