L1 Gluteal Region/Hip Joint

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Hip Joint; Gluteal Region

• The lecture covers hip joint and gluteal regions.
• Anatomical structures of hip joint are studied (bony and soft tissue structures).
• Radiographic images of hip are examined.
• Functional deficits in lower limb due to hip injuries and pathologies are considered.
• Important gluteal anatomical landmarks are identified.
• The attachments, nerve supply, and action of gluteal muscles are discussed.
• The spinal makeup, course, and relationships of named nerves and blood vessels in the gluteal region are described.

Learning Objectives

• Students will identify bony and soft tissue structures of the hip joint.
• Students will identify bony structures in radiographic hip images.
• Students will determine functional deficits in the lower limbs due to hip injuries or pathologies.
• Students will identify gluteal bony landmarks.
• Students will name, identify, and describe attachments, nerve supply, and action of the gluteal muscles.
• Students will describe the spinal makeup, course, relationships of named nerves, and blood vessels in the gluteal area.

Lower Limb Regions

• The document contains diagrams of lower limb regions.
• The diagrams display various anatomical structures, such as those of the anterior, posterior, lower limb, lower extremity, anterior thigh, posterior thigh, gluteal fold, knee joint, popliteal region, ankle joint, and foot.

Lower Limb Osteology

• The axial-appendicular articulations, including the sacroiliac joints are discussed.
• Weight of the body, including the head, arms, and trunk are transmitted to the os coxae through these joints.
• Body weight above the hip joints is transmitted to the lower limbs.

Bony Pelvis

• The acetabulum is the concave surface of the hip joint.
• The acetabulum forms at the junction of the three pelvic bone parts.

Hip Joint

• Diagrams and descriptions of anterior and posterior hip joint structures are contained within this document.

Proximal Femur

• A diagram displaying the front and back views of a proximal femur is shown.
• Labeling includes the head, neck, greater trochanter, and lesser trochanter.
• Diagrams illustrating abnormal angles of inclination (coxa vara and Coxa valga) are also included.

Hip Joint Capsule

• The posterior femur capsule attaches to the intertrochanteric crest.
• The os coxa has a capsule that attaches circumferentially around the acetabulum.
• The anterior femur’s capsule is attached to the intertrochanteric line.

Iliofemoral Ligament

• The iliofemoral ligament limits hip joint hyperextension.
• It also prevents anterior dislocation of the femur.

Hip Joint Acetabulum

• Fibrocartilage extends the joint cavity on the acetabulum.
• A fovea is present on the femoral head, along with an acetabular labrum.
• The labrum is connected to the femoral head by the acetabular branch of the obturator artery.

A-P Pelvis

• A-P Pelvis X-rays are used as surveys of the pelvic region in trauma cases.
• X-rays help identify areas with potential injury.

Hip PA/AP, Hip Lateral

• Identify acetabular fossa, fovea (head of femur), superior pubic ramus, obturator foramen, ischiopubic ramus, and ischial tuberosity on X-rays.
• Analyze the articular surface of acetabulum, head of femur, neck of femur, and greater and lesser trochanters on X-rays.

Blood Supply to Head of Femur

• Medial circumflex femoral artery is the primary contributor to blood supply to the femoral head in adults.
• Blood vessels penetrate the joint capsules at the lower neck of the femur, traveling up the neck.
• In aging, this arterial penetration provides almost the sole blood supply to the femoral head.

Proximal Femur Fractures

• Images showcase X-ray views of displaced and intertrochanteric fracture types in proximal femurs.

Fixation of Proximal Femur Fractures

• Images illustrate fixation methods for intertrochanteric and non-displaced femoral neck fractures.

Degenerative Arthritis of Hip Joint

• Images show hip resurfacing and total hip arthroplasty procedures.

Hip Joint Movements

• Diagrams demonstrate open-chain hip movements in various positions of the lower extremities.
• Diagrams show flexion, extension, abduction, adduction, rotation (medial and lateral), and circumduction movements.

Palpable Bony Landmarks - Gluteal

• Anatomical landmarks in the gluteal region (diagram):
• Iliac crest, posterior superior iliac spine, sacrum, and ischial tuberosity.

Cutaneous Nn. of Gluteal Region

• Collectively named superior, middle, and inferior clunial nerves.
• Details regarding dorsal rami, posterior femoral cutaneous nerve, etc.

Fascia Lata

• Deep fascia of gluteal region and thigh.
• Continuous with crural fascia (leg region) and deep fascia foot.

Iliotibial Tract

• IT band is thickening of fascia lata on lateral aspect of thigh.
• Contains Tensor fascia lata.
• Extends from tubercle of iliac crest to lateral tubercle of tibia, patella, and head of fibula.

Gluteus Maximus m.

• Medial (Superior) attachment - ilium, sacrum, coccyx, and sacrotuberous ligament.
• Lateral (Inferior) attachment – gluteal tuberosity.
• Function - extension and lateral rotation of thigh at hip joint.

Trochanteric Bursa/Bursitis

• Lies over greater trochanter and deep to IT band.

Gluteus Medius m.

• Lateral ilium to greater trochanter.
• Superior gluteal nerve (L5, S1).

Gluteus Minimus m.

• Lateral ilium to greater trochanter, deep to gluteus medius.
• Superior gluteal nerve (L5, S1).

Gluteus Medius and Minimus Mm.

• Anatomical structures: gluteus medius (G. medius) and gluteus minimus (G. minimus).

Gluteus Medius and Minimus Function

• Primary function is hip abduction.
• Secondary function is medial rotation of the femur at the hip joint.

Hip Abductor Functional Strength

• Abductors function when in a weight-bearing stance.
• Maintaining a level pelvic girdle requires contraction and isometric action by stance limb hip abductors.
• Trendelenburg sign for weak hip abductors.

Tensor Fasciae Latae

• Origin: anterior iliac crest.
• Insertion: iliotibial tract; innervation: superior gluteal n.
• Action: Abduction and medial rotation of the thigh.

Greater and Lesser Sciatic Foramina

• Diagrams of greater sciatic foramen (surrounding structures/ligaments).
• Lesser sciatic foramen (surrounding structures/ligaments).

Lateral Rotators

• Diagram of the muscles, detailing their origins, exits through foramina, attachments to greater trochanter region. Muscles include: piriformis, obturator internus, superior gemellus, inferior gemellus, and quadratus femoris.

Piriformis m. Obturator Internus m.

• Piriformis attachment – anterior sacrum.
• Obturator internus attachment – pelvic surface of obturator membrane.

Obturator Externus

• Bone surrounding obturator foramen and obturator membrane to greater trochanter.

Rotator Muscles of the Hip Joint

• Diagram of the hip joint and different muscles, detailing their function in medial and lateral rotation.

Lumbosacral Plexus

• Formed by anterior rami from L4-S3.
• Lumbosacral trunk (L4-L5) joins with sacral plexuses (S1-S3) to create the lumbosacral plexus.

Superior Gluteal n.

• Exits pelvis superior to piriformis; located between gluteus medius & minimus.
• Innervates gluteus minimus, gluteus medius, and tensor fasciae latae muscles.

Inferior Gluteal n.

• Exits pelvis inferior to piriformis.
• Innervates the gluteus maximus muscle.

Sciatic n.

• Exits pelvis below piriformis.
• Innervates hamstrings and various muscles of the lower limb.

Sciatic nerve variations

• 87% of individuals have the common fibular portion of the sciatic nerve passing through or over the piriformis.

Safe Zone for Intramuscular (IM) Injection in Gluteal Region

• The safe quadrant for gluteal injections is shown.
• Areas to avoid when injecting.

Other Motor Nerves Gluteal Region

• Anterior rami of S1 and S2 provide innervation for piriformis, obturator internus, superior gemellus, inferior gemellus, and quadratus femoris.

Posterior Femoral Cutaneous n.

• Innervates the skin over inferior buttocks and posterior thigh.

Pudendal n.

• Exits the pelvis via the greater sciatic foramen.
• Crosses the sacrospinous ligament and enters the ischial anal fossa.
• Passes through the lesser sciatic foramen with accompanying artery and vein.

Gluteal Region Dermatomes

• Diagrams illustrating dermatomes related to gluteal region.

Lower Limb Blood Supply

• Structures include abdominal aorta, common iliac artery, external iliac artery, femoral artery, etc.

Gluteal Region Blood Supply

• Superior gluteal artery exits the pelvis.
• Travels between gluteus medius/minimus.
• Supplies the upper portion of gluteus maximus.
• Inferior gluteal artery exits inferior to piriformis.
• Supplies gluteus maximus muscle.

Gluteal Region Lymphatic Drainage

• Superficial tissues drain to superficial inguinal nodes.
• Deep tissues drain to internal iliac nodes along gluteal vessels.

Practice Question

• A 80-year-old woman reporting difficulty climbing stairs likely has gluteus maximus weakness.

This lecture focuses on the hip joint and gluteal region, exploring the anatomical structures involved, both bony and soft tissue. Students will examine radiographic images and consider functional deficits related to hip injuries and pathologies. A thorough understanding of these components is essential for effective practice in osteopathic medicine.