Musculoskeletal Anatomy: Pelvic Girdle Osteology PDF

Housekeeping Reminders: – Online Quiz #8 (Open until March 20th, 12pm, noon) Announcements: – Labs switching to CRN 221 starting MONDAY! – Final Exam, April 16, 7-9pm – Course Evaluations!  Today’s Lecture Identify the bones and landmarks of the pelvic girdle and t...

Housekeeping Reminders: – Online Quiz #8 (Open until March 20th, 12pm, noon) Announcements: – Labs switching to CRN 221 starting MONDAY! – Final Exam, April 16, 7-9pm – Course Evaluations!  Today’s Lecture Identify the bones and landmarks of the pelvic girdle and thigh Identify and understand the function of the hip joint, including the supporting ligaments Identify the muscles that position/move the thigh (i.e., act at the hip) Distinguish major arteries and veins bringing blood to and from the lower extremity  MUSCULOSKELETAL ANATOMY WEEK #10 – PELVIC GIRDLE OSTEOLOGY  Objectives 1) Introduce the anatomical definitions of the pelvis and pelvic girdle. 2) Overview bony landmarks of the coxal bone and bony pelvis. 3) Compare the structure of a male vs. female bony pelvis.  Introduction The appendicular skeleton includes: – Pectoral girdle Upper Extremity – Upper limbs – Pelvic girdle Lower Extremity – Lower limbs  Pelvic Girdle Pelvic Girdle – Supports and protects the lower abdominal viscera and the reproductive organs Pelvic girdle consists of: – Two coxal bones (“hip bones”) ‘Pelvic Girdle’ does NOT – Each coxal bone consists of one: include sacrum & coccyx! Ilium Ischium Pubis  Ilium Pelvic Girdle Synostosis - Joint between fused bones ANTERIOR POSTERIOR - Completely fused by Age 25 Ischium Pubis Medial view Ilium POSTERIOR ANTERIOR Pubis Ischium Lateral view  Pelvic Girdle (lateral) Iliac crest Posterior gluteal line Anterior gluteal line Anterior superior Posterior superior iliac spine iliac spine Posterior inferior Anterior inferior iliac spine iliac spine Inferior iliac notch Greater sciatic notch Inferior gluteal line Lesser sciatic notch Lateral view  Pelvic Girdle (lateral) Greater sciatic notch (pathway for Sciatic Nerve) Acetabulum Acetabular fossa Ischial spine Superior pubic ramus Lesser sciatic notch Pubic tubercle Ischial tuberosity Inferior pubic ramus (Sitting Bones) Obturator foramen Ischial ramus (Closed by obturator membrane) Lateral view  Pelvic Girdle (medial) Iliac crest (Spans ASIS & PSIS) Iliac Iliac tuberosity fossa Anterior superior Posterior superior iliac spine iliac spine Anterior inferior Auricular surface iliac spine Sacro-iliac joint Attachment between Lower Extremity & Axial Skeleton Obturator foramen Posterior inferior iliac spine Medial view  Pelvic Girdle (medial) Superior pubic Greater sciatic notch ramus Ischial spine Pectineal line Lesser sciatic notch Pubic tubercle Pubic symphysis Ischial tuberosity Ischial ramus Inferior pubic ramus Medial view Pelvic Girdle vs. Pelvis The Pelvis – Composite structure consisting of: 2 coxal bones (appendicular) Pelvic Girdle Sacrum (axial) Ilium Coccyx (axial) Sacrum Ischium Pubis Coccyx  Pelvis (anterior) Iliac crest Iliac fossa Sacro-iliac joint Arcuate line Acetabulum Pubic symphysis Anterior view  Figure 7.11b The Pelvis (Part 1 of 2) Pelvis (posterior) Iliac crest Posterior Superior iliac spine Posterior inferior Greater iliac spine sciatic notch Ischial spine Ischial tuberosity Sciatic Nerve! Posterior view  Pelvis The Pelvis: – Greater (false) pelvis → from left to right iliac crest – Lesser (true) pelvis → inferior to pelvic brim  Pelvis Consists of two pelvic spaces: 1. Pelvic inlet → superior space between the brim of each coxal (hip) bone 2. Pelvic outlet → inferior space between the ischial tuberosities AND between symphysis and coccyx Pelvic Inlet Pelvic Outlet  Pelvis (superior/inferior) Greater pelvis Pelvic outlet Pelvic brim and Bony edges of lesser lesser pelvis pelvis Pelvic inlet Pelvic outlet Covered by Pelvic floor muscles Ischial tuberosity Ischial spine Pelvis Comparison Male and Female Pelvis – Anatomical differences relate to childbearing Ischial spine – Female Pelvis: Wider pelvic inlet and 90° or less outlet Male Ilia project laterally Less curvature of the sacrum/coccyx Broader pubic angle Ischial spine 100° or more Female  Pubic Angle Male: < 90∘ Female: ≥ 90∘ 90 50 ∘ ∘ Male Female  Pelvic Inlet Male: Heart Shape Female: Oval Shape Male Female  Coccyx Male: Points Anteriorly Female: Points Inferiorly Anterior Anterior Posterior Posterior Male Female Greater Sciatic Notch Male: narrow Female: wide Male (Arrow Length: 0.9 cm) Female (Arrow Length: 1.3 cm)  Summary Pelvic Girdle (Coxal Bones) vs. Pelvis (Coxal Bones + Sacrum/Coccyx). Bony Landmarks of the Coxal Bones: – Ilum – Ischium – Pubis Pelvic spaces/distinctions: – Greater vs. Lesser Pelvis – Pelvic Inlet vs. Pelvic outlet Male vs. Female Pelvis – Pubic Angle – Pelvic Inlet – Coccyx – Greater Sciatic Notch MUSCULOSKELETAL ANATOMY WEEK #10 – FEMUR OSTEOLOGY The Lower Limb Responsible for transferring the Femur body weight to the ground Patella Tibia Fibula Tarsal bones Metatarsal bones Phalanges  head Articulates with Acetabulum Anterior Neck Fovea Greater Femur trochanter Intertrochanteric line Lesser trochanter Femur: Longest & heaviest bone in the body! Shaft (body) of femur Lateral epicondyle Medial epicondyle Patellar surface Lateral condyle Medial condyle  Articular surface of head Greater trochanter Proximal Femur Intertrochanteric crest Greater trochanter Neck Articular Lesser surface Fovea trochanter of head Ligament of head of femur Medial view of the femoral head Neck Trochanters: Attachment site for ligaments & muscles Lateral view of the femoral head  Head Neck Posterior Greater trochanter External Hip Rotators Femur Lesser trochanter Intertrochanteric crest Hip flexors Pectineal line Pectineus muscle Gluteal Tuberosity Glut Max muscle Linea aspera Adductor hip muscles Lateral supracondylar ridge Medial supracondylar ridge Lateral epicondyle Popliteal Surface Adductor tubercle Lateral condyle Medial epicondyle Medial condyle Intercondylar fossa Superior view of Femur Femoral Neck Greater head trochanter Lesser trochanter Lateral condyle Medial condyle A superior view of the femur  Inferior view of Femur Patella Patellar groove Intercondylar fossa Location of Anterior & Posterior Cruciate Ligaments (ACL and PCL) Medial condyle Lateral condyle  MUSCULOSKELETAL ANATOMY WEEK #10 – PROXIMAL LOWER EXTREMITY ARTHROLOGY  Objectives 1) Overview the structure and function of selected joints from the lower extremity. 2) Overview relevant stabilizing structures (i.e. ligaments). Joints of Pelvic Girdle and Lower Limb  Sacro-iliac (SI) Joint Planar (gliding) diarthrosis Connection between axial skeleton and lower extremity http://upload.wikimedia.org/wikipedia/commons/thumb/9/91/Sacroiliac_joint.svg/450px-Sacroiliac_joint.svg.png  Pubic Symphysis Amphiarthrosis – Symphysis (little movement) Only articulation between two coxal (hip) bones Typically, very little movement. Increased Movement during childbirth. Pubic symphysis  Hip Joint Ball and socket diarthrosis Strong, dense and deep articular capsule – increases stability of joint – extends to the intertrochanteric line of femur enclosing both the femur head and neck – 5 ligaments stabilize the joint – Additional stabilization is provided by muscles surrounding hip  Hip Joint (Anterior) Ilium Pubis (1) Pubofemoral ligament Greater trochanter (2) Iliofemoral ligament Lesser trochanter Anterior view of the right hip joint Hip Joint (Posterior) (2) Iliofemoral ligament (3) Ischiofemoral ligament ishium Greater trochanter Lesser trochanter Ischial tuberosity Posterior view of the right hip joint  Hip Joint (Lateral) Acetabular labrum Acetabulum (4) Ligament of the femoral head Attaches to Fovea (5) Transverse acetabular ligament Lateral view of the right hip joint with the femur removed  Hip Fractures 2 main types – femoral neck and intertrochanteric Surgically repaired  Hip Replacement Damaged hip joint is removed and replaced with artificial joint (a prosthesis). Age related degeneration  Hip Dislocation Anterior and posterior (most common) Posterior can cause permanent nerve damage (sciatic nerve) – Leg turns inward & femoral head points posteriorly HipdisX.png  MUSCULOSKELETAL ANATOMY WEEK #11 – MUSCLES THAT MOVE THE THIGH  Objectives 1) Review the movements occurring at the hip joint. 2) Overview the structure and function of muscle groups acting at the hip joint to move the femur.  Muscles of the Pelvic Girdle and Lower Limbs These muscles are larger and more powerful than those of the upper limb Can be divided into three groups: – Muscles that move the thigh (act at hip) – Muscles that move the leg (act at knee) – Muscles that move the feet and toes (act at ankle, etc.) Muscles that move the thigh - Hip Joint Movements Muscle actions depend on orientation relative to acetabulum! Four Groups: (1) Gluteal Group (2) Lateral Rotator Group (3) Adductor Group (4) Iliopsoas Group Muscles that move the thigh  Gluteus maximus Gluteal Group Iliac crest, sacrum, coccyx & thoracolumbar fascia ↓ Gluteus medius (cut) Gluteal Tuberosity Ilium (between posterior & Extension & Lat. Rotation Anterior gluteal lines) Inf. Gluteal Nerve ↓ Greater Trochanter Abduction & Med. Rotation Sup. Gluteal Nerve Gluteus minimus Ilium (between posterior & Inferior lines) ↓ Greater Trochater Abduction & Med. Rotation Sup. Gluteal Nerve Gluteal Group Gluteus medius Tensor fasciae latae Iliac Crest & ASIS ↓ Iliotibial Tract Hip Abduction & Medial Rotation Knee Extension Sup. Gluteal Nerve Gluteus maximus Muscles that move the thigh  Lateral Rotator Group – 6 small muscles Piriformis Anterolateral Sacrum ↓ Quadratus femoris Greater Trochanter Ischial Tuberosity Lat. Rotation & Abduction ↓ Sacral Nerves (S1 & S2) Intertrochanteric Crest Lat. Rotation Nerve to quadratus femoris Obturator internus Medial margin of obturator foramen P ↓ Greater Trochanter G Lat. Rotation & Abduction O Obturator N. G Gemelli (superior & inferior) Ischial Spine (Superior) & Tuberosity (Inferior) ↓ Greater Trochanter Lat. Rotation & Abduction Nerves to obturator interus & quadratus femoris Lateral Rotator Group Piriformis Obturator Obturator internus externus Muscles that move the thigh Adductor Group Adductor magnus Inferior ramus of pubis & ischial tuberosity ↓ Anterior part: Linea aspera & Adductor tubercle Adduction, flexion and extension Hip Flexion Obturator & Sciatic Nerves Posterior part: Hip Extension Action lines of the adductor magnus  Adductor Group Adductor brevis Inferior Ramus of Pubis ↓ Linea Aspera Adduction & Flexion (Hip) Obturator Nerve Adductor longus Inferior Ramus of Pubis ↓ Pectineus Linea Aspera Sup. Pubic Ramus Adduction, Flexion & Med. Rotation (hip) ↓ Obturator Nerve. Pectineal Line (femur) Flexion & Adduction (hip) Gracilis Femoral Nerve Inferior Ramus of Pubis ↓ Medial surface of tibia Adduction & Med. Rotation (hip) Flexion & Med. Rotation (knee) Obturator Nerve Muscles that move the thigh  Iliopsoas Group – hip flexion ~40% of people Psoas major also have a Psoas Anterior Surface & TP (T12-L5) minor muscle! ↓ Lesser Trochanter Flexion (hip) Lumbar Nerves (L2-L3) Iliacus Iliac Fossa ↓ Lesser Trochanter Flexion (hip) Femoral Nerve Both Muscles Combined = ‘Iliopsoas’  Summary Gluteal Group – Gluteus Maximus → Extension & Lateral Rotation (insert @ gluteal tuberosity) – Gluteus Medius Abduction & Medial Rotation (insert @ greater trochanter) – Gluteus Minimis Lateral Rotator Group – Piriformis – Obturator Internus/Externus Abduction & Lateral Rotation (insert @ greater trochanter) – Gemelli – Quadratus Femoris → Lateral rotation (insert @ intertrochanteric crest) Adductor Group – Adductor Longus – Adductor Brevis – Adductor Magnus Three Page Book with Binding, ‘Adductor’ muscles insert @ Linea Aspera – Gracilis – Pectineus →Flexion & Adduction (Pectineal Line → Pectineal Line) Iliopsoas Group – Iliacus Hip Flexion (both insert @ lesser trochanter) – Psoas  MUSCULOSKELETAL ANATOMY WEEK #12 – VENOUS AND ARTERIAL BLOODSUPPLY OF THE LOWER EXTREMITY  Objectives 1) Overview Venous and Arterial Blood Supply of the Lower Extremity. 2) Summarize the Lower Extremity Compartment Supplied by each Structure.  Common iliac Anterior Arteries External iliac Deep Femoral Inguinal Femoral ligament Popliteal Anterior tibial (anterior to interosseous membrane) Fibular Anterior view of the arteries supplying the right lower limb Posterior Arteries External iliac Deep Femoral Femoral Popliteal Posterior tibial Anterior tibial (posterior to interosseous membrane) Fibular Posterior view of the arteries supplying the right lower limb Summary - Lower limb arteries Common Iliac ↓ External iliac ↓ Femoral Deep Femoral ↓ Popliteal Anterior Tibial Posterior Tibial ↓ Dorsal & Plantar Arches Fibular  Right common iliac Anterior External iliac Veins Femoral Great saphenous Longest vein in the body! Small saphenous From Popliteal Vein Anterior tibial Plantar venous arch Connect Anterior Tibial & Fibular Veins Dorsal venous arch Digital veins Anterior view showing the veins of the right lower limb Posterior Veins Right external iliac Both Saphenous Veins are Superficial. Femoral Great saphenous KEY Popliteal Superficial veins Small saphenous Deep veins Anterior tibial Fibular Posterior tibial Posterior view showing the veins of the right lower limb  Summary - Lower limb veins Fibular Ant. Tibial Small Saphenous Great Saphenous Post. Tibial Popliteal Femoral External iliac  Anterior superior iliac spine Femoral Inguinal ligament Triangle Pubic tubercle Femoral artery Femoral nerve “SAIL” Femoral vein Sartorius Adductor longus Adductor longus Sartorius Inguinal Ligament  Femoral Triangle Inguinal ligament Femoral artery Sartorius “SAIL” Femoral nerve muscle Femoral vein Adductor longus muscle Summary