L1 Gluteal Region; Hip Joint PDF

Notice and Agreement Medical Gross Anatomy - Lecture # 1 Hip Joint; Gluteal Region This session is being recorded Class recordings are distributed for the exclusive use of students in the LMU DeBusk College of Osteopathic Medicine. Student access to an...

Notice and Agreement Medical Gross Anatomy - Lecture # 1 Hip Joint; Gluteal Region This session is being recorded Class recordings are distributed for the exclusive use of students in the LMU DeBusk College of Osteopathic Medicine. Student access to and use of class recordings are conditioned on agreement with the terms and conditions set below. Any student who does not agree to them is prohibited from accessing or making any use of such recordings. 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For the course name, lecture # and lecture title, faculty are to use EXACTLY what is listed on the official schedule on the LMU-DCOM website. 1  Hip Joint Gluteal Region Moore (9th ed.) 674-682, 731-738, 741-749 John Gassler DPT DOSYS 702 Lecture 1, January 7, 2025 2  Learning Objectives At the end of this lecture the student will be able to: Identify the bony and soft tissue structures of the hip joint Identify bony anatomical structures in radiographic images of the hip region Determine the functional deficit in the lower limb due to injury or pathologic conditions of the hip Identify important bony landmarks in the gluteal region Name, identify, and describe the attachments, nerve supply, and action of the muscles of the gluteal region Describe the spinal makeup, and the course and relationships of the named nerves and blood vessels in the gluteal region 3 3  Lower Limb Regions Lower Limb Lower Extremity Popliteal region Gray’s Anatomy for Students 4 4  Lower Limb Osteology HAT Axial - Appendicular Articulations -Sacroiliac Joints Weight of body above the pelvis (HAT – head, arms, trunk) is transmitted to the os coxae through the sacro-iliac joints Body weight above hip joints is transmitted to the lower limbs (femurs) through the hip joints Moore Fig 7.3, p. 676 5 5  Bony Pelvis Tubercle of the iliac crest Lateral PSIS Acetabulum forms the concave ASIS AIIS surface of the hip joint Forms at the junction of the three PIIS parts of the pelvic bone Greater sciatic notch Lesser sciatic notch Ischiopubic ramus Gilroy Fig 19.3A, p. 229 6 6  Hip Joint Anterior inferior iliac spine Body of pubis Ischiopubic ramus Anterior Gilroy Fig 31.6A and B, p. 408 Posterior 7 7  Proximal Femur Head Shaft Anterior Posterior "Trokhos" (Greek) = "wheel", with reference to the spherical femoral head which was first Gilroy Fig 31.4 A and B, p. 406 named "trokhanter". 8 Abnormal angles of inclination 8  Hip Joint Capsule Gilroy Fig 31.10B, Os coxa - capsule p. 411 Posterior attaches Anterior Gilroy Fig 31.9B, p. 411 Posterior femur – capsule circumferentially Anterior femur – capsule attaches attaches to intertrochanteric crest around the to intertrochanteric line acetabulum 9 9  Hip Joint Capsule Iliofemoral lig. Pubofemoral lig. Ischiofemoral lig. Gilroy Fig 31.9A, Gilroy Fig 31.10A, p. 411 p. 411 ligament Iliofemoral ligament Ischiofemoral ligament limits hyperextension at hip joint limits hyperextension of prevents anterior dislocation of femur at hip joint femur from acetabulum prevents posterior Pubofemoral ligament limits dislocation of femur from abduction of thigh at hip joint acetabulum 10 10  Hip Joint Acetabulum Fibrocartilage extension of joint cavity Gilroy Fig 31.8B, p. 410 11 Moore Fig 7.83A, p. 797 11  Hip Joint Acetabulum Labrum – fibrocartilage ring at edge of bony acetabulum Deepens socket to increase stability of hip joint Ligament of the head of the femur – attaches from labrum to head of femur Contains artery for blood supply Obturator a. to head of femur – acetabular branch of obturator a. Gilroy Fig 31.8C, p. 410 12 12  A-P Pelvis Used as a survey of pelvic region in trauma cases to identify areas of potential injury 13 13  Articular surface Hip PA/AP of acetabulum Acetabular fossa Head of femur Fovea, head of femur Neck of femur Superior pubic ramus Obturator foramen Greater trochanter Ischiopubic ramus Intertrochanteric region Ischial tuberosity Lesser trochanter 14 14 Hip Lateral Articular surface of acetabulum Head of femur Neck of femur Greater trochanter Lesser trochanter Shaft of femur 15 15  Blood Supply to Head of Femur Moore Fig 7.86, p. 801 Gilroy Fig 34.4A, p. 467 Medial circumflex femoral artery is the primary contributor to blood supply to the head of the femur in adults Arteries penetrate the joint capsule at the lower neck of the femur and travel up the neck 16 of the femur to the head – in aging, the only blood supply to femoral head 16  Proximal Femur Fractures Displaced femoral neck fracture Intertrochanteric fracture 17 17 Fixation of Proximal Femur Fractures Old New Fixation of Fixation of Fixation of non-displaced displaced intertrochanteric fractures femoral neck femoral neck fracture fracture 18 18 Degenerative Arthritis of Hip Joint Hip Resurfacing Total Hip Arthroplasty (THA) 19 19 Hip Joint Movements X X Rotation Medial Lateral Circumduction Open chain – foot off the ground 20 20 Palpable Bony Landmarks - Gluteal 21 Gilroy Fig 31.1B, p. 402 21 Cutaneous Nn. of Gluteal Region Collectively named Superior, middle, and inferior clunial nerves 22 Gilroy Fig 34.26B, p. 480 22  Fascia Lata Deep fascia of the gluteal region and thigh Continuous with crural fascia of the leg and deep fascia of foot (Crural fascia) 23 23  Iliotibial Tract Tensor Fasciae IT band is a thickening of the Latae M. fascia lata on the lateral aspect of the thigh Tensor fascia lata is IT Band contained within the iliotibial band Extends from tubercle of iliac crest to lateral tibia, patella, and head of fibula IT band attaches to lateral tibia 24 24  Gluteus Maximus m. Inferior Gluteal N. L5,S1,2 Medial (superior) attachment – ilium, sacrum, coccyx, sacrotuberous ligament Lateral attachment Superior portion attaches to iliotibial tract Moore, Fig 7.38, p. 734 Inferior portion attaches to gluteal tuberosity Function Primary – Extension and lateral rotation of the thigh at the hip joint 25 Primary muscle used for standing up from squat or sitting, climbing steps 25  Trochanteric Bursa/Bursitis Gilroy Fig 34.35B, p. 487 Lies over greater trochanter and deep to IT Band 26 26  Gluteus Medius m. Superior Gluteal N. L5,S1 Lateral ilium to greater trochanter Gilroy Fig 34.20A, p. 421 27 27  Gluteus Minimus m. Superior Gluteal N. L5,S1 Lateral ilium to greater trochanter, deep to gluteus medius 28 Gilroy Fig 31.14B, p. 416 28 Gluteus Medius and Minimus Mm. G. medius G. minimus 29 29  Gluteus Medius and Minimus Function Gluteus medius Gluteus minimus Piriformis Primary action Open chain (foot off the ground) – hip abduction Closed chain (foot on ground and weight bearing on one foot) – maintain level pelvic girdle or elevate opposite side of pelvis Secondary action – medial rotation of femur at hip joint 30 30  Hip Abductor Functional Strength Function of hip abductors when weight bearing on one lower extremity (closed chain) is for the abductors of the stance limb to contract isometrically to maintain a level pelvic girdle If stance limb hip abductors are weak, pelvis will drop to the opposite side Trendelenberg Sign When walking - Trendelenberg gait Normal Weak hip abductors pattern 31 Moore Fig B7.19, p. 750 31  Tensor Fasciae Latae Origin: Anterior iliac crest Insertion: Iliotibial tract Tensor fasciae latae Innervation: Superior gluteal n. Action: Abduct and medially rotate thigh 32 32 Greater and Lesser Sciatic Foramina Gilroy Fig 19.11A, p. 235 33 Gilroy Fig 31.8A, p. 410 33  Lateral Rotators Piriformis Origin - anterior sacrum exits pelvis through greater sciatic foramen Obturator internus Origin - bone around obturator foramen, obturator membrane exits pelvis through lesser sciatic foramen Gilroy Fig 31.20B, p. 421 Gemelli – superior and inferior O: Ischial spine (superior) O: Ischial tuberosity (inferior) All attach laterally to Quadratus femoris greater trochanter region Ischial tuberosity to intertrochanteric crest 34 34  Piriformis m. Obturator Internus m. Pelvic Attachments Piriformis – anterior sacrum Obturator internus – Pelvic surface of obturator membrane and surrounding bone 35 Gilroy Fig 31.13, p. 415 35 Obturator Internus m. 36 36  Obturator Externus Anterior Posterior Gluteus maximus Gilroy Fig 31.22B, p. 423 Bone surrounding obturator foramen, Obturator membrane à greater trochanter Gilroy Fig 31.15A, p. 418 37 37  Rotator Muscles of the Hip Joint How They Work Superior and Inferior gemelli Superior view Moore Fig 7.42D, p. 737 Moore Fig 7.83A, p. 797 38 38  Lumbosacral Plexus L1 L4,5,S1,2,3 L4 Formed by part of L5 L4 Lumbosacral trunk anterior ramus of L4 L5 and all of anterior ramus of L5 The lumbosacral trunk (L4-L5) joins the sacral plexus (S1-S3) to form the lumbosacral plexus (L4 – S3) 39 Gray’s Anatomy for Students 39  Superior Gluteal n. (L4)-L5,S1 Exits pelvis superior to piriformis Located between gluteus medius and gluteus minimus Innervates: Gluteus medius m. Gluteus minimus m. Tensor fasciae latae m. Gilroy Fig 34.21A, p. 477 40 40  Inferior Gluteal n. L5,S1-2 Exits pelvis inferior to piriformis Gluteus maximus m. Gilroy Fig 34.21B, p. 477 41 41  Sciatic n. -Tibial n. L4-5,S1-3 -Common Fibular L4-5,S1-2 Sciatic n. exits pelvis inferior to piriformis 42 Gilroy Fig 34.32C, p. 484 42  Sciatic Nerve Variations 87% Common fibular portion of sciatic n. may pass through or over piriformis m. 12.5% 0.5% Moore Fig 7.46, p. 744 43 43 Safe Zone For Intramuscular (IM) Injection in Gluteal Region Clemente Figs. 434-435 44 44  Other Motor Nerves Gluteal Region Anterior rami of S1,2 piriformis N. To Obturator internus L5,S1 Obturator internus Superior gemellus N. To Quadratus femoris L5,S1 Inferior gemellus Quadratus femoris Netter Plate 490 45 45 Posterior Femoral Cutaneous n. S1-3 Skin over inferior portion of buttock Skin of posterior thigh Posterior femoral cutaneous n. Gilroy Fig 34.19, p. 476 46 46  Pudendal N. (S2-4) Exits pelvis through greater sciatic foramen Piriformis Crosses over sacrospinous ligament Enters ischio-anal fossa through lesser sciatic foramen Internal pudendal a. and v. travel with pudendal n. Inferior rectal n. Netter Plate 490 47 47 Gluteal Region Dermatomes A and B – Map corresponds to clinical findings C and D – More traditional map, corresponds to principles of development of lower limb Moore Fig 7.19, p. 705 48 48  Lower Limb Blood Supply Abdominal Aorta -Common Iliac a. -External Iliac a. -Femoral a. -Profunda Femoris a. -Internal Iliac a. -Superior Gluteal a. -Inferior Gluteal a. Moore Fig. 6.16, p. 583 49 49  Gluteal Region Gluteus medius Blood Supply Gluteus minimus Superior gluteal a. exits pelvis superior to piriformis m. travels between gluteus medius and minimus with superior gluteal n. TFL Small branch supplies upper portion of gluteus maximus m. Inferior gluteal a. exits pelvis inferior to piriformis m. Supplies gluteus maximus m. 50 Gray’s Anatomy for Students 50  Gluteal Region Lymphatic Drainage Superficial tissues drain to superficial inguinal nodes Deep tissues drain to internal iliac Moore Fig 7.48, p. 746 51 nodes along gluteal vessels 51  Practice Question An 80-year-old woman reports difficulty climbing stairs. Muscle testing reveals significant weakness in hip extension. Which muscle is most likely responsible for this loss of function? a. Adductor magnus b. Gluteus maximus c. Gluteus medius d. Gluteus minimus e. Iliopsoas 52 52