Hip Joint & Popliteal Fossa Anatomy PDF

Hip Joint and Popliteal Fossa Body Movement and Function Dr Sara Sulaiman [email protected] Learning outcomes By the end of this lecture, you should be able to: Discuss the hip joint, including structure, actions and neurovascular structures Discuss hip dislocations and fractures and the c...

Hip Joint and Popliteal Fossa Body Movement and Function Dr Sara Sulaiman [email protected] Learning outcomes By the end of this lecture, you should be able to: Discuss the hip joint, including structure, actions and neurovascular structures Discuss hip dislocations and fractures and the complications that may arise from these two injuries Describe the boundaries and contents of the popliteal fossa Interpret Radiological imaging of the hip and popliteal fossa Describe and demonstrate femoral vessels, profunda femoris, sciatic nerve, tibial and common peroneal nerves Recommended reading Abrahams, Peter H. et al. McMinn & Abrahams’ Clinical Atlas of Human Anatomy. Seventh edition. Maryland Heights, Missouri: Elsevier Mosby, 2013. Print Drake, Richard L. Gray’s Anatomy For Students. 4th. ed. Philadelphia: Elsevier, Inc., 2020. Print. Moore, Keith L., Arthur F. Dalley, and A. M. R. Agur. Essential Clinical Anatomy. 4th ed. Philadelphia, Pa.; London: Lippincott Williams & Wilkins, 2011. Print. Netter, Frank H. (Frank Henry). Atlas of Human Anatomy. 5th ed. Philadelphia, Pa.; London: Saunders, 2010. Print. Smith, C., Dilley, A., Mitchell, B. and Drake, R.L., 2017. Gray’s Surface Anatomy and Ultrasound: Gray’s Surface Anatomy and Ultrasound E-Book. Elsevier Health Sciences. Spratt, J., Salkowski, L.R., Loukas, M., Turmezei, T., Weir, J. and Abrahams, P.H., 2020. Weir & Abrahams' Imaging Atlas of Human Anatomy. Elsevier Health Sciences. Anatomy of a long bone Epiphysis: the ends of the bone Diaphysis: the shaft of the bone Metaphysis: the widening part of the bone between the diaphysis and epiphysis Endochondral ossification Ossification of the femur The primary ossification centre for the shaft appears at 7 weeks in utero. At birth, growth plates separate the bony shaft from the upper and lower cartilaginous epiphyses. A secondary ossification centre appears in the: Lower epiphysis shortly before birth. Upper epiphysis for the head at 1 year Greater trochanter at 4 years Lesser trochanter at 12 years. The upper epiphysis fuses with the shaft at about the 18th year. The lower epiphysis fuses with the shaft at about 20 years.  Pelvic bones at different ages Nine month old 11 months Older child Adult 45 years Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 2715 and of Ian Bickle, Radiopaedia.org, rID: 37956  Synovial joint (ball and socket): between the head of the femur and acetabulum. Hip joint (Acetabulofemoral Joint​) Allows flexion, extension, abduction, adduction, lateral and medial rotation and circumduction. Labrum Acetabulum Partially covered with cartilage Lunate surface Deepened by fibrocartilage (labrum) Horse-shoe shaped Provides a larger articular surface-stability Head of femur: Covered by hyaline cartilage (except at fovea) The ligament of the head of the femur- Ligament of head of ligamentum teres the femur Attaches to the fovea and acetabular fossa. Transverse Contains artery to head of femur (branch of acetabular ligament obturator) Joint capsule-synovial Attaches to the margins of articulating surfaces Around the acetabulum and intertrochanteric line and neck of the femur. It lines the fibrous capsule. Joint capsule-Fibrous Strong and thick Iliofemoral Margins of the acetabulum to the intertrochanteric line and neck Three main ligaments: Ilio-femoral ligament Pubofemoral Y-shaped AIIS to upper and lower parts of the intertrochanteric line Prevents hyper-extension Intertrochanteric line Pubo-femoral ligament Triangular Pubic bone to femur Prevents hyper-abduction Ischio-femoral ligament Spiral shaped Ischium/posterior margin of acetabulum to femur Ischiofemoral Weakest of the three Stabilizing factors Deep acetabulum Deep socket Made deeper by the labrum Ligaments Deep gluteal muscles Gluteal muscles Obturator externus Iliopsoas Gluteus medius and minimus Pelvis Full support If support from one leg is taken away on two legs The pelvis should drop BUT……  If support from one leg is taken away The pelvis should drop BUT the contraction of the gluteus medius and minimus on the opposite side abduct the pelvis and maintain it  Hip joint movements Extension ABduction  Gluteus maximus  Gluteus medius  Semimembranosus  Gluteus minimus  Semitendinosus  Piriformis  Biceps femoris  Superior & inferior gemellus  Obturator internus Flexion  Iliopsoas Adduction  Rectus femoris  Sartorius  Adductor longus  Pectineus  Adductor brevis  Adductor magnus  Pectineus Lateral rotation  Gracilis  Biceps femoris  Gluteus maximus Medial rotation  Piriformis  Adductors (longus,  Obturator externs & brevis and magnus) internus  Anterior fibers of  Superior & inferior gluteus medius and gemellus minimus  Quadrates femoris Hip joint nerve supply Hilton’s law: Nerves supplying the muscles acting on a joint will also innervate the joint. The main nerves innervating the hip joint are: Femoral nerve Obturator nerve Superior and inferior gluteal nerve Nerve to quadratus femoris John Hilton, a British anatomist and surgeon  Medial and lateral circumflex femoral arteries Branch from profundal Blood supply femoris artery Medial circumflex mainly give off the retinacular arteries (intracapsular). Main supply to the head of femur in adults Artery to the head of the femur Branch of obturator Only significant in children Superior and inferior gluteal Branch from the internal iliac artery  Two important anastomoses around the hip Cruciate anastomosis: Located on the back of the thigh. Formed by: Medial and lateral circumflex femoral 1st perforating branch of the profunda femoris Branch of inferior gluteal Trochanteric anastomosis: located at the greater trochanter. Formed by: Superior gluteal Inferior gluteal Medial and lateral circumflex arteries From: https://www.instantanatomy.net/leg/vessels/hip.html Dislocation of the hip joint Posterior dislocation (90%) Through the inferior and posterior part of the joint capsule, where it is at its weakest. The affected limb becomes shortened and medially rotated. Sciatic nerve injury (occurs in 10-20% of cases) Anterior dislocation (rare) Traumatic extension, abduction and lateral rotation. Femoral head is displaced anteriorly and (usually) inferiorly in relation to the acetabulum. Fractures Affected limb appears shortened Laterally rotated Common in older women (osteoporosis) Two types Int Intertrochanteric rac (extracapsular)-at the aps Ex level of the greater and ula tra r lesser trochanter ca psu Blood supply preserved lar to proximal segment Intracapsular-femoral neck Damage to the retinacular arteries Can result in avascular necrosis  Shenton’s line Images from: https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x- ray_trauma_lower_limb/hip_fracture_x-ray#top_8th_img Popliteal fossa Diamond-shaped space behind the Biceps femoris Semitendinosus knee joint. Upper margins: Semimembranosus Medially: semitendinosus and semimembranosus muscles Laterally: biceps femoris muscle. Lateral Medial Lower margins: Medially: medial head of the Plantaris gastrocnemius muscle Laterally: plantaris muscle and the lateral head of the gastrocnemius muscle. Floor: Capsule of the knee joint and adjacent surfaces of the femur and tibia, Gastrocnemius More inferiorly, by the popliteus muscle (medial head) Gastrocnemius (Lateral head) Popliteal fossa Terminal branches of the posterior cutaneous nerve of the thigh Roof: Covered by superficial fascia and Small saphenous skin. vein The small saphenous vein Posterior cutaneous nerve of the Popliteal Tibial nerve thigh vein Popliteal fascia (deep facias, Popliteal continuous with fascia lata) artery Content: Filled with fat. Structures arranged from superficial to deep Tibial nerve Popliteal vein Popliteal artery Thank you