GHSB S1LE10 Anteromedial Thigh & Hip Joint PDF

1ST GROSS HUMAN STRUCTURAL BIOLOGY S1LE10 ANTEROMEDIAL THIGH AND HIP JOINT Dr. Miranda | September 11, 2018 SEM OUTLINE anteriorly there is a prominence (ASIS)...

1ST GROSS HUMAN STRUCTURAL BIOLOGY S1LE10 ANTEROMEDIAL THIGH AND HIP JOINT Dr. Miranda | September 11, 2018 SEM OUTLINE anteriorly there is a prominence (ASIS)  Pubic crest – thickened anterior border of the pubs I. Surface Anatomy which receives the tendon and aponeurosis of the II. Superficial fascia A. Superficial Fascia abdominal muscles B. Cutaneous Nerve  Pubic tubercle – located on top of the body of the C. Cutaneous Vessels pubis providing the main pubic attachment for the D. Superficial Lymph Nodes inguinal ligament III. Deep Fascia o On the lateral part of symphysis pubis, you A. Fascia Lata B. Saphenous Opening can find the pubic crest and pubic tubercle C. Intermuscular Septa o Inguinal ligament will attach from the pubic IV. Femoral Sheath & Femoral Triangle tubercle up to ASIS A. Femoral Sheath B. Femoral Triangle II. SUPERFICIAL FASCIA, CUTANEOUS NERVES & C. Adductor’s Canal VESSELS, SUPERFICIAL LYMPH NODES V. Muscles of Anterior Compartment VI. Femoral Artery, Vein and Nerve A. SUPERFICIAL FASCIA VII. Muscles of Medial Compartment - Continuous with that of the abdomen superiorly, VIII. Obturator Nerve and Vessles IX. Hip Joint gluteal region and leg A. Ligaments - Made up of 2 layers with the vessels and nerves in B. Capsule of hip joint between C. Blood Supply of Hip Joint A. The more superficial layer is fatty or D. Nerve Supply of Hip Joint E. Trochanteric Anastomosis subcutaneous tissue  F. Muscles and Movement Involved B. The deeper layer is adherent to the deep G. Clinical fascia below the inguinal ligament along the medial thigh and at the edge of the fossa ovalis Legend: or called the saphenous hiatus/saphenous Remember opening Previous Basta yung bumabalot sa muscle, it’s the Lecturer Book (Exams) Trans deep fascia; it encloses the thigh like a trouser a. Saphenous hiatus/saphenous     opening/ Fossa Ovalis - covered by a fascia called the Cribriform Fascia I. SURFACE ANATOMY - It is a defect in deep fascia but it is significant because you will be able to Important Surface Landmarks of Hip Bone expose the femoral vein. There are  Anterior superior iliac spine – anterior end of the superficial veins here that will drain → iliac crest; gives lateral attachment to the inguinal saphenous vein  ligament b. Great Saphenous vein will drain into  Iliac crest – the highest part of ilium separating the the Femoral vein via the saphenous abdominal wall from the gluteal region hiatus If you place your hand on top of your hip bone, C. Cribriform fascia: deeper layer of the superficial parang nakapamaywang (Iliac crest) and if you follow fascia over the fossa ovalis TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 1of11 ANTEROMEDIAL THIGH & HIP JOINT  Posterior branch – supplies the skin of the lower lateral B. Cutaneous Nerve quadrant of the buttocks  Patellar plexus – lies in front of the knee: o Terminal branches of the lateral, intermediate & medial cutaneous nerves of the thigh o Terminal branch of Lumbar plexus and Femoral Nerve o Infrapatellar branch of the saphenous nerve Saphenous nerve – another branch of femoral nerve which descends down. It has an infrapatellar branch that will innervate the patellar area C. Cutaneous Vessels  If arteries have branches, veins have tributaries because the flow of blood is going towards the larger vessel  Great saphenous vein – it has tributaries namely: o Superficial external pudendal artery  From the femoral nerve: o Superficial epigastric artery & vein o Medial cutaneous nerve of the thigh – o Superficial circumflex iliac artery & vein supplies the medial aspect of the thigh - All of this will drain to the great saphenous vein and joins the patellar plexus o Intermediate cutaneous nerve of the thigh – supplies the anterior aspect of the thigh and joins the patellar plexus  From the obturator nerve o Branch of obturator nerve – branches from its anterior division supplies a variable area of the skin on the medial aspect of the thigh  From the lumbar plexus ARTERIES: arise from the femoral artery; supplies the skin of o Ilioinguinal nerve (L1) external genitalia of the groin & lower part of anterior  Enters the thigh through the abdominal wall superficial inguinal ring  Distributed to the: skin of the VEINS: converge towards the saphenous openings; joins the root of the penis, adjacent part great saphenous vein before it enters the cribriform fascia of the scrotum (in Females: the root of the clitoris & adjacent part of labia majora), small area of skin below the medial part of inguinal ligament o Femoral branch of Genitofemoral nerve (L1, L2) - Enters the thigh behind the middle of the inguinal ligament and supplies a small area of skin below the inguinal ligament o Lateral cutaneous nerve of the thigh (L2, L3) – enters the thigh behind the lateral end of the inguinal ligament  Anterior branch – supplies the skin of the lateral aspect of the knees and thigh TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 2of11  ANTEROMEDIAL THIGH & HIP JOINT o Originates/ begins on the dorsum of the foot from the medial end of the dorsal venous D. Superficial Lymph nodes arch, passes anterior to the medial  Divided into a horizontal & vertical group malleolus, ascends on the medial leg & Along the inguinal ligament, meron kayong infection sa paa, medial side of the knee & enters the you will able to palpate painful lymph nodes in the inguinal saphenous opening region. Simply because there are superficial lymph nodes, o Ends in the femoral vein where there is inflammatory process in the lower extremities o Great Saphenous vein – when the that will pass through and become → Lymphadenopathy dorsal venous arch goes to the medial side; Short saphenous vein – when it goes to the III. DEEP FASCIA lateral side  Deep fascia – covers the muscles   Great Saphenous vein - from the A. Fascia Lata Dorsal venous arch it will ascend in front of the medial malleolus as it ascends at the medial aspect of the leg and it will go a little bit posterior to the knees and will ascend further at the medial side of the thigh piercing the cribriform fascia of the saphenous opening and drain into the femoral vein   Short Saphenous vein will drain into the popliteal vein   The superficial fascia and saphenous vein has connection with the venae commitantes that is surrounding the artery. When you see that there is interruption in the flow of this veins it could lead to Varicosities because of the tributaries of the  Deep fascia of the thigh saphenous vein that are superficial   Medial aspect is thin & delicate  Lateral aspect is dense & thickened to form the C. Intermuscular Septa iliotibial tract which extends from the iliac crest down to the condyle of the tibia, this is the attachment of the iliotibial tract B. Saphenous Opening  Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur  Due to the presence of the 3 septa, thigh is divided into 3 compartments: Anterior, Medial & Posterior  There is No Lateral compartment of the thigh, because it is only the Iliotibial tract that is located on the lateral aspect of the thigh  An oval aperture in the deep fascia located below the inguinal ligament  The great saphenous vein passes through this opening as it drains into the femoral vein  Great saphenous vein o Largest superficial vein of the lower limb TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 3of11 ANTEROMEDIAL THIGH & HIP JOINT IV. FEMORAL SHEATH & FEMORAL TRIANGLE A. Femoral Sheath  Boundaries of the Femoral Canal o Anteriorly: Inguinal or Poupart’s ligament o Medially: Lacunar or Gimbernat’s ligament o Posteriorly: Pectineal or Cooper’s ligament o Laterally: Femoral vein o Upper end: Femoral ring closed by plug of fat called Femoral septum o Lower end: closed by fusion of its walls  A funnel shape covering where it covers the femoral Sino ang mga naka-encased kay femoral sheath? artery and vein - femoral vein and femoral artery only, hindi kasama  An extension coming from the abdomen mainly, si femoral nerve Fascia transversalis & Fascia iliaca  A funnel shaped fascial tube (prolongation of the B. Femoral Triangle fascia transversalis & fascia iliaca) that surrounds the uppermost inch & a half of the femoral vessels  Its mouth opens into the abdomen  The lower part gradually closes upon the vessels  Divided into 3 compartments by 2 anteroposterior septa: o Lateral compartment – occupied by the femoral artery & femoral branch of  A triangular depressed area situated in the upper part genitofemoral nerve of the medial aspect of the thigh just below the o Intermediate compartment – occupied by inguinal ligament femoral vein  Boundaries: o Medial compartment o Superior: Inguinal ligament - This is the femoral canal; upper opening of o Lateral: fibers of Sartorius this canal is referred to as Femoral ring o Medial: Medial border of the adductor - Medial compartment is occupied only by longus lymphatics & lymph nodes (Nodes of  Apex – meeting of Sartorius & adductor longus Cloquet) o It is significant because there is a space or  Clinical: Femoral Hernia groove underneath which is Subsartorial or - Femoral ring is the site of hernias Adductor or Hunter’s canal  - Typically enters the femoral canal via femoral ring o Subsartorial – located under the Sartorius - Mass is palpable at the saphenous opening muscle o Subsartorial canal contains the Femoral artery, Femoral Vein, Saphenous nerve and Nerve to Vastus Medialis TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 4of11  ANTEROMEDIAL THIGH & HIP JOINT  Commences above the apex of the femoral triangle & ends below at the adductor hiatus  Boundaries: o Anteromedial wall: fibrous sheet deep to the Sartorius o Posterior wall: Adductor longus and magnus o Lateral wall: Vastus medialis  Contents: o Femoral artery o Femoral vein o Deep lymph vessels - these 3 will exit through the Adductor Hiatus which is found within the fibers of adductor magnus Nilagay ko to para mas madali nating mavisualize - jpm o Saphenous nerve – supplies the medial  Floor – Iliopsoas, Pectineus, Adductor longus aspect of the leg & foot  Roof – skin & fascia of the thigh o Nerve to Vastus medialis  Base – Adductor Hiatus o Terminal part of the anterior division of  Contents: obturator nerve NAVEL = Nerve Artery Vein Lymphatic vessels (from - These nerves pass the subsartorial canal but DO lateral hip towards the medial) NOT pass the adductor hiatus o Femoral vessels - Si Femoral nerve kasi, as it goes down the o Femoral nerve anterior thigh it will immediately distribute fibers or o Deep external pudendal artery innervations to the muscle kaya nagiging Muscular Profunda Femoris artery – deep branch of o Branches na siya, it became Saphenous Nerve and femoral artery Nerve to Vastus Medialis. Therefore femoral nerve o Lateral & medial circumflex artery does not pass but its branches pass the subsartorial o Femoral branch of Genitofemoral nerve canal. o Lateral cutaneous nerve of the thigh C. Adductor Canal Only the Femoral artery and vein passes through the ADDUCTOR HIATUS (found in the apex of the femoral triangle) and it will descend posteriorly into the popliteal fossa and the femoral artery and vein will now become → Popliteal artery and vein. The Popliteal vein beside the popliteal artery will pass through the adductor hiatus is called Femoral vein  Adductor Hiatus – Femoral artery & vein; Popliteal Fossa – Popliteal artery & vein  Also known as “Hunter’s canal or Subsartorial canal”  Intermuscular cleft situated on the medial aspect of the middle third of the thigh TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 5of11  ANTEROMEDIAL THIGH & HIP JOINT  Psoas Major – long fusiform muscle that arises within the abdomen & descends into the thigh V. MUSCLES OF THE ANTERIOR COMPARTMENT o Origin: roots of the transverse process, side of vertebral bodies and intervertebral discs T12 to L5 o Insertion: Lesser trochanter (medial side) o Nerve: Lumbar plexus (why? Because the lumbar plexus is formed within the fiber of psoas muscle) o Action: flexion of thigh at the trunk at the hip joint, flexion of trunk on the thigh when the thigh is fixed, medial rotation of thigh  ILIOPSOAS – once the Iliacus & Psoas pass through the inguinal ligament, the fibers will merge at each other to become the Iliopsoas and both will be inserted to the lesser trochanter   Iliopsoas is a POWERFUL FLEXOR OF THE HIP JOINT, siya yung muscle na ginagamit mo pag nag sisit-ups ka   Pectineus - more medial o Origin: superior ramus of the pubis o Insertion: upper end of linea aspera (posterior shaft of femur that extends down - Common innervation: FEMORAL NERVE  the supracondylar ridge) immediately below - muscles of anterior thigh usually passes the hip joint, thus its lesser trochanter main action is flex the hip joint & it also passes the knee joint, Linea aspera is very important because it so it also extend the knee joint is the common site of insertion of muscle o Nerve: Femoral nerve (in some cases, it -muscle of lateral aspect can flex, abduct and laterally rotate receives branch from the obturator nerve) the o Action: flexion and adduction of thigh at hip joint -muscle of medial aspect can flex and adduct  QUADRICEPS FEMORIS  Sartorius – long slender straplike muscle, “Tailor’s These muscles are all inserted into: Quadriceps muscle”, runs in oblique fashion along the anterior tendon where it is inserted into the patella and into thigh and will insert into the tibia  the tibial tuberosity via the patellar ligament thus o Origin: ASIS having a common action, EXTENSION of KNEE o Insertion: Upper part of the medial surface of JOINT the tibial shaft Only the RECTUS FEMORIS passes through the hip o Nerve: Femoral Nerve joint, the rest are originated in the femur, therefore only o Action: flexion, abduction & lateral rotation of the rectus femoris has an action on the hip joint  thigh at hip joint; flex & medially rotate the leg at knee joint  Rectus femoris take note na sa dalawang joint siya o Origin: Straight head (AIIS), Reflected head nagproproduce ng action kasi dumaan siya (from the ilium above the acetabulum) sa hip and sa knee; basta pag anterior o Insertion: via quadriceps tendon to the extends kapag nasa medial or lateral side patella initial action if flexion o Nerve: Femoral Nerve  Iliacus o Action: flexion of thigh at hip joint, extension o Origin: iliac fossa of leg at knee joint o Insertion: converge and join the psoas  Vastus lateralis tendon to form the iliopsoas muscle to insert o Origin: intertrochanteric line, base of greater at the lesser trochanter trochanter, linea aspera of femur, lateral o Nerve: Lumbar plexus, Femoral nerve deep fascial septum o Action: flexion of thigh at the trunk at the hip o Insertion: via quadriceps tendon to the joint, flexion of the trunk on the thigh when patella the thigh is fixed, medial rotation of thigh at o Nerve: Femoral Nerve the hip joint o Action: extension of leg at knee joint TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 6of11  ANTEROMEDIAL THIGH & HIP JOINT  Vastus medialis o Superficial external pudendal artery o Origin: intertrochanteric line, medial lip of o Superficial circumflex iliac artery linea aspera, medial deep fascial septum o Insertion: via quadriceps tendon to the  Deep patella o Profunda femoris (deep femoral) o Nerve: Femoral Nerve o Deep external pudendal artery o Action: extension of leg at knee joint o Descending genicular artery – arterial supply  Both the Vastus medialis and lateralis covers the to the knee joint medial and lateral half of the femur, both of them also B. Femoral vein are arising from the deep fascial septum  Direct continuation of the popliteal vein as it passes  Vastus intermedius through the opening of the adductor magnus o Origin: anterior and lateral surfaces of the (adductor hiatus) shaft of femur, medial deep fascial septum,  Traverses the adductor canal and femoral triangle and becomes the external iliac vein behind the ARTICULARIS GENUS (upper part of inguinal ligament synovial membrane of the knee joint, so  What is the relationship femoral vein to the when the knee is in extension it pulls it up) femoral artery? It is medial to femoral artery o Insertion: tibial tuberosity via quadriceps  See photo at page 2, take note saang canal, hiatus tendon to the patella siya pumapasok. o Nerve: Femoral Nerve C. Femoral nerve o Action: extension of the leg at knee joint VI. FEMORAL ARTEY, VEIN & NERVE Femoral sheath – femoral artery & vein can be found; Femoral triangle – Femoral artery, vein & nerve can be found A. Femoral artery  Arises from the lumbar plexus from the posterior division of the L2, L3, L4 spinal nerves  Descends into the grooves in-between the iliacus & psoas major tignan mo sa lateral side ni psoas nandoon si femoral nerve  Comes from the internal iliac artery and pass the inguinal ligament will transition to become the femoral Basta tandaan niyo lang yung NAVY: Lateral – Femoral artery NERVE – Femoral ARTERY – Femoral VEIN – Medial  It is in the lateral compartment of your femoral sheath, it is only present in the femoral triangle  Enters the thigh behind the inguinal ligament and iliac  Enter the thigh by passing behind the inguinal fascia and divides into anterior & posterior divisions ligament as a continuation of the external iliac artery which give off muscular and cutaneous branches  Initially, it is lateral to the vein but as it approaches the  Branches of the ANTERIOR division: apex of the femoral triangle it becomes anterior to the o Motor: nerve to pectineus femoral vein o Sensory: medial cutaneous nerve of thigh,  In the Hunter’s canal: it lies medial to the femoral vein intermediate cutaneous nerve of thigh  Femoral artery and vein, magdi-disappearing act  Branches of the POSTERIOR division: yan sa Adductor Hiatus o Motor: nerve to Sartorius, nerve to  The femoral artery moves through the adductor quadriceps femoris hiatus, and enters the posterior compartment of the o Sensory: saphenous nerve thigh, proximal to the knee. The femoral artery now  Cutaneous branches known as the popliteal artery. o Anterior Cutaneous nerve of the thigh  Branches: o Medial and Intermediate Cutaneous nerves  Superficial of the thigh o Superficial epigastric artery TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 7of11  ANTEROMEDIAL THIGH & HIP JOINT  Saphenous nerve- the terminal cutaneous branch of  Adductor magnus – powerful thigh muscle femoral nerve that supplies the skin of medial side of consisting of an ADDUCTOR (medial part) & the leg and foot HAMSTRING PORTION (posterior part)  Nerve to Vastus Medialis o Origin: inferior pubic ramus, ramus of Take note again, hindi mo makikita si femoral nerve sa ischium, ischial tuberosity Adductor Canal, yung branches niya ang makikita mo doon o Insertion: Adductor portion (posterior surface of the femur from the quadrate tubercle above & along the linea aspera to VII. MUSCLES OF MEDIAL COMPARTMENT the medial supracondylar ridge below); Hamstring portion (adductor tubercle) o Nerve: Obturator nerve (adductor portion); Tibial branch of Sciatic nerve (hamstring portion) o Action: adduction, lateral rotation of thigh, helps flexion of hips (adductor portion); extension of hip joint (hamstring portion)  Lahat ng adductors mo naka insert sa linea aspera  Lahat din ng adductors perform adduction , flexion and lateral rotation of the hip joint  Note that the hamstring portion of adductor magnus is not part of the medial compartment, it is part of the posterior thigh “hamstrings” with common origin to other hamstring muscles: Ischial tuberosity -wait niyo lang trans ng topic ni doc Surio, babanggitin doon hehe They are ADDUCTORS OF HIP JOINT, and can also do FLEXION Common innervation: OBTURATOR NERVE Common arterial supply: Obturator Artery  Gracilis o Origin: outer surface of the inferior pubic ramus & ramus of ischium o Insertion: upper part of the medial surface of the tibial shaft o Nerve: Obturator nerve o Action: adduction of thigh, flexion of knee, medial rotation of leg VIII. OBTURATOR NERVE & VESSELS o Since its insertion is near the Sartorius, A. Obturator Nerve their action is the same except that this muscle adducts the thigh (the sartorius abducts the thigh)  Adductor longus o Origin: front body of the pubis (anterior surface) o Insertion: linea aspera o Nerve: Obturator nerve o Action: adduction, flexion, lateral rotation of thigh at hip joint Intertrochanteric line = anterior; Intertrochanteric crest = posterior  Adductor brevis o Origin: inferior pubic ramus o Insertion: upper medial lip of linea aspera o Nerve: Obturator nerve  Arises from the lumbar plexus: from the anterior o Action: adduction, flexion & lateral rotation of division of L2, L3, L4 spinal nerves emerging on the thigh medial border of the psoas muscle within the Lesser trochanter – ILIOPSOAS; Below the lesser abdomen trochanter/upper part of linea aspera – PECTINEUS  Leaves the pelvis through the obturator foramen and divides into the anterior & posterior divisions TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 8of11  ANTEROMEDIAL THIGH & HIP JOINT o ANTERIOR DIVISION: gives branch to  Intracapsular ligaments: found inside the joint adductor longus, brevis and gracilis capsule o POSTERIOR DIVISION: supplies the - only intracapsular ligament is the ligament of head adductor magnus of femur. It is a relatively small structure, which runs B. Obturator Artery from the acetabular fossa - It encloses a branch of the obturator artery (artery to  A branch of internal iliac artery (anterior division) head of femur), a minor source of arterial supply to o Common iliac artery → divides into: the hip joint External iliac artery & Internal iliac artery -Branches: o External iliac artery → femoral artery o Transverse acetabular ligament o Internal iliac artery → goes to pelvic o Ligamentum teres femoris/ round cavity and divides into: Anterior & ligament of femur Posterior division The acetabulum has cartilaginous margin or rim =  Anterior division will give off ACETABULAR LABRUM, which has a U shape configuration branches: Obturator artery, Superior & Inferior gluteal artery (or c shape) kasi meron siyang defect kung saan nandoon ang  Gives off muscular branches and an articular branch acetabular notch, yung portion na iyon na incomplete is to the hip joint patched up by the transverse acetabular ligament C. Obturator Vein There is also space behind the transverse acetabular ligament  Receives tributaries that correspond to the branches where the round ligament of femur from the fovea capitis will of the arteries exit.  Drains into the internal iliac vein IX. HIP JOINT  Type: Synovial, Ball & Socket joint  Diarthrosis  Articulating bone: Head of femur & acetabulum  Capsule: attached to the acetabular labrum medially  Extracapsular ligaments – protecting the joint & intertrochanteric line & neck of femur laterally capsule of the hip joint; found outside the capsule  Protective and supportive part: Joint capsule, synovial o Iliofemoral ligament/ Y-ligament of membrane, synovial fluid and cavity and ligaments Bigelow – 2 strips; coming from the ilium above and inserted into the base of neck of A. Ligaments femur, prevents hyperextension of hip joint o Pubofemoral ligament – coming from the pubis and into the femur, triangular shape, and prevents excessive abduction and extension. o Ischiofemoral ligament (Posterior) – coming from the ischium and into the base of the neck of femur, spiral orientation, and prevents hyperextension and holds the femoral head in the acetabulum. Another groove of transverse acetabular ligament, there is a space behind, where the ligamentum femoris will pass through = ACETABULAR FORAMEN Acetabular Foramen: formed by the bony margins of the acetabular notch and completed by the transverse ligament of the hip. From its margins (both transverse ligament and acetabular notch) arises the ligamentum teres TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 9of11  ANTEROMEDIAL THIGH & HIP JOINT o Adductor magnus (adductor portion) o Assisted by pectineus & gracilis B. Capsule of Hip Joint o This movement is limited by contact with opposite limb and by the tension in the  Protects the ball & socket joint ligamentum teres femoris  Attached to the acetabular labrum above and to the  Lateral rotation base of neck of femur distally o Priformis o Obturator internus & externus C. Nerve supply of Hip Joint o Gemelli muscles  Femoral nerve – anterior -the small lateral rotators of the thigh  Obturator nerve – medial o Quadratus femoris  Nerve to quadratus femoris – posterior o Assisted by gluteus maximus o This movement is limited by the alteral D. Blood Supply of Hip Joint portion of the iliofemoral ligament and the pubofemoral ligament  Coming from Internal iliac artery → superior & inferior  Medial rotation gluteal artery o Gluteus medius & minimus  From femoral artery → Medial and lateral femoral o Tensor fascia latae circumflex arteries o This movement is limited by the  Branches Obturator artery ischiofemoral ligament   Circumduction - combination of all the muscles mention above These arteries wind above the greater trochanter.  Stability of hip joint is best when the hip joint is in E. Trochanteric Anastomosis extension, less stable in a flex position  The arteries that wind above the greater trochanter medially to that is the TROCHANTERIC FOSSA and the place where they meet together is called G. CLINICAL TROCHANTERIC ANASTOMOSIS. Kung meron  Fractures of Hip Joint mang sira sa femur, meron pang alternate passage - Accidental or traumatic in nature for the blood supply going to the hip joint which is Superior & Inferior gluteal artery. - Commonly occur at home (sabi ni doc, sa kusina daw kasi sa  TROCHANTERIC ANASTOMOSIS – main source of mantika, sa cr tubig at sabon sa sahig) blood supply going to head and neck of femur - To fix this, do open reduction and internal fixation make sure na lang na hindi ka osteoporotic kasi if oo, prostetic ang They merged together to form the trochanter kailangang ilagay mo anastomosis found in the trochanteric fossa. The importance of this is, if there is a compromise in the femoral artery, meron ka pang supply na manggagaling sa Internal Iliac Artery, so it is the main source of blood supply to the head and neck of femur. F. Muscles & Movements involved in Hip joint  Flexion – anterior thigh muscles and medial compartement of thigh o Iliopsoas o Rectus femoris o Sartorius o Adductor muscles o Movement is linked by the anterior abdominal wall- this limits flexion (you can not overflexed)  Extension – gluteus maximus & hamstring muscles o This movement is limited by the iliofemoral,  Hip Dislocation pubofemoral & ischiofemoral ligaments a) Posterior Dislocation of the Hip Joint  Abduction - Accounts for 90% of hip dislocation and the o Gluteus minimus & medius fractured femoral head lie posterior to the acetabulum o Assisted by Sartorius of the ischium. o Tensor fascia latae - may result from rupture of both posterior acetabular o Piriformis labrum and ligamentum capitis o This movement is limited by the - It results to shortened, flexed, adducted and pubofemoral ligament medially rotated lower limb  Adduction o Adductor longus o Adductor brevis TRANSCRIBERS Rianne M. Malabanan, RMT Jessa Mae P. Manibog, RMT 10of11  ANTEROMEDIAL THIGH & HIP JOINT b) Anterior Dislocation -head of femur is displaced anteroinferior to the acetabulum or pubic bone. Affected limb is slightly flexed, abducted, laterally rotated c) Medial/ Central/ Intrapelvic Disolocation - accompanied by acetabular fracture of the bladder REFERENCES: 1. GHSB Lecture Guide 2. PPT Lecture 3. Recordings LALABAN PA BA? Oo, kasi pinalaki tayo ng Jumbo Hotdog, kaya KAYA NATIN TO! *JUMBO HOTDOG KAYA MO BA TO? KAYA MO BA TO?* TRANSCRIBERS Rianne M. Malabanan, RMT 11of11 Jessa Mae P. Manibog, RMT