this is the first unit of anatomy on the lower half of the body. we start off looking at the hip bones, which are the fusion of three bones, the ilium, ischium, and pubis. lying on top of the hip bones is the sacrum, which connects via a synovial joint to the hips at the auricular surfaces of the sacrum and the ilium and the iliac tuberosity. the sacroiliac joint capsule is directly stabilized by the iliolumbar and the ventral/dorsal sacroiliac ligaments. the sacrum is generally in a 45 degree angle pointing downwards can undergo "nutation", which is an anterior/posterior rotation on the sacrum's axis, which is the second vertebrae. this movement is limited and stabilized by several other ligaments: the interosseus ligaments attach from the iliac tuberosity to the sacrum, the sacrospinous ligaments which attach from the lower sacrum to the ischial spine, and the sacrotuberous ligaments which attach from the lower sacrum to the ischial tuberosity.
the muscles of the hip joint are then introduced. these muscles are grouped in terms of the actions that they have on the femur. the psoas, iliacus (which attach to the lesser trochanter), and tensor fascia lata are the muscles that flex the femur. the obturators, gemellis, and quadratus femoris are a group of small muscles in the posterior hip bone that all attach to the greater trochanter and laterally rotate the femur. the gluteus maximus starts on the iliac crest / sacrum / coccyx and attaches into the iliotibial band (which inserts onto the lateral condyle of the tibia) and is the only muscle that extends the femur, and also laterally rotates the femur. the gluteus minimus and medius originate on the back of the ilium and insert onto the greater trochanter and medially rotate the femur.
the nerves that branch off of the lumbar and sacral plexuses are looked at. the lumbar plexus are the nerves that branch off of lumbar vertebraes 1-4. the femoral nerve branches off of L2,3,4 and innervates the iliacus, sartorius, and quadriceps. the obturator nerve branches off of L2,3,4 as well and innervate the adductors. the muscular branch of the lumbar plexus innervates the psoas and the quadratus lumborum. the iliohypogastric and ilioinguinal nerves innervate the lower abdominal muscles and skin. the genitofemoral nerve innervates the cremaster muscle and thigh skin. the lateral cutaneous nerve to the thigh innervates the lateral thigh skin.
the sacral plexus is formed from nerves branching off of L4-S4. the largest nerve coming off of it is the sciatic nerve, which comes off of L4,5,S1,2,3 and splits into the tibular and common fibular nerve, and innervates the hamstrings, 1/2 of the adductor magnus, and some other leg/foot muscles. the superior gluteal nerve branches off from L4,5,S1, exits superior to the piriformis, and innervates the gluteus medius/minimus and tensor fascia lata. the inferior gluteal nerve branches off from L5,S1,2, exits inferior to the piriformis and innervates the gluteus maximus. the pudendal nerve originates S2,3,4 and innervates the anal and urethral sphincters and genitalia. the nerve to the quadratus femoris originates in L4,5,S1, while the nerve to the obturator originates in L5,S1,2.
the last section added a few details about the hip joint; it is stabilized by the transverse acetabular ligament and the acetabular labrum, which enlarge the articular surface of the joint. the ligamentum teres attaches from the head of the femur to the transverse acetabular ligament. the blood supply to the hip joint is supplied by the medial and lateral circumflex arteries as well as the artery to the ligamentum teres.
questions
1. hip bone is also called the...
2. hip bone is the fusion of which bones?
3. conjunction of ischium and pubis forms...
4. what are some landmarks in the ilium?
5. sacroiliac joint is formed from...
6. what are the landmarks on the ischium?
7. what are the landmarks on the pubis?
8. what forms the synovial joint in the SI joint?
9. what can happen to the SI joint with age/inflammation?
10. what are the ligaments that stabilize the SI joint?
11. what is the anatomical position of the hip bone in the upright position?
12. where is the interosseus sacroiliac ligament?
13. sacrotuberous?
14. sacrospinous?
15. what do the sacrotuberous/sacrospinous ligaments form?
16. where is the axis of rotation for the sacrum?
17. what is nutation?
18. what is the result of nutation?
origins, insertions, innervation, actions...
19. psoas
20. iliacus
21. (quadratus lumborum)
22. gluteus maximus
23. gluteus medius
24. gluteus minimus
25. tensor fascia lata
26. obturator internus
27. superior and inferior gemelli
28. quadratus femoris
29. obturator externus
30. piriformis
which muscle(s) perform these actions...
31. medial rotation
32. lateral rotation
33. abduction
34. extension
35. flexion
lumbar plexus...
36. where does the femoral nerve originate and what does it innervate?
37. where does the obturator nerve originate and what does it innervate?
38. what innervates the psoas and the iliacus?
39. what innervates the lower abdominal muscles and skin?
40. what does the genitofemoral nerve innervate?
41. what innervates the lateral thigh skin?
42. where does the sciatic nerve originate and what does it split into?
43. where does the superior gluteal nerve originate?
44. where does the inferior gluteal nerve originate?
45. where does the pudendal nerve originate and what does it innervate?
46. where does the posterior cutaneous nerve originate?
47. where does the nerve to the quadratus femoris originate?
48. where does the nerve to the obturator internus originate?
49. what does the sciatic nerve innervate?
50. where does the sciatic nerve enter the thigh?
51. what does the superior gluteal nerve innervate and where is it in relation to the piriformis?
52. what does the inferior gluteal nerve innervate and where is it in relation to the piriformis?
53. what are the ligaments that attach the femur and acetabulum and what do they do?
54. what are the spiral ligaments around the hip joint capsule?
55. femoral head derives blood from...
56. failure of anastomoses can lead to...
answers
1. os coxae and innominate bone
2. ilium, ischium, pubis.
3. obturator foramen
4. greater sciatic notch, ASIS/AIIS, PSIS/PIIS
5. iliac tuberosity and auricular surfaces of ilium and sacrum
6. ischial spine, ischial tuberosity, lesser sciatic notch
7. pubic tuberosity.
8. auricular surfaces of sacrum and ilium.
9. fusion of the sacrum and ilium: "synostosis"
10. ventral/dorsal sacroiliac ligaments, iliolumbar ligaments
11. tilted 45 degrees forward such that the ISIS and pubic
12. iliac tuberosity and sacrum
13. sacrum to ischial tuberosity
14. sacrum to ischial spine
15. greater and lesser sciatic foramina
16. the second sacral vertebrae
17. rotation or tilting of sacrum around axis though interossues ligaments.
18. changes anterior-posterior diameter of pelvic outlet.
19. O: bodies, TVP's of T12-L5. I: lesser trochanter of femur N: lumbar plexus A: lat flex vertebral column, flex femur
20. O: iliac fossa I: lesser trochanter N: femoral nerve A: flex femur
21. O: iliac crest, TVP's of L1-5 I:12th rib N:lumbar plexus
22. O: iliac crest and sacrum, I: gluteal tuberosity and iliotibial tract, N: inferior gluteal, A: extend lat rotate femur
23. O: dorsal ilium, I: greater trochanter, N: superior gluteal, A: abduct, medially rotate femur
24. O: dorsal ilium, I:greater trochanter, N:superior gluteal, A: abduct, medially rotate femur
25. O: ASIS, I:iliotibial tract -> lat condyle of tibia, N:superior gluteal, A: abduct, medially rotate, flex femur, keep knee extended
26. O: obturator membrane I:greater trochanter, N:nerve to obturator internus, A: laterally rotate femur
27. O: ischium, I:greater trochanter, N:nerves to obturator internus and quad fem, A: laterally rotate femur
28. O:ischial tuberosity, I: quadrate tubercle, N: nerve to quadratus femoris, A:lateral rotate femur
29. O:obturator membrane, I:greater trochanter, N:obturator nerve, A: laterally rotate femur
30. O:ant sacrum, I:greater trochanter, N:S1,2 A:abduct, laterally rotate femur
31. tensor fascia lata, gluteus medius, gluteus minimus
32. gluteus maximus, piriformis, obturator internus, obturator externus, gemelli brothers, quadratus femoris
33. tensor fascia lata, gluteus medius, gluteus minimus, piriformis
34. gluteus maximus
35. iliacus/psoas, tensor fascia lata
36. L234, quadriceps, sartorius, iliacus, pectineus
37. L234, adductors
38. the muscular branches of the lumbar plexus.
39. iliohypogastric, ilioinguinal
40. cremaster muscle and thigh skin
41. lateral cutameous nerve to thigh
42. L4,5, S1,2,3. splits into the fibular and tibial nerve.
43. L4,5 S1
44. L5, S1,2
45. S2,3,4, innervates anal and urethral sphincters, external genitalia
46. S123
47. L4,5 S1
48. L5, S1,2
49. hamstrings, 1/2 of the adductor magnus, muscles of the leg/foot
50. between hamstrings and adductor magnus, through the adductor hiatus.
51. gluteus medius and minimus, exits above piriformis
52. gluteus maximus, exits below piriformis.
53. acetabular labrum and transverse acetabular ligament enlarge articular surface, ligamentum teres attaches head of femur to transverse acetabular ligament.
54. iliofemoral, ischiofemoral, pubofemoral.
55. medial and lateral circumflex femoral arteries and the artery to the ligamentum teres.
56. avascular necrosis of femoral head.
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