Lumbar and hips

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Floating topic

Acetabulum

The acetabulum has a notch that is bridge by the transverse acetabulum ligament

The round ligament of the head of the femur arises from the transverse acetabular ligament and inserts onto the fovea capitis of femur. This structure carries blood vessels and head of the femur.

Composed of ilium, ischial, and pubic

Menisci

Reduces localized pressure on the articular surfaces by improving congruency

Increases concavity of the tibial condyle (Joint Stability)

Provides proprioception via tension on coronary ligaments and muscular attachments

Semimembranosus attaches to medial meniscus and Popliteus attaches to lateral meniscus

Gets Nutrition vis osmosis

Physical Therapy Applications

Trendelenburg Sign

If the right gluteal muscle is weak = left side will drop when the patient stands on right leg

Produced when a patient is asked to stand on one leg and the opposite side that is not standing on the ground drops (pelvic drop). Superior glute nerve innervates the gluteus medius and minimus which plays an important role in stabilizing the pelvis during locomotion.

Trochanteric Bursitis

This occurs when there is an inflammation of the bursitis. Results from repetitive actions such as climbing stairs or even running on a treadmill. These movements involve the gluteus maximus which moves superior tendinous fibers repeatedly back and forth over the bursa of the greater trochanter.

Bursae

Ischial Bursa: Located between the Gluteus maximus and the Ischial tuberosity

Gluteofemoral bursa: Located between the Gluteus maximus and then greater trochanter

Trochanter Bursa: Located between the greater trochanter and the gluteus maximus

Obturator Externus Bursa: Located between the Obturator externus muscle and the posterior neck of the femur

Obturator Internus Bursa: Located between the obturator internus muscle and then ischial spine and tuberosity

Gluteal Region

Deep

Superior Gemelles

Obturator Internus

Inferior Gemelles

Quadratus Femoris

The Deep muscles externally rotate the leg

Superficial

Gluteus Maximus

Gluteus Minimus

Gluteus Medius

Tensor Fasia Lata

Gluteus Maximus Externally rotates and extends the leg while the rest of superficial muscles internally rotates

Biomechanics Hip Motion/Lsp Motion/ Lsp Arthrokinematics/ open chain/ closed chain

Closed Chain

Flexion (stand -> sit) Posterior Roll; Anterior glide

Extension (sit -> stand) Anterior Roll; posterior glide

Open Chain

Extension: Anterior Roll; anterior glide

Flexion: Posterior Roll; Posterior glide

(Right side weight bearing) Lateral Tilt pelvic hike

Left hip Hip

Lateral Flexion on Left side

Left facet goes down R Facet goes Up

Hip is Abduction

(Right side weight bering) Lateral tilt Pelvic drop

Left Hip drop

Lateral flexion of right side (compensation)

L facet goes up and R facet goes down

Abduction on hip

Posterior Pelvic Tilt

Extension of Hip

Flexion of back

Facets fo anterior/ superior

Anterior Pelvic Tilt

Hip: Flexion

Lsp Motion: Extension

Lsp Arthrokinematics: Posterior/ Inferior

Ligaments of Knee

PCL Limits

Posterior translation of tibia relative to femur

ACL Limits

Anterior translation of tibia relative to femur

LCL Limits

Tibial ADD

Femur ABD

Varus

MCL Limits

Tibial ABD

Femur ADD

Knee Angels

Q Angle

Another measurement of valgus

normal Q angle 10-15 degrees

Abnormal >20 degrees

Varus

Excess Genu Varus

>180 degrees

Bow string

Valgus

Excessive Genu Valgum

<165 degrees

Knocked Knees

Alignment in Frontal Plane

A slight Valgus is normal

>20 degrees is abnormal

Joints

Femoropatellar Joint

Medial and lateral condyles with condylopatellar facets/surfaces

Knee Joint

Modified Hinge Joint

Femorotibial Joint

Formed by articulation of the medial and lateral condyles of the femur with the lateral tibial condyles on tibial plateau

Ligaments of the Hip

Ishiofemoral Ligament

Prevents excess extension & Adduction

Pubofemoral Ligament

Prevents excess extension & abduction

Iliofemoral Ligament

Y ligament

Prevents excess extension & external rotation

Anterior Thigh Compartment

Adductor Canal

Posterior: Adductor Longus & Adductor Magnus

Lateral: Vastus Medialis

Anterior-medially: Sartorius

Contents: Femoral A.&V. , Saphenous N.

The femoral a. become the popliteal A. after passing thorough the adductor hiatus

Femoral Triangle

Includes: Femoral Artery, Femoral Vein, Femoral Nerve

Superior Border: Inguinal Ligament

Medial Border: Adductor Longus

Lateral Border: Sartorius

Floor: Iliopsoas

Roof: Fascia Lata

Female Reproductive Organs

Uterus

3 Layers: Endometrium (inner layer: Baby develops), Myometrium (middle layer: menstruation occurs), perimetrium (outer layer)

Fallopian Tube

Where oocytes get fertilized

Vagina

Discharges menstrual fluid and other vagina fluids

Male Reproductive Organs

Processes of ejaculation

Urethra

Prostate

Ejaculatory Duct

Ductus Deferens & Seminal Glands

Epididymus

Testes

Lower Limb Muscles

Posterior

Bicep Femoris: Has 2 heads (short head: origin is linea aspera and innervated by common fibular) (long head: origin ischial tuberosity and innervated by the sciatic n. tibial

Semimembranosus

Semitendinosus

Adductor Magnus

Majority innervated by the Sciatic N. tibial portion

Gets supplied by the inferior gluteal artery and perforating branches of the deep femoral artery

Flexes the knee and Extend the hip

Medial Compartment

Adductor Longus

Adductor Brevis

Adductor Magnus: Has 2 components (adductor innervated by the obturator n.) (hamstring portion and innervated by the sciatic n. tibial)

Subtopic

Gracilis

Majority Innervated by the Obturator N.

Adducts the hip

Anterior Compartment

Psoas Major

Pectinous

Sartorius

Performs: Hip flexion, abduction, and external rotation & Knee flexion

Rectus Femoris

Preforms: knee extension & hip flexion

Vastus Medialis

Vastus Lateralis

Vastus Intermedius

Tensor Fascia Latae

Ilium

Majority innervated by the femoral artery

Pelvic Girdle Muscles

Obturator internus

Supports pelvic viscera

Closes floor of inferior bony pelvis

Piriformis

Levator Ani

Pubococcygeus which includes puborectalis & pubovaginalis

Iliococcygeus: Coccygeus (ishiococcygeus)

Iliococcygeus

Blood Supply

Femoral Artery then goes down the adductor canal and exits through the adductor hiatus and turns into popliteal artery

In the femoral triangle, the profunda femoris artery arises and travels posteriorly giving off : perforating branches, lateral femoral circumflex, medial circumflex.

Under the inguinal ligament the femoral nerve then enters the femoral triangle

The internal iliac artery becomes anterior and posterior iliac artery and they innervate the pelvic girdle

External iliac artery turns into femoral artery & internal iliac artery turns into anterior and posterior iliac artery (below the inguinal ligament)

External and internal iliac artery (at L4 and L5)

Common iliac artery

Abdominal aorta

Bones

Pelvic Girdle

Composed of ilium, ischial, pubic known as innominate bone or os coxae

Fused Anteriorly by the pubic symphysis

Fused posteriorly by the sacroiliac joint

Sacrum and coccyx

Function: support the abdomen, links vertebral column to the lower limbs and transmits forces from the lower limbs to the vertebral column through trabecular systems