Kin191 A. Ch.8. Pelvis. Thigh. Anatomy

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  • 1.KIN 191A Advanced Assessment of Lower Extremity Injuries THE PELVIS AND THIGH ANATOMY

2. INTRODUCTION

  • BONY ANATOMY
  • ARTICULATIONS AND LIGAMENTOUS ANATOMY
  • MUSCULAR ANATOMY
  • BURSAES
  • VASCULAR/NEURO ANATOMY

3. BONY ANATOMY

  • Anterior & lateral portion of the pelvic formed by two innominate bones
    • Each consisting of
      • Ilium
      • Ischium
      • Pubis
  • Posterior junction of the pelvis girdle is formed by the sacrum
    • Fixates the spinal column to the pelvis
    • Sacrum (4~5 fused segments)

4. Pubis Ischium Ilium ArticularSurface 5. ASIS AIIS PIIS PSIS 6. Iliac Crest Iliac Tuberosity 7. Ischial Tuberosity Ischial Spine Ramos of Ischium 8. S. Ramosof Pubis Ischium Ilium Pubic TubercleI. Ramosof Pubis 9.

  • Acetabulum
    • Downwardly and outwardly directed depression
    • Accepts the femoral head within its fossa
    • Superior wall (ilium)
    • Inferior wall (ischium)
    • Internal, medial wall (pubis)

Lateral Aspect of the Pelvic 10.

    • Ligamentum teres
      • Centered within fossa
    • Labrum
      • A thick ring of fibrocartilage
      • Lines the outer rim of the acetabulum
      • Deepens the articular area
      • Thicker and stronger superiorly than inferiorly

11. Rim of Acetabulum Acetabulum Notch Acetabulum Lunate Surface Acetabulum Fossa 12.

  • A 180 degree arc in diameter
  • Thickly covered with hyaline cartilage
    • Except a central depression that accepts the ligamentum teres
  • Connected to the femurs shaft by the femoral neck
  • Frontal plane: angled at approximately 125
    • Known as the angle of inclination
    • Slightly decreased in women
  • Transverse plane: between femoral head and shaft is the angle of torsion
    • Normally 15

Femoral Head 13. 14.

  • Trochanters are the attachment sites for many of the pelvic and hip muscles
  • Greater trochanter
    • Projects laterally
  • Lesser trochanter
    • Projects medially

15. 16. Median Sacral Crest Cornua Coccygeal Cornua Transverse Process Articular Surface Hiatus I. L. 17. Dorsal Sacrum Foramina Transverse Tubercles 1 stCoccygeal Vertebra Fused 2 nd-4 thVertebrae 18. ARTICULATIONS AND LIAGAMENTOUS ANATOMY

  • Pubic symphysis
    • Articulates anteriorly
    • Relatively immobile joint
    • Fibrocartilaginous interpubic disk
    • Subtle distraction, compression, rotation motion
  • Coxofemoral joint
    • Ball-and-socket joint
    • 3 degrees of freedom

19.

  • Sacroiliac (SI) joint
    • Posteriorly, each ilium articulates with the sacrum
    • Very strong joint with limited mobility irregular shapes contribute to stability
    • Anterior (ventral) and posterior (dorsal) sacroiliac ligaments
    • Sacrotuberous ligament sacrum to ischial tuberosity
    • Sacrospinous ligament ischial spine to sacrum/coccyx

20.

  • Originates from AIIS
  • One band inserting on the distal aspect of the anterior intertrochanter line
  • Other band inserting on the proximal aspect of the anterior intertrochanter line and the femoral neck
  • Limiting hyperextension
  • Superior fibers (limits adduction)
  • Inferior fibers (limits abduction)

Iliofemoral Ligament(Y ligament of bigelow) 21. Iliofemoral Ligament Ingunial Ligament Pubofemoral Ligament Ischiofemoral Ligament SacrotuberousLigament 22. Pubofemoral Ligament

  • Emerging from the pubic ramus
  • Inserting on the anterior aspect of the intertrochanteric fossa
  • Limits
    • Abduction
    • hyperextension

23. Ischiofemoral Ligament

  • Triangular ligament
  • From posterior acetabulum rim with upwardly spiraling fibers attaching to the joint capsule and the inner surface of the greater trochanter
  • Limits
    • Extension

24. Ingui n al Ligament

  • Originates from ASIS
  • Inserts at the pubic symphysis

25. Ligamentum Teres

  • Known as the ligament of the head of the femur
  • Serves as a conduit for the medial and lateral circumflex arteries

26. Ischiofemoral L. Transverse Acetabulum Ligament Pubofemoral L. Iliofemoral L. Ligamentum Teres 27. MUSCULAR ANATOMY

  • Anterior Musculature
  • Medial Musculature
  • Lateral Musculature
  • Posterior musculature

28. Anterior Musculature

  • Quadriceps
    • Rectus femoris
    • Vastus medialis, lateralis, intermedius
  • Sartorius
  • Iliopsoas
    • Iliacus
    • Psoas major/minor

29. Rectus Femoris

  • O:AIIS
  • I:Tibial tuberosityvia infrapatellartendon
  • N:Femoral
  • A: Knee extension,hip flexion

30. Vasti Muscles

  • O:VL Greater trochanter,lateral lip of linea aspera
    • VI Anterolateral upper 2/3of femur,lateral lipoflinea aspera
    • VM Distal intertrochantericline, mediallip oflineaaspera
  • I:Tibial tuberosity viainfrapatellartendon
  • N:Femoral
  • A:Knee extension

31. Sartorius

  • O:ASIS
  • I:Anteromedial tibialflare (pes anserine)
  • N:Femoral
  • A: Hip flexion,
  • Hip abduction,
  • Hip external rotation
  • Knee flexion

32. Iliopsoas

  • Iliacus
    • O:I liac fossa/crest
    • I:L esser trochanter
    • N: L1-L4
    • A: Hip flexion, lateral rotation
  • Psoas major/minor
    • O:T ransverse processes T12-L5 /T12-L1
    • I:L esser trochanter /Pectineal line of thepubis
    • N: L1-L4
    • A: Hip flexion, lateral rotation
    • Anterior pelvic tilt/Posterior pelvic tilt

33. Medial Musculature

  • Pectineus
  • Adductor longus
  • Gracilis
  • Adductorbrevis (deep to adductor longus)
  • Adductormagnus (deepest)

34. Pectineus

  • O:S uperior pubicsymphysis
  • I:P ectineal line of femur
  • N:O bturator
  • A:Hip adduction, flexion
    • Anterior pelvic tilt

35. Adductor Longus

  • O:P ubic symphysis
  • I:M edial 1/3 of lineaaspera
  • N:O bturator
  • A: Hip adduction, flexion
    • Anterior pelvic tilt

36. Gracilis

  • O:Anterior body of pubis
  • I:Pes anserine tendon
  • N:O bturator
  • A:Hip adduction, flexion
    • Knee flexion
    • Anterior pelvic tilt

37. Adductor Brevis

  • O:P ubic ramus
  • I:Proximal 1/3linea aspera
  • N:O bturator
  • A:Hip adduction, flexion
  • Anterior pelvic tilt

38. Adductor Magnus

  • O:I nferior pubic ramus, is c hicalramus, ischial tuberosity
  • I:G luteal tuberosity to adductortubercle
  • N:O bturator, tibial and commonperoneal
  • A: Hip adduction, extension
  • Posterior pelvic tilt

39. Lateral Musculature

  • Tensor fascia latae
  • Gluteus medius/minimus
  • External rotators(superior to inferior)
    • Piriformis