DOCSLIB.ORG

Systematic Approach to the Interpretation of Pelvis and Hip

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Systematic Approach to the Interpretation of Pelvis and Hip Volume 37 • Number 26 December 31, 2014 Systematic Approach to the Interpretation of Pelvis and Hip Radiographs: How to Avoid Common Diagnostic Errors Through a Checklist Approach MAJ Matthew Minor, MD, and COL (Ret) Liem T. Bui-Mansfi eld, MD After participating in this activity, the diagnostic radiologist will be better able to identify the anatomical landmarks of the pelvis and hip on radiography, and become familiar with a systematic approach to the radiographic interpretation of the hip and pelvis using a checklist approach. initial imaging examination for the evaluation of hip or CME Category: General Radiology Subcategory: Musculoskeletal pelvic pain should be radiography. In addition to the com- Modality: Radiography plex anatomy of the pelvis and hip, subtle imaging fi ndings often indicating signifi cant pathology can be challenging to the veteran radiologist and even more perplexing to the Key Words: Pelvis and Hip Anatomy, Radiographic Checklist novice radiologist given the paradigm shift in radiology residency education. Radiography of the pelvis and hip is a commonly ordered examination in daily clinical practice. Therefore, it is impor- tant for diagnostic radiologists to be profi cient with its inter- The initial imaging examination for the evaluation pretation. The objective of this article is to present a simple of hip or pelvic pain should be radiography. but thorough method for accurate radiographic evaluation of the pelvis and hip. With the advent of cross-sectional imaging, a shift in residency training from radiography to CT and MR imag- Systematic Approach to the Interpretation of Pelvis ing has occurred; and as a result, the art of radiographic and Hip Radiographs interpretation has suffered dramatically. However, the Common views of the pelvis and proximal femur include the AP projection of the pelvis, anterior and posterior 45-degree oblique (Judet) projections of the pelvis, AP pro- Dr. Minor is Radiology Resident, SAUSHEC, Fort Sam Houston, Texas; and Dr. Bui-Mansfi eld is Chief, Musculoskeletal Radiology Section, Department of jection of the hip, and frog-leg lateral or straight lateral (Dan Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas, and Miller) projection of the hip. More specifi c views of the hip Associate Professor, Department of Radiology, Uniformed Services University and pelvis to include pelvic inlet and outlet (Ferguson) views of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814; E-mail: liem.mansfi [email protected]. may be obtained depending on the clinical presentation. Each The authors and all staff in a position to control the content of this CME activity projection has advantages for visualization of the complex and their spouses/life partners (if any) have disclosed that they have no relation- pelvic anatomy. For example, the posterior column of the ships with, or fi nancial interests in, any commercial organizations pertaining to pelvis is best visualized on the Judet view; the sacroiliac this educational activity. joints are best appreciated on the pelvic outlet view; and the The opinions and assertions contained herein are those of the authors and should not be construed as offi cial or as representing the opinions of the Department of anterior and posterior aspects of the femoral neck are best the Army, Department of the Air Force, or the Department of Defense. seen on the frog-leg lateral view.1-3 Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This continuing medical education activity expires on March 20, 2015. 1 CCDRv37n26.inddDRv37n26.indd 1 111/17/141/17/14 99:36:36 PPMM The proximal femur, which can be divided into the fem- oral head, femoral neck, trochanters, and femoral shaft, articulates with the pelvis at the acetabulum. Normal angu- lation of the femoral head is approximately 125 to 135 degrees with respect to the long axis of the femoral shaft, with approximately 25 to 30 degrees of anteversion.3 The femoral neck, composed of the subcapital, transcervical, and basicervical segments, has characteristic compressive (vertically oriented) and tensile (arc-shaped) trabeculae. The intertrochanteric line (anterior) and the intertrochanteric crest (posterior) mark the transition between the femoral neck and the shaft. From the fusion of the 3 pelvic bones and articulation of the femur with the pelvis, several distinct Figure 1. This AP view of the pelvis shows the Hilgenreiner (H, radiographic lines, rings, and arcs are formed and are essen- horizontal dashed line) and Perkins (P, perpendicular solid line) lines on the right. On the left, the pubis (blue), ischium (yellow), tial to the analysis of pelvic radiographs. Table 1 outlines and ilium (red) are shown. the basic checklist approach for the evaluation of pelvic and hip radiographs. The complex anatomy of the pelvis derives from the sym- In the absence of trauma, an avulsion injury metric fusion of 3 pelvic bones: the ilium, ischium, and pubis of the pelvis or proximal femur in an adult at the acetabulum (Figure 1). Initially, the 3 pelvic bones are should raise concern of an underlying bone connected by a Y-shaped growth plate, the triradiate cartilage, neoplasm. which fuses at approximately 14 to 16 years of age.4-6 Anteriorly, the right and left pubis, composed of a body and superior and inferior pubic rami, articulate at the pubic sym- On every pelvic radiograph, the white cortical margins or physis. Posteriorly, the body of the ilium articulates with the lines of the pelvis and femur should be closely scrutinized sacrum forming the sacroiliac joints, which are composed of for evidence of disruption. Loss of the white cortical line is a synovial component at the lower one third and a syndes- due most commonly to fracture, followed by neoplasm, infec- motic component at the upper two thirds of the joint. Key tion, and erosion from arthritis. An example of a fracture components of the ilium include the iliac crest and the ante- disrupting the cortical white line of the ilium is an isolated rior inferior and anterior superior iliac spines. The ischium, impaction fracture or Duverney fracture7 (Figure 2). In young which forms the posterior border of the acetabulum, also is athletic individuals, traumatic pelvic avulsion injuries will composed of a body and 2 rami. Spines arising from the result in disruption of the cortical white margin; however, it ischium and ilium form the greater and lesser sciatic notches should be noted that in the absence of trauma an avulsion posteriorly. The obturator foramen, which is anterior, is injury in an adult should raise concern for an underlying bone formed by the fusion of the superior and inferior pubic rami neoplasm.8 Similarly, the pelvic and obturator rings should and the inferior ischial ramus.5 be smooth and continuous. Disruption of the pelvic or obtu- rator ring requires 2 fractures or a fracture and dislocation, most frequently described by the hard pretzel analogy. Initially, the 3 pelvic bones are connected at the Therefore, whenever a radiologist detects a fracture in either acetabulum by the triradiate cartilage, which the pelvic or obturator ring, it is incumbent upon him or her fuses at approximately age 14 to 16 years. to search for a second fracture or a diastasis of either the sacroiliac joint or symphysis pubis. The continuing education activity in Contemporary Diagnostic Radiology is intended for radiologists. EDITOR: Robert E. Campbell, M.D., Clinical Professor of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Contemporary Diagnostic Radiology (ISSN 0149-9009) is published bi-weekly by Lippincott Williams & Wilkins, Inc., 16522 Hunters Green Parkway, Hagerstown, MD 21740-2116. Customer Service: Phone (800) 638-3030; FOUNDING EDITOR: William J. Tuddenham, M.D. Fax (301) 223-2400; E-mail: [email protected]. Visit our website at LWW.com. Publisher, Randi Davis. EDITORIAL BOARD: Copyright 2014 Lippincott Williams & Wilkins, Inc. All rights reserved. Priority Postage paid at Hagerstown, MD, and at Teresita L. Angtuaco, MD Bruce L. McClennan, MD additional mailing offi ces. POSTMASTER: Send address changes to Contemporary Diagnostic Radiology, Subscription George S. Bisset III, MD Johnny U. V. Monu, MBBS, Msc Dept., Lippincott Williams & Wilkins, P.O. Box 1600, 16522 Hunters Green Parkway, Hagerstown, MD 21740-2116. William G. Bradley Jr., MD, PhD Pablo R. Ros, MD, MPH, PhD PAID SUBSCRIBERS: Current issue and archives (from 1999) are available FREE online at www.cdrnewsletter.com. Liem T. Bui-Mansfi eld, MD William M. Thompson, MD Valerie P. Jackson, MD Subscription rates: Individual: US $692.00 with CME, $542.00 with no CME; international $1013.00 with CME, $743.00 with no CME. Institutional: US $1001.00, international $1139.00. In-training: US resident $139.00 with Opinions expressed do not necessarily refl ect the views of the Publisher, Editor, no CME, international $162.00. GST Registration Number: 895524239. Send bulk pricing requests to Publisher. or Editorial Board. A mention of products or services does not constitute Single copies: $43.00. COPYING: Contents of Contemporary Diagnostic Radiology are protected by copyright. endorsement. All comments are for general guidance only; professional coun- Reproduction, photocopying, and storage or transmission by magnetic or electronic means are strictly prohibited. sel should be sought for specifi c situations. Indexed by Bio-Science Information Services. Violation of copyright will result in legal action, including civil and/or criminal penalties.
Load more

Recommended publications
  • Pelvic Anatomyanatomy
    PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx)
    [Show full text]
  • Applied Anatomy of the Hip RICARDO A
    Applied Anatomy of the Hip RICARDO A. FERNANDEZ, MHS, PT, OCS, CSCS • Northwestern University The hip joint is more than just a ball-and- bones fuse in adults to form the easily recog- socket joint. It supports the weight of the nized “hip” bone. The pelvis, meaning bowl head, arms, and trunk, and it is the primary in Latin, is composed of three structures: the joint that distributes the forces between the innominates, the sacrum, and the coccyx pelvis and lower extremities.1 This joint is (Figure 1). formed from the articu- The ilium has a large flare, or iliac crest, Key PointsPoints lation of the proximal superiorly, with the easily palpable anterior femur with the innomi- superior iliac spine (ASIS) anterior with the The hip joint is structurally composed of nate at the acetabulum. anterior inferior iliac spine (AIIS) just inferior strong ligamentous and capsular compo- The joint is considered to it. Posteriorly, the crest of the ilium ends nents. important because it to form the posterior superior iliac spine can affect the spine and (PSIS). With respect to surface anatomy, Postural alignment of the bones and joints pelvis proximally and the PSIS is often marked as a dimple in the of the hip plays a role in determining the femur and patella skin. Clinicians attempting to identify pelvic functional gait patterns and forces associ- distally. The biomechan- or hip subluxations, leg-length discrepancies, ated with various supporting structures. ics of this joint are often or postural faults during examinations use There is a relationship between the hip misunderstood, and the these landmarks.
    [Show full text]
  • 2019 Radiology Cpt Codes
    2019 RADIOLOGY CPT CODES BONE DENSITOMETRY 1 Bone Density/DEXA 77080 CT 1 CT Abd & Pelvis W/ Contrast 74177 1 CT Enterography W/ Contrast 74177 1 CT Max/Facial W/O Contrast 70486 # CT Sinus Complete W/O Contrast 70486 1 CT Abd & Pelvis W W/O Contrast 74178 1 CT Extremity Lower W/ Contrast 73701 1 CT Neck W/ Contrast 70491 # CT Sinus Limited W/O Contrast 76380 1 CT Abd & Pelvis W/O Contrast 74176 1 CT Extremity Lower W/O Contrast 73700 1 CT Neck W/O Contrast 70490 # CT Spine Cervical W/ Contrast 72126 1 CT Abd W/ Contrast 74160 1 CT Extremity Upper W/ Contrast 73201 1 CT Orbit/ IAC W/ Contrast 70481 # CT Spine Cervical W/O Contrast 72125 1 CT Abd W/O Contrast 74150 1 CT Extremity Upper W/O Contrast 73200 1 CT Orbit/ IAC W/O Contrast 70480 # CT Spine Lumbar W/ Contrast 72132 1 CT Abd W W/O Contrast 74170 1 CT Head W/ Contrast 70460 1 CT Orbit/ IAC W W/O Contrast 70482 # CT Spine Lumbar W/O Contrast 72131 1 CT Chest W/ Contrast 71260 1 CT Head W/O Contrast 70450 1 CT Pelvis W/ Contrast 72193 # CT Spine Thoracic W/ Contrast 72129 1 CT Chest W/O Contrast 71250 1 CT Head W W/O Contrast 70470 1 CT Pelvis W/O Contrast 72192 # CT Spine Thoracic W/O Contrast 72128 1 CT Chest W W/O Contrast 71270 1 CT Max/Facial W/ Contrast 70487 1 CT Pelvis W W/O Contrast 72194 # CT Stone Protocol W/O Contrast 74176 CTA 1 Cardiac Calcium Score only 75571 1 CT Angiogram Abd & Pelvis W W/O Contrast 74174 1 CT Angiogram Head W W/O Contrast 70496 # CT / CTA Heart W Contrast 75574 1 CT Angiogram Abdomen W W/O Contrast 74175 1 CT Angiogram Chest W W/O Contrast 71275
    [Show full text]
  • Outlet Contraction of the Pelvis *
    OUTLET CONTRACTION OF THE PELVIS * By W. I. C. MORRIS, M.B., F.R.C.S.E., M.R.C.O.G. There is no great unanimity in regard to the incidence or even the existence of outlet contraction. Stander (1946) states that contractions of the pelvic outlet occur in about 6 per cent, of all women. De Lee (1938) quoted figures as high as 26 per cent. (Stocker), but others, including Bourne and Williams (1939), are sceptical of the importance of outlet contraction, and emphasise that the head which passes the pelvic brim is unlikely to meet grave difficulty at the outlet. All of us, however, are familiar with the occasional unexpectedly stiff forceps operation, as a result of which we deliver with much soft tissue damage a still-born baby, or, perhaps worse, one which survives to develop signs of grave intra-cranial damage. A tentative diagnosis of outlet contraction in such a case may enable us to lay a flattering unction to our souls, but outlet contraction is a subtle condition which may result from a variety of deformities and abnormalities, and its detection before the occurrence of a disaster is often difficult. I propose to devote the major portion of this lecture to an examination of various diagnostic criteria which may give such forewarning, and to deal but briefly with other aspects of outlet contraction. The Shape and Dimensions of the Fcetal Head in Labour The first approach to this problem should be to obtain an accurate picture of the fcetal head in that stage of labour when it first meets the outlet resistance.
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • What Are the Differences Between the Skeletons of a Human and a Bird?
    What are the differences between the skeletons of a human and a bird? The avian (bird) skeleton has many features that resemble the human skeleton, and the majority of the bones are the same, they are only shaped different. The arm bones of the human consist of the humerus, the radius and the ulna. These bones are also found in the bird. The leg consists of a long femur which attaches to the pelvis and then two bones of the lower leg. In the bird, these two bones: the tibia and fibula are fused together. The head of both birds and humans is protected by a large cranium. The upper jaw of the human, and the upper beak of the bird is composed of a bone called the maxilla. The lower jaw, and lower beak is composed of a bone called the mandible. The main difference between the human and bird skeleton is that the bird's skeleton is adapted for flight. The bones of a bird are hollow which makes the skeleton lighter. The other differences between the bird and human skeleton are very apparent in the pectoral girdle, which is the place where the forelimbs attach to the spine. The bird's forelimbs are wings and must have a strong support system. The collarbone of the bird is fused to form the furculum, or wishbone. The "shoulderblade" of the human is actually a bone called the scapula, birds have a scapula and they also have an additional shoulder blade bone called the corocoid. Another obvious difference between the human and bird skeleton is the shape and size of the sternum.
    [Show full text]
  • The Pelvis Structure the Pelvic Region Is the Lower Part of the Trunk
    The pelvis Structure The pelvic region is the lower part of the trunk, between the abdomen and the thighs. It includes several structures: the bony pelvis (or pelvic skeleton) is the skeleton embedded in the pelvic region of the trunk, subdivided into: the pelvic girdle (i.e., the two hip bones, which are part of the appendicular skeleton), which connects the spine to the lower limbs, and the pelvic region of the spine (i.e., sacrum, and coccyx, which are part of the axial skeleton) the pelvic cavity, is defined as the whole space enclosed by the pelvic skeleton, subdivided into: the greater (or false) pelvis, above the pelvic brim , the lesser (or true) pelvis, below the pelvic brim delimited inferiorly by the pelvic floor(or pelvic diaphragm), which is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. Pelvic floor separate the pelvic cavity above from the perineum below. The pelvic skeleton is formed posteriorly (in the area of the back), by the sacrum and the coccyx and laterally and anteriorly (forward and to the sides), by a pair of hip bones. Each hip bone consists of 3 sections, ilium, ischium, and pubis. During childhood, these sections are separate bones, joined by the triradiate hyaline cartilage. They join each other in a Y-shaped portion of cartilage in the acetabulum. By the end of puberty the three bones will have fused together, and by the age of 25 they will have ossified. The two hip bones join each other at the pubic symphysis.
    [Show full text]
  • Covariation Between Human Pelvis Shape, Stature, and Head Size Alleviates the Obstetric Dilemma
    Covariation between human pelvis shape, stature, and head size alleviates the obstetric dilemma Barbara Fischera,b,1 and Philipp Mitteroeckerb aCentre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, NO-0316 Oslo, Norway; and bDepartment of Theoretical Biology, University of Vienna, 1090 Vienna, Austria Edited by Robert G. Tague, Louisiana State University, Baton Rouge, Louisiana, and accepted by the Editorial Board March 25, 2015 (received for review October 24, 2014) Compared with other primates, childbirth is remarkably difficult in response to changes in nutrition, poor food availability, and infec- humans because the head of a human neonate is large relative to tious disease burden, among others, might influence the severity of the birth-relevant dimensions of the maternal pelvis. It seems the obstetric dilemma (17–19). puzzling that females have not evolved wider pelvises despite the Despite the effect of environmental factors, pelvic dimensions high maternal mortality and morbidity risk connected to child- are highly heritable in human populations (most pelvic traits birth. Despite this seeming lack of change in average pelvic have heritabilities in the range of 0.5–0.8) (20) (SI Text and Table morphology, we show that humans have evolved a complex link S1). It has further been claimed that low levels of integration in between pelvis shape, stature, and head circumference that was the pelvis enable high evolvability (14, 21, 22), yet pelvis shape not recognized before. The identified covariance patterns contribute has seemingly not sufficiently responded to the strong selection to ameliorate the “obstetric dilemma.” Females with a large head, pressure imposed by childbirth.
    [Show full text]
  • Knee Pain Program Targeting Hip, Pelvis, and Trunk Perform ____ Sets of ______Repetitions for Each Exercise
    Knee Pain Program Targeting Hip, Pelvis, and Trunk Perform ____ sets of ______ repetitions for each exercise. I. Side Lying Straight Leg Raise Lying on side, kick leg back then raise straightened leg, hold, then lower to starting position. Ankle weights can also be added. II. Clam Shells With band around knees and keeping heels touching, move knees apart, with the action coming from the hip. III. Fire Hydrants Starting on all fours with band around knees, lift knee out to the side while keeping the hips stable and in place. IV. Bridges with Knee Extension Lying on back, lift hips off of table, then extend leg, and return to starting position. Repeat with opposite leg. Advanced position: Place arms across chest then complete as described. V. Standing Abduction/Extension Standing with band around effected leg, balance on one foot and move straight leg against the resistance of the band. VI. Lateral Step Downs Standing on 4-8 step with effected leg, lower body at the hip, keeping knees straight and hips level. Then raise up to return to the starting position. VII. Leg Press Perform leg press with addition of A Theraband around the knees. VIII. Wall Squat With a Theraband around the knees, perform a wall sit/squat. An exercise stability ball may be added to increase difficulty. IX. Kick Backs Standing in running stance on effected leg, with Theraband around opposite ankle, kick back, keeping effected knee bent. .
    [Show full text]
  • Chapter 21: the Thigh, Hip, Groin, and Pelvis
    Chapter 17: The Thigh, Hip, Groin, and Pelvis Anatomy of the Pelvis, Thigh, and Hip Bony Anatomy • Pelvic Girdle –Ilium • Iliac crest • Anterior superior iliac spine • Posterior superior iliac spine • Anterior inferior iliac spine • Ischium –Ischial tuberosity –Hamstring or bursa problems –Should sit on this area of pelvis • Pubis –Pubic symphysis • Acetabulum • Femur –Head –Neck –Greater trochanter –Lesser trochanter –Shaft –Medial condyle –Lateral condyle Ligaments - Major source of strength –Ligamentum teres-head of femur –Iliofemoral ligament • Y ligament • Strongest in the body • Prevents hyperextension, external rotation, abduction • Pubofemoral ligament –Prevents abduction • Ischiofemoral ligament –Prevents medial rotation Bursa • 18 in hip • Ischial bursa • Greater trochanteric bursa –Found at attachment of gluteus maximus and IT band • Iliopsoas Muscles • Flexors –Iliopsoas –Rectus femoris (quad) –Sartorius • Anterior thigh (quads) –Vastus medialis –Vastus lateralis –Vastus intermedialis • Extensors –Gluteus maximus –Semitendonosis (hamstring) –Semimembranosis (hamstring) –Biceps femoris (hamstring) • Abductors –Gluteus medius –Gluteus minimus –Tensor fascia latae (Iliotibial band) • Adductors –Adductor magnus –Adductor brevis –Adductor longus –Pectineus –Gracilis • External Rotators –Oburator externus –Obturator internus –Quadratus femoris –Piriformis – sciatic nerve goes through it. –Gamellus superior –Gamellus inferior –Gluteus maximus • Internal Rotators –Gluteus minimus –Tensor fascia Latae –Gluteus medius Assessment of the
    [Show full text]
  • Sacrum and Pelvic Lecture 7
    Sacrum and Pelvic Lecture 7 Please check our Editing File. َ َّ َ َ وََمنْ َيتوَكلْ عَلى اَّّللْه ْفوُهوَْ } هذا العمل ﻻ يغني عن المصدر اﻷساسي للمذاكرة {حَس بووهْ Objectives ● Describe the bony structures of the pelvis. ● Describe in detail the hip bone, the sacrum, and the coccyx. ● Describe the boundaries of the pelvic inlet and outlet. ● Identify the structures forming the Pelvic Wall. ● Identify the articulations of the bony pelvis. ● List the major differences between the male and female pelvis. ● List the different types of female pelvis. ● Text in BLUE was found only in the boys’ slides ● Text in PINK was found only in the girls’ slides ● Text in RED is considered important ● Text in GREY is considered extra notes Bony Pelvis From team 436 Bony Pelvis, Functions: ❖ The skeleton of the pelvis is a basin- shaped ring of bones with holes in its walls that connect the vertebral column (Trunk) to both femora (lower extremities). ❖ Its Primary Functions are: ➢ Bears the weight of the upper body when sitting and standing “the most important function”. ➢ Transfers that weight from the axial skeleton to the lower appendicular skeleton when standing and walking. ➢ Provides attachments and withstands the forces of the powerful muscles of locomotion (movement) and posture. ❖ Its Secondary Functions are: ➢ Contains and Protects the pelvic and abdominopelvic viscera (inferior parts of the urinary tracts, internal reproductive organs) ➢ Provides attachment for external reproductive organs and associated muscles and membranes. Pelvic Girdle : Hip Bone : ❖ Compared to the ❖ Each one is a large irregular Pectoral Girdle, the bone. pelvic girdle is Larger, ❖ Formed of three bones: heavier, and stronger.
    [Show full text]
  • Bones and Joints of the Lower Limb: Pelvic Girdle and Femur
    Unit 5: Bones and joints of the lower limb: pelvic girdle and femur Chapter 5 (Lower limb) and Chapter 3 (Pelvis and perineum) GENERAL OBJECTIVES: - recognize, name and correctly orient hip bones and femur - explain how is anatomy of hip bones/pelvis adjusted to its function - name and describe all joints of pelvis focusing of anatomical and functional properties - remember concepts and common structural properties of flat and long bones SPECIFIC OBJECTIVES: Bones of the pelvic girdle and femur HIP BONE Describe anatomical position of the hip bone, which bony elements lay in frontal plane? Which primary bones fuse to form hip bone? What are differences between male and female pelvis? Identify the bony structures on each of the following parts of the HIP BONE. Ileum: the body and alae, - Iliac crest - Gluteal surface and lines - Iliac fossa - Sacral side with auricular surface and iliac tuberosity Pubis: the body and rami (superior and inferior) - Superior ramus - Inferior ramus Ischium: the body and ramus -Ischial spine and tuberostiy -Greater and lesser sciatic notches Acetebulum Obturator foramen FEMUR - Upper (proximal) end: head, neck, angles, trochanters, intertrochanteric crest, trochanteric fossa - Shaft: linea aspera with lips - Lower (distal) end: condyles, intercondilar fossa, patellar surface, Joints of the pelvis and hip Bony Pelvis (Hip Bones, Sacrum & Coccyx) Bony Features & Articular Surfaces Attachments of: Ligaments & Muscles Lesser Pelvis Pelvic Brim -> Pelvic Inlet (Superior Aperture) Lateral & Posterior Walls: Obturator
    [Show full text]