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Arthroscopic and Open Anatomy of the Hip 11
CHAPTER Arthroscopic and o'pen Anatomy of the Hip Michael B. Gerhardt, Kartik Logishetty, Morteza lV1eftah, and Anil S. Ranawat INTRODUCTION movements that they induce at the joint: 1) flexors; 2) extensors; 3) abductors; 4) adductors; 5) external rotators; and 6) interI12 I The hip joint is defined by the articulation between the head rotators. Although some muscles have dual roles, their primary of the femur and the aeetahulum of the pelvis. It is covered by functions define their group placem(:)nt, and they all have ullique :l large soft-tissue envelope and a complex array of neurovascu- neurovascular supplies (TIt ble 2-1). lar and musculotendinous structures. The joint's morphology The vascular supply of tbe hip stems from the external and anu orientation are complex, and there are wide anatomi c varia- internal iLiac ancries. An understanding of the course of these tions seen among individuals. The joint's deep location makes vessels is critical fo r ,lVo iding catasu"ophic vascular injury. fn both arthroscopic and open access challenging. To avoid iatro- addition, the blood supply to the fel11()ra l head is vulnerahle to genic injury while establishing functional and efficient access, both traumatic and iatrogenic injury; the disruption of this sup- the hip surgeon should possess a sound ana tomic knowledge of ply can result in avascular necrosis (Figure 2-2). the hip. T he human "hip" can be subdivided into three categories: I) the superficial surface anatomy; 2) the deep femoroacetabu- la r Joint and capsule; and 3) the associated structures, including the muscles, nerves, and vasculature, all of which directly affeet HIP MUSCULATURE its function. -
The Zona Orbicularis of the Hip Joint: Anatomical Study and Review of the Literature
Original Article www.anatomy.org.tr Received: November 30, 2017; Accepted: December 7, 2017 doi:10.2399/ana.17.047 The zona orbicularis of the hip joint: anatomical study and review of the literature Alexandra Fayne1, Peter Collin2, Melissa Duran1, Helena Kennedy2, Kiran Matthews3, R. Shane Tubbs4,5, Anthony V. D’Antoni6 1SUNY Downstate College of Medicine, New York, USA 2New York University School of Medicine, New York, USA 3City University New York, New York, USA 4Seattle Science Foundation, Seattle, WA, USA 5Department of Anatomical Sciences, St. George’s University, Grenada, West Indies 6Division of Anatomy, Department of Radiology, Weill Cornell Medical College, New York, USA Abstract Objectives: Although it is used as a landmark during various orthopedic procedures of the hip, few studies have focused on the anatomy of the zona orbicularis. Therefore, the purpose of the present research was to study its morphology to improve our understanding of its structure and potential variation. Methods: Ten adult cadavers (four males and six females) underwent dissection of the left and right hip joints to observe the morphology and location of the zona orbicularis. A digital caliper was used to measure the length and width of the zona orbic- ularis. Results: We found a zona orbicularis on all sides and that when present anteriorly, many of the inferior fibers of the zona orbic- ularis were confluent with the fibers of the iliofemoral ligament. The mean length for right sides was 35.95 mm and the mean length for left sides was 43.93 mm. The mean width for right sides was 3.74 mm and the mean width for left sides was 4.4 mm. -
Femur Pelvis HIP JOINT Femoral Head in Acetabulum Acetabular
Anatomy of the Hip Joint Overview The hip joint is one of the largest weight-bearing HIP JOINT joints in the body. This ball-and-socket joint allows the leg to move and rotate while keeping the body Femoral head in stable and balanced. Let's take a closer look at the acetabulum main parts of the hip joint's anatomy. Pelvis Bones Two bones meet at the hip joint, the femur and the pelvis. The femur, commonly called the "thighbone," is the longest and heaviest bone of the body. At the top of the femur, positioned on the femoral neck, is the femoral head. This is the "ball" of the hip joint. The other part of the joint – the Femur "socket" – is found in the pelvis. The pelvis is a bone made of three sections: the ilium, the ischium and the pubis. The socket is located where these three sections fuse. The proper name of the socket is the "acetabulum." The head of the femur fits tightly into this cup-shaped cavity. Articular Cartilage The femoral head and the acetabulum are covered Acetabular with a layer of articular cartilage. This tough, smooth tissue protects the bones. It allows them to labrum glide smoothly against each other as the ball moves in the socket. Soft Tissues Several soft tissue structures work together to hold the femoral head securely in place. The acetabulum is surrounded by a ring of cartilage called the "acetabular labrum." This deepens the socket and helps keep the ball from slipping out of alignment. It also acts as a shock absorber. -
The Femoral Hernia: Some Necessary Additions
International Journal of Clinical Medicine, 2014, 5, 752-765 Published Online July 2014 in SciRes. http://www.scirp.org/journal/ijcm http://dx.doi.org/10.4236/ijcm.2014.513102 The Femoral Hernia: Some Necessary Additions Ljubomir S. Kovachev Department of General Surgery, Medical University, Pleven, Bulgaria Email: [email protected] Received 28 April 2014; revised 27 May 2014; accepted 26 June 2014 Copyright © 2014 by author and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Purpose: The anatomic region through which most inguinal hernias emerge is overcrowded by various anatomical structures with intricate relationships. This is reflected by the wide range of anatomic interpretations. Material and Methods: A prospective anatomic study of over 100 fresh cadavers and 47 patients operated on for femoral hernias. Results: It was found that the transver- salis fascia did not continue distally into the lymphatic lacuna. Medially this fascia did not reach the lacunar ligament, but was rather positioned above it forming laterally the vascular sheath. Here the fascia participates in the formation of a fossa, which varies in width and depth—the pre- peritoneal femoral fossa. The results did not confirm the presence of a femoral canal. The dis- tances were measured between the pubic tubercle and the medial margin of the femoral vein, and between the inguinal and the Cooper’s ligaments. The results clearly indicate that in women with femoral hernias these distances are much larger. Along the course of femoral hernia exploration we established the presence of three zones that are rigid and narrow. -
Lower Extremity Clinical/Anatomical Review
LOWER EXTREMITY CLINICAL/ANATOMICAL REVIEW Clinical Condition Anatomy Cause Symptom Hip/Pelvis Femoral Hernia Femoral ring is a weak point in Increase in pressure in Bulge in anterior thigh abdomino-pelvic cavity; abdomen (lifting heavy below Inguinal Ligament Lymphatic vessels course object, cough, etc.) can through Femoral ring to force loop of bowel into Femoral Canal in medial part Femoral Canal (out of Femoral sheath (Sheath Saphenous opening) surrounds Fem. Art, Vein, Lymph) Hip Pointer Anterior Superior Iliac spine Fall on hip causes Bruise on hip (origin of Sartorius, Tens. contusion at spine Fasc. Lata m.) is subcutaneous Pulled Groin Adductor muscles of thigh take Tear in Adductor Pain in groin (at or near origin from pubis muscles can occur in pubis) contact sports Hamstring Pull Hamstring muscles of post. Excessive contraction Agonizing pain in thigh have common origin at (often in running) produces posterior thigh if muscles Ischial Tuberosity tear or avulsion of are avulsed hamstring muscles from Ischial tuberosity Gluteal Gait Gluteus Medius and Minimus Damage to Superior Gluteal Gait act to support body weight Gluteal Nerve or polio (Trendelenberg Sign): when standing (essential when pelvis tilts to down opposite leg is lifted in toward non-paralyzed walking) side when opposite (non- paralyzed) leg is lifted in walking Collateral Cruciate anastomosis links Damage to External Iliac Bleeding (can ligate circulation at hip Inf. Gluteal artery (from Int. or Femoral arteries (stab between Internal Iliac Iliac.) and Profunda -
Elbow Checklist
Workbook Musculoskeletal Ultrasound September 26, 2013 Shoulder Checklist Long biceps tendon Patient position: Facing the examiner Shoulder in slight medial rotation; elbow in flexion and supination Plane/ region: Transverse (axial): from a) intraarticular portion to b) myotendinous junction (at level of the pectoralis major tendon). What you will see: Long head of the biceps tendon Supraspinatus tendon Transverse humeral ligament Subscapularis tendon Lesser tuberosity Greater tuberosity Short head of the biceps Long head of the biceps (musculotendinous junction) Humeral shaft Pectoralis major tendon Plane/ region: Logitudinal (sagittal): What you will see: Long head of biceps; fibrillar structure Lesser tuberosity Long head of the biceps tendon Notes: Subscapularis muscle and tendon Patient position: Facing the examiner Shoulder in lateral rotation; elbow in flexion/ supination Plane/ region: longitudinal (axial): full vertical width of tendon. What you will see: Subscapularis muscle, tendon, and insertion Supraspinatus tendon Coracoid process Deltoid Greater tuberosity Lesser tuberosity Notes: Do passive medial/ lateral rotation while examining Plane/ region: Transverse (sagittal): What you will see: Lesser tuberosity Fascicles of subscapularis tendon Supraspinatus tendon Patient position: Lateral to examiner Shoulder in extension and medial rotation Hand on ipsilateral buttock Plane/ region: Longitudinal (oblique sagittal) Identify the intra-articular portion of biceps LH in the transverse plane; then -
Ultrasonographic Analysis of the Anatomical Relationship Between Femoral Vessels in the Upper Part of Thigh in Critically Ill Patients – a Cross Sectional Study
November - December, 2018/ Vol 6/Issue 08 Print ISSN: 2321-127X, Online ISSN: 2320-8686 Original Research Article Ultrasonographic analysis of the anatomical relationship between femoral vessels in the upper part of thigh in critically ill patients – a cross sectional study Suresh Kumar V.K. 1, Vijayan D. 2, Kunhu S. 3, Varghese B. 4 1Dr. Suresh Kumar V.K., Senior Consultant, 2Dr. Deepak Vijayan, Senior Consultant, 3Dr. Shamim Kunhu, Associate Consultant; above all authors are affiliated with Department of Critical Care Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 4Dr. Boban Varghese, Consultant ICU Physician, Valluvanadu Hospital, Ottappalam, Kerala, India Corresponding Author: Dr. Suresh Kumar, Senior Consultant, Department of Critical Care Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India. E-mail: [email protected] ……………………………………………………………………………………………………………………………...… Abstract Objective: Femoral vessels are one of the frequently used sites of cannulation in intensive care units. In resource limited settings cannulations are done blindly without ultrasonographic guidance based on a traditional belief that in the upper thigh vein keeps a medial relationship to artery. In this trial we tried to analyse the anatomical relationship of femoral vein to femoral artery using ultrasound in critically ill patients. Methods: This cross sectional study analysed the anatomical relationship of femoral vein to femoral artery at 2cm, 4 cm and 6 cm from the mid inguinal point in both thighs of the patients using ultrasonography. The study was done among patients admitted in a multidisciplinary intensive care unit. Results: Three hundred limbs of one hundred and fifty patients were analysed by ultrasonography. A total of 900 measurements were taken at three different levels of both legs. -
Injuries to the Lower Extremity II
Injury to lower extremity InjuriesInjuries toto thethe lowerlower extremityextremity IIII Aree Tanavalee MD Associate Professor Department of Orthopaedics Faculty of Medicine Chulalongkorn University Injury to lower extremity TopicsTopics • Fracture of the shaft of the femur • Fractures around the knee • Knee dislocation and fracture dislocation • Fractures of tibia and fibular • Fractures around the ankle • Fracture and fracture dislocation of the foot Injury to lower extremity CommonCommon symptomssymptoms andand signssigns ofof fracturesfractures – Pain – Deformity – Shortening – Swelling – Ecchymosed – Loss of function – Open injury • Gross finding of fractures Injury to lower extremity RadiographicRadiographic evaluationevaluation forfor fracturesfractures • At least, 2 different planes of Fx site – Includes joint above and below – Some types of Fx, special views – Sometimes, 2 different times – Sometimes, calls second opinion Injury to lower extremity ComplicationsComplications ofof fracturesfractures • General – Delayed union – Nonunion – Malunion – Shortening – Infection • Severe – Neurovascular injuries – Compartment syndrome – Fat embolism – Adult respiratory distress syndrome (ARDS) Injury to lower extremity FatFat embolismembolism • Common in Fx of long bone and pelvis • Multiple Fxs >> single Fx • Respiratory insufficiency • Usually manifests within 48 hr • Clinical – Fever – Tachepnea – Tachycardia – Alters consciousness • Treatment – Respiratory support – Early Fx stabilization Injury to lower extremity CompartmentCompartment -
Front of Thigh
Dorsal divisions Ventral divisions Ilio-Hypogastric N L-1 Ilio-Inguinal N Lat. Cut. N.of Thigh L-2 Genito-Femoral N L-3 Obturator N Femoral N L-4 Acc.Obturator N Branch to L.S. Trunk Front of Thigh • 7 Cutaneous nerve • 3 Cutaneous arteries • Gr. Saphenous vein & tributaries • Superficial inguinal Lymph nodes & lymphatics • Pre-patellar & subcutaneous Infra-patellar bursae Cutaneous Nerve •Lat. Cut. Br. of Subcostal N. •Ilio-Inguinal N (L1) •Femoral br. of Genito-femoral N(L1,2 •Lat. Cut. N. of Thigh (L-2,3) •Intermediate Cut. N. of Thigh(L-2,3) •Medial Cut. N. of Thigh (L-2,3) •Cut. Br. of Ant. Division.- Obturator N (L-2,3) •Saphenous N (L-3,4) Three Tributaries •Sup. External Pudendal V •Sup.Circumflex iliac V •Sup. Epigastric V Superficial Inguinal Lymph Nodes Upper horizontal Gr. Upper lateral Upper Medial Lower Vertical Gr. Femoral Sheath • Funnel shaped extension of fascial lining of abdominal cavity • surrounding upper 4 cms of femoral artery & vein Femoral Sheath Walls • Ant.wall – fascia transversalis • Post. Wall – fascia iliaca • Lateral wall longer & vertical • Divided in three compartments by two vertical antero-post. septa A V Femoral canal & ring • Medial compartment of femoral sheath • Conical in shape , wide above, narrow below • Base or upper end called Femoral Ring • Closed by condensation of extra-peritoneal tissue called femoral septum • Wider in females due to wider pelvis & small femoral vessels Femoral Ring • Oval shaped • 1 inch diameter Boundary • Ant.- inguinal ligament • Post.- pectineus & covering fascia • Laterally- IM septum • Medially- Lacunar ligament Content • Lymph node (cloquet or Rossenmuller) with lymphtics & areolar tissue – drain glans penis in males & clitoris in females •Sartorius •Quadriceps Femoris Rectus femoris Three Vasti Vastus medialis Vastus Intermedius Vastus lateralis •Articularis Genu Femoral Triangle Contents • Femoral artery & Branches - 3 Superficial & 3 Deep • Femoral Vein & tributaries • Femoral Sheath • Nerves Femoral N Femoral Br. -
Femoral Triangle Anatomy: Review, Surgical Application, and Nov- El Mnemonic
Journal of Orthopedic Research and Therapy Ebraheim N, et al. J Orthop Ther: JORT-139. Review Article DOI: 10.29011/JORT-139.000039 Femoral Triangle Anatomy: Review, Surgical Application, and Nov- el Mnemonic Nabil Ebraheim*, James Whaley, Jacob Stirton, Ryan Hamilton, Kyle Andrews Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo Orthopedic Research Institute, USA *Corresponding author: Nabil Ebraheim, Department of Orthopedic Surgery, University of Toledo Medical Center, Orthopaedic Residency Program Director, USA. Tel: 866.593.5049; E-Mail: [email protected] Citation: Ebraheim N, Whaley J, Stirton J, Hamilton R, Andrews K(2017) Femoral Triangle Anatomy: Review, Surgical Applica- tion, and Novel Mnemonic. J Orthop Ther: JORT-139. DOI: 10.29011/JORT-139.000039 Received Date: 3 June, 2017; Accepted Date: 8 June, 2017; Published Date: 15 June, 2017 Abstract We provide an anatomical review of the femoral triangle, its application to the anterior surgical approach to the hip, and a useful mnemonic for remembering the contents and relationship of the femoral triangle. The femoral triangle is located on the anterior aspect of the thigh, inferior to the inguinal ligament and knowledge of its contents has become increasingly more important with the rise in use of the Smith-Petersen Direct Anterior Approach (DAA) to the hip as well as ultrasound and fluo- roscopic guided hip injections. A detailed knowledge of the anatomical landmarks can guide surgeons in their anterior approach to the hip, avoiding iatrogenic injuries during various procedures. The novel mnemonic “NAVIgate” the femoral triangle from lateral to medial will aid in remembering the borders and contents of the triangle when performing surgical procedures, specifically the DAA. -
M34 M34/1 Latin M34, M34/1
M34 M34/1 M34 M34/1 Latin M34, M34/1 1 Tibia 34 Retinaculum 62 Vagina tendinum musculi 2 Malleolus medialis musculorum fibularium extensoris hallucis longi 3 Talus inferius [Retinaculum 63 A. dorsalis pedis 4 Lig. collaterale mediale musculorum peroneorum 64 M. extensor hallucis brevis [Lig. deltoideum] inferius] 65 N. cutaneus dorsalis 5 Lig. talonaviculare 35 Tendo musculi fibularis medialis 6 Os naviculare longus [Tendo musculi 66 Mm. interossei dorsales 7 Ligg. tarsi dorsalia fibularis longus] 67 Tendines musculi 8 Os metatarsi I 36 Lig. calcaneofibulare extensoris digitorum longi [Os metatarsale I] 37 Tendo calcaneus 68 Tendo musculi extensoris 9 Articualtio 38 Retinaculum musculo- hallucis longi metatarsophalangeae I rum fibularium superius 69 Nn. digitales dorsales pedis 10 Phalanx proximalis I [Retinaculum musculorum 70 Aa. digitales dorsales 11 Phalanx distalis I peroneorum superius] 71 M. abductor digiti minimi 12 Ligg. metatarsalia dorsalia 39 Lig. talocalcaneum 72 Tendines musculi 13 Os cuboideum interosseum extensoris digitorum brevis 14 Lig. bifurcatum 40 Lig. talofibulare posterius 73 Aa. metatarsales dorsales 15 Lig. talofibulare anterius 41 Articulationes metatarsop- 74 A. arcuata 16 Malleolus lateralis halangeae, Ligg. plantaria 75 M. fibularis tertius 17 Lig. tibio-fibulare anterius 42 Basis ossis metatarsi I [M. peroneus tertius] 18 Fibula 43 Ligg. tarsometatarsalia 76 Tendo musculi fibularis 19 Membrana interossea cruris plantaria brevis [Tendo musculi 20 Lig. collaterale mediale 44 Lig. cuboideonaviculare peronei brevis] [Lig. deltoideum], pars plantare 77® A. tarsalis lateralis tibiotalaris anterior 45 Lig. calcaneonaviculare 78 N. cutaneus dorsalis inter- 21 Lig. collaterale mediale plantare medius [Lig. deltoideum], pars 46 Sustentaculum tali 79 Retinaculum musculorum tibiocalcanea 47 Tuber calcanei extensorum superius 22 Lig. -
Lower Extremity Focal Neuropathies
LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Arturo A. Leis, MD S.H. Subramony, MD Vettaikorumakankav Vedanarayanan, MD, MBBS Mark A. Ross, MD AANEM 59th Annual Meeting Orlando, Florida Copyright © September 2012 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Table of Contents Course Committees & Course Objectives 4 Faculty 5 Basic and Special Nerve Conduction Studies of the Lower Limbs 7 Arturo A. Leis, MD Common Peroneal Neuropathy and Foot Drop 19 S.H. Subramony, MD Mononeuropathies Affecting Tibial Nerve and its Branches 23 Vettaikorumakankav Vedanarayanan, MD, MBBS Femoral, Obturator, and Lateral Femoral Cutaneous Neuropathies 27 Mark A. Ross, MD CME Questions 33 No one involved in the planning of this CME activity had any relevant financial relationships to disclose.