Anma Homework 4- The Femoral Head and Pelvis

1. The hip (coxal joint) is the articulation of the femoral head of the femur bone and
acetabulum within the fusion of the illium, pubis, and ischium of the pelvic girdle. The
meeting of these creates a ball and socket joint akin to the glenohumeral articulation in
the upper arm.
The pelvic unit is part of the appendicular skeleton and unites the top and bottom of the
body via the coccyx, sacrum, and lumbar vertebrae. The cartilaginous vertebral column
and sacroiliac joints are found within the pelvic girdle and act upon the hips, which are
located laterally on the pelvis, superior to the ischium and distal to the ilium. The tops of
the acetabulum are located lateroanteriorly, approximately level with the posteriorly
situated proximal coccyx when viewed from anatomical position.
Other major articulations acting on the hips are the tibiofemoral joints. The bones here
are the tibia and fibia of the lower leg, femur of the upper, and sesamoid patella.
Owing to the body being one whole with the hips located centrally, joints such as the
tibiofemorals, talocrurals and atlantoaxial have musculature around them that can directly
or indirectly act upon the hips either via their origins and insertions or by virtue that they
have an effect on the fascia that surrounds the body.
Specific muscles that act upon the hips are the adductors, hamstrings, uadriceps, the
gluteals !maximus,medius,minimus" fascia lata, psoas and iliacus, uadratus lumborum,
latissimus dorsi owing to its fascial origins at the ilium, similarly the sacrospinialis group,
rectus and transverse abdominis, piriformis, sartorius, the obturator group !externus,
internus" and gemellus inferior and superior.
#. The Hara is referred to as being located within the pelvic area of the body and is
attributed as being a centre or convergence of energy.
$. Ocular asics is a test to determine whether the sacral level, neck%righting
mechanisms, piriformis muscle and pelvic proprioceptors are neurologically
disorganised. The eyes link to musculature in the neck and occiput, which work with the
sacrum and thusly affect the attached piriformis muscle.
&f, having performed a posterior clavicular muscle !'()" test with a piriformis stretch
giving a weak response, left or right eye movement strengthens this, it will direct a
practitioner to that piriformis muscle being neurologically weak.
*. The hip is a synovial ball and socket joint. &t articulates with the femur head in
acetabulum and is capable of complete circumduction.
+. The !irous capsule o! the hip joint is the space in which the femoral head is free to
move. &t unites the top and bottom of the body &t is thicker anteriorly than it is
posteriorly so that it can bear loads effectively, and is similar to the inner bearing race of
loose%ball bearings used in industries.
The capsule in reinforced by extracapsular ligaments and an intracapsular ligament that
stop the joint moving beyond its normal range. The ligaments comprise of directional
fibres% circular fibres form a sling around the neck of the femur posteriorly, with anterior
longitudinal fibres in greater numbers at the front of the capsule, reinforcing the joint in
this direction.
,. "hat and where are#
Acetaulum- These are the lateroanterior depressions in the pelvis that house the
articulating femur heads. They are situated within the pubis region of the pelvic girdle
and constitute the capsule of the hip joint.
Oturator Foramen- This is the hole situated distally and medially compared to
the acteabulum. &t is a point of origin for the obturator muscle group !internus and
externus" and its fibrous membrane partially covers the hole.
$reater Trochanter- This is the lateral proximal part of the femur. The
articulating head lies medial to this within the acetabulum. The greater trochanter is a
site of muscle insertions !gluteus medius and minimus, obturator internus, gemellus
group, piriformis" for lateral rotators of the hip.
%esser Trochanter- This lies medially and distally compared to the greater
trochanter, underneath the trochantic fossa. &t is an attachment site for the psoas major
and illiacus, providing stabilisation of the hip and lower back !with origins fixed" and a
fulcrum to flex the trunk !with insertions fixed".
Femur Head- This is the articulating structure of the femur. &t is proximal and
medial to the greater trochanter, lies within the capsule of the coxal joint, is supported
and reinforced by the intracapsual and extracapsual ligaments and has a cartilaginous
surface to aid smooth movement.
-. Ori&ins' (nsertions' and Actions o!#
Piri!ormis- This originates at the lateral edge of the sacrum and inserts at the
superior portion of the greater trochanter. &t acts upon the femur to provide lateral
rotation to the coxal joint, abducting it when flexed.
Psoas- The psoas originates from the transverse processes of the twelfth rib and
first to fifth lumbar vertebrae, and inserts posteriomedially at the lesser trochanter of the
femur. &t shares a common tendon with the iliacus and its action is to stabilise the pelvis
and flex the trunk with its insertion fixed, flexing the coxal joint with its origin fixed.
$luteus )edius- This originates deep to the gluteus maximus at the gluteal
surface of the ilium just below !inferior" the iliac crest. The gluteus medius inserts at the
lateral part of the greater trochanter and its action is to extend and abduct the coxal joint,
with the anterior fibres medially rotating the joint.
*uadriceps- The rectus femoris muscle of this group of four originates superiorly
compared to the vastus muscles at the .&&S !anterior superior iliac spine". .ll muscles in
the group pass over the patella and insert via the patella ligament at the tibial tuberosity.
/astus lateralis originates at the lateral linea aspera, gluteal tuberosity and lateral greater
trochanter, vastus intermedius lays lateroanteriorly on the proximal shaft of the femur,
and vastus medialis originates at the medial linea aspera of the femur. Their collective
action is to flex the tibiofemoral joint, with rectus femoris flexing the coxal joint.
+artorius- The sartorius will flex the tibiofemoral joint, medially rotating it
whilst in this state, as well as flex and laterally rotate the coxal articulation. &t originates
at the .&&S, inserting at the pes anserinus tendon, and is referred to as placing the leg into
the 0tailor1s position2.
Hamstrin&- This group is a collection of three muscles% the biceps femoris,
semimambranosus and semitendinosus. .ll originate at the ischial tuberosity of the
pelvic girdle. 3iceps femoris inserts at the fibula head, semimambranosus at pes
anserinus on the medial aspect of the proximal tibia, and semitendinosus inserts at the
posterior medial tibia. Their actions collectively are to flex the tibiofemoral joint with
semimembranosus and semitendinosus assisting medial rotation of the hip and flexed
knee, as well as extending the hips.
Adductors- The five muscles in this group !adductor brevis and longus, magnus
gracilis and pectineus" all act to adduct and medially rotate the hips owing to their
medial femur insertions. They originate at the ramus of the pubis and ischium, and
individually, the gracilis will assist flexion of the hip and knee as well as medially rotate
it when flexed.
Tensor Fascia %ata- This originates posteriorly from the .S&S at the iliac crest
and joins the gluteal fascia laterally and posteriorly. 4rom here, it runs distally to become
the iliotibial tract that then inserts at the tibial tubercle situated proximally and laterally
on the tibia. The action of the T45 is to abduct, medially rotate, and flex the coxal joint,
as well as provide lateral stabilisation of the knee.
$luteus )aximus- Originating at the lateral sacrum, coccyx and posterior iliac
crest, inserting at the iliotibial tract superiorly, and gluteal tuberosity slightly inferiorly.
The gluteus maximus extends, laterally rotates, and abducts the coxal joint, with its
lower fibres assisting in adduction.
6. The purpose of ocular asics tests are to determine whether the righting mechanisms
of the neck are involved in pelvic proprioception and if there is neurological
disorganisation between these, the sacrum, and piriformis muscle. &f so, the occiput and
sacrum will be compromised.
7. The structural nervous system comprises the central and peripheral nervous
s,stems !brain and spinal chord". The !unctional system has components in the (8S and
'8S and contains voluntary !somatic" and involuntary !autonomic" nervous systems. The
somatic nervous system allows conscious control over skeletal muscles whilst the
autonomic system regulates the body eg9 hormone and fight or flight responses. This
divides further into the sympathetic and parasympathetic systems: the first prepares the
body for stressful situations, the second predominantly relating to homeostatic function.
1;. To appraise a prosthetic !emoral head and hip & would assess range in flexion and
extension, comparing this to the biological limb. This would provide good information
regarding the limits of the limb1s movement, albeit in linear planes.
& would use toe%in and toe%out tests to gauge internal and external rotation of the femur
head, again comparing it to the normal limb, as well as particularly careful use of
abduction and adduction. This information provides a greater assessment of range in
different vectors, giving a better picture of the limb1s functional use.
& would not use circumduction, as this is liable to cause discomfort to the client as well as
there being significant risk of dislocating the coxal joint.
11. Osteo arthritis is a degenetarive, wear and tear disease involving the degradation of
the articular cartilage in a joint. &t is more common than rheumatoid arthritis. &t is often
hereditary, but may occur because of injury or lifestyle !being overweight", and the result
of cartilage surfaces degrading is a loss of movement at an articulation. &t is extremely
painful. Owing to lack of movement at a joint, surrounding muscles may atrophy and
ligaments become slack. This is detrimental to joint function, as the structures holding the
bones together become weaker !ligaments" and the muscles needed to move the joint, less
functional. (ompounding this, there is sometimes an overgrowth of bone that further
limits smooth articulation of the joint. Often located at the larger joints in the body, osteo
arthritis naturally has severe ramifications for functional gait.
(omparatively, rheumatoid arthritis is an immune system response that attacks the
body1s joints causing chronic inflammation of the connective tissues, often at smaller
joints than osteo arthritis. The onset is uicker and affects joint structures contralaterally
rather than ipsilaterally, with stiffness being prolonged.
1#. A joint is the point of connection between two or more bones. <oints are either freely
moveable !synovial", slightly moveable !cartilaginous" or fixed !fibrous". Synovial joints
involve ligaments to hold bones together with tendons affixing muscles to these in order
that movement may occur.
(artilaginous joints like the vertebral column use this material to cushion the vertebrae,
and fibrous joints are fused together, offering no movement at all.
1$. A s,novial memrane is a connective tissue membrane that lines the non%weight
bearing aspects of articular cavities around a joint. &t secretes synovial fluid to assist the
smooth function of the moving joint and has the ability to regenerate. =uring functional
movement of a joint, the synovial membrane will change shape in order to cover and
lubricate the articulating bones within the articular cavity, however disease such as
rheumatoid arthritis will attack this.
1*. The difference between li&aments and tendons is that the former connects bones to
bones and the latter connects muscles to bones. Tendons are slightly elastic compared to
ligaments, which are almost completely inelastic.
1+. -aw is a neurological function that communicates with the body in the planes and
vectors of diagonal and front to back. .n example of yawing is to lay supine with the
head to the left or right, knees bent at the knee towards the chest and with them pointing
in the opposite direction to the head, as in an ocular basics test.
1,. .ursitis is inflammation of the bursa>bursae. These fluid filled sacs with a synovial
membrane around them reduce friction between bones, tendons, and muscles around a
joint. They work by providing a cushion. There are several bursae around the
tibiofemoral joint, at pes anserinus where the gracilis, sartorius and semitendinosus
tendons insert, as well as above the patella at the patella ligament, and below it near the
tibial tuberosity.
1-. The divisions o! the nervous s,stem detailed in the diagram below clearly show the
central !(8S" and peripheral !'8S" systems working together. The '8S has a is sub%
classified as autonomic and somatic. ?e control the somatic system, but not the
autonomic. The autonomic division splits into sympathetic and parasympathetic systems.
The sympathetic is the stress response arm of the nervous system that increases heart rate
and blood flow, and the parasympathetic, the vegetative system is concerned with
maintaining normal body function.
&n the /0+ we see the brain and spinal column whose function is to process, receive and
distribute nerve signals respectively. &n the brain, the cererum or lar&e rain controls
voluntary movements, interprets consciousness, for example, sensations of pain, heat,
cold, and controls mental activities such as memory and reasoning.
The cereellum or small rain located at the base of the cerebrum and spinal chord
coordinates smooth muscular activity and maintains tonus in order that the body may
remain upright and functional. &t is also responsible for keeping the body in balance
!proprioception".
The h,pothalamus is located inside the cerebrum at the top of the brain stem and
regulates !homeostasis" the body1s balance of water, metabolic euilibrium, temperature,
and is responsible for urges such as thirst, hunger, and sexual appetite.
&t contains the pituitary gland that is vital to hormonal releases, particularly in puberty. &t
is the rain stem' or mid rain that transmits messages between the spinal chord,
cerebrum and cerebellum, with the pons varolii linking each hemisphere of the brain
together. .gain, this transmits nerve impulses between the spinal chord and cerebellum.
The medulla olon&ata is the lowest part of the brain stem and is responsible for
controlling cardiac responses, respiration, reflux with regard to irritants in the body, and
managing vaso%motor responses that dilate or constrict blood vessels. ?ithout the spinal
chord to connect these, the central nervous system would be useless.
4unctionally the spinal chord, this transmitter and receiver of neurological impulses to
and from body and brain, extends from the base of the medulla oblongata, through the
vertebrae of the spine, to the first lumbar vertebra. &t contains cushioning cerebrospinal
fluid and meninges !membranes" that protect the entire nervous system acting to maintain
even pressure in the brain and spinal chord !meningitis being the inflammatory and often
fatal disease herein". The spinal chord is vital to the (8S acting as an intermediary
between it and the peripheral nervous system.
The Peripheral 0ervous +,stem is the system outside the (8S and is comprised of
somatic and autonomic divisions. The somatic nervous system controls (8S impulses to
skeletal muscles allowing conscious control of the body, whereas the autonomic nervous
system conducts (8S impulses to cardiac and smooth muscles% we do not control these.
The autonomic system is subdivided into sympathetic and parasympathetic systems. The
s,mpathetic prepares the body for stressful situations by releasing hormones,
vasodilating arteries, increasing blood supply to this organ and increasing oxygen intake.
The paras,mpathetic is the body1s vegetative system that keeps it functioning normally.
The body is fed by nerves situated at the cervical, rachial, thoracic, lumar, sacral
and cocc,&eal plexuses1 The types of nerves are sensory and motor with sensor, nerves
comprising exteroceptors that respond to the external environment eg9 touch and
temperature. 2isceroceptors control homeostasis, and proprioceptors monitor the
body1s awareness of itself in space which is vital for effective coordination, movement
and functional gait. )otor nerves give the central nervous system signals in order that it
may responds to a stimulus such as skeletal muscle responses for movement of the body
as part of somatic responses, as well as protective reflex actions.
16. 3e!inition o! Terms#
0euron- This is the smallest functional unit in the nervous system and is attached
to nerve fibres that transmit impulses.
Axon% . long nerve fibre that transmits signals away from the body. .xons are
normally distributed one per neuron.
+,napse% The gap where neurones meet. This is filled with a chemical that
facilitates the transmission of signals between one neuron and another.
Proprioceptor% &s a sensory nerve that allows us to be aware of balance, pressure
and angles at joints, tension of muscles and tendons, our postural habits and dynamic
abiities.
/erero-spinal Fluid% This is clear liuid produced in the ventricles of the brain.
&t is a cushion between the bony parts of the skull and the brain and acts to maintain
eual pressures between it and the spinal chord. &t also nourishes the organ.
17. . simple re!lex is conducted by the brain as an automatic response to stimulus>li. &t is
instantaneous and often a protection mechanism of the body, for example, immediately
moving a finger that touches boiling water, away from it.
#;. The Trendelenur& test is an orthopaedic evaluation of the body1s neurological
ability to fire the gluteus medius so as to maintain the level of the iliac crests whilst in
gait. &t involves monitoring the posterior iliac crests whilst the subject raises one leg and
attempts to maintain their balance.
. raising of this on the non%weight bearing leg indicates a negative Trendelenburg
evaluation and alludes to a neurologically responsive gluteus medius muscle owing to its
ability to maintain the level of the hips within a walking phase. . failure of the iliac crest
to rise on the non%weight bearing leg, or a dropping of the crest on the weight%bearing
side indicates a positive Trendelenburg test and suggests a weak gluteus medius, and
potential issues with the hips dropping whilst walking.
The muscle test confirming or refuting this observation is the gluteus medius, and is
conducted with the client supine with one leg abducted to approximately thirty degrees,
and just raised off the treatment table. Test pressure is applied to adduct the leg medially
and the test must be performed with each individual leg.