Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Non Muscular Anatomy Hip Joint Articulation between head of femur and acetabulum Synovial ball and socket joint Transmits weight from trunk to lower limb Joint Orientation Acetabulum faces laterally, anteriorly and inferiorly Femoral head faces medially, anteriorly and superiorly Anterior part of the femoral head articulates with the joint capsule Acetabulum missing inferiorly forming the “acetabular notch” Acetabular fossa forms the non-articulating part of the acetabulum Ligamentous Anatomy Capsular ligaments Anterior o Iliofemoral ligament ASIS and rim of acetabulum, passes obliquely downwards and lateral to the intertrochanteric line on the anterior femoral head Very strong and think Closely connected to the joint capsule Y shaped Split into two bands Anterior to the joint o Pubofemoral ligament From the obturator crest and the superior ramus of the pubis to the inferior capsule and iliofemoral ligament Strengthens the inferior and anterior aspects of the joint capsule Merges with the inferior band of the iliofemoral ligament Posterior o Ischiofemoral ligament From the ischium and acetabulum merging with the capsule posteriorly attaching into the intertrochanteric line of the femur Spiral ligament Attaches onto the superior femoral neck and greater trochanter More posterior Ligament restraints to motion All 3 ligaments under some tension in standing Become more relaxed in hip flexion 1 Under tension in hip extension Flexion o Posterior capsule Extension o Anterior capsule and iliofemoral ligament o Capsular ligaments pull the femoral head tightly against the acetabulum o Causes articular cartilage to deform slightly due to compressive load o Close pack position of joint Abduction o Inferior medial capsule o Pubofemoral ligament, ischiofemoral ligament and inferior band of iliofemoral ligament Adduction o Superior joint capsule o Superior band of iliofemoral ligament Internal Rotation o Posterior joint capsule o Ischiofemoral ligament External Rotation o Anterior joint capsule o Iliofemoral ligament and pubofemoral ligament Joint Capsule and Synovial Membrane Fibrous capsule is very strong Surrounds the acetabulum and attaches onto the intertrochanteric line of the neck of the femur Gluteus minimus tendon inserts into the capsule Synovial membrane lines the internal surface of the capsule Arises from the acetabular labrum and tranverse ligament to the fovea capitis Anterior capsule communicates with the psoas bursa Extracapsular Structures Transverse ligament of the acetabulum o Completes the inferior decificieny of the acetabular rim o Creates a foramen with the acetabular notch o Vessels and nerves pass through the foramen Acetabular labrum o Fibrocartilaginous ring around the acetabulum and transverse ligament o Deepens the hip joint increasing joint stability o Acts as a shock absorber o Decreases the force transmitted to the articular cartilage by increasing the surface area of the acetabulum 2 o Provides a seal for the joint to maintain synovial fluid and pressure Intracapsular Structures Ligamentum teres o Weak flattened band of connective tissue o Attaches from the adjacent margins of the acetabular notch and the lower border of the transverse ligament and then inserts onto the fovea capitis on the head of the femur o Enclosed in a sleeve of synovial membrane Therefore intracapsular but extrasynovial o Role of this ligament is unknown as its too weak to provide stability and often not present Arthrokinematics Capsular Pattern Resting Position Close Packed Position End Feel Acetabulofemoral Joint Flexion, Abduction, Internal Rotation (order varies) 30° Flexion, 30° Abduction, 20° External Rotation End range extension, internal rotation and abduction Flexion o SOFT tissue approximation o Or FIRM If tension in posterior capsule and glute max Extension o FIRM Tension anterior capsule, iliofemoral ligament Stretch hip flexors Abduction o FIRM Tension inferior joint capsule, pubofemoral ligament, ischiofemoral ligament and inferior band of iliofemoral ligament Stretch adductors Adduction o FIRM Tension in superior joint capsule, superior band of iliofemoral ligament Stretch glute medius and minimus, TFL Internal Rotation o FIRM Tension in posterior joint capsule, ischiofemoral ligament Stretch piriformis, glutes med (post fibres) glute max External Rotation o FIRM 3 Movements Tension in anterior joint capsule, iliofemoral ligament and pubofemoral ligament Stretch glute med (ant fibres) glute min, adductors, piriformis Tight fit between acetabulum and femoral head limits translational movements Flexion o Knee to chest Femoral anterior roll Femoral posterior and inferior glide o Standing touching toes Pelvis anterior roll Pelvis anterior glide Extension o Non weight bearing Femoral posterior roll Femoral anterior glide o Weight bearing Pelvis posterior roll Pelvis posterior glide Abduction o Neutral flexion/extension – non weight bearing Femoral superior roll Femoral inferior glide o 90 hip flexion – non weight bearing Femoral anterior glide o Weight bearing Acetabulum glides towards opposite pelvis Contralateral side hikes Adduction o Neutral flexion/extension – non weight bearing Femoral inferior roll Femoral superior glide o 90 hip flexion – non weight bearing Femoral posterior glide o Weight bearing Acetabulum glides towards ipsilateral femur Contralateral side drops Internal Rotation o Neutral flexion/extension – non weight bearing Femoral internal spin Femoral posterior glide o 90 hip flexion – non weight bearing Femoral inferior glide o Weight bearing Acetabulum spins towards the side of rotation E.g right internal rotation, pelvis rotates to the right 4 External Rotation o Neutral flexion/extension – non weight bearing Femoral external spin Femoral anterior glide o 90 hip flexion – non weight bearing Femoral superior glide o Weight bearing Acetabulum spins away from the side of rotation E.g right external rotation, pelvis rotates to the left 5