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Non Muscular Anatomy
Hip Joint
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Articulation between head of femur and acetabulum
Synovial ball and socket joint
Transmits weight from trunk to lower limb
Joint Orientation
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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
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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
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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
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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
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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
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Movements
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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
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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
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