Download PTA Hip presentation

The Hip (Iliofemoral) Joint
Presented by: Rob, Rachel, Alina and Lisa
Surface Anatomy: Posterior
Surface Anatomy: Anterior
Bones: Os Coxae
Consists of 3 Portions:
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Ilium
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Ischium
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Pubis
Bones: Pubis Portion
Pubic Crest
Pubic Symphysis
Superior Pubic Ramus
Acetabulum
Inferior Pubic Ramus
Obturator Foramen
Bones: Ischium Portion
Ischial Spine
Lesser Sciatic Notch
Ischial Tuberosity
Bones: Ilium Portion
Iliac crest
Anterior Superior Iliac Spine
Anterior Inferior Iliac Spine
Posterior Superior Iliac Spine
Posterior Inferior Iliac Spine
Greater Sciatic Notch
Iliac Fossa
Bones: Femur
Head
Greater trochanter
Linea aspera
Adductor tubercle
Neck
Lesser trochanter
Pectineal line
Ligaments
Iliofemoral Ligament
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Thickened portion of articular
capsule
“Y” shaped
From: Ilium (anterior inferior
iliac spine)
To: Femur (intertrochanteric
line)
Prevents hyperextension of
the hip
Ligaments
Pubofemoral Ligament
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Thickened portion of
articular capsule
From: Pubic part of the rim
of the acetabulum
To: Neck of the femur
Prevents hyper-abduction of
hip joint
Ligaments
Ischiofemoral Ligament
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Thickened portion of the
articular capsule
From: Ischial wall of
acetabulum
To: Neck of the femur
Prevents hyperextension
of hip joint
Ligaments
Ligament of the Head of the
Femur
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Also called round ligament
Flat, triangular band
From: Fossa of the
acetabulum
To: Fovea capitis
Weak, little importance of
strengthening the hip joint;
conducts artery to head of
femur
Prevents dislocation of head
of femur
Ligaments
Zona Orbicularis
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Also referred as annular ligament
Ligament on the neck of the
femur
Formed by the circular fibers of
the articular capsule of the hip
joint
Key structure for hip stability in
distraction
Ligaments
Transverse Ligament of the
Acetabulum
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Joins the inferior ends of the
labrum, crosses acetabular
notch
Completes the acetabular
ring
Provides support for head of
femur
Forms a tunnel which blood
vessels pass through
Ligaments
Sacrotuberous Ligament
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From: Sacrum
To: Tuberosity of
ischium
Contains coccygeal
branch of inferior
gluteal artery
Provides support for
sacroiliac joint
Ligaments
Inguinal Ligament
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From: Pubic tubercle
To: Anterior superior
iliac spine
Important for operating
on hernia patients
Bursae
Trochanteric Bursa
Deep to Tensor Fasciae Latae
Reduce friction with IT
band/TFL and Greater
trochanter
Bursae
Ischial Bursa
Reduces friction between
gluteus maximus and
ischial tuberosity
Bursae
Gluteofemoral Bursa
Separates gluteus maximus
from superior part of vastus
lateralis
Also reduces friction between
the Gluteus maximus and
femur
Cartilage
Acetabular Labrum
Ring of cartilage that surrounds the acetabulum
of the hip
Articular Cartilage of Head of Femur
Articular cartilage is very smooth and it can
withstand high compression forces for its
weightbearing function
Articular Capsule
Fibrous Layer
Attaches to rim of the acetabulum to neck of the
femur
Synovial Membrane
Lines the fibrous layer along with bony surfaces
not lined with articular cartilage
Muscles: Those Innervated by the Gluteal Nerves
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Gluteus maximus - Inferior gluteal nerve
Gluteus medius, gluteus minimus, TFL - Superior gluteal nerve
Muscles: Gluteus Maximus
O: Iliac crest, sacrum,coccyx and aponeurosis of sacrospinalis
I: Iliotibial tract of fascia latae & lateral part of linea aspera under
greater trochanter (gluteal tuberosity) of femur
A: Extends thigh at hip & laterally rotates thigh; upper fibers abduct
N: Inferior gluteal nerve
R: L5, S1, S2
S: Flex: rectus femoris, TFL, iliopsoas, pectineus, sartorius; Med
Rot: gluteus (min & med), TFL, pectineus, gracilis, adductors
A: Ext: semimembranosus, semitendinosus, biceps femoris,
adductor magnus; Lat Rot: piriformis, iliopsoas, sartorius
Muscles: Gluteus Medius
O: Dorsal of ilium inferior to iliac crest
I: Greater trochanter of femur
A: Abducts & medially rotates hip
N: Superior gluteal nerve
R: L4, L5, S1
S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus max,
piriformis, iliopsoas, sartorius
A: Abd: gluteus (max & min), TFL, sartorius; Med Rot: gluteus
min, TFL, adductors, pectineus, gracilis
Muscles: Gluteus Minimus
O: Dorsal of ilium between inferior & anterior gluteal lines
I: Greater trochanter of femur
A: Abducts & medially rotates hip
N: Superior gluteal nerve
R: L4, L5, S1
S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus max, piriformis,
iliopsoas, sartorius
A: Abd: gluteus (max & med), TFL, sartorius; Med Rot: adductors, gluteus
med, TFL, pectineus, gracilis
Muscles: Tensor Fasciae Latae
O: Anterior superior iliac spine & anterior iliac crest
I: Tibia by way of iliotibial tract
A: Flexes & abducts thigh at hip joint
N: Superior gluteal nerve
R: L4, L5, S1
S: Flex: rectus femoris, iliopsoas, pectineus, sartorius; Abd:
glutes, sartorius
A: Ext: gluteus max, semimembranosus, semitendinosus,
bicep femoris; Add: gracilis, pectineus, adductors
Muscles: Those Innervated by the Obturator & Plexi
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Gracilis & adductors (longus & brevis) - Obturator nerve
● Piriformis - Sacral plexus
● Psoas major - Lumbar plexus
Muscles Continued: Overview
Muscles: Gracilis
O: Body and inferior ramus of pubis
I: Anterior medial proximal tibia
A: Adducts & medially hip; flexes knee
N: Obturator nerve
R: L2 & L3
S: Add: adductors, gracilis, pectineus; Med Rot: gluteus (min &
med), adductors, pectineus, TFL; Knee Flex: semimembranosus,
semitendinosus, biceps femoris, gracilis, gastrocnemius, popliteus,
sartorius
A: Abd: glutes, TFL, sartorius; Lat Rot: gluteus max, sartorius,
piriformis, iliopsoas; Knee Ext: rectus femoris, vastus muscles
Muscles: Piriformis
O: Anterior surface of lateral process of sacrum and gluteal surface
of ilium at the margin of the greater sciatic notch
I: Superior border of greater trochanter
A: Laterally rotates & abducts thigh when hip is flexed
N: Piriformis nerve
R: L5, S1, S2
S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus (min &
med), TFL, adductors, gracilis, pectineus
A: Abd: gluteus (med & min), TFL, sartorius; Med Rot: gluteus
max, iliopsoas, sartorius
Muscles: Psoas Major
O: Transverse processes of L1-L5
I: Lesser trochanter
A: Hip/thigh flexion
N: Lumbar nerves (L1-L3)
R: L1-L3
S: Hip flex: rectus femoris, pectineus, TFL, sartorius, adductors
(longus & brevis)
A: Hip ext: gluteus max, semimembranosus, semitendinosus, biceps
femoris (LH), adductor magnus
Muscles: Adductor Longus
O: Body of pubis inferior to pubic crest & lateral pubic symphysis
I: Middle ⅓ of linea aspera of femur
A: Adducts, flexes, and helps medially rotate hip
N: Obturator nerve
R: L2-L4
S: Add: adductors (magnus & longus), gracilis, pectineus
A: Abd: glutes, TFL, sartorius
Muscles: Adductor Brevis
O: Anterior surface of the inferior ramus of the pubis
I: Pectineal line, medial lip of linea aspera of femur
A: Adducts, flexes, and helps medially rotate hip
N: Obturator nerve
R: L2-L4
S: Add: adductors (longus & magnus), gracilis, pectineus
A: Abd: glutes, TFL, sartorius
Muscles: Those Innervated by the Femoral Nerve
Muscles: Iliacus
O: Iliac crest, fossa, anterior sacroiliac ligament
I: Lesser trochanter
A: Hip & thigh flexion
N: Femoral
R: L2-L3
S: Hip Flex: rectus femoris, pectineus, TFL, sartorius,
adductors (longus & brevis)
A: Hip Ext: gluteus max, semimembranosus,
semitendinosus, biceps femoris (LH), adductor magnus
Muscles: Sartorius
O: Anterior superior iliac spine
I: Upper medial surface of body of tibia
A: Flexes knee; flexes, abducts, & laterally rotates hip
N: Femoral nerve
R: L2-L3
S: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL; Hip Abd: gluteus
(min & med); Knee Flex: semimembranosus, semitendinosus, biceps
femoris, gracilis, gastrocnemius, popliteus, sartorius; Lat Rot: gluteus max,
piriformis
A: Hip Ext: gluteus max, semimembranosus, semitendinosus, biceps
femoris, adductor magnus; Hip Add: adductors, pectineus, gracilis; Knee
Ext: quadriceps; Med Rot: gluteus (med & min), adductors (longus &
brevis), gracilis, pectineus
Muscles: Pectineus
O: Superior ramus of pubis
I: Pectineal line interior to lesser trochanter of femur
A: Flexes, adducts & assists in medial rotation
N: Femoral & obturator
R: L2-L4
S: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL; Hip
Add: adductors, gracilis, pectineus; Med Rot: gluteus (med &
min), adductors (longus & brevis), gracilis
A: Ext: gluteus max, semimembranosus, semitendinosus,
bicep femoris, adductor magnus; Abd: gluteus (min & med),
TFL, sartorius; Lat Rot: gluteus max, piriformis, sartorius
Muscles: Rectus Femoris
O: Anterior inferior iliac spine
I: Patella via quadriceps tendon & tibial tuberosity via patellar ligament
A: Extension at the knee and flexion at the hip
N: Femoral nerve
R: L2-L4
S: Hip Flex: iliopsoas, pectineus, TFL, sartorius, adductors (longus & brevis);
Knee Ext: vastus muscles
A: Hip Ext: gluteus max, semimembranosus, semitendinosus, biceps
femoris; Knee Flex: semimembranosus, semitendinosus, biceps femoris,
gracilis, gastrocnemius, popliteus, sartorius
Muscles: Those Innervated by the Sciatic Nerve
The sciatic nerve branches (tibial and fibular or peroneal) innervate the hamstrings
and adductor magnus
Muscles: Biceps Femoris
O: Ischial tuberosity (LH) & linea aspera of femur (SH)
I: Head of fibula & lateral condyle of tibia
A: extends hip and flexes knee (LH) & flexes knee, laterally rotates hip and flexed
knee (SH)
N: Tibial (LH) & Fibular (SH)
R: L5, S1, S2
S: Hip Ext: gluteus max, semitendinosus, semimembranosus, adductors; Lat Rot:
gluteus max, piriformis, iliopsoas, sartorius; Knee Flex: semitendinosus,
semimembranosus, gracilis, sartorius, gastrocnemius
A: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL, sartorius; Med Rot: gluteus
med & min, TFL, adductors, pectineus, gracilis; Knee Ext: vastus, rectus femoris
Muscles: Semitendinosus
O: Ischial tuberosity
I: Proximal medial shaft of tibia at Pes Anserinus tendon
A: Flexes knee, extends hip, medially rotates flexed knee
N: Tibial
R: L5, S1, S2
S: Knee Flex: biceps femoris, semimembranosus, gracilis, sartorius, gastrocnemius,
popliteus; Hip Ext: gluteus max, biceps femoris, semimembranosus; Med Rot:
semimembranosus, gracilis, sartorius, popliteus
A: Knee Ext: rectus femoris, vastus; Hip Flex: rectus femoris, iliopsoas, pectineus,
sartorius; Lat Rot: biceps femoris
Muscles: Semimembranosus
O: [same as semitendinosus]
I: Posterior medial condyle of
tibia
A: [same as semitendinosus]
N: [same as semitendinosus]
R: [same as semitendinosus]
S: [same as semitendinosus]
A: [same as semitendinosus]
Muscles: Adductor Magnus
O: Inferior ramus of pubis and ischium to ischial tuberosity
I: Linea aspera of femur, medial supracondylar line & adductor
tubercle
A: Adducts thigh, superior horizontal fibers flexes thigh; posterior
portion extends thigh at hip joint
N: Obturator & tibial nerves
R: L2-L4
S: Add: adductors (longus & brevis), gracilis, pectineus
A: Abd: glutes, TFL, pectineus
Blood Vessels: Muscles they Supply
Superficial Femoral
The entire lower limb (MAIN ARTERY OF LE)
Deep (Profunda) Femoral
Femur & deep muscles of the thigh
Superior Gluteal
Glutes, TFL, & piriformis
Inferior Gluteal
Piriformis, gluteus max, & superior hamstrings
Lateral Circumflex Femoral
Femoral neck
Medial Circumflex Femoral
Femoral neck & adductor magnus
Femoral Vein
Those supplied by the femoral artery (MAIN VEIN OF LE)
Great Saphenous Vein
Superficial muscles as part of the superficial venous system of
the lower limb
Obturator
Deep Femoral Vein
Iliacus & the adductors
Those supplied by the deep (profunda) femoral artery
Arteries
Arteries Continued
Veins
Clinical Concerns: Piriformis Syndrome
Clinical Concerns: Total Hip Replacement
http://www.webmd.com/pain-management/video/hip-replacement
Conclusion
PROOF YOU CAN LITERALLY FIND ANYTHING ON THE INTERNET.