Download The Hip

The Hip
Clarification of Terms
O Lower extremity = pelvis, thigh, leg, and foot
O Pelvic Girdle (aka Pelvis) = the two hip bones
(innominates), the sacrum, and the coccyx
O Innominate = the ilium, ischium and pubis
fused together
O Thigh = femur and patella
O Leg = tibia and fibula
Lippert, p261
Osteology of the Hip
The “hip bone” (aka innominate) is really the
union of 3 bones:
• The ilium, the ischium & the pubis
Ilium
Pubis
Ischium
Lippert, p262
Osteology of the Hip
The “hip bone” (aka innominate) is really the
union of 3 bones :
• The ilium, the ischium & the pubis
Lateral Aspect Right Hip
Lippert, p262
Anterior Aspect Right Hip
Osteology of the Hip (Bones)
O Ilium
O Iliac fossa
O Iliac crest
O Anterior superior iliac spine (ASIS)
O Anterior Inferior Iliac Spine (AIIS)
O Posterior Superior Iliac Spine (PSIS)
O Posterior Inferior Iliac Spine (PIIS)
Lippert, p263
Osteology of the Hip
Osteology of the Hip (Bones)
O Ischium
O Body
O Ramus
O Ischial tuberosity
O spine
Lippert, p263
Osteology of the Hip
Osteology of the Hip (Bones)
O Pubis
O Body
O Superior ramus
O Inferior ramus
O Symphysis pubis
O Pubic tubercle
Lippert, p
Osteology of the Hip (Bones)
O Made up of combinations of the ilium,
ischium and pubis
O Acetabulum
O Obturator foramen
O Greater sciatic notch
Osteology of the Hip (Bones)
Obturator
foramen
Greater Sciatic Notch
Osteology of the Hip (Bones)
O Femur
O Adductor tubercle
O Head
O Linea aspera
O Neck
O Pectineal line
O Greater trochanter
O Lesser trochanter
O Patellar surface
O Body
O Medial condyle
O Lateral condyle
O Lateral epicondyle
O Medial epicondyle
Lippert, p264-265
Osteology of the Hip
Osteology of the Hip
Osteology of the Hip
Anterior Aspect Right Femur
anatomical neck
surgical neck
Posterior Aspect Right Femur
Osteology of
the Hip
Hip Joint Structure
O The hip is the most proximal of the lower
O
O
O
O
extremity joints
Ball and socket joint
Triaxial joint – motion in all 3 planes = 3
degrees of freedom
A very stable joint
The convex-shaped femoral head fits into
and articulates with the concave-shaped
acetabulum
Lippert, p262
Hip Joint Structure…cont
O Angle of Inclination:
O Frontal plane angle created between the
femoral neck and the shaft of the femur
O Normal angle = 125 degrees, which directs
the shaft of the femur toward midline,
positioning the knee directly under the weight
of the body
Mansfield, p233
Hip Joint Structure…cont
Angle of
Inclination
continued
O Deviations in the angle can occur from
abnormal development or from trauma
O This can cause instability and stress on the
joint, which can lead to degeneration, pain
and gait abnormalities
Mansfield, p233
Hip Joint Structure…cont
O Torsion Angle
O The femur is naturally twisted along its long
axis
O The twist is described as torsion between the
shaft and neck of the femur
O Relative to the femoral condyles, the femoral
neck projects anteriorly 15 degrees (known
as normal anteversion)
Mansfield, p233
Hip Joint Structure…cont
O Torsion Angle continued
O Normal anteversion is
associated with the most
optimal alignment of the
femur in the acetabulum
O When extreme, excessive
anteversion may lead to
anterior hip instability and a
hip that appears to be
internally rotated instead of
neutral
Mansfield, p233
Hip Joint Movement
O Osteokinematics:
O Sagittal plane = flexion, extension,
hyperextension
O Frontal plane = abduction, adduction
O Transverse plane = internal and external
rotation
O Arthrokinematics:
O The convex femoral head slides in the
direction opposite to the movement of the
thigh
Lippert, p
Hip Joint: Supporting
Structures
O Supporting Structures located within the hip
joint
O Transverse acetabular ligament: spans
acetabular notch, completing the “cup” of the
acetabulum
O Acetabular labrum: a ring of fibrocartilage
surrounding the outer rim of the acetabulum,
which deepens the socket and “seals” the
joint
O Articular cartilage: acts as a shock absorber
Mansfield, p234
Hip Joint: Supporting
Structures
O Supporting Structures located outside the hip
joint
O Joint capsule: covers hip joint in cylindrical
fashion and is reinforced by 3 ligaments:
O Iliofemoral Ligament or “Y” Ligament: one of the
thickest ligaments in the body, looks like inverted
Y, limits excessive hip extension
O Ischiofemoral Ligament: spirals around the
femoral neck, limits extension and internal
rotation
O Pubofemoral Ligament: limits abduction and
extension
Lippert, p234
Hip Joint Myology
Lippert, p267
Muscle Group
1 joint muscles
2 joint muscles
Anterior
iliopsoas
Rectus femoris
Sartorius
Medial
Pectineus
Gracilis
Adductor magnus
Adductor lungus
Adductor brevis
Posterior
Gluteus maximus
Semimembranosus
6 deep rotators
Semitendinosus
Long head biceps
femoris
Lateral
Gluteus medius
Gluteus minimus
Tensor fascia latae
Iliopsoas
Origin
Psoas Major: transverse
processes of T12-L5
Iliacus: Iliac fossa
Insertion
Lesser trochanter of the
femur
Innervation
Femoral n.
Action
Hip flexion, trunk
flexion, anterior pelvic
tilt
Lippert, p267
Myology of the Hip
Your
subtopic
goes here
Rectus
Femoris
Origin
Anterior-inferior iliac spine
Insertion
Tibial tuberosity via the quadriceps
tendon
Innervation
Femoral n.
Action
Hip flexion, knee extension
“tidbit”
One of the heads of the “quads”
Lippert, p268
Myology of the Hip
Your
subtopic goes here
Sartorius
Origin
ASIS
Insertion
Proximal-medial surface of the tibia (via
the pes anserinus)
Innervation
Femoral n.
Action
Hip flexion, hip ABD, Hip ER, knee
flexion
“tidbit”
Longest muscle in the body
Lippert, p268
Myology of the Hip
Your
subtopic goes here
Pectineus
Origin
superior ramus of pubis
Insertion
Pectineal line on posterior surface
of the femur
Innervation
Femoral Nerve (may receive a
branch from Obturator Nerve)
Action
Hip ADD, hip flexion
Lippert,268
Myology of the Hip
Your
subtopic
goes here
ADDuctor
Longus
Origin
Anterior surface of the body of
the pubis
Insertion
Middle 1/3 of the linea aspera of
the femur
Innervation
Obturator n.
Action
Hip ADD, Hip flexion
“tidbit”
What’s in a name?
Lippert, 269
Myology of the Hip
Your
subtopic
goes here
ADDuctor
Brevis
Origin
Proximal Attachment: Anterior
surface of the inferior pubic ramus
Insertion
Proximal 1/3 of the linea aspera of
the femur
Innervation
Obturator n.
Action
Hip ADD, Hip flexion
“tidbit”
What’s in a name?
Lippert, 270
Myology of the Hip
Your subtopic goes here
ADDuctor Magnus
Origin
Ischium and Pubis
Insertion
Entire linea aspera and adductor
tubercle
Innervation
Obturator and sciatic nerve (L3, L4)
Action
Hip adduction
“tidbit”
What’s in a name?
Lippert, p270
Myology of the Hip
Your
subtopic goes here
Gracillis
Origin
Body and inferior ramus of the
pubis
Insertion
Proximal-medial aspect of the
tibia (pes anserinus)
Innervation
Obturator n.
Action
Hip ADD, hip flexion, knee
flexion
Lippert, p270
Myology of the Hip
Your
subtopic
goes here
Gluteus
Maximus
Origin
Posterior ilium, sacrum, coccyx
Insertion
ITB and Posterior femur distal to
the greater trochanter
Innervation
Superior gluteal n.
Action
Hip extension, hip ER
Lippert, p271
Myology of the Hip
Deep Rotators
Origin
Posterior sacrum, ischium, pubis
Insertion
Greater trochanter area
Innervation
Numerous
Action
Hip external rotation
Deep Rotators:
Piriformis
Gemellus Superior
Gemellus Inferior
Quadratus Femoris
Quadratus Internus
Lippert, p271
Myology of the Hip
Your
subtopic goes here
Semimembranosus
Origin
Ischial tuberosity
Insertion
Medial condyle of the tibia, posterior aspect
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion
“tidbit”
One of the hamstrings
Lippert, 271
Myology of the Hip
Your
subtopic goes here
Semitendinosus
Origin
Ischial tuberosity
Insertion
Proximal-medial surface of the tibia
(pes anserinus)
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion,
“tidbit”
One of the hamstrings
Lippert, p271
Myology of the Hip
Your
subtopic
goes here
Biceps
Femoris
Origin
Long Head: Ischial tuberosity
Short Head: lateral lip of linea
aspera
Insertion
Head of the fibula
Innervation
Long Head: Sciatic n.
Short Head: Common Peroneal n.
Action
Long Head: Hip extension, knee
flexion
Short Head: knee flexion
“tidbit”
One of the hamstrings
Lippert, p271
Hamstrings
Myology of the Hip
Your
subtopic
goes here
Gluteus
Medius
Origin
Outer surface of the ilum
Insertion
Greater trochanter of the femur
Innervation
Superior gluteal n.
Action
Hip ABD
Gluteus
Medius
Gluteus
Maximus
Lippert, p272
Iliac Crest
Myology of the Hip
Your
subtopic
goes here
Gluteus
Minimus
Origin
Outer surface of the ilium, inferior
to the gluteus medius
Insertion
Greater trochanter
Innervation
Superior gluteal n.
Action
Hip ABD, hip IR
Trendelenberg Sign
The Hip ABDuctors play an important role in
maintaining an upright posture during
single limb support.
If hip weakness is suspected,
single limb support over the
affected limb would look like
this when the uninvolved
limb is lifted
The pelvis drops down toward
the unsupported side
Mansield, p259
Myology of the Hip
Your
subtopic
goes
here
Tensor
Fascia
Latae
Origin
ASIS
Insertion
Proximal 1/3 of the ITB
Innervation
Superior gluteal n.
Action
Hip flexion, hip ABD,
Lippert, p274
Anterior Superficial Muscles of
the Thigh
Lippert, p274
Anterior Deep Muscles of the
Thigh
Lippert, p274
Medial Thigh Muscles
Lippert, p275
Lateral Thigh Muscles
Lippert, p276
Posterior Superficial Muscles
of the Thigh
Lippert, p275
Posterior Deep Muscles of the
Thigh
Myology of the Hip
Lippert, p278
Prime Movers
Action
Muscle
Flexion & Abduction
TFL
Flexion, Abduction, ER
Sartorius
Flexion
Rectus femoris, iliopsoas, pectineus
Extension
Gluteus maximus, semitendinosis,
semimembranosus, long head biceps femoris
Hyperextension
Gluteus maximus
Abduction
Gluteus medius, gluteus minimus
Adduction
Pectineus, adductor longus, adductor brevis,
adductor magnus, gracilis
Internal Rotation
Gluteus minimus
External Rotation
Gluteus maximus, deep rotators
Common Hip Pathologies
O Congenital Hip Dislocation
O Legg-Calve-Perthes Disease
O Slipped Capital Femoral Epiphysis
O Coxa Valga
O Coxa Vara
O Anteversion
O Retroversion
Congenital Hip Dislocation
Lippert, p275
Legg-Calve-Perthes
Lippert, p275
Slipped Capital Femoral
Epiphysis
Lippert, p275
Coxa Valga and Vara
Anteversion and Retroversion
O Best picture is in Lippert, p 277
Lippert, p277 & Mansfield, p233
Identify what you can! (in the hips)
Hip ADDuctors
Sartorius
ADDuctor Longus
ADDuctor Brevis
ADDuctor Magnus
Hip Flexors
Rectus femoris
TFL
Hip ABDuctors
TFL
Identify what you can! (in the hips)
Gluteus Maximus
Gluteus medius
Hamstrings
Semimembranosus
Biceps Femoris
Semitendinosus
TFL
OK go for it!
Pick out everything
else!
References
O Lippert, L.S. (2011). Clinical Kinesiology and
Anatomy, 5th ed. Philadelphia, PA: F.A. Davis.
O Mansfield, P.J., & Neumann, D.A. (2009).
Essentials of Kinesiology for the Physical
Therapist Assistant. St. Louis, MO: Mosby
Elsevier.