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HEALTH SCIENCES 365 Chapter 9 – Hip Joint & Pelvic Girdle Bones of the Hip Joint & Pelvic Girdle Pelvic Girdle (acetabulum, acetabular notch, obturator foramen) Os Coxae (3 parts) 1. Ilium Iliac crest Anterior Superior Iliac Spine Anterior Inferior Iliac Spine Posterior Superior Iliac Spine Posterior Inferior Iliac Spine Sacral Articulation Iliac Fossa Pectinal line Iliopectineal Eminance Greater Sciatic Notch Auricular Surface External Surface (Anterior, Posterior, & Inferior Gluteal Lines) 2. Ischium Ischial Tuberosity Superior & Inferior Rami Spine of the Ischium Lesser Sciatic Notch 3. Pubis Crest Pubic Tubercle Superior & Inferior Rami Pubic Symphysis (cartilage) Femur Head (fovea capitus) Neck Greater Trochanter Lesser Trochanter Pectinal line Intertrochanteric Line (anterior) Intertrochanteric Crest (posterior) Quadrate Tubercle Gluteal Tuberosity Linea Aspera (med. & lat. Lips) Adductor Tubercle Medial & Lateral Condyles Patellar Surface Intercondyloid Fossa Popliteal Surface Joints of the Pelvis & Hip Pubis Symphysis (amphiarthrodial) Fibrocartilaginous interpubic disc ___________________________________________ Superior Pubic Ligament __________________________________________________ Inferior Pubic Ligament ___________________________________________________ Sacroiliac Joints (arthroidial) – junction of the sacrum suspended between the two iliac bones Posterior Sacroiliac Ligament ______________________________________________ Anterior Sacroiliac Ligament ______________________________________________ Sacrotuberous Ligament __________________________________________________ Acetabulofemoral (enarthrodial) Iliofemoral “Y” Ligament _________________________________________________ Pubofemoral Ligament ____________________________________________________ Ischiofemoral Ligament ___________________________________________________ Teres Ligament __________________________________________________________ Acetabulum Labrum ______________________________________________________ Hip Joint Range of Motion Flexion: 120° (knee flexed) 90° (knee extended) Extension: 20° Abduction: 45° Adduction: 20° - 30° Internal Rotation: 40° External Rotation: 45° Why do we have more hip external rotation vs. internal rotation? Hip Joint Movements Hip Flexion: movement of the femur straight anteriorly from any point in the saggital plane toward the pelvis Hip Abduction: movement of the femur in the frontal plane laterally to the side away from the body midline Hip External Rotation: lateral rotary movement of the femur in the transverse plane around its longitudinal axis away from the body midline Anterior Pelvic Rotation: anterior movement of the upper pelvis; the iliac crest tilts forward in a saggital plane (anterior tilt); accomplished by hip flexion and/or lumbar extension Left Lateral Pelvic Rotation: in the frontal plane, the left pelvis moves inferiorly in relation to the right pelvis; either the left pelvis rotates downward or the right pelvis rotates upward; (left lateral tilt); accomplished by left hip abduction, right hip adduction, and/or right lumbar lateral flexion Left Transverse Pelvic Rotation: in a horizontal plane of motion, rotation of the pelvis to the body’s left; the right iliac crest moves anteriorly in relation to the left iliac crest, which moves posteriorly; accomplished by right hip external rotation, left hip internal rotation, and/or right lumbar rotation Hip Extension: movement of the femur straight posteriorly from any point in the saggital plane away from the pelvis Hip Adduction: movement of the femur in the frontal plane medially toward the body midline Hip Internal Rotation: medial rotary movement of the femur in the transverse plane around its longitudinal axis toward the body midline Posterior Pelvic Rotation: posterior movement of the upper pelvis; the iliac crest tilts backward in the saggital plane (posterior tilt); accomplished by hip extension and/or lumbar flexion Right Lateral Pelvic Rotation: in the frontal plane, the right pelvis moves inferiorly in relation to the left pelvis; either the right pelvis rotates downward or the left pelvis rotates upward; (right lateral tilt); accomplished by the right hip abduction, left hip adduction, and/or left lumbar lateral flexion Right Transverse Pelvic Rotation: in the horizontal plane of motion, rotation of the pelvis to the body’s right; the left iliac crest moves anteriorly in relation to the right iliac crest, which moves posteriorly; accomplished by left hip external rotation, right hip internal rotation, and/or left lumbar rotation Myotome & Cutaneous Distribution of the Femoral, Obturator, Tibial & Peroneal Nerves Muscles of the Hip Joint Anterior – primarily hip flexion Iliacus Psoas (major & minor) Pectineus Rectus Femoris Sartorius Lateral – primarily hip abduction Tensor fasciae latae Gluteus medius Gluteus minimus Posterior – primarily hip extension Gluteus maximus Semitendinosus Semimembranosus Biceps femoris 6 External Rotators Medial – primarily hip adduction Adductor brevis Adductor longus Adductor magnus Gracilis Muscles of the Hip: “Anterior” – Primarily Hip Flexion Iliacus O. Iliac fossa I. Lesser trochanter of the femur A. _________________________________________________________ _________________________________________________________ N. Femoral Psoas Major & Minor O. Sides of bodies of T12 – L5 vertebrae, transverse processes of L1-L5, intervertebral discs, and anterior surface of upper sacrum I. Lesser trochanter of femur (major), Pectinal line & iliopectinal emminance of ilium (minor) A. _________________________________________________________ _________________________________________________________ N. 2nd & 3rd Lumbar nerve Pectineus O. Superior ramus of the pubis on pectinal line I. Pectinal line from lesser trochanter to medial lip of linea aspera A. _________________________________________________________ _________________________________________________________ N. Femoral Rectus Femoris O. Anterior inferior iliac spine and superior brim of acetabulum I. Superior aspect of patella and patellar tendon to tibial tuberosity A. _________________________________________________________ _________________________________________________________ N. Femoral Sartorius O. Anterior superior iliac spine I. Anteromedial surface of the proximal tibia just below medial condyle A. _________________________________________________________ _________________________________________________________ N. Femoral Muscles of the Hip: “Lateral” – Primarily Hip Abduction Tensor Fascia Latae O. Anterior part of the iliac crest I. Approx. ¼ way down lateral thigh into the fascia iliotibial band which inserts into Gerdy’s tubercle of the anterolateral tibial condyle A. _________________________________________________________ _________________________________________________________ N. Superior Gluteal Gluteus Medius O. Lateral surface of ilium just below iliac crest I. Lateral surface of greater trochanter of femur A. _________________________________________________________ _________________________________________________________ N. Superior Gluteal Gluteus Minimus O. Lateral surface of ilium just below origin of gluteus medius I. Anterior surface of greater trochanter of femur A. _________________________________________________________ _________________________________________________________ N. Superior Gluteal Muscles of the Hip: “Posterior” – Primarily Hip Extension Gluteus Maximus O. Posterior ¼ of iliac crest, posterior surface of sides of sacrum and coccyx I. Gluteal tuberosity, upper lateral lip of linea aspera, and iliotibial band A. _________________________________________________________ _________________________________________________________ N. Inferior Gluteal Semitendinosus O. Ishial tuberosity I. Anteromedial surface of the proximal tibia just below medial condyle A. _________________________________________________________ _________________________________________________________ N. Sciatic (Tibial Division) Semimembranosus O. Ischial tuberosity I. Posteromedial surface of the medial tibial condyle A. _________________________________________________________ _________________________________________________________ N. Sciatic (Tibial Division) Biceps Femoris O. Long Head: Ischial tuberosity Short Head: Lower half of lateral lip of linea aspera I. Posterolateral part of lateral tibial condyle & head of fibula A. _________________________________________________________ _________________________________________________________ N. Long Head: Sciatic (Tibial Division) Short Head: Sciatic (Peroneal Division) Origin: Anterior sacrum, posterior portions of the ischium and obturator foreman Insertion: Superior and posterior aspect of the greater trochanter of the femur Action: Hip external rotation Nerve: Branches of the sacral plexus and the obturator nerve Six Deep External Hip Rotators 1. Periformis 2. Gemellus Superior 3. Obturator Internus 4. Gemellus Inferior 5. Obturator Externus 6. Quadratus Femoris Muscles of the Hip: “Medial” – Primarily Hip Adduction Adductor Brevis O. Anterior surface of inferior ramus of pubis I. Upper 1/3 of medial lip of linea aspera A. _________________________________________________________ _________________________________________________________ N. Obturator Adductor Longus O. Anterior pubis just below pubic crest I. Middle 1/3 of the medial lip of the linea aspera A. _________________________________________________________ _________________________________________________________ N. Obturator Adductor Magnus O. Ischial tuberosity, inferior ramus of ischium and pubis I. Entire length of the linea aspera, medial supracondylar ridge of femur, and adductor tubercle A. _________________________________________________________ _________________________________________________________ N. Anterior: Obturator, Posterior: Sciatic (Tibial Division) Gracilis O. Anterior surface of inferior ramus of pubis I. Anteromedial surface of the proximal tibia just below medial condyle A. _________________________________________________________ _________________________________________________________ N. Obturator Pelvic Evaluation and Deviations Pelvis (coxa) Techniques in evaluating levelness of pelvis 1. Anterior Superior Iliac Spines Pelvic Deviations 1. Relationship to Lordosis (pelvic tilt) 2. Relationship to Scoliosis 2. Posterior Superior Iliac Spines 3. Iliac Crests 3. Pelvic Torsion (internal twist of bone on itself) Relationship to leg length discrepancy Determining Leg Length Discrepancy 1. Standing Position: levelness of iliac crests (asymmetry of all 4 iliac spines?) 2. Measure from ASIS to tip of medial malleolus (supine) 3. Determine if femur and tibia are same length Femur: __________________ Tibia: _____________________ Note: If iliac crests are level and there is a measurement difference = __________ Deviations of the Hip 1. Hip Flexion Contracture (contributes to a lordosis condition) a. Test – Both knees to chest. Maintain one knee to chest while lowering other leg – should be flat on table. b. Distinguish between the commonly tight muscles: Iliopsoas Rectus Femoris Tensor Fasciae Latae 2. Femur Angle a. Coxa Normal: Between 115° - 140°, averaging 126° at adulthood b. Coxa Vara – decrease in angle caused by weight bearing on weak femur. Results in weak gluteus medius c. Coxa Valga – increase in angle caused by non-weight bearing Gait Patterns – Manner or Style of Walking 1. Gluteus Medius Gait a. Etiology: Nerve damage or other pathology Functional weakness due to coxa vara ( distance between O. & I. resulting in excessive slack in the muscle) Congenital Hip Dislocation b. Test: ______________________________________________________________ c. Gait: ________________________________________________________________ Positive Trendelenburg Test 2. Gluteus Maximus Gait: ______________________________________________________ 3. Hip Flexor Gait: ____________________________________________________________