Download HEALTH SCIENCES 365

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
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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: ____________________________________________________________