Download The Hip Joint

The Hip Joint
Shenequia Howard
David Rivera
Topics Of Discussion
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Movement
Bony Anatomy
Ligamentous Anatomy
Muscular Anatomy
– Origin/Insertion/Action/Innervation
• Common Injuries
MOVEMENT
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Flexion
Extension
Abduction
Adduction
Internal Rotation
External Rotation
Bony Anatomy
• The hip jt is the hip bone fused with the
ilium, ischium, and pubis
• The hip bone forms the bony connection
between the sacrum and femur
Ilium
• Composes the largest part of the hip bone and
contributes the superior part of the acetabulum
• Anteriorly , the ilium has an anterior superior iliac
spine and inferior to it an anterior inferior iliac
spine
• Iliac crest
• Gluteal Line
• Posterior superior iliac spine
Ischium
• Composes the posteroinferior part of the hip bone
• The superior part of the body of the ischium fuses
with the pubis and ilium, forming the
posterioinferior aspect of the acetabulum
• Ramus of the ischium
• Ischial spine
• Ischial tuberosity the body weight rest on it in the
sitting position
PUBIS
• Composes the anteromedial part of the hip
bone
• Contributes the anterior part of acetabulum
• Is divided into a flattened body and two
rami, superior and inferior
• Body of pubis
• Pubic crest
ACETABULUM
• Is the large cup-shaped cavity or socket on
the lateral aspect of the hip bone
• Articulates with the head of the femur to
form the hip joint
• The Ilium, Ishium, and Pubis join to form
the acetabulum
FEMUR
• The largest and heaviest bone in the body
• The head of the femur projects
superomedially and slightly anterior
• The head is attached to the femoral body by
the neck of the femur
• Lesser trochanter
• Greater trochanter
• Intertrochanteric line
BONY ANATOMY OF THE
FEMUR
BONY ANATOMY OF THE
FEMUR
BONY ANATOMY OF THE
HIP
BONY ANATOMY OF THE
HIP
BONY ANATOMY OF THE
HIP
LIGAMENTS
• Illiofemoral ligament
-also known as the Y ligament
-runs from the base of the AIIS to the intertrochantic
line
-reinforces the fibrous capsule anteriorly
-strongest ligament in the hip
-prevents hyperextension of the hip during standing
by screwing the femoral head into the acetabulum
LIGAMENTS
• Pubicfemoral ligament
-runs from the anterior pubis ramus to the
anterior surface of the intertrochantic fossa
-reinforces the fibrous capsule inferiorly and
anteriorly
-tighten during abduction and extension
-prevents overabduction of the hip joint
LIGAMENTS
• Ischiofemoral ligament
-the ischial portion of the acetabulum and
spirls to the neck of the femur and base of
the greater trochanter
-prevents hyperextension of the hip
-fibers relaxed during flexion
LIGAMENTS
• Ligamentum teres
-known also as the ligament of the head of the
femur
-attaches to the acetabular notch and the
transverse acetabular ligament to the pit in
the head of the femur
-is weak
-supplies the blood for the femur head
Ligamentous Anatomy
Ligamentous Anatomy
Ligamentous Anatomy
Muscular Anatomy
Muscular Anatomy
Muscular Anatomy
Muscular Anatomy
Muscular Anatomy
Muscular anatomy
Movements of the Hip and its
main Muscles
• Flexion
– Illiopsoas, sartorius, tensor fascia lata, rectus femoris,
pectineus, adductor longus, adductor brevis, adductor
magnus, gracilis
• Extension
– Hamstrings, adductor magnus, gluteus maximus
• Abduction
– Gluteus medius, gluteus minimus, tensor fascia lata
• Adduction
– Adductor longus, adductor brevis, adductor
magnus, gracilis, pectineus, oburator externus
• Rotation
– Medial
• Gluteus medius, gluteus minimus, tensor fascia lata
– Lateral
• Obturator externus, obturator internus, gemelli,
piriformis, quadratus femoris, gluteus maximus
Origin/Insertion/Action
• Adductor Brevis
– O - Inferior Pubic Ramus
– I - Pectineal Line and Linea Aspera
– A - adducts, flexes, and medially rotates
femur
• Gracillis
– O - pubic Symphysis and inferior pubic
ramus
– I - medial surface of the tibia
– A - adducts thigh, flexes medially and
medially rotates thigh, flexes leg
Origin/Insertion/Action
• Pectineus
-O - Superior ramus of
pubis
-I - Pectineal line of femur
-A – adducts and flexes
thigh
Origin/Insertion/Action
• Adductor Longus
– O - med portion of the superior
pubic ramus
– I - linea aspera of femur
– A - adducts, flexes, and
medially rotates the femur
Origin/Insertion/Action
• Adductor Magnus
– O - ischiopubic ramus and ischial
tuberosity
– I - linea aspera of the femur; the
ischiocondylar part inserts on the
adductor tubercle of the femur
– A - adducts, flexes, and medially
rotates the femur; extends the femur
– Inn - post div of oburator nerve; tibial
nerve
Origin/Insertion/Action
• Biceps Femoris Longus
-O - long head: ischial tuberosity,
short head: linea aspera of femur
-I - lateral side of head of fibula
-A - extends the thigh
Origin/Insertion/Action
• Gluteus Maximus
-O - ilium posterior to posterior
gluteal line
-I - end in the iliotibial tract that
inserts into the lateral condyle
of the tibia
-A - extends the thigh
Origin/Insertion/Action
• Gluteus Medius
-O – external surface of ilium
-I – lateral surface of greater
trochanter of femur
-A – abducts and internally rotates
the thigh
Origin/Insertion/Action
• Gluteus Minimus
-O – external surface of ilium
-I – anterior surface of greater
trochanter of femur
-A – abducts and internal rotates
Origin/Insertion/Action
• Piriformis
-O – lateral border of ischial
tuberosity
-I – superior border of greater
trochanter of femur
-A – external rotation extended
thigh and abducts flexed thigh
Origin/Insertion/Action
• Quadratus femoris
-O – lateral border of ischial
tuberosity
-I – quadrate tubercle on
intertrochanteric crest of femur
-A - external rotation extended
thigh and abducts flexed thigh
Origin/Insertion/Action
• Obturator Externus
-O – pelvis surface of obturator
membrane
-I – medial surface of greater
trochanter
-A - external rotation extended thigh
and abducts flexed thigh
Origin/Insertion/Action
• Iliopsoas
-O – sides of T12-L5 vertebrae,
iliac crest
-I – lesser trochanter of femur,
pectineal line, lesser
trochanter
-A – flexing the thigh
Origin/Insertion/Action
• Rectus Femoris
-O – AIIS and ilium superior to
acetabulum
-I – base of patella
-A – flex thigh
Origin/Insertion/Action
• Sartorius
-O – ASIS
-I – superior part of medial surface of tibia
-A – flexes, abducts, and external rotates
thigh
• Tensor Fascia Lata
-O – ASIS
-I – iliotibial tract
-A- abducts, medial rotates, and flexes
thigh
Origin/Insertion/Action
• Semimembranosus
-O – ischial tuberosity
-I – posterior part of medial
condyle of tibia
-A – extend thigh
Origin/Insertion/Action
• Semitendinosus
-O – ischial tuberosity
-I – medial surface of superior
part of tibia
-A – extend thigh
Origin/Insertion/Action
• Vastus lateralis
-O – greater trochanter and lateral lip of linea
aspera of femur
• Vastus medialis
-O – intertrochanteric line and medial lip of
linea aspera of femur
• Vastus intermedius
-O – anterior and lateral surfaces of body of
femur
*Same for all 3
-I – base of patella and A – helps flex thigh
Common Injuries
• Dislocation
-femoral head moves out of the
acetabulum
-usually it goes posterior into notch
-position typically flexion, adduction,
and internal rotation
-common mechanism: knee to
dashboard during traffic collision
-signs and symptoms: extreme pain,
obvious deformity, unwilling to
move the extremity
COMMON INJURIES
• Hip Pointer
-contusion to the iliac crest
-signs and symptoms: pain, swelling, and
ecchymosis
-severe limit to motion
-palpable hematoma
COMMON INJURIES
• Piriformis Syndrome
-sciatic nerve through piriformis
-pressure on the sciatic nerve due to muscle
spasm, trigger points, or tightness causing
posterior thigh pain
-other signs and symptoms: pain, limited
ROM, pt tenderness deep to the gluteals
COMMON INJURIES
• Hip Fracture
-most frequently occurs through the femoral
neck
-a direct blow to the lateral hip
-signs and symptoms: pain, swelling, and loss
of function
-the involved leg will appear shortened and
will be externally rotated
COMMON INJURIES
• Trochanteric Bursitis
-cause is abnormal friction or irritation of the bursa
between the IT band and greater trochanter, direct
blow, or improper biomechanics
-usually a sport such as running
-signs and symptoms: local pain, swelling, pt
tenderness, and crepitus over the greater
trochanter
-patient may complain of hip snapping
COMMON INJURIES
• Ischial Bursitis
-lies over the ischial tuberosity
-may become painful and inflamed with excessive
friction
-signs and symptoms: pain with sitting, pt
tenderness over ischial tuberosity, pain w/ passive
hip flexion and active/resistive hip extension
-often difficult to differentiate from proximal
hamstring tendinitis
COMMON INJURIES
• Hip Joint Sprain
-less common
-excessive forcible exertion of the extremity
that stretch or tear the surrounding
ligaments
-signs and symptoms: pain and decrease
ROM
COMMON INJURIES
• Hip Joint Strains
-resulting from overstretching or from a rapid,
forceful contraction of the muscle
-explosive starts and slipping of the foot during
cutting are common mechanisms for hip flexor
and adductor strains
-these injuries frequently occur during the beginning
of practice and preseason training
-signs and symptoms: pain, pt tenderness, muscle
spasm, swelling, ecchymosis , and decreased
ROM
COMMON INJURIES
• Avulsion Fracture
-results from a violent contraction or tractioning of
the attaching muscle
-common sites: ASIS, AIIS, lesser trochanter, and
ischial tuberosity
-signs and symptoms: complain of a sudden sharp
pain at time of injury, unwilling to move the
extremity, pt tenderness along the bone, also may
have a muscle bulging away from the attachment,
and swelling
COMMON INJURIES
• Legg-Calve-Perthes Disease
-characterized by avascular necrosis of the proximal
femoral epiphysis
-a chronic condition that develops slowly in children
-often in males than in females
-signs and symptoms: pain in the hip or groin that
radiate to the knee, limping, decreased ROM, and
hip flexor tightness may be noted
-physician should be consulted to rule out serious
pathologies such as this
COMMON INJURIES
• Avascular Necrosis of the Femoral Head
-blood supply to the femur head is severed of
is occluded for a prolonged period of time.
-this is a common complication following hip
dislocations, fractures, and chronic
synovitis and often necessitates a hip
replacement
COMMON INJURIES
• Chronic Synovitis
-inflammatory process at the hip that is
characterized by chronic irritation and
excess secretion of synovial fluid within the
capsule
-this condition is very difficult to detect
-may lead to avascular necrosis of the femoral
head