Download OTA Hip Presentation

ANATOMY OF THE HIP
Presented By: Cassie Litzinger, Julia Meyer,
Sarah Doumit and Susan Reider
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Iliac Crest
Supracristal Plane
Gluteal Fold
Gluteal Sulcus
Intergluteal Cleft
SURFACE ANATOMY
SD
• Anterior Iliac Spine
• Posterior Iliac Spine
• Inguinal Ligament
Anterior view
Posterior View
SURFACE ANATOMY
SD
• Sacrum
• Tip of the Greater
Trochanter
SURFACE ANATOMY
SD
• Iliofemoral Ligament:
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Connects ilium to femur
Prevents hyperextension
Internal/External Rotation
Anteriorly & Superiorly
• Pubofemoral Ligament:
• Connects pubis to femur
• Tightens during extension and
Abduction
• Prevents over-abduction
• Inferiorly & Anteriorly
LIGAMENTS
CL
• Ischiofemoral Ligament:
• Connects ischium to
femur
• Posterior side of hip
joint
• Prevents Posterior
Displacement (dislocation)
LIGAMENTS
CL
• Inguinal Ligament:
• Arched fibers of the external
oblique
• Consists of collagen fibers
• Inguinal Hernias common here
LIGAMENTS
CL
• Transverse Ligament of
Acetabulum:
• Bridges acetabular notch
• Formed by acetabular labrum
LIGAMENTS
CL
• Sacrotuberous Ligament:
• Gluteal ligament
• Convert sciatic notches into
greater and lesser sciatic
foramina
LIGAMENTS
CL
• Ligament of the Head of
the Femur:
• Also called ligamentum
teres or “round ligament”
• Weak ligament
• Conducts artery to head
LIGAMENTS
CL
• Zona Orbicularis
• Circular fibers
• Forms collar around
femoral neck
LIGAMENTS
CL
• Trochanteric Bursa:
• Gluteus Maximus –
Greater Trochanter
• Ischial Bursa:
• Prevents friction between
ischial tuberosity and
gluteus maximus
• Gluteofemoral Bursa:
BURSAE
CL
• Acetabular Labrum:
• Hip joint stability/deepens
socket
• Fibrous cartilage ring
• Articular Cartilage of the
Head of the Femur
CARTILAGE
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• Synovial Membrane:
• Lines the capsule
• Fibrous Layer/capsule:
• Attaches on hip bone to
bony rim of acetabulum
• Deep fibers form orbicular
zone
• Reinforces hip
ARTICULAR CAPSULE
CL
PELVIC GIRDLE
• Ilium
• “Hip Bone”
• Ischium
• “Sit Bone”
• Pubis
BONES OF THE OS COXAE
JM
• Iliac Crest
• Iliac Fossa
• Iliac Spines
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Anterior Superior
Anterior Inferior
Posterior Superior
Posterior Inferior
ILIUM
JM
• Ischial Tuberosity
• Ischial Spine
• Greater Sciatic Notch
• Lesser Sciatic Notch
ISCHIUM
JM
• Superior Pubic
Ramus
• Inferior Pubic
Ramus
• Pubic Arch
• Obturator Foramen
PUBIS
JM
• Pubic Crest
• Pubic Symphysis
• Acetabulum
PUBIS
JM
DIFFERENTIATION
JM
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Head
Neck
Greater Trochanter
Lesser Trochanter
Linea Aspera
Pectineal Line
Adductor Tubercle
FEMUR
JM
• PECTINEUS
O: Superior Ramus of the
Pubis
I: Pectineal line inferior to
Lesser Trochanter of Femur
A: Flexes, Adducts, and assists
with Medial Rotation of the
Hip
N: Femoral Nerve and fibers
of Obturator Nerve L2-L4
MUSCLES
SR
• GRACILIS
O: Body and Inferior Ramus of
the Pubis
I: Anterior medial proximal
Tibia
A: Adducts and Medially rotates
the hip, Flexes the Knee
N: Obturator Nerve L2-L3
MUSCLES
SR
• ADDUCTOR MAGNUS
O: Inferior Ramus of Pubis and
Ischium to Ischial Tuberosity
I: Linea Aspera of Femur,
medial Supracondylar Line and
adductor Tubercle
A: Adducts thigh, Superior
horizontal fibers Flex thigh,
and posterior portion Extend
thigh at Hip joint
N: Obturator and Tibial Nerves
L2-L4
MUSCLES
SR
• ADDUCTOR LONGUS
O: Body of Pubis inferior to
Pubic Crest and lateral Pubic
Symphysis
I: Middle 1/3 of Linea Aspera of
Femur
A: Adducts, Flexes and helps
Medially Rotate Hip
N: Obturator Nerve L2-L4
• ADDUCTOR BREVIS
O: Anterior surface of the inferior
ramus of Pubis
I: Pectineal Line and medial lip of
Linea Aspera of Femur
A: Adducts, Flexes and helps
medially rotate Hip
N: Obturator Nerve L2-L4
MUSCLES
SR
• PECTINEUS
• GRACILIS
• ADDUCTOR:
• MAGNUS
• LONGUS
• BREVIS
ADDUCTOR MUSCLES
SR
• PSOAS MAJOR:
O: Transverse Process L1-L5
I: Lesser Trochanter
A: Hip/Thigh Flexion
N: Lumbar Nerves L1-L3
MUSCLES
CL
• ILIACUS:
O: Iliac Crest, Fossa,
Anterior sacroiliac
ligament
I: Lesser Trochanter
A: Hip Flexion
N: Femoral L2-L3
MUSCLES
CL
• TENSOR FASCIA LATAE:
O: Anterior Superior Iliac
Spine/Anterior iliac crest
I: Tibia by way of iliotibial tract
A: Flexes and abducts thigh at hip
joint/Helps stabilize and steady hip
N: Superior Gluteal Nerve
**acts in concert with psoas major
and illiacus**
MUSCLES
CL
• PSOAS MAJOR
• ILIACUS
• TENSOR FASCIA LATAE
MUSCLES
CL
• RECTUS FEMORIS
O: Anterior Inferior Iliac
Spine
I: Patella via quadriceps
tendon and tibia tuberosity
via patellar ligament
A: knee extension and hip
flexion
N: Femoral L2-L4
MUSCLES
JM
• SARTORIUS
O: Anterior Superior Iliac
Spine
I: Upper medial surface of
the body of the Tibia
A: Knee flexion, Hip
flexion, abduction and
lateral rotation
N: Femoral L2-L3
MUSCLES
JM
• GLUTEUS MAXIMUS
O: Iliac Crest, Sacrum,
Coccyx and Aponeurosis of
Sacrospinalis
I: Iliotibial Tract of Fascia
Lata and lateral part of Linea
Aspera under Greater
Trochanter of Femur
A: Hip Extension and Lateral
Rotation, Upper fibers
Abduct
N: Inferior Gluteal Nerve
L5-S2
MUSCLES
JM
• GLUTEUS MEDIUS
O: Dorsal Ilium inferior to
Iliac Crest
I: Greater Trochanter of
Femur
A: Hip Abduction and
Medial Rotation
N: Superior Gluteal Nerve
L4-S1
MUSCLES
JM
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RECTUS FEMORIS
SARTORIUS
GLUTEUS MAXIMUS
GLUTEUS MEDIUS
MUSCLES
JM
• BICEPS FEMORIS
O: (Long Head) Ischial
Tuberosity (Short Head)
Linea Aspera of Femur
I: Head of the Fibula and
Lateral Condyle of Tibia
A: (Long Head) Hip Extension
and Knee Flexion (Short
Head) Knee Flexion and
Lateral Rotation of Hip (and
knee while flexed)
N: (Long Head) Tibial Nerve
(Short Head) Fibular Nerve
L5-S2
MUSCLES
SD
• SEMITENDINOSUS
O: Ischial Tuberosity
I: Proximal medial shaft of
Tibia at Pes Anserinus
Tendon
A: Hip Extension, Knee
Flexion and Medial Rotation
while flexed
N: Tibial Nerve L5-S2
MUSCLES
SD
• SEMIMEMBRANOSUS
O: Ischial Tuberosity
I: Posterior Medial Condyle
of Tibia
A: Knee Flexion, Medially
Rotates Knee while flexed,
and Hip Extension
N: Tibial Nerve L5-S2
MUSCLES
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• BICEPS FEMORIS
• SEMIMEMBRANOSUS
• SEMITENDINOSUS
HAMSTRINGS
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Femoral Nerve
Sciatic Nerve
Inferior Gluteal Nerve
Superior Gluteal Nerve
Obturator Nerve
Common Peroneal Nerve
NERVES
SR
• Common Peroneal Nerve:
• branches off of the sciatic
nerve around the knee,
sometimes can branch before
the knee. Approximately mid
posterior thigh
NERVES
SR
• Femoral Artery
• Obturator Artery
• Medial Circumflex Femoral Artery • Superior Gluteal Artery
• Inferior Gluteal Artery
• Lateral Circumflex Femoral Artery
• Deep (Profunda) Femoral Artery
ARTERIES
SR
VEINS
• Femoral Vein
• Profunda Femoral Vein
• Great Saphenous Vein
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“Hip replacement surgery is a safe and effective procedure that can relieve your
pain, increase motion, and help you get back to enjoying normal, everyday
activities.” (Foran, 2015)
• Successful surgical intervention
• 300,000+ in US each year
• CANDIDATES: 50 – 80 y/o
• Arthritis: OA/RA
• Fractures
• Aging: pain/stiffness/weakness
• Process:
• Orthopedic Evaluation
• Medication»Therapy»Injections»Surgery
TOTAL HIP REPLACEMENT
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Healthy Hip
Degenerated Hip
TOTAL HIP REPLACEMENT
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• SURGICAL PROCEDURE: Damaged bone and cartilage is
removed and replaced with Prosthetic Components
• Femoral Head replaced with metal stem and articulating ball
• Acetabulum replaced with metal socket (cemented or screwed)
• Cartilage is replaced by a plastic or ceramic “spacer”
TOTAL HIP REPLACEMENT
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• PRECAUTIONS:
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PPE
Weight Bearing Status
Positioning
ROM
Transfers
Home Planning
TOTAL HIP REPLACEMENT
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REFERENCES:
• Biel, A. (2014). Pelvis and Thigh. In Trail Guide to the Body
(5th ed., pp. 276-342). Boulder, CO: Books of Discovery.
• Blevins, Gary. (2016) Hip (Iliofemoral) Joint Handout.
OTA/PTA 106; Regional Human Anatomy and Physiology
• Fairchild, S. L. (2013). Principles and Techniques of Patient
Care (5th ed.). St. Louis, MO: Elsevier Saunders.
• Foran, J. R., MD. (2015, August). Total Hip Replacement.
Retrieved November 20, 2016, from
http://orthoinfo.aaos.org/topic.cfm?topic=A00377
• Gylys, B. A., & Wedding, M. E. (2013). Medical, Surgical, and
Diagnostic Procedures. In Medical Terminology Systems: A
Body Systems Approach (7th ed., p. 333). Philadelphia, PA: F.
A. Davis Company.
QUESTIONS?
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