Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ANATOMY OF THE HIP Presented By: Cassie Litzinger, Julia Meyer, Sarah Doumit and Susan Reider • • • • • 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: • • • • 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 CL • 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 • • • • 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 • • • • • • • 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 • • • • 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 SD • BICEPS FEMORIS • SEMIMEMBRANOSUS • SEMITENDINOSUS HAMSTRINGS SD • • • • • • 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 SR “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 SD Healthy Hip Degenerated Hip TOTAL HIP REPLACEMENT SD • 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 SD • PRECAUTIONS: • • • • • • PPE Weight Bearing Status Positioning ROM Transfers Home Planning TOTAL HIP REPLACEMENT SD 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? THANK YOU!