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The Hip Joint
MOVEMENT
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Flexion
Extension
Abduction
Adduction
Internal Rotation
External Rotation
Bony Anatomy
• The hip joint 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
• 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
posteroinferior 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, Ischium, 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
spirals 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
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
-more often in males than in females
-signs and symptoms: pain in the hip or groin that
radiates 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 or
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