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The Hip Joint MOVEMENT • • • • • • 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