Download Ligaments

Hip
• Ball-and-socket joint
• Head of femur and acetabulum of the hip bone
• Allows
– Flexion
– Extension
– Abduction
– Adduction
– Circumduction
– Medial & lateral rotation
Ligaments - Dense regular
connective tissue that attaches
bone to bone
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Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Ligament of the head
Transverse ligament
Sacrotuberous ligament
Zona orbicularis
Inguinal ligament
Iliofemoral ligament
• Prevents
hyperextension
• Connects anterior
inferior illiac spine of
hip to interochanteric
line of femur
Pubofemoral ligament
•Strengthens articular
capsule
•Attaches pubic rim of
acetabulum to neck of
femur
Pubofemoral ligament
Ischiofemoral Ligament
• Attaches ischial wall
of acetabulum to
neck of femur
Ligament of the Head
• Flat
triangular band
extends from the
acetabulum to the
neck of the femur
Zona Orbicularis
• Ligament that
consists of
circular tissue
• Forms the
collar around
the neck of
the femur
Transverse Ligament
• Crosses over acetabular
notch
•Supports acetabular
labrum
•Connected with the
ligament of the head and
the articular capsule
Sacrotuberous Ligament
• Allows limited
upward movement of
the inferior end of
sacrum
• Gluteal ligamentruns from the
sacrum to the
tuberosity of the
ischium
Inguinal Ligament
• Spans between the
anterior superior iliac
spine and the pubic
tubercle as the inguinal
ligament
Bursae-membranous sacs
containing synovial fluid, reduces
friction and permits free movement
• Trochanteric bursa
• Ischial bursa
• Gluteofemoral bursa
Bursae
• Trochanteric bursa
separates the superior part
of the gluteus maximus
from the greater
trochanteric of the femur
• Ischial bursa separates
the inferior gluteus
maximus from the ischial
tuberosity
Gluteofemoral Bursa
• Gluteofemoral bursaseparates the iliotibial
tract from the superior
part of the proximal
attachment of the vastus
lateralis
http://www.anesthesia-analgesia.org/content/108/5/1662/F1.expansion.html
Articular Cartilage/Hyaline Cartilage
Covers articulating surface of the bones in the
synovial joint with a smooth slippery surface
-Allows free movement of bones
-Reduces friction & absorbs shock
• Acetabular Labrum
• Articular cartilage of head of the femur
Acetabular Labrum
Acetabular Labrum Fibrocartilage rim
attached to the margin
of acetabulum to
enhance the depth of
the acetbulum
Articular cartilage of head of femur
Primarily a synovial fold
conducting a blood vessel
Articular capsule
Surrounds the synovial joint, encloses the
synovial cavity and unites the articulating
bones
• Layers
– Fibrous/Outer-dense irregular connective
tissue
– Synovial membrane/Inner-areolar
connective tissue/elastic fibers
Articular Capsule
• Fibrous-attaches to
the periosteum
(external bone
surface) of the
articulating bones
-permits bone
movement, prevents
bone dislocation
•Synovial-lines fibrous
layer along femoral
neck to edge of
femoral head
Hip joint muscle groups
• Flexors
-Sartorius
-Pectineus
• Adductors
-Gracilis
-Pectineus
• Extensors
-Semitendinosus
-Biceps femoris
Flexor/Sartorius
Origin-anterior superior iliac spine
Insertion-proximal medial tibia
Action-hip flexion, abduction,
lateral rotation
Inner-femoral nerve, lateral
circumflex femoral artery
Flexor-Adductor/Pectineus
Origin-superior ramus of pubis
Insertion-pectineal line of femur
Action-hip flexion, adduction
Inner-femoral nerve, medial
circumflex femoral artery
Adductor/Gracilis
Origin-pubis
Insertion-anterior medial
surface of proximal end of tibia
Action-hip adduction
Inner-obturator nerve & artery
Extensor/Semitendinosus
Origin-Ischial tuberosity
Insertion-anteromedial surface
of proximal tibia
Action-extend hip, flex knee
Inner-sciatic nerve, deep
femoral
Extensor/Biceps Femoris
Origin-long: ischial tuberosity
short: lateral lip of linea aspera
Insertion-fibular head
Action-long: extend hip/flex knee
-short: flex knee
Inner-long: sciatic nerve
-short: common peroneal nerve
Interior gluteal artery
Hip Bones
Your hip bone’s connected to
your?????
Os Coax:
Three fused bones, the
Ileum Pubis, and Ischium
Ilium: Attachment point for
Gluteus Max / Med / Minimus
Iliac Crest: Superior margin;
attachment point
Iliac Crest
Ant./Sup Iliac spine
Iliac Fossa
Post/Inferior Iliac Spine
Pectineal line
Superior ramus of
pubis
Pubic Crest
depression; attachment point
for Iliacus muscle.
Greater Sciatic notch
Ischial Spine
Lesser Sciatic notch
Obturator Foramen
Pubic symphysis
Iliac Fossa: Broad
Post/Superior Iliac Spine
Ant/ Inf Iliac spine
Ischial Tuberosity
Inferior ramus of
pubis
Ant./Sup. Iliac Spine:
Attachment point for the
Sartorius muscle, Tensor
Fascia Late and Inguinal
ligament.
Pubic arch
Ant./Inf. Iliac Spine:
attachment point for Rectus
Femoris.
Symphysis Pubis (8)
OS Coax continued.
More about the Os Coax
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Pubis: Attachment point for Adductor Brevis/Longus, and Gracilis
Pubic Crest:
Attachment point for abdominal muscles.
Symphysis Pubis: Region where the two pubic bones articulate
Superior Pubic Ramus: Attachment point of Pectineus muscle.
Inferior Pubic Ramus: Attachment point for Adductor Brevis /Magnus and Gracilis
Acetabulum: (Little saucer of vinegar) articulates w/ head of femur.
Obturator Foramen: (To stop up) Lightens the Os Coxa
Ischial Tuberosity: Attachment point for Semi- Tendinosis/ Membranosis, Biceps
Femoris (Long) and supports weight of body when sitting.
Ischial Spine: Attachment point for sacrospinous ligament.
Post/Sup. Iliac Spine: Attachment point for ligaments that hold pelvis together
Post/ Inf. Iliac Spine: Same as Post/Superior
Lessor Sciatic Notch: Forms part of a foramen for nerves and vessels to exit the
pelvis
Greater Sciatic Notch: Forms large part of foramen through which the Sciatic nerve
reaches the lower limb.
The Hip
bone’s
Connected
to the
Femur
Bone!!!
L. Femur
Head: Articulates with the pelvis
at the acetabulum.
Neck: Joins the head with the
Head
Greater trochanter
Neck
shaft. (Freq. site of fractures)
Greater trochanter: Large,
rounded projection located lateral
to the neck and superior to the
shaft; serves as attachment point
for Gluteus Medius/ Miniums,
Piriformis.
Lesser trochanter
Lesser trochanter: Small
prominence on medial side of
bone just inf. To neck; serves as
attachment point for Psoas Major,
Iliacus muscles.
Adductor tubercle: small
elevation on superior surface of
medial condyle; serves as
attachment point for Adductor
Magnus muscle.
Adductor tubercle
Femur
Cont.
Pectineal line:
Femur
Small ridge on
posterior surface;
attachment point
for Pectineus,
Adductor Brevis
muscle.
Linea Aspera:
Rough ridge along
the midline of the
post. surface;
med/lat Lips are
attachment points
for the Adductor
Brevis, Magnus,
Longus, Biceps
Femoris muscles.
Tibia
Medial Condyle:
Articular surface for
medial condyle of
femur; posterior
attachment for
Semimembranosis
muscle.
Lateral Condyle:
Articular surface for
lateral condyle of
femur. Attachment
point for Tensor Fascia
Late.
Intercondylar
Eminence
Tibial Tuberosity:
Attachment point for
Rectus Femoris
Shin Bone
Medial side of the
ankle joint
Hip Muscles
Gluteus Maximus:
Gluteus Med.
O: Posterior
Gluteus Min.
Sacrum & Ilium
I: Posterior Femur distal
to Greater Trochanter
A: Hip ext., hyper-ext.,
lateral rotation
Innervation: Inferior gluteal nerve,
Superior gluteal artery
Gluteus Medius:
O: Lateral Ilium
I: Greater Trochanter
A: Hip abduction
Innervation: Superior gluteal
nerve, Superior gluteal artery
Gluteus Max
Piriformis
Hip Muscles Cont…
Tensor Fascia Late:
O: Anterior Superior Iliac
spine
I: Lateral condyle of Tibia
A: Combo hip flex and abd
Innervation: Superior gluteal
Tensor Fascia Late
nerve, Superior gluteal artery
Adductor Longus:
O: Pubis
I: Mid 1/3 of linea aspera
A: Hip Adduction
Innervation: Obturator nerve,
Obturator artery, Deep femoral artery
Adductor longus
Hip Muscles
Cont….
Gluteus Minimus:
O: Lateral Ilium
I: Anterior Surface of
the Greater Trochanter
A: Hip abd, medial rot
Innervation: Superior gluteal
nerve, Superior gluteal artery
Piriformis:
O: Internal surface of
sacrum
I: Superior border of
Greater Trochanter
A: Lateral rot abd, helps
hold femur in acetabulum.
Innervation: L5, S1 and 2;
Superior/Inferior gluteal arteries
Gluteus Max.
Piriformis
Hip Movements
Ball and
Socket
joint
What is Piriformis Syndrome?
• Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic
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nerve is compressed or otherwise irritated by the piriformis muscle causing pain,
tingling and numbness in the buttocks and along the path of the sciatic nerve
descending down the lower thigh and in to the leg.
Piriformis syndrome refers to sciatica symptoms not originating from spinal
roots and/or spinal disk compression, but involving the overlying piriformis
muscle.
Some possible causes are: Inactive gluteal muscles, (ex. Continuous sitting : w/
hips flexed, Overuse injury. (ex. Strenuous activities performed in the sitting/flexed
position such as rowing, running, bicycling) When not balanced by lateral
movement of the legs, repeated forward movements can lead to
disproportionately weak hip abductors and tight adductors. This causes the
piriformis muscle to shorten and severely contract. If the contraction is significant
it can cause sciatic nerve impingement.
• Piriformis Syndrome treatment: (If caused by weak abductors w/ tight
adductors) Stretching and strengthening these muscle groups. An exercise
regimen targeting the gluteus medius and hip abductor muscle groups can
alleviate symptoms within days.
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Quoted from Wikipedia, the free encyclopedia;
www.en.wiipedia.org/w/index.php?title=Piriformis_syndrome Accessed 11/19/2011
Piriformis Stretch
Surface
Anatomy
Action:
Hip Flexion
Psoas Major:
Origin: Anterior and Lateral surfaces of T12 through L5
Insertion: Lesser Trochanter
Innervation: L2 and L3
Iliacus:
Origin: Iliac fossa
Insertion: Lesser trochanter
Innervation: Femoral Nerve
Action:
Hip adduction
Adductor Brevis:
Origin: Pubis
Insertion: Pectineal line and proximal linea aspera.
Innvervation: Obturator nerve, obturator artery, deep femoral artery.
Adductor Magnus:
Origin: Ischium and pubis.
Insertion: Entire linea aspera and adductor tubercle.
Innervation: Obturator nerve, Obturator artery.
Action:
Extend hip and flex knee
Semimembranosus:
Origin: Ischial tuberosity
Insertion: Posterior surface of medial condyle of tibia
Innervation: Sciatic nerve, Inferior gluteal artery
Action:
Hip flexion , knee extension
Rectus Femoris:
Origin: Anterior inferior iliac spine
Insertion: Tibial tuberosity
Innervation: Femoral nerve, lateral circumflex femoral artery
Sciatic Nerve
1.Femoral nerve 2. Sciatic nerve 3. Inferior gluteal nerve
4. Obturator nerve 5. Superior gluteal nerve
6. Common peroneal nerve
1. Femoral Artery 2. Inferior gluteal artery 3. Lateral circumflex femoral
artery 4. Deep femoral (profunda) artery 5. Superior gluteal artery 6.
Obturator artery 7. Medial circumflex femoral artery
Superior & Inferior gluteal arteries & veins
Superior gluteal artery
1.Femoral Vein 2. Profunda Femoral Vein
3. Great Saphenous Vein
Femoral vein
Profunda femoral vein