HIP JOINT

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HIP JOINT

• It is one of the largest joints in the body.
• It is the connection between the lower limb and
  the pelvic girdle.
• TYPE
• It is a most perfect example of Ball and Socket
  joint.

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ARTICULAR SURFACES

• Hemispherical head of the femur and the cup
  shaped Acetabulum.
• The cavity of the acetabulum is deepened by a
  fibro-cartilagenous lip attached to its margins
  (Labrum Acetabulare).

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CAPSULE

• It is attached to
• (a) Medially to
• The hip bone
• 1.Labrum acetabulare.
• 2. Transverse acetabular ligament.

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CAPSULE

• (b) Laterally to
• The femur
• 1. In front
• Along the
• 1. Intertrochanteric line.
• 2.The bases of the greater and lesser trochanters.

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CAPSULE

• 2. Behind
• Halfway along the posterior aspect of the neck.

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NECK OF FEMUR CAPSULE

• Anteriorly
• The neck of the femur is completely inside the
  capsule of the joint
• Posteriorly
• Part of the neck lies inside the capsule and the
  other part is outside it.

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RETINACULA

• They are Bands of fibers from the capsule that
  are reflected to the neck of the femur.
• They are very adherent to the bone and run to the
  margin of the head.
• Function
• They carry blood vessels to supply the head of
  the femur.

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EXTRINSIC LIGAMENTS

• (1) ILio-femoral
• It is a very strong inverted Y shaped ligament
  which supports the front of the capsule.
• Its base is attached to the Anteriorf inferior
  Iliac spine and the two limbs of the Y to the
  intertrochanteric line.
• It resists hyper extension strains on the hip
  joint during standing.

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EXTRINSIC LIGAM ENTS

• (2) Pubo-femoral
• It is a triangular ligament which supports the
  inferomedial part of the capsule.
• It arises from the superior pubic ramus and
  blends with the lower and anterior parts of the
  capsule (lower part of intertrochanteric line).
• It limits extension and abduction.

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EXTRINSIC LIGAMENTS

• (3) Ischio-femoral
• It is spiral shaped. It is attached to the body
  of the ischium below the acetabulum and to the
  greater trochanter.
• It supports the posterior and upper parts of the
  capsule.
• It limits extension.

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INTRINSIC LIGAMENTS

• (1) Transverse Acetabular ligament
• It bridges over the acetabular notch inferiorly
  and transforms it into the acetabular foramen.

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INTRINSIC LIGAMENTS

• (2) ligament of the head of the femur
• It lies inside the hip joint and therefore it is
  ensheathed with a tube of synovial membrane.
• It is a weak ligament. It is attached between the
  pit of the head of the femur and the transverse
  acetabular ligament and the margins of the
  acetabuluar notch.

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ligament of the head of the femur

• Its function is to carry blood supply to the head
  of the femur.
• It has no function with keeping the stability of
  the joint.

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SYNOVIAL MEMBRANE

• It lines the capsule and is reflected to cover
  the intra capsular part of the neck of the femur.
• It covers all the structures inside the joint
  (ligament of the head of the femur and the pad of
  fat) Except the articular surfaces.

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SYNOVIAL MEMBRANE

• It bulges anteriorly between the ilio-femoral and
  pubo- femoral ligaments to form the psoas bursa.

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RELATIONS

• The hip joint is directly related to many
  muscles.
• (1) Anterior (In Front)
• From medial to lateral, they are
• Pectineus, iliopsoas and rectus femoris (straight
  head).
• The iliopsoas and pectineus separate the femoral
  nerve and vessels from the anterior aspect of the
  joint.

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RELATION

• (2) Lateral
• Tensor fascia latae Gluteus medius and Minimus.
• (3) Superior (above)
• Piriformis and gluteus minimus.
• (4) Inferio (below )
• Obturator externus.

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RELATIONS

• (5) Posterior (behind)
• From above downwards
• obturator internus ( two gemelli) and the
  quadratus femoris.
• They separate the joint from the Sciatic nerve.

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STABILITY OF THE JOINT

• The hip joint is one of the most stable joints of
  the body because
• (1) The head of the femur fits very accurately in
  the acetabulum due to the following
• A. The acetabulum is very deep and its depth is
  increased by the labrum acetabulare.

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STABILITY OF THE JOINT

• B. The labrum acetabulare forms a firm grip on
  the head of the femur.
• C. The atmospheric pressure resists separation
  between the head of the femur and the acetabulum.
• (2) The three strong extrinsic ligaments.
• (3) The surrounding strong muscles.

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MOVEMENTS

• (1) Flexion Iliopsoas.
• Sartorius.
• Tensor fascia latae. Rectus femoris. Pectineus.
• Adductor Longus. Adductor Brevis.
• Adductor Magnus. Gracilis.

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MOVEMENTS

• (2) Extension
• Hamstrings (Semitendinosus, Semimembranosus, Long
  head of Biceps Femoris).
• Adductor Magnus.
• Gluteus Maximus.
• The extensor muscles are more powerful than the
  flexors.

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MOVEMENTS

• (3) Adduction Adductor Longus.
• Adductor Brevis. Adductor Magnus. Gracilis.
• Pectineus Obturator Externus.

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MOVEMENTS

• (4) Abduction Gluteus Medius. Gluteus Minimus.
  Tensor Fascia Latae.
• (5) Medial rotation
• Gluteus Medius.
• Gluteus Minimus.
• Tensor Fascia Latae.

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MOVEMENTS

• (6) Lateral rotation Obturator Externus.
• Obturator Internus.
• Gemelli.
• Piriformis.
• Quadratus Femoris.
• Gluteus Maximus.
• The lateral rotators are more powerful than the
  medial rotators.

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LIMITATION OF MOVEMENTS

• 1. Extension
• The ilio femoral, pubofemoral and ischiofemoral
  ligaments.
• 2. Flexion
• Tension of the hamstring group of muscles.

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LIMITATION OF MOVEMENTS

• (3) Abduction
• The pubo femoral ligament.
• (4) Adduction
• The two limbs come in contact with each other.

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LIMITATION OF MOVEMENTS

• (5) Medial rotation
• The ischio-femoral ligament.
• (6) Lateral rotation
• The pubo-femoral ligament.

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BLOOD SUPPLY

• The main arterial supply is from branches of the
  circumflex femoral arteries ( especially the
  medial).

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BLOOD SUPPLY

• The blood supply passes to the joint through
• (1) Retinacular fibers.
• (2) Ligament of the head of the femur.

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BLOOD SUPPLY

• Damage of the retinacular fibers as in fracture
  neck of the femur can results in A vascular
  necrosis of the head of the femur.
• Fracture neck of the femur is common after age
  of (60) years especially in women because of
  Osteoprosis.

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NERVE SUPPLY

• Femoral.
• Sciatic.
• Obturator.
• Nerve to Quadratus Femoris.

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REFERRED PAIN

• Osteoarthritis is the most common cause of pain
  and stifness in the hip joint of adults.
• The pain is referred to the knee through the
  obturator nerve which supplies both joints.

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CONGENITAL DISLOCATION

• More common in girls and associated with
  inability to abduct the thigh.
• The upper lip of the acetabulum fails to develop
  adequately.
• The head of the femur rides up out of the
  acetabulum onto the gluteal surface of the ileum.
  

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TRAUMATIC DISLOCATION

• It is common in motor vehicle accidents when the
  thigh is flexed and adducted.
• The dislocated head is displaced posteriorly to
  lie on the posterior surface of the ileum.
• In posterior dislocation the sciatic nerve is
  liable to be injured.

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TRENDELENBURGS SIGN

• Positive sign
• Tilting of the pelvis downwards on the
  unsupported side (with the foot is raised above
  the ground).

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TRENDELENBURGS SIGN

• The stability needs
• (1) Normally functioning glutei medius and
  minimus.
• (2) The head of the femur is located in the
  acetabulum.
• (3) The neck of the femur is intact and has a
  normal angle with the shaft.