The%20Hip%20Joint

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The Hip Joint
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MOVEMENT

• Flexion
• Extension
• Abduction
• Adduction
• Internal Rotation
• External Rotation

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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

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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

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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

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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

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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

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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

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BONY ANATOMY OF THE FEMUR
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BONY ANATOMY OF THE FEMUR
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BONY ANATOMY OF THE HIP
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BONY ANATOMY OF THE HIP
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BONY ANATOMY OF THE HIP
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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

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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

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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

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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

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Ligamentous Anatomy
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Ligamentous Anatomy
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Ligamentous Anatomy
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Muscular Anatomy
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Muscular Anatomy
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Muscular Anatomy
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Muscular Anatomy
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Muscular Anatomy
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Muscular anatomy
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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

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COMMON INJURIES

• Hip Pointer
• -contusion to the iliac crest
• -signs and symptoms pain, swelling, and
  ecchymosis
• -severe limit to motion
• -palpable hematoma

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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