The Hip Joint. Shenequia Howard David Rivera

Transcription

1 The Hip Joint Shenequia Howard David Rivera

2 Topics Of Discussion Movement Bony Anatomy Ligamentous Anatomy Muscular Anatomy Origin/Insertion/Action/Innervation Common Injuries

3 MOVEMENT Flexion Extension Abduction Adduction Internal Rotation External Rotation

4 Bony Anatomy The hip jt is the hip bone fused with the ilium, ischium, and pubis The hip bone forms the bony connection between the sacrum and femur

5 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 Gluteal Line Posterior superior iliac spine

6 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 posterioinferior aspect of the acetabulum Ramus of the ischium Ischial spine Ischial tuberosity the body weight rest on it in the sitting position

7 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

8 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, Ishium, and Pubis join to form the acetabulum

9 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

10 BONY ANATOMY OF THE FEMUR

11 BONY ANATOMY OF THE FEMUR

12 BONY ANATOMY OF THE HIP

13 BONY ANATOMY OF THE HIP

14 BONY ANATOMY OF THE HIP

15 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

16 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

17 LIGAMENTS Ischiofemoral ligament -the ischial portion of the acetabulum and spirls to the neck of the femur and base of the greater trochanter -prevents hyperextension of the hip -fibers relaxed during flexion

18 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

19 Ligamentous Anatomy

20 Ligamentous Anatomy

21 Ligamentous Anatomy

22 Muscular Anatomy

23 Muscular Anatomy

24 Muscular Anatomy

25 Muscular Anatomy

26 Muscular Anatomy

27 Muscular anatomy

28 Movements of the Hip and its main Muscles Flexion Illiopsoas, sartorius, tensor fascia lata, rectus femoris, pectineus, adductor longus, adductor brevis, adductor magnus, gracilis Extension Hamstrings, adductor magnus, gluteus maximus Abduction Gluteus medius, gluteus minimus, tensor fascia lata

29 Adduction Adductor longus, adductor brevis, adductor magnus, gracilis, pectineus, oburator externus Rotation Medial Gluteus medius, gluteus minimus, tensor fascia lata Lateral Obturator externus, obturator internus, gemelli, piriformis, quadratus femoris, gluteus maximus

30 Origin/Insertion/Action Adductor Brevis O - Inferior Pubic Ramus I - Pectineal Line and Linea Aspera A - adducts, flexes, and medially rotates femur Gracillis O - pubic Symphysis and inferior pubic ramus I - medial surface of the tibia A - adducts thigh, flexes medially and medially rotates thigh, flexes leg

31 Origin/Insertion/Action Pectineus -O - Superior ramus of pubis -I - Pectineal line of femur -A adducts and flexes thigh

32 Origin/Insertion/Action Adductor Longus O - med portion of the superior pubic ramus I - linea aspera of femur A - adducts, flexes, and medially rotates the femur

33 Origin/Insertion/Action Adductor Magnus O - ischiopubic ramus and ischial tuberosity I - linea aspera of the femur; the ischiocondylar part inserts on the adductor tubercle of the femur A - adducts, flexes, and medially rotates the femur; extends the femur Inn - post div of oburator nerve; tibial nerve

34 Origin/Insertion/Action Biceps Femoris Longus -O - long head: ischial tuberosity, short head: linea aspera of femur -I - lateral side of head of fibula -A - extends the thigh

35 Origin/Insertion/Action Gluteus Maximus -O - ilium posterior to posterior gluteal line -I - end in the iliotibial tract that inserts into the lateral condyle of the tibia -A - extends the thigh

36 Origin/Insertion/Action Gluteus Medius -O external surface of ilium -I lateral surface of greater trochanter of femur -A abducts and internally rotates the thigh

37 Origin/Insertion/Action Gluteus Minimus -O external surface of ilium -I anterior surface of greater trochanter of femur -A abducts and internal rotates

38 Origin/Insertion/Action Piriformis -O lateral border of ischial tuberosity -I superior border of greater trochanter of femur -A external rotation extended thigh and abducts flexed thigh

39 Origin/Insertion/Action Quadratus femoris -O lateral border of ischial tuberosity -I quadrate tubercle on intertrochanteric crest of femur -A - external rotation extended thigh and abducts flexed thigh

40 Origin/Insertion/Action Obturator Externus -O pelvis surface of obturator membrane -I medial surface of greater trochanter -A - external rotation extended thigh and abducts flexed thigh

41 Origin/Insertion/Action Iliopsoas -O sides of T12-L5 vertebrae, iliac crest -I lesser trochanter of femur, pectineal line, lesser trochanter -A flexing the thigh

42 Origin/Insertion/Action Rectus Femoris -O AIIS and ilium superior to acetabulum -I base of patella -A flex thigh

43 Origin/Insertion/Action Sartorius -O ASIS -I superior part of medial surface of tibia -A flexes, abducts, and external rotates thigh Tensor Fascia Lata -O ASIS -I iliotibial tract -A- abducts, medial rotates, and flexes thigh

44 Origin/Insertion/Action Semimembranosus -O ischial tuberosity -I posterior part of medial condyle of tibia -A extend thigh

45 Origin/Insertion/Action Semitendinosus -O ischial tuberosity -I medial surface of superior part of tibia -A extend thigh

46 Origin/Insertion/Action Vastus lateralis -O greater trochanter and lateral lip of linea aspera of femur Vastus medialis -O intertrochanteric line and medial lip of linea aspera of femur Vastus intermedius -O anterior and lateral surfaces of body of femur *Same for all 3 -I base of patella and A helps flex thigh

47 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

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

49 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

50 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

51 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

52 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

53 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

54 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

55 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

56 COMMON INJURIES Legg-Calve-Perthes Disease -characterized by avascular necrosis of the proximal femoral epiphysis -a chronic condition that develops slowly in children -often in males than in females -signs and symptoms: pain in the hip or groin that radiate 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

57 COMMON INJURIES Avascular Necrosis of the Femoral Head -blood supply to the femur head is severed of 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

58 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