The Hip (Iliofemoral) Joint Presented by: Rob, Rachel, Alina and Lisa
Surface Anatomy: Posterior
Surface Anatomy: Anterior
Bones: Os Coxae Consists of 3 Portions: Ilium Ischium Pubis
Bones: Pubis Portion Pubic Crest Pubic Symphysis Superior Pubic Ramus Acetabulum Inferior Pubic Ramus Obturator Foramen
Bones: Ischium Portion Ischial Spine Lesser Sciatic Notch Ischial Tuberosity
Bones: Ilium Portion Iliac crest Anterior Superior Iliac Spine Anterior Inferior Iliac Spine Posterior Superior Iliac Spine Posterior Inferior Iliac Spine Greater Sciatic Notch Iliac Fossa
Bones: Femur Head Greater trochanter Linea aspera Adductor tubercle Neck Lesser trochanter Pectineal line
Ligaments Iliofemoral Ligament Thickened portion of articular capsule Y shaped From: Ilium (anterior inferior iliac spine) To: Femur (intertrochanteric line) Prevents hyperextension of the hip
Ligaments Pubofemoral Ligament Thickened portion of articular capsule From: Pubic part of the rim of the acetabulum To: Neck of the femur Prevents hyper-abduction of hip joint
Ligaments Ischiofemoral Ligament Thickened portion of the articular capsule From: Ischial wall of acetabulum To: Neck of the femur Prevents hyperextension of hip joint
Ligaments Ligament of the Head of the Femur Also called round ligament Flat, triangular band From: Fossa of the acetabulum To: Fovea capitis Weak, little importance of strengthening the hip joint; conducts artery to head of femur Prevents dislocation of head of femur
Ligaments Zona Orbicularis Also referred as annular ligament Ligament on the neck of the femur Formed by the circular fibers of the articular capsule of the hip joint Key structure for hip stability in distraction
Ligaments Transverse Ligament of the Acetabulum Joins the inferior ends of the labrum, crosses acetabular notch Completes the acetabular ring Provides support for head of femur Forms a tunnel which blood vessels pass through
Ligaments Sacrotuberous Ligament From: Sacrum To: Tuberosity of ischium Contains coccygeal branch of inferior gluteal artery Provides support for sacroiliac joint
Ligaments Inguinal Ligament From: Pubic tubercle To: Anterior superior iliac spine Important for operating on hernia patients
Bursae Trochanteric Bursa Deep to Tensor Fasciae Latae Reduce friction with IT band/tfl and Greater trochanter
Bursae Ischial Bursa Reduces friction between gluteus maximus and ischial tuberosity
Bursae Gluteofemoral Bursa Separates gluteus maximus from superior part of vastus lateralis Also reduces friction between the Gluteus maximus and femur
Cartilage Acetabular Labrum Ring of cartilage that surrounds the acetabulum of the hip Articular Cartilage of Head of Femur Articular cartilage is very smooth and it can withstand high compression forces for its weightbearing function
Articular Capsule Fibrous Layer Attaches to rim of the acetabulum to neck of the femur Synovial Membrane Lines the fibrous layer along with bony surfaces not lined with articular cartilage
Muscles: Those Innervated by the Gluteal Nerves Gluteus maximus - Inferior gluteal nerve Gluteus medius, gluteus minimus, TFL - Superior gluteal nerve
Muscles: Gluteus Maximus O: Iliac crest, sacrum,coccyx and aponeurosis of sacrospinalis I: Iliotibial tract of fascia latae & lateral part of linea aspera under greater trochanter (gluteal tuberosity) of femur A: Extends thigh at hip & laterally rotates thigh; upper fibers abduct N: Inferior gluteal nerve R: L5, S1, S2 S: Flex: rectus femoris, TFL, iliopsoas, pectineus, sartorius; Med Rot: gluteus (min & med), TFL, pectineus, gracilis, adductors A: Ext: semimembranosus, semitendinosus, biceps femoris, adductor magnus; Lat Rot: piriformis, iliopsoas, sartorius
Muscles: Gluteus Medius O: Dorsal of ilium inferior to iliac crest I: Greater trochanter of femur A: Abducts & medially rotates hip N: Superior gluteal nerve R: L4, L5, S1 S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus max, piriformis, iliopsoas, sartorius A: Abd: gluteus (max & min), TFL, sartorius; Med Rot: gluteus min, TFL, adductors, pectineus, gracilis
Muscles: Gluteus Minimus O: Dorsal of ilium between inferior & anterior gluteal lines I: Greater trochanter of femur A: Abducts & medially rotates hip N: Superior gluteal nerve R: L4, L5, S1 S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus max, piriformis, iliopsoas, sartorius A: Abd: gluteus (max & med), TFL, sartorius; Med Rot: adductors, gluteus med, TFL, pectineus, gracilis
Muscles: Tensor Fasciae Latae O: Anterior superior iliac spine & anterior iliac crest I: Tibia by way of iliotibial tract A: Flexes & abducts thigh at hip joint N: Superior gluteal nerve R: L4, L5, S1 S: Flex: rectus femoris, iliopsoas, pectineus, sartorius; Abd: glutes, sartorius A: Ext: gluteus max, semimembranosus, semitendinosus, bicep femoris; Add: gracilis, pectineus, adductors
Muscles: Those Innervated by the Obturator & Plexi Gracilis & adductors (longus & brevis) - Obturator nerve Piriformis - Sacral plexus Psoas major - Lumbar plexus
Muscles Continued: Overview
Muscles: Gracilis O: Body and inferior ramus of pubis I: Anterior medial proximal tibia A: Adducts & medially hip; flexes knee N: Obturator nerve R: L2 & L3 S: Add: adductors, gracilis, pectineus; Med Rot: gluteus (min & med), adductors, pectineus, TFL; Knee Flex: semimembranosus, semitendinosus, biceps femoris, gracilis, gastrocnemius, popliteus, sartorius A: Abd: glutes, TFL, sartorius; Lat Rot: gluteus max, sartorius, piriformis, iliopsoas; Knee Ext: rectus femoris, vastus muscles
Muscles: Piriformis O: Anterior surface of lateral process of sacrum and gluteal surface of ilium at the margin of the greater sciatic notch I: Superior border of greater trochanter A: Laterally rotates & abducts thigh when hip is flexed N: Piriformis nerve R: L5, S1, S2 S: Add: adductors, gracilis, pectineus; Lat Rot: gluteus (min & med), TFL, adductors, gracilis, pectineus A: Abd: gluteus (med & min), TFL, sartorius; Med Rot: gluteus max, iliopsoas, sartorius
Muscles: Psoas Major O: Transverse processes of L1-L5 I: Lesser trochanter A: Hip/thigh flexion N: Lumbar nerves (L1-L3) R: L1-L3 S: Hip flex: rectus femoris, pectineus, TFL, sartorius, adductors (longus & brevis) A: Hip ext: gluteus max, semimembranosus, semitendinosus, biceps femoris (LH), adductor magnus
Muscles: Adductor Longus O: Body of pubis inferior to pubic crest & lateral pubic symphysis I: Middle ⅓ of linea aspera of femur A: Adducts, flexes, and helps medially rotate hip N: Obturator nerve R: L2-L4 S: Add: adductors (magnus & longus), gracilis, pectineus A: Abd: glutes, TFL, sartorius
Muscles: Adductor Brevis O: Anterior surface of the inferior ramus of the pubis I: Pectineal line, medial lip of linea aspera of femur A: Adducts, flexes, and helps medially rotate hip N: Obturator nerve R: L2-L4 S: Add: adductors (longus & magnus), gracilis, pectineus A: Abd: glutes, TFL, sartorius
Muscles: Those Innervated by the Femoral Nerve
Muscles: Iliacus O: Iliac crest, fossa, anterior sacroiliac ligament I: Lesser trochanter A: Hip & thigh flexion N: Femoral R: L2-L3 S: Hip Flex: rectus femoris, pectineus, TFL, sartorius, adductors (longus & brevis) A: Hip Ext: gluteus max, semimembranosus, semitendinosus, biceps femoris (LH), adductor magnus
Muscles: Sartorius O: Anterior superior iliac spine I: Upper medial surface of body of tibia A: Flexes knee; flexes, abducts, & laterally rotates hip N: Femoral nerve R: L2-L3 S: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL; Hip Abd: gluteus (min & med); Knee Flex: semimembranosus, semitendinosus, biceps femoris, gracilis, gastrocnemius, popliteus, sartorius; Lat Rot: gluteus max, piriformis A: Hip Ext: gluteus max, semimembranosus, semitendinosus, biceps femoris, adductor magnus; Hip Add: adductors, pectineus, gracilis; Knee Ext: quadriceps; Med Rot: gluteus (med & min), adductors (longus & brevis), gracilis, pectineus
Muscles: Pectineus O: Superior ramus of pubis I: Pectineal line interior to lesser trochanter of femur A: Flexes, adducts & assists in medial rotation N: Femoral & obturator R: L2-L4 S: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL; Hip Add: adductors, gracilis, pectineus; Med Rot: gluteus (med & min), adductors (longus & brevis), gracilis A: Ext: gluteus max, semimembranosus, semitendinosus, bicep femoris, adductor magnus; Abd: gluteus (min & med), TFL, sartorius; Lat Rot: gluteus max, piriformis, sartorius
Muscles: Rectus Femoris O: Anterior inferior iliac spine I: Patella via quadriceps tendon & tibial tuberosity via patellar ligament A: Extension at the knee and flexion at the hip N: Femoral nerve R: L2-L4 S: Hip Flex: iliopsoas, pectineus, TFL, sartorius, adductors (longus & brevis); Knee Ext: vastus muscles A: Hip Ext: gluteus max, semimembranosus, semitendinosus, biceps femoris; Knee Flex: semimembranosus, semitendinosus, biceps femoris, gracilis, gastrocnemius, popliteus, sartorius
Muscles: Those Innervated by the Sciatic Nerve The sciatic nerve branches (tibial and fibular or peroneal) innervate the hamstrings and adductor magnus
Muscles: Biceps Femoris O: Ischial tuberosity (LH) & linea aspera of femur (SH) I: Head of fibula & lateral condyle of tibia A: extends hip and flexes knee (LH) & flexes knee, laterally rotates hip and flexed knee (SH) N: Tibial (LH) & Fibular (SH) R: L5, S1, S2 S: Hip Ext: gluteus max, semitendinosus, semimembranosus, adductors; Lat Rot: gluteus max, piriformis, iliopsoas, sartorius; Knee Flex: semitendinosus, semimembranosus, gracilis, sartorius, gastrocnemius A: Hip Flex: rectus femoris, iliopsoas, pectineus, TFL, sartorius; Med Rot: gluteus med & min, TFL, adductors, pectineus, gracilis; Knee Ext: vastus, rectus femoris
Muscles: Semitendinosus O: Ischial tuberosity I: Proximal medial shaft of tibia at Pes Anserinus tendon A: Flexes knee, extends hip, medially rotates flexed knee N: Tibial R: L5, S1, S2 S: Knee Flex: biceps femoris, semimembranosus, gracilis, sartorius, gastrocnemius, popliteus; Hip Ext: gluteus max, biceps femoris, semimembranosus; Med Rot: semimembranosus, gracilis, sartorius, popliteus A: Knee Ext: rectus femoris, vastus; Hip Flex: rectus femoris, iliopsoas, pectineus, sartorius; Lat Rot: biceps femoris
Muscles: Semimembranosus O: [same as semitendinosus] I: Posterior medial condyle of tibia A: [same as semitendinosus] N: [same as semitendinosus] R: [same as semitendinosus] S: [same as semitendinosus] A: [same as semitendinosus]
Muscles: Adductor Magnus O: Inferior ramus of pubis and ischium to ischial tuberosity I: Linea aspera of femur, medial supracondylar line & adductor tubercle A: Adducts thigh, superior horizontal fibers flexes thigh; posterior portion extends thigh at hip joint N: Obturator & tibial nerves R: L2-L4 S: Add: adductors (longus & brevis), gracilis, pectineus A: Abd: glutes, TFL, pectineus
Blood Vessels: Muscles they Supply Superficial Femoral The entire lower limb (MAIN ARTERY OF LE) Deep (Profunda) Femoral Femur & deep muscles of the thigh Superior Gluteal Glutes, TFL, & piriformis Inferior Gluteal Piriformis, gluteus max, & superior hamstrings Lateral Circumflex Femoral Femoral neck Medial Circumflex Femoral Femoral neck & adductor magnus Femoral Vein Those supplied by the femoral artery (MAIN VEIN OF LE) Great Saphenous Vein Superficial muscles as part of the superficial venous system of the lower limb Obturator Deep Femoral Vein Iliacus & the adductors Those supplied by the deep (profunda) femoral artery
Arteries
Arteries Continued
Veins
Clinical Concerns: Piriformis Syndrome
Clinical Concerns: Total Hip Replacement http://www.webmd.com/pain-management/video/hip-replacement
Conclusion PROOF YOU CAN LITERALLY FIND ANYTHING ON THE INTERNET.