Chapter 18 Hip Hip bone – aka os coxae; ilium, ischium & pubis

Joint Structure and Motions Flexion/extension/hyperextension Abduction/adduction Medial/lateral rotation Triaxial; 3 degrees of freedom Flexion 120; extension – return from flexion 120; hyperextension 15 Abduction – 45; adduction – 25 Medial/lateral rotation – 45 each

Bones and Landmarks Ilium Iliac fossa Iliac crest ASIS AIIS PSIS PIIS

Bones and Landmarks Ischium Body Ramus Ischial tuberosity Spine

Bones and Landmarks Pubis Superior ramus Inferior ramus Pubic symphysis Pubic tubercle Acetabulum Abductor foramen

Bones and Landmarks Femur Lateral condyle Head Medial condyle Neck Greater trochanter Lesser trochanter Body Medial epicondyle Lateral epicondyle Lateral condyle Medial condyle Adductor tubercle Linea aspera Pectineal line Patellar surface

Bones and Landmarks Tibia Tibial tuberosity

Ligaments and Other Structures Joint capsule Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Ligamentum teres Acetabular labrum Inguinal ligament Iliotibial band Iliofemoral – Y ligament; Ligament of Bigelow; limits hyperextension; anterior Pubofemoral – anterior; limits hyperextension & abduction; medial & inferior Ischiofemoral – posterior; limits hyperextension & IR Ligamentum teres – blood supply Inguinal ligament – separates abdominal wall from thigh

Muscles of the Hip Anterior Iliopsoas Rectus femoris Sartorius Flexors

Muscles of the Hip Medial Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis Adductors

Muscles of the Hip Posterior Gluteus maximus Deep rotators (6) Semimembranosus Semitendinosus Biceps femoris (long and short heads) Extensors/Rotators Deep rotators – Table 18.3 Page 272

Muscles of the Hip Lateral Gluteus medius Gluteus minimus Tensor fascia latae Abductors

Hip Anatomical relationships Summary of muscle action Summary of muscle innervation Anatomical Relationships – Table 18.2 page 267 Muscle actions – Table 18.4 page 278 Muscle innervation – Tables 18.5 & 18.6 pp. 278-279

Common Hip Pathologies Congenital hip dislocation Legg-Calvé-Perthes disease Slipped capital femoral epiphysis Coxa valga/coxa vara Anteversion/retroversion Osteoarthritis Congenital hip dislocation – dysplasia; shallow acetabulum Legg Calve Perthes – necrosis of femoral head; children 5-10; Coxa Valga - > 125; longer LE; hip adducted Coxa Vara - < 125; shorter LE; pelvic drop Anteversion - > 15-25; toe in; IR Retroversion - < 15-25; toe out; ER

Common Hip Pathologies Hip fracture Iliotibial band syndrome Trochanteric bursitis Hamstring strain Hip fracture – intertrochanteric or femoral Hip Pointer – contusion of iliac crest/ASIS