The Hip Joint

MOVEMENT Flexion Extension Abduction Adduction Internal Rotation External Rotation

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

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

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

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

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

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

BONY ANATOMY OF THE FEMUR

BONY ANATOMY OF THE FEMUR

BONY ANATOMY OF THE HIP

BONY ANATOMY OF THE HIP

BONY ANATOMY OF THE HIP

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

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

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

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

Ligamentous Anatomy

Ligamentous Anatomy

Ligamentous Anatomy

Muscular Anatomy

Muscular Anatomy

Muscular Anatomy

Muscular Anatomy

Muscular Anatomy

Muscular anatomy

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

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

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

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

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

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

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

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

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

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

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

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