The Hip (Iliofemoral) Joint Presented by: Heidi Jackie Kayla Paul

Surface Anatomy

Surface Anatomy

Surface Anatomy

Surface Anatomy

Right Hip Bone Medial View Lateral View © Trail Guide to the Body by Books of Discovery © Trail Guide to the Body by Books of Discovery

Iliac Spines

Femur Adductor Tubercle

Tibia

Muscles of Hip Flexion Psoas Major Iliacus Sartorius Pectineus Rectus femoris Tensor fascia latae © Trail Guide to the Body by Books of Discovery

Psoas Major Iliacus O: Iliac Fossa I: Lesser trochanter A: Hip flexion Inv: Femoral Nerve O: Anterior and lateral surfaces of T12 thru L5 I: Lesser trochanter A: Hip Flexion Inv: L2 and L3 © Trail Guide to the Body by Books of Discovery

Sartorius Pectineus O: Anterior superior iliac spine I: Proximal medial aspect of tibia A: Combination of hip flexion, abduction, lateral rotation Inv: Femoral nerve Vas: Lateral circumflex femoral artery O: Superior ramus of pubis I: Pectineal line of femur A: Hip flexion and adduction Inv: Femoral nerve Vas: Medial circumflex femoral artery © Trail Guide to the Body by Books of Discovery

Rectus Femoris Tensor Fascia Latae O: Anterior inferior iliac spine I: Tibial tuberosity A: Hip flexion, knee extention Inv: Femoral nerve Vas: Lateral circumflex femoral artery O: Anterior superior iliac spine I: Lateral condyle of tibia A: Combined hip flexion and abduction Inv: Superior gluteal nerve Vas: Superior gluteal artery © Trail Guide to the Body by Books of Discovery

Muscles of Extension Semimembranosus Semitendinosus Biceps femoris Gluteus maximus © Trail Guide to the Body by Books of Discovery

Semimembranosus Semitendinosis O: Ischial tuberosity I: Posterior surface of medial condyle of tibia A: Extend hip and flex knee Inv: Sciatic nerve Vas: Inferior gluteal artery O: Ischial tuberosity I: Anteromedial surface of proximal tibia A: Extend hip and flex knee Inv: Sciatic nerve Vas: Deep femoral © Trail Guide to the Body by Books of Discovery

Biceps Femoris Gluteus Maximus O: LH Ischial tuberosity; SH Lateral lip of linea aspera I: Fibular head A: LH extend hip and flex knee; SH flex knee Inv: LH Sciatic nerve; SH Common peroneal nerve Vas: Inferior gluteal artery O: Posterior sacrum and ilium I: Posterior femur distal to greater trochanter A: Hip extension, hyperextension, lateral rotation Inv: Inferior gluteal nerve Vas: Superior gluteal artery © Trail Guide to the Body by Books of Discovery

Muscles of Adduction Adductor Brevis Adductor Magnus Adductor Longus Gracilis Pectineus © Trail Guide to the Body by Books of Discovery

Adductor Brevis Adductor Magnus O: Pubis I: Pectineal line and proximal linea aspera A: Extend hip and flex knee Inv: Obturator nerve Vas: Deep femoral artery O: Ischium and pubis I: Entire linea aspera and adductor tubercle A: Hip adduction Inv: Obturator nerve Vas: Obturator and Deep femoral artery © Trail Guide to the Body by Books of Discovery

Adductor Longus O: Pubis I: Middle one- third of the linea aspera A: Hip adduction Inv: Obturator nerve Vas: Obturator artery and Deep Femoral artery © Trail Guide to the Body by Books of Discovery

Gracilis Pectineus O: Pubis I: Anterior medial surface of proximal end of tibia A: Hip adduction Inv: Obturator nerve Vas: Obturator artery O: Superior ramus of pubis I: Pectineal line of femur A: Hip flexion and adduction Inv: Femoral nerve Vas: Medial circumflex femoral artery © Trail Guide to the Body by Books of Discovery

Muscles of Abduction Sartorius Gluteus medius Gluteus minimus Piriformis Tensor fascia latae © Trail Guide to the Body by Books of Discovery

Gluteus Medius Gluteus Minimus O: Lateral ilium I: Greater trochanter A: Hip Abduction Inv: Superior gluteal nerve Vas: Superior gluteal artery O: Lateral ilium I: Anterior surface of the greater trochanter A: Hip abduction, medial rotation Inv: Superior gluteal nerve Vas: superior gluteal artery © Trail Guide to the Body by Books of Discovery

Piriformis O: Internal surface of sacrum; Sacrotuberous ligament I: Superior border of greater trochanter A: Lateral rotation, abduction, helps hold femur in acetabulum Inv: L5, S1 and S2 Vas: Superior and inferior gluteal arteries © Trail Guide to the Body by Books of Discovery

Lateral Rotation Sartorius Gluteus Maximus Piriformis © Trail Guide to the Body by Books of Discovery

Gluteus Maximus O: Posterior sacrum and ilium I: Posterior femur distal to greater trochanter A: Hip extension, hyperextension, lateral rotation Inv: Inferior gluteal nerve Vas: Superior gluteal artery © Trail Guide to the Body by Books of Discovery

Medial Rotation Gluteus minimus © Trail Guide to the Body by Books of Discovery

Ligaments of Hip Joint: fibrous tissue that connects bones to other bones Iliofemoral Ligament: lies anterior of hip joint, serves great strength to joint by resisting hyperextension. Pubofemoral Ligament: lies inferior to hip joint, helps thicken the capsule. http://en.wikipedia.org/wiki/Iliofemoral_ligament http://en.wikipedia.org/wiki/Pubofemoral_ligament Fundamentals of Anatomy & Physiology 6th edition http://www.laboratorium.dist.unige.it/~piero/Teaching/Gait/Malanga%20and%20DeLisa%20Clinical%20Observation.htm

Ligaments Continued Ischiofemoral Ligament: lies posterior to hip joint, consist of triangular band of strong fibers, helps thicken capsule. Zona Orbicularis Ligament: lies at lower and back of capsule, forms a circular collar around the neck of femur . http://en.wikipedia.org/wiki/Ischiofemoral_ligament http://en.wikipedia.org/wiki/Zona_orbicularis Fundamentals of Anatomy & Physiology 6th edition http://content.answers.com/main/content/wp/en-commons/thumb/d/de/250px-Gray343.png http://www.laboratorium.dist.unige.it/~piero/Teaching/Gait/Malanga%20and%20DeLisa%20Clinical%20Observation.htm

Ligaments Continued Transverse of Acetabulum Ligament: crosses the acetabular notch, fills in gap of inferior border of acetabulum. Ligament of femoral head: lies along transverse acetabular ligament, attaches to a small pit in the center of femoral head & acts when hip is flexed and thigh is laterally rotated. Fundamentals of Anatomy & Physiology 6th edition http://www.laboratorium.dist.unige.it/~piero/Teaching/Gait/Malanga%20and%20DeLisa%20Clinical%20Observation.htm

Ligaments Continued Sacrotuberous Ligament: runs from sacrum to ischial tuberosity of ischium, is flat and triangular shape, in a study was absent in 13% of cadavers. Inguinal Ligament: formed by external oblique aponerurotic fibers , runs from anterior superior iliac spine to pubic tubercle. Strengthens the abdominal wall. Is concerned with hernias. http://en.wikipedia.org/wiki/Sacrotuberous_ligament http://www.med.mun.ca/anatomyts/digest/abwall.htm http://www.laboratorium.dist.unige.it/~piero/Teaching/Gait/Malanga%20and%20DeLisa%20Clinical%20Observation.htm http://www.smbs.buffalo.edu/ana/newpage32.htm

Articular Cartilage: provide smooth and slick surfaces to reduce friction during movements of joint. Acetabular labrum: is a ring of cartilage that surrounds the acetabulum to deepen the socket, making it harder for the femur head to slip out of place. Articular cartilage of head of femur: Is smooth and tough material that covers the femur head that help cushion between the bones and lets the femur move easily. http://en.wikipedia.org/wiki/Acetabular_labrum http://www.aafp.org/afp/991015ap/1687_f7.jpg http://www.lasvegaspaininstitute.com/pain.htm Fundamentals of Anatomy and Physiology sixth edition

Articular Capsule Articular capsule: The joint cavity that is enclosed by a two-layered articular (joint) capsule. Fibrous Capsule: A tough external layer composed of dense irregular tissue that is continuous with the periostea of the articulating bones. It strengthens the joint so that the bones are not pulled apart. Synovial membrane: The inner layer of the joint capsule that is composed of loose connective tissue. The synovial membrane secretes synovial fluid. Synovial fluid is found within the articular cartilages, it provides a slippery weight-bearing film that reduces friction between the cartilages.

Bursae: small fluid filled pockets located in connective tissue Bursae: small fluid filled pockets located in connective tissue. They develop where tendons or ligaments rub against other tissue. Trochanteric Bursae: is inflammation to the hip located on the tip of greater trochanter. Is common cause of hip pain. Most often caused by overuse or direct trauma to joint. More likely to involve in women. Ischial Bursae: inflammation that separates the gluteal maximus muscle from the ischial tuberosity. Usually formed from prolonged sitting on hard surfaces that press against the bones. Fundamentals of Anatomy & Physiology 6th edition http://www.clevelandclinic.org/arthritis/treat/facts/Tronchanteric%20Bursitis.htm http://www.medterms.com/script/main/art.asp?articlekey=17111 http://d2844653.temp75.hostica.com/images/Trochanteric-bursitis.jpg

Bursae Continued Glutealfemoral Bursae: contains 2 or3 small bursae located between the tendon of the gluteus maximus and the rough line of the femur shaft. http://dictionary.reference.com/search?q=intermuscular%20gluteal%20bursa

Piriformis Syndrome Piriformis Syndrome is caused when the sciatic nerve is compressed by the piriformis muscle. Piriformis syndrome will cause a dull pain in the hip or buttock region and sometimes may be experienced from the lower back all the way to the foot.

Piriformis Syndrome Piriformis Syndrome is caused by two main groups: Overload- caused by training errors, sports that require a lot of running, and sedentary lifesyles. Exercising on hard surfaces Exercising on uneven surfaces Exercsing in worn-out shoes Sitting for long periods of time Biomechanical Inefficiencies- faulty foot and body mechanics, gait disturbances, and poor posture or sitting habits. Poor running or walking habits Walking with your toes pointing out Stiff muscles in the lower back, buttocks, and hips

Treatment Have a thorough warm-up to help prepare the tendons and muscles for an upcoming activity. This way the muscles will not be tight or stiff when you are exercising. Always allow your muscles for rest and recovery after heavy exercise. Strengthening and conditioning of the hips, buttocks, and lower back will help prevent piriformis syndrome. Flexible muscles and tendons are significant in the prevention of strains or sprains. When muscles and tendons are flexible they are able to move and perform without being overstretched unlike muscles that are tight or stiff.

Name That Surface Anatomy!! Posterior Superior Iliac Spine Greater Trochanter

Bone Quiz! Acetabulum Ischial Spine YOU DID IT!!

Do You Know Your Muscles?! What muscle is shown? Rectus Femoris What action does it assist in? Flexion

How About Those Ligaments?! What three ligaments are shown? Iliofemoral Ligament: Ischiofemoral Ligament Zona Orbicularis Ligament