Presentation Hip Joint By: Aaron White, Ashley Garbarino, Anna Mueller Clinical Anatomy Presentation Hip Joint By: Aaron White, Ashley Garbarino, Anna Mueller

Pelvic Girdle PSIS Illiac fossa ASIS Superior Ramus Pubic crest Obturator Foramen Inferior Ramus Pubic arch

Os Coxae and Femur Greater sciatic notch Ischial spine Lesser sciatic notch

Pectineal line Femur Linea aspera Adductor tubercle

Condyles and Epicondyles

Tibia Lateral epicondyle Medial epicondyle Tibial tuberosity Anterior crest Intercondylar eminence Tibia Medial malleolus

Hot guy!!! ASIS Tip of greater trochanter Supracristal line Inguinal ligament

Even hotter!!! Illiac crest PSIS Sacrum Gluteus maximus Gluteal fold (sulcus) Intergluteal cleft

Cartilage: Articular Surfaces of hip joint Acetabular labrum is a fiberocartilage rim It enhances the depth of acetabulum

Ball and socket - synovial joint

Articular Capsule Anterior view Right hip joint 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

Ligaments: Anterior view of right hip joint

Ligaments: Posterior view of right hip

Ligaments: Anterior view of right hip joint

Ligaments: Superior view of transverse cut

Ligaments: Right hip bone and femur

Ligaments: Anterior view Right hip bone Inguinal ligament

Trochanteric Bursa & Ischial Bursa Bursa: They are sac like structures filled with synovial fluid that cushion movement. Strategically situated to alleviate friction – between muscles and boney prominences.

Gluteofemoral Bursa

Sciatic nerve

Femoral nerve (yellow) Femoral artery (red) Femoral vein (blue)

Superior gluteal nerve Inferior gluteal nerve

Superior gluteal artery Inferior gluteal artery

Common peroneal nerve

Obturator nerve

Obturator artery

Great saphenous vein

Deep femoral (profunda) artery

Profunda femoral vein

Lateral circumflex femoral artery Medial circumflex femoral artery

Psoas Major

Psoas Major Origin: Anterior and lateral surfaces of T12 through L5 T12 through L5

Psoas Major Insertion: Lesser trochanter

Psoas Major Action: Hip flexion Innervations & vascular supply: L2 and L3

Iliacus

Iliacus Origin: Iliac fossa

Iliacus Insertion: Lesser trochanter

Iliacus Action: Hip flexion Innervations & vascular supply: Femoral nerve

Adductor Brevis

Adductor Brevis Origin: Pubis

Adductor Brevis Insertion: Pectineal line and proximal linea aspera

Adductor Brevis Action: Hip adduction Innervations & vascular supply: Obturator nerve, Obturator artery, Deep femoral artery

Semimembranosus

Semimembranosus Origin: Ischial tuberosity

Semimembranosus Insertion: Posterior surface of medial condyle of tibia

Semimembranosus Action: Extend hip and flex knee Innervations & vascular supply: sciatic nerve and inferior gluteal artery

Rectus Femoris

Rectus Femoris Origin: Anterior inferior iliac spine

Rectus Femoris Insertion: Tibial tuberosity

Rectus Femoris Action: Hip flexion and knee extension Innervations & vascular supply: Femoral nerve, Lateral circumflex femoral artery

Adductor Magnus

Adductor Magnus Origin: Ischium and pubis

Adductor Magnus Insertion: Entire linea aspera and adductor tubercle

Adductor Magnus Action: Hip adduction Innervations & vascular supply: Obturator nerve and Obturator artery

Semitendinosus

Semitendinosus Origin: Ischial tuberosity

Semitendinosus Insertion: Anteromedial surface of proximal tibia

Semitendinosus Action: Extend hip and flex knee Innervations & vascular supply: Sciatic nerve and Deep femoral

Sartorius

Sartorius Origin: Anterior superior iliac spine

Sartorius Insertion: Proximal medial aspect of tibia

Sartorius Action: Combination of hip flexion, abduction, lateral rotation Innervations & vascular supply: Femoral nerve and Lateral circumflex femoral artery

Gracilis

Gracilis Origin: Pubis

Gracilis Insertion: Anterior medial surface of proximal end of tibia

Gracilis Action: Hip adduction Innervations & vascular supply: Obturator nerve and Obturator artery

Biceps Femoris

Biceps Femoris Origin: Long head: Ischial tuberosity Short head: Lateral lip of linea aspera

Biceps Femoris Insertion: Fibular head

Biceps Femoris Action Long head: extend hip and flex knee Short head: flex knee Innervations & vascular supply: Long head: Sciatic nerve Short head: Common peroneal nerve and inerior gluteal artery

Pectineus

Pectineus Origin: Superior ramus of pubis

Pectineus Insertion: Pectineal line of femur

Pectineus Action: Hip flexion and adduction Innervation and vascular supply: Femoral nerve, Medial circumflex femoral artery

Gluteus Maximus

Gluteus Maximus Origin: Posterior sacrum and ilium

Gluteus Maximus Insertion: Posterior femur distal to greater trocanter

Gluteus Maximus Action: Hip extension, hyperextension, lateral rotation Innervations & vascular supply: Inferior gluteal nerve and Superior gluteal artery

Gluteus Medius

Gluteus Medius Origin: Lateral ilium

Gluteus Medius Insertion: Greater Trochanter

Gluteus Medius Action: Hip abduction Innervations & vascular supply: Superior gluteal nerve and Superior gluteal artery

Adductor Longus

Adductor Longus Origin: Pubis

Adductor Longus Insertion: Medial 1/3 of the linea aspera

Adductor Longus Action: Hip adduction Innervations & vascular supply: Obturator nerve, Obturator artery, Deep femoral artery

Gluteus Minimus

Gluteus Minimus Origin: Lateral ilium

Gluteus Minimus Insertion: Anterior surface of the greater trochanter

Gluteus Minimus Action: Hip abduction, medial rotation Innervations & vascular supply: Superior gluteal nerve and Superior gluteal artery

Piriformis

Piriformis Origin: Internal surface of sacrum, Sacrotuberous ligament

Piriformis Insertion: Superior border of greater trochanter

Piriformis Action: Lateral rotation, abduction, helps hold femur in aceatabulum Innervations & vascular supply: L5, S1, and 2 Superior and inferior gluteal arteries

Sciatica -Irritation of the sciatic nerve due to an injury. -Pain radiates down the back of the leg. May be confused for a herniated disc. -Piriformis muscle spasms and compresses against Sciatic nerve against the pelvis. -MRI (neurography) to help diagnose Piriformis Syndrome. -PT’s & PTA’s treatment is heat (cold if post-surgical), ultrasound, and massage as well as stretching exercises.

Botox -Botox injection to paralyze the Piriformis muscle. -Surgery is the last resort.

Tensor Fascia Latae

Tensor Fascia Latae Origin: Anterior superior iliac spine

Tensor Fascia Latae Insertion: Lateral condyle of tibia

Tensor Fascia Latae Action: Combined hip flexion and abduction Innervations & vascular supply: Superior gluteal nerve, Superior gluteal artery

ANTERIOR VIEW OF LEG Psoas major Illiacus

Posterior view of leg Biceps femoris

Posterior view of leg Semitendinosus Semimembranosus

ANTERIOR VIEW OF LEG Pectineus Adductor brevis Adductor longus Rectus femoris Sartorius

MEDIAL VIEW OF LEG Gracilis Sartorius Adductor magnus

Gluteus minimus Gluteus maximus Gluteus medius Piriformis

Tensor fascia latae