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ANATOMY OF THE HIP Presented By: Cassie Litzinger, Julia Meyer,
Sarah Doumit and Susan Reider
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SURFACE ANATOMY Iliac Crest Supracristal Plane Gluteal Fold
Gluteal Sulcus Intergluteal Cleft SURFACE ANATOMY SD
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SURFACE ANATOMY Anterior Iliac Spine Posterior Iliac Spine
Inguinal Ligament Anterior view SURFACE ANATOMY Posterior View SD
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Sacrum Tip of the Greater Trochanter SURFACE ANATOMY SD
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LIGAMENTS Iliofemoral Ligament: Pubofemoral Ligament:
Connects ilium to femur Prevents hyperextension Internal/External Rotation Anteriorly & Superiorly Pubofemoral Ligament: Connects pubis to femur Tightens during extension and Abduction Prevents over-abduction Inferiorly & Anteriorly LIGAMENTS CL
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LIGAMENTS Ischiofemoral Ligament: Connects ischium to femur
Posterior side of hip joint Prevents Posterior Displacement (dislocation) LIGAMENTS CL
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LIGAMENTS Inguinal Ligament: Arched fibers of the external oblique
Consists of collagen fibers Inguinal Hernias common here LIGAMENTS CL
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LIGAMENTS Transverse Ligament of Acetabulum: Bridges acetabular notch
Formed by acetabular labrum LIGAMENTS CL
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LIGAMENTS Sacrotuberous Ligament: Gluteal ligament
Convert sciatic notches into greater and lesser sciatic foramina LIGAMENTS CL
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LIGAMENTS Ligament of the Head of the Femur:
Also called ligamentum teres or “round ligament” Weak ligament Conducts artery to head LIGAMENTS CL
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LIGAMENTS Zona Orbicularis Circular fibers
Forms collar around femoral neck LIGAMENTS CL
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BURSAE Trochanteric Bursa: Ischial Bursa: Gluteofemoral Bursa:
Gluteus Maximus – Greater Trochanter Ischial Bursa: Prevents friction between ischial tuberosity and gluteus maximus Gluteofemoral Bursa: BURSAE CL
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CARTILAGE Acetabular Labrum:
Hip joint stability/deepens socket Fibrous cartilage ring Articular Cartilage of the Head of the Femur CARTILAGE CL
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ARTICULAR CAPSULE Synovial Membrane: Fibrous Layer/capsule:
Lines the capsule Fibrous Layer/capsule: Attaches on hip bone to bony rim of acetabulum Deep fibers form orbicular zone Reinforces hip ARTICULAR CAPSULE CL
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BONES OF THE OS COXAE PELVIC GIRDLE Ilium Ischium Pubis “Hip Bone”
“Sit Bone” Pubis BONES OF THE OS COXAE JM
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ILIUM Iliac Crest Iliac Fossa Iliac Spines Anterior Superior
Anterior Inferior Posterior Superior Posterior Inferior ILIUM JM
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ISCHIUM Ischial Tuberosity Ischial Spine Greater Sciatic Notch
Lesser Sciatic Notch ISCHIUM JM
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PUBIS Superior Pubic Ramus Inferior Pubic Ramus Pubic Arch
Obturator Foramen PUBIS JM
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Pubic Crest Pubic Symphysis Acetabulum PUBIS JM
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DIFFERENTIATION JM
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FEMUR Head Neck Greater Trochanter Lesser Trochanter Linea Aspera
Pectineal Line Adductor Tubercle FEMUR JM
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MUSCLES PECTINEUS O: Superior Ramus of the Pubis
I: Pectineal line inferior to Lesser Trochanter of Femur A: Flexes, Adducts, and assists with Medial Rotation of the Hip N: Femoral Nerve and fibers of Obturator Nerve L2-L4 MUSCLES SR
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MUSCLES GRACILIS O: Body and Inferior Ramus of the Pubis
I: Anterior medial proximal Tibia A: Adducts and Medially rotates the hip, Flexes the Knee N: Obturator Nerve L2-L3 MUSCLES SR
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MUSCLES ADDUCTOR MAGNUS
O: Inferior Ramus of Pubis and Ischium to Ischial Tuberosity I: Linea Aspera of Femur, medial Supracondylar Line and adductor Tubercle A: Adducts thigh, Superior horizontal fibers Flex thigh, and posterior portion Extend thigh at Hip joint N: Obturator and Tibial Nerves L2-L4 MUSCLES SR
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MUSCLES ADDUCTOR LONGUS ADDUCTOR BREVIS
O: Body of Pubis inferior to Pubic Crest and lateral Pubic Symphysis I: Middle 1/3 of Linea Aspera of Femur A: Adducts, Flexes and helps Medially Rotate Hip N: Obturator Nerve L2-L4 ADDUCTOR BREVIS O: Anterior surface of the inferior ramus of Pubis I: Pectineal Line and medial lip of Linea Aspera of Femur A: Adducts, Flexes and helps medially rotate Hip MUSCLES SR
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PECTINEUS GRACILIS ADDUCTOR: MAGNUS LONGUS BREVIS ADDUCTOR MUSCLES SR
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MUSCLES PSOAS MAJOR: O: Transverse Process L1-L5 I: Lesser Trochanter
A: Hip/Thigh Flexion N: Lumbar Nerves L1-L3 MUSCLES CL
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MUSCLES ILIACUS: O: Iliac Crest, Fossa, Anterior sacroiliac ligament
I: Lesser Trochanter A: Hip Flexion N: Femoral L2-L3 MUSCLES CL
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MUSCLES TENSOR FASCIA LATAE:
O: Anterior Superior Iliac Spine/Anterior iliac crest I: Tibia by way of iliotibial tract A: Flexes and abducts thigh at hip joint/Helps stabilize and steady hip N: Superior Gluteal Nerve **acts in concert with psoas major and illiacus** MUSCLES CL
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PSOAS MAJOR ILIACUS TENSOR FASCIA LATAE MUSCLES CL
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MUSCLES RECTUS FEMORIS O: Anterior Inferior Iliac Spine
I: Patella via quadriceps tendon and tibia tuberosity via patellar ligament A: knee extension and hip flexion N: Femoral L2-L4 MUSCLES JM
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MUSCLES SARTORIUS O: Anterior Superior Iliac Spine
I: Upper medial surface of the body of the Tibia A: Knee flexion, Hip flexion, abduction and lateral rotation N: Femoral L2-L3 MUSCLES JM
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MUSCLES GLUTEUS MAXIMUS
O: Iliac Crest, Sacrum, Coccyx and Aponeurosis of Sacrospinalis I: Iliotibial Tract of Fascia Lata and lateral part of Linea Aspera under Greater Trochanter of Femur A: Hip Extension and Lateral Rotation, Upper fibers Abduct N: Inferior Gluteal Nerve L5-S2 MUSCLES JM
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MUSCLES GLUTEUS MEDIUS O: Dorsal Ilium inferior to Iliac Crest
I: Greater Trochanter of Femur A: Hip Abduction and Medial Rotation N: Superior Gluteal Nerve L4-S1 MUSCLES JM
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RECTUS FEMORIS SARTORIUS GLUTEUS MAXIMUS GLUTEUS MEDIUS MUSCLES JM
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MUSCLES BICEPS FEMORIS
O: (Long Head) Ischial Tuberosity (Short Head) Linea Aspera of Femur I: Head of the Fibula and Lateral Condyle of Tibia A: (Long Head) Hip Extension and Knee Flexion (Short Head) Knee Flexion and Lateral Rotation of Hip (and knee while flexed) N: (Long Head) Tibial Nerve (Short Head) Fibular Nerve L5-S2 MUSCLES SD
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MUSCLES SEMITENDINOSUS O: Ischial Tuberosity
I: Proximal medial shaft of Tibia at Pes Anserinus Tendon A: Hip Extension, Knee Flexion and Medial Rotation while flexed N: Tibial Nerve L5-S2 MUSCLES SD
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MUSCLES SEMIMEMBRANOSUS O: Ischial Tuberosity
I: Posterior Medial Condyle of Tibia A: Knee Flexion, Medially Rotates Knee while flexed, and Hip Extension N: Tibial Nerve L5-S2 MUSCLES SD
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BICEPS FEMORIS SEMIMEMBRANOSUS SEMITENDINOSUS HAMSTRINGS SD
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NERVES Femoral Nerve Sciatic Nerve Inferior Gluteal Nerve
Superior Gluteal Nerve Obturator Nerve Common Peroneal Nerve NERVES SR
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NERVES Common Peroneal Nerve:
branches off of the sciatic nerve around the knee, sometimes can branch before the knee. Approximately mid posterior thigh NERVES SR
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ARTERIES Obturator Artery Femoral Artery
Medial Circumflex Femoral Artery Femoral Artery Superior Gluteal Artery Inferior Gluteal Artery Lateral Circumflex Femoral Artery Deep (Profunda) Femoral Artery ARTERIES SR
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VEINS Femoral Vein Profunda Femoral Vein Great Saphenous Vein SR
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TOTAL HIP REPLACEMENT Successful surgical intervention
“Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.” (Foran, 2015) Successful surgical intervention 300,000+ in US each year CANDIDATES: 50 – 80 y/o Arthritis: OA/RA Fractures Aging: pain/stiffness/weakness Process: Orthopedic Evaluation Medication»Therapy»Injections»Surgery TOTAL HIP REPLACEMENT SD
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TOTAL HIP REPLACEMENT Healthy Hip Degenerated Hip SD
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SURGICAL PROCEDURE: Damaged bone and cartilage is removed and replaced with Prosthetic Components
Femoral Head replaced with metal stem and articulating ball Acetabulum replaced with metal socket (cemented or screwed) Cartilage is replaced by a plastic or ceramic “spacer” TOTAL HIP REPLACEMENT SD
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TOTAL HIP REPLACEMENT PRECAUTIONS: PPE Weight Bearing Status
Positioning ROM Transfers Home Planning TOTAL HIP REPLACEMENT SD
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QUESTIONS? REFERENCES:
Biel, A. (2014). Pelvis and Thigh. In Trail Guide to the Body (5th ed., pp ). Boulder, CO: Books of Discovery. Blevins, Gary. (2016) Hip (Iliofemoral) Joint Handout. OTA/PTA 106; Regional Human Anatomy and Physiology Fairchild, S. L. (2013). Principles and Techniques of Patient Care (5th ed.). St. Louis, MO: Elsevier Saunders. Foran, J. R., MD. (2015, August). Total Hip Replacement. Retrieved November 20, 2016, from Gylys, B. A., & Wedding, M. E. (2013). Medical, Surgical, and Diagnostic Procedures. In Medical Terminology Systems: A Body Systems Approach (7th ed., p. 333). Philadelphia, PA: F. A. Davis Company. QUESTIONS? THANK YOU!
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