The Hip Joint

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The Hip Joint

• By Andra Theobald, Jessica Deering, Kati Terry,
  Natalie Burke, Jessica Slinkard, and Christine
  Lindsay

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Bones of the Hip Joint

• Sacrum
• Coccyx
• Ilium
• Ischium
• Pubis

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Ligaments of the Hip

• Ischiofemoral Ligament
• Iliofemoral Ligament
• Pubofemoral Ligament

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Ischiofemoral Ligament

• Origin at ischial part of acetabular rim
• Inserts onto the femur
• Reinforces posterior hip joint capsule
• Limits medial rotation
• Prevents hyperextension

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Iliofemoral Ligament

• Attaches from the pelvis to the femur
• One band to lesser and one to greater trochanter
  of the femur
• Covers the hip joint anteriorly
• Is known as the strongest ligament
• Is Y-shaped
• Lateral band limits adduction
• Medial band limits lateral rotation
• Resists excessive extension of hip joint

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Pubofemoral Ligament

• Origin is pubis bone of pelvis
• Inserts onto femur
• Reinforces anterior inferior part of capsule
• Limits abduction

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Ligament of the head of the femur

• Plays a small role in strengthening
• From the head of the femur to the acetabular notch

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Muscles of the Hip
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Gluteal Group

• Gluteus Maximus
• Origin- from the back of the pelvis, erector
  spinae tendon, and
  sacrotuberous ligament.
• Insertion- iliotibial track and gluteal
  tuberosity of the femur.
• Action- extends, abducts, and
  laterally rotates the thigh at the hip.
• Gluteus Medius
• Origin- below iliac crest and between the
  anterior and posterior
  gluteal lines.
• Insertion- greater trochanter of the femur.
• Action- a strong abductor and medial rotator
  of the thigh.
• Gluteus Minimus
• Origin- arises from the ilium beneath the
  gluteus medius.
• Insertion- greater trochanter of the femur.
• Action- strong abductor of the thigh at the
  hip medially rotates the thigh.
• Tensor Fascia Lata
• Origin- anterior part of the crest of the
  ilium.
• Insertion- iliotibial tract and lateral
  condyle of the tibia.
• Action- flexes and medially rotates the thigh
  at the hip and helps stabilize both
  hip and knee joints helps extend the knee.

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Gluteal group
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Adductor Group

• Adductor Longus
• Origin- arises from the pubis
• Insertion- middle third of the linea aspera
• Action- adducts and medially rotates the
  thigh.
• Adductor Brevis
• Origin- arises from inferior pubic ramus
• Insertion- back of the upper half of the femur
• Action- adducts and medially rotates the
  thigh.
• Adductor Magnus
• Origin- arises from the inferior pubic ramus,
  the ramus of the ischium, and the
  ischial tuberosity.
• Insertion- gluteal tuberosity, linea aspera,
  medial supracondylar line, and the
  adductor tubercle of the femur. The portion
  inserting on the supracondylar
  line is called the adductor portion. The portion
  inserting on the adductor
  tubercle is called the hamstring portion.
• Action- powerful adductor of the thigh at the
  hip. The superior portion weakly flexes and
  medially rotates the thigh. The lower
  portion helps extend and laterally rotate the
  thigh.
• Pectineus
• Origin- upper surface of the superior ramus of
  the pubic bone.
• Insertion- pectineal line below the lesser
  trochanter of the femur.
• Action- flexes the hip joint and medially
  rotates and adducts the thigh.
• Gracilis
• Origin- margin of the pubis and inferior
  ischiopubic ramus.
• Insertion- below the medial condyle to the
  tibia as part of the pes anserinus.

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Adductor Group
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Iliopsoas Group
Iliacus Origin- iliac fossa
Insertion- with psoas major into the
lesser trochanter of the femur
Action- with psoas, it flexes the
thigh at the hip and acts as an
important flexor of the trunk at
the hip. Psoas Major Origin- transverse
processes, bodies and intervertebral
disks of lumbar vertebrae
and body of 12th thoracic
vertebrae. Insertion-
lesser trochanter of femur.
Action- with iliacus, it flexes the
thigh at the hip and acts as an
important flexor of the trunk at the
hip.
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Lateral Rotators

• Obturator Externus
• Origin- arises from around the obturator
  foramen and from the obturator
  membrane.
• Insertion- in the pit in the greater
  trochanter of the femur.
• Action- laterally rotates the thigh.
• Obturator Internus
• Origin- from inside the pelvis off the
  obturator membrane and surrounding
  bone.
• Insertion- greater trochanter of the femur.
• Action- laterally rotates the thigh.
• Piriformis
• Origin- arises from front of the sacrum inside
  the pelvis and passes
  through the greater sciatic notch.
• Insertion- greater trochanter of the femur.
• Action- laterally rotates the thigh.
• Superior and Inferior Gemelli
• Origin- from superior and inferior margins of
  the lesser sciatic notch,
  respectively.
• Insertion- on the tendon of the obturator
  internus muscle.
• Action- aid in lateral rotation of the thigh.
• Quadratus Femoris
• Origin- from the lateral side of the ischial
  tuberocity.
• Insertion- intertrochanteric crest of the
  femur.

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Lateral Rotator Group
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Nerves of the Hip Joint
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• Sciatic Nerve
• Largest nerve of the body and carries
  contributions from L4 to S3
• Divides into the common fibular nerve and tibial
  nerve in the posterior compartment of the thigh
• Innervates all muscles in the posterior
  compartment of the thigh, the part of the
  adductor magnus originating from the ischium, all
  muscles in the leg and foot, and the skin on the
  lateral side of the leg and the lateral side of
  the sole of the foot

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• Obturator Nerve
• Originates from L2 to L4
• Innervates all muscles in the medical compartment
  of the thigh except the part of the adductor
  magnus muscle that originates from the ischium
  and the pectineus muscle
• Also innervates the obturator externus muscle and
  the skin on the medial side of the upper thigh

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• Femoral Nerve
• Carries contributions from the anterior rami of
  L2 to L4
• Lateral to the femoral artery in the femoral
  triangle
• Innervates all muscles in the anterior
  compartment of the thigh, the skin over the
  anterior aspect of the thigh, the anteromedial
  side of the knee, the medial side of the leg, and
  the medial side of the foot

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• Nerve to Quadratus Femoris
• Supplies the inferior gemellus and quadratus
  femoris muscles
• Passes through the greater sciatic foramen
  inferior to the piriformis muscle and enters the
  gluteal region

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Blood Supply to the Hip Joint
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• Inferior Gluteal Artery
• Originates in the pelvic cavity as a branch of
  the internal iliac artery and supplies the
  gluteal region
• Leaves the pelvis through the greater sciatic
  foramen below the piriformis muscle

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• Obturator Artery
• Branch of the internal iliac artery in the pelvic
  cavity
• Passes through the obturator canal to enter and
  supply the medial compartment of the thigh

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• Lateral Circumflex Femoral Artery
• Usually originates proximally from the lateral
  side of the deep artery of the thigh, but may
  arise directly from the femoral artery
• Passes deep to the sartorius and rectus femoris
  and divides into three terminal branches
• Ascending branch passes above the grater
  trochanter of the femur to enter the gluteal
  region
• Transverse branch passes below and lateral to
  the greater trochanter
• Descending branch accompanies the nerve to the
  vastus lateralis into that muscle, supplying it
  and descending to the knee

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• Medial Circumflex Femoral Artery
• Usually originates proximally from the
  posteromedial aspect of the deep artery of the
  thigh, but may originate from the femoral artery
• The main trunk passes over the superior margin of
  the adductor magnus and divides into two major
  branches deep to the quadratus femoris muscle
• Ascending branches appears in gluteal region
  above the quadratus femoris muscle
• Transverse branch appears in the back of the
  thigh between the quadratus femoris and adductor
  magnus

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Hip Movements
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Flexion

• This action is mainly caused by contraction of
  the iliopsoas, but the sartorius, rectus femoris
  and pectineus muscles also assist in flexing the
  hip.
• Flexion is necessary for walking, running,
  sitting down, sitting up and various other common
  movements.

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Extension

• The gluteus maximus is the main muscle used in
  extention, yet the hamstrings also assist.

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Adduction

• The adductor longus, brevis, magnus and the
  gracilis all work to adduct the leg at the hip.
• Workouts for athletes need to include one-sided
  straight leg raises in order to prevent injury.
  This is especially important in sports like
  hockey.

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Abduction

• The three gluteal muscles act to abduct the thigh
  at the hip.
• Abduction is seen in side-stepping motion and is
  the main motion responsible for shifting weight
  in the hips during throwing or hitting actions.
• These muscles also keep the pelvis stable during
  walking or running. With weak abductors, the hip
  will drop, causing back problems.

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Lateral Rotation

• The gluteus maximus, quadratus femoris,
  piriformis, obturator internus and externus and
  gemelli all work to laterally rotate the thigh at
  the hip.
• Lateral rotation is seen when stepping out during
  activities such as running or pitching.

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Medial Rotation

• The anterior part of the gluteus mininus and
  medius muscles as well as the tensor fascia lata
  act in medial rotation.
• This movement can be seen in the follow through
  of a pitch.

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In A Nutshell

• These muscles cause these movements.

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Hip Injuries
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http//familydoctor.org/540.xml
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Hip Fractures

• Signs and symptoms of a hip fracture may include
• Severe pain in your hip or groin
• Inability to put weight on your leg on the side
  of your injured hip
• Stiffness, bruising and swelling in and around
  your hip area
• Shorter leg on the side of your injured hip
• Turning outward of your leg on the side of your
  injured hip

http//www.mayoclinic.com/health/hip-fracture/DS00
185/DSECTION2
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Hip Fractures (cont)

• Causes
• Falling
• Weak bones
• Trauma to the hip (sports injuries, car accidents
• Treatment
• Surgery
• Traction (only when patient has a serious illness
  that makes surgery too risky

• http//www.mayoclinic.com/health/hip-fracture/DS00
  185/DSECTION7

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Hip Pointers

• An injury to the iliac crest in which the bone
  and overlying muscle can be bruised
• Can result in a fracture
• Treatment includes rest, ice, and
  anti-inflammatory medication

http//orthopedics.about.com/cs/hipsurgery/g/hippo
inter.htm
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Arthritis

• Osteoarthritis- most common form
• Characterized by wearing away of the cartilage of
  the joint causing the bones to be exposed
• Symptoms pain with activities, limited range of
  motion, stiffness of the hip, and walking with a
  limp

http//orthopedics.about.com/cs/hipsurgery/a/hipar
thritis.htm
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Congenital Hip Dysplasia

• Abnormal formation of the hip joint in which the
  femoral head is not stable in the acetabulum
• Signs legs of different lengths, uneven skin
  folds, less mobility or flexibility on one side,
  limping, toe walking, and a waddling gait
• Treatment replace the head of the femur into the
  acetabulum by applying constant pressure
• Pavlik harness and von Rosen splint are commonly
  used in infants

http//arthritis-symptom.com/a-c/congenital-hip-dy
splasia.htm
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Slipped Capitol Femoral Epiphysis

• Starts if the epiphysis of the femur slips from
  the ball of the hip joint
• Symptoms stiffness of the leg, limping, pain
  that comes and goes (in hip, thigh, or knee), may
  lose ability to move involved hip, leg twists out
  and may look shorter than the other leg
• Treatment surgery (single central screw holds
  bone in place)

http//familydoctor.org/282.xml
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Hip Replacement
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Symptoms of Degeneration

• Pain when weight-bearing
• Limp
• Reduction of range of motion
• Bone spurs

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When does a person need a hip replacement?

• When degeneration causes pain that affects the
  ability of the person to lead a normal life
• Caused by conditions such as osteoarthritis,
  vascular necrosis, or other abnormalities

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Hip Replacement- Parts of the prosthesis
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Hip Replacement- Step 1Removal of Femoral Head

• The femur is removed from the femoral head using
  a bone saw
• The femoral head is removed from the acetabulum

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Hip Replacement-Step 2Insertion of Acetabular
Component

• The acetabular shell is inserted along with a
  liner

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Hip Replacement-Step 3Insertion In Femoral
Compartment

• The femoral component is attached to the femur
  using either cement or a material that allows the
  remaining bone to attach to the new joint
• Then the replacement femoral head is attached to
  the acetabular shell

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Hip Replacement- Final Step

• A drain may be inserted to help drain fluid
• Muscles are reattached and the incision is closed