• Final Exam 14th May 2015

(12:00- 2:00)

102 lecture room.

The Hip Joint

Lower Extremity Bones

Joint structures and motions

• The hip is the most proximal of the lower extremity joints.

• It is very important in weight-bearing and walking activities.

• It is a ball-and-socket joint The rounded or convex-shaped femoral head fits into and articulates with the concave-shaped acetabulum.

The Hip Joint ………

• Hip joint is a very stable joint sacrifices some range of motion.

• Shoulder joint allows a great deal of motion but is not as stable.

Movement!!!!!!!!!!!

• Ball and socket a tri-axial joint motion in all three planes:

Flexion (120 d),hyperextension(15 d) Sagittal plane.

Abduction (45 d) and adduction (??) Frontal plane.

Medial and lateral rotations (45d) Transverse plane

Ligaments and other structures:

• Hip synovial joints a fibrous joint capsule It is strong, thick, and covers the hip joint in a cylindrical fashion It attaches proximally around the lip of the acetabulum and distally to the neck of the femur.

• It forms a cylindrical sleeve that encloses the joint and most of the femoral neck.

Hip joint capsule is reinforced by three ligaments:

• Ilio-femoral ligament, Ischio-femoral ligament & Pubo-femoral ligament

Ilio-femoral; Y; Bigelow ligament

It is the most important of these ligaments!!!!It reinforces the capsule anteriorly : proximally AIIS crossing the joint anteriorly It splits into two parts distally to attach to the inter-trochanteric line of the femur. Its main function is to limit hyperextension.

pubo-femoral ligament

Medial medial part of the acetabular rim & superior ramus of the pubis down and back neck of the femur.

It spans the hip joint medially and inferiorly:

limits hyperextension &

abduction.

Ischio-femoral ligament

It covers the capsule posteriorly.

It attaches on the ischial portion of the acetabulum, crosses the joint in a lateral and superior direction, and attaches on the femoral neck.

Its fibres limit hyperextension and medial rotation.

Hip joint capsule reinf. ligaments...…..

• These three ligaments all attach along the rim of the acetabulum and cross the hip joint in a spiral fashion to attach on the femoral neck.

• The combined effect of this spiral attachment is to limit motion in one direction (hyperextension) while allowing full motion (flexion) in the other direction.

these ligaments are slack in flexion and become taut as the hip moves into hyperextension.

Spiral attachments

Ilio-femoral ligament the most important???!!!!

ligamentum teres

• It is a small intra-capsular ligament of debatable importance!!!.

• It attaches proximally in the acetabulum and distally in the fovea of the femoral head.

However, given its size, it is doubtful that it adds significantly to the strength of the joint. Its other feature is that it contains a blood vessel that supplies the head of the femur. However, by itself, this vessel is unable to supply enough blood to the head to keep it viable.Some sources indicate that it becomes taut during adduction or during lateral rotation, when the hip is semi-flexed.

It contains a blood vessel that supplies the head of the femur It is unable to supply enough blood to the headit becomes taut during adduction or during lateral rotation, when the hip is semi-flexed not siginificant strength

Acetabular labrum

• The depth of the acetabulum is increased by the fibro-cartilaginous which is located around the rim.

• The free end of the labrum surrounds the femoral head and assists in holding the head in the acetabulum.

Inguinal ligament

• Although the inguinal ligament has no function at the hip joint, it should be identified because of its presence.

It runs from ASIS to the pubic tubercle and is the landmark that separates the anterior abdominal wall from the thigh.

Ilio-tibial band /tract

• It is the very long, tendinous portion of the tensor fascia latae muscle.

• It attaches to the anterior portion of the iliac crest and runs superficially down the lateral side of the thigh to attach to the tibia.

Both the gluteus maximus and tensor fascia latae muscles have fibres attaching to it.

Muscles of the hip

• Anterior muscles Flexors,• posterior muscles Extensors,• Lateral muscles Abductors, • Medial muscles Adductors.

One -joint muscles Control

Two- joints muscles ROM

The iliopsoas muscle

• It is actually two muscles with separate proximal attachments and a common distal attachment.

Iliacus muscle O iliac fossa,Psoas major muscle O the transverse processes, bodies,

and inter-vertebral disks of the T12 through L5 vertebrae.

Ins the lesser trochanter of the femur.

Function: the prime mover in hip flexion.

psoas muscle portion: contributes to trunk flexion when the femur is stabilized.

The iliopsoas muscle

The rectus femoris muscle

• The rectus femoris muscle is part of the quadriceps muscle group!!!!

• Two –joints muscle!!!!

• The rectus femoris muscle is a prime mover in hip flexion and knee extension.

The rectus femoris muscle

The Sartorius muscle:

• The sartorius muscle is the longest muscle in the body.

• Two –joints muscle!!!

• Movement flexing, abducting, and laterally rotating the hip & knee flexion

The Sartorius muscle

The pectineus muscle

• It is Located medial to the iliopsoas muscle and lateral to the adductor longus muscle.

• Because it spans the hip anteriorly as well as medially, it provides hip flexion and adduction.

The pectineus muscle

Adductor muscles

• There are three other one-joint hip adductors, all with the same first name.

• - Adductor longus muscle!!!

• - Adductor brevis muscle!!!

• -Adductor magnus muscle!!!

Adductor longus muscle

• the most superficial of the three, O Anterior surface of the pubis

• Ins middle third of the linea aspera of the femur.

• It is superficial….

• It is a prime mover in hip adduction

Adductor brevis muscle

• It is the shorter of the three

• O inferior ramus of the pubis

• Ins pectineal line and proximal linea aspera

• It lies deep to the adductor longus muscle, but superficial to the adductor magnus muscle. It is a prime mover in hip adduction.

Adductor magnus muscle

The largest, most massive, and deepest.

• O ischial tuberosity and ramus of the ischium and inferior ramus of the pubis.

• Ins along the entire linea aspera and adductor tubercle.

• Because of its size, the adductor magnus muscle is a very strong hip adductor.

•  

The gracilis muscle

• The only hip adductor that is a two-joint muscle

• O symphysis and inferior ramus of the pubis

• Ins the antero-medial surface of the proximal tibia.

• It is assistive in knee flexion.

Gluteus maximus muscle

It is a large, one-joint, quadrilateral-shaped, thick muscle located superficially on the posterior buttock.

• O from the general area of the posterior sacrum, coccyx, and ilium.

• Ins posterior femur inferior to the greater trochanter.

it is very strong in hip extension, hyperextension, and lateral rotation.

Gluteus maximus muscle

External hip rotators

• There are six small, deep, mostly posterior muscles that span the hip joint in a horizontal direction, and they all laterally rotate the hip.

• Because they all work together to produce the same motion, their individual attachments are not functionally important. Therefore, they can be grouped together as the deep rotator muscles

Deep rotator muscles

Deep rotator muscles

Piriformis

• The piriformis is the best known of this group, perhaps because of its close relationship to the sciatic nerve.

Hamstrings muscles

• Three muscles!!!

Semimembranosus muscle

• The semimembranosus muscle runs down the medial side of the thigh deep to the semitendinosus muscle

Semitendinosus muscle

Biceps femoris muscle

The gluteus medius muscle:

• It is triangular shaped (like the deltoid muscle)

• Anterior fibres are able to assist the gluteus minimus muscle in medially rotating the hip.

The gluteus minimus muscle

• It lies deep and inferior to the gluteus medius muscle.

Reversal of gluteal muscles function

• When you stand on one leg, the distal segment (femur) becomes more stable than the proximal segment (pelvis); therefore, the origin moves toward the insertion. If these muscles did not contract when you stood on one leg, the opposite side of your pelvis would drop.

The gluteus medius and minimus muscles contract to keep the pelvis fairly level and prevent the opposite side of the pelvis from dropping very much when you stand on one leg.

• .

Trendelenberg gait

The tensor fascia latae muscle

• It is a very short muscle with a very long tendinous attachment.

• Thank You !!!!