Chapter 9The Hip Joint and Pelvic Girdle

Pelvic Girdle

Anterior Gluteal Line

External Surface

Auricular Surface

Iliopectineal Eminence

Greater Sciatic Notch

Iliac Fossa

Iliac Crest

Posterior Superior Iliac Spine

Posterior Inferior Iliac Spine Anterior

Inferior Iliac Spine

Anterior Superior Iliac Spine

Ischium Label

Ilium Label

Pubis Label

Ischial Tuberosity

Spine of the Ischium

Lesser Sciatic Notch

Inferior Rami

Superior Rami

Pubic Crest

Inferior Rami

Superior Rami

Pubic Symphysis

Sacral Articulation

Posterior Gluteal Line

Inferior Gluteal Line

Joints•Symphysis Pubis (amphiarthrodial)

–Fibrocartilaginous interpubic disc–Superior Pubic Ligament–Inferior Pubic Ligament

•Sacroiliac Joints (arthroidial)

–Junction of the sacrum suspended between the two iliac bones

•Posterior Sacroiliac Ligament•Sacrotuberous ligament•Anterior Sacroiliac Ligament

Joints• Acetabulofemoral

(enarthrodial)– Iliofemoral “Y” Ligament– Teres Ligament– Pubofemoral Ligament– Ischiofemoral Ligament

Range of Motion• Flexion

– 120° (knee flexed)– 90° (knee

extended)

• Extension– 20°

• Abduction– 45°

• Adduction– 20°-30°

• Internal Rotation– 40°

• External Rotation– 45°

Cutaneous Distribution

Cutaneous Distribution (Sciatic)

Movements• Hip Flexion• Hip Extension• Hip Abduction• Hip Adduction • Hip External Rotation• Hip Internal Rotation • Anterior Pelvic Rotation• Posterior Pelvic Rotation• Left Lateral Pelvic Rotation• Right Lateral Pelvic Rotation • Left Transverse Pelvic Rotation• Right Transverse Pelvic

Rotation

Gluteus minimusGluteus minimusIliacusIliacusPsoasPsoas

PectineusPectineusTensor fasciae lataeTensor fasciae latae

SartoriusSartoriusAdductor longusAdductor longus

GracilisGracilisRectus FemorisRectus Femoris

Gluteus maximusGluteus maximusAdductor Magnus Adductor Magnus

Biceps femorisBiceps femorisSemitendinosusSemitendinosus

SemimembranosusSemimembranosusAdductor BrevisAdductor Brevis

External RotatorsExternal RotatorsGluteus MediusGluteus Medius

Label

Muscles•Iliopsoas

–Iliacus–Psoas Major

•Strengthening

•Stretching

Muscles•Sartorius •Strengthening

•Stretching

Muscles•Rectus Femoris •Strengthening

•Stretching

Muscles•Tensor Fasciae Latae

•Strengthening

•Stretching

Muscles•Gluteus Maximus •Strengthening

•Stretching

Muscles•Gluteus Medius •Strengthening

•Stretching

Muscles•Gluteus Minimus •Strengthening

•Stretching

Muscles•Six Deep Lateral Rotator Muscles

–Piriformis–Gemellus Superior–Gemellus Inferior–Obturator Externus–Obturator Internus–Quadratus Femoris

•Strengthening

•Stretching

Muscles•Semitendinosus •Strengthening

•Stretching

Muscles•Semimembranosus •Strengthening

•Stretching

Muscles•Biceps Femoris

–Long head–Short head

•Strengthening

•Stretching

Muscles•Adductor Brevis •Strengthening

•Stretching

Muscles•Adductor Longus •Strengthening

•Stretching

Muscles•Adductor Magnus •Strengthening

•Stretching

Muscles•Pectineus •Strengthening

•Stretching

Muscles•Gracilis •Strengthening

•Stretching

Techniques In Evaluating Levelness of Pelvis

• Anterior Superior Iliac Spines• Posterior Superior Iliac Spines• Iliac Crests

Pelvic Deviations• Lordosis (pelvic tilt)• Scoliosis• Pelvic Torsion

– Leg length discrepancy

Determining Leg Length Discrepancy1. Standing Position: levelness of iliac crests

(symmetry of all 4 iliac spines)1. Measure from ASIS to tip of medial malleolus

(supine)2. Determine if femur and tibia are same length

Note: If iliac crests are level and there is a measurement difference = Pelvic Torsion

Deviations of the Hip• Hip Flexion Contracture (contributes

to a lordosis condition)– Test

• Both knees to chest. Maintain one knee to chest while lowering other leg – should be flat on table.

– Distinguish between the commonly tight muscles:

• Iliopsoas• Rectus Femoris• Tensor Fasciae Latae

• Femur Angle– Coxa Normal

• Between 115°-140°, averaging 126° at adulthood– Coxa Vara

• Decrease in angle caused by weight bearing on weak femur

– Results in weak gluteus medius

– Coxa Valga• Increase in angle caused by non-weight bearing

• Gluteus Medius Gait• Caused by:

– Nerve damage or other pathology– Functional weakness due to coxa vara– Congenital Hip Dislocation

– Stance• Hip abducted position, leaning toward side of

weakness– Gait

• Manner of style of walking– .– Positive Trendelenburg Gait

Deviations of the Hip

Coxa Normal

Coxa Vara

Coxa Valga

Positive Trendelenburg Test Click for movie

Gaits

• Gluteus Maximus Gait– Anatomy– Gait: Posterior sway on side of

weakness with weight bearing on same side

• Hip Flexor Gait– Circumduction gait