Hip (Coxal) JointBy: Hadil A. Elsayed

Hip Joint• Type:

Multiaxial ball-and-socket synovial joint

• Articulation:The Hip Joint articulates between the hemispherical head of the femur and the cup-shaped acetabulum of the hip bone

Bones of the Hip Joint Femur

Femoral Head Femoral Neck Greater Trochanter Lesser Trochanter Intertrochanteric Crest Intertrochanteric Line Gluteal Tuberosity

Acetabulum

Acetabulum

• Is the large cup-shaped cavity or socket on the lateral aspect of the hip bone

• Articulates with the head of the femur to form the hip joint

• The Ilium, Ischium, and Pubis join to form the acetabulum

Bones of the Hip Joint Pelvic Girdle

Acetabulum 3 bones fused together

• Ilium• Ischium• Pubis

Ilium

– Iliac fossa– Iliac Crest– Iliac Tuberosity– ASIS– AIIS– PSIS– PIIS– Gluteal Lines

Ischium– Ramus of ishium– Ischial tuberosity– Ischial spine– Lesser Sciatic Notch

Pubis– Superior Ramus of Pubis– Inferior Ramus of Pubis– Pubic Crest– Pubic Tubercle– Pectin– Symphyseal Surface

Ligaments of the Hip Joint

Ligaments of the Hip Joint• Iliofemoral Ligament• Ischiofemoral ligament• Pubofemoral ligament• Ligamentun teres

capitis femoris• Transverse acetabular

ligament

Illiofemoral ligament-Also known as the Y ligament-Runs from the base of the AIIS

to the intertrochantic line-Reinforces the fibrous capsule

anteriorly-Strongest ligament in the hip-Prevents hyperextension of the

hip during standing by screwing the femoral head into the acetabulum

Pubofemoral ligament-Runs from the anterior pubis

ramus to the anterior surface of the intertrochantic fossa

-Reinforces the fibrous capsule inferiorly and anteriorly

-Tighten during abduction and extension

-Prevents overabduction of the hip joint

Ischiofemoral ligament

-The ischial portion of the acetabulum and spirals to the neck of the femur and base of the greater trochanter

-Prevents hyperextension of the hip

-Fibers relaxed during flexion

Ligamentum teres• Known also as the ligament

of the head of the femur• Attaches to the acetabular

notch and the transverse acetabular ligament to the pit in the head of the femur

• Weak• Supplies the blood for the

femur head

Transverse acetabular ligament• A fibrous band that bridges

the acetabular notch and converts it into a foramen

• Through it the nutrients vessels enter the joint

Anterior– Rectus Femoris– Sartorius– Iliopsoas Muscle Group

• Iliacus• Psoas Major

Hip Muscles

Hip MusclesPosterior– Semimembranosus– Semitendinosus– Biceps Femoris– Gluteus Maximus

Hip MusclesMedial– Adductor Brevis– Adductor Longus– Adductor Magnus– Pectineus– Gracilus

Hip Muscles

Lateral• Gluteus Medius

-Gluteus Minimus-Tensor Fascia Lata-Six Intrinsic External Rotators

• Periformis• Quadratus Femoris• Obturator Internus• Obturator Externus• Gemellua Superior• Gemellus Inferior

Movement of the Hip Joint• Flexion

-Ilioposeas-Rectus femoris-Sartorius-Adductor muscles

• Extension-Gluteus maximus-Hamstring ms.

• Lateral rotation:-Pirifomis-Obturator internus and externu-superior and inferior gemelli-quadratus femoris-Gluteus maximus

Movement of the Hip Joint

• Abduction:-Gluteus medius -Gluteus minimus-Sartorius-Tensor fasciae latae-Piriformis

• Adduction:-adductor longus-brevise-adductor fibers of the adductor magnus

• Medial rotation:-Gluteus medius-Gluteus minimus-tensor fasciae latae

COMMON INJURIES

Dislocation of the Hip(Traumatic or Congenital)

• Femoral head moves out of the acetabulum

• Usually it goes posterior into notch

• Position: typically flexion, adduction, and internal rotation

• Common mechanism: knee to dashboard during traffic collision

• Signs and symptoms: extreme pain, obvious deformity, unwilling to move the extremity

Hip Joint Stability and Trendelenburg’s Sign

The Stability of the hip Joint depends on:

I. The Gluteus medius and minimus must be functioning normally

II. The head of the femu must be located normally within the accetabulum

III. The neck of the femur must be intact and must have a normal angle with the shaft of the femur

Hip Joint Stability and Trendelenburg’s Sign

• If any of the factors mentioned is defective, the pelvis will sink downward on the opposite, unsupported side. Then pt. then is said to exhibit a positive Trendelenburg’s Sign

Hip Joint Stability and Trendelenburg’s Sign

Arthritis of the Hip Joint (Osteoarthritis)

Arthritis of the Hip Joint (Osteoarthritis)

Most common disease of the Hip joint in Adults Signs & Symptoms: pain, stiffness, and deformity o Pain: maybe in the hip joint itself or referred to the

kneeo Stiffness: caused by the pain and refelx spasm of the

surrounding ms.o Deformaty: flextion, adduction, and external

rotation. Produced by ms. Spasm and later by ms. Contracture.