Hip & Pelvis

Hip Joint

Between Acetabulum (Pelvis) & Head of Femur

Ball and Socket Joint Weight Bearing

Acetabulum

• Formed from Ilium, Ischium, and Pubis

• Oriented laterally, anteriorly, inferiorly

• Acetabular Rim

• Acetabular Notch

Netter

453

Femur

Head

Neck

Greater Trochanter

Lesser Trochanter

Intertrochanteric Line

Intertrochanteric Crest

Netter

453

Femoral Neck AnglesCoronal Plane

Normal Coxa Valga Coxa Vara

125 > Normal < Normal

Femoral Neck AnglesHorizontal Plane

Normal 15° anterior

Anteversion

> 15° anterior

Toe-In Posture

Retroversion

< 15° anterior

Toe-Out Posture

Joint Capsule

Netter

454

Acetabular Labrum

Transverse Acetabular Ligament

Ligamentum Teres

Capsular Ligaments

Accessory Ligaments

Accessory Ligaments

Netter

454

Anterior – limit extension &

external rotation– Iliofemoral Ligament (Y)– Pubofemoral Ligament

Posterior– Ischiofemoral Ligament

Movements of the

Hip & Pelvis

Movement at the Hip Flexion Extension Abduction Adduction Internal Rotation External Rotation Circumduction

Movement of the Pelvis

Anterior Rotation (AS Ilium, +X)

Posterior Rotation (PI Ilium, - X)

Lateral Flexion (High or Low Ilium

– (+ or - Z)

Rotation (+ or - Y)

Determining APICompare angle between PSIS & ASIS to horizontal

Posture - Pelvis ( X)

Anterior & Posterior Rotation

Angle of Pelvic Inclination (API)

Males = 0° to 5° anterior

Females = 5° to 10° anterior

Combined Movements Movement of the Pelvis at the end

range of Hip movement– Due to ligamentous attachments

Movements of the Pelvis and Lumbar Spine with a Fixed Femur (standing)

Effects of Contracture/Shortening of muscles on Posture and Movement

Hip Flexion

Anatomy of

Movement

186

End Range of Hip Flexion - Effects on Pelvis & Lumbar Spine

Posterior Rotation of Pelvis

Decreased Lumbar Lordosis

Anatomy of

Movement

206

Muscles that Flex the Hip

Iliopsoas

Rectus Femoris

Tensor Fascia Lata (TFL)

Sartorius

Anatomy of

Movement

231

Major Hip Flexor Iliopsoas Proximal Attachments– Psoas Major - Lumbar

vertebral bodies & discs– Iliacus - Entire internal iliac

fossa Distal Attachment– Common tendon attaches to

lesser trochanter of femur

Netter

462

Other Hip Flexors

458 Rectus Femoris– AIIS to patella (via

quadriceps tendon)

Sartorius– ASIS to Pes Anserine

insertion (Tibia)

Tensor Fascia Lata– ASIS to Iliotibial Band

fascia

Netter

458

Action of Hip Flexors with Femur fixed

Anterior rotation of Pelvis

Increased Lumbar Lordosis

Anatomy of

Movement

214

Effects of Contracture of Hip Flexors on Posture & Movement

Anteriorly Rotated Pelvis• Sagittal Plane

• +X rotation (anterior ilium)

Increased Lumbar Lordosis

Limited Hip Extension

Hip Extension

Anatomy of

Movement

187

End Range of Hip Extension - Effects on Pelvis & Lumbar Spine

Anterior Rotation of Pelvis

Increased Lumbar Lordosis

Anatomy of

Movement

222

Muscles that Extend the Hip

Gluteus Maximus

Hamstrings– Biceps Femoris– Semimembranosus– Semitendinosus

Anatomy of

Movement

231

Hip Extensors Gluteus Maximus– Medial Attachments - Medial Ilium,

Lateral Sacrum, Sacrotuberous Ligament

– Lateral Attachments - Posterior shaft of Proximal Femur, Iliotibial Band

– Also externally rotates hip Netter

461

Hip Extensors Hamstrings Attach proximally on

Ischial Tuberosity Distal Attachments

– Biceps Femoris (lateral on fibular Head)

– Semimembranosus & Semitendinosus (medial on tibia)

Netter

461 & 468

Action of Hip Extensors with Femur fixed

Posterior rotation of Pelvis

Decreased Lumbar Lordosis

Anatomy of

Movement

222

Effects of Contracture of Hip Extensors on Posture

Posteriorly rotated pelvis

Indirectly causes Lumbar Hypolordosis

Limited Hip flexion (with knee extended - Hamstrings)

Hip Abduction

Anatomy of

Movement

188

Position of Femur

Femur must be externally rotated for full abduction

Internal Rotation External

Rotation

Anatomy of

Movement

188

End Range of Hip Abduction - Effects on Pelvis & Lumbar Spine

Contralateral Lateral Flexion of Pelvis

Ipsilateral Lateral Flexion of Lumbar Spine

Anatomy of

Movement

188

Hip Abductors

Gluteus Medius

Gluteus Minimus

Tensor Fascia Lata

Gluteus Maximus

Anatomy of

Movement

231

Hip Abductors - Attachments

Gluteus Medius– Upper part of External Iliac

Fossa to Lateral aspect of Greater Trochanter

Gluteus Minimus– Lower part of External Iliac

Fossa to Lateral aspect of Greater Trochanter

Netter

469

Tensor Fascia Lata

ASIS to Iliotibial Band

Actions - Abduction, Flexion & Internal Rotation

Netter

460

Anatomy of

Movement

227

Action of Hip Abductors with Fixed Femur Ipsilateral

lateral flexion of pelvis

Stabilization of Pelvis during stance on one leg

Anatomy of

Movement

227 & 229

Effects of Contracture of Hip Abductors on Posture

Low ilium (ipsilateral lateral flexion of pelvis)

Limits adduction (widened stance)

May limit flexion or extension of hip

Weakness of Hip Abductors

Weakness causes contralateral lateral flexion of Pelvis during stance on one leg

Trendelenberg Test

Adduction of the Hip

Anatomy of

Movement

187

Hip Adductors

Pectineus

Adductor Longus

Adductor Brevis

Adductor Magnus

Gracilis

Anatomy of

Movement

232

External Rotation of the Hip

Anatomy of

Movement

189

Hip External Rotators Gluteus Maximus

– Medial Attachments - Medial Ilium, Lateral Sacrum, Sacrotuberous Ligament

– Lateral Attachments - Posterior shaft of Proximal Femur, Iliotibial Band

– Also extends hip Netter

461

Hip External Rotators

Piriformis– Anterior sacrum to greater trochanter

Short External Rotators– Gemelli– Obturators– Quadratus Femoris

Netter

469

Internal Rotation of the Hip

Anatomy of

Movement

189

Internal Rotators

Tensor Fascia Lata

Anterior fibers of Gluteus Medius and Gluteus Minimus

Netter

460