Rania Gabr

Hip Joint

Objectives• Know the type and formation of hip

joint.• Differentiate the stability and mobility

between the hip joint and shoulder joint.

• Identify the muscles that act at the hip joint.

Type & Articular Surfaces Type:

• Synovial, ball & socket joint. Articular Surfaces:

• Acetabulum of hip (pelvic) bone

• Head of femur• The lunate surface and the

head of the femur(except for the fovea) are covered by hyaline cartilage

• The nonarticular acetabular fossa contains loose connective tissue.

• Acetabular labrum:

• C-shaped fibro-cartilaginous collar attached to margins of acetabulum, increases its depth for better retaining of head of femur.

The hip joint is enclosed within strong fibrous capsule lined by synovial membrane .

• Proximally:it is attached to the acetabulum, and to the transverse acetabular ligament .

• Distally: Anteriorly: covers the neck & is attached to intertrochanteric line Posteriorly: covers medial half of the neck of femur

Capsule

Inte

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line

ANTERIOR

POSTERIOR

• The synovial membrane lines the capsule and the nonarticular surfaces.

• It reflects along the femoral neck to the edge of the femoral head

Synovial Membrane

The arteries that supply the femoral head and neck course within the synovial folds.

They are called retinacular vessels

Pubofemoral ligament:• Located antero-inferior to joint• Limits abduction & lateral rotation

Iliofemoral ligament: • Y-shaped• Located anterior to joint• Limits extension

Ligaments: 3 Extracapsular

Ischiofemoral ligament:• Located posterior to joint• Limits medial rotation

Ligaments: 2 Intracapsular (Extrasynovial)

Transverse acetabular ligament:• formed by the acetabular labrum

as it bridges the acetabular notch • converts acetabular notch into

foramen through which pass acetabular vessels

Ligament of femoral head: carries vessels to head of femur

• Flexion.• Extension,

Movements of the hip

• Abduction. • Adduction.

• Medial and lateral rotation.• Circumduction.

Iliopsoas(composite muscle)Chief flexor of HIP: Psoas major iliacus• Origin:1- Anterior surfaces of the transverse processes of T12-L5 vertebrae2- Upper two thirds of the iliacus• Insertion: Lesser trochanter of the femur after being joined by the iliacus• Action: 1-Flexion of thigh at hip2- Assists in extension of the lumbar spine3. Lateral Flexion of the spine when acting unilaterally• Innervation: Lumbar plexus (L2,3,4)

Hip Flexion

Psoas Major

OriginIliac fossa within abdomenInsertionLowermost surface of lesser trochanter of femur, after joining psoasActionFlexes &laterally rotates hipNerveFemoral nerve in abdomen (L2,3)

Iliacus

Gluteal region:

-Gluteus maximus(most powerful extensor,also lateral rotator)

Insertion:Gluteal tuberosity +Iliotibial tract (band)

gluteus maximus

iliotibial tractTensor FasciaeLatae

Gluteusmaximus

Gluteus Maximus and Tensor Fascia Lata insert into Iliotibial Tract- Iliotibial tract is a thickening of the deep fascia (fascia lata) that extends from the ilium to the tibia. - Tension from contraction of gluteus maximus and tensor fasciae latae stabilizes the lower limb as a weight-bearing column.

Hip extension

Medial Compartmentmain function = adduction Obturator externus Adductor brevis Adductor longus Adductor magnus Gracilis

Most innervated by:Obturator nerve (L2-L4)(lumbar plexus)

Exception:-Hamstring component of adductor magnus (extensor) (tibial division of sciatic nerve)

obturator nerve

adductor longus

adductor brevis

Adductormagnus

gracilis

obturatorexternus

Hip Adduction

Deep to gluteus maximus:-Abductors:

gluteus mediusgluteus minimus

(anterior fibres medially rotate)

-Lateral (external) rotators:piriformisobturator internus(associated gemelli)quadratus femoris

[obturator externus is also alateral rotator]

inferior gamellus

superior gamellus

gluteus medius

gluteus minimus

piriformis

obturator internus

quadratus femoris

gluteus maximus

Lateral Rotation of the hip

Flexion - Anterior + medial compartments of thigh (iliopsoas, sartorius, rectus femoris, adductor)

group)

Extension - Gluteal region /posterior compartment of thigh (gluteus maximus, hamstrings, adductor magnus)

Adduction - Medial (adductor) compartment of thigh

Abduction - gluteus medius & minimus, Tensor Fascia Lata

Rotation:Lateral - Gluteus maximus, lateral rotators

Medial - anterior parts of gluteus medius & minimus, + Tensor Fascia Lata

SummaryMovements of the Hip Joint (ball and socket)

• 1- Obturator artery. • 2-Medial &• 3-Lateral circumflex

femoral arteries.• 4- Superior and inferior

gluteal arteries. • 5- First perforating branch

of the deep artery of the thigh.

The articular branches of these vessels form a network(anatomosis) around the joint .

Vascular supply to the hip joint

• The hip joint is innervated by articular branches (Hilton’s Law) from:

• Femoral.• Obturator.• Superior gluteal nerves• Nerve to the

quadratus femoris.• Sciatic nerve.

Nerve Supply of the hip joint

Perthes' disease is a condition where the top of the thigh bone in the hip joint (the femoral head) softens and breaks down.

It occurs in some children and causes a limp and other symptoms. The bone gradually heals and reforms as the child grows.

The aim of treatment is to make sure the femoral head reforms back into its normal shape so that the hip joint can work well.

Applied anatomyPerthes disease

Coxa vara and Coxa Valga

Avascular Necrosis of the Head of the Femur