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The Hip
Clarification of Terms O Lower extremity = pelvis, thigh, leg, and foot O Pelvic Girdle (aka Pelvis) = the two hip bones
(innominates), the sacrum, and the coccyx O Innominate = the ilium, ischium and pubis
fused together O Thigh = femur and patella O Leg = tibia and fibula
Lippert, p261
Osteology of the Hip The “hip bone” (aka innominate) is really the union of 3 bones:
• The ilium, the ischium & the pubis
Ilium
Pubis Ischium Lippert, p262
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Osteology of the Hip The “hip bone” (aka innominate) is really the union of 3 bones :
• The ilium, the ischium & the pubis
Lateral Aspect Right Hip
Anterior Aspect Right Hip
Lippert, p262
Osteology of the Hip (Bones) O Ilium O Iliac fossa O Iliac crest O Anterior superior iliac spine (ASIS) O Anterior Inferior Iliac Spine (AIIS) O Posterior Superior Iliac Spine (PSIS) O Posterior Inferior Iliac Spine (PIIS)
Lippert, p263
Osteology of the Hip
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Osteology of the Hip (Bones) O Ischium O Body O Ramus O Ischial tuberosity O spine
Lippert, p263
Osteology of the Hip
Osteology of the Hip (Bones) O Pubis O Body O Superior ramus O Inferior ramus O Symphysis pubis O Pubic tubercle
Lippert, p
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Osteology of the Hip (Bones) O Made up of combinations of the ilium,
ischium and pubis O Acetabulum O Obturator foramen O Greater sciatic notch
Osteology of the Hip (Bones)
Obturator foramen
Greater Sciatic Notch
Osteology of the Hip (Bones) O Femur
O Adductor tubercle
O Head
O Linea aspera
O Neck
O Pectineal line
O Greater trochanter O Lesser trochanter
O Patellar surface
O Body O Medial condyle O Lateral condyle O Lateral epicondyle O Medial epicondyle
Lippert, p264-265
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Osteology of the Hip
Osteology of the Hip
Osteology of the Hip
Anterior Aspect Right Femur
Posterior Aspect Right Femur
anatomical neck
surgical neck
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Osteology of the Hip
What can you palpate? What can you NOT palpate?
Hip Joint Structure O The hip is the most proximal of the lower
extremity joints
O Ball and socket joint O Triaxial joint – motion in all 3 planes = 3
degrees of freedom
O A very stable joint O The convex-shaped femoral head fits into
and articulates with the concave-shaped acetabulum
Lippert, p262
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Hip Joint Structure…cont O Angle of Inclination: O Frontal plane angle created between the
femoral neck and the shaft of the femur O Normal angle = 125 degrees, which directs
the shaft of the femur toward midline, positioning the knee directly under the weight of the body
Mansfield, p233
Hip Joint Structure…cont Angle of Inclination continued
O Deviations in the angle can occur from
abnormal development or from trauma
O This can cause instability and stress on the
joint, which can lead to degeneration, pain and gait abnormalities Mansfield, p233
Hip Joint Structure…cont O Torsion Angle O The femur is naturally twisted along its long
axis O The twist is described as torsion between the
shaft and neck of the femur O Relative to the femoral condyles, the femoral
neck projects anteriorly 15 degrees (known as normal anteversion)
Mansfield, p233
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Hip Joint Structure…cont O Torsion Angle continued O Normal anteversion is
associated with the most optimal alignment of the femur in the acetabulum O When extreme, excessive anteversion may lead to anterior hip instability and a hip that appears to be internally rotated instead of neutral Mansfield, p233
Hip Joint Movement O Osteokinematics: O Sagittal plane = flexion, extension,
hyperextension
O Frontal plane = abduction, adduction O Transverse plane = internal and external
rotation
O Arthrokinematics: O The convex femoral head slides in the
direction opposite to the movement of the thigh Lippert, p
Hip Joint: Supporting Structures O Supporting Structures located within the hip
joint
O Transverse acetabular ligament: spans
acetabular notch, completing the “cup” of the acetabulum O Acetabular labrum: a ring of fibrocartilage surrounding the outer rim of the acetabulum, which deepens the socket and “seals” the joint O Articular cartilage: acts as a shock absorber Mansfield, p234
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Hip Joint: Supporting Structures O Supporting Structures located outside the hip
joint
O Joint capsule: covers hip joint in cylindrical
fashion and is reinforced by 3 ligaments:
O Iliofemoral Ligament or “Y” Ligament: one of the
thickest ligaments in the body, looks like inverted Y, limits excessive hip extension
O Ischiofemoral Ligament: spirals around the
femoral neck, limits extension and internal rotation
O Pubofemoral Ligament: limits abduction and
extension
Lippert, p234
Hip Joint Myology
Lippert, p267
Muscle Group
1 joint muscles
2 joint muscles
Anterior
iliopsoas
Rectus femoris
Medial
Pectineus
Sartorius Gracilis
Adductor magnus Adductor lungus Adductor brevis Posterior
Gluteus maximus
Semimembranosus
6 deep rotators
Semitendinosus Long head biceps femoris
Lateral
Gluteus medius
Tensor fascia latae
Gluteus minimus
Iliopsoas Origin
Psoas Major: transverse processes of T12-L5 Iliacus: Iliac fossa
Insertion
Lesser trochanter of the femur
Innervation
Femoral n.
Action
Hip flexion, trunk flexion, anterior pelvic tilt
Lippert, p267
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Myology of the Hip Your subtopic goes here Rectus Femoris Origin
Anterior-inferior iliac spine
Insertion
Tibial tuberosity via the quadriceps tendon
Innervation
Femoral n.
Action
Hip flexion, knee extension
“tidbit”
One of the heads of the “quads”
Lippert, p268
Myology of the Hip Your subtopic goes here Sartorius Origin
ASIS
Insertion
Proximal-medial surface of the tibia (via the pes anserinus)
Innervation
Femoral n.
Action
Hip flexion, hip ABD, Hip ER, knee flexion
“tidbit”
Longest muscle in the body
Lippert, p268
Myology of the Hip Your subtopic goes here Pectineus Origin
superior ramus of pubis
Insertion
Pectineal line on posterior surface of the femur
Innervation
Femoral Nerve (may receive a branch from Obturator Nerve)
Action
Hip ADD, hip flexion
Lippert,268
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Myology of the Hip Your subtopic goes here ADDuctor Longus Origin
Anterior surface of the body of the pubis
Insertion
Middle 1/3 of the linea aspera of the femur
Innervation
Obturator n.
Action
Hip ADD, Hip flexion
“tidbit”
What’s in a name?
Lippert, 269
Myology of the Hip Your subtopic goes here ADDuctor Brevis Origin
Proximal Attachment: Anterior surface of the inferior pubic ramus
Insertion
Proximal 1/3 of the linea aspera of the femur
Innervation
Obturator n.
Action
Hip ADD, Hip flexion
“tidbit”
What’s in a name?
Lippert, 270
Myology of the Hip Your subtopic goes here ADDuctor Magnus Origin
Ischium and Pubis
Insertion
Entire linea aspera and adductor tubercle
Innervation
Obturator and sciatic nerve (L3, L4)
Action
Hip adduction
“tidbit”
What’s in a name?
Lippert, p270
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Myology of the Hip Your subtopic goes here Gracillis Origin
Body and inferior ramus of the pubis
Insertion
Proximal-medial aspect of the tibia (pes anserinus)
Innervation
Obturator n.
Action
Hip ADD, hip flexion, knee flexion
Lippert, p270
Myology of the Hip Your subtopic goes here Gluteus Maximus Origin
Posterior ilium, sacrum, coccyx
Insertion
ITB and Posterior femur distal to the greater trochanter
Innervation
Inferior gluteal n.
Action
Hip extension, hip ER
Lippert, p271
Myology of the Hip Deep Rotators Origin
Posterior sacrum, ischium, pubis
Insertion
Greater trochanter area
Innervation
Numerous
Action
Hip external rotation
Deep Rotators: Piriformis Gemellus Superior Gemellus Inferior Quadratus Femoris Quadratus Internus
Lippert, p271
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Myology of the Hip Your subtopic goes here Semimembranosus Origin
Ischial tuberosity
Insertion
Medial condyle of the tibia, posterior aspect
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion
“tidbit”
One of the hamstrings
Lippert, 271
Myology of the Hip Your subtopic goes here Semitendinosus Origin
Ischial tuberosity
Insertion
Proximal-medial surface of the tibia (pes anserinus)
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion,
“tidbit”
One of the hamstrings
Lippert, p271
Myology of the Hip Your subtopic goes here Biceps Femoris Origin
Long Head: Ischial tuberosity Short Head: lateral lip of linea aspera
Insertion
Head of the fibula
Innervation
Long Head: Sciatic n. Short Head: Common Peroneal n.
Action
Long Head: Hip extension, knee flexion Short Head: knee flexion
“tidbit”
One of the hamstrings
Lippert, p271
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Hamstrings
Myology of the Hip Your subtopic goes here Gluteus Medius Origin
Outer surface of the ilum
Insertion
Greater trochanter of the femur
Innervation
Superior gluteal n.
Action
Hip ABD
Gluteus Medius
Iliac Crest
Gluteus Maximus
Lippert, p272
Myology of the Hip Your subtopic goes here Gluteus Minimus Origin
Outer surface of the ilium, inferior to the gluteus medius
Insertion
Greater trochanter
Innervation
Superior gluteal n.
Action
Hip ABD, hip IR
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Trendelenberg Sign The Hip ABDuctors play an important role in maintaining an upright posture during single limb support. If hip weakness is suspected, single limb support over the affected limb would look like this when the uninvolved limb is lifted The pelvis drops down toward the unsupported side
Mansield, p259
Myology of the Hip Your subtopic goes here Tensor Fascia Latae Origin
ASIS
Insertion
Proximal 1/3 of the ITB
Innervation
Superior gluteal n.
Action
Hip flexion, hip ABD,
Lippert, p274
Anterior Superficial Muscles of the Thigh
Lippert, p274
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Anterior Deep Muscles of the Thigh
Lippert, p274
Medial Thigh Muscles
Lippert, p275
Lateral Thigh Muscles
Lippert, p276
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Posterior Superficial Muscles of the Thigh
Lippert, p275
Posterior Deep Muscles of the Thigh
Myology of the Hip Lippert, p278
Prime Movers
Action
Muscle
Flexion & Abduction
TFL
Flexion, Abduction, ER
Sartorius
Flexion
Rectus femoris, iliopsoas, pectineus
Extension
Gluteus maximus, semitendinosis, semimembranosus, long head biceps femoris
Hyperextension
Gluteus maximus
Abduction
Gluteus medius, gluteus minimus
Adduction
Pectineus, adductor longus, adductor brevis, adductor magnus, gracilis
Internal Rotation
Gluteus minimus
External Rotation
Gluteus maximus, deep rotators
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Common Hip Pathologies O Congenital Hip Dislocation O Legg-Calve-Perthes Disease O Slipped Capital Femoral Epiphysis O Coxa Valga O Coxa Vara O Anteversion O Retroversion
Congenital Hip Dislocation
Lippert, p275
Legg-Calve-Perthes
Lippert, p275
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Slipped Capital Femoral Epiphysis
Lippert, p275
Coxa Valga and Vara
Anteversion and Retroversion O Best picture is in Lippert, p 277
Lippert, p277 & Mansfield, p233
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Pin the Tail on the Donkey O Point to the… O Hip flexors O Hip extensors O Hip abductors O Hip adductors
Identify what you can! (in the hips) Hip ADDuctors Sartorius ADDuctor Longus ADDuctor Brevis ADDuctor Magnus Hip Flexors Rectus femoris TFL Hip ABDuctors TFL
Identify what you can! (in the hips) Gluteus Maximus Gluteus medius Hamstrings Semimembranosus Biceps Femoris Semitendinosus TFL
OK go for it! Pick out everything else!
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References O Lippert, L.S. (2011). Clinical Kinesiology and
Anatomy, 5th ed. Philadelphia, PA: F.A. Davis. O Mansfield, P.J., & Neumann, D.A. (2009).
Essentials of Kinesiology for the Physical Therapist Assistant. St. Louis, MO: Mosby Elsevier.
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