Functional Anatomy of the Hip, Buttock, & Thigh

Name the osteology of the hip.

• ilium

• ischium

• pubis

• acetabulum

Describe the lunate surface of the acetabulum.

• smooth articular surface

• portion where head of femur articulates

• broadest superiorly

Describe the acetabular notch of the acetabulum.

• opening, covered by transverse ligament

Describe the acetabular fossa of the acetabulum.

• where ligament of the head of the femur attaches

Describe the labrum of the acetabulum.

• u-shaped cartilage

• deepens socket

• enhances joint stability

Describe the transverse acetabular ligament of the acetabulum.

• crosses over the acetabular notch

• neurovascular structures pass just deep of the ligament

What bony landmarks can be viewed from the posterior view of the proximal femur

• femoral head

• fovea

• femoral neck

• greater trochanter

• lesser trochanter

• intertrochanteric crest

• linea aspera

• gluteal tubersity

• pectineal line

Where is the intertrochanteric crest located?

• posterior aspect of femur

• runs between lesser and greater trochanter

Where is the linea aspera located?

• ridge on posterior aspect of femur

• forms into the medial lip (where adductor longus and brevis) and lateral lip (where short head of the biceps femoris proximally attaches)

Where is the gluteal tuberosity located?

where the lateral lip leads to

Where is the pectineal line located?

where medial lip leads to

Where is the intertrchanteris line located?

• anterior aspect of femur

• where pectineal lines leads to in the front

What is the hip jpoint classifieds as?

• diarthrodial

• ball and socket

• multiaxial

• simple

• complex

Name the bony members of the hip joint.

• pelvis

  • acetabulum: faces anterolateral & inferior

• Femur

  • head of femur: faces superior, anterior, and medial

What is the normal angle of inclination for the femur from the frontal plane alignment?

125 degrees

What is coxa vara

• < 125 degrees of angle of inclination

• greater trochanter more prominent

• decrease leg length

• may lead to genu valgum and/or “squinting patella”

What is coxa valga

• > 125 degrees of angle of inclination

• increases leg length

• may lead to genu varum and/or laterally positioned patella

Describe the normal orientation of the femur in the transverse plane.

normal to have anteversion — 12-15 degrees

Describe the transverse plane deformity anteversion

• >15 degrees

• compensatory hip IR

• excessive hip IR, decreased ER

• in-toeing

Describe the transverse plane deformity retroversion

• < normal anteversion

• compensatory hip ER

• excessive hip ER, decreased IR

• out-toeing

Describe the zone of weakness

• superior and lateral neck of femur

• common fracture site

Describe open/loose packed position.

• 30 deg flx

• 30 deg abd

• slight ER

Describe the closed packed position ligamentous.

ext, IR, ABD

Describe the closed packed position bony congruency.

full flx, ABD, ER

Name the ligaments of the hip joint.

• iliofemoral

• pubofemoral

• ischiofemoral

Which movement do all of the hip joint ligaments limit

extension

Where do each hip joint ligament originate?

off each perspective edge of acetabulum

What is the iliofemoral ligament also known as?

Y ligament of Bigelow

What is the proximal attachment of the iliofemoral ligament?

iliac portion of the rim of the acetabulum and the AIIS

What is the distal attachment of the iliofemoral ligament?

anterior capsule and the intertrochanteric line

What does the iliofemoral ligament limit?

• hip hyperextension and ER

• also superior fibers limit hip adduction

What is the proximal attachment of the pubofemoral ligament?

pubic portion of the acetabular rim

What is distal attachment of the pubofemoral ligament?

blends into inferior capsule

What does the pubofemoral ligament limit?

hip extension and hip abduction

What is the proximal attachment of the ischiofemoral ligament?

ischial portion of rim of acetabulum

What is the distal attachment of the ischiofemoral ligament?

• 1 portion runs horizontally — reinforcing posterior capsule

• 1 spirals over femoral neck to attach to greater trochanter

What does the ischiofemoral ligament limit?

• spiral fibers limit hip extension

• posterior fibers limit hip IR

• limit adduction when hip is flexed

What does the transverse acetabular ligament provide when weight bearing?

shock absorption to the hip joint

What does the transverse acetabular ligament protect?

neurovascular supply to head of femur

When does slack occur for the ligament of head of femur?

during most movements

Where does the ligament of head of femur attach?

in acetabular notch and fossa, and runs to fovea

What does the ligament of head of femur contain?

an artery that gives blood supply to the head of the femur

What is the normal ROM for hip flexion?

120

What is the normal ROM for hip extension?

30

What is the normal ROM for hip abduction?

45

What is the normal ROM for hip adduction?

30

What is the normal ROM for IR?

45

What is the normal ROM for ER?

45

What are the contributions of pelvis and lumbar spine to hip flexion?

• posterior pelvic rotation

• flexes the lumbar spine

What are the contributions of pelvis and lumbar spine to hip extension?

• anterior pelvic rotation

• extends the lumbar spine

The convex femoral head moves on concave acetabulum during open or closed chain movements?

open

Which directions do rolls and glides move in relation to each other?

opposite directions

What action at the hip does anterior pelvic tilt produce

• produces hip flexion

What action at the hip does posterior pelvic tilt produce

• produces hip extension

Pelvic rotation to the left produces what actions at the hip

• left hip IR

• right hip ER

Pelvic rotation to the right produces what actions at the hip?

• left hip ER

• right hip IR

What happens at the hip when lateral pelvic tilt occurs?

• pelvis elevated on one side

• hip on elevated side is is adduction

• hip on opposite is abducted

What are the three bursae of the hip

• iliopectineal bursa

• greater trochanteric bursa

• ischiogluteal bursa

Where is the iliopectineal bursa located?

between iliopsoas and anterior aspect of hip joint

Where is the greater trochanteric bursa located?

between glute max and posterolateral aspect of greater trochanter

Where is the ischiogluteal bursa located?

ischial tuberosity

What are the three compartments of the thigh?

• anterior

• medial

• posterior

What separates the compartments of the thigh

thinly lined wall

What separates the anterior compartment from the posterior compartment?

• lateral IMS

What separates the anterior compartment from the medial compartment?

medial intermuscular septa

What are the muscular contents of the anterior compartment?

muscles that mainly extend the knee joint

Which nerve is in the anterior compartment?

femoral nerve

What separates the posterior compartment from the medial compartment?

• fascial plane between adductor magnus and hamstrings

What are the muscular contents of the posterior compartment?

muscles that mainly extend the hip joint and flex the knee joint

Which nerve is located in the posterior compartment?

sciatic nerve

What are the muscular contents of the medial compartment?

muscles that mainly adduct the thigh

Which nerve is in the medial compartment?

obturator nerve

What is the main vascular supplier of the hip?

femoral artery

What does the femoral nerve stem from?

arises from the ventral rami of L2-4

Where does the obturator nerve stem from?

arises from the ventral rami L2-4

which muscles does the obturator supply?

muscles in the medial compartment

Name the borders of the femoral triangle.

• Inguinal Ligament

• Sartorius

• Adductor Longus

name the floors of the femoral triangle

• Medial: pectineus

• lateral: iliopsoas

Name the contents of the femoral triangle from medial to lateral.

• Vein

• Artery

• Nerve

Where does the superior gluteal nerve exit?

superior to piriformis

Where does the inferior gluteal nerve exit?

inferior to piriformis

Describe the sciatic nerve

• levels L4-S3

• exits inferior to piriformis

• innervates posterior thigh

• descends between th egreater trochanter of the femur and ischial tuberosity

Describe adductor hiatus

small hole by adductor magnus distally