The Hip part 1

What type of the joint is the Hip? (2)

What type of the joint is the Hip? (2)

• Multi-axial Ball and Socket Joint

• Very Stable Joint

Hip Joint structure characteristics: about the acetabulum and how are the ligaments&muscles?

• Deep Acetabulum

• Strong Ligaments and Muscles

What direction does the Acetabulum face?

Lateral, Inferior, Anterior (LIA)

What are the 3 Extra-Articular Ligs of the Hip?

• Iliofemoral Lig (Y Ligaments of Bigelow)

• Ischiofemoral Lig

• Pubofemoral Lig

Function of Iliofemoral Lig?

• Strongest lig in the body

  • Prevents excessive extension of hip or anterior glide

How strong is the ischiofemoral and what does it prevent?

• Weakest of the 3 Extra Articular Ligs

  • Limits Extension and IR

Function of Pubofemoral Lig?

Prevents Excessive Abduction

What will happen if hip ligs become lax, if pt has sway back, or if hip is always in Anterior Position? (Lecture Example)

Hip position may begin to stretch tissue and overtime pt might develop wobble in Anterior Direction = Anterior type glide syndrome of the Hip

What are the 2 Intra Articular Ligs of the Hip?

Ligamentum Teres and Transverse Lig

Ligumentum Teres Function?

Transmits a branch of Obturator Artery to Femoral Head (Children and Infants)

Transverse Lig Function?

Bridges gap across Acetabular Fossa to Labrum

What does the Capsule enclose?

Hip Joint

Where does the Capsule attaches to?

Acetabular rim and laterally at trochanter line on femoral neck

Which position has the most forces on the Hip? (4)

• B/L Standing = 0.33x BW

• Single Limb Support = 2.4-2.6x BW

• Walking Up Stairs = 3-6x BW

• Running = 4.5x BW

Major vascular supply to the Hip Joint?

Medial and Lateral Femoral Circumflex Artery

Vascular Clinical Note: What can displaced femoral neck fractures do?

Disrupt the blood supply leading to Osteonecrosis (Bone Cell Death)

The Acetabulum is formed and deepened by what?

• Formed: Ilium, Ischium, Pubis

• Deepened by Labrum

All bursas are deep except which one?

Subcutaneous Trochanteric Bursa

Three most clinically significant Bursas of the Hip:

• Trochanteric (Lat Hip)

• Iliopectineal (Ant Hip)

• Ischiogluteal (Near Ischial Tub)

Which bursa is most commonly diagnosed and should be palpated for tenderness?

Trochanteric Bursa

What does the Trochanteric Bursa do?

Decrease friction between IT band, Glute Med, Glute Max, and Greater Trochanter

Where does the Iliopectineal Bursa lie?

Btw Iliopsoas and Ilipectineal eminence of bone at the superior rim of acetabulum

How much of the population has Iliopectineal Bursa?

15% >> This bursa communicates w hip joint

Where does the Ischiogluteal Bursa lie?

Btw Ischial Tuberosity and Common HS Tendon

Ischiogluteal Bursa is common in what population? What is it known as?

• People who sit on hard surfaces a lot

• AKA Weavers Bottom

ABductor and Adductor Muscles of the Hip

• AB: Glute Med/Min, TFL, Prirformis

• AD: Adductor Magnus/Longus/Brevis, Gracilis, Pectineus

Long and Short Extensor Muscle of the Hip

• Short Extensors: Glute Max

• Long Extensors: Biceps Fem, Semitendinosus, Semimembranosus

Short and Long Flexors of the Hip

• Short Flexors: Iliac and Psoas

• Long Flexors: Rec Fem, Sartorius, TFL

ER and IR of the Hip

• ER: Obt. Internus/Externus, Glute Max, Sartorius

• IR: Adductor Family, Glute Med and Min

What muscle is the primary stabilizer of hip and pelvis in SLS (Single Limb Stance)?

Glute Med

What is the most common posture in humans?

SLS

What does SLS require of the Glute Med to prevent what?

to generate 2x the BW to prevent trendeleberg

Glute Med is ____% of Hip Abductor Size

60%

Glute Min is ___%, TFL is ____%, and Piriformis is ____% of Hip Abductor Size

• Glute Min: 20%

• TFL and Piriformis: 10%

Origin of Glute Med

Along most of Superior Iliac Crest and Posterior to Greater Trochanter

Insertion of Glute Med

Anterior to midline of Greater Trochanter

What can contracture of the Iliopsoas disturb?

Normal Kinetics btw Lumbar, Pelvis, Hips

What can Contracture Disturbance of Iliopsoas cause what 3 things?

Altered gait, function, and pain

What 5 muscles are part of the Adductor Family?

Magnus, Longus, Brevis, Gracilis, Pectineus

What is the Adductor Family important for? (2)

• Adduction torque

• Bidirectional role of flexion and extension (Helps control limb in space)

What does Adductor Fam help w? What do you oftenly see?

To smooth transition between flexion and extension in running and gait >> Often seen w Adductor Strains

What 2 muscles make up the hip extensors?

Glute max

Hamstrings

When is the HS most active?

Gait and ADL's

When is the Glute Max active?

W propulsive activities >> Stair Climbing, Jumping, Running

Hip Extensor Clinical Pearl: (MMT) (2 positions)

• MMT hip ext w knee extend = more HS

• MMT hip ext w knee flex = more Glute Max

What muscle is the only muscle that passes through the Greater Sciatic Foramen along w ___ nerves and ___ blood vessels

• Piriformis Bitch

• 7 nerves

• 6 blood vessels

Piriformis Syndrome characteristics: often over what? What does it usually refer to? Referred pain for what?

• Often over diagnosed

• Usually refers to trigger point pn in Piriformis OR

• Referred pn for Irritated Sciatic Nerve

Piriformis: Greater than 90 deg of flexion =

IR

Piriformis: Less than 40 deg of flexion =

ER

Piriformis: Btw 40-90 degrees =

Abductor

What envelops muscles of the thigh?

Fascia Latae

Where for the IT Band extend from?

Iliac Crest to Tibia

IT Band crossing over Trochanter can possibly cause what?

Bursitis

What muscles attach to the IT Band and at what level?

• Glute Max and TFL

• At level of Greater Trochanter

What are the 3 other important Fascia?

• Abdominal

• Thoracolumbar

• Deep fascia of the butt