Hip Anatomy PDF

HIP ANATOMY PT7001  LEARNING OUTCOMES By the end of the lecture students should be able to: Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays State the shape of the a...

HIP ANATOMY PT7001  LEARNING OUTCOMES By the end of the lecture students should be able to: Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays State the shape of the articular surfaces and describe the attachments of the State capsule and synovium Describe the capsular and intra-capsular ligaments of the joint and know how Describe they limit joint movement Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability Describe the blood and nerve supply to the joint, and appreciate the significance Describe of this supply in relation to hip fractures NEUTRAL 0° FLEXION 100° EXTENSION 0° ABDUCTION 0°  MEDIAL ROTATION 0° LATERAL ROTATION 0°  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays ACETABULOFEMORAL JOINT Classification = A Synovial Ball and Socket joint Movements available = Flexion, Extension, Adduction, Abduction, Medial & Lateral rotation Planes of movement = Sagittal Frontal Transverse Multi-axial = Medial-Lateral Anterior-Posterior Superior-Inferior DEEP - gives STABILITY but compromises on MOBILITY  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays ACETABULOFEMORAL JOINT Acetabulum - Ilium Fuse to form - Ischium the innominate - Pubis bone Femur  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays The Femur Head Neck Greater trochanter Lesser trochanter Shaft Linea aspera Trochanter = Greek ‘to run’ - running muscles attach  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays  Know the principal bony features in and around the hip joint, and describe their Know appearance in plain X-rays  State the shape of the articular surfaces and describe the State attachments of the capsule and synovium SURFACES lūna - moon, lūnātus - crescent-shaped Prominent lunate surface of acetabulum covered by articular cartilage Acetabular fossa (non-articular) contains fat, nerves, blood vessels Acetabular foramen (gap) allows nerve & artery to the joint - bridged by transverse acetabular ligament  State the shape of the articular surfaces and describe the State attachments of the capsule and synovium SURFACES Femoral head articulates with the lunate surface - - covered with articular cartilage - - except for the fovea capitus  - L. of head of femur attachment - (ligamentum teres) Cartilage coefficient of friction ≈ 0.002 - 0.01 (ice ≈ 0.2- 0.5)  State the shape of the articular surfaces and describe the attachments of the State capsule and synovium A C E TA B U L A R A C E TA B U L A R H YA L I N E LABRUM C A RT I L A G E Acetabulum is deepened all round by the fibrocartilaginous acetabular labrum attached to the bony rim and to the transverse ligament. 2/3 of femoral head in contact Fibrocartilaginous lip to with the acetabulum deepen socket vital for joint stability rupture can lead to dislocation likewise, disloc can cause rupture  State the shape of the articular surfaces and describe the State attachments of the capsule and synovium Synovial capsule CAPSULE Very strong fibrous capsule - surrounds the head and neck of femur and acetabulum to increase stability of joint, but flexible enough to allow great RoM Attaches: - proximally to the acetabulum & transverse acetabular ligament - distally to the neck of the femur anteriorly at the GT Synovial membrane (synovium) - lines the inner surface of the fibrous capsule and covers the acetabular labrum - secretes synovial fluid  State the shape of the articular surfaces and describe the attachments of the State capsule and synovium STABILITY Anteromedially the capsule is strengthened by the deep fibres of the reflected head of rectus femoris Laterally the capsule is strengthened by deep fibres from gluteus minimus  State the shape of the articular surfaces and describe the attachments of the State capsule and synovium CAPSULE ATTACHMENTS  Describe the capsular and intra-capsular ligaments of the joint and know how Describe they limit joint movement CAPSULAR LIGAMENTS iliofemoral ligament very strong and thick triangular band pubofemoral ligament strengthens the inferior and anterior aspects of the joint capsule ischiofemoral ligament spiral in shape less well defined  Describe the capsular and intra-capsular ligaments of the Describe joint and know how they limit joint movement Anteriorly situated ILIOFEMORAL Originates at the AIIS and then fans out to insert along the intertrochanteric line of the femur. LIGAMENT Resists hip extension, adduction (superior fibres), and abduction (inferior fibres). Anteriorly situated. Originates from the anterior aspect of the pubic PUBOFEMORAL ramus and the iliopubic eminence and inserts on LIGAMENT the anterior surface of the intertrochanteric fossa. Resists hip abduction and extension. Posteriorly situated. Originates on the posterior surface of the ISCHIOFEMORAL acetabular rim and is said to "wind" around the LIGAMENT joint and insert on the superior, anterior aspect of the greater trochanter. Resists hip extension and medial rotation.  Describe the capsular and intra-capsular ligaments of the joint and know how Describe they limit joint movement INTRA-CAPSULAR LIGAMENTS Transverse acetabular ligament - crosses the acetabular notch Ligament of head of femur (ligamentum teres) - attach to fovea - no role in stability - its synovial membrane forms a tube for blood vessels - sometimes absent in adults  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability HIP MUSCLES  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability GLUTEAL MUSCLES Gluteus Maximus Large, powerful extensor F - Extends & laterally rotates the thigh O - Posterior gluteal line of the ilium, iliac crest, aponeurosis of the erector spinae, dorsal surface of the lower part of the sacrum, side of the coccyx, sacrotuberous ligament and intermuscular fascia I - Iliotibial tract of the fascia lata and the gluteal tuberosity of the femur i - Inferior gluteal nerve. L5-S2  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability GLUTEAL MUSCLES Gluteus Medius F - Abducts and medially rotates the thigh. Anterior portion flexes the thigh & the posterior portion extends thigh O - Outer surface of the ilium between the iliac crest of the posterior gluteal line, anterior gluteal line I - The lateral surface of the greater trochanter i - Superior gluteal nerve. L4-S1 Gluteus Minimus F - Abducts & medially rotates the thigh O - Outer surface of the ilium between the anterior & inferior gluteal lines and the margin of the greater sciatic notch I - The ridge laterally situated on the anterior surface of the greater trochanter  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability TENSO R FA SCIA L ATA/ ILI O TI BIA L BAN D TFL F - Hip flexion, abduction, MR O - Iliac crest & lateral surface of ASIS I - into tendinous iliotibial tract (band) i - Superior gluteal nerve. L4-S1 ITB Strong membranous fascia, Continuous of TFL Attaches to the lateral condyle of the tibia  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability HIP FLEXORS Rectus Femoris of quadriceps group F - Flexes the hip joint & extends the knee joint O - by two heads, from the anterior inferior iliac spine and a reflected head from a groove above the acetabulum I - Base of the patella i - Femoral nerve. L2-L4 Iliacus O - Iliac fossa superior 2/3, and upper sacrum I - lesser trochanter via psoas major tendon F - flexes the thigh i – Femoral nerve L2-L3 Psoas major and iliacus form conjoined tendon which inserts on to lesser trochanter = ILIOPSOAS  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability ILIOPSOAS GROUP Powerful hip flexors 3 muscles with different O but common I - Iliacus - psoas minor - psoas major Psoas major O - transverse processes, bodies and intervertebral discs of lumbar (& body of 12th thoracic) I - lesser trochanter of femur i – Lumbar plexus L2-L3  ADDUCTORS Adductor Magnus Adductor Brevis Adductor Longus O – inferior ramus of pubis and ischium O - pubis O – pubic crest & symphysis I - linea aspera and has tendon all the I - medial portion of I - medial portion of linea way to medial epicondyle upper linea aspera aspera (below brevis) i - obturator nerve. L2-L4 & Tibial i - obturator nerve. L2-L4 i - obturator nerve. L2-L4 portion of the sciatic nerve. L2-L4  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability PIRIFORMIS F - Laterally rotates & abducts the thigh, also medially rotates thigh depending on hip position O - Anterior sacrum, gluteal surface of the ilium, capsule of the sacroiliac joint & sacrotuberous ligament I - Upper border of the greater trochanter of the femur i - Sacral plexus. S1 Sciatic nerve L4-S3 10% of population sciatic nerve runs through the piriformis rather than under  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability QUADRATUS FEMORIS F - Laterally rotates and adducts the hip joint. O - Superior lateral margin of the ischial tuberosity. I - Quadrate tubercle of the intertrochenteric crest and the bone immediately inferior. i - Sacral plexus. L5–S2.  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability OBTURATOR INTERNUS F - Laterally rotates the hip joint. Abducts when thigh is flexed O - Internal surface of the anterolateral wall of the pelvis & the obturator membrane I - Medial surface of the greater trochanter of the femur i - Nerve to obturator internus. L5–S2.  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability OBTURATOR EXTERNUS F - Laterally rotates the thigh O - Rami of pubis, ramus of the ischium & medial 2/3rdof the outer surface of the obturator membrane I - Trochanteric fossa of the femur Ii - Obturator nerve. L3-L4.  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability HAMSTRINGS Common origin = Ischial tuberosity BF (except short head Biceps Femoris) Biceps Femoris ST 2 heads different origins - Long head origin = Ischial tuberosity - Short head origin = Linea Aspera SM Common insertion (lateral side of head of Fibula and lateral Tibial condyle) Both flex knee, long head also hip extension Semimembranosus, Semitendinosus Insertions = shaft of tibia, medial tibial condyle Knee flexion, hip extension & slight medial rotation i - Tibial portion of the sciatic nerve. L5-S2  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability BI-ART ICULAR MUS CLES OF THE HIP Rectus femoris As before Sartorius F - Flexes, abducts & laterally rotates the hip joint, also rotates the tibia medially O - ASIS and notch below I - superior medial surface of tibia, anterior to gracilis i - femoral nerve L2-L3 Gracilis F - Adducts the hip joint, flexes the knee & rotates the tibia medially O - Thin aponeurosis from the medial margins of the lower half of the body of the pubis & the whole of the inferior ramus I - Proximal part of the medial surface of the tibia, below the tibial condyle & just proximal to the tendon of semitendinosus i - Obturator nerve. L2-L3  Describe the functions of the muscles surrounding the hip joint in terms of their Describe attachment, actions, nerve supply and their role in stability MUS CLE ATTA CHM ENT SIT ES AT THE HIP LIMITATIONS OF MOVEMENTS  Describe the blood and nerve supply to the joint, and appreciate the significance Describe of this supply in relation to hip fractures HIP FRACTURES TRANSCERVICAL  (intracapsular) INTERTROCHANTERIC  (extracapsular) SUBTROCHANTERIC  (extracapsular)  Describe the blood and nerve supply to the joint, and appreciate the significance Describe of this supply in relation to hip fractures BL OO D SU PPLY TO A major complication of displacement of the femoral TH E FEMO RA L HE A D head through either fracture or dislocation is avascular necrosis - if blood supply is denied, the head will die within 6 hours and will not repair itself. PROFUNDA FEMORIS (LATERAL & MEDIAL CIRCUMFLEX FEMORAL ARTERIES)  Branches to RETINACULAR ARTERIES  Describe the blood and nerve supply to the joint, and appreciate the significance Describe of this supply in relation to hip fractures B L O O D S U P P LY TO T H E F E M O R A L H E A D The blood supply to the femoral head is complex and involves several arteries with blood being delivered from distal to proximal. KEY VESSELS. If there is a fracture at the femoral head, these vessels may be at risk of rupture - if intertrochanteric, they will be ok - if # is through the neck or just below the head, the retinacular arteries are at risk - if rupture or clotting occurs  avascular necrosis  Describe the blood and nerve supply to the joint, and appreciate the significance Describe of this supply in relation to hip fractures AVA SCULAR NECROS IS OF FE MORAL HE AD  FUNCTION OF THE Q-ANGLE The Q angle represents the relationship and alignment between the pelvis, leg and foot Line of force of the quadriceps muscle Important in athletes since repetitive stress on structures causes injury and pain Angle 13° - 20° ‘normal’. Wide discrepancies! Males lower end, females higher end Abnormally high Q angle can promote injuries at knee, hip, foot, and lower back