2 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.
3 Type & Articular Surfaces Synovial, ball & socket joint.Articular Surfaces:Acetabulum of hip (pelvic) boneHead of femurThe lunate surface and the head of the femur(except for the fovea) are covered by hyaline cartilageThe nonarticular acetabular fossa contains loose connective tissue.
4 Acetabular labrum:C-shaped fibro-cartilaginous collar attached to margins of acetabulum, increases its depth for better retaining of head of femur.
5 CapsuleThe 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 linePosteriorly: covers medial half of the neck of femur
7 Synovial MembraneThe synovial membrane lines the capsule and the nonarticular surfaces.It reflects along the femoral neck to the edge of the femoral head
8 The arteries that supply the femoral head and neck course within the synovial folds. They are called retinacular vessels
9 Ligaments: 3 Extracapsular Pubofemoral ligament:Located antero-inferior to jointLimits abduction & lateral rotationIliofemoral ligament:Y-shapedLocated anterior to jointLimits extensionIschiofemoral ligament:Located posterior to jointLimits medial rotation
10 Ligaments: 2 Intracapsular (Extrasynovial) Ligament of femoral head: carries vessels to head of femurTransverse acetabular ligament:formed by the acetabular labrum as it bridges the acetabular notchconverts acetabular notch into foramen through which pass acetabular vessels
15 Hip Flexion Psoas Major Iliopsoas(composite muscle) Chief flexor of HIP:Psoas majoriliacusOrigin:1- Anterior surfaces of the transverse processes of T12-L5 vertebrae2- Upper two thirds of the iliacusInsertion: Lesser trochanter of the femur after being joined by the iliacusAction: 1-Flexion of thigh at hip2- Assists in extension of the lumbar spine3. Lateral Flexion of the spine when acting unilaterallyInnervation: Lumbar plexus (L2,3,4)Psoas Major
16 Iliacus Origin Iliac fossa within abdomen Insertion Lowermost surface of lesser trochanter of femur, after joining psoasAction Flexes &laterally rotates hipNerve Femoral nerve in abdomen (L2,3)
17 Hip extension Gluteal region: iliotibial tractTensorFasciaeLataeGluteusmaximusGluteal region:-Gluteus maximus(most powerful extensor,also lateral rotator)Insertion:Gluteal tuberosity+Iliotibial tract (band)gluteus maximusGluteus 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.
18 Hip Adduction Medial Compartment main function = adduction Obturator externusAdductor brevisAdductor longusAdductor magnusGracilisMost innervated by:Obturator nerve (L2-L4)(lumbar plexus)Exception:-Hamstring component ofadductor magnus (extensor)(tibial division of sciatic nerve)obturatorexternusobturatornerveadductor brevisAdductormagnusadductor longusgracilis
19 Lateral Rotation of the hip gluteus mediusgluteusmaximusgluteus minimusDeep 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]piriformissuperiorgamellusobturatorinternusquadratusfemorisinferiorgamellus
20 Movements of the Hip Joint (ball and socket) SummaryMovements of the Hip Joint (ball and socket)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 thighAbduction - gluteus medius & minimus, Tensor Fascia LataRotation:Lateral - Gluteus maximus, lateral rotatorsMedial - anterior parts of gluteus medius & minimus,+ Tensor Fascia Lata
21 Vascular supply to the hip joint 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 .
23 Nerve Supply of the hip joint The hip joint is innervated by articular branches (Hilton’s Law) from:Femoral.Obturator.Superior gluteal nervesNerve to the quadratus femoris.Sciatic nerve.
24 Applied anatomy Perthes disease 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.