Chapter 9 The Hip Joint and Pelvic Girdle

Pelvic Girdle Anterior Gluteal Line External Surface Auricular Surface Iliopectineal Eminence Greater Sciatic Notch Iliac Fossa Iliac Crest Posterior Superior Iliac Spine Posterior Inferior Iliac Spine Anterior Inferior Iliac Spine Anterior Superior Iliac Spine Ischium Label Ilium Label Pubis Label Ischial Tuberosity Spine of the Ischium Lesser Sciatic Notch Inferior Rami Superior Rami Pubic Crest Inferior Rami Superior Rami Pubic Symphysis Sacral Articulation Posterior Gluteal Line Inferior Gluteal Line

Joints Symphysis Pubis (amphiarthrodial) –Fibrocartilaginous interpubic disc –Superior Pubic Ligament –Inferior Pubic Ligament Sacroiliac Joints (arthroidial) –Junction of the sacrum suspended between the two iliac bones Posterior Sacroiliac Ligament Sacrotuberous ligament Anterior Sacroiliac Ligament

Joints Acetabulofemoral (enarthrodial) –Iliofemoral “Y” Ligament –Teres Ligament –Pubofemoral Ligament –Ischiofemoral Ligament

Range of Motion Flexion –120° (knee flexed) –90° (knee extended) Extension –20° Abduction –45° Adduction –20°-30° Internal Rotation –40° External Rotation –45°

Cutaneous Distribution

Cutaneous Distribution (Sciatic)

Movements Hip Flexion Hip Extension Hip Abduction Hip Adduction Hip External Rotation Hip Internal Rotation Anterior Pelvic Rotation Posterior Pelvic Rotation Left Lateral Pelvic Rotation Right Lateral Pelvic Rotation Left Transverse Pelvic Rotation Right Transverse Pelvic Rotation

Gluteus minimus IliacusPsoasPectineus Tensor fasciae latae Sartorius Adductor longus Gracilis Rectus Femoris Gluteus maximus Adductor Magnus Biceps femoris SemitendinosusSemimembranosus Adductor Brevis External Rotators Gluteus Medius Label

Muscles Iliopsoas –IliacusIliacus –Psoas MajorPsoas Major Strengthening Stretching

Muscles Sartorius Strengthening Stretching

Muscles Rectus Femoris Strengthening Stretching

Muscles Tensor Fasciae Latae Strengthening Stretching

Muscles Gluteus Maximus Strengthening Stretching

Muscles Gluteus Medius Strengthening Stretching

Muscles Gluteus Minimus Strengthening Stretching

Muscles Six Deep Lateral Rotator Muscles –PiriformisPiriformis –Gemellus Superior –Gemellus Inferior –Obturator Externus –Obturator Internus –Quadratus FemorisQuadratus Femoris Strengthening Stretching

Muscles Semitendinosus Strengthening Stretching

Muscles Semimembranosus Strengthening Stretching

Muscles Biceps Femoris –Long head –Short headShort head Strengthening Stretching

Muscles Adductor Brevis Strengthening Stretching

Muscles Adductor Longus Strengthening Stretching

Muscles Adductor Magnus Strengthening Stretching

Muscles Pectineus Strengthening Stretching

Muscles Gracilis Strengthening Stretching

Techniques In Evaluating Levelness of Pelvis Anterior Superior Iliac Spines Posterior Superior Iliac Spines Iliac Crests

Pelvic Deviations Lordosis (pelvic tilt) Scoliosis Pelvic Torsion –Leg length discrepancy Determining Leg Length Discrepancy 1. Standing Position: levelness of iliac crests (symmetry of all 4 iliac spines) 1. Measure from ASIS to tip of medial malleolus (supine) 2. Determine if femur and tibia are same length Note: If iliac crests are level and there is a measurement difference = Pelvic Torsion

Deviations of the Hip Hip Flexion Contracture (contributes to a lordosis condition) –Test Both knees to chest. Maintain one knee to chest while lowering other leg – should be flat on table. –Distinguish between the commonly tight muscles: Iliopsoas Rectus Femoris Tensor Fasciae Latae

Femur Angle –Coxa Normal Between 115°-140°, averaging 126° at adulthood –Coxa Vara Decrease in angle caused by weight bearing on weak femur –Results in weak gluteus medius –Coxa Valga Increase in angle caused by non-weight bearing Gluteus Medius Gait Caused by: –Nerve damage or other pathology –Functional weakness due to coxa vara –Congenital Hip Dislocation –Stance Hip abducted position, leaning toward side of weakness –Gait Manner of style of walking –.–. –Positive Trendelenburg Gait Deviations of the Hip Coxa Normal Coxa Vara Coxa Valga Positive Trendelenburg Test Click for movie

Gaits Gluteus Maximus Gait –Anatomy –Gait: Posterior sway on side of weakness with weight bearing on same side Hip Flexor Gait –Circumduction gait