Chapter 10 The Hip and Pelvis

Bones of the Pelvis Pelvic Bone: A Coccyx: L Pubic Symphysis: A1 Acetabulum: R Sacrum: J Sacroiliac Joint: K

Bones of the Pelvis The pelvic bone Is split into 3 parts: Ileum: O Ischium: P Pubis: Q

Pelvic Bone Each bone has different processes that tendons and ligaments attach to: Acetabulum: R Anterior Superior Iliac Spine (ASIS): O2 Iliac Crest: O3 Posterior Superior Iliac Spine (PSIS): O4 Ischial Spine: P1 Ischial Tuberosity: P3 Obturator Foramen: Q5

ROM of the Hip Joint Adduction Abduction Flexion Extension Internal Rotation External Rotation Torso Flexion Torso Extension Lateral Flexion Circumduction

Gluteus Maximus (E posterior diagram) Origin: posterior gluteal line of the ilium, and posterior surface of the sacrum and coccyx Insertion: On the femur and the Iliotibial Band Action

Gluteus Medius Origin: Outer surface of the posterior ilium Insertion: Lateral surface of the greater trochanter of the femur Action

Gluteus Minimus Origin: Outer surface of the posterior ilium Insertion: Anterior surface of the greater trochanter of the femur Action

Tensor Fascia Latae C: anterior diagram Origin: Anterior portion of the iliac crest and the ASIS Insertion: Iliotibial band of the fascia latae Action

Iliacus B: Anterior Diagram Origin: Iliac crest and fossa Insertion: Lesser trochanter of the femur Action

Psoas Major and Psoas Minor Major: A (anterior) Origin: Transverse processes and bodies of the last thoracic vertebrae and all of the lumbar vertebrae Insertion: Lesser trochanter of the femur Action Minor: c (anterior) Origin: same Insertion: same

Sartorius D: Anterior diagram C: Posterior diagram Origin: ASIS, most anterior point of the ilium Insertion: Upper part of the medial surface of the tibia, medial to tibial tuberosity Action

Pectineus M (anterior) Origin: Pubic bone Insertion: Medial aspect of the upper 1/3 of the femur Action

Adductor Muscle Group Anterior Diagram Adductor Longus: J Origin: Anterior surface of the pubis near pubic symphysis Insertion: middle third of the medial portion of the linea aspera (posterior aspect of femur) Action Adductor Longus – Origin – Anterior surface of the pubis near pubic symphysis. Insertion – middle third of the medial portion of the linea aspera (posterior aspect of femur). Action – adduct the hip

Adductor Muscle Group cont. Adductor Brevis: Origin: Outer surface of inferior ramus of pubis Insertion: proximal half of the linea aspera Action Adductor Magnus: I Origin: Inferior pubic ramus, ramus of the ischium, and the ischial tuberosity Insertion: linea aspera and medial condyle of the femur

Gracilis L: anterior diagram D: posterior diagram Origin: Inferior half of the symphysis pubis Insertion: medial surface of the tibia, distal to condyle Action Origin – Inferior half of the symphysis pubis Insertion – medial surface of the tibia, distal to condyle. Action – adducts hip, flexes knee, and medially rotates knee.

Piriformis Labeled on posterior diagram Origin: Anterior surface of the sacrum Insertion: Superior border of the greater trochanter of the femur Action Origin – Anterior surface of the sacrum Insertion – Superior border of the greater trochanter of the femur. Action – lateral rotation of thigh; assists in extension and abduction of the thigh.

Quadratus Femoris J: posterior diagram Origin: Ischial tuberosity Insertion: shaft of femur just below the greater trochanter Action Origin – Ischial tuberosity Insertion – shaft of femur just below the greater trochanter Action – lateral rotation of the thigh.

Hamstrings **Will NOT need to label on quiz!** Biceps Femoris Knee flexion Hip extension Semitendinosus Semimembranosus Biceps Femoris – Origin – Ischial tuberosity and back of femur Insertion – head of fibula and lateral condyle of tibia Action – knee flexion and hip extension Semitendinosus – Origin – Ischial tuberosity Insertion – Upper medial surface of the tibial shaft Semimembranosus – Origin – Ischial tuberosity Insertion – posterior aspect of medial condyle of tibia (upper inside part of tibia) Action – knee flexion and hip extension.

Quadriceps Group **Will NOT need to label on quiz!** Rectus Femoris Knee extension Hip flexion Vastus Lateralis Knee flexion Vastus Intermedius Vastus Medialis Rectus Femoris – Origin – ASIS of Ilium above acetabulum. Insertion – via patellar tendon to tibial tuberosity Function – Knee extension and hip flexion (ex. In combination, when kicking a ball) Vastus Lateralis – Origin – Upper half of the shaft of the femur Function – Knee extension Vastus Intermedius – (deep, under rectus femoris) Origin – Upper half of the shaft of the femur Vastus Medialis – Origin – Upper half of the shaft of the femur

Muscle Groups of the Hip Hip flexors Psoas Major Psoas Minor Iliacus Rectus Femoris Tensor Fascia Latae Sartorius Hip Extensors Gluteus Maximus Biceps Femoris Semimembranosus Semitendinosus Piriformis Hip Adductors Adductor Longus Adductor Magnus Adductor Brevis Gracilis Pectineus Hip Abductors Gluteus Medius Piriformis Sartorius Tensor Fascia Latae/IT Band

Muscles Groups of the Hip Internal Rotators Gluteus medius Tensor Fascia Latae Gracilis External Rotators Gluteus maximus Piriformis Quadratus Femoris Sartorius

Common Injuries Injury to the coccyx Hip strains Trochanteric Bursitis Testicular Contusion Hip Pointer Hip Dislocation Thigh Contusion Myositis Ossificans Pelvic Fracture Femur Fracture Iliotibial Band Syndrome Osteitis Pubis Piriformis Syndrome

Coccyx Injury Cause: usually from a fall on a hard surface. Can result in a contusion, dislocation, or fracture. X-ray illustrates a dislocated coccyx. Treat with PRICE and refer to physician if dislocation or fracture suspected.

Hip Strains Stretching or tearing of tendon or muscle in the hip. Usually caused from a violent twisting motion at the joint. Treat with PRICE and ROM exercises. Refer to a physician if a complete tear is suspected.

Trochanteric Bursitis Occurs at the gluteus medius/IT band insertion at the greater trochanter of the femur. CAUSE: poor form or hip misalignment Running form should be evaluated. Treat with heat if a chronic condition; acute conditions treat with PRICE. May be treated with a cortisone injection.

Testicular Contusion Results from a direct blow to the groin region. Can cause hemorrhaging, swelling, and muscle spasm. Treat by laying athlete on back and raise thighs to chest. Apply ice. Refer to physician if necessary. http://www.youtube.com/watch?feature=player_detailpage&v=OBSJJi6Qo5c

Hip Pointer Caused by a direct blow to the iliac crest. Extremely painful because of the lack of natural protection for iliac crest. Apply padding to prevent further injury.

Hip Dislocation Extremity will normally be found flexed and internally rotated. Medical emergency. Extreme amount of stress on the joint is the cause. May also have a femoral fracture. Transport by ambulance immediately!!! http://www.youtube.com/watch?feature=player_detailpage&v=vXLLdU8-jO8#t=44s

Thigh Contusions Caused by direct blow, usually to quadriceps muscles. Treat with PRICES. Can lead to further complications if not treated properly.

Myositis Ossificans Caused by a severe blow to the thigh, or repeated blows to the thigh. Myositis = inflammation of the muscle Ossificans = ossification (formation of bone) of tissue. Bone forms in the muscle and is very painful. Treat with ice, compression wrap, and flexion to help relieve pain and prevent myositis ossificans formation.

Pelvic Fracture Caused by external force. X-ray illustrates a “crushed” pelvis. Medical emergency. Transport by ambulance immediately!!! Splint in position found with backboard and full leg splint if possible

Femur Fracture Most common fracture in older adults after a fall. Neck of femur is the weakest part of the bone. Often mistaken for a dislocation. Medical emergency! Surgically repaired with rods and screws.

Iliotibial Band Friction Syndrome Inflammation of the Iliotibial Band. Causes: Excessive pronation, leg length discrepancy, bowed legs, and lateral pelvic tilt. May lead to patellar subluxation.

Osteitis Pubis Osteitis pubis is a noninfectious inflammation of the pubis symphysis causing varying degrees of lower abdominal and pelvic pain. Occurs most often in soccer players and distance runners.

Piriformis Syndrome A condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. Often misdiagnosed. Piriformis massage to relieve tension.