Hip & Pelvis

Hip Joint Between Acetabulum (Pelvis) & Head of Femur Ball and Socket Joint Weight Bearing

Acetabulum Formed from Ilium, Ischium, and Pubis Oriented laterally, anteriorly, inferiorly Acetabular Rim Acetabular Notch Netter 453

Femur Head Neck Greater Trochanter Lesser Trochanter Netter 453 Head Neck Greater Trochanter Lesser Trochanter Intertrochanteric Line Intertrochanteric Crest

Femoral Neck Angles Coronal Plane  125 > Normal < Normal Normal Coxa Valga Coxa Vara

Femoral Neck Angles Horizontal Plane Normal  15° anterior Anteversion > 15° anterior Toe-In Posture Retroversion < 15° anterior Toe-Out Posture

Joint Capsule Acetabular Labrum Transverse Acetabular Ligament Ligamentum Teres Capsular Ligaments Accessory Ligaments Netter 454

Accessory Ligaments Anterior Posterior limit extension & external rotation Iliofemoral Ligament (Y) Pubofemoral Ligament Posterior Ischiofemoral Ligament Netter 454

Movements of the Hip & Pelvis

Movement at the Hip Flexion Extension Abduction Adduction Internal Rotation External Rotation Circumduction

Movement of the Pelvis Anterior Rotation (AS Ilium, +X) Posterior Rotation (PI Ilium, - X) Lateral Flexion (High or Low Ilium (+ or - Z) Rotation (+ or - Y)

Determining API Compare angle between PSIS & ASIS to horizontal

Posture - Pelvis ( X) Angle of Pelvic Inclination (API) Anterior & Posterior Rotation Angle of Pelvic Inclination (API) Males = 0° to 5° anterior Females = 5° to 10° anterior

Combined Movements Movement of the Pelvis at the end range of Hip movement Due to ligamentous attachments Movements of the Pelvis and Lumbar Spine with a Fixed Femur (standing) Effects of Contracture/Shortening of muscles on Posture and Movement

Hip Flexion Anatomy of Movement 186

End Range of Hip Flexion - Effects on Pelvis & Lumbar Spine Posterior Rotation of Pelvis Decreased Lumbar Lordosis Anatomy of Movement 206

Muscles that Flex the Hip Iliopsoas Rectus Femoris Tensor Fascia Lata (TFL) Sartorius Anatomy of Movement 231

Major Hip Flexor Iliopsoas Proximal Attachments Distal Attachment Psoas Major - Lumbar vertebral bodies & discs Iliacus - Entire internal iliac fossa Distal Attachment Common tendon attaches to lesser trochanter of femur Netter 462

Other Hip Flexors Rectus Femoris Sartorius Tensor Fascia Lata AIIS to patella (via quadriceps tendon) Sartorius ASIS to Pes Anserine insertion (Tibia) Tensor Fascia Lata ASIS to Iliotibial Band fascia 458 Netter 458

Action of Hip Flexors with Femur fixed Anterior rotation of Pelvis Increased Lumbar Lordosis Anatomy of Movement 214

Effects of Contracture of Hip Flexors on Posture & Movement Anteriorly Rotated Pelvis Sagittal Plane +X rotation (anterior ilium) Increased Lumbar Lordosis Limited Hip Extension

Hip Extension Anatomy of Movement 187

End Range of Hip Extension - Effects on Pelvis & Lumbar Spine Anterior Rotation of Pelvis Increased Lumbar Lordosis Anatomy of Movement 222

Muscles that Extend the Hip Gluteus Maximus Hamstrings Biceps Femoris Semimembranosus Semitendinosus Anatomy of Movement 231

Hip Extensors Gluteus Maximus Medial Attachments - Medial Ilium, Lateral Sacrum, Sacrotuberous Ligament Lateral Attachments - Posterior shaft of Proximal Femur, Iliotibial Band Also externally rotates hip Netter 461

Hip Extensors Hamstrings Attach proximally on Ischial Tuberosity Distal Attachments Biceps Femoris (lateral on fibular Head) Semimembranosus & Semitendinosus (medial on tibia) Netter 461 & 468

Action of Hip Extensors with Femur fixed Posterior rotation of Pelvis Decreased Lumbar Lordosis Anatomy of Movement 222

Effects of Contracture of Hip Extensors on Posture Posteriorly rotated pelvis Indirectly causes Lumbar Hypolordosis Limited Hip flexion (with knee extended - Hamstrings)

Hip Abduction Anatomy of Movement 188

Position of Femur Femur must be externally rotated for full abduction Internal Rotation External Rotation Anatomy of Movement 188

End Range of Hip Abduction - Effects on Pelvis & Lumbar Spine Contralateral Lateral Flexion of Pelvis Ipsilateral Lateral Flexion of Lumbar Spine Anatomy of Movement 188

Hip Abductors Gluteus Medius Gluteus Minimus Tensor Fascia Lata Gluteus Maximus Anatomy of Movement 231

Hip Abductors - Attachments Gluteus Medius Upper part of External Iliac Fossa to Lateral aspect of Greater Trochanter Gluteus Minimus Lower part of External Iliac Fossa to Lateral aspect of Greater Trochanter Netter 469

Tensor Fascia Lata ASIS to Iliotibial Band Actions - Abduction, Flexion & Internal Rotation Anatomy of Movement 227 Netter 460

Action of Hip Abductors with Fixed Femur Ipsilateral lateral flexion of pelvis Stabilization of Pelvis during stance on one leg Anatomy of Movement 227 & 229

Effects of Contracture of Hip Abductors on Posture Low ilium (ipsilateral lateral flexion of pelvis) Limits adduction (widened stance) May limit flexion or extension of hip

Weakness of Hip Abductors Weakness causes contralateral lateral flexion of Pelvis during stance on one leg Trendelenberg Test

Adduction of the Hip Anatomy of Movement 187

Hip Adductors Pectineus Adductor Longus Adductor Brevis Adductor Magnus Gracilis Anatomy of Movement 232

External Rotation of the Hip Anatomy of Movement 189

Hip External Rotators Gluteus Maximus Medial Attachments - Medial Ilium, Lateral Sacrum, Sacrotuberous Ligament Lateral Attachments - Posterior shaft of Proximal Femur, Iliotibial Band Also extends hip Netter 461

Hip External Rotators Piriformis Short External Rotators Anterior sacrum to greater trochanter Short External Rotators Gemelli Obturators Quadratus Femoris Netter 469

Internal Rotation of the Hip Anatomy of Movement 189

Internal Rotators Tensor Fascia Lata Anterior fibers of Gluteus Medius and Gluteus Minimus Netter 460