CHS 371- Exam 2 (Hip)

• Pelvis
• Femur
• Sacrum
• Ilium bone
• Pubic Bone
• Ischium

made of 3 bones: Ilium, Ischium, and Pubis

Separate boes at birth and during growth and development

Fused at maturity

Classification: long bone

Function: lever

longest bone in the body

It is the extension of the spinal cord

5 fused vertebrae

posteriorly between the 2 pelvic bones

SI joint is formed by the pelvis and sacrum

classification: flat bone

function: protection

"PUBIS"

Classification: irregular bone

Function: protection

Classification: irregular bone

function: protection

Large Stable Joint

consists of: head of femur and acetabulum of Pelvis  (ball and socket)

• Structure: synovial joint
• Function: ball and socket joint
• Provides: stability, mobility,shock absorption, and protection

• 3 degrees of freedom:
• Frontal, saggital and transverse

• "ball"
• spherical
• smooth surface

covered by articular cartilage (hyaline cartilage)

Function: shock absorption, joint nutrition

• "socket"
• Latin = little vinegar cup

• lined by articular hyaline cartilage
• supports entire body weight

Latin = lip

• Fibrocartilage
• deepens the socket
• provides stability and proprioception (body awareness)

• Femoroacetabular ligament consists of 3 main ligaments :
• Illiofemoral ligament
• Ischiofemoral ligament
• Pubofemoral Ligament

ilium to femur

anterior to hip joint

prevents abduction and external rotation

ischium to femur

triangular band of strong fibers

posterior side of hip joint

limits medial rotation

pubis to femur

anterior to hip joint

limits abduction

• flexion
• extension
• abduction
• adduction
• internal rotation
• external rotation

movement of the femur anteriorly toward the pelvis

Normal ROM: 0-130*

saggital plane motion

Movement of the femur straight posteriorly away from the pelvis

Normal ROM: 0-30*

saggital plane motion

Movement of the femur laterally to the side away from midline

normal ROM: 0-45*

Frontal plane motion

movement of the femur medially towards the midline

normal ROM: 0-30*

frontal plane motion

rotary movement of the femur medially around its longitudinal axis toward the midline

normal ROM: 0-45*

Transverse plane motion

Rotary movement of the femur laterally around its longitudinal axis away from the midline

Normal ROM: 0-50*

Transverse plane motion

• psoas (major and minor)
• Illiacus
• Rectus Femoris
• Sartorius
• Tensor Fascia Latae (TFL)
• Adductor Longus

O: T-12 to L-5 vertebrae

I: Lesser trochanter of femur

A: Hip Flexion

O: inner part of illium

I: lesser trochanter of femur

A: Hip flexion

O: Iliac spine

I: Tibial tuberosity

• A: hip flexion
•     knee extension

O: anterior illium

I: upper medial tibia

A: hip flexion

O: Anterior iliac crest

I: IT band

• A: hip flexion
•     hip abduction

O: Anterior Pubis

I: Proximal medial femur

• A: Hip addiction
•     hip flexion

• Gluteus maximus
• semimebranosis
• semitendinosis
• biceps femoris

O: Psterior ilium and sacrum

I: greater trochanter of femur and IT band

• A: hip extension
•     external rotation

O: ischial tuberosity

I: proximal medial tibia

• A: hip extension
•     knee flexion

O: ischial tuberosity

I: proximal and medial tibia

• A: hip extension
•     knee flexion

O: ischial tuberosity

• I: lateral condyle of tibia 
•    head of fibula

• A: hip extension
•     knee flexion

• Gluteus medius
• Gluteus minimus
• Tensor Fascia Latae (TFL)

O: Lateral ilium

I: greater trochanter

• A: hip abduction
•     internal rotation
•     external rotation

O: lateral ilium (below gluteus medius)

I: greater tochanter

• A: hip abduction
•     internal rotation
•     external rotation

O: anterior iliac crest

I: IT band

• A: hip abduction
•     hip flexion

• Adductor longus
• adductor brevis
• adductor magnus
• pectinius
• gracilis

O: anterior pubis

I: proximal medial femur

• A: hip adduction
•     hip flexion

• O: anterioinferior pubis
•   
• I: Proximal medial femur

A: hip adduction

• O: pubis
•      ischium
•      ischial tuberosity

I: posterior and medial femur

A: hip adduction

O: pubis

I: upper medial femur

• A: hip flexion
•     hip adduction
•     hip internal rotation

O: pubis

I: medial tibia

• A: hip adduction
•     hip internal rotation

• Gracilis
• pectinius
• gluteus medius (anterior fibers)
• gluteus minimus (anterior fibers)
• TFL

• Gluteus medius (posterior fibers)
• Gluteus minimus (posterior fibers)
• Gluteus Maximus

• Piriformis
• superior gemellus
• inferior gemellus
• quadratus femoris
• obturator internus
• obturator externus

O: sacrum and ischium

I: greater trochanter

A: Hip external rotation

very movable

great stability

supported by strong ligaments

groin pain

Disruption of the blood supply

• truama
• steroid use
•     asthma
• Alcoholism
•      fatty deposits in bloodstream

• Pain in groin
• range of motion loss

Treatment: activity modification, surgery

Epiphysis = area at end of long bone that is separated from main part of  bone by a growth plate.

• common after onset of puberty
• males> females
• common in obese children

• cause: unknown
• may be caused by weak growth plate
•       trauma
•       inflammation
•       change in hormone levels

treatment: surgery (pins or screws)

usually to the femoral neck of the femur

• Cause: trauma
•               falls
•               accidents
•              usually over 65
•               women at higher risk

• pain in groin
• unable to bear weight
• swelling and bruising

treatment: surgery

most common affected tissue

• gluteus medius tendon
• trochanteric bursa (hip bursitis)

• pain over the greater trochanter
• pain with walking, climbing)
• pain when sleeping on side affected

• test: stretching IT band
•         contracting med or TFL
•         normal xrays, possible calcification in        glut med tendon or bursa
•         referred pain in the back

15% in women 66.6% in men

acute trauma (falls, impact) increased activity/exercise rubbing of tight IT band

Ice, rest, cortisone shot, stretch IT band, restore hip, strengthen glut med and TFL

• Bruise to the ilium
• pain above groin
• treat: ice, padding, rest

• cause: overuse
• runners
• military
• poor biomechanics
• occurs at femoral neck

• pain in groin
• while running often no pain while walking or sitting

treatment: rest, pool running, bioimechanics, training modification

pain in adductors (adductor longus)

excessive motion (soccer, hockey)

treatment: rest, ice, regain motion, eccentric loading

"femeroacetabular impingement"

Tear of fibrocartilage labrum

cause: trauma, excessive motion (hockey, golf, gymnastics)

• might not have symptoms
• groin pain
• catching or popping
• pain with twisting
• motion loss

• treatment: non surgical
•                       motion restoration
•                       neuromuscular control
•                 surgical
•                       repair
•                       debridement

pain in groin due to severe osteoarthritis or trauma

protective cartilage of the hip erodes (articular cartilage protects ends of bones)

replaces the ball and socket

• end stage operation
• nothing else helped
• patient can't walk, function, sleep

• good outcomes but high risk
•       infection
•       blood clots
•       death