anatomy of the hip joint anoop
TRANSCRIPT
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DR ANOOP S
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THE HIP JOINT IS A MULTIAXIAL SYNOVIAL JOINT OF BALL-AND-SOCKET TYPE.
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ACETABULUM
APPROXIMATELY HEMISPHERICAL CAVITY CENTRAL ON THE LATERAL ASPECT OF THE INNOMINATE BONE.
FACING ANTEROINFERIORLY. SURROUNDED BY AN IRREGULAR
MARGIN DEFICIENT INFERIORLY AT THE ACETABULAR NOTCH.
STARTS TO OSSIFY AT 12 YEARS FUSE AT 17 YEARS
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THE ACETABULAR FOSSA FORMS THE CENTRAL FLOOR-ROUGH AND NON ARTICULAR.
THE ARTICULAR LUNATE SURFACE IS WIDEST ABOVE (THE 'DOME'), WHERE WEIGHT IS TRANSMITTED TO THE FEMUR.
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THE HIP JOINT IS A MULTIAXIAL SYNOVIAL JOINT OF BALL-AND-SOCKET TYPE
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ARTICULAR SURFACES THE FEMORAL HEAD ARTICULATES WITH
THE CUP-SHAPED ACETABULUM, ITS CENTRE LYING A LITTLE BELOW THE MIDDLE THIRD OF THE INGUINAL LIGAMENT.
THE ARTICULAR SURFACES ARE RECIPROCALLY CURVED.
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THE CLOSE-PACKED POSITION IS IN FULL EXTENSION, WITH SLIGHT ABDUCTION AND MEDIAL ROTATION.
LEAST PACK SEMIFLEXION
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THE FEMORAL HEAD IS COVERED BY ARTICULAR CARTILAGE, EXCEPT FOR A ROUGH PIT FOR THE LIGAMENTUM TERES
IN FRONT, THE CARTILAGE EXTENDS LATERALLY OVER A SMALL AREA ON THE ADJOINING NECK
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CARTILAGE THICKNESS IS MAXIMAL ANTEROSUPERIORLY IN THE ACETABULUM AND ANTEROLATERALLY ON THE FEMORAL HEAD
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THE ACETABULAR ARTICULAR SURFACE IS AN INCOMPLETE RING, THE LUNATE SURFACE
DEFICIENT INFERIORLY OPPOSITE THE ACETABULAR NOTCH
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THE ACETABULAR FOSSA IS DEVOID OF CARTILAGE BUT CONTAINS FIBROELASTIC FAT LARGELY COVERED BY SYNOVIAL MEMBRANE
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ACETABULAR DEPTH IS INCREASED BY THE ACETABULAR LABRUM
DEEPENS THE CUP AND BRIDGES THE ACETABULAR NOTCH AS THE TRANSVERSE ACETABULAR LIGAMENT.
DIAMETER OF THE ACETABULAR CAVITY IS CONSTRICTED BY THE LABRAL RIM
EMBRACES THE FEMORAL HEAD, MAINTAINING JOINT STABILITY
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FIBROUS CAPSULE STRONG AND DENSE
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ATTACHMENT
ANTERIORLY TO THE INTERTROCHANTERIC LINE
SUPERIORLY TO THE BASE OF THE FEMORAL NECK,
POSTERIORLY 1 CM ABOVE THE INTERTROCHANTERIC CREST
INFERIORLY TO THE FEMORAL NECK NEAR THE LESSER TROCHANTER
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IT HAS TWO SETS OF FIBRES, CIRCULAR AND LONGITUDINAL
THE CIRCULAR FIBRES (ZONA ORBICULARIS) ARE INTERNAL AND FORM A COLLAR ROUND THE FEMORAL NECK.
PARTLY BLENDED WITH THE PUBOFEMORAL AND ISCHIOFEMORAL LIGAMENTS BUT ARE NOT DIRECTLY ATTACHED TO BONE
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EXTERNALLY, LONGITUDINAL FIBRES ARE MOST NUMEROUS IN THE ANTEROSUPERIOR REGION, REINFORCED BY THE ILIOFEMORAL LIGAMENT.
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THE CAPSULE IS ALSO STRENGTHENED BY THE PUBOFEMORAL AND ISCHIOFEMORAL LIGAMENTS
EXTERNALLY IT IS ROUGH, COVERED BY MUSCLES AND SEPARATED FROM PSOAS MAJOR AND ILIACUS BY A BURSA
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THE CAPSULAR ATTACHMENT TO THE FEMUR LIES DISTAL TO THE GROWTH PLATE OF THE FEMORAL HEAD BOTH ANTERIOR AND POSTERIORLY
THE UPPER FEMORAL EPIPHYSIS ENTIRELY INTRACAPSULAR
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LIGAMENTS ILIOFEMORAL, PUBOFEMORAL,
ISCHIOFEMORAL, TRANSVERSE ACETABULAR AND THE LIGAMENTUM TERES.
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ILIOFEMORAL LIGAMENT VERY STRONG AND SHAPED LIKE AN
INVERTED Y, LYING ANTERIORLY AND INTIMATELY BLENDED WITH THE CAPSULE.
APEX IS ATTACHED BETWEEN THE ANTERIOR INFERIOR ILIAC SPINE AND ACETABULAR RIM, ITS BASE TO THE INTERTROCHANTERIC LINE
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ERECT POSTURE, A VERTICAL LINE THROUGH THE CENTER OF GRAVITY OF THE BODY FALLS SLIGHTLY BEHIND A LINE JOINING THE CENTERS OF THE TWO HIP JOINTS.
THE TENDANCY OF THE BODY TO FALL BACKWARDS ON THE HIP JOINTS IS RESISTED BY THE ILIOFEMORAL LIGAMENTS WHICH MAINTAIN THE ERECT POSTURE WITHOUT MUSCULAR ACTIVITY AT THESE JOINTS
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PUBOFEMORAL LIGAMENT
TRIANGULAR, ITS BASE ATTACHING TO THE ILIOPUBIC EMINENCE, SUPERIOR PUBIC RAMUS, OBTURATOR CREST AND OBTURATOR MEMBRANE.
IT BLENDS DISTALLY WITH THE CAPSULE AND DEEP SURFACE OF THE MEDIAL ILIOFEMORAL LIGAMENT..
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ISCHIOFEMORAL LIGAMENT
THICKENS THE BACK OF THE CAPSULE AND CONSISTS OF THREE DISTINCT PARTS
CENTRAL MEDIAL LATERAL
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CENTRAL PART, THE SUPERIOR ISCHIOFEMORAL LIGAMENT
LATERAL AND MEDIAL INFERIOR ISCHIOFEMORAL LIGAMENTS EMBRACE THE POSTERIOR CIRCUMFERENCE OF THE FEMORAL NECK
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TRANSVERSE ACETABULAR LIGAMENT
PART OF THE LABRUM BUT HAS NO CARTILAGE CELLS.
ITS STRONG, FLAT FIBRES CROSS THE ACETABULAR NOTCH FORMING A FORAMEN THROUGH WHICH VESSELS AND NERVES ENTER THE JOINT.
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LIGAMENTUM TERES (LIGAMENT OF THE HEAD OF THE FEMUR)
TRIANGULAR, FLATTENED BAND APEX ATTACHED ANTEROSUPERIORLY IN
THE FOVEA ON THE FEMORAL HEAD BASE IS ATTACHED ON BOTH SIDES OF
THE ACETABULAR NOTCH, BETWEEN WHICH IT BLENDS WITH THE TRANSVERSE LIGAMENT.
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IT ALSO RECEIVES WEAKER CONTRIBUTIONS FROM THE MARGINS OF THE ACETABULAR FOSSA.
ENSHEATHED BY SYNOVIAL MEMBRANE,
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SYNOVIAL MEMBRANE LINES INNER PORTION OF CAPSULE AND
NON ARTICULAR STRUCTURES
THE SYNOVIAL MEMBRANE COVERS THE INTRACAPSULAR PART OF THE FEMORAL NECK.
THEN PASSES TO THE INTERNAL SURFACE OF THE CAPSULE TO COVER THE ACETABULAR LABRUM, LIGAMENTUM TERES AND FAT IN THE ACETABULAR FOSSA.
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IT IS THIN ON THE DEEP SURFACE OF THE ILIOFEMORAL LIGAMENT WHERE IT IS COMPRESSED AGAINST THE FEMORAL HEAD AND SOMETIMES IS EVEN ABSENT HERE.
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BLOOD SUPPLY
OBTURATOR ARTERY 2 CIRCUMFLEX FEMORAL ARTERIES 2 GLUTEAL ARTERIES
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OBTURATOR ARTERY
BRANCH OF THE INTERNAL ILIAC ARTERY
GIVES RISE TO AN ACETABULAR BRANCH AND SUPPLIES THE FAT IN THE ACETABULAR FOSSA.
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MEDIAL CIRCUMFLEX FEMORAL ARTERY
ARISES FROM THE PROFUNDA FEMORIS THREE BRANCHES
ACENDING TRANSVERSE TERMINAL
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LATERAL CIRCUMFLEX ARTERY ARISES FROM THE PROFUNDA FEMORIS HAS THREE BRANCHES
ACENDING TRANSVERSE DECENDING
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SUPERIOR GLUTEAL ARTERY ARISES FROM THE POSTERIOR BRANCH
OF THE INTERNAL ILIAC ARTERY
TWO DIVISIONS SUPERFICIAL DEEP—TAKES PART IN TROCHANTERIC
ANASTOMOSIS
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INFERIOR GLUTEAL ARTERY ANTERIOR BRANCH OF THE INTERNAL
ILIAC ARTERY
6 DIVISIONS: ARTICULAR BRANCHES OF THE HIP JOINT CRUCIATE ANASTOMOTIC BRANCHES
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SUPERIOR GLUTEAL ARTERY SUPPLIES THE UPPER PART OF THE ACETABULUM
INFERIOR GLUTEAL ARTERY SUPPLIES THE INFERIOR AND POSTERIOR PART OF THE ACETABULUM AND THE CAPSULE
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BLOOD SUPPLY OF THE HEAD OF FEMUR
EXTRACAPSULAR ARTERIAL RING AT THE BASE OF THE FEMORAL NECK; FORMED POSTERIORLY BY BRANCH OF MFCA FORMED ANTERIORLY BY BRANCHES OF LFCA; SUPERIOR & INFERIOR GLUTEAL
ARTERY HAVE MINOR CONTRIBUTIONS;
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ASCENDING CERVICAL BRANCHES
- THESE GIVE RISE TO RETINACULAR ARTERIES - GIVES RISE TO SUBSYNOVIAL INTRA ARTICULAR RING
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ARTERY OF LIGAMENTUM TERES
DERIVED FROM OBTURATOR OR MFCA
INADEQUATE TO SUPPLY FEMORAL HEAD WITH DISPLACED FRACTURES
FORMS THE MEDIAL EPIPHYSEAL VESSELS
ONLY SMALL & VARIABLE AMOUNT OF THE FEMORAL HEAD IS NOURISHED BY ARTERY OF LIGAMENTUM TERES
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EPIPHYSEAL BLOOD SUPPLY:
EPIPHYSEAL ARTERIAL BRANCHES ARISE AS ARTERIES OF SUBSYNOVIAL INTRAARTICULAR RING
TWO GROUPS OF EPIPHYSEAL ARTERIES: LATERAL & INFERIOR
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METAPHYSEAL BLOOD SUPPLY:
ARISES FROM EXTRACAPSULAR ARTERIAL RING
ARISE FROM BRANCHES OF ASCENDING CERVICAL ARTERIES- SUBSYNOVIAL INTRA ARTICULAR RING
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NERVE SUPPLY OF THE HIP JOINT
FEMORAL NERVE
ANTERIOR DIVISION OF THE OBTURATOR NERVE
NERVE TO QUADRATUS FEMORIS
SUPERIOR GLUTEAL NERVE
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FEMORAL NERVE FORMED BY THE DORSAL DIVISIONS OF THE
ANTERIOR PRIMARY RAMI OF SPINAL NERVES L2,L3,L4
GIVES RISE TO MUSCULAR/CUTANEOUS/ ARTICULAR BRANCHES
ARTICULAR BRANCH-NERVE TO RECTUS FEMORIS SUPPLIES THE HIP JOINT
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OBTURATOR NERVE
VENTRAL DIVISIONS OF THE ANTERIOR PRIMARY RAMI OF SPINAL NERVES L2,L3,L4
WITHIN THE OBTURATOR CANAL THE NERVE DIVIDES INTO ANTERIOR AND POSTERIOR DIVISONS
BRANCH TO THE HIP JOINT ARISES FROM THE ANTERIOR DIVISON
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NERVE TO QUADRATUS FEMORIS
ARISES FROM THE SACRAL PLEXUS (L4,L5,S1)
SUPPLIES THE QUADRATUS FEMORIS, GEMELLUS INFERIOR AND THE HIP JOINT
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SUPERIOR GLUTEAL NERVE
ARISES FROM THE SACRAL PLEXUS( L4,L5,S1)
SUPPLIES THE GLUTEUS MEDIUS, GLUTEUS MINIMUS AND TENSOR FASCIA LATAE AND THE HIP JOINT
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MOVEMENTS MUSCLES NERVE SUPPLY
FLEXION ILIACUS AND PSOAS MAJOR
LUMBAR VENTRAL RAMI
RECTUS FEMORIS
FEMORAL
SARTORIUS FEMORALTENSOR FACIA LATA
SUPERIOR GLUTEAL
PECTINEUS FEMORALADDUCTORS LONGUS AND BREVIS
OBTURATOR
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MOVEMENTS MUSCLES NERVE SUPPLY
EXTENSION GLUTEUS MAXIMUS
INFERIOR GLUTEAL
SEMIMEMBRANOSUS
SCIATIC(TIBIAL PART)
SEMITENDINOSUS
SCIATIC(TIBIAL PART)
BICEPS FEMORIS LONG HEAD
SCIATIC(TIBIAL PART)
ADDUCTOR MAGNUS ISCHIAL PART
SCIATIC(TIBIAL PART)
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MOVEMENTS MUSCLES NERVE SUPPLY
ADDUCTION ADDUCTORS LONGUS, BREVIS AND MAGNUS
OBTURATOR
GRACILIS OBTURATOR
PECTINEUS FEMORAL
QUADRATUS FEMORIS
L4/5 AND S1 VENTRAL RAMI
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MOVEMENTS MUSCLES NERVE SUPPLY
ABDUCTION GLUTEUS MEDIUS AND MINIMUS
SUPERIOR GLUTEAL
TENSOR FASCIA LATA
SUPERIOR GLUTEAL
PIRIFORMIS L5S1/2 VENTRAL RAMI
OBTURATOR INTERNUS IN FLEXION
L5S1/2 VENTRAL RAMI
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MOVEMENTS MUSCLES NERVE SUPPLY
MEDIAL ROTATION
TENSOR FASCIA LATA
SUPERIOR GLUTEAL
GLUTEUS MINIMUS
SUPERIOR GLUTEAL
GLUTEUS MEDIUS ANT FIBERS
SUPERIOR GLUTEAL
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MOVEMENTS MUSCLES NERVE SUPPLYLATERAL ROTATION
SARTORIUS FEMORALGLUTEUS MAXIMUS
INFERIOR GLUTEAL
OBTURATOR INTERNUS AND GEMELLI
L5S1/2 VENTRAL RAMI
OBTURATOR EXTERNUS
OBTURATOR
QUADRATUS FEMORIS
L4/5;S1 VENTRAL RAMI
PIRIFORMIS IN FLEXION
L5S1/2 VENTRAL RAMI
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REFERENCE
GRAY’S ANATOMY CUNNINGHAM’S MANUAL OF PRACTICAL
ANATOMY