structure and function of the hip - mcccbehrensb/documents/struchipbjb.pdf · structure and...
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Structure and Function
of the Hip
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The Hip
“The San Francisco 49ers placed Frank Gore on the
injured reserve list on Tuesday after the Pro Bowl
running back suffered a season-ending hip fracture a
day earlier.” 12/1/10
•The most proximal joint of the lower extremity responsible for
motion in all 3 planes.
•This mobility makes the hip prone to injury if all of the support
structures are not working properly.
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Osteology of the Hip
The “pelvis” is really the union of 3 bones:
• The ilium, the ischium & the pubis
Ilium
Pubis
Ischium
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Osteology of the Hip
The “pelvis” is really the union of 3 bones:
• The ilium, the ischium & the pubis
Lateral Aspect Right HipPosterior Aspect Left Hip
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Osteology of the Hip
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Osteology of the Hip
The Pubis
the superior pubic ramus &
the inferior pubic ramus
joined anteriorly by:
The Symphysis Pubis
or
Pubic Symphysis
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Osteology of the Hip
The Acetabulum
deep cup shaped structure encasing the head of
the femur formed by all 3 bones
Permits motion in all 3 planes
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Osteology of the Hip
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Osteology of the Hip
anatomical neck
surgical neck
Posterior Aspect Right FemurAnterior Aspect Right Femur
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Joint Motions
Hip
• flexion/extension
• internal/external rotation
• ABDuction/ADDuction
• circumduction
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The Hip
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Ligaments in the Pelvis (anterior)
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Ligaments of the Pelvis
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The Ilioinguinal Ligament
This ligament runs from the
ASIS to the pubic
tubercle
It separates the anterior
abdominal wall from the
thigh
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Common Hip Pathologies
Osteoarthritis of the hip
Degeneration of the articular
cartilage of the joint
Trauma
Wear & tear
Later in life
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Common Hip Pathologies
Congenital Hip dysplasia
Shallow acetabulum
Legg-Calve’Perthes Disease
Femoral head undergoes necrosis
Children 5-10
Head death 2-4 years then
revascularization and
remodeling.
Avascular Necrosis of the
Femoral Head
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Common Hip PathologiesHip Fractures
Intertrochanteric
Femoral neck
Iliotibial Band Syndrome
Overuse injury causing lateral knee pain
Cyclists
Runners
Hamstring Strain
Overload of the muscle
“Hip Pointer”
Pelvic injury
Severe bruise caused by direct contact to the iliac crest of the pelvis
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Iliopsoas
Origin Psoas Major: transverse
processes of T12-L5
Iliacus: Iliac fossa
Insertion Lesser trochanter of the
femur
Innervation Femoral n.
Action Hip flexion, trunk
flexion, anterior pelvic
tilt
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Myology of the Hip
Your subtopic goes hereRectus Femoris
Origin Anterior-inferior iliac spine
Insertion Tibial tuberosity via the quadriceps
tendon
Innervation Femoral n.
Action Hip flexion, knee extension
“tidbit” One of the heads of the “quads”
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Myology of the Hip
Your subtopic goes hereSartorius
Origin ASIS
Insertion Proximal-medial surface of the tibia (via
the pes anserinus)
Innervation Femoral n.
Action Hip flexion, hip ABD, Hip ER, knee
flexion
“tidbit” Longest muscle in the body
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Myology of the Hip
Your subtopic goes hereTensor Fascia Latae
Origin Outer surface of the iliac crest
posterior to the ASIS
Insertion Proximal 1/3 of the ITB
Innervation Superior gluteal n.
Action Hip flexion, hip ABD, hip IR
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Myology of the Hip
Your subtopic goes hereGluteus Maximus
Origin Posterior ilium, sacrum, coccyx
Insertion ITB, gluteal tuberosity of the femur
Innervation Superior gluteal n.
Action Hip extension, hip ER
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Myology of the Hip
Your subtopic goes hereSemitendinosus
Origin Ischial tuberosity
Insertion Proximal-medial surface of the tibia
(pes anserinus)
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion,
“tidbit” One of the hamstrings
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Myology of the Hip
Your subtopic goes hereBiceps Femoris
Origin Ischial tuberosity
Insertion Head of the fibula
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion
“tidbit” One of the hamstrings
A
A B C DBicep F Bicep F Semimem Semiten
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Myology of the Hip
Your subtopic goes hereSemimembranosus
Origin Ischial tuberosity
Insertion Medial condyle of the tibia, posterior aspect
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion
“tidbit” One of the hamstrings
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Myology of the Hip
Your subtopic goes hereGluteus Medius
Origin Outer surface of the ilum
Insertion Greater trochanter of the femur
Innervation Superior gluteal n.
Action Hip ABD
Gluteus
MediusIliac Crest
Gluteus
Maximus
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Myology of the Hip
Your subtopic goes hereGluteus Minimus
Origin Outer surface of the ilium, inferior
to the gluteus medius
Insertion Greater trochanter
Innervation Superior gluteal n.
Action Hip ABD, hip IR
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Trendelenberg Sign
The Hip ABDuctors play an important role in
maintaining an upright posture during
single limb support.
If hip weakness is suspected,
single limb support over the
affected limb would look like
this when the uninvolved
limb is lifted
The pelvis drops down toward
the unsupported side
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Myology of the Hip
Your subtopic goes herePectineus
Origin Pectineal line on superior ramus
Insertion Pectineal line on posterior surface
of the femur
Innervation Obturator n.
Action Hip ADD, hip flexion
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Myology of the Hip
Your subtopic goes hereADDuctor Longus
Origin Anterior surface of the body of
the pubis
Insertion Middle 1/3 of the linea aspera of
the femur
Innervation Obturator n.
Action Hip ADD, Hip flexion
“tidbit” What’s in a name?
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Myology of the Hip
Your subtopic goes hereGracillis
Origin Body and inferior ramus of the
pubis
Insertion Proximal-medial aspect of the
tibia (pes anserinus)
Innervation Obturator n.
Action Hip ADD, hip flexion, knee
flexion
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Myology of the Hip
Your subtopic goes hereADDuctor Brevis
Origin Proximal Attachment: Anterior
surface of the inferior pubic ramus
Insertion Proximal 1/3 of the linea aspera of
the femur
Innervation Obturator n.
Action Hip ADD, Hip flexion
“tidbit” What’s in a name?
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Myology of the Hip
Your subtopic goes hereADDuctor Magnus
Origin Extensor Head: Ischial tuberosity
Insertion Extensor Head: ADDuctor tubercle on
distal femur
Innervation Tibial portion of the sciatic n.
Action Hip extension, Hip ADD
“tidbit” What’s in a name?
ADDuctor Magnus
Origin ADDUctor Head: Ischial ramus
Insertion ADDUctor Head: entire linea aspera
of femur
Innervation Obturator n.
Action Hip ADD, Hip flexion
“tidbit” What’s in a name?
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Myology of the Hip
Intrinsic Hip ER: (6 muscles)
Piriformis, Obturator Internus, Obturator
Exterunus, Gemelus Superior,
Gemelus Inferior, Quadratus Femoris
Piriformis Syndrome:The sciatic nerve passes deep to the
piriformis in most cases (approximately 85%
of people) but can in fact pierce the piriformis
itself, predisposing to piriformis syndrome
and subsequent sciatica. Even if the sciatic
nerve runs deep to the piriformis, muscle
guarding in this muscle can put direct
pressure on the nerve, causing pain and
discomfort.
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Sciatic Nerve Distribution & the Piriformis
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Identify what you can! (in the hips)
Hip ADDuctors
Sartorius
ADDuctor Longus
ADDuctor Brevis
ADDuctor Magnus
Hip Flexors
Rectus femoris
TFL
Hip ABDuctors
TFL
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Identify what you can! (in the hips)
Gluteus Maximus
Gluteus medius
Hamstrings
Semimembranosus
Biceps Femoris
Semitendinosus
TFL
OK go for it!
Pick out everything
else!