Hip Flashcards
Classify the hip joint according to type and complexity
Synovial
Simple
Classify the hip joint according to shape and degrees of motion
Unmodified ovoid
3 degrees
Hip osteokinematics (mechanical axis)
Transverse axis through femoral neck
Hip osteokinematics (available movements and axis of movement)
Flex/extn - sagittal plane, transverse axis
Abd/add - coronal plane, sagittal axis
Int rot/Ext rot - transverse plane, vertical axis
Hip arthrokinematics (for each movement)
SPIN
Flex/extn
GLIDES
Abd - inferior
Add - superior
Int rot - posterior
Ext rot - anterior
What deepens the acetabulum and what is it made of?
The acetabular labrum (triangular fibrocartilaginous rim)
Where is the acetabulum deficient and why?
Labrum is deficient inferiorly for the acetabular notch (transverse acetabular ligament bridges it)
Where does the hip capsule attach to the labrum and what does it create?
Attaches at its peripheral base (creates a circular recess)
Describe the shape of the femoral head
Ellipsoid, convex 2/3 sphere with hyaline cartilage
Why is there a fovea in the femoral head?
Fovea for ligamentum teres
Describe the direction of the femoral head and the neck angle
Directed superior, anterior, medial
Femoral neck angle 120-125deg
Where is the articular cartilage thickest in the hip joint?
Thickest at anterosuperior acetabulum and anterolateral femoral head
Does articular cartilage cover of the neck of the femur?
Covers small area of intraarticular part of the neck of femur
Where is the hip capsule thickest and thinnest?
- Strong and dense
- Thickest anterosuperiorly and lax/thin posteroinferiorly
Where does the hip capsule attach proximally?
To bone (5mm beyond acetabular labrum) and the transverse acetabular ligament
Where does the capsule attach distally?
Anteriorly to trochanteric line and posteriorly to femoral neck above trochanteric crest
Describe the orientation of the layers of hip joint capsule (external and internal)
External = longitudinally oriented
Internal = circularly oriented
Describe the Zona orbicularis of the hip
Encircles proximal femoral neck, indents the synovium, no bony attachment
What does the zona orbicularis of the hip do?
Divides synovial cavity into medial and lateral recess
Describe the shape and direction of the acetabulum
Roughly concave and hemispheric
Projects anterolaterally and inferiorly
Describe the central fossa of the acetabulum (3)
Central fossa
- non-articular
- filled with loose areolar tissue
- covered with synovium (fat pad) for proprioception
Where is the acetabulum broadest?
Broadest superiorly (resist WB)
Hip nerves (segmental, peripheral, other)
L2-S1
Peripheral (obturator nerve and branches) - to capsule and intraarticular structures
Other - Accessory articular branches of femoral, superior gluteal and sciatic nerves supply each muscle crossing the hip
What arteries supply the hip joint?
Femoral arteries
- medial circumflex
- lateral circumflex
Foveal artery
What contribution does the foveal artery make?
Small contribution
Avoid avascular necrosis of femoral head with disruption of circumflex arteries
What are the two important anastomoses of the hip?
Anastamoses
- Cruciate
- Trochanteric
What are the bursae of the hip? (and where are they located)
BURSAE
- Greater trochanteric
- Gluteofemoral (between gluteus maximus and linea aspera)
- Ischial/ischiogluteal (between gluteus medius and ischial tuberosity)
- Iliopectineal (separates external hip joint capsule and iliopsoas)
- Psoas (psoas and lesser trochanter)
- Iliac (insertion of iliopsoas into lesser trochanter)
What muscles internally rotate the hip?
Gluteus minimus and medius with hip extended
TFL
Semitendinosis
Semimembranosus
What muscles ABduct the hip?
TFL
Gluteus medius
Gluteus minimus
What muscles ADduct the hip?
Adductors
- magnus
- longus
- brevis
Gracilis
Pectineus
What muscles flex the hip?
Iliopsoas
Sartorius
Rectus femoris
TFL
Pectineus
What muscles extend the hip?
Gluteus maximus
Semitendinosus
Semimembranosis
Biceps femoris
What are the 6 deep muscles that externally rotate the hip?
Deep
- Piriformis
- Gamellus superior and inferior
- Obturator internus and externus
- Quadratus femoris
What other 4 muscles externally rotate the hip?
Other
- Gluteus maximus (lower fibres)
- Gluteus medius and minimus when hip is flexed
- Psoas maj/min
- Sartorius
What is this hip ligament (#1)?
Pubofemoral ligament
What is this hip ligament (#2)?
Iliofemoral ligament (Y-shaped - iliotrochanteric and inferior band)
What is this ligament (#3)? (Posterior view)
Ischiofemoral ligament
What intraarticular ligaments are in the hip?
Ligamentum teres
Transverse acetabular ligament
