The Hip Flashcards
What blood vessels supply the hip?
- The femoral artery
- The obturator artery
- Superior gluteal vein
- Inferior gluteal vein
- Obturator vein
The femoral artery provides a branch to the medial and lateral circumflex arteries. The medical circumflex artery and the obturator artery go to the ligament teres.
The superior gluteal, inferior gluteal and obturator veins drain into the femoral vein.
What nerves innovate the hip?
- Femoral nerve
- Obturator nerve
- Superior gluteal nerve
(NB Sciatic nerve lies posterior to hip joint)
What type of joint is the hip? And what movement occurs at the hip?
The hip joint is a synovial ball and socket joint.
Flexion/Extension, Adduction/Abduction, Medial/Lateral rotation all occur at the joint
Name the hip flexor muscles and their attachments
Iliopsoas - made up of the iliacus & psoas major
Iliacus
Origin: Iliac Fossa
Insertion: Lesser trochanter of femur
Fibres: Fibres originate fanned along iliac fossa and converge into a smaller insertion on the lesser trochanter
Psoas Major
O: Spine (Bodies of the twelfth thoracic spine T12 & all lumbar vertebrae)
I: Lesser trochanter of femur
F: Fibres converge from wide origin and descend down the posterior abdominal wall
Rectus femoris O: AIIS I: Tibial tuberosity F: Run vertically in a downwards direction Also extends the knee
Tensor Fascia Late (TFL)
O: Iliac crest - posterior to ASIS
I: Iliotibial tract/band (ITB)
F: Run vertically in a downwards direction
Also abducts and medially rotates the hip
Name the muscles that extend the hip and their attachments
The hamstrings: Biceps femoris, semitendinosis & semimembranosus
Also flex the knee
Biceps femoris
O: Ischial tuberosity (long head), lateral lip of linea aspera (short head)
I: Head of fibula
F: run vertically in a downwards and laterally to the insertion on the head of the fibula
Semitendinosis
O: Ischial tuberosity
I: Proximal medial shaft of tibia
Semimembranosus
O: Ischial tuberosity
I: Posterior aspect of medial condyle of tibia
Gluteus maximus
O: Posterior gluteal line of ilium and adjacent part of iliac crest, posterior aspect of sacrum & side of coccyx
I: Iliotibial band (ITB) of fascia late, gluteal tuberosity of femur (superior to the greater trochanter)
F: run perpendicular to one another, lining up in direction of pull - giving it it’s quadrilateral appearance
What bones make up the hip joint?
The hip joint is made up of two parts - the acetabulum and the femoral head.
The acetabulum is made up of two innominate bones = ischium, ilium & pubis.
The femoral head is the femur.
Name the muscles that adduct the hip and their attachments
The adductors: Adductor magnus, adductor longus and adductor brevis
Adductor Magnus
Origin: Pubic Symphasis
Insertion: Linea aspera of femur
Fibres: Fibres fan out from narrow origin into wide insertion in a downwards direction
Adductor Longus
O: Inferior pubis ramus & ramus of ischium
I: Posterior surface of proximal femur, linear aspera
F: Fibres fan out from narrow origin into wide insertion in a downwards direction
Adductor Brevis
O: Inferior pubic ramus
I: Posterior surface of proximal femur, linear aspera
F: Triangular muscle - fibres fan out from narrow origin into wide insertion in a downwards direction
Name the muscles that abduct the hip and their attachments
The glutes: Gluteus maximus, gluteus minimus, gluteus medius
Gluteus maximus
O: Posterior gluteal line of ilium, posterior of sacrum & coccyx
I: Iliotibial band (ITB), gluteal tuberosity of femur (posterior to greater trochanter)
Gluteus minimus
O: Lateral surface of ilium - between inferior and anterior gluteal lines
I: Greater trochanter
Gluteus medius
O: Lateral surface of ilium - between inferior and anterior gluteal lines
I: Greater trochanter
Name the muscles that medially rotate the hip
Gluteus medius & gluteus minimus
Tensor fascia late (TFL)
The adductors: adductor magnus, adductor longus and adductor brevis
The hamstrings: bicep femoris, semimembranosus, semitendinosus
Name the muscles that laterally rotate the hip
Gluteus maximus
Pirformis
O: Anterior surface of sacrum
I: Greater trochanter of femur
(The most superior of the deep muscles of the pelvic wall)
What are the major ligaments of the hip joint?
Reinforce the joint capsule:
Iliofemoral ligament
Y shaped ligament running from ilium to femur
Pubofemoral ligament
Runs from pubis to femur
Ischiofemoral ligament
Runs from ischium to femur
Intra-capsular:
Transverse Ligament
Strong bands of fibrous tissue
Complete the inferior deficiency in acetabular notch
Creates a foramen (hole) with acetabular notch for vessels and nerves to access the joint
Ligament Teres
Attaches from boarder of acetabular notch & transverse ligament to fovea capitus on head of femur
Sits in sleeve synovial membrane
Carries the acetabular branch of the obturator artery to the femoral head
Adds little stability to joint
What structures add stability to the hip joint
Acetabular labrum:
A fibrocartilaginous collar that deepens the acetabulum or ‘socket’ and cups the femoral head
Attached to bony rim of acetabulum & inferior tranverse ligament
Helps with shock absorption on weight bearing
Ligaments:
Iliofemoral, ischiofemoral, pubofemoral
Muscles
Joint Capsule:
Very strong fibrous capsule, strengthened further by ligaments and muscles
Thicker anteriorly and superiorly - places of weight bearing to add stability
Circular fibres around neck
Proximally: Attaches to bone outside labrum & transverse ligament
Distally: Attaches anteriorly to intertrochanteric line and posteriorly at junction of neck with trochanters
What are bursae and where are they located?
Small fluid filled sacs that prevent friction between structures
Iliospoas, trochanteric and ischial
What special tests are used at the hip and what does a positive result indicate?
FABERs Test (flexion, abduction and external rotation) or ‘Figure 4’ Tests for labral tears or sacroiliac dysfunction. Can also identify muscle length differences Positive test: - Affected leg does not move as far as other leg - Pain at end of range, either in groin or buttock
FADIRs Test (flexion, adduction, internal rotation)
Tests for femoral acetabular impingement (FAI)
Also stretches soft tissue structures such as: ischiofemoral ligament, iliopsoas tendon & bursae, adductor longus and sartorius
Positive test:
- Reproduction of pain
Trendelenberg
Tests for muscle strength and function of hip adductors (gluteus medius and gluteus minimus)
Positive test:
- Pelvic level drops on unaffected side
Ober’s test Tests for ITB and TFL stretch Positive test: - Pain - Foot prevented from dropping down to the bed
Scour test Investigates the articular cartilage and labrum Positive test: - Clunk or click - Pain
Thomas test
Tests for hip flexion deformity and length of iliosoas and rectus femoris. Also can indicate tightness in TFL & ITB.
Positive test:
Sign Structures affected
Extended knee Quadriceps, rectus femoris
Flexed hip Psoas muscles
Abducted hip Tensor fascia lata, iliotibial band
What are the common hip pathologies?
Congential dislocation of the hip (CDH) / Hip dysplasia
An abnormality of the hip joint - resulting in the femoral head inadequately contained in acetabulum. Inadequate joint development, dislocation or dislocatabilitiy
Diagnosed: often aged 0-1 years
Causes:
- Genetically determined joint laxity causing a lack of stability = easy to dislocate
- Pregnancy ligament relaxing hormones secreted to foetus = ligament laxity
- Genetically determined dysplasia e.g. shallow acetabulum or flattened femoral head
Treatment:
- Wait 3 weeks - might stabilise spontaneously
- Post 3 weeks - splinting in reduced positive with moderate abduction for a minimum of 6 weeks or surgical intervention
NB - CDH = risk factor for early onset OA due to ‘normal loading on abnormal joint’
Total hip replacement (THR)
Usually acetabulum & femoral head, bone will be preserved where possible
Femoral acetabular impingement (FAI)
Motion related condition involving premature contact between femur & acetabulum.
2 types: CAM and pincer
CAM = excess bone growth on femur = hits articular cartilage on acetabulum
Pincer = Large acetabulum results in bone on bone in full hip flexion
Labral tears
Usually a mechanical MOI or direct trauma.
Twisting, repeated external rotation, hyperextension and hyperadduction (ballet, hockey, football, running)
Bursitis
Tendon pathologies
Muscle injuries / strain
Ligament sprain / tears
Rheumatoid arthritis
Osteoarthritis
