The Hip And Pelvis Flashcards
What makes the hip strong?
-articulate surface congruency (congruent in all positions)
-strong ligaments around the joint
-strong muscles
What is the closed-pack position of the hip?
-maximum extension
-medial rotataion
-abduction
What is the open-packed position of the hip joint?
-slight flexion
-abduction
-lateral rotation
What are active ranges of movement?
The movement range of a joint undertaken by the person themselves
What are passive ranges of movement?
The same physiological movement as active but with no effort of the person (all done by a therapist)
What movements can occur from the hip joint?
Flexion/extension
Abduction/adduction
Medial rotation/lateral rotation
What is an accessory movement?
A movement that a person can’t perform actively, but which can be performed on that person by an external force
What accessory movements are available at the hip?
Longitudinal Caudad (pulling leg to tail)
Distraction (taking the head of the femur out of the acetabulum
Antero-posterior (gliding backwards)
Posters-anterior (gliding forwards)
What are the names of the muscles responsible for hip flexion?
Psoas Major
Sartorius
Illiacus
Pectineus
Rectus femoris
Gracillis
What are the names of the muscles responsible for hip extension?
Gluteus maximus
Adductor Magnas (ext part)
Biceps femoris
Semimembranosius
Semitendinosus
What are the names of the muscles responsible for hip abduction?
Gluteus Med and Min
Sartorius
TFL
Piriformis
What are the names of the muscles responsible for hip adduction?
Adductor longus
Adductor brevis
Adductor Magnus
Pectineus
Gracilis
What are the names of the muscles responsible for medial rotation?
Gluteus Med and Min
TFL
Adductor Magnus
What are the names of the muscles responsible for hip lateral rotation?
Gluteus Maximus
Piriformis
Obturator Int and ext
Gemellus Superior and Inferior
Quadratus Femoris
Sartorius
What two muscles make up Ilio-Psoas
Illiacus and Psoas-Major
What is special about Ilio-Psoas?
It is a conjoined muscle
Where is the origin of Iliacus?
Iliac fossa (not extending onto the iliac crest)
Where is the origin of Psoas-Major?
Transverse processes T12-L4
Where does Ilio-Psoas insert?
The lesser trochanter
What action does the Ilio-Psoas provide?
Hip flexion/ trunk flexion at hip
(Trunk flexion occurs when feet are in fixed position)
What is the innervation of a muscle?
The supply or distribution of nerve fibres to any part of the body
What is the innervation of Ilio-Psoas?
L2-L3
Where is the origin of the Pectineus?
Superior pubic rami
Where does the Pectineus insert?
Lesser trochanter to the proximal aspect of linea aspera
What actions does the Pectineus partake in?
It flexes and adducts the thigh
What is the innervation of the Pectineus?
Femoral Nerve L2-L4
What type of muscle is the Rectus femoris?
A bipennate muscle
Where is the origin of the long head of the Rectus Femoris?
AIIS
Where is the origin of the short head of the Rectus Femoris?
Ilium above acetabulum
Where is the insertion of the Rectus femoris?
Quadriceps tendon of the patella
What is the action of the Rectus femoris?
Extends the knee and flexes the hip
What is the innervation of the Rectus femoris?
Femoral nerve L2-L4
What does Sartorius look like?
It is a long strap like muscle
Where does Sartorius originate from?
ASIS
Where does Sartorius insert?
Antero-medial surface of the proximal tibia
What are the actions of Sartorius?
Flexes, abducts and laterally rotates the thigh
Medially rotates the flexed knee
What is the innervation of Sartorius?
Femoral nerve L2-L3
Where is the origin of the Gluteus Maximus?
Outer surface of Posterior ilium sacrum and coccyx
Where does the Gluteus Maximus insert?
Iliotibial band, gluteal tuberosity of femur (on the posterior aspect of the femur)
What is the action of the Gluteus Maximus?
Extension of the trunk and thigh, lateral rotation of the thigh
What is the innervation of the Gluteus Maximus?
Inferior Gluteal nerve L5, S1-S2
What is the prone position?
When you are laying on your stomach
Where is the origin of the long head of the Biceps Femoris?
Ischial tuberosity
Where is the origin of the short head of the Biceps Femoris?
Linea aspera and lateral supracondylar ridge
Where does the Biceps Femoris insert?
Head of the fibular, lateral tibial condyle
What is the action of the Biceps Femoris?
Flexes and laterally rotates the knee
The long head extends the hip
What is the innervation of Biceps femoris?
Sciatic nerve L5, S1-S3
Where is the origin of the Semitendinosus?
Ischial tuberosity
Where does the Semitendinosus insert?
Medial surface of the proximal tibia
What is the action of the Semitendinosus?
Extends the hip
Flexes and medially rotates the knee
What is the innervation of Semitendinosus?
Sciatic nerve L5, S1, S2
What does the Semitendinosus sit on top of?
Semimembranosus
Where does the Semimembranosus originate from?
Ischial tuberosity
Where does Semimembranosus insert?
Posterior aspect of the medial tibial condyle
What is the action of the Semimembranosus?
Extends the hip, flexes and medially rotates the knee
What is the innervation of the Semimembranosus?
Sciatic nerve L5, S1, S2
What is the most powerful hip abductor?
Gluteus medius
Where is the origin of the Gluteus Medius?
Outer surface of the ilium ( just short of the iliac crest)
Where does the Gluteus Medius insert?
Lateral greater trochanter
What is the action of the Gluteus Medius?
Abducts and medially rotates the pelvis (this is does by the anterior fibres)
What is the innovation of the Gluteus Medius?
Superior Gluteal Nerve L4, L5, S1
Where is the Gluteus Minimus in comparison to the Gluteus medius?
Immediately deep to the Gluteus Medius
Where is the origin of the Gluteus Minimus?
Outer surface of the ilium
Where does the Gluteus Minimus insert?
Anterior surface of greater trochanter
What is the action of the Gluteus Minimus?
Abducts and medially rotates the pelvis ( by anterior fibres)
What is the innervation of the Gluteus Minimus?
Superior Gluteal nerve L4-L5, S1
Where is the origin of Tensor Fasciae Latae?
ASIS and lateral iliac crest
Where does tensor Fasciae Latae insert via?
Iliotibial band and Gerdy’s tubercle lateral aspect proximal tibia
What is the action of Tensor Fascia’s Latae?
Flexes and medially rotates the thigh
What is the innervation of the Tensor Fasciae Latae?
Superior Gluteal nerve L4, L5, S1
Where is the origin of Piriformis?
Internal surface of sacrum and gluteal surface of ilium
Where does Piriformis insert?
Greater trochanter
What is the action of Piriformis?
Lateral/external rotation and abduction of the flexed hip
What is the nerve supply for Piriformis?
1st and 2nd sacral nerves
Which nerve is Piriformis in close relation to?
Sciatic nerve
What prevents full hip extension?
Passive insufficiency of the hamstrings
How is Pes Anserinus formed?
Sartorius has a common insertion in the anterior-medial aspect of the proximal tibia with Gracilis and Semitendinosus to form Pes Anserinus
Where is the origin of Rectus Femoris?
It has two proximal heads, one inserts to a roughened area on the acetabulum the other is to the AIIS
What issues is Pisiform associated with?
Issues with the sciatic nerve
Where are the origins of adductor Magnus?
Inferior pubic ramus (anterior) and Ischial tuberosity (posterior)
Where does adductor Magnus insert?
Linea aspera and adductor tubercle
What are the actions of adductor magnus?
Superior part adducts, medically rotates and flexes the thigh
Inferior part adducts, laterally rotates and extends
What are the innervation of adductor Magnus?
Obturator nerve L3, L4
Sciatic nerve
Why is there a small hiatus in adduction Magnus?
To allow a neuromuscular bundle to travel between the anterior and posterior aspect of the thigh
What is the origin of adductor longus?
Body of the pubis
Where are the insertions of adductor longus?
Middle 2/3 of linea aspera
What are the actions of adductor longus?
Adducts and medially rotates the thigh
What is the innervation of adductor longus?
Obturator nerve L3 L4
Where is adductor brevis in comparison to adductor longus?
Deep to adductor longus
Where is adductor brevis in comparison to adductor longus?
Superficial
Where is the origin of adductor brevis?
Inferior pubic ramus
Where are the insertions of adductor brevis?
Lesser trochanter to proximal linea aspera
What are the actions of adductor brevis?
Adducts and medially rotates the thigh
What is the innervation of adductor brevis?
Obturator L3 L4
Where is the origin of Gracilis?
Inferior ramus of pubis
Where does Gracilis insert?
Upper aspect of medial shaft of tibia
What are the actions of gracilis?
Medically rotates and adducts the hip
Flexes and medically rotates the knee
What is the innervation of gracilis?
Obturator nerve L3, L4
Name the 6 deep and short rotator muscles of the hip
Piriformis
Obturator Internus
Obturator Externus
Gemellus Superior
Gemellus Inferior
Quadratus Femoris
Name the 5 hip flexors
Ilio-Psoas
Sartorius
Pectineus
Rectus femoris
Gracilis
What limits hip flexion?
Apposition of soft tissue and tension in hamstrings
Name the 5 hip extensors
Gluteus Maximus
Adductor Magnas (external part)
Biceps Femoris
Semimembranosius
Semitendinosus
What limits hip extension?
All ligaments
Close pack position
Name the 5 hip abductors
Gluteus Medius
Gluteus Minimus
Sartorius
FL
Piriformis
What are the limitations of hip abduction?
Pubofem/illiofemoral med band
Name the 5 hip adductors
Adductor longus
Adductor brevis
Adductor magnus
Pectineus
Gracilis
What are the limitations of hip adduction?
Iliofem lat band and Teres
What are the 4 hip medial rotators?
Gluteus medius
Gluteus Minimus
TFL
Adductor Magnus
What limits hip medial rotation?
Ischiofem/post capsule
What are the 8 hip lateral rotators?
Gluteus Maximus
Piriformis
Obturator Internus
Obturator Externus
Gemellus Superior
Gemellus Inferior
Quadriceps Femoris
Sartorius
What limits hip lateral rotation?
Iliofem lat band
Name the ligaments of the hip joint
illiofemoral ligament
Pubofemoral ligament
Ischial ligament
Ligament Teres
How many bands does the iliofemoral ligament have and what are there names?
Two bands -> superior and inferior
Where is the origin of the iliofemoral ligament from?
AIIS
Where do the iliofemoral ligaments descend to and cover?
The intertrochanteric line
What are the functions of the Iliofemoral ligament?
Prevent unwanted movement and limit normal physiological movemnt
What does the superior band of the iliofemoral ligament limit?
Extension and adduction
What does the inferior band of the iliofemoral ligament limit?
Extension and abduction
Where does the pubofemoral ligament come from?
Pubis
Where does the pubofemoral ligament go to?
All of the intertrochanteric line deep to the superior, inferior bands of the iliofemoral ligament
What is it called when the femoral neck inclination angle is increased?
Coxa valga
What is it called when the femoral neck inclination angle is decreased?
Coxa Vara
What is normal degree of femoral torsion?
12-15 degrees
What is it called when the angle of femoral torsion is decreased?
Retroversion
What is it called when the angle of femoral torsion is increased?
Anteversion
What is the name of the ligament of the head of the femur?
Ligamentum Teres
Describe the acetabulum of the hip joint
Acetabulum is the joint surface that faces infrolaterally and slightly anteriorly which receives the head of the femur
Lunate surface of hyaline cartilage-horseshoe shaped
Thickest above and centrally for weight bearing
Non articular region of acetabulum fossa and notch is covered with fat
Describe the acetabular labrum of the hip joint
Fibrocartilaginous rim
Triangular in cross section
Describe the structure of the head of the femur
Spheroid in shape, covered in hyaline cartilage
Thicker centrally than at the periphery
Cartilage is deficient over the fovea
What movements does the pubofemoral ligament limit?
Extension and abduction
Where does the ichiofemoral ligament come from?
The inferior aspect of the ischium
Where does the ichiofemoral ligament go to?
The capsule and the anterior part of the greater trochanter deep to the iliofemoral ligament
What movements does the ischiofemoral ligament limit?
Extension and medial rotation
Where is the apex of Ligament Teres?
From a pit (fovea) in the head of the femur
Where is the base of Ligament Teres?
Acetabular notch and transverse acetabular ligament
What does the Inguinal ligament connect?
It connects the ASIS to the pubic tubercle
Name 7 things that allow for hip joint stability
Strong surrounding ligaments
Cup shaped acetabulum
Deepened by the acetabular labrum
Strong capsule
Vacuum effect of ball within socket
Oblique angle of femoral neck
Arrangement of powerful surrounding muscles
What is nutation?
The sacrum moves forward into the pelvis
This is the closed packed position of the SIJ
What is counter nutation?
The sacrum moves backwards
What is the interosseous sacro-iliac ligament?
Massive ligament forming the bond between ilium and sacrum (syndesmosis)
Where is the Ventral sacro-iliac ligament found?
From lateral sacrum to the medial aspect of the ilium
What are the functions of the Ventral Sacro-iliac ligament?
Thickening of the capsule
Provides anterior stability