The hip and pelvis Flashcards
What does the pelvis consist off
the hip bone ( hemi pelvis either side of the sacrum), sacrum- centrally placed, coccyx- distal bone
What 3 bones form the hip bone
the ilium, the ischium and the pubis. These bones meet and fuse in the centre of the asatablum
The hip bones- iliac crest
runs all the way from the anterior to posterior, this finishes in 2 points, the anterior superior iliac spine, anterior inferior iliac spine, and the posterior superior iliac spine and the posterior inferior iliac spine
The hip bones- pubis
has a superior pubic rami and an inferior pubic rami, this fuses with ischium rami
structure of the sacrum
a dense block of 5 rudimentary vertebra which are fused together (no movement between vertebra), it has a medial and sacral crest that acts as processes, the top area is called the sacral promontory, concave anteriorly and convex posteriorly
Sacrum- joint and foramen
sacral iliac joint on the sacral side, it has a foramen that travels all the way through- spinal nerve routes emerge from the sacral foramen
Structure of the coccyx
3-4 rudimental vertebra these articulate at the sacral articular junction- little bit of movement but often lost at old age
Anterior palpable structures
iliac crest, anterior superior iliac spine, inguinal ligament- not a true ligament as it doesn’t cover muscle- it goes from ASIS to pubic tubercle, pubic symphysis and pubic tubercle
Posterior palpable structures
posterior superior iliac spine and inferior, sacrum, sacral spinal proceses, coccyx, ischial tuberosity- origin for hamstrings and extensor aspect of adductor magnus
Proximal femur- anterior
femoral head, femoral neck- after articular cartilage, greater trochanter- laterally facing, intertrochanteric line- this is were the hip ligaments attach too, lesser trochanter
Proximal femur- posterior
pectineal line, gluteal tuberosity, intertrochanteric crest- between greater and lesser trochanter, linea aspera
what is the linea aspera
off the gluteal tuberosity (where gluteus maximus inserts), this develops a posterior line and a pectineal line, these bond together to form the linear aspera. it distally divides into a medial and lateral supracondylar ridges, ridge mark attachments of powerful thigh muscles
femoral neck inclinations
Normal- 125°, coxa valga is were the inclination is more than 130°, coxa vera is a deformity where the angle is lessened, effecting the biomechanics of the hip (<120°)
Femoral torsion
Normal degree of femoral torsion 12-15°, retroversion this is were the angle is less than 15°, anteversion is were the angle is greater than 15°
what are anteverted hips
the femoral torsion angle is bigger than 15° (35°) this leads to the hip correcting itself by moving the toes inwards, this is an intoing gate, the patella is inwards and the food is medially rotated (inwards)
effect of anteverted hips
detrimental effect on lower limb biomechanics, internal tibial torsion
femoral head blood supply
ligamentum teres- artery within it, artery of the ligaments of the head of the femur
medial and lateral circumflex arteries
nutrient arteries within the femoral shaft
classification of the hip joint
synovial, polyaxial ball and socket joint with 3 degrees of movement
the hip joint surfaces- acetabulum
lunate surface of hyaline cartilage- horseshoe shaped, thickest above centrally, for weight bearing, non articular region of acetabular fossa and notch is covered with fat
the hip joint surfaces- acetabular labrum
fibro cartilaginous rim, triangular in cross section, labreal tear- clicking and catching of joint
head of femur
spheroid in shape, covered wit hyaline cartilage, thicker centrally than at the periphery- greater wear and tear, cartilage is deficient over the fovea, as soon as the articular cartilage is finished, then into the neck which is vulnerable to fracture
ligaments of the hip joint
iliofemoral ligaments (anterior), pubofemoral ligament (anterior), ischiofemoral ligament (posterior), ligamentum teres (intrenal)
iliofemoral ligament- structure
formed by 2 bands (superior and inferior), both bands originate from the AIIS, they cover all the intertrochanteric line (line between greater and lesser trochanter)
iliofemoral ligament- apex and base
Apex- from the AIIS, base- to the intertrochanteric line
iliofemoral ligament- limits
superior band limits extension/ adduction, inferior band limits extension/ abduction
pubofemoral ligament- apex and base
apex- from the pubic eminence, base- to the capsule and the medial band of the iliofemoral ligament and intertrochanteric line
pubofemoral ligament- limits
extension and abduction
ischiofemoral ligament- apex and base
apex- the inferior aspect of the ischium, base- the capsule and the anterior part of the greater trochanter deep to the iliofemoral ligament
ischiofemoral ligament- limits
extension and medial rotation
ligamentum teres- apex and base
apex- from pit (fovea) in the head of the femur, base- to the acetabular notch and transverse acetabular ligament
inguinal ligament
connects ASIS to the pubic tubercle
Hip joint stability- ligaments and muscle
strong surrounding ligaments- fibrous capsule is strong, arrangement of powerful and strong muscles
Hip joint stability- acetabulum
cup shaped acetabulum, deepend by the acetabular labrum- ring of cartilage that surrounds the acetabulum
Hip joint stability- ball and socket, oblique angle of femoral neck
vacuum effect of ball and socket- held well, oblique angle of femoral neck- on weight bearing and drives head of femur deeper into acetabulum
limitations to range of motion
tension to antagonists, soft tissue apposition- obese and late stage pregnancy, tension in ligaments limits range, relative congruence of articular surface
hip range of motion- flexion and extension
Flex- 100-120, ext- 15-20
hip range of motion- abduction and adduction
abd 40-45, add- 15-30
hip range of motion- lateral and medial rotation
lat- 45-60, medial- 30-40
closed pack position for hip
maximum extension, medial rotation, abduction
open pack position for hip
slight flexion, abduction, lateral rotation
classification- sacroiliac joint
synovial, plane joint (gliding and sliding, no physiological movement). Ridged articular surfaces- can lead to issues if one ridge gets stuck on another
joint movement- sacroiliac joint
nutation and counternutation
what is nutation
the sacrum moves forward into the pelvis, this is the closed pack position for the SIJ, anterior tilting of the sacral promontory, anterior rotation of the coccyx
what is counter nutation
the sacrum moves backwards, posterior tilting of the sacral promontory, anterior rotation of the coccyx
interosseous (between bones) sacroiliac ligament
massive ligament forming the bond between the ilium and the sacrum (syndesmosis), from- the anterior surface of the ilium, to- posterior aspect of the articular surface on the sacrum
ventral sacroiliac ligament
from- lateral sacrum, to- the medial aspect of the ilium, provides anterior stability and the thickening of capsule
what is the sacrotuberous ligament
from- PSIS, sacral tubercles, lateral margins of sacrum and coccyx, to- ishcial tuberosity, and ischial ramus
what does the sacrotuberous ligament limit
it limits nutation of the sacrum and posterior rotation of the ilium
what is the sacrospinous ligament
apex- the spine of the ischium, too- the lateral margins of the sacrum and coccyx, limits- nutation of the sacrum and posterior rotation of the ilium past the sacrum
Upper band of the iliolumbar ligament
from- transverse processes of L5, too- posterior aspect of the iliac crest
lower band of the iliolumbar ligament
from- transverse processes of L5, to- anterior sacrum and ventral sacro-iliac ligament
what is the classification of the symphysis pubis
secondary cartilaginous joint
symphysis pubis joint
interpunic disc, superior pubic ligament, inferior arcuate ligament, supported by hyaline cartilage end plates on either aspect of interpubis, minimal recorded movement
Similarities between symphysis pubis and SIJ
they have no muscles that control their movement directly, muscles do not contribute to the stability of the joint, joints are influenced by muscles the lumbar spine and hip joint
