Musculoskeletal bone muscle injuries shoulder elbow joint

1. THE HIP JOINT
Dr.Muntaha

2. Anatomy.
Ball and socket joint of synovial joint.
Connects the pelvic girdle to the lower limb
Made up of femoral head and acetabulum
Designed for stability and wide range of
movement
Covered with a thin layer of hyaline
cartilage

3. The articular surface of is horse-shoe shaped
and is deficient inferiorly- acetabular notch
Has a labrum -a circular layer of cartilage which
surrounds the outer part of the acetabulum
making the socket deeper and so helping
provide more stability
-Acetabular labral tears are a common injury
from major or repeated minor trauma

4. Iliofemoral Ligament
•This is a strong ligament
which connects the
pelvis to the femur
• at the front of the joint
• It resembles a Y in
shape
• Stabilises the hip by
limiting hyperextension

5. • Pubofemoral ligament
–The pubofemoral ligament attaches the part of
the pelvis known as the pubis (most forward part,
either side of the pubic symphysis) to the femur.
• Ischiofemoral ligament:
–This is a ligament which reinforces the posterior
aspect of the capsule
– attaches the ischium to the two trochanters of
the femur.

6. • Transverse acetabular Ligament:
–Bridges acetabular notch.
• Ligament of head of femur: flat and
triangular in shape
• Lies within joint, ensheathed by
synovium

7. Gluteals:
Gluteus Maximus, Gluteus Minimus and Gluteus
Medius
Attach to the Ilium and travel laterally to insert
into the greater trochanter of the femur
Medius and Minimus abduct and medially rotate
the hip joint, as well as stabilising the pelvis
Gluteus maximus extends and laterally rotates the
hip joint

8. Quadriceps
The four Quadricep muscles are Vastus lateralis,
medialis, intermedius and Rectus femoris
All attach inferiorly to the tibial tuberosity
Rectus femoris originates at the Anterior Inferior
Iliac Spine and acts to flex the hip
The 3 other Quad muscles do not cross the hip joint,
and attach around the greater trochanter and just
below it.

9. Iliopsoas:
The is the primary hip flexor muscle which
consists of 2 parts
Attaches superiorly to the lower part of the
spine and the inside of the ilium
Cross the hip joint and insert to the lesser
trochanter of the femur

10. Hamstrings:
The hamstrings are three muscles which
form the back of the thigh
Attach superiorly to the ischial tuberosity
Cause hip extension

11. Functional Group of Muscles Acting on the
Hip
Flexors:
Iliopsoas, sartorius, tensor fascia lata, rectus
femorus, pectineus, adductor longus, brevis,
and magnus, gracilis
Extensors:
- hamstrings, addcutor magnus, gluteus maximus
Adductors:
- adductor longus, brevis, and magnus, gracilis,
pectineus

12. Abductors:
- gluteus medius, minimus, tensor fascia
lata
External rotators:
- obturator externus, internus, piriformis,
quadratus femoris, gluteus maximus
Internal Rotators:
- gluteus medius, minimus, tensor fascia
lata.

13. Nerves
Femoral (L2,3,4)
Obturator (L2, 3, 4)
Sciatic (L4,5, S1, 2,)
WHY ARE THESE IMPORTANT???
-Referred pain to the knee can hide hip
pathology and vis versa

14. Influence of the Hip Joint
on Balance and Posture Control
The joint capsule is richly supplied with
mechanoreceptors that respond to variations in
position, stress, and movement for control of
posture, balance, and movement.
Reflex muscle contractions of the entire kinematic
chain, known as balance strategies, occur in a
predictable sequence when standing balance is
disturbed and regained.
Joint pathologies, restricted motion, or muscle
weakness can impair balance and postural control.

15. FUNCTIONAL RELATIONSHIPS
OF THE HIPS AND PELVIS
• The pelvis is the connecting link between the
spine and lower extremities.
• Anterior Pelvic Tilt
The anterior superior iliac spines of the pelvis
move anteriorly and inferiorly and thus closer to
the anterior aspect of the femur as the pelvis
rotates forward around the transverse axis of the
hip joints. This results in hip flexion and increased
lumbar spine extension.
Hip flexors cause an anterior pelvic.

16. Posterior Pelvic Tilt
The posterior superior iliac spines of the
pelvis move posteriorly and inferiorly.
This results in hip extension and lumbar
spine flexion.
hip extensors cause a posterior pelvic
tilt

17. • Pelvic Shifting
During standing, a forward translatory shifting
of the pelvis results in extension of the hip
and extension of the lower lumbar spinal
segments. There is a compensatory posterior
shifting of the thorax on the upper lumbar
spine with increased flexion of these spinal
segments. This is often seen with slouched or
relaxed postures.

18. • Lateral Pelvic Tilt
• Frontal plane pelvic motion results in
opposite motions at each hip joint.
• Pelvic motion is defined by what is
occurring to the iliac crest of the pelvis that
is opposite the weight-bearing extremity
(that is, the side of the pelvis that is
moving).
• When the pelvis elevates, it is called hip
hiking; when it lowers, it is called hip or
pelvic drop.

19. • On the side that is elevated, there is hip
adduction; on the side that is lowered, there is
hip abduction During standing, the lumbar
spine laterally flexes toward the sideof the
elevated pelvis (convexity of the lateral curve
is toward the lowered side).
• abductors and adductors cause a lateral pelvic
tilt.

20. • Pelvic Rotation
• Rotation occurs around one lower extremity
that is fixed on the ground.
• The unsupported lower extremity swings
forward or backward along with the pelvis.
• When the unsupported side of the pelvis
moves forward, it is called forward rotation
of the pelvis. The trunk concurrently rotates
in the opposite direction, and the femur on
the stabilized side concurrently rotates
internally.

21. • When the unsupported side of the pelvis
moves backward, it is called posterior
rotation; the femur on the stabilized side
concurrently rotates externally, and the trunk
rotates opposite
• Lumbopelvic Rhythm
• A coordinated movement between the lumbar
spine and pelvis occurs during maximum
forward bending of the trunk as when
reaching toward the floor or the toes.

22. Common Injuries
• Dislocation
-femoral head moves out of the acetabulum
-usually it goes posterior into notch
-position typically flexion, adduction, and
internal rotation
-common mechanism: knee to dashboard
during traffic collision
-signs and symptoms: extreme pain, obvious
deformity, unwilling to move the extremity

23. COMMON INJURIES
• Hip Pointer
-contusion to the iliac crest
-signs and symptoms: pain, swelling, and
ecchymosis(bleeding-hematoma formation)
-severe limit to motion
-palpable hematoma

24. COMMON INJURIES
• Piriformis Syndrome
-sciatic nerve through piriformis
-pressure on the sciatic nerve due to muscle
spasm, trigger points, or tightness causing
posterior thigh pain
-other signs and symptoms: pain, limited ROM,
pt tenderness deep to the gluteals

25. COMMON INJURIES
• Hip Fracture
-most frequently occurs through the femoral
neck
-a direct blow to the lateral hip
-signs and symptoms: pain, swelling, and loss of
function
-the involved leg will appear shortened and will
be externally rotated

26. COMMON INJURIES
• Trochanteric Bursitis
-cause is abnormal friction or irritation of the
bursa between the IT band and greater
trochanter, direct blow, or improper
biomechanics
-usually a sport such as running
-signs and symptoms: local pain, swelling, pt
tenderness, and crepitus over the greater
trochanter
-patient may complain of hip snapping

27. COMMON INJURIES
• Ischial Bursitis
-lies over the ischial tuberosity
-may become painful and inflamed with
excessive friction
-signs and symptoms: pain with sitting,
tenderness over ischial tuberosity, pain w/
passive hip flexion and active/resistive hip
extension
-often difficult to differentiate from proximal
hamstring tendinitis

28. COMMON INJURIES
• Hip Joint Sprain
-less common
-excessive forcible exertion of the extremity that
stretch or tear the surrounding ligaments
-signs and symptoms: pain and decrease ROM

29. • Hip Joint Strains
-resulting from overstretching or from a rapid,
forceful contraction of the muscle
-explosive starts and slipping of the foot during
cutting are common mechanisms for hip flexor
and adductor strains
-these injuries frequently occur during the
beginning of practice and preseason training
-signs and symptoms: pain, pt tenderness,
muscle spasm, swelling, ecchymosis , and
decreased ROM

30. COMMON INJURIES
• Avulsion Fracture
-results from a violent contraction or tractioning
of the attaching muscle
-common sites: ASIS, AIIS, lesser trochanter, and
ischial tuberosity
-signs and symptoms: complain of a sudden
sharp pain at time of injury, unwilling to move
the extremity, pt tenderness along the bone,
also may have a muscle bulging away from the
attachment, and swelling

31. • Legg-Calve-Perthes Disease
-characterized by avascular necrosis of the
proximal femoral epiphysis
-a chronic condition that develops slowly in
children
-more often in males than in females
-signs and symptoms: pain in the hip or groin
that radiates to the knee, limping, decreased
ROM, and hip flexor tightness may be noted
-physician should be consulted to rule out
serious pathologies such as this

32. COMMON INJURIES
• Avascular Necrosis of the Femoral Head
-blood supply to the femur head is severed or is
occluded for a prolonged period of time.
-this is a common complication following hip
dislocations, fractures, and chronic synovitis
and often necessitates a hip replacement

33. Labrum Tears and Cartilage Loss
• Labrum tears and cartilage loss are common in
patients with mechanical symptoms in the hip
• In young, active patients with a complaint of
groin pain
• The diagnosis of a labrum tear should be
suspected and investigated as radiographs and
the history may be nonspecific for this diagnosis

34. Trendelenburg Tests
MOB TCD

35. Treatment
Surgical
Early in disease process before significant
radiographic changes – synovectomy
Can be performed arthroscopically
Advanced disease
Joint replacement (Arthroplasty) –
particularly hip and knee
Restores pain free function
Joint fusion (arthrodesis) – now confined to
digital joints, ankle and wrist

36. Total Hip Replacement:
• Prosthetic replacement of arthritic hip joint
with metal.
• Two components acetabular & Femoral.

37. Arthroscopic Hip Procedure:
• Minimally invasive hip procedure designed to
carry out on selected patients for diagnostic or
therapeutic purpose.
• Indications: for identifying and treating labral
tear.
• for debridement of loose cartilaginous
fragment.
• Proceed for core decompression in selected
pt.
• arthroscopic washout for infected hip.

38. Early Postoperative Weight-Bearing
Restrictions After Total Hip Arthroplasty
Method of Fixation
• Cemented. Immediate postoperative weight
bearing as tolerated.
• Cementless and hybrid. Recommendations
vary from partial weight bearing (toe-touch
or touch-down) for at least 6 weeks to
weight bearing as tolerated (no restrictions)
immediately after surgery

39. Surgical Approach
• Standard versus minimally invasive. Weight-
bearing usually more restricted after standard
(traditional) approach because of more
extensive surgical disturbance and repair than
minimally invasive approach. Weight bearing
as tolerated may be permissible immediately
after minimally invasive procedure

40. • Trochanteric osteotomy. Although used
infrequently,
restricted weight bearing at least 6 to 8 weeks or
possibly
12 to 16 weeks for bone healing
Other Factors
• Use of bone grafts. Non-weight-bearing or
restricted weight bearing during bone healing.
• Poor quality of patient’s bone. Extended
restrictions so as not to jeopardize the stability
of the prosthetic implants.