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Hip joint
DR. PRIYANKA RANAWAT { PHYSIOTHERAPIST ]
INTRODUCTION
 The weight bearing joints of the lower limb
are more stable.
 Hip joint allows the same movement as
the mobile shoulder joint but range of
movement is restricted.
HIP JOINT
TYPE & ARTICULAR SURFACE OF HIP
JOINT
 Ball and socket variety of synovial joint . { three degree of
freedom }
 ARTICULAR SURFACE :-
 The head of femur articulates with the acetabulum of the hip
bone.
 The head of femur forms more than half sphere and
covered with hyaline cartilage .
CONT...
 The stability or strength depends upon :-
 Depth of acetabulum and narrowing of its mouth by the
acetabular labrum.
 Tension and strength of ligament .
 Length of the neck of femur.
LIGAMENTS
 TYPES :-
 INTRA ARTICULAR
 EXTRA ARTICULAR
INTRA ARTICULAR LIGAMENGT
 LIGAMENT OF FEMORAL HEAD :-
 Also known as round Ligament of the
femur.
 This ligament attaches between the
peripheral inferior acetabular notch and
the fovea of the femoral head.
 The main functions include carrying small
vessels and nerves to the femoral head
and providing proprioception and
structural stability to the hip joint by
limiting abduction and external rotation
when the hip is flexed.
CONT…
 TRANSVERSE LIGAMENT OF
THE ACETABULUM:-
 A fibrous structure that
transforms the acetabular
notch into a foramen. It
channels nerves and vessels
into the joint
EXTRA ARTICULAR LIGAMENT
 Iliofemoral ligament:-
strongest ligament
 (also known as the Y
ligament of
Bigelow) The primary
function of this
ligament is to prevent
hip hyperextension and
external rotation in an
upright position.
CONT..
 Ischio femoral ligament :- it consists
of a triangular band of fibers that form
the posterior hip joint capsule.
 It inserts in the ischium, behind the
acetabulum and attaches to the femur,
medial to the greater trochanter.
 The ligament has two roles: it limits
internal rotation and extension and
reinforces the posterior portion of the
capsule during internal rotation.
CONT…
 Pubofemoral ligament:- originates at the
pubic part of the acetabular rim and the
superior pubic ramus and attaches to the lower
part of the femoral neck.
 It limits abduction and external rotation during
hip extension and reinforces the inferior
capsule.
 Zona orbicularis:- is primarily a stabilizer
of the hip joint.
 This ligament is formed by the circular fibres
from the capsule, which contains fibres from all
extra-articular ligaments.
MUSCLES AROUND THE HIP JOINT
PSOAS MUSCLE
Origin:-
transverse processes and
lateral aspect of T12 –L5
vertebral bodies.
 Insertion :-
lesser trochanter
 Nerve supply :-
femoral nerve
 Action :- flexion
RECTUS FEMORIS
 Origin:- AIIS
 Insertion:-
tibial tuberosity
and quadriceps of patella
 Nerve supply :- Femoral
nerve
 Action :- flexion of hip
joint
TENSOR FASCIA LATAE
 Origin :- ASIS
 Insertion :- tibial band to
lateral condyle of tibia
 Nerve supply :- superior
gluteal nerve L4,L5,S1
 Action :- flexion ,
abduction
SARTORIUS MUSCLE :-
 Origin :- ASIS
 Insertion :- superior
aspect of medial tibia
 Nerve supply :- Femoral
nerve
 Action :- flexion , lateral
rotation
GLUTEUS MAXIMUS
 Origin :- posterior ilium,
sacrum, coccyx
 Insertion :- iliotibial band to
lateral condyle of tibia
 Nerve supply :- Inferior
gluteal nerve L5, S1 S2
 Action :- extension
GLUTEUS MINIMUS
 Origin :- lateral surface of
ilium between anterior or
inferior gluteal line
 Insertion :- greater
trochanter
 Nerve supply :- superior
gluteal nerve L4, L5 , L6
 Action :- medial rotation
GLUTEUS MEDIUS
 Origin :- lateral surface of
ilium between anterior or
posterior gluteal line
 Insertion :- greater
trochanter
 Nerve supply :- Superior
gluteal nerve L4, L5 L6
 Action :- abduction
BICEPS FEMORIS
 Origin :- ischial tuberosity
{ long head }
 Insertion :- lateral aspect
of fibular head
 Nerve supply :-sciatica
 Action :- extension of hip
joint
SEMITENDINOSUS
 Origin :- ischial
tuberosity
 Insertion :- superior
aspect of medial tibia
 Nerve supply :-
sciatic nerve
 Action:- extension
SEMIMEMBRANOSUS
 Origin :- ischial
tuberosity
 Insertion :-
posterior aspect pf
medial tibial condyle
 Nerve supply :-sciatic
nerve
 Action :- extension
ADDUCTOR MAGNUS
 Origin :- inferior ramus of pubis to
ischial tuberosity
 Insertion :- gluteal tuberosity to
adductor tubercle of femur
 Nerve supply :- Adductor part by
posterior division of obturator
nerve
 Hamstring part by tibial part of
sciatica nerve
 Action :- adduction
PIRIFORMIS
 Origin :- anterior
surface of sacrum
 Insertion :- greater
trochanter
 Nerve supply :- ventral
rami of S1 , S2
 Action :- lateral
rotation
BIOMECHANICS OF HIP
ACETABULUM
 The opening of acetabulum faces inferiorly
by 50 degree and rotated anteriorly 20 degree.
 In women A few degree greater
inclination and anteversion compared
with males.
 The articular surface area of acetabulum tends
to smaller in women than in men.
CENTER EDGE OF ANGLE
 Measured acetabular depth
 Formed by a line connecting the
lateral rim of acetabulum and the
center of femoral head and a vertical
line from the center of femoral head
 normal range :- 25 to 40 degree.
ANGLE OF INCLINATION OF THE
FEMUR
 The axis of femoral head and
neck forms an angle with the
axis of the femoral shaft called
angle of inclination .
 Normal range of angle :- 125
degree
 Greater medial angle :-
coxa valga
 Smaller medial angle :- coxa
vara
ANGLE OF TORSION OF
THE FEMUR
 An axis through the femoral
head and neck in the
transverse plane will lie at an
angle to an axis through
femoral condyles.
 Normal angle of torsion :- 10
to 20 degree
 For male :- 15 degree
 For female :- 18 degree
OPEN PACKED POSITION
 The open–packed position for the hip joint is with
the hip in 30 degree flexion, 30 degree
abduction, and external rotation.
 Min. Stability , full congruency
CLOSED PACKED POSITION
 The close-packed position for the hip joint is with
the hip in extension, adduction, and internal
rotation.
 This position is often referred to as the “standing
at attention” position.
 This position provides the most stability to the hip
joint.
 Max. Stability , less congruency because ligament
are taut .
END FEEL
 End feel is type of sensation or feeling that the
examiner experienced when the joint is at the
end of its available passive ROM in assessment
 End feel of hip :- muscular stretch
 Example :- hip flexion
 Firm end feel due to muscular , capsular and
ligamentous stretch .
HIP JOINT FORCES AND MUSCLE
FUNCTION
 Bilateral stance:-
 In erect bilateral stance , both hips are
neutral and slight extension and weight is
evenly distributed between both legs .
 The weight of the body acting around the
right hip tend to drop the pelvis down on
the left { right adduction moment }
 Weight acting around the left hip tends to
drop the pelvis down on the right { left
adduction moment } .
 Two opposing gravitational moments of
equal magnitude and balanced each other
UNILATERAL STANCE
• Centre of gravity moves distally and away from the supporting leg
• The non-supporting leg becomes a part of the body mass acting upon the
weight-bearing hip
• The downward force exerts a turning motion around the center of the
femoral head
• The abductors, including the upper fibers of the gluteus maximus, the tensor
fascia latae, the gluteus medius and minimus, the piriformis and obturator
internus, offsetthe action of the muscles resisting the rotation of the
femoral head. This creates a moment around the center of the femoral head
• The lever of the abductors is shorter than the lever arm of body weight.
Therefore, the combined force of the abductors must be multiples of body
weight.
CONT…
COMPENSATORY LATERAL LEAN OF THE
TRUNK
 When the trunk is laterally flexed towards the
stance limb , the moment arm of HATLL is
substantially reduced.
 The adductor remains unchanged .
 The result is substantially diminished torque
from HATLL and substantially decreased need
for hip abductor force to generate a counter
torque
USE OF CANE IPSILATERAL
 Pushing downward on a cane held in the hand on the side of
pain or weakness should reduce the superimposed body weight
by the amount of downward thrust,
 some of the weight of HATLL would follow the arm to the
cane, rather than arriving on the sacrum and the weight-
bearing hip joint.
 The proportion of body weight that passes through the cane
will not pass through the hip joint and will not create an
adduction torque around the supporting HIP joint .
USE OF CANE CONTROLATERAL
 When a cane is placed in the hand
opposite the painful supporting hip, the
weight passing through the right hip is
reduced, and activation of the left
latissimus dorsi provides a Counter
torque to that of HATLL and diminishes
the need for a contraction of the right
hip abductors.

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ANATOMY AND BIOMECHANICS OF HIP JOINT.pdf

  • 1. Hip joint DR. PRIYANKA RANAWAT { PHYSIOTHERAPIST ]
  • 2. INTRODUCTION  The weight bearing joints of the lower limb are more stable.  Hip joint allows the same movement as the mobile shoulder joint but range of movement is restricted.
  • 4. TYPE & ARTICULAR SURFACE OF HIP JOINT  Ball and socket variety of synovial joint . { three degree of freedom }  ARTICULAR SURFACE :-  The head of femur articulates with the acetabulum of the hip bone.  The head of femur forms more than half sphere and covered with hyaline cartilage .
  • 5. CONT...  The stability or strength depends upon :-  Depth of acetabulum and narrowing of its mouth by the acetabular labrum.  Tension and strength of ligament .  Length of the neck of femur.
  • 6. LIGAMENTS  TYPES :-  INTRA ARTICULAR  EXTRA ARTICULAR
  • 7. INTRA ARTICULAR LIGAMENGT  LIGAMENT OF FEMORAL HEAD :-  Also known as round Ligament of the femur.  This ligament attaches between the peripheral inferior acetabular notch and the fovea of the femoral head.  The main functions include carrying small vessels and nerves to the femoral head and providing proprioception and structural stability to the hip joint by limiting abduction and external rotation when the hip is flexed.
  • 8. CONT…  TRANSVERSE LIGAMENT OF THE ACETABULUM:-  A fibrous structure that transforms the acetabular notch into a foramen. It channels nerves and vessels into the joint
  • 9. EXTRA ARTICULAR LIGAMENT  Iliofemoral ligament:- strongest ligament  (also known as the Y ligament of Bigelow) The primary function of this ligament is to prevent hip hyperextension and external rotation in an upright position.
  • 10. CONT..  Ischio femoral ligament :- it consists of a triangular band of fibers that form the posterior hip joint capsule.  It inserts in the ischium, behind the acetabulum and attaches to the femur, medial to the greater trochanter.  The ligament has two roles: it limits internal rotation and extension and reinforces the posterior portion of the capsule during internal rotation.
  • 11. CONT…  Pubofemoral ligament:- originates at the pubic part of the acetabular rim and the superior pubic ramus and attaches to the lower part of the femoral neck.  It limits abduction and external rotation during hip extension and reinforces the inferior capsule.  Zona orbicularis:- is primarily a stabilizer of the hip joint.  This ligament is formed by the circular fibres from the capsule, which contains fibres from all extra-articular ligaments.
  • 12. MUSCLES AROUND THE HIP JOINT
  • 13. PSOAS MUSCLE Origin:- transverse processes and lateral aspect of T12 –L5 vertebral bodies.  Insertion :- lesser trochanter  Nerve supply :- femoral nerve  Action :- flexion
  • 14. RECTUS FEMORIS  Origin:- AIIS  Insertion:- tibial tuberosity and quadriceps of patella  Nerve supply :- Femoral nerve  Action :- flexion of hip joint
  • 15. TENSOR FASCIA LATAE  Origin :- ASIS  Insertion :- tibial band to lateral condyle of tibia  Nerve supply :- superior gluteal nerve L4,L5,S1  Action :- flexion , abduction
  • 16. SARTORIUS MUSCLE :-  Origin :- ASIS  Insertion :- superior aspect of medial tibia  Nerve supply :- Femoral nerve  Action :- flexion , lateral rotation
  • 17. GLUTEUS MAXIMUS  Origin :- posterior ilium, sacrum, coccyx  Insertion :- iliotibial band to lateral condyle of tibia  Nerve supply :- Inferior gluteal nerve L5, S1 S2  Action :- extension
  • 18. GLUTEUS MINIMUS  Origin :- lateral surface of ilium between anterior or inferior gluteal line  Insertion :- greater trochanter  Nerve supply :- superior gluteal nerve L4, L5 , L6  Action :- medial rotation
  • 19. GLUTEUS MEDIUS  Origin :- lateral surface of ilium between anterior or posterior gluteal line  Insertion :- greater trochanter  Nerve supply :- Superior gluteal nerve L4, L5 L6  Action :- abduction
  • 20. BICEPS FEMORIS  Origin :- ischial tuberosity { long head }  Insertion :- lateral aspect of fibular head  Nerve supply :-sciatica  Action :- extension of hip joint
  • 21. SEMITENDINOSUS  Origin :- ischial tuberosity  Insertion :- superior aspect of medial tibia  Nerve supply :- sciatic nerve  Action:- extension
  • 22. SEMIMEMBRANOSUS  Origin :- ischial tuberosity  Insertion :- posterior aspect pf medial tibial condyle  Nerve supply :-sciatic nerve  Action :- extension
  • 23. ADDUCTOR MAGNUS  Origin :- inferior ramus of pubis to ischial tuberosity  Insertion :- gluteal tuberosity to adductor tubercle of femur  Nerve supply :- Adductor part by posterior division of obturator nerve  Hamstring part by tibial part of sciatica nerve  Action :- adduction
  • 24. PIRIFORMIS  Origin :- anterior surface of sacrum  Insertion :- greater trochanter  Nerve supply :- ventral rami of S1 , S2  Action :- lateral rotation
  • 26. ACETABULUM  The opening of acetabulum faces inferiorly by 50 degree and rotated anteriorly 20 degree.  In women A few degree greater inclination and anteversion compared with males.  The articular surface area of acetabulum tends to smaller in women than in men.
  • 27. CENTER EDGE OF ANGLE  Measured acetabular depth  Formed by a line connecting the lateral rim of acetabulum and the center of femoral head and a vertical line from the center of femoral head  normal range :- 25 to 40 degree.
  • 28. ANGLE OF INCLINATION OF THE FEMUR  The axis of femoral head and neck forms an angle with the axis of the femoral shaft called angle of inclination .  Normal range of angle :- 125 degree  Greater medial angle :- coxa valga  Smaller medial angle :- coxa vara
  • 29. ANGLE OF TORSION OF THE FEMUR  An axis through the femoral head and neck in the transverse plane will lie at an angle to an axis through femoral condyles.  Normal angle of torsion :- 10 to 20 degree  For male :- 15 degree  For female :- 18 degree
  • 30. OPEN PACKED POSITION  The open–packed position for the hip joint is with the hip in 30 degree flexion, 30 degree abduction, and external rotation.  Min. Stability , full congruency
  • 31. CLOSED PACKED POSITION  The close-packed position for the hip joint is with the hip in extension, adduction, and internal rotation.  This position is often referred to as the “standing at attention” position.  This position provides the most stability to the hip joint.  Max. Stability , less congruency because ligament are taut .
  • 32. END FEEL  End feel is type of sensation or feeling that the examiner experienced when the joint is at the end of its available passive ROM in assessment  End feel of hip :- muscular stretch  Example :- hip flexion  Firm end feel due to muscular , capsular and ligamentous stretch .
  • 33. HIP JOINT FORCES AND MUSCLE FUNCTION  Bilateral stance:-  In erect bilateral stance , both hips are neutral and slight extension and weight is evenly distributed between both legs .  The weight of the body acting around the right hip tend to drop the pelvis down on the left { right adduction moment }  Weight acting around the left hip tends to drop the pelvis down on the right { left adduction moment } .  Two opposing gravitational moments of equal magnitude and balanced each other
  • 34. UNILATERAL STANCE • Centre of gravity moves distally and away from the supporting leg • The non-supporting leg becomes a part of the body mass acting upon the weight-bearing hip • The downward force exerts a turning motion around the center of the femoral head • The abductors, including the upper fibers of the gluteus maximus, the tensor fascia latae, the gluteus medius and minimus, the piriformis and obturator internus, offsetthe action of the muscles resisting the rotation of the femoral head. This creates a moment around the center of the femoral head • The lever of the abductors is shorter than the lever arm of body weight. Therefore, the combined force of the abductors must be multiples of body weight.
  • 36. COMPENSATORY LATERAL LEAN OF THE TRUNK  When the trunk is laterally flexed towards the stance limb , the moment arm of HATLL is substantially reduced.  The adductor remains unchanged .  The result is substantially diminished torque from HATLL and substantially decreased need for hip abductor force to generate a counter torque
  • 37. USE OF CANE IPSILATERAL  Pushing downward on a cane held in the hand on the side of pain or weakness should reduce the superimposed body weight by the amount of downward thrust,  some of the weight of HATLL would follow the arm to the cane, rather than arriving on the sacrum and the weight- bearing hip joint.  The proportion of body weight that passes through the cane will not pass through the hip joint and will not create an adduction torque around the supporting HIP joint .
  • 38. USE OF CANE CONTROLATERAL  When a cane is placed in the hand opposite the painful supporting hip, the weight passing through the right hip is reduced, and activation of the left latissimus dorsi provides a Counter torque to that of HATLL and diminishes the need for a contraction of the right hip abductors.