Applied Anatomy of Hip Joint

Applied Anatomy of Hip Joint
2/22/20151 Dept of Sports Medicine, AFMC
Maj Sunil Jhajharia
Dr Pradeep P

Applied Anatomy of Hip Joint
 Introduction
 Bones
 Ligaments
 Muscles & Movement
 Blood and Nerve
Supply
 Applied Radiology
 Applied Anatomy
2/22/2015Dept of Sports Medicine, AFMC2

Introduction
 It is the largest joint of
the human body
 It is the 2nd largest
weight bearing joint of
the human body
 Type:- Ball & Socket
variety of Synovial
joint

Head of Femur
 Globular, more than a
hemisphere
 Directed upward,
medially, and a little
forward
 Fovea capatis
femoris:- an ovoid
depression

Head of Femur
 Covered with hyaline
cartilage, except over
fovea capitis femoris
 The fovea capatis
gives attachment to
the ligament of the
head of femur

Acetabulum
 Horseshoe shaped
 Lunate articular
surface
 Acetabular fossa
 Acetabular notch
 Acetabular labrum

Acetabulum
Horse-shoe shaped
articular surface
Deepened by
fibro-cartilaginous
rim called
acetabular
labrum
Nonarticular
part, acetabular
fossa, lodges
pad of fat
Deficient
inferiorly as the
acetabular
notch that is
bridged up by
transverse
acetabular
ligament

Articulation
 Hemispherical head of
Femur
 Horseshoe-shaped
acetabulum of the hip
bone
 Articular surfaces
covered with hyaline
cartilage

Stability
 Unique in having a high degree of stability as well
as mobility
 Stability depends upon:
 Depth of Acetabulum and the narrowing of its mouth
by the Acetabular labrum
 Tension and strength of ligaments
 Strength of surrounding muscles
 Length and obliquity of the neck of the Femur

Ligaments
 Fibrous capsule
 Iliofemoral ligament
 Pubofemoral ligament
 Ischiofemoral
ligament
 Ligament of the head
of the Femur
 Acetabular labrum
 Transverse acetabular
ligament

Joint capsule
 Encloses the joint
 Anterosuperiorly-
 Thick & firmly
attached
 Posteroinferiorly-
 Thin & loosely
attached
 Two types of fibers
 Outer-longitudinal
 Inner-circular-zona
orbicularis

Iliofemoral ligament
 Strong, Y-shaped
 Covers the joint
anteriorly
 Prevents over-extension
during standing posture
 Attachment:
• Base to anterior inferior
iliac spine
• Two limbs to upper &
lower ends of
intertrochanteric line

Pubofemoral ligament
 Support the joint
inferomedially
 Triangular in shape
 Attachment:-
 Superiorly, attached to the
iliopubic eminence,the
obturator creast
 Inferiorly, merges with the
capsule and lower band of
iliofemoral ligament
 It limits extension &
abduction

Ischiofemoral Ligament
 Comparatively weak
and twisted & spiral
in shape
 Supports the joint
posteriorly
 Extend from the
ischium to the
acetabulum
 Limits the extension
of joint

Ligament of head of the Femur
 Round ligament or
ligamentum teres
 Flat and triangular in
shape
 Attachment:-
 Apex to the fovea
capatis
 Base to the
transverse ligament
and margins of the
acetabular notch

Ligament of head of the Femur
 It transmits arteries to
the head of Femur,
from the acetabular
branches of the
obturator and medial
circumflex femoral
arteries

Acetabular labrum
 Fibrocartilaginous rim
attached to the
margins of the
acetabulum
 Narrows the mouth of
the acetabulum
 Helps in holding the
head of femur in
position

Transverse acetabular ligament
 Formed by
acetabular labrum
 Bridges acetabular
notch, converting it
into tunnel through
which vessels and
nerves enter the
joint

Gluteus maximus
 Origin:-
 lower posterior iliac crest and
posterior surface of the
sacrum
 Insertion:-
 gluteal tuberosity (upper,
posterior aspect of the
femur) & IT band
 Actions:
 Extension of the hip
 External rotation of the hip
 Lower fibers (below the center
of motion) assist in adduction

Gluteus maximus
 Produces hip
extension beyond 15
degrees; not used
extensively during
walking
 Strongly used during
running, hopping,
skipping, and jumping
 Best isolated with the
knee flexed to reduce
hip extension from the
hamstrings

Gluteus medius
 Origin:-
 outer surface of the
ilium just below the
crest
 Insertion:-
 greater trochanter
 Actions:
 Abduction of the hip
 Anterior fibers:
Internal rotation,
 Posterior fibers:
External rotation

Gluteus minimus
 Origin:-
 Outer surface of the
ilium beneath the
gluteus medius
 Insertion:-
 Greater trochanter of
the femur
 Actions:-
 Internal rotation

Gluteus medius & minimus
 During walking these
muscles abduct (or
hold up) the free leg,
preventing it from
sagging.
 Both are important in
transferring weight
from one leg to the
other (e.g. running,
hopping, skipping,
etc.)
 Their effectiveness
decreases with age.

Tensor fasciae latae
 Origin:- iliac crest
 Insertion:- Iliotibial
band
 Actions:-
 Flexion of the hip

Iliopsoas
 Iliacus:-
• takes origin from upper 2/3rd
of iliac fossa
• Inner lip of the Iliac creast
• Upper surface of lateral part
of the Sacrum
• Psoas major:-
 From aterior surface and
lower borders of transverse
process of all lumber
vertebrae

Iliopsoas
 Insertion:-
 Iliacus and Psoas
Major both are
inserted into Lesser
trochanter of the
femur
 Actions:-
• Chief flexor of Hip
joint
• External rotation

Biceps femoris
 Origin:
 Long head:- ischial
tuberosity
 Short head:- lower half
of the linea aspera
 Insertion:-
 Head of the fibula
 Action:
 Extension of hip
 External rotation of the hip
(and knee)
 (Flexion of knee)

Semitendinosus
 Origin: Ischial
tuberosity
 Insertion: Medial
surface of proximal
end of the tibia
 Action:
 Extension of the
hip
 Internal rotation of
the hip (and knee)
 Flexion of the knee

Semimembranosus
 Origin: Ischial
tuberosity
 Insertion: Medial
surface of the tibia
 Action:-
 Flexion of the knee
 Extension of the hip
 Internal rotation of the
hip

Hamstrings

Rectus femoris
 Two joint muscle; most
superficial
 Origin: anterior-inferior
iliac spine of the ilium
 Insertion: top of the
patella and patellar
ligament to the tibial
tuberosity
 Actions:
 Flexion of the hip
 Extension of the knee

Sartorius
 Origin:-
 Anterior-Superior Iliac Spine
 Insertion:-
 Upper part of the medial
surface of shaft of Tibia
 Action:-
 Abduction and Lateral
rotation of the hip
 Flexion of the leg at knee
joint

Gracilis
 Origin:-
 Pubic crest
 Insertion:-
 Medial condyle of
tibia
 Actions:-
 Adduction at the hip
 Flexion (weak)

Pectineous
 Origin:
 pubic crest or ramus
 Insertion:-
 below the linea
aspera
 Actions
 Flexion
 Adduction
 External rotation

Adductor Brevis
 Origin:-
 Inferior ramus of
pubis
 Insertion:
 Pectineal line (linea
aspera)
 Actions:
 Adduction
 Flexion (weak)

Adductor Longus
 Below the adductor brevis
 Origin:-
 front of the pubis just
below its crest
 Insertion:-
 middle third of the linea
aspera
 Actions:-
 Adduction
 Flexion (weak)

Adductor Magnus
 Located posterior to the longus
 Origin:
 edge of the pubic crest and
ischial tuberosity
 Insertion:
 linea aspera
 Actions:
 Adduction
 Extension

Blood Supply
 Obturator artery
 Medial and lateral
circumflex femoral
Arteries
 Gluteal arteries

Nerve Supply
 Femoral nerve
 Superior Gluteal
nerve
 Anterior division of
Obturator nerve
 Nerve to Rectus
femoris
 Nerve to Quadratus
femoris

X RAY PELVIS
 Two standard views are taken to visualize hip
joint
 1. AP view
 2.lateral view

X RAY PELVIS
 Most trauma to the pelvis and hips can be
evaluated with an AP view of the pelvis and hips.
 Symptoms from fractures of the hip, acetabulum
and pelvis may be quite similar, thus, a full AP
pelvis radiograph including the hip must be
obtained if any of the above fractures are
expected.
 The femurs should be internally rotated when
obtaining an AP pelvis film so that the femoral
necks can be appropriately assessed for
fractures.

X RAY PELVIS

X Ray Of PELVIS
 Hip X-ray anatomy - Normal AP
 The five bones that comprise the pelvis are the
ilium, ischium, pubis, sacrum, coccyx, acetabulum
and head and neck of femur.
 Shenton's line is formed by the medial edge of
the femoral neck and the inferior edge of the
superior pubic ramus
 Loss of contour of Shenton's line is a sign of a
fractured neck of femur

Lateral X Ray Of Hip Joint
 Lateral x ray of hip joint is not routinely taken
 The Lateral view is often not so clear because
those with hip pain find the positioning required
difficult
 Taken to confirm the displacement of fracture
fragment and
 To confirm type of dislocation

Lateral X Ray Of Hip Joint

Arthritis Of Hip Joint

Avulsion Fracture Of ASIS

USG
 Usg is safe and painless procedure
 Is used to evaluate abnormalities of muscle, fluid
collection, benign and malignant tumors
 To visualize each structure position of probe and
patient differs

USG
STRUCTURES VISUALIZED
MUSCLE AND FAT HYPOECHOIC
TENDON HYPERECHOIC
LIGAMENTS HYPERECHOIC
BONE (CORTEX) HYPERECHOIC

USG
 Ultrasound of the hip is divided into anterior,
medial, lateral, and posterior approaches.

USG
 To visualize iliopsoas tendon:
Patient : supine position
Transducer : longitudinal or vertical
over the joint space

USG
To visualize Rectus femoris :
Patient : supine
Transducer : longitudinally or transversely
over AIIS

USG – RECTUS FEMORIS

USG – ADDUCTOR MUSCLE
 To visualize adductors muscle
Patient : thigh abducted and externally rotated
the knee joint
Transducer : longitudinally over medial aspect
of thigh
 Three layer are recognized on axial plane
superficial – Adductor longus and Gracilis
intermediate – Adductor brevis
deep – Adductor magnus

USG – ADDUCTOR MUSCLE

USG – ABDUCTOR MUSCLE
 To visualize abductors muscle
Patient lie on the opposite hip assuming an
oblique lateral or true lateral position
Transducer : Transverse and longitudinal US
planes obtained cranial to the greater trochanter
show the gluteus medius (superficial) and gluteus
minimus (deep) muscles.

USG – ABDUCTOR MUSCLE

USG - HAMSTRING
 To visualize hamstring muscles
The patient lies prone with the feet hanging out
of the bed.
Proximal origin of the semimembranosus,
semitendinosus and long head of the biceps
femoris muscles is visualized
 The ischial tuberosity is the main landmark

USG - HAMSTRING

USG

Mri Of Hip Joint

MRI OF KNEE JOINT
STRUCTURE T1W1 T2W1
Bone, Tendon
and Muscles
Dark Dark
Fat Bright Less bright
Fluid Dark Bright

MRI OF KNEE JOINT
Three standard views are
1.Coranal views
2.Axial views
3.Saggital

Coronal View
1.Iliac
2.Iliac Muscle
3.Gluteus med
4.Tensor fascia
lata
5.Pectineus
6.Urinary
bladder
7.Sym pubis
8. Gluteus mini

Axial View
1.Gluteus medius
2.Rectus femoris
3.Femoral vessels
4.Urinary bladder
5.Ilio psoas
6.Sartorius
7.TFL
8.Femoral head
9.Obturator
internus and
10. Gluteus maxi

Applied Anatomy

Avulsion Injuries Of Pelvis
 Avulsion injuries commonly seen in the
skeletally immature patient
 Avulsion injuries in adults involve tendinous
origins.
 The most common site of avulsion fractures in
the skeletally immature athlete are ischial
tuberosity, AIIS, and ASIS avulsions
 Most injuries occur from an eccentric muscle
contraction.
 Most injuries may be managed
nonoperatively.

Avulsion Injuries Of AIIS

Snapping Hip Syndrome
 Snapping hip syndrome, sometimes called
dancer's hip
 In most cases, snapping is caused by the
movement of a muscle or tendon over a bony
structure in the hip.
 The most common site is
1.when the iliotibial band passes over the
greater trochanter.
2.Iliopsoas tendon moves over the Iliopectineal
eminence
 Commonly seen in sports like
1.Atheletes

Snapping Hip Syndrome
 Fabers test positive
 MRI and ultrasound can confirm the diagnosis.
 Treatment : Avoidance of precipitating activities,
particularly hip flexion greater than 90°,
 NSAIDs and physiotherapy are the mainstay of
treatment

Adductor Muscle Strain
 Commonly seen in sports that involve sudden change
in direction
 1.Football
 2.Rugby
 3.Batminton etc..
 Treatment : 0-48 hrs
1.RICE
2.Active pain free ROM
• More than 48hrs
1.Strengthning exercise and
2. Sports specific skills

Iliopsoas Strain
 Iliopsoas is the strongest flexor of hip joint
 Iliopsoas problem occurs due to over use of hip
flexion
 Commonly injured in sports like
1.Football
2.Sprinters
Treatment :1. Avoid the aggravating
Factor
2. Stretching and strengthening of
Iliopsoas

Trochantric Bursitis
Bursa around Hip
Joint

 Commonly seen in long distance runners
 c/o lateral hip pain , aggrevated by hip movments
 Releived after rest
 Pain can be reproduced by stretching
of Gluteus medius
Treatment :1. Avoid the aggravating
Factor
2. Stretching and strengthening of
Gluteus medius

Conclusion
 It is essential to understand the basic anatomy of
hip joint
 Understanding the anatomy will be helpful to
come to final diagnosis and we can start early
treatment without depending upon the any
radiological investigation
 Which can also prevent the patient from any kind
of radiological exposure

References
22 February 2015Dept of Sports Medicine80
 Grays anatomy 40th edition
 Clinical sports medicine by Peter brukner and Karim
kahn 3 edition
 Current diagnosis and treatment by Patrick mc Mahon
1st edition
 http://www.rad.washington.edu/academics/academic-
sections/msk/teaching-materials/radiology-anatomy-
teaching-modules/basic-knee-anatomy
 Musculoskeletal Ultrasound Anatomy and Technique
by John O’Neill, MD
 Ultasound of Muscle Sports injuries by Jarret MD
Radiology

Thank you

Applied Anatomy of Hip Joint

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