4. Hip joint
• Hip joint is a ball-and-socket joint that is
relatively fixed to the body by the pelvic girdle
• Largest and strongest joint of body
5. • Structures of the hip can be divided into
several categories, These include;
–bones and joints
–capsules and ligaments
–muscles
–nerves
–blood vessels
–bursae
9. • Acetabulum is deficient inferiorly by acetabular
notch which is bridged with transverse acetabulur
ligament.
• Ligamentum teres passess through acetabular
notch which goes to fovea on the femoral head
• Articular cartilage covers the horse-shoe shaped
articular surface of acetabulum
• The center is free of cartilage-acetabular fossa
which is filled with fibrofatty tissue.
10. Acetabular labrum:
• fibrocartilage
• Deepens the acetabulum
• Distributes stresses to the joint during joint
loading
• Maintains intra-articular pressure
11. Femur head
• The femoral head articulates with the cup-
shaped (cotyloid) acetabulum,
• its Centre lying a little below the middle third
of the inguinal ligament.
• The femoral head is covered by articular
cartilage, except over the rough pit where the
ligamentum teres is attached
12.
13.
14. SYNOVIAL MEMBRANE
• Starting from the femoral articular margin, the
synovial membrane covers
– intracapsular part of the femoral neck,
– internal surface of the capsule
– acetabular labrum,
– ligamentum teres and
– fat in the acetabular fossa.
15. capsule
• There is a strong dense fibrous capsule
• This is attached proximately to the
acetabulum, the glanoid & the transverse
ligament
• Distally it covers the lateral margin of the
femoral head & most of the neck
• Anteriorly it is attached to the
intertrochanteric line & posteriorly to the neck
just above this
16. ligament
Capsule is reinforced by
• iliofemoral ligament,-infront
• pubofemoral ligament- inferiorly
• ischiofemoral ligament- behind
17.
18. • iliofemoral (Y-shaped ligament of Bigelow)—
which arises from the anterior inferior iliac spine,
bifurcates, and is inserted at each end of the
trochanteric line (Fig. 167);
• pubofemoral—arising from the iliopubic junction
to blend with the medial aspect of the capsule;
• ischiofemoral—arising from the ischium to be
inserted into the base of the greater trochanter.
the iliofemoral is by far the strongest and resists
hyperextension
19. • Ligamentum teres is an
intracapsular ligament
arises from the
transverse ligament of
the acetabular rim,
attaching to a pit in the
head of the femur, &
carries blood vessels
which provide
nourishment for a small
area of the head
25. Nerve supply
Hilton’s law nerves crossing a joint
– supply the muscles acting on it,
– the skin over the joint and
– the joint itself.
• The hip is no exception and
• receives fibres from the femoral, sciatic and
obturator nerves.
•
26. • The femoral nerve (L2-L4) supplies the
quadriceps and pectineus muscles of the
anterior thigh
• The sciatic nerve (L4-S3) supplies the long
head of biceps femoris, hamstring muscles
common, to supply the hip flexors and
muscles of the lower leg(peroneal and tibial
nerves
27. • superior gluteal nerve (L4,5)- gluteus medius,
minimus and TFL.
• Inferior gluteal nerve (L5, S1) - gluteus maximus.
• The obturator nerve (L2-4)
-anterior division-- hip joint and adductor longus,
brevis, and gracilis,
- posterior division obturator internus and adductor
magnus.
28. Blood supply
• Major blood supply to
the head and neck of
the femur is usually the
medial femoral
circumflex artery, a
branch of the common
femoral artery
• Fracture of the femoral
neck can disrupt the
blood supply and result
in osteonecrosis
29. bursae
• Approximately 18 bursae have been identified
• Clinically most important
– Iliopectineal or iliopsoas bursa
– Trochanteric bursa
– Ischiogluteal bursa
30. • Iliopectineal bursa
• It lies over the anterior
surface of the articular
capsule beneath the
deep surface of the
iliopsoas muscle
between the iliofemoral
& pubofemoral
ligament
• It is the largest & most
constant bursa
• In 15% cases
communicate with the hip
joint
32. • Trochanteric bursa
– Situated between the posterolateral surface of the
greater trochanter & the gluteus maximus muscle
– Actually comprises three bursae, the principal
being the gluteus maximus bursae; the bursae of
gluteus medius & gluteus minimus are at sites of
the prospective tendon attachment
33. • Ischiogluteal bursa
– Over the ischial
tubersity & overlies
the sciatic nerve
– Facilitates gliding of
the gluteus maximus
over the tuberosity
34. Criteria for Diagnosis of Trochanteric
Bursitis
1.Lateral hip pain
2.Distinct tenderness about the greater trochanter
3.Pain at the extreme of rotation, abduction, or
adduction,especially positive Patrick-FABERE test
4.Pain on hip abduction against resistance
5.Pseudoradiculopathy–pain radiating down the lateral
aspect of the thigh
6.Patrick-FABERE (Flexion, abduction, external rotation,
extension)
Need first 2 criteria plus one of the remaining criteria to
make diagnosis
