Transcript 43-Hip Joint

HIP JOINT
…..the largest
joint in the body
Dr. Zeenat Zaidi
ARTICULATION
 Hemispherical
head of Femur
 Cup-shaped
acetabulum of
the hip bone
 Articular
surfaces covered
with hyaline
cartilage
Head of Femur




Globular, more than a
hemisphere
Directed upward, medially,
and a little forward
Surface is smooth, covered
with hyaline cartilage,
except over an ovoid
depression, the fovea capitis
femoris, which is situated a
little below and behind the
center of the head
The fovea gives attachment
to the ligament of the
head of femur
ACETABULUM
Horseshoe
shaped
articular
surface
Nonarticular part,
acetabular fossa,
lodges pad of fat
Deepened by
fibrocartilaginous
rim called
acetabular
labrum
Deficient inferiorly
as the acetabular
notch that is filled
up by transverse
acetabular
ligament
TYPE
 Synovial
A
perfect
example of a
‘Ball and Socket’
joint
CAPSULE


•
•
Encloses the joint
Attachment:
Medially: Acetabular labrum
Laterally:
• Anteriorly: to the
intertrochanteric line.
Some fibers reflect
upward along the neck,
form ‘retinacula’ (carry
blood vessels for head &
neck of femur)
• Posteriorly halfway along
the posterior aspect of
neck
LIGAMENTS
 Iliofemoral
 Pubofemoral
 Ischiofemoral
 Transverse
acetabular
 Ligament of head of femur
Iliofemoral Ligament
o
o
Strong, Y-shaped
Attachment:
 Base to anterior
inferior iliac spine
 Two limbs to
upper & lower
ends of
intertrochanteric
line
Prevents over-extension
during standing
Pubofemoral Ligament
o
o
Triangular in
shape
Attachment:
 Base to superior
ramus of pubis
 Apex to lower
part of intertrochanteric line
Limits extension & abduction
Ischiofemoral Ligament
o
o
Spiral in shape
Attachment:
 Medially to the
body of the
ischium near
acetabulum
 Laterally to the
greater
trochanter
Limits extension
Transverse Acetabular Ligament
o
o
Formed by
acetabular
labrum
Bridges
acetabular notch,
converting it into
tunnel through
which vessels
and nerves enter
the joint
Ligament of Head of Femur
o
o
o
Flat & triangular
Attachment:
 Apex to the pit
(fovea) on the head
of femur
 Base to transverse
ligament & the
margin of
acetabulum
Intracapsular,
ensheathed by
synovial membrane
Carries articular branch of
obturator artery to the joint
SYNOVIAL MEMBRANE
Lines the capsule
 Attached to
margins of
articular surfaces
 Covers
intracapsular part
of the neck of
femur
 Ensheaths
ligament of head
of femur
 Covers pad of fat
in acetabular fossa

 Protrudes
anteriorly
through gap
between
pubofemoral &
iliofemoral
ligaments and
forms psoas
bursa
RELATIONS
Anterior
Iliopsoas
Inferior
Pectineus
Rectus
femoris
Obturator
externus
Posterior
Sciatic
nerve
Obturator
internus
Superior
& inferior
Gemelli
Quadratus
femoris
Superior
Gluteus
minimus
Piriformis
BLOOD SUPPLY
Head & intra-capsular
part of neck receives
its blood supply from
trochanteric
anastomosis, mainly
from branches of
medial circumflex
artery
 A branch from
obturator artery in the
ligament of head of
femur is importanat in
young child

NERVE SUPPLY
Apply Hilton’s law
The nerve
supplying a joint
also supplies both
the:
 Muscles that move
the joint &
 Skin covering the
articular insertion
(area of action) of
those muscles
• Femoral
• Obturator
• Sciatic
• Nerve to quadratus
femoris
These nerves also
supply knee joint &
therefore pain arising
in the hip joint may
be referred to the
knee
STRENGTH & STABILITY
Depends largely on the:
 Shape of the bones
 Ligaments
MOVEMENTS
 Wide
range (less than shoulder joint)
 Some movements sacrificed in order
to provide strength & stability
 Movements are:
 Flexion/Extension
 Abduction/Adduction
 Lateral/Medial rotation
 Circumduction
FLEXION
 Flexors:




Iliopsoas
Rectus femoris
Sartorius
Adductor muscles
Limitation: with the knee flexed: Anterior
surface of thigh coming in contact with the
anterior abdominal wall
with the knee extended: Tension of
hamstring group of muscles
EXTENSION
 Extensors:
 Gluteus
maximus
 Hamstring
muscles
Limitation: Tension of
iliofemoral, pubofemoral
& ischiofemoral ligaments
ABDUCTION
 Abductors:
 Gluteus
medius &
minimus
 Piriformis
 Sartorius
 Tensor fascia
lata
Limitation: Tension of
pubofemoral ligament
ADDUCTION
 Adductors:
 Adductors
(longus, brevis &
adductor part of
magnus)
 Pectineus
 Gracilis
Limitation: Contact with the
opposite limb & by tension
in ligament of head of femur
LATERAL ROTATION

Lateral Rotators:
 Piriformis
 Obturator internus
& externus
 Gemilli
 Quadratus femoris
 Gluteus maximus
Limitation: tension in
iliofemoral & pubofemoral
ligaments
MEDIAL ROTATION
 Medial
Rotators:
 Anterior fibers of
gluteus medius
& minimus
 Tensor fascia
lata.
Limitation: tension of
ischiofemoral ligament.
CLINICAL ANATOMY
Referred Pain From the Hip Joint
The pain originating in the hip joint
to be referred to the front and
medial side of the thigh (femoral
nerve)
 The hip joint disease may give rise
to pain in the knee joint (posterior
division of the obturator nerve
supplies both the hip and knee
joints)

Congenital Dislocation






Affects 1-2 babies in every
1000
Associated with a shallow
acetabulum and an altered
angle of the femoral head
May be bilateral
Females affected more
than males
May be caused by
mechanical factors i.e.
malformed uterus
The affected limb is
shorter than the normal
limb
•
•
•
•
Capsule is loose
Upper lip of
acetabulum is not
developed properly
(hypoplasia).
Head of femur moves
up out of acetabulum
and lies against the
gluteal surface of
ilium.
Characteristic clinical
sign is the inability to
abduct the hip
Traumatic Dislocation
Rare, because of the
strength of joint
 Occurs when joint is
flexed & abducted.

This can occur in a car
crash where the knee
is pushed backwards,
often breaking off the
posterior rim of the
acetabulum
•
•
•
•
•
The head of femur is
displaced posteriorly and
rests on the gluteal surface
of ilium (posterior
dislocation).
Sciatic nerve is prone to
get injured.
Lower limb is flexed,
adducted & medially
rotated and is shorter than
the normal limb
Positive Trendelenburg’s
sign
‘Dipping’ (unilateral
dislocation) or ‘waddling’
(bilateral dislocation) gait
Osteoarthritis
Most common disease
of hip joint in the adults
 Results in:
Pain
Stiffness (due to pain
and reflex spasm of
muscles)
Deformity i.e. flexion,
adduction & external
rotation (due to
muscle spasm & later
on muscle
contractures)

Arthritis of the Hip Joint


A patient with an inflamed hip joint
will place the femur in the position
that gives minimum discomfort (the
position in which the joint cavity
has the greatest capacity to contain
the increased amount of synovial
fluid secreted).
The hip joint is partially flexed,
abducted, and externally rotated
Tenderness over the head of the femur (on the
anterior aspect of the thigh just inferior to the inguinal
ligament and just lateral to the pulsating femoral
artery) usually indicates the presence of arthritis of
the hip joint.
Thank You & Good Luck