Transcript 18-hip joint

HIP JOINT
It is one of the largest joints
in the body.
It is the connection between
the lower limb and the pelvic
girdle.
TYPE 
It is a most perfect example
of Ball and Socket joint.

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ARTICULAR SURFACES
Hemispherical head of 
the femur and the cup
shaped Acetabulum.
The cavity of the 
acetabulum is deepened
by a fibrocartilagenous lip
attached to its margins
(Labrum
Acetabulare).
CAPSULE
It is attached to : 
(a) Medially to 
The hip bone : 
1.Labrum acetabulare.
2. Transverse 
acetabular ligament.

CAPSULE
(b) Laterally to 
The femur : 
1. In front : 
Along the 
1. Intertrochanteric
line.
2.The bases of the
greater and lesser
trochanters.


CAPSULE
2. Behind : 
Halfway along the
posterior aspect of
the neck.

NECK OF FEMUR & CAPSULE
Anteriorly : 
The neck of the femur is 
completely inside the
capsule of the joint
Posteriorly : 
Part of the neck lies 
inside the capsule and the
other part is outside it.
RETINACULA
They are Bands of fibers 
from the capsule that are
reflected to the neck of the
femur.
They are very adherent to 
the bone and run to the
margin of the head.
Function : 
They carry blood vessels to 
supply the head of the
femur.
EXTRINSIC LIGAMENTS
(1) ILio-femoral : 
It is a very strong inverted 
Y –shaped ligament which
supports the front of the
capsule.
Its base is attached to the 
Anteriorf inferior Iliac spine
and the two limbs of the Y
to the intertrochanteric line.
It resists hyper extension 
strains on the hip joint
during standing.
EXTRINSIC LIGAM ENTS
(2) Pubo-femoral 
It is a triangular ligament 
which supports the
inferomedial part of the
capsule.
It arises from the superior 
pubic ramus and blends with
the lower and anterior parts
of the capsule (lower part of
intertrochanteric line).
It limits extension and 
abduction.
EXTRINSIC LIGAMENTS
(3) Ischio-femoral : 
It is spiral shaped. It is
attached to the body of
the ischium below the
acetabulum and to the
greater trochanter.
It supports the 
posterior and upper
parts of the capsule.
It limits extension. 

INTRINSIC LIGAMENTS
(1) Transverse 
Acetabular
ligament
It bridges over the 
acetabular notch
inferiorly and
transforms it into the
acetabular foramen.
INTRINSIC LIGAMENTS
(2) ligament of the head 
of the femur :
It lies inside the hip joint and 
therefore it is ensheathed
with a tube of synovial
membrane.
It is a weak ligament. It is 
attached between the pit of
the head of the femur and
the transverse acetabular
ligament and the margins of
the acetabuluar notch.

ligament of the head of the
femur
Its function is to carry 
blood supply to the head
of the femur.
It has no function with 
keeping the stability of
the joint.
SYNOVIAL MEMBRANE
It lines the capsule and
is reflected to cover
the intra capsular part
of the neck of the
femur.
It covers all the 
structures inside the
joint (ligament of the
head of the femur and
the pad of fat) Except
the articular surfaces.

SYNOVIAL MEMBRANE
It bulges anteriorly 
between the ilio-femoral
and pubo- femoral
ligaments to form the
psoas bursa.
RELATIONS
The hip joint is directly 
related to many muscles.
(1) Anterior (In Front) 
From medial to lateral, they 
are :
Pectineus, iliopsoas and 
rectus femoris (straight
head).
The iliopsoas and pectineus 
separate the femoral nerve
and vessels from the anterior
aspect of the joint.
RELATION
(2) Lateral : 
Tensor fascia latae 
Gluteus medius and
Minimus.
(3) Superior (above) 
Piriformis and gluteus 
minimus.
(4) Inferio (below ) 
Obturator externus. 
RELATIONS
(5) Posterior 
(behind)
From above 
downwards :
obturator internus (+
two gemelli) and the
quadratus femoris.
They separate the 
joint from the Sciatic
nerve.
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STABILITY OF THE JOINT
The hip joint is one of the
most stable joints of the
body because :
(1) The head of the 
femur fits very accurately
in the acetabulum due to
the following
A. The acetabulum is very
deep and its depth is
increased by the labrum
acetabulare.

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STABILITY OF THE JOINT
B. The labrum acetabulare 
forms a firm grip on the
head of the femur.
C. The atmospheric pressure 
resists separation between
the head of the femur and
the acetabulum.
(2) The three strong 
extrinsic ligaments.
(3) The surrounding strong 
muscles.
MOVEMENTS
(1) Flexion : 
Iliopsoas.
Sartorius. 
Tensor fascia latae. 
Rectus femoris.
Pectineus.
Adductor Longus. 
Adductor Brevis.
Adductor Magnus. 
Gracilis.
MOVEMENTS
(2) Extension : 
Hamstrings 
(Semitendinosus,
Semimembranosus,
Long head of Biceps
Femoris).
Adductor Magnus. 
Gluteus Maximus. 
The extensor muscles
are more powerful than
the flexors.

MOVEMENTS
(3) Adduction : 
Adductor Longus.
Adductor Brevis. 
Adductor Magnus.
Gracilis.
Pectineus 
Obturator
Externus.
MOVEMENTS
(4) Abduction : 
Gluteus Medius.
Gluteus Minimus.
Tensor Fascia Latae.
(5) Medial rotation:
Gluteus Medius. 
Gluteus Minimus. 
Tensor Fascia Latae. 

MOVEMENTS
(6) Lateral rotation: 
Obturator Externus.
Obturator Internus. 
Gemelli. 
Piriformis. 
Quadratus Femoris. 
Gluteus Maximus. 
The lateral rotators are more
powerful than the medial
rotators.

LIMITATION OF MOVEMENTS
1. Extension : 
The ilio femoral, 
pubofemoral and
ischiofemoral
ligaments.
2. Flexion : 
Tension of the 
hamstring group of
muscles.
LIMITATION OF MOVEMENTS
(3) Abduction: 
The pubo femoral
ligament.
(4) Adduction : 
The two limbs 
come in contact
with each other.

LIMITATION OF MOVEMENTS
(5) Medial 
rotation :
The ischio- 
femoral ligament.
(6) Lateral 
rotation :
The pubo-femoral
ligament.

BLOOD SUPPLY
The main arterial supply
is from branches of the
circumflex femoral
arteries ( especially the
medial).

BLOOD SUPPLY
The blood supply 
passes to the joint
through :
(1) Retinacular 
fibers.
(2) Ligament of the
head of the femur.

BLOOD SUPPLY
Damage of the retinacular
fibers as in fracture neck
of the femur can results in
A vascular necrosis of
the head of the femur.
Fracture neck of the 
femur is common after age
of (60) years especially in
women because of
Osteoprosis.

NERVE SUPPLY
Femoral. 
Sciatic. 
Obturator. 
Nerve to Quadratus
Femoris.

REFERRED PAIN
Osteoarthritis is the
most common cause
of pain and stifness in
the hip joint of
adults.
The pain is referred 
to the knee through
the obturator nerve
which supplies both
joints.

CONGENITAL DISLOCATION
More common in girls
and associated with
inability to abduct
the thigh.
The upper lip of the 
acetabulum fails to
develop adequately.
The head of the femur
rides up out of the
acetabulum onto the
gluteal surface of the
ileum.
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TRAUMATIC DISLOCATION
It is common in motor 
vehicle accidents when
the thigh is flexed and
adducted.
The dislocated head is 
displaced posteriorly
to lie on the posterior
surface of the ileum.
In posterior dislocation 
the sciatic nerve is
liable to be injured.
TRENDELENBURG’S SIGN
Positive sign : 
Tilting of the pelvis
downwards on the
unsupported side
(with the foot is
raised above the
ground).

TRENDELENBURG’S SIGN
The stability needs : 
(1) Normally functioning 
glutei medius and
minimus.
(2) The head of the femur 
is located in the
acetabulum.
(3) The neck of the femur 
is intact and has a normal
angle with the shaft.