Hip Ballandsocket joint Head of femur and acetabulum

Hip • Ball-and-socket joint • Head of femur and acetabulum of the hip bone • Allows – Flexion – Extension – Abduction – Adduction – Circumduction – Medial & lateral rotation

Ligaments - Dense regular connective tissue that attaches bone to bone • • Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament Ligament of the head Transverse ligament Sacrotuberous ligament Zona orbicularis Inguinal ligament

Iliofemoral ligament • Prevents hyperextension • Connects anterior inferior illiac spine of hip to interochanteric line of femur

Pubofemoral ligament • Strengthens articular capsule • Attaches pubic rim of acetabulum to neck of femur Pubofemoral ligament

Ischiofemoral Ligament • Attaches ischial wall of acetabulum to neck of femur

Ligament of the Head • Flat triangular band extends from the acetabulum to the neck of the femur

Zona Orbicularis • Ligament that consists of circular tissue • Forms the collar around the neck of the femur

Transverse Ligament • Crosses over acetabular notch • Supports acetabular labrum • Connected with the ligament of the head and the articular capsule

Sacrotuberous Ligament • Allows limited upward movement of the inferior end of sacrum • Gluteal ligamentruns from the sacrum to the tuberosity of the ischium

Inguinal Ligament • Spans between the anterior superior iliac spine and the pubic tubercle as the inguinal ligament

Bursae-membranous sacs containing synovial fluid, reduces friction and permits free movement • Trochanteric bursa • Ischial bursa • Gluteofemoral bursa

Bursae • Trochanteric bursa separates the superior part of the gluteus maximus from the greater trochanteric of the femur • Ischial bursa separates the inferior gluteus maximus from the ischial tuberosity

Gluteofemoral Bursa • Gluteofemoral bursaseparates the iliotibial tract from the superior part of the proximal attachment of the vastus lateralis http: //www. anesthesia-analgesia. org/content/108/5/1662/F 1. expansion. html

Articular Cartilage/Hyaline Cartilage Covers articulating surface of the bones in the synovial joint with a smooth slippery surface -Allows free movement of bones -Reduces friction & absorbs shock • Acetabular Labrum • Articular cartilage of head of the femur

Acetabular Labrum Fibrocartilage rim attached to the margin of acetabulum to enhance the depth of the acetbulum

Articular cartilage of head of femur Primarily a synovial fold conducting a blood vessel

Articular capsule Surrounds the synovial joint, encloses the synovial cavity and unites the articulating bones • Layers – Fibrous/Outer-dense irregular connective tissue – Synovial membrane/Inner-areolar connective tissue/elastic fibers

Articular Capsule • Fibrous-attaches to the periosteum (external bone surface) of the articulating bones -permits bone movement, prevents bone dislocation • Synovial-lines fibrous layer along femoral neck to edge of femoral head

Hip joint muscle groups • Flexors -Sartorius -Pectineus • Adductors -Gracilis -Pectineus • Extensors -Semitendinosus -Biceps femoris

Flexor/Sartorius Origin-anterior superior iliac spine Insertion-proximal medial tibia Action-hip flexion, abduction, lateral rotation Inner-femoral nerve, lateral circumflex femoral artery

Flexor-Adductor/Pectineus Origin-superior ramus of pubis Insertion-pectineal line of femur Action-hip flexion, adduction Inner-femoral nerve, medial circumflex femoral artery

Adductor/Gracilis Origin-pubis Insertion-anterior medial surface of proximal end of tibia Action-hip adduction Inner-obturator nerve & artery

Extensor/Semitendinosus Origin-Ischial tuberosity Insertion-anteromedial surface of proximal tibia Action-extend hip, flex knee Inner-sciatic nerve, deep femoral

Extensor/Biceps Femoris Origin-long: ischial tuberosity short: lateral lip of linea aspera Insertion-fibular head Action-long: extend hip/flex knee -short: flex knee Inner-long: sciatic nerve -short: common peroneal nerve Interior gluteal artery

Hip Bones Your hip bone’s connected to your? ? ?

Os Coax: Three fused bones, the Ileum Pubis, and Ischium Ilium: Attachment point for Gluteus Max / Med / Minimus Iliac Crest: Superior margin; attachment point Iliac Fossa: Broad depression; attachment point for Iliacus muscle. Iliac Crest Ant. /Sup Iliac spine Iliac Fossa Post/Superior Iliac Spine Ant/ Inf Iliac spine Post/Inferior Iliac Spine Pectineal line Superior ramus of pubis Pubic Crest Greater Sciatic notch Ischial Spine Lesser Sciatic notch Obturator Foramen Pubic symphysis Ischial Tuberosity Inferior ramus of pubis Ant. /Sup. Iliac Spine: Attachment point for the Sartorius muscle, Tensor Fascia Late and Inguinal ligament. Pubic arch Ant. /Inf. Iliac Spine: attachment point for Rectus Femoris. Symphysis Pubis (8)

OS Coax continued.

More about the Os Coax • • • • Pubis: Attachment point for Adductor Brevis/Longus, and Gracilis Pubic Crest: Attachment point for abdominal muscles. Symphysis Pubis: Region where the two pubic bones articulate Superior Pubic Ramus: Attachment point of Pectineus muscle. Inferior Pubic Ramus: Attachment point for Adductor Brevis /Magnus and Gracilis Acetabulum: (Little saucer of vinegar) articulates w/ head of femur. Obturator Foramen: (To stop up) Lightens the Os Coxa Ischial Tuberosity: Attachment point for Semi- Tendinosis/ Membranosis, Biceps Femoris (Long) and supports weight of body when sitting. Ischial Spine: Attachment point for sacrospinous ligament. Post/Sup. Iliac Spine: Attachment point for ligaments that hold pelvis together Post/ Inf. Iliac Spine: Same as Post/Superior Lessor Sciatic Notch: Forms part of a foramen for nerves and vessels to exit the pelvis Greater Sciatic Notch: Forms large part of foramen through which the Sciatic nerve reaches the lower limb.

The Hip bone’s Connected to the Femur Bone!!!

L. Femur Head: Articulates with the pelvis at the acetabulum. Neck: Joins the head with the shaft. (Freq. site of fractures) Greater trochanter: Large, rounded projection located lateral to the neck and superior to the shaft; serves as attachment point for Gluteus Medius/ Miniums, Piriformis. Head Greater trochanter Neck Lesser trochanter: Small prominence on medial side of bone just inf. To neck; serves as attachment point for Psoas Major, Iliacus muscles. Adductor tubercle: small elevation on superior surface of medial condyle; serves as attachment point for Adductor Magnus muscle. Adductor tubercle

Femur Cont. Pectineal line: Femur Small ridge on posterior surface; attachment point for Pectineus, Adductor Brevis muscle. Linea Aspera: Rough ridge along the midline of the post. surface; med/lat Lips are attachment points for the Adductor Brevis, Magnus, Longus, Biceps Femoris muscles.

Tibia Medial Condyle: Articular surface for medial condyle of femur; posterior attachment for Semimembranosis muscle. Lateral Condyle: Articular surface for lateral condyle of femur. Attachment point for Tensor Fascia Late. Intercondylar Eminence Tibial Tuberosity: Attachment point for Rectus Femoris Shin Bone Medial side of the ankle joint

Hip Muscles Gluteus Maximus: Gluteus Med. O: Posterior Sacrum & Ilium I: Posterior Femur distal to Greater Trochanter A: Hip ext. , hyper-ext. , lateral rotation Innervation: Inferior gluteal nerve, Superior gluteal artery Gluteus Medius: O: Lateral Ilium I: Greater Trochanter A: Hip abduction Innervation: Superior gluteal nerve, Superior gluteal artery Gluteus Max Gluteus Min. Piriformis

Hip Muscles Cont… Tensor Fascia Late: O: Anterior Superior Iliac spine I: Lateral condyle of Tibia A: Combo hip flex and abd Innervation: Superior gluteal Tensor Fascia Late nerve, Superior gluteal artery Adductor Longus: O: Pubis I: Mid 1/3 of linea aspera A: Hip Adduction Innervation: Obturator nerve, Obturator artery, Deep femoral artery Adductor longus

Hip Muscles Cont…. Gluteus Minimus: O: Lateral Ilium I: Anterior Surface of the Greater Trochanter A: Hip abd, medial rot Innervation: Superior gluteal nerve, Superior gluteal artery Piriformis: O: Internal surface of sacrum I: Superior border of Greater Trochanter A: Lateral rot abd, helps hold femur in acetabulum. Innervation: L 5, S 1 and 2; Superior/Inferior gluteal arteries Gluteus Max. Piriformis

Hip Movements Ball and Socket joint

What is Piriformis Syndrome? • Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic • • nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and in to the leg. Piriformis syndrome refers to sciatica symptoms not originating from spinal roots and/or spinal disk compression, but involving the overlying piriformis muscle. Some possible causes are: Inactive gluteal muscles, (ex. Continuous sitting : w/ hips flexed, Overuse injury. (ex. Strenuous activities performed in the sitting/flexed position such as rowing, running, bicycling) When not balanced by lateral movement of the legs, repeated forward movements can lead to disproportionately weak hip abductors and tight adductors. This causes the piriformis muscle to shorten and severely contract. If the contraction is significant it can cause sciatic nerve impingement. • Piriformis Syndrome treatment: (If caused by weak abductors w/ tight adductors) Stretching and strengthening these muscle groups. An exercise regimen targeting the gluteus medius and hip abductor muscle groups can alleviate symptoms within days. • Quoted from Wikipedia, the free encyclopedia; www. en. wiipedia. org/w/index. php? title=Piriformis_syndrome Accessed 11/19/2011

Piriformis Stretch

Surface Anatomy

Action: Hip Flexion Psoas Major: Origin: Anterior and Lateral surfaces of T 12 through L 5 Insertion: Lesser Trochanter Innervation: L 2 and L 3 Iliacus: Origin: Iliac fossa Insertion: Lesser trochanter Innervation: Femoral Nerve

Action: Hip adduction Adductor Brevis: Origin: Pubis Insertion: Pectineal line and proximal linea aspera. Innvervation: Obturator nerve, obturator artery, deep femoral artery. Adductor Magnus: Origin: Ischium and pubis. Insertion: Entire linea aspera and adductor tubercle. Innervation: Obturator nerve, Obturator artery.

Action: Extend hip and flex knee Semimembranosus: Origin: Ischial tuberosity Insertion: Posterior surface of medial condyle of tibia Innervation: Sciatic nerve, Inferior gluteal artery

Action: Hip flexion , knee extension Rectus Femoris: Origin: Anterior inferior iliac spine Insertion: Tibial tuberosity Innervation: Femoral nerve, lateral circumflex femoral artery

Sciatic Nerve

1. Femoral nerve 2. Sciatic nerve 3. Inferior gluteal nerve 4. Obturator nerve 5. Superior gluteal nerve 6. Common peroneal nerve

1. Femoral Artery 2. Inferior gluteal artery 3. Lateral circumflex femoral artery 4. Deep femoral (profunda) artery 5. Superior gluteal artery 6. Obturator artery 7. Medial circumflex femoral artery

Superior & Inferior gluteal arteries & veins

Superior gluteal artery

1. Femoral Vein 2. Profunda Femoral Vein 3. Great Saphenous Vein Femoral vein Profunda femoral vein