The Hip http www youtube comwatch vwdx Iz

The Hip http: //www. youtube. com/watch? v=wdx. Iz 3 iqxa. Q

Bones of the Hip • Coxal Bone – hip bone composed of 3 fused bones: 1. Ilium iliac crest – serves as attachment point for abdominal muscles 2. Ischium ischial tuberosity – hamstring attachment 3. Pubis pubic symphysis The 3 bones fuse at the acetabulum – receives the head of the femur

• Coxal Bones – hip bones consists of 3 fused bones - ilium - ischium - pubis • Pelvis – 2 hip bones and the sacrum • Pelvic girdle – the paired coxal bones

• The Femur Greater Trochanter and Lesser Trochanter are sites for muscle attachments • The hip joint is a ball and socket joint that is designed for STABILITY and not for MOBILITY

Motions of the Hip Joint Hip Flexion Hip Extension Hip Abduction Hip Adduction Rotation

Muscles of the Hip Joint • Hip Flexors: 1. Iliopsoas - Iliacus - Psoas Major 2. Rectus Femoris (one of the Quad m. ) a hip flexor as well as a knee extensor

• • Exercises that work the hip flexors: - situps - leg raises - hanging leg raises

Hip Extensor Muscles • Gluteus Maximus – main hip extensor • Hamstring muscles – can not flex the knee and extend the hip fully at the same time

Hip Adductors • Adductor Longus • Adductor Brevis • Adductor Magnus • Gracilis • Pectineus

Hip Abductors • Gluteus Medius • Gluteus Minimus 2 parts of the same muscle

Tensor Fascia Lata Muscle – inserts into the Iliotibial Band. Helps to stabilize the hip joint

The Femoral Triangle • Borders: 1. Inguinal Lig 2. Sartorius 3. Adductor longus • Contents: 1. Femoral Vein 2. Femoral Artery 3. Femoral Nerve

Injuries to the Hip

Sacral Fractures - MOI: fall in a sitting position or direct contact - Displacement can injure nerves and the urinary bladder - Bed rest, only surgery for severe displacement

Coccyx Fractures • • • MOI – fall in a sitting position Sitting is almost impossible Treatment aimed at pain relief, sitting “forward” on the ischial tuberosities • Return to athletics as soon as comfortable

Acetabular Fractures • Rare, results from severe trauma • MOI – direct, violent force that passes through femoral neck into the acetabulum • Immediate pain, inability to walk on leg • Shortening of extremity • Bed rest, possible surgery, followed by ROM exercises • Best treatment may still result in osteoarthritis of the hip

Acetabular Fractures

Dislocations of the Hip • Posterior dislocations most common - 95% of all hip dislocations - Why? Anterior hip capsule is strong, and MOI occurs more commonly in athletics - MOI: hip and knee flexed at 900 , force exerted through shaft of femur, driving it posteriorly “dashboard injury” - S & S: severe pain, inability to move, hip flexed and internally rotated, shortened extremity - Complications: fractures, sciatic nerve problems, avascular necrosis, arthritis

Dislocations of the Hip • Anterior Hip Dislocation - less than 5% of hip dislocations - MOI: forceful ABDuction and external roation - S & S: immediate pain, limb is ABDucted and externally rotated, palpable mass in groin - Complications: avascular necrosis, compression of femoral vein which can lead to a thrombus

Fractures of the Femur • Strength of femur is very good in young athletes • Severe trauma causes the injury

Femoral Fractures

Femoral Neck Fractures

Slipped Capital Femoral Epiphysis • Occurs in growing athlete • More common in boys, usually between ages of 11 – 15, short, heavy boys more common • MOI: not always identifiable • S & S: pain, may be referred to knee, common to have coach “run it out” Common to see glutues medius limp Treament depends on degree of slippage

Hip Pointer

Avulsion of Lesser Trochanter of Femur • Forceful Strain of Ilioposas muscle

Avulsion of Ischial Tuberosity • Forceful stretch of Hamstring muscles

Avulsion of Anterior Superior Iliac Spine (ASIS) • Origin of the Sartorius muscle

Avulsion of Crest of Ilium • Forceful contraction of the abdominal muscle

Osteitis Pubis

Snapping Hip Syndrome

Legg-Calve-Perthes Disease

Slipped Capital Femoral Epiphysis

Quadriceps Contusion

Myositis Ossificans

Iliotibial Band Syndrome

Piriformis Syndrome

The Abdominal Muscles 1. Rectus Abdominus trunk flexion 2. Internal Oblique rotates trunk to same side 3. External oblique rotates trunk to opposite side