Presentation Hip Joint By: Aaron White, Ashley Garbarino, Anna Mueller Pelvic Girdle PSIS ASIS Illiac fossa Superior Ramus Pubic crest Obturator Foramen Inferior Ramus Pubic arch Os Coxae and Femur Greater sciatic notch Ischial spine Lesser sciatic notch Pectineal line Femur Linea aspera Adductor tubercle Condyles and Epicondyles Lateral epicondyle Medial epicondyle Tibial tuberosity Anterior crest Intercondylar eminence Tibia Medial malleolus Hot guy!!! ASIS Tip of greater trochanter Inguinal ligament Supracristal line Even hotter!!! Illiac crest Gluteus maximus Intergluteal cleft PSIS Sacrum Gluteal fold (sulcus) Acetabular labrum is a fiberocartilage rim It enhances the depth of acetabulum Ball and socket - synovial joint Articular Capsule Anterior view Right hip joint Fibrous layer: Attaches to rim of the acetabulum to neck of the femur Synovial membrane: Lines the fibrous layer along with bony surfaces not lined with articular cartilage Ligaments: Anterior view of right hip joint Ligaments: Posterior view of right hip Ligaments: Anterior view of right hip joint Ligaments: Superior view of transverse cut Ligaments: Right hip bone and femur Ligaments: Anterior view Right hip bone Inguinal ligament Trochanteric Bursa & Ischial Bursa Bursa: They are sac like structures filled with synovial fluid that cushion movement. Strategically situated to alleviate friction – between muscles and boney prominences. Gluteofemoral Bursa Sciatic nerve Femoral nerve (yellow) Femoral artery (red) Femoral vein (blue) Superior gluteal nerve Inferior gluteal nerve Superior gluteal artery Inferior gluteal artery Common peroneal nerve Obturator nerve Obturator artery Great saphenous vein Deep femoral (profunda) artery Profunda femoral vein Lateral circumflex femoral artery Medial circumflex femoral artery Origin: Anterior and lateral surfaces of T12 through L5 T12 through L5 Insertion: Lesser trochanter Action: Hip flexion Innervations & vascular supply: L2 and L3 Origin: Iliac fossa Insertion: Lesser trochanter Action: Hip flexion Innervations & vascular supply: Femoral nerve Origin: Pubis Insertion: Pectineal line and proximal linea aspera Action: Hip adduction Innervations & vascular supply: Obturator nerve, Obturator artery, Deep femoral artery Origin: Ischial tuberosity Insertion: Posterior surface of medial condyle of tibia Action: Extend hip and flex knee Innervations & vascular supply: sciatic nerve and inferior gluteal artery Origin: Anterior inferior iliac spine Insertion: Tibial tuberosity Action: Hip flexion and knee extension Innervations & vascular supply: Femoral nerve, Lateral circumflex femoral artery Origin: Ischium and pubis Insertion: Entire linea aspera and adductor tubercle Action: Hip adduction Innervations & vascular supply: Obturator nerve and Obturator artery Origin: Ischial tuberosity Insertion: Anteromedial surface of proximal tibia Action: Extend hip and flex knee Innervations & vascular supply: Sciatic nerve and Deep femoral Origin: Anterior superior iliac spine Insertion: Proximal medial aspect of tibia Action: Combination of hip flexion, abduction, lateral rotation Innervations & vascular supply: Femoral nerve and Lateral circumflex femoral artery Origin: Pubis Insertion: Anterior medial surface of proximal end of tibia Action: Hip adduction Innervations & vascular supply: Obturator nerve and Obturator artery Origin: Long head: Ischial tuberosity Short head: Lateral lip of linea aspera Insertion: Fibular head Action Long head: extend hip Short head: flex knee and flex knee Innervations & vascular supply: Long head: Sciatic nerve Short head: Common peroneal nerve and inerior gluteal artery Origin: Superior ramus of pubis Insertion: Pectineal line of femur Action: Hip flexion and adduction Innervation and vascular supply: Femoral nerve, Medial circumflex femoral artery Origin: Posterior sacrum and ilium Insertion: Posterior femur distal to greater trocanter Action: Hip extension, hyperextension, lateral rotation Innervations & vascular supply: Inferior gluteal nerve and Superior gluteal artery Origin: Lateral ilium Insertion: Greater Trochanter Action: Hip abduction Innervations & vascular supply: Superior gluteal nerve and Superior gluteal artery Origin: Pubis Insertion: Medial 1/3 of the linea aspera Action: Hip adduction Innervations & vascular supply: Obturator nerve, Obturator artery, Deep femoral artery Origin: Lateral ilium Insertion: Anterior surface of the greater trochanter Action: Hip abduction, medial rotation Innervations & vascular supply: Superior gluteal nerve and Superior gluteal artery Origin: Internal surface of sacrum, Sacrotuberous ligament Insertion: Superior border of greater trochanter Action: Lateral rotation, abduction, helps hold femur in aceatabulum Innervations & vascular supply: L5, S1, and 2 Superior and inferior gluteal arteries Sciatica -Irritation of the sciatic nerve due to an injury. -Pain radiates down the back of the leg. May be confused for a herniated disc. -Piriformis muscle spasms and compresses against Sciatic nerve against the pelvis. -MRI (neurography) to help diagnose Piriformis Syndrome. -PT’s & PTA’s treatment is heat (cold if post-surgical), ultrasound, and massage as well as stretching exercises. Botox -Botox injection to paralyze the Piriformis muscle. -Surgery is the last resort. Origin: Anterior superior iliac spine Insertion: Lateral condyle of tibia Action: Combined hip flexion and abduction Innervations & vascular supply: Superior gluteal nerve, Superior gluteal artery ANTERIOR VIEW OF LEG Psoas major Illiacus Posterior view of leg Biceps femoris Posterior view of leg Semitendinosus Semimembranosus ANTERIOR VIEW OF LEG Pectineus Adductor brevis Adductor longus Sartorius Rectus femoris MEDIAL VIEW OF LEG Gracilis Sartorius Adductor magnus Gluteus minimus Gluteus maximus Piriformis Gluteus medius Tensor fascia latae