THE HIP AND THIGH
LECTURE NOTES
ANATOMY
The Hip Bone:
- The 2 hip bones form the Pelvic Girdle
- Os Coxae:
- Formed by the fusion of the Ilium, Ischium, and Pubis
1. Ilium: broad portion of the hip bone which forms the superior part
- iliac crest – superior part, attachment site for abdominal muscles and back muscles
- anterior superior iliac spine – anterior end of iliac crest, attachment site of Sartorius and Tensor Fascia Latae
aka: ASIS
2. Ischium
- ischial tuberosity – attachment site for hamstrings; when sitting, weight passes through
3. Pubis
- pubic symphysis – fibrocartilage that connect each pubic bone
Coxal Bone – hip bones
Pelvic Girdle – the paired coxal bones
The ilium, ischium, and pubis fuse to form a cup-like structure known as the acetabulum, which holds the head of the femur
The Femur
- the thigh bone
- greater trochanter – attachment of hip abductor muscles
- lesser trochanter – attachment of hip flexor muscles
- head of the femur – sits in the acetabulum
The hip joint is a ball and socket joint formed by the head of the femur and the acetabulum of the coxa.
· The hip joint is a ball and socket that is designed for STABILITY, and not for MOBILITY
MOVEMENTS OF THE HIP
1. Flexion
- iliopsoas – the iliacus and psoas major
- rectus femoris – part of the quadriceps group, a 2 joint muscle
- Exercises that work the Hip flexors:
- situps, leg raises, hanging leg raises
2. Extension
- gluteus maximus – main hip extensor
- hamstrings
- biceps femoris
- semimembranosus
- semitendinosus
3. Adduction
- gracilis
- adductor longus
- adductor magnus
- adductor brevis
- pectineus
4. Abduction
- gluteus medius
- gluteus minimus
- tensor fascia latae
5. Medial and Lateral Rotation
THE FEMORAL TRIANGLE
Boundaries:
1. lateral border is the Sartorius muscles
2. medial border is the adductor longus muscle
3. upper boundary is the inguinal ligament
Contents:
1. femoral artery
2. femoral vein
3. femoral nerve
THE SCIATIC NERVE
Passes behind the hip joint, is covered by the gluteus maximus muscle, and into the posterior thigh muscles (the hamstrings)
Passes directly under the PIRIFORMIS muscle and can become irritated – PIRIFORMIS SYNDROME
THE ILIOTIBIAL BAND
A band of fibrous connective tissue that runs down the lateral thigh and inserts into the lateral knee (Gerdy’s tubercle on the tibia). It contributes to lateral knee stability.
The Tensor Fascia Latae muscle inserts into the IT Band and helps to stabilize the joint
INJURIES TO THE HIP JOINT
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 extremely painful
- Treatment is aimed at pain relief, sitting “forward” on the ischial tuberosities
- Return to athletics as soon as comfortable
ACETABULAR FRACTURES
- Rare, result from severe trauma
- MOI: direct, violent force that passes through femoral neck into the acetabulum
- Immediate pain, inability to walk on leg
- Shortening of the extremity
- Bed rest, possible surgery, followed by ROM exercises
- Best treatment may still result in osteoarthritis of the hip
DISLOCATIONS OF THE HIP
POSTERIOR DISLOCATIONS MOST COMMON
- 95% of all hip dislocations
- Why? Anterior hip capsule is strong, and the MOI occurs more commonly in athletics
- MOI: hip and knee flexed at 90o, force exerted through shaft of the femur, driving it posteriorly “dashboard injury”
- Signs and Symptoms: severe pain, inability to move, hip flexed and internally rotated, shortened extremity
- Complications: fractures, sciatic nerve problems, avascular necrosis, arthritis
ANTERIOR HIP DOSLOCATIONS
- Less than 5% of hip dislocations
- MOI: forceful ABDuction and external rotation
- Signs and Symptoms; immediate pain, limb is ABDucted and externally rotated, palpable mass in groin
- Complications: avascular necrosis, compression of femoral vein which can lead to a thrombosis
SLIPPED CAPITAL FEMORAL EPIPHYSIS
- Occurs in growing athlete
- It is a Salter Harris fracture – a fracture involving the growth plate
- More common in boys, usually between ages 11 – 15; short, heavy boys more common
- MOI: not always identifiable
- Signs and Symptoms: pain, may be referred to the knee; common to have coach “run it out’,
- Treatment depends on the degree of slippage
- May affect between 1 and 10 kids per 100,000
LEGG-CALVE-PERTHES DISEASE
- Childhood disease, usually ages 4-8
- Blood supply is temporarily interrupted to femoral head
- Signs and Symptoms: limping, pain/stiffness, limited ROM, soreness that is often described as “growing pains”
- Causes: unknown
- Can lead to osteoarthritis in adults
AVULSION OF LESSER TROCHANTER
- Forceful strain of the iliopsoas muscle
AVULSION OF ISCHIAL TUBEROSITY
- Forceful stretch of hamstring muscles
AVULSION OF ANTERIOR SUPERIOR ILIAC SPINE (ASIS)
- Origin of the Sartorius muscle
AVULSION OF ILIAC
- Forceful contraction of abdominal muscle
HIP POINTER
A contusion to the iliac crest of the ilium
MYOSITIS OSSIFICANS
Myositis ossificans is an uncommon condition that may occur following a thigh contusion (bruised thigh) and is characterized by bone formation (calcification) in the muscle belly at the site of the bruise.
OSTEITIS PUBIS
Inflammation of the Pubic Symphysis
SNAPPING HIP SYNDROME
Snapping hip is a condition in which you feel a snapping sensation or hear a popping sound in your hip when you walk, get up from a chair, or swing your leg around.
The snapping sensation occurs when a muscle or tendon (the strong tissue that connects muscle to bone) moves over the greater trochanter of the femur.
Although snapping hip is usually painless and harmless, the sensation can be annoying. In some cases, snapping hip leads to bursitis, a painful swelling of the fluid-filled sacs that cushion the hip joint.
PIRIFORMIS SYNDROME
Caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint.