Chapter 9: The Hip Joint and Pelvic Girdle

Pelvic Joints (overall)

Anterior- Pubic Symphesis Posterior- Sacroiliac Joints Acetabulofemural Joint

Muscles of Region: Thigh region

3 Compartments: Anterior- hip flexion, knee extension - quad, sartorius Posterior- hip extension, knee flexion - hamstrings Medial- adductors - 3 adductors, gracillus, pectineus

Acetabulofemural Joint

Acetabulofemoral Joint- (aka hip joint) enarthrodial joint; where femur fits into acetabulum; functions to weight bear + locomotion w/ its wide ROM; creates ability to run, cut, side-to-side, jump... Stable b/c: -bony architecture provides stability/no dislocation -extra strong, dense ligaments reinforce (*ant) -strong muscles -consists of acetabulum's labrum -influences ankle injuries w/ rotation

Bone markings....

anterior/posterior- Spines (ASIS, AIIS, PSIS, PIIS) superior- Iliac Crest posterior inferior- Ischial Tuberosity anterior lateral/medial- Greater/Lesser Trochanter of femur

Patella (origin of)

attach: 4 of the Quad muscles running med knee to above hip - Rectus Femoris - Pes Anserinus: attach Gracillus, Sartorius, Semitendinosus

Medial Pelvis (origin of)

attach: hip adductors - 3 adductors - pectineus - gracillus

Posterior Pelvis (origin of)

attach: hip extensors - gluteus maximus (to posterior iliac crest, sacrum, coccyx)

Posterior/Inferior Pelvis (origin of)

attach: hip extensors - hamstring (to ischial tuberosity)

Anterior Pelvis (origin of)

attach: hip flexors - sartorius (to ASIS) - rectus femoris (AIIS)

Proximal Tibia/Fibula (origin of)

attach: rest of the hip muscles - Pes Anserinus- tibia's upper/ant/med from med/post knee - Semimembranosus- tibia's post/med - Tensor Fasciae Latae- tibia's ant/lat Gerdy's tubercle - Biceps Femoris- fibula's head

Proximal thigh (origin of)

attach: short muscles of hip + 3 Quad Vasti knee extensors (to lesser/greater trochanter) muscles @ lesser- pull femur medial, forward muscles @ greater- pull femur lateral, backward, external rotation posterior- hip adductors flex, extend, rotate

Labrum

cartilaginous tissue around acetabulum for enhanced stability and shock absorption can degenerate/tear to osteoarthritis...hip replacement

Ligaments responsible for hip stabilization

iliofemoral ligament (anterior) Ischialfemoral ligament (posterior)

Anterior Ligaments of Acetabulofemoral Joint

iliofemoral ligament- ("Y ligament") prevents posterior hyperextension pubofemoral ligament- medial, inferior; limits excessive extension + abduction teres ligament- attached deep acetabulum to femoral depression at femur head; provides femur's main blood supply, slightly limits adduction

Posterior Ligaments of Acetabulofemoral Joint

ischiofemoral ligament- connects ischium to trochanter; prevents internal rotation by grabbing onto trochanter

Muscles of Lateral Hip/Pelvic Girdle

muscle group: hip abductors muscles: - Gluteus Medius *stabilize hip - Gluteus Minimus - External Rotators - Tensor Fasciae Latae *horizontal abduct

Muscles of Medial Hip/Pelvic Girdle

muscle group: hip adductors muscles: - Adductor Brevis - Adductor Longus - Adductor Magnus - Gracillus LOCATION- attach at low pubis rim

Muscles of Posterior Hip/Pelvic Girdle

muscle group: hip extensors BIG/STRONG muscles: - Gluteus Maximus - Hamstrings - Biceps Femoris - Semimembranosus - Semitendinosus - External Rotators

Muscles of Anterior Hip/Pelvic Girdle

muscle group: hip flexors muscles: - Iliopsoas - Pectineus (short quadrangular) - Rectus Femoris - Sartorius

Pelvic Girdle

pelvic girdle- moves back and forth w/in 3 planes for 6 motions, with all pelvic girdle rotation including 1 of the following moving as well: - R hip - L hip - Lumbar spine

Hip Abduction

plane: frontal axis: sagittal muscle location: lateral

Right Lateral Pelvic Rotation

plane: frontal axis: sagittal muscle location: lateral Motion- lean right-> right hip down, left hip up

Hip Adduction

plane: frontal axis: sagittal muscle location: medial

Left Lateral Pelvic Rotation

plane: frontal axis: sagittal muscle location: lateral Motion- lean left-> left hip down, right hip up

Hip Flexion

plane: sagittal axis: frontal muscle location: anterior

Anterior Pelvic Rotation

plane: sagittal axis: frontal muscle location: anterior hip flexors Motion- arched back with iliac crest/hips tilting forward and down

External Rotators

what: 6 small muscles where: very deep to glutes laterally motion: - hip: ''external rotation - knee:----------

muscles of the groin

adductors and flexors

Iliac Crest

(bony landmark) iliac crest- over the top edge of iliac- tensor fasciae latae attaches

Spines

(bony landmark) spine- outward ridge, 2 points on both anterior and posterior innominate bones anterior- ASIS (Anterior Superior Iliac Spine)- sartorius AIIS (Anterior Inferior Iliac Spine)- rectus femoris posterior- PSIS (Posterior Superior Iliac Spine) PIIS (Posterior Inferior Iliac Spine)

Ischial Tuberosity

(bony landmark) big bump of ischium that we sit on

Hip and Pelvic Girdle Muscle Motion

-depends on position and mvmt of body w/ gravity -less stable end moves -ex: stand + contract hip flexors- ant pelvic rot -ex: lay + contact hip flexors- quad flex, pelvis stable

Femur

Femur- Head- top, medial round end Trochanter- bony protrusion for articulation Greater trochanter- distal, superior to lesser; lateral to femur head; feel at side of hip; attach gluteus muscles + ext rotators Lesser trochanter- proximal(medial) posterior to greater

ROM in basic hip motions

Flexion- 0-130 Extension- 0-30 Abduction- 0-35 Adduction- 0-30 Internal rotation- 0-45 knee bent: foot moves lat, straight: move medial External rotation- 0-50 knee bent: foot moves med, straight: move lat

Biarticulate Muscles of Knee & Hip

Hamstring- (all) bicep femoris long head semimembranosus semitendinosus Quad- (1) rectus femoris Pes Anserines- (all) sartorius gracillus

6 Pelvic Rotations

Look at as if steering wheel was implanted into that particular plane and then turned

Muscles of Region: Gluteal region

Motion: extend, rotate hip Muscles: - Gluteus maximus - Gluteus medius - Gluteus minimi - Tensor Fasciae Latae

Muscles of Region: Iliac region

Motion: flex hip Muscles: - iliopsoas : flex hip, external rotation

Pelvic Bones

Pelvic bone = 2 Innominate bones = Hip bone Innominate- 2 sections L/R Sacrum- posteriorly joins L/R pelvic bones 3 bones of Pelvic bone grown into 1: - ileum- upper 2/5 - ischium- posterior lower 2/5 (sitting) - pubis- anterior lower 1/5

Pelvic Neutral Position

Pelvis and spine neither in flexion or extension

Anterior Pelvic Joint

Pubic Symphesis- amphiarthrodial joint; some mvmt; 2 pelvic bones join; important with relaxin for ligaments in birthing

Posterior Pelvic Joint

Sacroiliac Joint (SI)- synovial joint; stable; 2 SI joints where sacrum meets ileum of two pelvic bones

Pes Anserine muscle organization

Sartorius- across, all the way down posterior leg Gracillus- straight down medial thigh Semitendinosus- straight down posterior thigh all flex the knee

Coccyx

coccyx- (aka tailbone) bone inferior to sacrum that is a bottom extension of pelvis

Acetabulum

deep impression where head of femur fits into pelvic bone for stability

Hip flexors.... Hip extensors...

hip flexors -> Anterior Pelvic Rotators hip extensors -> Posterior Pelvic Rotators

Posterior Pelvic Rotation

plane: sagittal axis: frontal muscle location: posterior hip extensors (hamstrings) on ischium w/ adductors Motion- flat back with iliac crest tilted backwards and up

Hip Extension

plane: sagittal axis: frontal muscle location: posterior "hyperextension" = normal extension of hip

Hip Internal Rotation

plane: transverse axis: vertical muscle location: wrapped CHECK: leg bent + foot lateral w/ femur internal leg straight + foot turns medial w/ femur

Hip External Rotation

plane: transverse axis: vertical muscle location: wrapped CHECK: leg bent + foot medial w/ femur external leg straight + foot moves lateral w/ femur

Left Transverse Pelvic Rotation

plane: transverse axis: vertical muscle location: wrapped Motion- rotate pelvis/body twisting left-> left hip backwards, right hip forwards

Right Transverse Pelvic Rotation

plane: transverse axis: vertical muscle location: wrapped Motion- rotate pelvis/body twisting right -> right hip backwards, left hip forward

Hip Horizontal Abduction

plane: transverse axis: vertical muscle location: wrapped def- movement of femur in horizontal or transverse plane away from pelvis

Hip Horizontal Adduction

plane: transverse axis: vertical muscle location: wrapped def- movement of femur in horizontal or transverse plane towards pelvis

Sacrum

sacrum- extension of spine w/ 5 fused vertebrae

Iliopsoas

what: *Strongest Hip Flexor- "inner hip muscles" where: deep anterior ileum to lesser trochanter of medial femur, connected to low spine too motion: -hip: ''flexion, ''external rotation, ''anterior pelvic rot, transverse/lateral pelvic rotation -knee: ------------- -trunk flexion, lateral trunk flexion

Adductor Magnus

what: BIG adductor muscle where: large from low pubis rim medial leg, seen posterior and medially motion: - hip: ''adduction, ''external rotation, ''extension - knee: --------------- injured- painful strain

Gracillus

what: member of Pes Anserines where: strap down medial edge from low pubis rim to low leg Pes Anserine crossing knee motion: - hip: ''adduction, ''internal rotation - knee: ''flexion - tibial rotation biarticulate

Sartorius

what: member of Pes Anserines where: superior attach to ASIS to Pes Anserine crossing knee motion: -hip: ''flexion, ''external rotation, ''anterior pelvic rot, abduction -knee: ''flexion biarticulate

Semitendinosus

what: member of Pes Anserines/Hamstring where: runs straight down posterior leg medial to biceps femoris motion: - hip: ''extension, internal rotation, posterior pelvic rotation - knee: ''flexion - tibial internal rotation biarticulate

Pectineus

what: small quadrangular of upper medial thigh where: anterior, medial, groin area short from top crest of pubis to femur motion: - hip: ''flexion, ''adduction, ''external rotation, ''anterior pelvic rotation - knee:-----------

Gluteus Maximus

where: attach PSIS, most superficial gluteus motion: - hip: ''extension, ''external rotation, abduction, adduction, posterior pelvic rotation - knee:------------

Biceps Femoris

where: attach ischial tuberosity and run lateral to semitendinosus motion: - hip: ''extension, ''external rotation, posterior pelvic rotation - knee: ''flexion, external rotation of flexed knee long head- biarticulate

Gluteus Medius

where: beneath gluteus maximus motion: - hip: ''abduction (''prevents adduction), internal rotation, external rotation - knee:------------ ** STABILIZE HIP -eccentric, isometric control -injury: patellofemoral pain

Gluteus Minimus

where: deepest beneath gluteus medius motion: - hip: ''abduction, ''internal rotation, lateral pelvic rotation - knee:-----------

Adductor Longus

where: long from low pubis rim on medial leg, medial to adductor brevis motion: - hip: ''adduction, ''flexion, ''anterior pelvic rotation - knee: -------------

Semimembranosus

where: medial, inferior to semitendinosus on posterior leg motion: - hip: ''extension, ''internal rotation, posterior pelvic rotation - knee: ''flexion, internal rotation of flexed knee biarticulate

Tensor Fasciae Latae

where: runs down lateral leg over IT Band motion: - hip: ''abduction (in horizontal flexion of hip) - knee:--------------- **HORIZONTAL ABDUCTION Iliotibial band (IT Band)- white connective tissue running down lateral leg from ileum to tibia underneath tensor fasciae late

Adductor Brevis

where: short,thin from low pubis rim to medial leg, medial to pectineus, lateral to adductor longs motion: - hip: ''adduction, ''external rotation on linea aspera, flexion, anterior pelvic rotation - knee:---------------- ATTACHES TO LINEA ASPERA AND PULL MEDIAL

Rectus Femoris

where: superior attach to AIIS to tibial tuberosity motion: - hip: ''flexion, ''anterior pelvic rotation - knee: ''extension biarticulate