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HIP JOINT

HIP JOINT. It is one of the largest joints in the body. It is the connection between the lower limb and the pelvic girdle. TYPE It is a most perfect example of Ball and Socket joint. ARTICULAR SURFACES. Hemispherical head of the femur and the cup shaped Acetabulum .

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HIP JOINT

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  1. HIP JOINT • It is one of the largest joints in the body. • It is the connection between the lower limb and the pelvic girdle. • TYPE • It is a most perfect example of Ball and Socket joint.

  2. ARTICULAR SURFACES • Hemispherical head of the femur and the cup shaped Acetabulum. • The cavity of the acetabulum is deepened by a fibro-cartilagenous lip attached to its margins (Labrum Acetabulare).

  3. CAPSULE • It is attached to : • (a) Mediallyto • The hip bone : • 1.Labrum acetabulare. • 2. Transverse acetabular ligament.

  4. CAPSULE • (b) Laterally to • The femur : • 1.In front : • Along the • 1. Intertrochanteric line. • 2.The bases of the greater and lesser trochanters.

  5. CAPSULE • 2. Behind : • Halfway along the posterior aspect of the neck.

  6. NECK OF FEMUR & CAPSULE • Anteriorly : • The neck of the femur is completely inside the capsule of the joint • Posteriorly : • Part of the neck lies inside the capsule and the other part is outside it.

  7. RETINACULA • They are Bands of fibers from the capsule that are reflected to the neck of the femur. • They are very adherent to the bone and run to the margin of the head. • Function : • They carry blood vessels to supply the head of the femur.

  8. EXTRINSIC LIGAMENTS • (1)ILio-femoral : • It is a very strong inverted Y–shaped ligament which supports the front of the capsule. • Its base is attached to the Anteriorf inferior Iliac spine and the two limbs of the Y to the intertrochanteric line. • It resists hyper extensionstrains on the hip joint during standing.

  9. EXTRINSIC LIGAM ENTS • (2)Pubo-femoral • It is a triangular ligament which supports the inferomedial part of the capsule. • It arises from the superior pubic ramus and blends with the lower and anterior parts of the capsule (lower part of intertrochanteric line). • It limits extension and abduction.

  10. EXTRINSIC LIGAMENTS • (3) Ischio-femoral : • It is spiral shaped. It is attached to the body of the ischium below the acetabulum and to the greater trochanter. • It supports the posteriorand upper parts of the capsule. • It limits extension.

  11. INTRINSIC LIGAMENTS • (1) Transverse Acetabular ligament • It bridges over the acetabular notch inferiorly and transforms it into the acetabular foramen.

  12. INTRINSIC LIGAMENTS • (2)ligament of the head of the femur : • It lies inside the hip joint and therefore it is ensheathed with a tube of synovial membrane. • It is a weak ligament. It is attached between the pit of the head of the femur and the transverse acetabular ligament and the margins of the acetabuluar notch.

  13. ligament of the head of the femur • Its function is to carry blood supply to the head of the femur. • It has no function with keeping the stability of the joint.

  14. SYNOVIAL MEMBRANE • It lines the capsule and is reflected to cover the intra capsular part of the neck of the femur. • It covers all the structures inside the joint (ligament of the head of the femur and the pad of fat) Except the articular surfaces.

  15. SYNOVIAL MEMBRANE • It bulges anteriorly between the ilio-femoral and pubo- femoral ligaments to form the psoas bursa.

  16. RELATIONS • The hip joint is directly related to many muscles. • (1) Anterior (In Front) • From medial to lateral, they are : • Pectineus, iliopsoas and rectus femoris (straight head). • The iliopsoas and pectineus separate the femoral nerve and vessels from the anterior aspect of the joint.

  17. RELATION • (2) Lateral : • Tensor fascia latae Gluteus medius and Minimus. • (3)Superior (above) • Piriformis and gluteus minimus. • (4)Inferio (below ) • Obturator externus.

  18. RELATIONS • (5)Posterior (behind) • From above downwards : • obturator internus (+ two gemelli) and the quadratus femoris. • They separate the joint from the Sciatic nerve.

  19. STABILITY OF THE JOINT • The hip joint is one of the most stable joints of the body because : • (1) The head of the femur fits very accurately in the acetabulum due to the following • A. The acetabulum is very deep and its depth is increased by the labrum acetabulare.

  20. STABILITY OF THE JOINT • B. The labrum acetabulare forms a firm grip on the head of the femur. • C. The atmospheric pressure resists separation between the head of the femur and the acetabulum. • (2) The three strong extrinsic ligaments. • (3) The surrounding strong muscles.

  21. MOVEMENTS • (1)Flexion: Iliopsoas. • Sartorius. • Tensor fascia latae. Rectus femoris. Pectineus. • Adductor Longus. Adductor Brevis. • Adductor Magnus. Gracilis.

  22. MOVEMENTS • (2)Extension : • Hamstrings (Semitendinosus, Semimembranosus, Long head of Biceps Femoris). • Adductor Magnus. • Gluteus Maximus. • The extensor muscles are more powerful than the flexors.

  23. MOVEMENTS • (3)Adduction : Adductor Longus. • Adductor Brevis. Adductor Magnus. Gracilis. • Pectineus Obturator Externus.

  24. MOVEMENTS • (4)Abduction : Gluteus Medius. Gluteus Minimus. Tensor Fascia Latae. • (5)Medial rotation: • Gluteus Medius. • Gluteus Minimus. • Tensor Fascia Latae.

  25. MOVEMENTS • (6)Lateral rotation: Obturator Externus. • Obturator Internus. • Gemelli. • Piriformis. • Quadratus Femoris. • Gluteus Maximus. • The lateral rotators are more powerful than the medial rotators.

  26. LIMITATION OF MOVEMENTS • 1. Extension : • The ilio femoral, pubofemoral and ischiofemoral ligaments. • 2. Flexion : • Tension of the hamstring group of muscles.

  27. LIMITATION OF MOVEMENTS • (3)Abduction: • The pubo femoral ligament. • (4)Adduction : • The two limbs come in contact with each other.

  28. LIMITATION OF MOVEMENTS • (5)Medial rotation: • The ischio-femoral ligament. • (6)Lateralrotation: • The pubo-femoral ligament.

  29. BLOOD SUPPLY • The main arterial supply is from branches of the circumflex femoral arteries ( especially the medial).

  30. BLOOD SUPPLY • The blood supply passes to the joint through : • (1) Retinacular fibers. • (2) Ligament of the head of the femur.

  31. BLOOD SUPPLY • Damage of the retinacular fibers as in fracture neck of the femur can results in A vascular necrosis of the head of the femur. • Fracture neck of the femur is common after age of (60) years especially in women because of Osteoprosis.

  32. NERVE SUPPLY • Femoral. • Sciatic. • Obturator. • Nerve to Quadratus Femoris.

  33. REFERRED PAIN • Osteoarthritis is the most common cause of pain and stifness in the hip joint of adults. • The pain is referred to the knee through the obturator nerve which supplies both joints.

  34. CONGENITAL DISLOCATION • More common in girls and associated with inability to abduct the thigh. • The upper lip of the acetabulum fails to develop adequately. • The head of the femur rides up out of the acetabulum onto the gluteal surface of the ileum.

  35. TRAUMATIC DISLOCATION • It is common in motor vehicle accidents when the thigh is flexed and adducted. • The dislocated head is displaced posteriorly to lie on the posterior surface of the ileum. • In posterior dislocation the sciatic nerve is liable to be injured.

  36. TRENDELENBURG’S SIGN • Positive sign : • Tilting of the pelvis downwards on the unsupported side (with the foot is raised above the ground).

  37. TRENDELENBURG’S SIGN • The stability needs : • (1) Normally functioning glutei medius and minimus. • (2) The head of the femur is located in the acetabulum. • (3) The neck of the femur is intact and has a normal angle with the shaft.

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