Chapter 9 The Hip Joint and Pelvic Girdle

Chapter 9 The Hip Joint and Pelvic Girdle Manual of Structural Kinesiology R.T. Floyd, EdD, ATC, CSCS Hip relatively joint (acetabularfemoral) functions bony strong large stable due to The enhanced architecture supportive ligaments Hip in muscles Joint significantly weight and bearing by Pelvic its wide & locomotion Girdle ability motion jump, & to many run, cross-over other directional cut, side-step changes range cut, of 2007 McGraw-Hill Higher Education. All rights reserved. 9-1 2007 McGraw-Hill Higher Education. All rights reserved. 9-2 Ball Head Pelvic with girdle & acetabulumof socket girdle femur joint connecting pelvic Femur right pelvic& left pelvic bone longest joined by ischium, sacrum bones together & pubis are in posteriorly body ilium, 2007 McGraw-Hill Higher Education. All rights reserved. 9-3 Pelvic Sacrum areas extension with 5 fused of vertebrae spinal column Upper extending inferiorly is the Posterior coccyx Anterior ischium bone -divided into 3 pubis two && lower fifths = one two ilium fifths = = 2007 McGraw-Hill Higher Education. All rights reserved. 9-4 Bony Anterior for tensor landmarks sartorius-anterior anterior hip flexors fasciae pelvis -origin superior iliac crest spine latae- rectus anterior spine femoris- inferior iliac Bony Lateral origin abductors gluteus landmarks minimus-just for pelvis medius& hip - below iliac crest 2007 McGraw-Hill Higher Education. All rights reserved. 9-5 2007 McGraw-Hill Higher Education. All rights reserved. 9-6 1

Bony Medially hip adductor landmarks pectineus, adductors -origin magnus, brevis, longus, & gracilispubis ramus & its inferior for Bony Posteriorly extensors gluteus landmarks posterior maximus- iliac sacrum origin crest && for coccyx hip Posteroinferiorly-origin for hamstrings tuberosity hip extensors -ischial 2007 McGraw-Hill Higher Education. All rights reserved. 9-7 2007 McGraw-Hill Higher Education. All rights reserved. 9-8 Bony Proximal landmarks thigh -insertion for short Proximal glutealmuscles iliopsoas-lesser deep trochanter external of thigh hiprotators -origin & trochanter most -greater of the six extensors three hip anteriorly adductors vastimuscles -lineaaspera of quadriceps for 3 knee Bony Patella Proximal quadriceps for landmarks sartorius, remainder insertion tibia muscles of or hip fibula for muscles all insertion 4 -upper anteromedial gracilis, & semitendinosus semimembranosus-posteromedially just crossing on medial below knee tibialcondyle condyleafter tibialsurface 2007 McGraw-Hill Higher Education. All rights reserved. 9-9 2007 McGraw-Hill Higher Education. All rights reserved. 9-10 Bony Proximal for biceps remainder landmarks tibia fibula muscles insertion iliotibialtract on attaching fibula femoris laterally, head on of with tensor some tibialcondyle fibers primarily anterolaterallyon Gerdy stubercle fasciae latae of 2007 McGraw-Hill Higher Education. All rights reserved. 9-11 Anteriorly Posteriorly Two Sacrum symphysispubis, amphiarthrodial pelvic bones join to form Strong joints bones between the 2 pelvic movable & to ligaments forms joints rigid, the unite sacroiliac slightly these 2007 McGraw-Hill Higher Education. All rights reserved. 9-12 2

Large Very Body heavy occur minimal & muscles sacroiliac heavy oscillating-type bones joints, covered as movements walking by thick, pelvic movements girdle & hip usually involve entire In with flexion walking, pelvic & backward girdle hip flexion, in hip & extension forward in occur hip Jogging Pelvic movements & running & greater result range in faster stride increases the of greater in distance running; kicking it length results of in a kick or more speed to the 2007 McGraw-Hill Higher Education. All rights reserved. 9-13 2007 McGraw-Hill Higher Education. All rights reserved. 9-14 Acetabulofemoraljoint joints Multiaxialarrangement Bony body (except glenohumeral) -most mobile Enarthrodial-type relatively dislocations architecture few hip provides subluxations& stability Femoral Reinforced ligamentouscapsule, head by extremely inserting joint especially into strong acetabulum & anteriorly dense Acetabulofemoraljoint Iliofemoralor Pubofemoral ligament anteriorly, hyperextension located prevents Y located anteromedially ligament - & excessive abduction inferiorly, extension limits & 2007 McGraw-Hill Higher Education. All rights reserved. 9-15 2007 McGraw-Hill Higher Education. All rights reserved. 9-16 Acetabulofemoraljoint Teres Ischiofemoralligament from depression slightly located deep ligament limits posteriorly, acetabulumto adduction -attaches extends head, a from fossa ischiumto femur, limits trochanteric internal Some about range movement exact disagreement flexion 130 of each in possible hip joint of 0 extension to degrees of 2007 McGraw-Hill Higher Education. All rights reserved. 9-17 2007 McGraw-Hill Higher Education. All rights reserved. 9-18 3

0 to 35 30 degrees of abduction adduction 0 to 45 50 degrees of internal external 2007 McGraw-Hill Higher Education. All rights reserved. 9-19 2007 McGraw-Hill Higher Education. All rights reserved. 9-20 Pelvic 3 movements All planes at pelvic girdle for girdle a moves total of back 6 results different & forth from within right one or more locations motion left lumbar hipspine Motions accompanying pelvic Lumbar Spine Right Hip Pelvic Rotation Anterior Posterior Right lateral Left lateral Right transverse Left transverse Motion Extension Flexion Right lateral flexion Left lateral flexion Left transverse Right transverse Motion Flexion Extension Adduction Abduction Internal Left Hip Motion Flexion Extension Abduction Adduction Internal 2007 McGraw-Hill Higher Education. All rights reserved. 9-21 2007 McGraw-Hill Higher Education. All rights reserved. 9-22 Anterior & posterior pelvic sagittal or anteroposterior plane Right & left lateral lateral or frontal plane Right transverse (clockwise) & left transverse (counterclockwise) horizontal or transverse plane of motion Hip flexion movement of femur straight anteriorly toward pelvis Hip extension movement of the femur straight posteriorly away from the pelvis; sometimes referred to as hyperextension 2007 McGraw-Hill Higher Education. All rights reserved. 9-23 2007 McGraw-Hill Higher Education. All rights reserved. 9-24 4

Hip abduction movement of femur laterally to side away from midline Hip adduction movement of femur medially toward midline Hip external rotary movement of femur laterally around its longitudinal axis away from midline; lateral Hip internal rotary movement of femur medially around its longitudinal axis toward to midline; medial 2007 McGraw-Hill Higher Education. All rights reserved. 9-25 2007 McGraw-Hill Higher Education. All rights reserved. 9-26 Hip diagonal abduction movement of femur in a diagonal plane away from midline of body Hip diagonal adduction movement of femur in a diagonal plane toward midline of body Anterior pelvic anterior movement of upper pelvis; iliac crest tilts forward in a sagittal plane; anterior tilt Posterior pelvic posterior movement of upper pelvis; iliac crest tilts backward in a sagittal plane; posterior tilt 2007 McGraw-Hill Higher Education. All rights reserved. 9-27 2007 McGraw-Hill Higher Education. All rights reserved. 9-28 Left lateral pelvic in frontal plane left pelvis moves inferiorly in relation to right pelvis; either left pelvis rotates downward or right pelvis rotates upward; left lateral tilt Right lateral pelvic in frontal plane right pelvis moves inferiorly in relation to left pelvis; either right pelvis rotates downward or left pelvis rotates upward; right lateral tilt Left transverse pelvic in horizontal plane pelvis rotates to body's left; right iliac crest moves anteriorly in relation to left iliac crest, which moves posteriorly Right transverse pelvic in horizontal plane pelvis rotates to body's right; left iliac crest moves anteriorly in relation to right iliac crest, which moves posteriorly 2007 McGraw-Hill Higher Education. All rights reserved. 9-29 2007 McGraw-Hill Higher Education. All rights reserved. 9-30 5

Seven at hip & two-joint another muscles at kneehave one action Body motions movement earth depend involved and position largely in hip & on of pelvic body direction in girdle least & gravitational forces relation of Standing stabilized part that both moves most will be the part to Lying trunk move & supine forward pelvis & rotate into contracting feet flexion anteriorly & contracting hip the flexors, stable hip the pelvis flexors, thighs the Modified from Anthony CP, Kolthoff NJ: Textbook of anatomy and physiology, ed 9, St. Louis, 1975, Mosby. 2007 McGraw-Hill Higher Education. All rights reserved. 9-31 2007 McGraw-Hill Higher Education. All rights reserved. 9-32 Hip toward flexor trunk muscles used in moving thighs up In when on raised downward the extensor pelvis on femur femur & muscles and phase trunk (rising concentrically move used to standing downward eccentrically when position) slowly trunk is movement muscles in eccentric primarily at contraction hips involved & of knees knee-bend -hip is flexion & knee exercise, extensors Hip muscles Anterior flexion Iliopsoas joint &-primarily pelvic girdle Pectineus Rectus femoriship Sartorius 2007 McGraw-Hill Higher Education. All rights reserved. 9-33 2007 McGraw-Hill Higher Education. All rights reserved. 9-34 Medial adduction Adductor -primarily brevis longuship Gracilismagnus Posterior extension Gluteus Biceps Semitendinosus femoris -primarily maximuship Semimembranosus rotators 2007 McGraw-Hill Higher Education. All rights reserved. 9-35 2007 McGraw-Hill Higher Education. All rights reserved. 9-36 6

Lateral abduction Gluteusmedius Gluteusminimus -primarily hip Tensor fasciae rotators latae Pelvic Iliac Iliacus Psoasmajor Psoasminor region muscles -iliopsoasmuscle acting on hip flexes jointhip 2007 McGraw-Hill Higher Education. All rights reserved. 9-37 2007 McGraw-Hill Higher Education. All rights reserved. 9-38 Pelvic Gluteal Gluteus muscles region maximus -extend acting on & rotate hip joint Tensor fascia medius minimi hip Six externus, gemellusinferior, deep external obturatorinternus, latae& rotators quadratusfemoris -piriformis, gemellussuperior, obturator Thigh intermuscularsepta -divided into 3 compartments by 2007 McGraw-Hill Higher Education. All rights reserved. 9-39 2007 McGraw-Hill Higher Education. All rights reserved. 9-40 Anterior extensors Rectus Vastusmedialis Vastusintermedius compartment femoris primarily knee Vastuslateralis Sartorius Posterior Biceps Semitendinosus Semimembranosus femoris compartment -hamstring group Medial Adductor Pectineus compartment brevis magnus longus -primarily adductors Gracilis 2007 McGraw-Hill Higher Education. All rights reserved. 9-41 2007 McGraw-Hill Higher Education. All rights reserved. 9-42 7

All innervated (lumbosacralplexus) hip & pelvic from girdle lumbar muscles & sacral -plexus Lumbar formed ramiof L1 fibers through spinal by plexus anterior L4 nerves &- Lower and from the abdomen anterior T12some & medial lower extremity portions of 2007 McGraw-Hill Higher Education. All rights reserved. 9-43 Sacral by L5, Lower perineum, anterior & S1 plexus through ramiof -formed surface back, posterior pelvis, S4 L4, leg, and of dorsal thigh & plantar foot surfaces of 2007 McGraw-Hill Higher Education. All rights reserved. 9-45 2007 McGraw-Hill Higher Education. All rights reserved. 9-44 Lumbar Femoral Arises Iliopsoas plexus -major nerves Rectus Vastusmedialis n. -anterior muscles Vastusintermedius lumbar from plexus posterior division of Vastuslateralis Pectineus femoris Sartorius Sensation thigh and medial to anterior leg & foot lateral 2007 McGraw-Hill Higher Education. All rights reserved. 9-46 Lumbar Obturator Arises from nerve anterior -major division nerves Adductor lumbar plexus brevis magnus longus of Gracilis Obturator Sensation externus to medial thigh Sacral Superior plexus Inferior arises medius, lataeglutealnerve from gluteus L4, L5, L5, minimus, S1 to & innervate tensor fasciae gluteus Branches piriformis(s1, maximus S2), L5, gemellusinferior S2), from & S2), quadratusfemoris(l4, sacral S1, gemellussuperior & S2 & plexus obturatorinternus(l4, to supply gluteus (L5, S1) S1, 2007 McGraw-Hill Higher Education. All rights reserved. 9-47 2007 McGraw-Hill Higher Education. All rights reserved. 9-48 8

Sacral Sciatic tibialdivision semitendinosus, plexus nerve semimembranosus, femoris(long magnusfor posterolateral head) & biceps adductor common sensation lower foot leg & dorsum peroneal(fibular) leg & to plantar anterolaterallower of foot aspect division of Flexion of femur Iliopsoas Muscle Transverse pelvic contralaterally when ipsilateral femur is stabilized 2007 McGraw-Hill Higher Education. All rights reserved. 9-49 2007 McGraw-Hill Higher Education. All rights reserved. 9-50 Flexion Flexion of knee of thigh as it flexes hip & knee Abduction of hip Anterior pelvic Sartorius Muscle Flexion Extension of knee Anterior pelvic Rectus Femoris Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-51 2007 McGraw-Hill Higher Education. All rights reserved. 9-52 Abduction Flexion Tendency to rotate hip internally as it flexes Anterior pelvic Tensor Fasciae Latae Muscle Extension Upper fibers assist in abduction Lower fibers assist in adduction Posterior pelvic Gluteus Maximus Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-53 2007 McGraw-Hill Higher Education. All rights reserved. 9-54 9

Abduction Internal & flexion (anterior fibers) & extension (posterior fibers) Gluteus Medius Muscle Abduction Internal as femur abducts Flexion Gluteus Minimus Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-55 2007 McGraw-Hill Higher Education. All rights reserved. 9-56 Six Deep Lateral Rotator Piriformis, Gemellus superior, Gemellus inferior, Obturator externus, Obturator internus, Quadratus femoris Flexion of knee Extension Internal of hip Internal of flexed knee Posterior pelvic Semitendinosus Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-57 2007 McGraw-Hill Higher Education. All rights reserved. 9-58 Flexion of knee Extension Internal Internal of flexed knee Posterior pelvic Semimembranosus Muscle Flexion of knee Extension of flexed knee Posterior pelvic Biceps Femoris Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-59 2007 McGraw-Hill Higher Education. All rights reserved. 9-60 10

Adductor Brevis Muscle Adductor Longus Muscle Adduction as it adducts hip Adduction Assists in flexion Assists in flexion 2007 McGraw-Hill Higher Education. All rights reserved. 9-61 2007 McGraw-Hill Higher Education. All rights reserved. 9-62 Adduction as hip adducts Extension Adductor Magnus Muscle Flexion Adduction of hip of hip Pectineus Muscle 2007 McGraw-Hill Higher Education. All rights reserved. 9-63 2007 McGraw-Hill Higher Education. All rights reserved. 9-64 Adduction Weak flexion of knee Internal Assists with flexion Gracilis Muscle Agonists Psoas Iliacus (Iliopsoas) Rectus Femoris Pectineus Sartorius Tensor Fasciae Latae Hip Flexion 2007 McGraw-Hill Higher Education. All rights reserved. 9-65 2007 McGraw-Hill Higher Education. All rights reserved. 9-66 11

Agonists Gluteus Maximus Biceps Femoris (Long Head) Semitendinosus Semimembranosus Hip Extension Agonists Gluteus Medius Tensor Fasciae Latae Gluteus Maximus Gluteus Minimus Hip Abduction 2007 McGraw-Hill Higher Education. All rights reserved. 9-67 2007 McGraw-Hill Higher Education. All rights reserved. 9-68 Agonists Adductor Brevis Adductor Longus Adductor Magnus Gracilis Hip Adduction Agonists Gluteus Minimus Gluteus Medius Tensor Fasciae Latae Hip Internal Rotation 2007 McGraw-Hill Higher Education. All rights reserved. 9-69 2007 McGraw-Hill Higher Education. All rights reserved. 9-70 Agonists Gluteus Maximus Six Deep Rotators Hip Rotation 2007 McGraw-Hill Higher Education. All rights reserved. 9-71 Web Sites Radiologic Anatomy Browser http://radlinux1.usuf1.usuhs.mil/rad/iong This site has numerous radiological views of the musculoskeletal system. University of Arkansas Medical School Gross Anatomy for Medical Students http://anatomy.uams.edu/anatomyhtml/gross.html Dissections, anatomy tables, atlas images, links, etc. Loyola University Medical Center: Structure of the Human Body www.meddean.luc.edu/lumen/meded/grossanatomy/index.htm An excellent site with many slides, dissections, tutorials, etc. for the study of human anatomy Wheeless Textbook of Orthopaedics www.wheelessonline.com/ This site has an extensive index of links to the fractures, joints, muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopedic journals and other orthopedic and medical news. 2007 McGraw-Hill Higher Education. All rights reserved. 9-72 12

Web Sites Premiere Medical Search Engine www.medsite.com This site allows the reader to enter any medical condition and it will search the net to find relevant articles. Virtual Hospital www.vh.org Numerous slides, patient information, etc. Arthroscopy.com www.arthroscopy.com/sports.htm Patient information on various musculoskeletal problems of the lower extremity Human Anatomy Online www.innerbody.com/image/musc08.html Interactive musculoskeletal anatomy The Hip and Knee Institute www.hipsandknees.com/hip/contents.htm Arthritis of the Hip Joint 2007 McGraw-Hill Higher Education. All rights reserved. 9-73 Web Sites Adam Healthcare Center http://adam.about.com/surgery/100006.htm Hip joint replacement American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/category.cfm?topcategory=hip Patient education library on the hip Sports Injury Bulletin www.sportsinjurybulletin.com/archive/1054-groin-strain.htm Groin strain causes HealthGate Data Corp http://healthgate.partners.org/browsing/browsecontent.asp?filen ame=11822.xml&title=groin%20strain Groin Strain The Physician and Sportsmedicine www.physsportsmed.com/issues/2004/0104/meislin.htm Symptomatic Snapping Hip 2007 McGraw-Hill Higher Education. All rights reserved. 9-74 Web Sites Neurography Institute www.neurography.com/images/piriformis/piriformis1.htm Piriformis Syndrome 2007 McGraw-Hill Higher Education. All rights reserved. 9-75 13