Hip Joint
Hip joint
The hip joint is a multiaxial ball-and-socket joint, formed by the head
of femur and acetabulum
The acetabulum is positioned so that it faces laterally, anteriorly, and
slightly inferiorly. The head of the femur is directed medially,
superiorly, and projects anteriorly within the acetabulum.
Angle of inclination (AI)
The average normal value for the AI is 125 degrees.
Coxa vara
Coxa valga
Angle of torsion (AT)
Angle of torsion (AT),
exists within the
transverse plane. This
angle is best visualized by
placing the femoral
condyles in the frontal
plane and measuring the
angle between the frontal
plane and a line drawn
through the femoral head
and neck. A normal range
for the AT in adults is 15
to 25 degrees.
Ligaments of the Hip joint
The capsuloligamentous complex (CLC) of the hip spans from
the rim of the acetabulum to the intertrochanteric line of the
femur, thus encapsulating the entire femoral head and neck.
Iliofemoral ligament: Y shaped ligament.
anterior stability
Pubofemoral ligament: anterior stability.
Ischiofemoral ligament: posterior stability.
Ligamentum teres : Ligaments help to twist the head of femur into
the socket
Muscles of Hip joint
PATIENT HISTORY
AGE?
Congenital Hip Dysplasia(CHD) is seen in
infancy, primarily in girls;
Legg Calvé-Perthes disease is more common
in boys 3 to 12 years old.
Elderly women are more prone to
osteoporotic femoral neck fractures.
Injury ? And Its Mechanism?
Land on the outside of the hip (trochanteric bursitis)
Land on or hit the knee, thus jarring the hip (e.g.,
subluxation, acetabular labral tear).
Repetitive loading activity (e.g femoral stress fracture)
Mechanical hip problems…symptoms get worse with
activity, twisting movements are painful, sitting is
uncomfortable (hip flexion), getting up from sitting may
cause catching, difficult ascending and descending stairs
and getting in and out of car.
Pain and Symptoms
Hip intra-articular pain (like labral tears and anterior
impingement), is felt mainly in the groin and along the
front or medial side of the thigh to the knee
Buttock pain is associated with posterior labral tears
and lumbar spine problems.
Adductor pain may be the result of overactive
adductors caused by pelvic instability.
Pain also referred to hip from several structures. Pain
from the lumbar spine may commonly be referred to
the back or lateral aspect of the hip.
Con…..
Lateral hip pain may be due to a trochanteric bursitis or tear of
the gluteus medius tendon, most commonly in older patients.
Lateral hip pain may also simulate L4 nerve root pain (screen
back)
Clicking is common with labral tears.
Snapping in and around the hip (coxa saltans) has many
causes like Iliopsoas tendon snapping or Capsular instability.
Are there any movements that the patient feels are weak or
abnormal?
For example, in piriformis syndrome,
the sciatic nerve may be compressed, the piriformis muscle is
tender, and hip abduction and lateral rotation are weak.
Observation
Gait. Analyze gait
If the hip is affected, the weight is lowered carefully
on the affected side and the knee bends slightly to
absorb the shock.
The length of the step on the affected side is shorter
so that weight can be taken off the leg quickly.
If the hip is stiff, the entire trunk and affected leg
swing forward together.
In standing, the patient commonly has the hip slightly
flexed if there is pain in the hip.
Pathology in the hip region can lead to tight
adductors, flexors, piriformis, Tensor Fascia lata , and
hamstrings while abductors become weak.
Internal hip pathology or a flexion contracture may
lead to a “pelvic wink.” (excessive rotation in the axial
plane (more than 40°) toward the affected hip in an
attempt by the patient to obtain terminal hip
extension.)
Weak extensors cause the patient to move the trunk
backward to maintain balance.
bony and soft-tissue contours.
Swelling
Deformity
Active physiological movement examination
Passive physiological Movement Examination
Passive Accessory Movement Examination
Accessory Motion of Hip
Mulligan Technique
Lateral Glide for Hip Flexion
Lateral glide MWM for Internal
Rotation
LATERAL GLIDE MWM FOR HIP
EXTENSION
LATERAL GLIDE MWM FOR HIP
FLEXION
LATERAL GLIDE FOR INTERNAL
ROTATION
POSTERIOR GLIDE FOR HIP
ABDUCTION
