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Anatomy of The Hip Jointt of human beings .ppt
- 1. HIP JOINT Dr AdamAfodun 07/11/22
- 2. Hip Joint • Synovialball and socket joint • Multiaxial • Three degrees of freedom • Movement in three planes • Close pack extension and medial rotation • Least pack semiflexion • One of most stable joints in the body • Articular surface of hip joint are reciprocally curved • Superior surface of femur and acetabulum sustain greatest pressure
- 7. Acetabulum • Y-shaped epiphyseal cartilage •Start to ossify at 12 years • Fuse 16-17 years • Acetabular notch is inferior • Nonarticular fossa, thin related medially to obturator internus • Pad of fat, proprioceptive nerves
- 8. Articular Surface of Hip Joint •Semilunar articular surface covered with hyaline cartilage • Deepened by acetabular labrum • Wedge shaped fibrocartilage
- 9. • Head offemur 2/3rd of sphere • Pit for ligamentum teres • Covered with articular cartilage • Cartilage thicker posterior superior • Epiphyseal line for head intracapsular Articular Surface
- 10. • 2 CAPSULES:synovial membrane and fibrous capsule • Posterior • Free border, finger’s breath from trochanteric crest due to insertion of obturator externus • Into trochanteric fossa and • Root greater trochanter • Strongest superiorly • Anteromedially, deep fibres reflected head of rectus femoris • Iliopsoas is anterior • Lateral deep fibres of gluteus minimus • Proximally attached • Margins of the acetabular fossa • Base of labrum • Distally, anterior to the intertrochanteric line • Inferiorly, femoral neck close to lesser trochanter Capsule of Hip
- 11. Articulation • The hipjoint is the articulation between the hemispherical head of femur and the cup shaped acetabulum of the hip bone • The articular surface of the acetabulum is horseshoe shaped and is deficient inferiorly at the acetabular notch • Its primary function is to support the weight of the body in both static (e.g. standing) and dynamic (e.g. walking or running) postures
- 13. Retinacular Fibres • Fibresof capsule reflected along neck to articular margin called retinacular fibres • Blood supply to head run under retinacular fibres
- 14. Ligaments of Hip •Acetabular labrum • Transverse ligament • Ligament of head/ ligamntum teres • Iliofemoral ligament • Pubofemoral ligaments • Ischiofemoral ligaments • Zona orbicularis Transverse ligament is part of the labrum Ligamentum teres is triangular, its base is attached to transverse ligament, and the apex to the pit on the head of femur Blood supply to epiphysis from obturator artery Only supplies a flake of bone in elderly
- 15. Iliofemoral Ligament • Thickeningof capsule • Lower half of anterior inferior iliac spine and adjoining acetabulum • Distally • Upper and lower parts of inter trochanteric line • One of strongest ligaments in body • Tightens in extension • Helps maintain erect posture • Facet on anterior aspect of neck • Prevents hyperextension • Fulcrum reducing hip
- 16. Pubofemoral Ligament • Superiorpubic ramus • Inferior part of inter trochanteric line and upturned part • Relatively weak • Prevents abduction • Bursa between it and iliofemoral Ischiofemoral Ligament • Ischium to posterior part of joint (weak) • Circular fibres called zona orbicularis • Centre of gravity in front of head • Synovial under obturator externus
- 18. Synovial Membrane • Linesinner portion of capsule and non articular structures • It is attached to the margins of the articular surfaces • It covers the portion of the neck of the femur that lies within the joint capsule • Ligament of head (by synovial fold) • Fat in acetabular fossa • A pouch of synovial membrane frequently protrudes through a gap in the anterior wall of the capsule • Forms the psoas bursa beneath the psoas tendon • Bursa under obturator externus
- 19. Bursa Under GluteusMaximus • Trochanteric bursa • Posterolateral aspect of greater trochanter gluteofemoral • Vastus lateralis ischial bursa • Ischial tuberosity
- 20. Blood Supply • Child,obturator artery via ligamentum teres supplies epiphysis • Elderly, main supply via retinacular vessels from trochanteric and cruciate anastamoses • Medial and lateral circumflex femoral vessels • Superior gluteal supplies the upper part of the acetabulum • Inferior gluteal supplies the inferior and posterior and the capsule • Transverse and ascending branches of lateral circumflex femoral artery • Transverse and ascending branch of medial circumflex femoral • Cruciate and trochanteric anastomosis • Fractures of neck may cause avascular necrosis, extra capsular arteries enter the trochanter at the base of neck • Medial and lateral circumflex femoral vessels and superior gluteal
- 22. Hip Joint…. ProfessorKS Satyapal BLOOD SUPPLY TO HEAD OF FEMUR
- 23. Hip Joint…. ProfessorKS Satyapal CRUCIATE & TROCHANTERIC ANASTOMOSIS Ascending branch of Lateral Circumflex Artery Descending branch of Superior Gluteal Artery Ascending branch of Medial Circumflex Artery Inferior Gluteal Artery Descending branch of Inferior Gluteal Artery Transverse Lateral Circumflex Artery Transverse Medial Circumflex Artery Ascending branch of First perforating Artery
- 24. MOVEMENTS Hip Joint…. ProfessorKS Satyapal
- 25. All nerve tothe muscles of a joint also innervates the joint. •Femoral nerve •Obturator nerve •Superior gluteal nerve •Nerve to quadratus femoris Clinical anatomy: •Posterior dislocation may damage sciatic •Pain in hip referred to knee Nerve Supply
- 26. Anterior Relations • Rectusfemoris • Adductor longus • Pectineus • Psoas and iliacus • Femoral sheath • Femoral nerve
- 27. Inferior and PosteriorRelations • Obturator externus • Passes inferior and then posterior to joint • Superior gluteal nerve • Inferior gluteal nerve • Sciatic nerve • Posterior cutaneous nerve thigh • Nerves to obturator internus and quadratus femoris • Pudendal nerve
- 28. Lateral Relations • Gluteusminimus • Gluteus medius • Superior gluteal vessels and nerves between • Iliotibial tract • Superficial three quarters of gluteus maximus
- 29. Posterior Relations • Piriformis •Superior gemellus • Obturator internus • Inferior gemellus • Quadratus femoris • Adductor magnus • Obturator externus • Gluteus maximus
- 30. Movements: Flexion • Limited byanterior abdominal wall • Psoas • Iliacus • Pectineus • Adductor longus and brevis • Rectus femoris
- 31. Movements: Extension • Hamstrings first10° • Long head of biceps • Semitendinosus • Semimembranosus • 123, extended knee ++ • Adductor magnus • Gluteus maximus most efficient when hip is flexed 45°
- 32. • Obturator nerve •Adductor longus • Adductor brevis Movements: Adduction • Adductor magnus • Can flex or extend depending on position of hip
- 33. • Gluteus medius •Gluteus minimus • Standing on leg, gluteus medius and minimus abduction • By preventing adduction Movements: Abduction
- 34. • Iliopsoas • Adductors •Anterior fibres of gluteus medius Movements: Medial Rotation
- 35. • Obturator internus •Piriformis • Superior gemmelus • Obturator Internus • Inferior gemmelus • Quadratus femoris Movements: Lateral Rotation
- 36.
- 37. Piriformis Syndrome • PiriformisSyndrome is caused when the sciatic nerve is compressed by the piriformis muscle. • Piriformis syndrome will cause a dull pain in the hip or buttock region and sometimes may be experienced from the lower back all the way to the foot.
- 38. Piriformis Syndrome Piriformis Syndromeis caused by two main groups: Overload- caused by training errors, sports that require a lot of running, and sedentary lifesyles. • Exercising on hard surfaces • Exercising on uneven surfaces • Exercsing in worn-out shoes • Sitting for long periods of time Biomechanical Inefficiencies- faulty foot and body mechanics, gait disturbances, and poor posture or sitting habits. • Poor running or walking habits • Walking with your toes pointing out • Stiff muscles in the lower back, buttocks, and hips
- 39.
- 40. Fractured Neck ofFemur