Functional Anatomy and Exam of the Hip, Groin, and Johnson A.pdf  "The warrior above all others prays

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  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    LTC ANTHONY E. JOHNSON, MD, FAAOS CHAIRMAN, DEPARTMENT OF ORTHOPAEDICS & REHABILITATION

    CO-CHAIRMAN, U.S. ARMED FORCES SPORTS, MEDICAL ADVISORY GROUP TEAM PHYSICIAN, USA PARALYMPIC BASKETBALL

    ACSM Team Physician Course 5 February 2015

    Functional Anatomy and Exam of the Hip, Groin, and Thigh

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Hip Joint True ball and socket joint Intrinsic stability Moves in all three planes, particularly during gait

    Pelvis Moves in all three planes Anterior tilting

    Changes degree of lumbar lordosis Lateral tilting

    Changes degree of hip abduction

    Functional Anatomy

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    ACETABULUM

    FEMORAL HEAD

    GREATER TROCHANTER

    LESSER TROCHANTER

    FEMORAL NECK

    CORTICAL BONE

    MEDULLARY BONE

    FOVEA CAPITIS

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  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Articulation

    The cavity of acetabulum is deepened by a fibrocartilaginous acetabular labrum

    The articular surface of the acetabulum is horseshoe shaped Deficient inferiorly at the acetabular notch

    The labrum bridges across the acetabular notch The transverse acetabular ligament Converts the notch into a tunnel

    Vessels and nerves enter the joint

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Creative Commons Attribution ShareAlike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

    http://creativecommons.org/licenses/by-sa/3.0/

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Creative Commons Attribution ShareAlike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

    http://creativecommons.org/licenses/by-sa/3.0/

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Type & Capsule

    Synovial ball and socket joint Enclosed by capsule

    Attachments Medially: acetabular labrum Laterally: intertrochanteric line of the femur in front

    and along the posterior aspect of the neck

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Ligaments of the Hip Joint

    Pubofemoral A triangular ligament Base attached to the superior ramus of the pubis Apex attached to the the intertrochanteric line Limits extension and abduction

    Ischiofemoral A spiral shaped ligament Base attached to ischium near the acetabular margin Apex attached to the greater trochanter Limits extension

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Creative Commons Attribution ShareAlike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

    http://creativecommons.org/licenses/by-sa/3.0/

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Creative Commons Attribution ShareAlike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

    http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/http://creativecommons.org/licenses/by-sa/3.0/

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Nerve Supply

    Femoral nerve Arises from posterior divisions of of L2, L3, L4 Passes inferolaterally thru psoas, over Iliacus muscle

    Enters thigh underneath the inguinal ligament

    Supplies quadriceps & anteromedial thigh Continues on as the saphenous nerve

    Three (3) branches: Pectineus (at level of inguinal ligament) Sartorius Quadriceps

    http://www.wheelessonline.com/ortho/nerves_arising_from_l2http://www.wheelessonline.com/ortho/nerves_arising_from_l3http://www.wheelessonline.com/ortho/nerves_arising_from_l4http://www.wheelessonline.com/ortho/psoashttp://www.wheelessonline.com/ortho/iliacushttp://www.wheelessonline.com/ortho/quadriceps_musclehttp://www.wheelessonline.com/ortho/saphenous_nervehttp://www.wheelessonline.com/ortho/pectineushttp://www.wheelessonline.com/ortho/sartoriushttp://www.wheelessonline.com/ortho/quadriceps_muscle

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Nerve Supply

    Obturator nerve Formed from anterior branches of L2, L3, L4 Largest nerve formed from anterior divisions of lumbar

    plexus Roots unite within the posterior psoas

    Runs over sacral ala into lesser pelvis lateral to ureter & internal iliac vessels

    Enters the obturator foramen and subsequently divides into anterior and posterior branches

    http://www.wheelessonline.com/ortho/nerves_arising_from_l2http://www.wheelessonline.com/ortho/nerves_arising_from_l3http://www.wheelessonline.com/ortho/nerves_arising_from_l4

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Nerve Supply

    Obturator nerve Anterior Branch:

    Runs in front of obturator externus & adductor brevis Runs behind the pectineus and adductor longus muscles Gives off articular twig that enters hip joint thru acetabular notch

    Cutaneous Branch: When present, innervates skin and fascia over distal 2/3 of thigh

    Posterior Branch: Pierces anterior part of obturator externus Runs inferiorly behind the adductor brevis & in front of the

    adductor magnus

    http://www.wheelessonline.com/ortho/adductor_brevishttp://www.wheelessonline.com/ortho/pectineushttp://www.wheelessonline.com/ortho/adductor_longushttp://www.wheelessonline.com/ortho/adductor_brevishttp://www.wheelessonline.com/ortho/adductor_magnus

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Nerve Supply

    Sciatic nerve Arises from lumbrosacral plexus: L4, L5, S1, S2, S3

    Nerve emerges from pelvis below piriformis Enters thigh between ischial tuberosity & greater

    trochanter Descends near middle of thigh, lying on adductor

    magnus muscle & being crossed obliquely by long head of biceps femoris

    Nerve usually separates in upper part of popliteal space Gives off tibial and peroneal branches

    http://www.wheelessonline.com/ortho/lumbrosacral_plexushttp://www.wheelessonline.com/ortho/nerves_arising_from_l4http://www.wheelessonline.com/ortho/nerves_arising_from_l5http://www.wheelessonline.com/ortho/nerves_arising_from_s1http://www.wheelessonline.com/ortho/nerves_arising_from_s2http://www.wheelessonline.com/ortho/nerves_arising_from_s3http://www.wheelessonline.com/ortho/piriformishttp://www.wheelessonline.com/ortho/adductor_magnushttp://www.wheelessonline.com/ortho/adductor_magnushttp://www.wheelessonline.com/ortho/biceps_femoris

  • San Antonio Military Medical Center

    "The warrior above all others prays for peace, for it is the warrior above all others who must suffer and bear the deepest wounds and scars of war

    Nerve Supply

    Sciatic nerve Tibal Nerve:

    Anterior branches of LS plexus: L4, L5, S1, S2, S3 2 branches from tibial division: below quadratus femoris:

    Upper branch innervates long head of biceps femoris & superior portion of semitendinosus

    Lower branch: innervates inferior portion of semitendinosus, semimembranous & ischiocondylar portion of adductor magnus

    Common Peroneal Nerve: Posterior branches: L4, L5, S1, S2 Nerve to short head of biceps femoris arises