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7/28/2013
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The Hip
Clarification of Terms
O Lower extremity = pelvis, thigh, leg, and foot
O Pelvic Girdle (aka Pelvis) = the two hip bones
(innominates), the sacrum, and the coccyx
O Innominate = the ilium, ischium and pubis
fused together
O Thigh = femur and patella
O Leg = tibia and fibula
Lippert, p261
Osteology of the Hip
The “hip bone” (aka innominate) is really the
union of 3 bones:
• The ilium, the ischium & the pubis
Ilium
Pubis
Ischium
Lippert, p262
7/28/2013
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Osteology of the Hip
The “hip bone” (aka innominate) is really the
union of 3 bones :
• The ilium, the ischium & the pubis
Lateral Aspect Right Hip Anterior Aspect Right Hip
Lippert, p262
Osteology of the Hip (Bones)
O Ilium
O Iliac fossa
O Iliac crest
O Anterior superior iliac spine (ASIS)
O Anterior Inferior Iliac Spine (AIIS)
O Posterior Superior Iliac Spine (PSIS)
O Posterior Inferior Iliac Spine (PIIS)
Lippert, p263
Osteology of the Hip
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Osteology of the Hip (Bones)
O Ischium
O Body
O Ramus
O Ischial tuberosity
O spine
Lippert, p263
Osteology of the Hip
Osteology of the Hip (Bones)
O Pubis
O Body
O Superior ramus
O Inferior ramus
O Symphysis pubis
O Pubic tubercle
Lippert, p
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Osteology of the Hip (Bones)
O Made up of combinations of the ilium,
ischium and pubis
O Acetabulum
O Obturator foramen
O Greater sciatic notch
Osteology of the Hip (Bones)
Obturator
foramen
Greater Sciatic Notch
Osteology of the Hip (Bones)
O Femur
O Head
O Neck
O Greater trochanter
O Lesser trochanter
O Body
O Medial condyle
O Lateral condyle
O Lateral epicondyle
O Medial epicondyle
O Adductor tubercle
O Linea aspera
O Pectineal line
O Patellar surface
Lippert, p264-265
7/28/2013
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Osteology of the Hip
Osteology of the Hip
Osteology of the Hip
anatomical neck
surgical neck
Posterior Aspect Right Femur Anterior Aspect Right Femur
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Osteology of
the Hip
What can you palpate?
What can you NOT palpate?
Hip Joint Structure
O The hip is the most proximal of the lower extremity joints
O Ball and socket joint
O Triaxial joint – motion in all 3 planes = 3 degrees of freedom
O A very stable joint
O The convex-shaped femoral head fits into and articulates with the concave-shaped acetabulum
Lippert, p262
7/28/2013
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Hip Joint Structure…cont
O Angle of Inclination:
O Frontal plane angle created between the
femoral neck and the shaft of the femur
O Normal angle = 125 degrees, which directs
the shaft of the femur toward midline,
positioning the knee directly under the weight
of the body
Mansfield, p233
Hip Joint Structure…cont
O Deviations in the angle can occur from abnormal development or from trauma
O This can cause instability and stress on the joint, which can lead to degeneration, pain and gait abnormalities
Mansfield, p233
Angle of
Inclination
continued
Hip Joint Structure…cont
O Torsion Angle
O The femur is naturally twisted along its long
axis
O The twist is described as torsion between the
shaft and neck of the femur
O Relative to the femoral condyles, the femoral
neck projects anteriorly 15 degrees (known
as normal anteversion)
Mansfield, p233
7/28/2013
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Hip Joint Structure…cont
O Torsion Angle continued
O Normal anteversion is associated with the most optimal alignment of the femur in the acetabulum
O When extreme, excessive anteversion may lead to anterior hip instability and a hip that appears to be internally rotated instead of neutral
Mansfield, p233
Hip Joint Movement
O Osteokinematics:
O Sagittal plane = flexion, extension, hyperextension
O Frontal plane = abduction, adduction
O Transverse plane = internal and external rotation
O Arthrokinematics:
O The convex femoral head slides in the direction opposite to the movement of the thigh
Lippert, p
Hip Joint: Supporting Structures
O Supporting Structures located within the hip joint
O Transverse acetabular ligament: spans acetabular notch, completing the “cup” of the acetabulum
O Acetabular labrum: a ring of fibrocartilage surrounding the outer rim of the acetabulum, which deepens the socket and “seals” the joint
O Articular cartilage: acts as a shock absorber
Mansfield, p234
7/28/2013
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Hip Joint: Supporting Structures
O Supporting Structures located outside the hip joint O Joint capsule: covers hip joint in cylindrical
fashion and is reinforced by 3 ligaments:
O Iliofemoral Ligament or “Y” Ligament: one of the thickest ligaments in the body, looks like inverted Y, limits excessive hip extension
O Ischiofemoral Ligament: spirals around the femoral neck, limits extension and internal rotation
O Pubofemoral Ligament: limits abduction and extension
Lippert, p234
Hip Joint Myology Muscle Group 1 joint muscles 2 joint muscles
Anterior iliopsoas Rectus femoris
Sartorius
Medial Pectineus Gracilis
Adductor magnus
Adductor lungus
Adductor brevis
Posterior Gluteus maximus Semimembranosus
6 deep rotators Semitendinosus
Long head biceps
femoris
Lateral Gluteus medius Tensor fascia latae
Gluteus minimus
Lippert, p267
Iliopsoas
Origin Psoas Major: transverse
processes of T12-L5
Iliacus: Iliac fossa
Insertion Lesser trochanter of the
femur
Innervation Femoral n.
Action Hip flexion, trunk
flexion, anterior pelvic
tilt
Lippert, p267
7/28/2013
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Myology of the Hip
Your subtopic goes here Rectus Femoris
Origin Anterior-inferior iliac spine
Insertion Tibial tuberosity via the quadriceps
tendon
Innervation Femoral n.
Action Hip flexion, knee extension
“tidbit” One of the heads of the “quads”
Lippert, p268
Myology of the Hip
Your subtopic goes here Sartorius
Origin ASIS
Insertion Proximal-medial surface of the tibia (via
the pes anserinus)
Innervation Femoral n.
Action Hip flexion, hip ABD, Hip ER, knee
flexion
“tidbit” Longest muscle in the body
Lippert, p268
Myology of the Hip
Your subtopic goes here Pectineus
Origin superior ramus of pubis
Insertion Pectineal line on posterior surface
of the femur
Innervation Femoral Nerve (may receive a
branch from Obturator Nerve)
Action Hip ADD, hip flexion
Lippert,268
7/28/2013
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Myology of the Hip
Your subtopic goes here ADDuctor Longus
Origin Anterior surface of the body of
the pubis
Insertion Middle 1/3 of the linea aspera of
the femur
Innervation Obturator n.
Action Hip ADD, Hip flexion
“tidbit” What’s in a name?
Lippert, 269
Myology of the Hip
Your subtopic goes here ADDuctor Brevis
Origin Proximal Attachment: Anterior
surface of the inferior pubic ramus
Insertion Proximal 1/3 of the linea aspera of
the femur
Innervation Obturator n.
Action Hip ADD, Hip flexion
“tidbit” What’s in a name?
Lippert, 270
Myology of the Hip
Your subtopic goes here
ADDuctor Magnus
Origin Ischium and Pubis
Insertion Entire linea aspera and adductor
tubercle
Innervation Obturator and sciatic nerve (L3, L4)
Action Hip adduction
“tidbit” What’s in a name?
Lippert, p270
7/28/2013
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Myology of the Hip
Your subtopic goes here Gracillis
Origin Body and inferior ramus of the
pubis
Insertion Proximal-medial aspect of the
tibia (pes anserinus)
Innervation Obturator n.
Action Hip ADD, hip flexion, knee
flexion
Lippert, p270
Myology of the Hip
Your subtopic goes here Gluteus Maximus
Origin Posterior ilium, sacrum, coccyx
Insertion ITB and Posterior femur distal to
the greater trochanter
Innervation Inferior gluteal n.
Action Hip extension, hip ER
Lippert, p271
Myology of the Hip
Deep Rotators
Origin Posterior sacrum, ischium, pubis
Insertion Greater trochanter area
Innervation Numerous
Action Hip external rotation
Deep Rotators:
Piriformis
Gemellus Superior
Gemellus Inferior
Quadratus Femoris
Quadratus Internus
Lippert, p271
7/28/2013
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Myology of the Hip
Your subtopic goes here Semimembranosus
Origin Ischial tuberosity
Insertion Medial condyle of the tibia, posterior aspect
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion
“tidbit” One of the hamstrings
Lippert, 271
Myology of the Hip
Your subtopic goes here Semitendinosus
Origin Ischial tuberosity
Insertion Proximal-medial surface of the tibia
(pes anserinus)
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion,
“tidbit” One of the hamstrings
Lippert, p271
Myology of the Hip
Your subtopic goes here Biceps Femoris
Origin Long Head: Ischial tuberosity
Short Head: lateral lip of linea
aspera
Insertion Head of the fibula
Innervation Long Head: Sciatic n.
Short Head: Common Peroneal n.
Action Long Head: Hip extension, knee
flexion
Short Head: knee flexion
“tidbit” One of the hamstrings
Lippert, p271
7/28/2013
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Hamstrings
Myology of the Hip
Your subtopic goes here Gluteus Medius
Origin Outer surface of the ilum
Insertion Greater trochanter of the femur
Innervation Superior gluteal n.
Action Hip ABD
Gluteus
Medius
Iliac Crest
Gluteus
Maximus
Lippert, p272
Myology of the Hip
Your subtopic goes here Gluteus Minimus
Origin Outer surface of the ilium, inferior
to the gluteus medius
Insertion Greater trochanter
Innervation Superior gluteal n.
Action Hip ABD, hip IR
7/28/2013
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Trendelenberg Sign
The Hip ABDuctors play an important role in
maintaining an upright posture during
single limb support.
If hip weakness is suspected,
single limb support over the
affected limb would look like
this when the uninvolved
limb is lifted
The pelvis drops down toward
the unsupported side
Mansield, p259
Myology of the Hip
Your subtopic goes here Tensor Fascia Latae
Origin ASIS
Insertion Proximal 1/3 of the ITB
Innervation Superior gluteal n.
Action Hip flexion, hip ABD,
Lippert, p274
Anterior Superficial Muscles of the Thigh
Lippert, p274
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Anterior Deep Muscles of the Thigh
Lippert, p274
Medial Thigh Muscles
Lippert, p275
Lateral Thigh Muscles
Lippert, p276
7/28/2013
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Posterior Superficial Muscles of the Thigh
Lippert, p275
Posterior Deep Muscles of the Thigh
Myology of the Hip Prime Movers
Action Muscle
Flexion & Abduction TFL
Flexion, Abduction, ER Sartorius
Flexion Rectus femoris, iliopsoas, pectineus
Extension Gluteus maximus, semitendinosis,
semimembranosus, long head biceps femoris
Hyperextension Gluteus maximus
Abduction Gluteus medius, gluteus minimus
Adduction Pectineus, adductor longus, adductor brevis,
adductor magnus, gracilis
Internal Rotation Gluteus minimus
External Rotation Gluteus maximus, deep rotators
Lippert, p278
7/28/2013
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Common Hip Pathologies
O Congenital Hip Dislocation
O Legg-Calve-Perthes Disease
O Slipped Capital Femoral Epiphysis
O Coxa Valga
O Coxa Vara
O Anteversion
O Retroversion
Congenital Hip Dislocation
Lippert, p275
Legg-Calve-Perthes
Lippert, p275
7/28/2013
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Slipped Capital Femoral Epiphysis
Lippert, p275
Coxa Valga and Vara
Anteversion and Retroversion
O Best picture is in Lippert, p 277
Lippert, p277 & Mansfield, p233
7/28/2013
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Pin the Tail on the Donkey
O Point to the…
O Hip flexors
O Hip extensors
O Hip abductors
O Hip adductors
Identify what you can! (in the hips)
Hip ADDuctors
Sartorius
ADDuctor Longus
ADDuctor Brevis
ADDuctor Magnus
Hip Flexors
Rectus femoris
TFL
Hip ABDuctors
TFL
Identify what you can! (in the hips)
Gluteus Maximus
Gluteus medius
Hamstrings
Semimembranosus
Biceps Femoris
Semitendinosus
TFL
OK go for it!
Pick out everything
else!
7/28/2013
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References
O Lippert, L.S. (2011). Clinical Kinesiology and
Anatomy, 5th ed. Philadelphia, PA: F.A. Davis.
O Mansfield, P.J., & Neumann, D.A. (2009).
Essentials of Kinesiology for the Physical
Therapist Assistant. St. Louis, MO: Mosby
Elsevier.
