Chapter 9 the Hip Joint and Pelvic Girdle

Home , Acetabulum, Adductor longus muscle, Biceps femoris muscle, Ilium (bone), Ischium, Pectineus muscle

The Hip Joint and Pelvic Girdle

• Hip joint (acetabular femoral) – relatively stable due to • bony architecture Chapter 9 • strong ligaments • large supportive muscles The Hip Joint and Pelvic Girdle – functions in weight bearing & locomotion • enhanced significantly by its wide range of Manual of Structural Kinesiology motion • ability to run, cross-over cut, side-step cut, R.T. Floyd, EdD, ATC, CSCS jump, & many other directional changes

Bones Bones

• Ball & socket joint – Sacrum – Head of femur connecting • extension of spinal column with acetabulum of pelvic with 5 fused vertebrae girdle • extending inferiorly is the coccyx – Pelvic girdle • Pelvic bone - divided into 3 • right & left pelvic bone areas joined together posteriorly by sacrum – Upper two fifths = ilium • pelvic bones are ilium, – Posterior & lower two fifths = ischium, & pubis ischium – Femur – Anterior & lower one fifth = pubis • longest bone in body

Bones Bones

• Bony landmarks • Bony landmarks – Anterior pelvis - origin – Lateral pelvis - for hip flexors origin for hip • tensor fasciae latae - abductors anterior iliac crest • gluteus medius & • sartorius - anterior minimus - just superior iliac spine below iliac crest • rectus femoris - anterior inferior iliac spine

1 Bones Bones

• Bony landmarks • Bony landmarks – Medially - origin for – Posteriorly – origin for hip hip adductors extensors • adductor magnus, • gluteus maximus - adductor longus, posterior iliac crest & adductor brevis, posterior sacrum & coccyx pectineus, & gracilis - – Posteroinferiorly - origin pubis & its inferior for hip extensors ramus • hamstrings - ischial tuberosity

Bones Bones

• Bony landmarks • Bony landmarks – Proximal thigh - insertion for short – Patella – insertion for all 4 muscles of hip quadriceps muscles • gluteal muscles & most of the six deep external rotators - greater – Proximal tibia or fibula – insertion trochanter for remainder of hip muscles • iliopsoas - lesser trochanter • sartorius, gracilis, & semitendinosus - upper anteromedial tibial surface – Proximal thigh - origin for 3 knee just below medial condyle after extensors crossing knee posteromedially • three vasti muscles of quadriceps – • semimembranosus - posteromedially anteriorly on medial tibial condyle • hip adductors - linea aspera

Bones Joints

• Bony landmarks • Anteriorly – Proximal tibia or fibula – insertion – Two pelvic bones join to form for remainder of hip muscles symphysis pubis, amphiarthrodial • biceps femoris – laterally, primarily on fibula head with some fibers • Posteriorly attaching on lateral tibial condyle – Sacrum is between the 2 pelvic • iliotibial tract of tensor fasciae latae – bones & forms the sacroiliac anterolaterally on Gerdy’s tubercle of joints tibia – Strong ligaments unite these bones to form rigid, slightly movable joints

2 Joints Joints

• Large & heavy bones covered by thick, • Jogging & running result in faster heavy muscles movements & greater range of • Very minimal oscillating-type movements movement occur in sacroiliac joints, as in walking • Pelvic rotation increases the length of • Body movements usually involve entire stride in running; in kicking it results in a pelvic girdle & hip joints greater distance or more speed to the • In walking, hip flexion & extension occur kick with pelvic girdle rotation, forward in hip flexion & backward in hip extension

Joints Joints

• Acetabulofemoral joint - most mobile • Acetabulofemoral joint joints of body (except glenohumeral) – Iliofemoral or Y – Multiaxial arrangement ligament – located – Bony architecture provides stability anteriorly, prevents hyperextension • relatively few hip joint subluxations & dislocations – Pubofemoral ligament - – Enarthrodial-type joint located anteromedially & inferiorly, limits – Femoral head inserting into acetabulum excessive extension & – Reinforced by extremely strong & dense abduction ligamentous capsule, especially anteriorly

Joints Joints

• Acetabulofemoral joint • Some disagreement – Teres ligament - attaches about exact possible from deep in acetabulum to a range of each depression in femoral head, slightly limits adduction movement in hip joint – Ischiofemoral ligament – – 0 to 130 degrees of located posteriorly, extends flexion from ischium to trochanteric – 0 to 30 degrees of fossa of femur, limits internal rotation extension

3 Joints Joints

– 0 to 35 degrees of abduction – 0 to 45 degrees of internal rotation – 0 to 30 degrees of adduction – 0 to 50 degrees of external rotation

Joints Joints Motions accompanying pelvic rotation • Pelvic girdle moves back & forth within Pelvic Rotation Lumbar Spine Right Hip Left Hip 3 planes for a total of 6 different Motion Motion Motion movements Anterior rotation Extension Flexion Flexion – All pelvic girdle rotation results from motion Posterior rotation Flexion Extension Extension Right lateral Right lateral at one or more locations Adduction Abduction rotation flexion • right hip Left lateral rotation Left lateral flexion Abduction Adduction • left hip Right transverse Left transverse Internal External • lumbar spine rotation rotation rotation rotation Left transverse Right transverse External Internal rotation rotation rotation rotation

Movements Movements

• Anterior & posterior pelvic rotation • Hip flexion – sagittal or anteroposterior plane – movement of femur straight anteriorly toward • Right & left lateral rotation pelvis – lateral or frontal plane • Hip extension • Right transverse (clockwise) rotation & – movement of the femur left transverse (counterclockwise) straight posteriorly away rotation from the pelvis; sometimes referred to as – horizontal or transverse plane of motion hyperextension

4 Movements Movements

• Hip abduction • Hip external rotation – movement of femur – rotary movement of femur laterally to side away from laterally around its midline longitudinal axis away from midline; lateral rotation • Hip adduction • Hip internal rotation – movement of femur – rotary movement of femur medially toward midline medially around its longitudinal axis toward to midline; medial rotation

Movements Movements

• Hip diagonal abduction • Anterior pelvic rotation – movement of femur in a – anterior movement of upper diagonal plane away from pelvis; iliac crest tilts forward in midline of body a sagittal plane; anterior tilt • Hip diagonal adduction • Posterior pelvic rotation – movement of femur in a – posterior movement of upper diagonal plane toward pelvis; iliac crest tilts backward midline of body in a sagittal plane; posterior tilt

Movements Movements

• Left lateral pelvic rotation • Left transverse pelvic rotation – in frontal plane left pelvis moves inferiorly – in horizontal plane pelvis rotates to in relation to right pelvis; either left pelvis body's left; right iliac crest moves rotates downward or right pelvis rotates anteriorly in relation to left iliac upward; left lateral tilt crest, which moves posteriorly • Right lateral pelvic rotation • Right transverse pelvic rotation – in frontal plane right pelvis moves inferiorly – in horizontal plane pelvis rotates to in relation to left pelvis; either right pelvis body's right; left iliac crest moves rotates downward or left pelvis rotates anteriorly in relation to right iliac upward; right lateral tilt crest, which moves posteriorly

5 Muscles Muscles • Seven two-joint muscles have one action • Muscles involved in hip & pelvic girdle at hip & another at knee motions depend largely on direction of movement and position of body in relation to earth & gravitational forces • Body part that moves most will be the part least stabilized – Standing on both feet & contracting hip flexors, the trunk & pelvis rotate anteriorly – Lying supine & contracting hip flexors, the thighs move forward into flexion on the stable pelvis

Modified from Anthony CP, Kolthoff NJ: Textbook of © 2007 McGraw-Hill Higher Education. All rights reserved. anatomy and physiology , ed 9, St. Louis, 1975, Mosby. 9-31 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-32

Muscles Muscles

• Hip flexor muscles used in moving thighs up • Hip joint & pelvic girdle toward trunk muscles • Hip extensor muscles used eccentrically – Anterior - primarily hip when pelvis & trunk move downward slowly flexion on the femur and concentrically when trunk is • Iliopsoas raised on femur (rising to standing position) • Pectineus • In downward phase of knee-bend exercise, • Rectus femoris movement at hips & knees is flexion • Sartorius – muscles primarily involved - hip & knee extensors in eccentric contraction

Muscles Muscles

– Medial - primarily hip – Posterior - primarily hip adduction extension • Adductor brevis • Gluteus maximus • Adductor longus • Biceps femoris • Adductor magnus • Semitendinosus • Gracilis • Semimembranosus • External rotators

6 Muscles Muscles

• Pelvic muscles acting on hip joint – Lateral - primarily hip – Iliac region - iliopsoas muscle flexes hip abduction • Iliacus • Gluteus medius • Psoas major • Gluteus minimus • External rotators • Psoas minor • Tensor fasciae latae

Muscles Muscles

• Pelvic muscles acting on hip joint • Thigh - divided into 3 compartments by – Gluteal region - extend & rotate hip intermuscular septa • Gluteus maximus • Gluteus medius • Gluteus minimi • Tensor fascia latae • Six deep external rotators - piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, & quadratus femoris

Muscles Muscles

– Anterior compartment – primarily knee – Medial compartment - primarily adductors extensors • Adductor brevis • Rectus femoris • Adductor longus • Vastus medialis • Adductor magnus • Vastus intermedius • Pectineus • Vastus lateralis • Gracilis • Sartorius – Posterior compartment - hamstring group • Biceps femoris • Semitendinosus • Semimembranosus

7 Nerves Nerves • All hip & pelvic girdle muscles - – Lumbar plexus - innervated from lumbar & sacral plexus formed by anterior (lumbosacral plexus) rami of spinal nerves L1 through L4 & some fibers from T12 • Lower abdomen and the anterior & medial portions of lower extremity

Nerves Nerves • Lumbar plexus - major nerves – Sacral plexus - formed by anterior rami of L4, – Femoral n. - anterior muscles L5, & S1 through S4 • Arises from posterior division of lumbar plexus • Lower back, pelvis, • Iliopsoas perineum, posterior • Rectus femoris surface of thigh & • Vastus medialis leg, and dorsal & • Vastus intermedius plantar surfaces of • Vastus lateralis foot • Pectineus • Sartorius • Sensation to anterior & lateral thigh and medial leg & foot © 2007 McGraw-Hill Higher Education. All rights reserved. 9-45 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-46

Nerves Nerves • Lumbar plexus - major nerves • Sacral plexus – Obturator nerve – Superior gluteal nerve • Arises from anterior division of • arises from L4, L5, & S1 to innervate gluteus lumbar plexus medius, gluteus minimus, & tensor fasciae • Adductor brevis latae • Adductor longus – Inferior gluteal nerve • Adductor magnus • arises from L5, S1, & S2 to supply gluteus maximus • Gracilis – Branches from sacral plexus • Obturator externus • piriformis (S1, S2), gemellus superior (L5, S1, • Sensation to medial thigh S2), gemellus inferior & obturator internus (L4, L5, S1, S2), & quadratus femoris (L4, L5, S1)

8 Nerves Iliopsoas Muscle Transverse pelvic rotation • Sacral plexus Flexion External rotation contralaterally when ipsilateral – Sciatic nerve of hip of femur femur is stabilized • tibial division – semitendinosus, semimembranosus, biceps femoris (long head) & adductor magnus – sensation for posterolateral lower leg & plantar aspect of foot • common peroneal (fibular) division – sensation to anterolateral lower leg & dorsum of foot

Sartorius Muscle Rectus Femoris Muscle

Flexion of hip Flexion of knee External rotation of Flexion of hip thigh as it flexes hip & Extension of knee knee Abduction of Anterior pelvic hip rotation Anterior pelvic rotation

Tensor Fasciae Latae Muscle Gluteus Maximus Muscle

Abduction of hip Extension of hip Flexion of hip External rotation of hip Upper fibers assist in abduction Tendency to rotate Lower fibers assist hip internally as in adduction it flexes Posterior pelvic Anterior pelvic rotation rotation

9 Gluteus Medius Muscle Gluteus Minimus Muscle Abduction of hip Abduction of hip Internal rotation & flexion Internal rotation as (anterior femur abducts fibers) Flexion of hip External rotation & extension (posterior fibers)

Six Deep Lateral Rotator Muscles Semitendinosus Muscle Piriformis, Gemellus superior, Gemellus inferior, Flexion of knee Obturator externus, Obturator internus, Quadratus femoris Extension of hip Internal rotation of hip Internal rotation of flexed knee External Posterior pelvic rotation rotation of hip

Semimembranosus Muscle Biceps Femoris Muscle

Flexion of knee Flexion of knee Extension of hip Extension of hip Internal rotation External of hip rotation Internal rotation of hip of flexed External knee rotation of flexed Posterior pelvic knee rotation Posterior pelvic rotation

10 Adductor Brevis Muscle Adductor Longus Muscle

Adduction of hip Adduction of hip Assists in External rotation flexion of hip as it adducts hip

Assists in flexion of hip

Adductor Magnus Muscle Pectineus Muscle

Flexion of hip Adduction of hip Adduction of hip External rotation as hip adducts External rotation of Extension of hip hip

Gracilis Muscle Hip Flexion • Agonists Adduction of hip – Psoas Weak flexion of knee – Iliacus Internal rotation (Iliopsoas) of hip – Rectus Assists with Femoris flexion of hip – Pectineus • Sartorius • Tensor Fasciae Latae

11 Hip Extension Hip Abduction • Agonists – Gluteus Maximus • Agonists – Biceps Femoris – Gluteus Medius (Long Head) • Tensor Fasciae – Semitendinosus Latae – Semimembranosus • Gluteus Maximus • Gluteus Minimus

Hip Adduction Hip Internal Rotation • Agonists – Adductor • Agonists Brevis – Gluteus – Adductor Minimus Longus • Gluteus – Adductor Medius Magnus • Tensor – Gracilis Fasciae Latae

Hip External Rotation Web Sites

Radiologic Anatomy Browser http://radlinux1.usuf1.usuhs.mil/rad/iong • Agonists – This site has numerous radiological views of the musculoskeletal system. – Gluteus University of Arkansas Medical School Gross Anatomy for Maximus Medical Students http://anatomy.uams.edu/anatomyhtml/gross.html – Six Deep – Dissections, anatomy tables, atlas images, links, etc. External Loyola University Medical Center: Structure of the Human Body www.meddean.luc.edu/lumen/meded/grossanatomy/index.htm Rotators – 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. 9-71 © 2007 McGraw-Hill Higher Education. All rights reserved. 9-72

12 Web Sites Web Sites

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

Web Sites

Neurography Institute www.neurography.com/Images/Piriformis/Piriformis1.htm – Piriformis Syndrome