Iliofemoral Joint (Hip)Presented By:

Angela, Clifford, Casey

Hip Joint Cut & Labeled

A. Ligaments Iliofemoral

ligament #3 Pubofemoral

ligament #4

® Anterior view (both)

A. Ligaments Ischiofemoral

ligament #5® Posterior view

Ligament of the head (aka – ligamentum teres femoris)

A. Ligaments

A. Ligaments Transverse ligament of the

acetabulum Zona orbicularis

A. Ligaments Sacrotuberous

ligament Inguinal ligament

B. Bursae Trochanteric bursa Ischial Bursa Gluteofemoral bursa (aka – intermuscular

bursa)

The Gluteofemoral bursa is found here under the muscle

F. Clinical Concerns Piriformis SyndromeHow to get rid of a pain

in the buttocks.It is thought to be

caused by an impingement of the sciatic nerve by the shortening or tightening of the piriformis muscle.

G. Surface Anatomy Gluteal fold (aka -

Gluteal sulcus) Intergluteal cleft

G. Surface Anatomy

Supracristal Plane (SCR)This is best described as a transverse plane

passing through the tops or summits of the iliac crests; it usually passes through the fourth lumbar spinous process.

G. Surface Anatomy Posterior Superior

Iliac Spine

G. Surface Anatomy Sacrum Anterior superior iliac

spine Iliac crest

G. Surface Anatomy Inguinal ligament Tip of Greater

Trochanter

G. SurfaceAnatomy

The Hip (Iliofemoral) Joint is a diarthrosis, or synovial triaxial articulation permitting movement in all three planes. Structural Classification: Ball-and-socket

Cartilage

Acetabular Labrum: projecting rim located on the fibrocartilaginous layer which increases depth of joint cavity

Articular Cartilage of Head of Femur: opposing cartilage surface (shown in blue)

Acetabular Labrum

Articular Cartilage

Articular CapsuleDense collagen fiber sleeve which surrounds the joint providing protection and stabilization. Covers approximately the proximal two thirds of the neck of the femur posteriorly. Synovial Membrane: lines the joint cavity and produces synovial fluid. Fibrous Layer: attaches proximally on the hip bone to the rim of the acetebelum and the transverse acetabular ligament

The Hip Joint is composed of the articulation between the Os Coxae and the Femur. The Os Coxae is made up of three bones: the Ilium, the Ishium and the Pubis. (The Os Coxae also articulates with the Sacrum at the Sacroiliac Joint) The Acetabulum is a concave socket shared by all three bones on the lateral surface which articulates with the Head of the Femur.

Movements of the Hip Joint

Circumductionand complexmotions

Four Iliac Spines can be found on the margins of the Ilieum. These spines are attachment points for muscles and ligamentsand include the Anterior-Superior and Inferior spines and the Posterior-Superior and Inferior spines. The very superior point of the Ileum is called the Iliac Crest. Inferior to the Iliac Crest on the medial portion is a shallow depression called the Iliac Fossa, or Wing. Just inferior to the Posterior-Inferior Iliac Spine lies the Greater Sciatic Notch.

The Ischium forms the posterior, inferior portion of the Os Coxae. The Ischial Spine projects superior to the Lesser Sciatic Notch. The Ischial Tuberosity lies at the posterior and lateral edge of the Ischium. The Ischial Ramus connects the Ischium to the Pubis. The Inferior Ramus of the Pubis meets the Ischium and extends to the Pubic Crest. Just superior to the crest the Superior Ramus connects the Pubis to the Ilieum. Together, the Ischium and the Pubis encircle the Obturator Foramen.

The Symphysis Pubis, a pad of fibrocartilage, interconnectsthe medial anterior surfaces of both hip bones together.

The Pubic Arch is formed by the inferior rami of the Pubis and Ishium of the two sides.

A male pelvis has a pubic angle of 90 degrees or less. A female pelvis has a pubic angle of 100 degrees or more.

Femur: The longest and heaviest bone in the bodyThe rounded Head of the Femur articulates with the acetabulum of the pelvis to form the Hip Joint. The Femur runs from the Hip Joint to articulate with the Tibia to form the Knee Joint. The Neck of the Femur joins the shaft at 125 degrees.The Greater Trochanter projects laterally. The Lesser Trochanter projects posteriorly and medially. These trochanters are where large tendons attach to the Femur.

The Linea Aspera is a prominent elevation which runs along the posterior surface and serves as an attachment site for hip muscles.

The Pectineal Line is located just beneath the Lesser Trochanter.

The Adductor Tubercle is a bony prominance which can be found just above the medial epicondyle.

TibiaThe Tibia articulates with the Femur at the Medial and Lateral Tibial Condyles. The condyles are separated by a ridge called the Intercondylar Eminence. The Tibial Tuberosity lies near the condyles and is large and rough enough to be felt through the skin.The Anterior Margin or Crest of the Tibia runs from the Tibial Tuberosity down the anterior surface.

Sites of Bony Attachment

Muscles

Psoas Major Ant. and Lat. Surface of

T12-L5 Lesser Tochanter Hip Flexion L2 and L3 nerve

Iliacus Iliac fossa Lesser trochanter Hip Flexion Femoral nerve

Psoas Major

Iliacus

Adductor Brevis Pubis Pectineal line and Prox.

Linea aspera Hip Adduction Obturator nerve Obturator and Deep

femoral artery Adductor Magnus

Ishcium and pubis Entire linea aspera and

adductor tubercle Hip Adduction Obturator nerve Obturator artery

Semimembranosus Ischial tuberosity Post. Surface of medial

condyle of Tibia Extend hip and flex knee Sciatic nerve Inf. Gluteal artery

Semitendinosus Ischial tuberosity Anteromedial surface of Prox.

Tibia Extend hip and flex knee Sciatic nerve Deep femoral

Rectus Femoris Ant. Inf. Iliac spine Tibial tuberosity Hip flexion, knee extention Femoral nerve Lat. Circumflex femoral

artery Sartorius

Ant. Sup. Iliac spine Prox. Medial aspect of tibia Hip flexion, abduction, lat.

Rotation Femoral nerve Lateral circumflex femoral

artery

Sartorius

Adductor Longus Pubis Middle one-third of the linea

aspera Hip adduction Obturator nerve Obturator and Deep femoral

artery Gracilis

Pubis Ant. Med. Surface of Prox.

end of tibia Hip adduction Obturator nerve Obturator arteryGracil

is

Biceps Femoris Long head: Ischial tuberosity Short head: Lat. Lip of linea

aspera

Fibular head

Long head: Extend hip and flex knee

Short head: Flex knee

Long head: Sciatic nerve Short head: Common

peroneal nerve

Inf. Gluteal artery

Pectineus Sup. Ramus of pubis Pectineal line of femur Hip flexion and adduction Femoral nerve Medial circumflex femoral

artery Tensor Fascia Latae

Ant. Sup. Iliac spine Lateral condyle of tibia Hip flexion and abduction Superior gluteal nerve Superior gluteal artery

Gluteus Maximus Post. Sacrum and ilium Post. Femur distal to greater

tochanter Hip extension,

hyperextension, lateral rotation

Inferior gluteal nerve Superior gluteal artery

Gluteus Medius Lateral ilium Greater tochanter Hip abduction Superior gluteal nerve Superior gluteal artery

Gluteal minimus Lateral ilium Ant. Surface of the greater

tochanter Hip abduction, medial

rotation Superior gluteal nerve Superior gluteal artery

Piriformis Internal surface of sacrum,

Sacrotuberous ligament Sup. Border of the greater

tochanter Lateral rotation, abduction,

helps hold femur in acetabulum

L5, S1-S2 nerves Sup. And Inf. Gluteal arteries

Questions?