Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in...
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![Page 1: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/1.jpg)
Lower Extremity
Introduction
![Page 2: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/2.jpg)
Hip Joint
Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum similar to glenoid labrum Acetabulum is not a complete circle, open
inferiorly. This opening is closed by the transverse ligament
Head of femur attached to inside of acetabulum by ligamentum teres
![Page 3: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/3.jpg)
Acetabulum
![Page 4: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/4.jpg)
Acetabulum
![Page 5: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/5.jpg)
Acetabulum
![Page 6: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/6.jpg)
Femur
![Page 7: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/7.jpg)
Femur
![Page 8: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/8.jpg)
Hip Joint
![Page 9: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/9.jpg)
Hip
Strong but loose joint capsule running from above the acetabulum and labrum down to the intertrochanteric line
Suction exists in joint owing to atmospheric differences – this increases joint stability
Approximately 70% of head of femur in contact with acetabulum at max contact
![Page 10: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/10.jpg)
Anterior Capsule
![Page 11: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/11.jpg)
Anterior Capsule
![Page 12: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/12.jpg)
Posterior Capsule
![Page 13: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/13.jpg)
Acetabular Labrum
![Page 14: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/14.jpg)
Head Ligament
![Page 15: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/15.jpg)
Hip
Iliofemoral ligament – AKA the “Y” ligament or the “Y ligament of Bigelo”
AIIS inferiorly to the intertrochanteric line Triangular in shape Supports hip anteriorly, resists extension,
internal rotation and some external rotation
![Page 16: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/16.jpg)
“Y” Ligament
![Page 17: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/17.jpg)
Hip
Pubofemoral Runs from the superior pubic ramus and the
acetabular rim, to just above lesser trochanter
Resists ABD with some resistance to external rotation
![Page 18: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/18.jpg)
Pubofemoral
![Page 19: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/19.jpg)
Hip
Ischiofemoral From the ischium to the posterior neck of
the femur – is directed upwards and laterally
Resists ADD and internal rotation ALL three loose during flexion, the freest
motion
![Page 20: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/20.jpg)
Ischiofemoral
![Page 21: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/21.jpg)
Hip
Nerve Supply– Superior gluteal– Inferior gluteal and – Femoral
Blood Supply – Medial circumflex artery– Lateral circumflex artery
Bursae– Iliopectineal
![Page 22: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/22.jpg)
My Friends
![Page 23: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/23.jpg)
Blood Supply to Hip
![Page 24: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/24.jpg)
Blood Supply
![Page 25: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/25.jpg)
Iliopectineal Bursae
![Page 26: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/26.jpg)
Hip Angles
Femur is held away from the hip joint and the pelvis via the femoral neck
Forms an angle called the angle of inclination– In the frontal plane, angle = approximately 125
degrees; the range = from about 90 degrees to 135 degrees
Determines – The effectiveness of hip ABD muscles
– The length of the limb
– The forces acting on the hip joint and femoral neck
![Page 27: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/27.jpg)
Hip Angles
If greater than 125 degrees called coxa valgus– Increase = lengthened limb length, increase
load on femoral head, decrease stress on femoral neck, decrease effectivness of hip ABD
If less than 125 degrees, called coxa cara– Decrease = shortened limb, decrease load on
femoral head, increase stress on femoral neck, increase effectiveness of hip ABD
![Page 28: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/28.jpg)
Angle of Inclination
![Page 29: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/29.jpg)
Hip Angles Angle of femoral neck in the transverse plane is
termed anterversion Neck is rotated 12-14 degrees with respect to
femur Increases the MA of the gluteus maximus –
making it a more effective hip external rotator– Excessive (beyond 14 degrees) to the anterior side
means that the head of femur is uncovered – tends to dislocate, unstable hip
– Decrease (less than 12 degrees) is called Retroversion, angle reversed and moved posteriorly
![Page 30: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/30.jpg)
Angle of Inclination
![Page 31: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/31.jpg)
Hip ROM
70-140 degrees of flexion – 90 with knees extended, 125-140 with knees flexed
4-15 degrees of hyperextension (beyond anatomical position)
Hyperextension is limited by anterior capsule, strong hip flexors, iliofemoral ligament
ABD = about 30-50 ADD = about 25 from anatomical position
![Page 32: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/32.jpg)
Lumbo-Sacral Plexus
Two distinctly different plexi that are connected and serve the entire Hip and LE
Lumbar from T12, L1, L2, L3, L4 Sacral from L4, L5, S1, S2, S3, and S4 Ventral rami, anterior and posterior
divisions and terminal nerves
![Page 33: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/33.jpg)
Lumbar Plexus Schematic
![Page 34: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/34.jpg)
Sacral Plexus Schematic
![Page 35: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/35.jpg)
Lumbar DivisionVentral Rami from T12 to L5 Subcostal (T12) Iliohypogastric (T12,L1) Ilioinguinal (L1) Genitofemoral (L1, L2) Lateral Femoral Cutaneous (Post. Divisions
L2,L3) Femoral (Posterior Division L2,L3,L4) Obturator (Anterior Division L2,L3,L4) Sacral Trunk (L4,L5)
![Page 36: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/36.jpg)
Lumbar Division
![Page 37: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/37.jpg)
Lumbar Plexus in Situ
![Page 38: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/38.jpg)
More Important Stuff
![Page 39: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/39.jpg)
Sacral DivisionVentral Rami from L4 to S4 Posterior Division Nerves
– Superior Gluteal (L4,L5,S1)– Inferior Gluteal (L5,S1,S2)– Common Peroneal (L4,L5,S1,S2)
Anterior Division– Tibial (L5,S1,S2,S3)
Both Divisions– Posterior Femoral Cutaneous (S1.S2.S3)
![Page 40: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/40.jpg)
Both
![Page 41: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/41.jpg)
Sacral Plexus in Situ
![Page 42: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/42.jpg)
Sacral Plexus
![Page 43: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/43.jpg)
Small Nerves from Sacral Plexus
Branch to Quadratus Femoris and Inferior Gemellus (L4,L5,S1) [ant. div.]
Branch to Obturator Internus and Superior Gemellus (L5, S1, S2)
Nerve to Piriformis (S1, S2) [post. div.] Pudenal Nerve (S3, S4)
![Page 44: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/44.jpg)
Small Nerves
![Page 45: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/45.jpg)
Coccygeal Plexus
![Page 46: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/46.jpg)
Femoral Nerve
![Page 47: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/47.jpg)
Femoral Nerve
![Page 48: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/48.jpg)
Obturator Nerve
![Page 49: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/49.jpg)
Obturator Nerve
![Page 50: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/50.jpg)
“Sciatic” Nerve
![Page 51: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/51.jpg)
“Sciatic Nerve”
![Page 52: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/52.jpg)
Tibial Nerve
![Page 53: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/53.jpg)
Common Peroneal Nerve
![Page 54: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/54.jpg)
Common Peroneal Nerve
![Page 55: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/55.jpg)
Tibial Nerve Foot
![Page 56: Lower Extremity Introduction. Hip Joint Head of the femur with acetabulum of innominate Ball in socket Better union than shoulder Acetabular labrum.](https://reader036.fdocuments.us/reader036/viewer/2022062315/5697bf9d1a28abf838c93f36/html5/thumbnails/56.jpg)
Tibial Nerve Foot