Rehab Abid

M-17940

Submitted to: Dr. Mishal Shamsi

SUBMITTED ON: 05-05-2020
SEMESTER II
SECTION B
Hip Joint
Type
Hip joint is a ball and socket synovial joint.

Articular surfaces
1. The head of the femur articulates with the acetabulum of the hip bone to form the hip
joint.
2. The head of the femur forms more than half a sphere and is covered with hyaline
cartilage except at the fovea capitis.
3. The acetabulum presents a
 Horse-shaped,
 Lunate articular surface,
 Acetabulum notch
 Acetabular fossa.
4. The lunate surface is covered with cartilage.
5. The Hip joint provides a high degree of stability as well as mobility. The stability depends
upon.
 Tension and strength of ligament.
 Strength of the surrounding muscles.
 A fairly wide range of mobility is possible because of the fact that the femur has
a long neck which is narrower than the equatorial diameter of the head.
 Depth of the acetabulum and narrowing of the mouth by acetabular labrum.
Ligaments
The ligaments include

I. The fibrous capsule

I. The fibrous capsule is attached on
 Hip bone to the acetabular labrum
 Including transverse acetabular ligament
 Margins of the acetabular notch
II. The capsule is thick and firmly attached anterioposteriorly. This is the part which
receives the maximum tension in the standing position. Posteroinferiorly, the
capsule is thin and loosely attached to the bone.
III. This capsule is formed of two types of fibers. The outer fibers are longitudinal.
The inner fibers Zona Orbicularis are circular.

II. Illiofemoral ligament

I. It is also known as y-shaped ligament of Bigelow.
II. It lies anteriorly.
III. One of the Strongest Ligament
IV. Ligament is triangular in shape
V. The attachement of illiofemoral ligament is
 Attached to the lower half of anterior superior iliac spine
 Base to the intertrochanteric line.
  The upper and lower vertical fibers form thick and strong bands. The middle
fibers are thin and weak.

III. Pubofemoral ligament

I. This ligament supports the joint inferiomedially.
II. It is triangular in shape.
III. Superiorly, it is attached to the
 illiopubic eminence.
 Obturator crest
 Obturator membrane
IV. Inferiorly, It will merge with the anterioinferior part of the capsule and the lower band
of illiofemoral ligament.

IV. Ischiofemoral Ligament

i. It covers the joint posteriorly
ii. The fibers are twisted and extend to form the ischium to the acetabulum.
iii. The fibers form the zona orbicularis, some are attached to the greater trochanter .

V. Ligament of the head of femur ( ligament teres)

i. It is a round ligament or ligamentum teres. ( limits adduction on hip joint)
ii. It is flat and triangular ligament
iii. It is very thin or it can be absent
 iv. It transmits arteries to the head of the femur, from the acetabular branches of
the obturator and medial circumflex femoral arteries.

VI. Acetabular labrum

i. It is fibracartilaginous rim attached to the margins of the acetabulum.
ii. It narrows the mouth of the acetabulum
iii. The head of femur is held in its position due to this

VII. Transverse Ligament of the acetabulum

i. It is part of the acetabular labrum which bridges the acetabular notch.
ii. This notch will convert into formamen
iii. This foramen transmits acetabular vessels and nerves to the joint.

Relations of the Hip Joint

Anterior relation
The tendon of illiopsoas is separate from the joint by a bursa and femoral vein, femoral artery
and femoral nerve.

Posterior relations
The joint is related to the muscles

i. Obturator externus
ii. Quadratus femoris
iii. Obturator internus
iv. Gemeilli
v. Piriformis
vi. Sciatiac nerve
vii. Gluteus maximus

Superior relations
Reflected head of rectus femoris covered by gluteus minimus, gluteus medius and partly by
gluteus maximus.
Inferior relation
Lateral Fibers of pectineus and the obturator externus, gracilis, adductor longus, brevis, magnus
and hamstring muscles.

Blood Supply
The hip joint is supplied by the

i. Obturator artery
ii. Two circumflex femoral arteries
iii. Two gluteal arteries

Nerve Supply
Femoral nerve supplies hip joint through nerve to rectus femoris, the division of the obturator
nerve, the nerve to the quadratus femoris and the superior gluteal nerve.

Movements
i. Flexion
ii. Extension (15 degree)
iii. Adduction
iv. Abduction (50 degree)
v. Medial Rotation (25 degree)
 vi. Lateral rotation ( 60 degree)
vii. Circumduction

The movements that can be carried out at the hip joint are listed below, along with the
principle muscles responsible for each action:

 Flexion – iliopsoas, rectus femoris, sartorius, pectineus

 Extension – gluteus maximus; semimembranosus, semitendinosus and biceps femoris
(the hamstrings)
 Abduction – gluteus medius, gluteus minimus, piriformis and tensor fascia latae
 Adduction – adductors longus, brevis and magnus, pectineus and gracilis
 Lateral rotation – biceps femoris, gluteus maximus, piriformis, assisted by the
obturators, gemilli and quadratus femoris.
 Medial rotation – anterior fibres of gluteus medius and minimus, tensor fascia latae

The degree to which flexion at the hip can occur depends on whether the knee is flexed – this
relaxes the hamstring muscles, and increases the range of flexion.

Extension at the hip joint is limited by the joint capsule and the iliofemoral ligament. These
structures become taut during extension to limit further movement.