THE HIP REGION

BONES

ACETABULUM ISCHIUM > 2/5 ILEUM < 2/5 PUBIS = 1/5

HEAD OF FEMUR

CAPSULE

FRONT

BACK

Muscular anatomy

Muscular Anatomy ANTERIOR

Muscular Anatomy POSTERIOR

Muscular anatomy Medial Group

ILIO-PSOAS MUSCLE

Movements of the Hip and its main Muscles
– Flexion • Iliopsoas • Sartorius • Tensor fascia lata • Rectus femoris • Pectineus • Adductor longus • Adductor brevis • Adductor magnus • Gracilis

Movements of the Hip and its main Muscles
• Extension
– – – – – – Hamstrings Adductor magnus Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia lata

• Abduction

Movements of the Hip and its main Muscles
• Adduction
– Adductor longus – Adductor brevis – Adductor magnus – Gracilis – Pectineus

Movements of the Hip and its main Muscles
• Rotation
– Medial • Gluteus medius • Gluteus minimus • Tensor fascia lata – Lateral • Obturator externus • Obturator internus • Gemelli • Piriformis • Quadratus femoris • Gluteus maximus

FEMORAL TRIANGLE

GLUTEAL AREA

BLOOD SUPPLY OF THE FEMORAL HEAD

EXAMINATION OF THE HIP JOINT

symptomatology
Pain Limping Deformity STIFFNESS Snapping

DEFORMITIES

Abnormal fixed position of the joint
Deformities along sagittal plain )flexion, extension ( Deformity along mediolateral plain )coronal plain ( abduction, adduction} deformity { Rotational deformity external, internal rotation} deformity {

Deformities along sagittal plain flexion

• exaggeration of lumbar lordosis • +ve Thomas test

HIP EXAMINATION

THOMAS TEST

Flexion deformity

NORMAL LIMB

DISEASED LIMB

:Thomas test
This test is used to diagnose fixed flexion deformity of the hip. The examiner blocks the pelvis by bringing the contralateral sound hip into maximal flexion. This eliminates lumbar lordosis that can beused to compensate for the hip flexion contracture of the affected hip. The leg to be examined is then brought into maximal extension with the hip in neutral adduction and rotation.

Deformities along coronal plain

Pelvic tilting

Abduction: lowering of the
ASIS of the diseased side

+

Adduction:elevation of the
ASIS of the diseased side

)Lateral deviation of the spine ) scoliosis

Disease Synovitis Arthritis Coxa vara Psterior dislocation Anterior dislocation Fracture neck femur

deformity Flextion,abduction, external rotaion Flexion,adduction,internalrotation Flexion,adduction Flexion,adduction,internal rotation Flexion,abduction, external rotation External rotation

LOWER LIMB LENGTH -TRUE -APPARENT

Apparent shortening & lengthening

ADDUCTION Apparent shortening ABDUCTION Apparent lengthening

Developmental Dysplasia of Hip
Clinical screening for DDH: Ortolani & Barlow tests.

ble clunks and not audible clicks are cons

• Shortening / limitation

of hip abduction can be detected in unilateral cases with established dislocation. DDH ( CDH )

• This test examine the

strength of the gluteus medius. Normally, in a one legged stance, the pelvis is raised up on the unsupported side. If the weight bearing hip is unstable, the pelvis drops on the unsupported side, to avoid falling the patient has to throw his or her body towards the loaded side. • In the classic test, the examiner stands behind the patient. If the patient stands on a healthy hip the gluteal fold on this side drops. Trendelenburg • If the patient stands on a diseased leg the gluteal fold on the opposite side drops (the Sound S positive The causes ofide Sags). Trendelenburg test are:1.. Weakness of the hip abductors e.g. poliomyelitis 2.. Shortening of femoral neck e.g. coxa vara. 3. Dislocation or subluxation of the hip FALSE POSITIVE: Pain on weight bearing

sign

Clinical findings In fractures
• History of trauma • Pain • Loss of active movment • Abnormal movment • Painful passive movment • Crepitus at injured area • Deformity of the limb: •

external rotation ; severe in intertrochanteric
moderate in fracture of the neck

fractures and

• Flexion,abduction, external rotation in anterior dislocation • Flexion,adduction,internal rotation in posterior dislocation

HIP REGION PROBLEMS
TRAUMA INFECTIONS DEGENERATIVE NEOPLASTIC CONGENITAL PARALYTIC METABOLIC

COMMON INJURIES AROUND THE HIP

Coxa vara
Neck shaft angle

CDH or DDH
BILATERAL

UNILATERAL

Slipped Upper Femoral Epiphysis
Common in boys 10-17  .yrs .Bilateral in 1/3 of pts  Possible underlying  endocrine disease eg .hypothyroidism Pt may present with  knee .pain :AP view Line tangent to superior  border of neck normally .cuts through epiphysis

Perthes’ Disease

Most common inboys 4-8 .yrs Self limiting disease characterised by AVN of .femoral head

Completerevascularization of epiphysis occurs without any .ttt,but may take 3 yrs Deformation of epiphysis occurs during revascularization .in some patients

PERTHES DISEASE

DEGENERATIVE ARTHROSIS AVN

RT A

TY IP AS H L P O R H

Chronic Osteomyelitis

osteochondroma

Multiple Myeloma

Multiple Myeloma

NERVE ENTRAPMENT SYNDROME
DEFINITION COMPRESSION NEUROPATHIES TRANSIENT PERMNANT •NERVE ROOT • PLEXUS PERIPHERAL NERVE SYMPATHETIC TRUNK LEADS TO
,SENENSORY

,MOTOR REFLEX SUDOMOTOR CHANGES

SPECIAL INVESTIGATIONS

CT

CT

& 3D-CT

BONE SCAN

US examination

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