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HIP

ANATOMY AND
SPECIAL TEST
By: Lyka, Dan, Angel,
Dom, Mia, Mica,
Maridel, Guinet, Wesley,
Ralph

ANATOMY

HIP

o The hip joint is one of the largest and most stable

joints in the body.


o The hip joint is a multiaxial ball-and-socket joint
that has maximum stability because of the deep
insertion of the head of the femur into the
acetabulum
o The femoral head is much more stable in the
acetabulum for the hip than the humerus is in the
glenoid for the shoulder.
o To allow sufficient movement and proper
alignment to occur at the hip joint, the femur has a
longer neck than the humerus and is anteverted

ANATOMY
Resting

position: 30
flxion, 30 abduction,
slight lateral rotation
Closed packed
position: Full
extension, medial
rotation, and abduction
Capsular pattern:
Flexion, abduction,
medial rotation (but in
some cases, medial
rotation is limited)

HIP

ANATOMY
ARTICULATION

Articulation between the


hemispherical head of the femur
and the cup-shaped acetabulum
of hip bone.
Acetabular notch- horseshoe
shaped and is deficient inferiorly.
Acetabular labrum- cavity of
acetabulum is deepened by the
presence of a fibrocartilaginous
rim.
Transverse acetabular ligamentlabrum bridge across the
acetabular notch.

HIP

ANATOMY
In addition, the hip, like the

shoulder, has a labrum, which


helps to deepen and stabilize the
joint.
The acetabular labrum increases
the articular surface area of the
acetabulum and volume, and it
creates a seal for the central
compartment, which is part of the
intraarticular hip joint.
The seal resists distraction of the
femoral head from the socket by
maintaining a negative pressure
and resists fluid flow that
enhances nutrition of the hip
articular cartilage, which in turn
provides a smooth gliding surface.

HIP

ANATOMY
The acetabulum is formed by

fusion of part of the ilium,


ischium, and pubis, which
taken as a group are
sometimes called the
innominate bone or pelvis.
The acetabulum opens
outward, forward, and
downward.
It is half of a sphere, and the
femoral head is two thirds of a
sphere.

HIP

ANATOMY
TYPE:

Hip joint synovial ball-and-socket


joint.

CAPSULE:

Medially - Capsule encloses the


joint and is attached to the
acetabular labrum.
Laterally - attached to the
interchanteric line of the femur
in front and the halfway along
posterior aspect of the neck of
the bone behind.
Retinacula- are reflected upward
along the neck as bands,these
blood vessels supply the head
and neck of femur

HIP

ANATOMY

HIP

LIGAMENTS:

Iliofemoral ligaments- strong (prevents over


extension during standing), inverted Y-shaped
ligament. Base attached to the AIIS above; below, the
two limbs of the Y are attached to the upper and
lower parts of the intertrochanteric line of femur.
Pubofemoral ligamenttriangular. Limits the extension
and abduction. The base is
attached to superior ramus
of the pubis, and the apex is
attached below to the lower
part of the intertrochanteric
line.

ANATOMY

HIP

LIGAMENTS:

Ischiofemoral ligament- spiral shaped and attached


to the body of ischium near the acetabular margin. The
fibers pass upward and laterally and are attached to the
greater trochanter. Limits extension.
Transverse acetabular ligament- formed by the
acetabular labrum as it bridges the acetabular notch.
Ligaments converts the notch into a tunnel through
which the blood vessels and nerves enter the joint.
Ligament of the head of the femur- flat and
triangular. Attached by its apex to the pit on the head of
femur and by its base to the transverse ligament and
the margin of the acetabular notch. It lies within the
joint and is ensheathed by synovial membrane.

ANATOMY
Under low loads, the joint surfaces

are incongruous; under heavy


loads, they become congruous,
providing maximum surface
contact.
The maximum contact brings the
load per unit area down to a
tolerable level.
Depending on the activity, the
forces exerted on the hip will vary.
When considering movement or
kinematics at the hip joint, one
must consider whether the pelvis
is moving on
stationary femur (weight-bearing)

HIP

ANATOMY
Forces on the Hip
Standing: 0.3 times the body
weight
Standing on one limb: 2.4 to 2.6
times the body weight
Walking: 1.3 to 5.8 times the body
weight
Walking up stairs: 3 times the body
weight
Running: 4.5 + times the body
weight

HIP

ANATOMY
SYNOVIAL MEMBRANE :

Lines the capsule and is attached


to the margins of the articular
surfaces.
It is covers the portion of the neck
of femur that lies within the joint
capsule.
It ensheathes the ligament of the
head of the femur and covers the
pad of fat contained in the
acetabular fossa.
Psoas bursa- formed between
pubofemoral and iliofemural,
beneath the psoas tendon.

HIP

ANATOMY

HIP

Muscles of the Hip: Their Actions, Innervation, and


Nerve Root Derivation
Action
Flexion of hip

Muscles Acting
1. Psoas
2. Iliacus
3. Rectus femoris
4. Sartorius
5. Tensor fasciae latae
6. Pectineus
7. Adductor longus
8. Adductor brevis
9. Gracilis
10. Gluteus medius
(anterior fibers)

Innervation
L1L3
Femoral
Femoral
Femoral
Superior gluteal
Femoral
Obturator
Obturator
Obturator
Superior gluteal

ANATOMY

HIP

Muscles of the Hip: Their Actions, Innervation, and


Nerve Root Derivation
Action
Extension of hip

Muscles Acting
1. Biceps femoris (long
head)
2. Semimembranosus
3. Semitendinosus
4. Gluteus maximus
5. Gluteus medius
(middle and posterior
part)
6. Adductor magnus
(ischiocondylar part

Innervation
Sciatic
Sciatic
Sciatic
Inferior gluteal
Superior gluteal
Sciatic

ANATOMY

HIP

Muscles of the Hip: Their Actions, Innervation, and


Nerve Root Derivation
Action
Abduction of hip

Muscles Acting
1. Tensor fasciae latae
2. Gluteus minimus
3. Gluteus medius
4. Gluteus maximus
5. Sartorius
6. Piriformis
7. Rectus femoris

Innervation
Superior gluteal
Superior gluteal
Superior gluteal
Inferior gluteal
Femoral
L5, S1, S2
Femoral

ANATOMY

HIP

Muscles of the Hip: Their Actions, Innervation, and


Nerve Root Derivation
Action
Medial rotation of hip

Muscles Acting
1. Adductor longus
2. Adductor brevis
3. Adductor magnus
(posterior head)
4. Gluteus medius
(anterior part)
5. Gluteus minimus
(anterior part)
6. Tensor fasciae latae
7. Pectineus
8. Gracilis

Innervation
Obturator
Obturator
Obturator and Sciatic
Superior gluteal
Superior gluteal
Superior gluteal
Femoral
Obturator

ANATOMY

HIP

Muscles of the Hip: Their Actions, Innervation, and


Nerve Root Derivation
Action
Lateral rotation of hip

Muscles Acting
1. Gluteus maximus
2. Obturator internus
3. Obturator externus
4. Quadratus femoris
5. Piriformis
6. Gemellus superior
7. Gemellus inferior
8. Sartorius
9. Gluteus medius
(posterior part)
10. Gluteus minimus
(posterior part)
11. Biceps femoris (long
head)

Innervation
Inferior gluteal
N. to obturator internu
Obturator
N. to quadratus femoris
L5, S1S2
N. to obturator internus
N. to quadratus femoris
Femoral
Superior gluteal
Superior gluteal
Sciatic

SPECIAL TEST
o Most tests are done primarily to confim a diagnosis or to
determine pathology and should not be used as stand
alone tests when considering a diagnosis.
o As with all special tests, if the test is positive, it is highly
suggestive that the problem exists, but if it is negative,
it does not necessarily rule out the problem.
o Therefore, special tests should not be taken in isolation
but should be used to support the history, observation,
and clinicalexamination

SPECIAL TEST
Tests for Hip Pathology

Bryants Triangle

Patients Position: Patient


lying supine
Stimulus: The examiner drops
an imaginary perpendicular line
from the ASIS of the pelvis.
A second imaginary line is
projected up from the tip of the
greater trochanter of femur to
meet the first line at a right
angle. This line is measured, and
the two sides are compare
Indication: Differences may
indicate conditions, such as coxa

HIP

SPECIAL TEST
Tests for Hip Pathology

Craigs Test

Patients Position:
Patient lies
prone with the knee flexed to
90.

Stimulus: The examiner


palpates
the posterior aspect of the
greater trochanter of the
femur.
The hip is then passively
rotated medially and laterally
until the greater trochanter is
parallel with the examining

HIP

SPECIAL TEST
Tests for Hip Pathology

Dial Test of the Hip.

Patients Position: The


patient lies supine with the
hips in neutral (i.e., no
rotation).
Stimulus: The examiner
medially rotates the limb and
then releases it allowing the
leg to go into lateral rotation.
If the patients leg passively
rotates greater than 45 from
vertical in the axial plane
Response: the test is
positive for hip instability

HIP

SPECIAL TEST
Tests for Hip Pathology

Flexion-Adduction Test

Patients Position: The


patient lies supine

Stimulus: the examiner


flexes the patients hip to at
least 90 with the knee
flexed.
The examiner then adducts
the flexed leg (normally, the
knee will pass over the
opposite hip without rolling
the pelvis) in pathological
hips, adduction is limited and
accompanied by pain or

HIP

SPECIAL TEST
Tests for Hip Pathology

Foveal Distraction Test

Patients Position:
The
patient is in supine

Stimulus: The
examiner abducts the
hip to 30 and applies
an axial traction to the
leg which reduces
intra-articular
pressure.
Response: Relief of
pain indicates the pain

HIP

SPECIAL TEST
Tests for Hip Pathology

Hip Scour Test

Patients Position: The


patient is in supine
Stimulus: The examiner flexes
and add. the patients hip. As
slight resistance is maintained,
patients hip is taken into
abduction while maintaining
flexion in an arc of movement. As
the movement is performed, the
examiner should look for any
irregularity in the movement,
(e.g.bumps) pain or patient
apprehension, which may give an
indication of where the pathology

HIP

SPECIAL TEST
Tests for Hip Pathology

Log Roll Test

PATIENTs POSITION: The patient

lies supine with both lower


extremities extended
STIMULUS: The examiner passively
medially and laterally rotates the
femur to end range comparing both
hips
RESPONSE/SIGN:
If a click is present, it may indicate a
labral tear.
The maneuver also shows hip
rotational mobility if restricted or
painful, indicates hip pathology

HIP

SPECIAL TEST
Tests for Hip Pathology

McCarthy Hip Extension Sign

PATIENTs POSITION: The patient

lies
supine on the bed with both hips
flexed.
STIMULUS: The examiner then
takes the good hip and extends it
from the flexed
position, fist with the hip in lateral
rotation, and then repeats the test
with the hip in medial rotation. The
nontest leg is kept in flexion. The
test is repeated with the affected
hip

HIP

SPECIAL TEST
Tests for Hip Pathology

McCarthy Hip Extension Sign

Three positive tests that

would help to predict labral


pathology:
1) pain with the McCarthy hip
extension test
2) painful impingement with hip
flexion
abduction and lateral rotation
(the anterior labial tear test)
3) inguinal pain on resisted
straight leg raise (Stinchfield
resisted hip flexion test)

HIP

SPECIAL TEST
Tests for Hip Pathology

Nlatons Line

Nlatons line is an imaginary


line drawn from the ischial
tuberosity of the pelvis to the
ASIS of the pelvis on the same
side
SIGN: If the greater trochanter

of the femur is palpated well


above the line
INDICATION: dislocated hip or
coxa vara.

HIP

SPECIAL TEST

HIP

Tests for Hip Pathology

Patricks Test (FABER or Figure-4 Test)

PATIENTs POSITION:

Supine
STIMULUS:
the examiner places the
patients test leg so that
the foot of the test leg is
on top of the knee of the
opposite leg
The examiner then
slowly lowers the knee of
the test leg toward the
examining table.

SPECIAL TEST

HIP

Tests for Hip Pathology

Patricks Test (FABER or Figure-4 Test)

RESPONSE:

(+)test is indicated by the test legs knee falling to the table


or at least being parallel with the opposite leg.
(-) test is indicated by the test legs knee remaining above
the opposite straight leg.

INDICATION: If positive, the test indicates that the hip

joint may be affected, that there may be iliopsoas spasm,


or that the sacroiliac joint may be affected.
Flexion, abduction, and external rotation (FABER) is
the position of the hip at which the patient begins the
test. The test is sometimes referred to as Jansens test.

SPECIAL TEST

HIP

Tests for Hip Pathology

Patricks Test (FABER or Figure-4 Test)

Rotational Deformities
Rotational deformities can occur anywhere between the

hip and the foot


Patients Position : The patient lies supine with the
lower limbs straight while the examiner looks at the
patellae.
RESPONSE: If the patellae face in (squinting patellae)
INDICATION: medial rotation of the femur or the tibia.

SPECIAL TEST

HIP

Tests for Hip Pathology

Patricks Test (FABER or Figure-4 Test)

Rotational Deformities
RESPONSE: If the patellae face up, out, and away from

each other (frog eyes or grasshopper eyes),


INDICATION: it is a possible indication of lateral rotation
of the femur or the tibia.
RESPONSE: the feet face in (pigeon toes) for medial
rotation and face out more than 10 for excessive lateral
rotation of the tibia while the patellae face straight
ahead.
INDICATION: If the tibia is affected,
Normally, the feet angle out 5 to 10 (Fick angle) for
better balance.

SPECIAL TEST

HIP

Tests for Hip Pathology

StinchfildResistedHip Flexion Test.

PATIENTs POSITION: Supine


STIMULUS: Pt then actively elevates the straight

leg (i.e., flexes the hip) to about 20 to 30 while the


examiner applies gentle resistance.
RESPONSE/SIGN: In a positive test, pain may be
referred into the sensory distribution of the femoral,
obturator, or sciatic nerves.
INDICATION: A positive test indicates intra-articular
pathology, which may include a labral tear,
synovitis, arthritis, occult femoral neck fractures,
iliopsoas tendinitis/bursitis, and prosthetic failure or
loosening.

SPECIAL TEST

HIP

Tests for Hip Pathology

Torque Test.

The patient
lies supine close to the edge of
the examining table with the
femur of the test leg extended
over
STIMULUS:
the edge of the table
PATIENTs POSITION:

The test leg is extended until the pelvis (i.e., the ASIS)
begins to move.
The examiner uses one hand to medially rotate the femur
to the end of range and the other hand to apply a slow
posterolateral pressure along the line of the neck of the
femur for 20 seconds to stress the capsular
ligaments

INDICATION: test the stability of the hip joint.