hip joint

Rashed Dawabsheh

Hip joint

Ball and socket jointWeight bearing jointStable joint between the femur and acetabulum of the pelvis

Anatomical Components:1. Articular Capsule2. Acetabular labrum3. Ligaments:

Iliofemoral Pubofemoral Ischiofemoral Ligament of the head of the femur Transverse ligament of the acetabulum

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Anterior view

Posterior view

Medial view with acetabular floor

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Anterior view with capsule removed

Bursaethin sac of tissue that contains fluid to

lubricate the area and reduce friction that occurs between muscles, tendons, and bones

E.g. greater trochanteric bursa

can get inflammed(trochanteric bursitis) producing Lateral Superficial hip pain that may radiate down the lateral aspect of the thigh, Usually aggravated when lying on the side at night

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Femoral neck angle

Surrounding Vital Structures: Nerves:

All of the nerves that travel down the thigh pass by the hip. The main nerves are the femoral nerve in front and the sciatic nerve in back of the hip. A smaller nerve, called the obturator nerve, also goes to the hip

Blood Vessel & Blood Supply of the Jointfemoral artery passes by the front of the hip area, and has a deep branch, called the profunda femoris. The profunda femoris sends two vessels that go through the hip joint capsule. Lateral & Medial femoral circumflex arteriesThese vessels are the main blood supply for the femoral head, the ligamentum teres (Ligament of the head of the femur) contains a small blood vessel hat gives a very small supply of blood to the top of the femoral head.

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Hip Joint Movements:Flexion = 0º - 120ºExtension = 0º - 20º

Abduction = 0º - 45ºAdduction = 0º - 25º

Hip Joint Movements:

Internal Rotation = 0º - 45ºExternal Rotation = 0º - 45º

Hip Joint Movements:

History Hip Joint Pain:

- Groin pain that may radiate to the Ant. Thigh & knee - Usually increased with activity (OA)

- Pain over the greater trochanter is typically trochanteric bursitis

-The buttock is not the hip! Buttock pain is typically

from the sciatic nerve or lumbar spine

History Limping can be due to:

- Pain (as in antalgic limp).- Shortening of one of the limbs.- Weakness in abductors (as in trendelenburg gait).

History Age:

in >70 or postmenopausal woman, there is an increased chance of neck fracture

Important Questions:- How did this affect your daily activity?- How Long/Far can you walk?- Do you use any Walking Aid?

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Examination Before Examination:1.Introduction2.Privacy3.Position: for most of the exam the patient should be supine lying on a flat table. patient's hands should remain at his/her sides with the head resting on a pillow. The knees and hips should be in the anatomical position

4.Privacy5.Exposure: patient's hips should be exposed so that the quadriceps muscles and greater trochanter can be assessed

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Examination Look …. Feel …. Move….

Look: - Gait (while ptn is standing)

- Masses / Scars / Lesions / Signs of trauma or previous surgery

- Bony alignment (rotation, leg length) - Muscle bulk and symmetry at the hip

and knee

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Examination Feel: - Tenderness over the greater trochanter

(Trochanteric Bursitis) - Assessing for fractures & Injuries look

for Tenderness over: ischial spine, Pubic Rami, Lesser trochanter & ischial tuberosity

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Examination Move: - Internal/External Rotation:

with leg in full extension with rolling the leg on the couch & using the foot to indicate the range of rotation, and then test with knee (and hip) flexed at 90º

- Flexion: with your hand under the back(to detect any masking of hip movement

by the pelvis or lumbar spine)

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Examination (Move Cont.)

- Extension: with ptn’s face down on the couch & with place your left hand on the pelvis

- Abduction/Adduction: to stabilize the pelvis place your left hand on the opposite

iliac crest

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Examination (Move Cont.)

- Check in several positions - Compare with the contralateral side

- Neurovascular exam

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MovementNormal Range

Flexion0º - 120º

Extension0º - 20º

Abduction0º - 45º (up to 90º in infants)

Adduction0º - 25º

External Rotation

0º - 45º

Internal Rotation

0º - 45º

Thomas’s Test Measures fixed flexion deformity (incomplete extension) - place your hand under ptn’ lumbar spine

- passively flex both legs (hips & knees) as far as possible- you should feel that lumber spine lordosis got eliminated- now ask the ptn to extend the test hip- Incomplete extension indicates fixed flexion deformity

Special Tests

Shortening (Leg Length Discrepancy)Ask the ptn to lie spine and stretch both legs as

possibleMeasure with tape:

From Umbilicus to medial malleolus: the apparent length From ASIS to medial malleolis: the ‘true length’

Special Tests

In hip fractures the affected leg is often shortened and externally rotated .

Trendelenburg Sign- Ask the ptn to stand on one knee for 30 seconds- Repeat with the other leg- Watch the iliac crest on each side if it moves up or

downThe Trendelenburg sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg.

Special Tests

Trendelenburg Sign The weakness is present on the side of the stance leg. The body is not

able to maintain the center of gravity on the side of the stance leg. Normally, the body shifts the weight to the stance leg, allowing the shift of the center of gravity and consequently stabilizing or balancing the body. However, in this scenario, when the patient/person lifts the opposing leg, the shift is not created and the patient/person cannot maintain balance leading to instability.

It is positive in:- Weakness / paralysis in hip abductors.- Marked proximal dislocation / subluxation of the hip.- Shortening of femoral neck.- Any painful disorder of the hip.

Special Tests

Imaging X-ray CT scan MRISonographyOthers.