Hip Joint Anatomy

Front 1

Name the four ligaments integral to the capsule of the hip joint.

Back 1

Iliofemoral lig.
Pubofemoral lig.
Ischiofemoral lig.
Zona Orbicularis

Front 2

List the features of synovial joints that can be found in the hip joint ? Which of these features are constant components and which are optional ?

Back 2

Joint space (constant)
Joint capsule (constant)
Synovial membrane/fluid (constant)
Hyaline cartilage (acetabulum=lunate, femoral head) (constant)
Acetabular labrum of fibrocartilage (optional)

Front 3

Describe the blood supply to the head of the femur

Back 3

A small branch of the Obturator Artery supplies blood to the head of femur. It passes through the Acetabular Foramen with the Ligamentum Teres which then attaches to the fovea.

Front 4

Describe where the hip joint capsule attaches.

Back 4

Anteriorly - capsule extends from rim of acetabulum to the Intertrochanteric Line.

Posteriorly - capsule extends from rim of acetabulum to middle 2/3rds of femoral neck only.

Front 5

Features of synovial joints found in hip joint ?

Back 5

Joint space
Joint capsule
Synovial membrane
Hyaline cartilage (lunate)
Acetabular labrum (around rim of acetabulum)

Front 6

True/false ?

The Iliofemoral Ligament attaches on the ilium between the two heads of Rectus Femoris.

Back 6

True - The Iliofemoral Ligament attaches on the ilium between the two heads of Rectus Femoris.

Front 7

The hip joint is a --------, ball and socket joint, between the ---------- and the head of the -----.

Back 7

The hip joint is a SYNOVIAL ball and socket joint, between the ACETABULUM and the head of the FEMUR.

Front 8

What movement does the hip joint allow ?

Back 8

The hip joint allows:
(a) flexion/extension
(b) abduction/adduction
(c) medial/lateral rotation
& (d) circumduction.

Front 9

How many degrees of freedom does the hip joint allow?

Back 9

There is three degrees of freedom at the hip joint.

Front 10

State the ligaments of the hip joint.

Back 10

There are 5 hip joint ligaments in total:

Capsular ligaments:
Pubofemoral, Iliofemoral, Ischiofemoral, Zona Orbicularis

Transverse acetabular ligament, Ligamentum Teres (head of femur)

Front 11

Name the hip joint FLEXORS

Back 11

Hip joint flexors:

Iliacus
Psoas Major
Rectus Femoris
Sartorius
Pectineus

Front 12

Name the hip joint EXTENSORS

Back 12

HIP JOINT EXTENSORS:

Gluteus Maximus + Hamstrings (Biceps Femoris, Semimembranosus, Semitendinosus)

Front 13

Name the hip joint ABDUCTORS

Back 13

Hip joint ABDUCTORS:
Tensor Fasicae Latae
Gluteus Medius
Gluteus Minimus
Gluteus Maximus

Front 14

Name the hip joint ADDUCTORS

Back 14

Hip joint ADDUCTORS:
Pectineus
Adductor Brevis
Adductor Longus
Adductor Magnus
Gracilis

Front 15

Name the lateral/external rotators of the hip

Back 15

Hip LATERAL rotators:
Gluteus Maximus
Piriformis
Gemellus Superior
Obturator Internus
Gemellus Inferior
Obturator Externus
Quadratus Femoris

Front 16

Name the medial/internal hip rotators

Back 16

The medial/internal hip rotators:

Tensor Fasciae Latae
Anterior fibres of Gluteus Medius
Anterior fibres of Gluteus Minimus
Psoas Major
Iliacus

Front 17

How would you palpate the femoral artery ?

Back 17

Draw imaginary line between ASIS and public crest. Femoral pulse can be felt two-thirds of way to pubic crest.

Front 18

How would you locate the Greater Trochanter ?

Back 18

Widest part of hips. Ask model to internally and externally rotate entire leg from hip.

Front 19

What nerve usually emerges from beneath Piriformis in the gluteal region ?

Back 19

The sciatic nerve emerges from beneath the Piriformis muscle in the gluteal region (in 87% of people).

Front 20

Explain the route by which the Femoral, Obturator and Sciatic nerves leave the pelvis.

Back 20

The Femoral nerve leaves the pelvis under the Inguinal Ligament.

The Obturator Nerve leaves pelvis through the Obturator Foramen.

The Sciatic Nerve leaves the Pelvis through the Greater Sciatic Foramen.

Front 21

Describe the Origin and Insertions of Gluteus Maximus

Back 21

Gluteus Maximus

Originates = Gluteal face of Ilium, posterior aspect of Sacrum, Sacrotuberous Ligament

Deep fibres insert on posterior femur on Gluteal Line.
Superficial fibres insert onto Iliotibial Tract over greater trochanter area

Front 22

State the origin/insertion of Tensor Fasciae Latae

Back 22

Tensor Fasciae Latae

Originates = Anterior Superior Iliac Spine (ASIS)
Inserts = directly onto Iliotibial Tract on lateral thigh, below level of Greater Trochanter

Front 23

State the origin/insertion of the Iliotibial Tract

Back 23

Iliotibial Tract

Originates = Anterior lateral face of ilium

Inserts = lateral tibia and head of fibula

Front 24

True or false :

The ankle, knee and hip joints are all close-packed at full extension.

Back 24

True. The ankle, knee and hip joints are all in their close-packed positions at full extension.

Front 25

What is the Trendelenberg gait ? What does it indicate ?

Back 25

Patient cannot keep hips level when standing on one leg - the contralateral hip drops.
This indicates weakness in Gluteus Medius (one of the hip ABDUCTORS).

Front 26

Name the origins and insertions of the Iliotibial Tract.

Back 26

Iliotibial tract.

Originates = tubercule of crest of ilium.

Inserts = lateral tibia and head of fibula

Front 27

Name the nerves arising from the Lumbar and Sacral Plexi and describe their routes out of the pelvis.

Back 27

Femoral Nerve L2-4
Obturator Nerve L2-4 and
Sciatic Nerve L4, L5, S1-3

The Femoral Nerve exits the pelvis anteriorly under the Inguinal Ligament.
The Obturator Nerve exits the pelvis through the Obturator Foramen.
The Sciatic Nerve leaves the pelvis posteriorly through the Greater Sciatic Foramen.

Front 28

By the presence of what structure are the greater and lesser sciatic foramen created ? To what does this structure attach ?

Back 28

The Sacrospinous Ligament runs between the Ischial Spine and the lateral border of the Sacrum, thus creating the Greater Sciatic Foramen above it, and the Lesser Sciatic Foramen below.

Front 29

Show on your model where the Iliotibial Tract can be found.
State the origin and attachment of the ITT.

Back 29

-
ITT originates on the lateral face of ala of ilium, runs downwards on the lateral thigh and attaches to the lateral side of the proximal tibia and head of the fibula.

Front 30

What is the function of the Iliotibial Tract ?

Back 30

The ITT is a common aponeurosis for Gluteus Maximus and Tensor Fasciae Latae. It acts as a hip abductor. It assists in maintaining knee extension when standing.

Front 31

Is the neck of femur intra- or extra- capsular ?

Back 31

Part of the femoral neck is intracapsular and part of it is extracapsular.

Anteriorly, ALL the neck of femur lies within the joint capsule. Posteriorly, only PART of the NOF is within the capsule, which covers only the medial 2/3rds of the femoral neck.

Front 32

Explain the difference between the sacroiliac joint and the hip joint.

Back 32

The Sacroiliac joint is between the sacrum and the ilium. The Iliofemoral joint (hip/coxal joint) is between the acetabulum of the innominate bone and the head of the femur.

Front 33

Can you palpate the acetabulum ? Why ?

Back 33

You cannot palpate the acetbulum as it is a concave structure lying deep to the fibrous joint capsule, capsular ligaments and the tendons of the thigh muscles. In addition, the convex head of the femur sits within the acetabulum thus preventing palpation of this structure.

Front 34

Is the acetabulum a weightbearing surface ?

Back 34

Yes.

Front 35

Describe the shape of the articular cartilage in the acetabulum.

Back 35

The acetabular cartilage is lunate in shape, i.e. in a horseshoe shape, with its loop facing superiorly towards the superior surface of the acetabulum, which bears the weight of the torso through the joint.

Front 36

Use your model to demonstrate full lateral/medial hip rotation.

Back 36

Model prone. flex knee passively to 90 degrees. Move leg internally (external rotation of hip) and externally (internal rotation of hip).

Front 37

Describe the origins and attachments of the HIP EXTENSOR muscles.

Back 37

Hip extensors muscles:

Hamstrings (Biceps Femoris, Semimembranosus & Semitendinosus). Arise from Ischial Tuberosity (and posterior femur for short head of BF). BF inserts onto head of fibula (two attachments divided by lateral collateral ligament). ST inserts onto anteromedial tibia into Pes Anserinus tendon. SM inserts posterior tibia just under tibial condyle.

Front 38

Palpate the muscle bellies of the HIP EXTENSORS.

Back 38

Locate the muscle tendons then follow muscle up to belly.

Medially, Semimembranosus belly can be palpated proximal to Semitendinosus tendon above popliteal region.

Laterally, locate Biceps Femoris tendon then follow muscle up thigh.

Front 39

Use your model to demonstrate eccentric contraction of the HIP EXTENSORS.

Back 39

-

Front 40

Use your model to demonstrate concentric contraction of the HIP EXTENSORS.

Back 40

Ask model to rise from seated position. Gluteus maximus will contract concentrically.

Front 41

What tendons would you be able to palpate on the anteromedial aspect of the proximal tibia ?

Back 41

Semitendinosus, Gracilis and Sartorius muscles form a partly joined, flattened common tendon (the Pes Anserinus tendon) which inserts onto the medial surface of the upper part of the tibia.

Front 42

Using your model, demonstrate isometric/concentric and eccentric contraction of the hip MEDIAL ROTATORS.

Back 42

Hip medial rotators are:
Tensor Fasciae Latae
Anterior parts of Gluteus Medius and Gluteus Minimus

Front 43

Describe the motor and sensory supply of the Femoral Nerve.

Back 43

MOTOR:
The Femoral Nerve (roots L2-L4) innervates muscles of the anterior thigh.

SENSORY:
The Femoral Nerve innervates the skin of the anterior thigh, medial leg and medial foot.

Front 44

Identify the pubofemoral, iliofemoral and ischiofemoral ligaments on the pelvic model.

Back 44

Anterior aspect: Pubofemoral ligament (pubis to Intertrochanteric Line of femur).

Anterior aspect: Iliofemoral ligament (from AIIS between both insertions of Rectus Femoris: one band inserts onto greater trochanter and the other to the lesser trochanter).

Posterior aspect: Ischiofemoral ligament (from body of ischium below acetabulum spirals forwards to insert into neck and root of greater trochanter).

Front 45

Which ligaments of the hip joint are intracapsular ?

Back 45

Within the hip joint, the Transverse Acetabular ligament and Ligamentum Teres are both intracapsular.

Front 46

By what arteries does the hip joint receive its blood supply ?

Back 46

The hip joint receives its blood supply from:
1) the medial/lateral circumflex Femoral arteries
2) the Superior/Inferior Gluteal arteries.

These form a PERIARTICULAR ANASTOMOSIS.

The Obturator artery also supplies the head of the femur, but this is an inadequate supply in itself.

Front 47

Which hip joint ligaments form the anterior and posterior "walls" of the hip joint capsule ? Which ligament forms the "floor" ?

Back 47

The iliofemoral ligament forms the anterior wall of the capsule, and the ischiofemoral ligament forms the posterior wall of the capsule.

The pubofemoral ligament lies beneath the hip joint.

Front 48

Is the hip joint capsule looser anteriorly or posteriorly ?

Back 48

The hip joint capsule is looser posteriorly.

Front 49

What is the lunate surface made of ?

Back 49

The lunate surface of the acetabulum is made of hyaline cartilage.

Front 50

Which nerve innervates Iliacus muscle ?

Back 50

The Femoral Nerve innervates Iliacus.

Front 51

Which nerve roots innervate Psoas Major ?

Back 51

Psoas Major is innervated by the lumbar plexus roots L1-L3.

Front 52

What is the origin/insertion of Psoas Major ?

Back 52

O=Psoas Major arises from T12-L5, transverse lumbar processes, intervertebral discs and adjacent bodies and the tendinous arches between them.
I=Lesser trochanter

Front 53

State the origins and insertions of the hip joint lateral rotator muscles.

Back 53

Piriformis
O=anterolateral surface of sacrum
I=Greater Trochanter

Gemellus Superior
O=Gluteal aspect of Ischial Spine
I=Greater Trochanter

Obturator Internus
O=internal aspect of Obturator membrane
I=Greater Trochanter

Gemellus Inferior
O=Ischial Tuberosity
I=Greater Trochanter

Obturator Externus
O=external aspect of Obturator membrane
I=Trochanteric Fossa

Quadratus Femoris
O=Ischial Tuberosity
I=Quadrate Tubercule & area around it

Front 54

What structures might limit hip FLEXION ?

Back 54

With knee flexed - flexion is limited only by contact of thigh on anterior abdominal wall.

With knee extended - tension in Hamstrings will limit hip flexion.

Front 55

What structures might limit hip EXTENSION ?

Back 55

Tension in iliofemoral and pubofemoral ligaments will limit hip extension.

Front 56

What structures limit LATERAL hip ROTATION ?

Back 56

Lateral hip rotation is limited by:
medial rotator muscle tension, and the iliofemoral and pubofemoral ligaments.

Front 57

What structures limit MEDIAL hip ROTATION ?

Back 57

Medial hip rotation is limited by tension in the lateral rotators, and the ischiofemoral ligament.

Front 58

What structures limit hip ABDUCTION ?

Back 58

Hip abduction is limited by tension in the hip adductors, and by the pubofemoral ligament.

Front 59

What structures limit hip ADDUCTION ?

Back 59

Hip adduction is limited by tension in the hip abductors, and by the lateral part of the iliofemoral ligament.

Front 60

Demonstrate how to isolate and test the strength of Gluteus Maximus.

Back 60

Model prone on couch with one leg flexed to 90 degrees. Press on thigh whilst asking patient to raise thigh against resistance. N.B. If model's knee is extended, the hamstrings will assist Gluteus Maximus and you will not have isolated this muscle.

Front 61

Describe the boundaries of the Femoral Triangle, its contents and the order of the structures from lateral to medial.

Back 61

The Femoral Triangle is on the anterior thigh. Its superior border is the Inguinal Ligament. Its medial border is the lateral border of Adductor Longus. Its lateral border is the medial border of Sartorius.

From lateral to medial, the order of structures in the Femoral Triangle is N.A.V. i.e. Femoral Nerve, Femoral Artery and Femoral Vein.

Front 62

What is the action of the Hamstrings ?

Back 62

the Hamstrings extend the hip and flex the knee.

Front 63

Demonstrate how to test hip FLEXION maximum ROM.

Back 63

Model Supine on couch. Passively put knee nearest you in 80 degrees of flexion. Around the end of range, observe the opposite ASIS as the pelvis will tilt posteriorly (ASIS will rise) indicating that no further hip joint mvmt. is occuring.

Front 64

When contraction of the hamstrings occurs with an extended knee, what movement occurs ?

Back 64

Hip extension is produced.

Front 65

Describe where the synovial membrane of the hip joint attaches.

Back 65

The synovial membrane lines the inside surface of the joint capsule. As a rule, synovial membrane attaches where articular cartilage ends. Therefore, in the hip this is the rim of the acetabulum, to the middle 2/3rds of posterior femoral neck, and anteriorly to the Intertrochanteric Line.

Front 66

What nerve innervates:

The Gemelli
Piriformis
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Adductor Magnus

Back 66

Gemelli - sacral plexus
Piriformis - S1,S2
Glut.Maximus - Inferior Gluteal Nerve
Glut.Medius - Superior Gluteal Nerve
Glut.Minimus - Superior Gluteal Nerve
Adductor Magnus - Obturator & Sciatic Nerves

Front 67

Name the three extra-capsular ligaments of the hip joint.

Back 67

The 3 extra-capsular hip joint ligaments are the pubofemoral, iliofemoral and ischiofemoral ligaments.

Front 68

What nerve innervates Semitendinosus and what is the nerve root ?

Back 68

Semitendinosus is innervated by the Tibial portion of the Sciatic Nerve (roots L5,S1,S2)

Front 69

What artery/s and vein/s supply Gluteus Medius ?

Back 69

Arterial supply:
The Femoral Artery gives off the Profunda Femoris which then gives off the Lateral Circumflex Artery.

The LCA's Ascending branch supplies the Gluteal region & hip joint.

Venous drainage:
Drains into the Femoral Vein

Front 70

Palpate Gluteus Maximus and demonstrate it working isometrically.

Back 70

-

Front 71

What muscles extend the hip ?

Back 71

Hip extensors:
Gluteus Maximus and Hamstrings

Front 72

What is normal ROM at the hip joint in the transverse plane ?

Back 72

Normal hip rotation ROM in transverse plane is medial 30 / lateral 60

Front 73

Which is the main ligament that limits hip extension ? Identify it on the model.

Back 73

The main hip joint ligament that limits hip extension is the Iliofemoral ligament, which lies anterior to the hip joint.

Front 74

Name the ligaments which strengthen the hip joint capsule.

Back 74

Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Zona Orbicularis

Front 75

What is the Zona Orbicularis ?

Back 75

The Zona Orbicularis is a band of circularly oriented ligamentous fibres that reinforce the hip joint capsule, and helps keep the head of the femur in its socket.

Front 76

What nerves usually emerge from above the Piriformis through the greater sciatic foramen ?

Back 76

The Superior and Inferior Gluteal Nerves exit the pelvis above Piriformis via the greater sciatic foramen.

Front 77

Which nerve supplies Obturator Externus and Obturator Internus ?

Back 77

Obturator Externus supplied by Obturator Nerve.

Obturator Internus supplied by the Sacral Plexus.