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Rashed Dawabsheh

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Hip jointBall and socket joint

Weight bearing joint

Stable joint

between the femur andacetabulum of the pelvis

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Anatomical Components:1. Articular Capsule

2. Acetabular labrum

3. Ligaments: Iliofemoral

Pubofemoral

Ischiofemoral

Ligament of the head of the femur Transverse ligament of the acetabulum

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Anterior view

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Posterior view

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Medial view withacetabular floor

removed

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Anterior view withcapsule removed

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Bursaethin sac of tissue that contains fluid to lubricate

the area and reduce friction that occurs betweenmuscles, tendons, and bones

E.g. greater trochanteric bursa

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

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Femoral neck angle

dd

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urroun ng aStructures:Nerves:

All of the nerves that travel down the thigh pass by the hip. The mainnerves are the femoral nerve in front and the sciatic nerve in back of thehip. 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 deepbranch, called the profunda femoris. The profunda femoris sends twovessels that go through the hip joint capsule.

Lateral & Medial femoral circumflex arteries

These vessels are the main blood supply for the femoral head,the ligamentum teres (Ligament of the head of the femur) contains asmall blood vessel hat gives a very small supply of blood to the top ofthe femoral head.

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Hip Joint Movements:

Flexion = 0 - 120

Extension = 0 - 20

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Abduction = 0 - 45

Adduction = 0 - 25

Hip Joint Movements:

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Internal Rotation = 0 - 45

External Rotation = 0 - 45

Hip Joint Movements:

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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 istypically

from the sciatic nerve or lumbar spine

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History Limping can be due to:

- Pain (as in antalgic limp).

- Shortening of one of the limbs.

- Weakness in abductors (as in trendelenburggait).

Adde

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History Age:

in >70 or postmenopausal woman, there is anincreased 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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Adde

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ExaminationBefore Examination:

1.Introduction

2.Privacy3.Position: for most of the exam the patient should be supine lyingon a flat table. patient's hands should remain at his/her sides with the headresting on a pillow. The knees and hips should be in the anatomical position

4.Privacy

5.Exposure: patient's hips should be exposed so that the quadriceps musclesand greater trochanter can be assessed

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Adde

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ExaminationLook . Feel . Move.

Look:- Gait (while ptn is standing)

- Masses / Scars / Lesions / Signs oftrauma or previous surgery

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

and knee

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Adde

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ExaminationFeel:

- Tenderness over the greater trochanter(Trochanteric Bursitis)

- Assessing for fractures & Injuries lookfor Tenderness over: ischial spine,Pubic Rami, Lesser trochanter & ischialtuberosity

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Adde

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ExaminationMove:

- 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 90

- Flexion: with your hand under the back

(to detect any masking of hip movementby the pelvis or lumbar spine)

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Adde

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Examination (Move Cont.)- Extension: with ptns 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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Adde

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Examination (Move Cont.)- Check in several positions

- Compare with the contralateral side

- Neurovascular exam

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Movement Normal Range

Flexion 0 - 120

Extension 0 - 20

Abduction 0 - 45 (up to 90 in infants)

Adduction 0 - 25

External Rotation 0 - 45

Internal Rotation 0 - 45

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Thomass TestMeasures 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

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

possible

Measure 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 oftenshortened and externally rotated.

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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 theside opposite to the stance leg.

Special Tests

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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 shiftof the center of gravity and consequently stabilizing or balancing thebody. However, in this scenario, when the patient/person lifts the

opposing leg, the shift is not created and the patient/person cannotmaintain 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

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ImagingX-ray

CT scan

MRISonography

Others.