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Chapter 9The Hip Joint and Pelvic Girdle
Pelvic Girdle
Anterior Gluteal Line
External Surface
Auricular Surface
Iliopectineal Eminence
Greater Sciatic Notch
Iliac Fossa
Iliac Crest
Posterior Superior Iliac Spine
Posterior Inferior Iliac Spine Anterior
Inferior Iliac Spine
Anterior Superior Iliac Spine
Ischium Label
Ilium Label
Pubis Label
Ischial Tuberosity
Spine of the Ischium
Lesser Sciatic Notch
Inferior Rami
Superior Rami
Pubic Crest
Inferior Rami
Superior Rami
Pubic Symphysis
Sacral Articulation
Posterior Gluteal Line
Inferior Gluteal Line
Joints•Symphysis Pubis (amphiarthrodial)
–Fibrocartilaginous interpubic disc–Superior Pubic Ligament–Inferior Pubic Ligament
•Sacroiliac Joints (arthroidial)
–Junction of the sacrum suspended between the two iliac bones
•Posterior Sacroiliac Ligament•Sacrotuberous ligament•Anterior Sacroiliac Ligament
Joints• Acetabulofemoral
(enarthrodial)– Iliofemoral “Y” Ligament– Teres Ligament– Pubofemoral Ligament– Ischiofemoral Ligament
Range of Motion• Flexion
– 120° (knee flexed)– 90° (knee
extended)
• Extension– 20°
• Abduction– 45°
• Adduction– 20°-30°
• Internal Rotation– 40°
• External Rotation– 45°
Cutaneous Distribution
Cutaneous Distribution (Sciatic)
Movements• Hip Flexion• Hip Extension• Hip Abduction• Hip Adduction • Hip External Rotation• Hip Internal Rotation • Anterior Pelvic Rotation• Posterior Pelvic Rotation• Left Lateral Pelvic Rotation• Right Lateral Pelvic Rotation • Left Transverse Pelvic Rotation• Right Transverse Pelvic
Rotation
Gluteus minimusGluteus minimusIliacusIliacusPsoasPsoas
PectineusPectineusTensor fasciae lataeTensor fasciae latae
SartoriusSartoriusAdductor longusAdductor longus
GracilisGracilisRectus FemorisRectus Femoris
Gluteus maximusGluteus maximusAdductor Magnus Adductor Magnus
Biceps femorisBiceps femorisSemitendinosusSemitendinosus
SemimembranosusSemimembranosusAdductor BrevisAdductor Brevis
External RotatorsExternal RotatorsGluteus MediusGluteus Medius
Label
Muscles•Iliopsoas
–Iliacus–Psoas Major
•Strengthening
•Stretching
Muscles•Sartorius •Strengthening
•Stretching
Muscles•Rectus Femoris •Strengthening
•Stretching
Muscles•Tensor Fasciae Latae
•Strengthening
•Stretching
Muscles•Gluteus Maximus •Strengthening
•Stretching
Muscles•Gluteus Medius •Strengthening
•Stretching
Muscles•Gluteus Minimus •Strengthening
•Stretching
Muscles•Six Deep Lateral Rotator Muscles
–Piriformis–Gemellus Superior–Gemellus Inferior–Obturator Externus–Obturator Internus–Quadratus Femoris
•Strengthening
•Stretching
Muscles•Semitendinosus •Strengthening
•Stretching
Muscles•Semimembranosus •Strengthening
•Stretching
Muscles•Biceps Femoris
–Long head–Short head
•Strengthening
•Stretching
Muscles•Adductor Brevis •Strengthening
•Stretching
Muscles•Adductor Longus •Strengthening
•Stretching
Muscles•Adductor Magnus •Strengthening
•Stretching
Muscles•Pectineus •Strengthening
•Stretching
Muscles•Gracilis •Strengthening
•Stretching
Techniques In Evaluating Levelness of Pelvis
• Anterior Superior Iliac Spines• Posterior Superior Iliac Spines• Iliac Crests
Pelvic Deviations• Lordosis (pelvic tilt)• Scoliosis• Pelvic Torsion
– Leg length discrepancy
Determining Leg Length Discrepancy1. Standing Position: levelness of iliac crests
(symmetry of all 4 iliac spines)1. Measure from ASIS to tip of medial malleolus
(supine)2. Determine if femur and tibia are same length
Note: If iliac crests are level and there is a measurement difference = Pelvic Torsion
Deviations of the Hip• Hip Flexion Contracture (contributes
to a lordosis condition)– Test
• Both knees to chest. Maintain one knee to chest while lowering other leg – should be flat on table.
– Distinguish between the commonly tight muscles:
• Iliopsoas• Rectus Femoris• Tensor Fasciae Latae
• Femur Angle– Coxa Normal
• Between 115°-140°, averaging 126° at adulthood– Coxa Vara
• Decrease in angle caused by weight bearing on weak femur
– Results in weak gluteus medius
– Coxa Valga• Increase in angle caused by non-weight bearing
• Gluteus Medius Gait• Caused by:
– Nerve damage or other pathology– Functional weakness due to coxa vara– Congenital Hip Dislocation
– Stance• Hip abducted position, leaning toward side of
weakness– Gait
• Manner of style of walking– .– Positive Trendelenburg Gait
Deviations of the Hip
Coxa Normal
Coxa Vara
Coxa Valga
Positive Trendelenburg Test Click for movie
Gaits
• Gluteus Maximus Gait– Anatomy– Gait: Posterior sway on side of
weakness with weight bearing on same side
• Hip Flexor Gait– Circumduction gait