The Hip (Coxal) Joint

• acetabular labrum • aiis • articular surfaces • asis • ball and socket • capsule • coxal joint • extracapsular • extracapsular ligament • hip • hip abduction • hip adduction • hip extension • hip flexion • hip lateral rotation • hip medial rotation • hip rotation • hip surface markings • iliofemoral • intracapsular • intracapsular ligament • ischiofemoral • joint articular surfaces • ligaments • movements of the hip joint • pubic tubercle • pubofemoral • synovial membrane

The Hip Coxal Joint Physiotherapy Solihull Simon Evans

Articular Surfaces

  • Class - Synovial, Ball & Socket Joint
  • Close packed in Extension, abduction, medial rotation
  • Articular Surfaces:
    • Spherical head of femur
    • Covered in HC except fovea capitis
  • Acetabulum
    • Divided into articulating (covered with HC) and non-articulating (acetabular fossa) portions
  • Orientated lateral, anterior and inferior
  • Acetabular fossa contains fibro-elastic fat pad - covered with synovial membrane
  • Role is probably nutritional or protective 

Acetabular Labrum

  • Acetabulum is deepened by the Fibrocartilage Acetabular Labrum. 
  • Triangular in X-section 
  • Labrum is deficient inferiorly
  • Replaced by Transverse Acetaublar Ligament

Capsule

  • Complex and very strong - best developed anteriorly and superiorly - limit extension
  • 3 sets of Fibres:
    • Longitudinal - pelvis to femur
    • Oblique - pelvis to femur
    • Circular - Zona orbicularis - no bony attachment
  • Attachments:
    • ~ 6mm beyond labrum and to transverse acetabular ligament
    • to Neck of femur:
      • Intertrochanteric line (ant.)
      • 1 cm proximal to intertrochanteric crest (post.)
      • Proximal to lesser trochanter (inferior)
      • Base of neck of femur (superior)

Synovial Membrane

  • Lines Capsule:
    • Attached to acetabular margins and transverse ligament
    • And to articular margins on femur - note femoral neck is covered in SM
  • Note presence of Ilio-Psoas Bursa Anteriorly to separate tendon of iliopsoas (communicating) 

Ligaments - Intracapsular

  • Acetabular labrum and Transverse Acetabular ligament
  • Ligamentum Teres
    • Flattened triangular band
    • Attached from fovea capitis to transverse ligament and acetabular notch
    • Intracapsular but extrasynovial
    • Role is unclear but believed to provide passage for nutrient artery to head of femur

Ligaments - Extracapsular

  •  3 key ligaments to provide stability - all form thickenings in the capsule
  • Anteriorly:
    • Iliofemoral - Y shaped structure from AIIS to upper and lower parts of intertrochanteric line (weakest centrally) 
    • Pubofemoral - from iliopubic eminence and superior pubic ramus to join with lower part of iliofemoral ligament
  • Both limit extension & lateral rotation
  • Ischiofemoral Ligament:
    • Situated posteriorly
    • Spirals over the neck of the femur running with oblique fibres of capsule
    • Attached to body of ischium, spirals over NoF to insert into the root of the greater trochanter
    • Limits extension and medial rotation

Surface Markings

  • Anteriorly
    • A line (concave inferiorly) passing through a point 1½  cm below the middle of the inguinal ligament (ASIS to Pubic Tubercle)
  • Laterally
    • A line passing through the apex of the greater trochanter (concave inferiorly)
  • Ligaments
    • Iliofemoral – from AIIS (2 cm below and 2cm medial to ASIS) to intertrochanteric line (greater trochanter to tendon of adductor longus)
    • Pubofemoral – from superior pubic ramus to lower ½ of iliofemoral ligament
    • Both ligaments will cross the surface marking of the hip joint anteriorly

Movements at the Hip Joint

  • When assessing the end of a joint range of motion each movement should have a specific end feel – soft tissue apposition, bony apposition, ligamentous tension, muscular tension
  • Multiaxial joint therefore movements are possible in all 3 planes
  • Flexion - (120∞) - limited by soft tissue apposition
  • Extension - (25∞) - limited by tension in the extracapsular ligaments and hip flexors
  • When assessing the end of a joint range of motion each movement should have a specific end feel – soft tissue apposition, bony apposition, ligamentous tension, muscular tension
  • Multiaxial joint therefore movements are possible in all 3 planes
  • Flexion - (120∞) - limited by soft tissue apposition
  • Extension - (25∞) - limited by tension in the extracapsular ligaments and hip flexors
  • Abduction - (45∞) - limited by tension in adductors, inferior part of iliofemoral ligament and capsule and pubofemoral ligament
  • Adduction - (45∞) - limited by soft tissue apposition
  • Medial Rotation - (30∞) - limited by tension in ischiofemoral ligament and posterior capsule and lateral rotators
  • Lateral Rotation - (60∞) - limited by ilio and pubofemoral ligaments, anterior capsule and medial rotators

See More Articles on the Human Anatomy - Click HereThe Hip Coxal Joint Physiotherapy Solihull Simon Evans



← Older Post Newer Post →