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THE HIP REGION

ACETABULUM
BONES ISCHIUM > 2/5
ILEUM < 2/5
PUBIS = 1/5

HEAD OF FEMUR
CAPSULE

FRONT
BACK
Muscular anatomy
Muscular Anatomy
ANTERIOR
Muscular Anatomy
POSTERIOR
Muscular
anatomy
Medial Group
ILIO-PSOAS MUSCLE
Movements of the Hip
and its main Muscles
– Flexion
• Iliopsoas
• Sartorius
• Tensor fascia lata
• Rectus femoris
• Pectineus
• Adductor longus
• Adductor brevis
• Adductor magnus
• Gracilis
Movements of the Hip
and its main Muscles
• Extension
– Hamstrings
– Adductor magnus
– Gluteus maximus
• Abduction
– Gluteus medius
– Gluteus minimus
– Tensor fascia lata
Movements of the Hip
and its main Muscles
• Adduction
– Adductor
longus
– Adductor
brevis
– Adductor
magnus
– Gracilis
– Pectineus
Movements of the Hip
and its main Muscles
• Rotation
– Medial
• Gluteus medius
• Gluteus minimus
• Tensor fascia lata
– Lateral
• Obturator externus
• Obturator internus
• Gemelli
• Piriformis
• Quadratus femoris
• Gluteus maximus
FEMORAL TRIANGLE
GLUTEAL AREA
BLOOD SUPPLY OF
THE FEMORAL HEAD
EXAMINATION
OF THE HIP JOINT
symptomatology

Pain
Limping
Deformity
STIFFNESS
Snapping
DEFORMITIES
Abnormal fixed position of the joint
Deformities along sagittal plain
)flexion, extension (

Deformity along mediolateral plain


)coronal plain (
abduction, adduction} deformity {

Rotational deformity
external, internal rotation} deformity {
Deformities along sagittal plain

flexion
• exaggeration of lumbar lordosis

• +ve Thomas test


HIP EXAMINATION

THOMAS TEST Flexion deformity

NORMAL LIMB

DISEASED LIMB
:Thomas test
This test is used to
diagnose fixed flexion
deformity of the hip. The
examiner blocks the pelvis
by bringing the contralateral
sound hip into maximal
flexion. This eliminates
lumbar lordosis that can
beused to compensate for
the hip flexion contracture
of the affected hip. The leg
to be examined is then
brought into maximal
extension with the hip in
neutral adduction and
rotation.
Deformities along
coronal plain

Pelvic tilting

Abduction: lowering of the Adduction:elevation of the

+
ASIS of the diseased side ASIS of the diseased side

)Lateral deviation of the spine ) scoliosis


Disease deformity

Synovitis Flextion,abduction, external rotaion

Arthritis Flexion,adduction,internalrotation

Coxa vara Flexion,adduction

Psterior dislocation Flexion,adduction,internal rotation

Anterior dislocation Flexion,abduction, external rotation

Fracture neck femur External rotation


LOWER LIMB LENGTH
-TRUE
-APPARENT
Apparent shortening &
lengthening

ADDUCTION Apparent shortening

ABDUCTION Apparent lengthening


Developmental Dysplasia of
Hip
Clinical screening for DDH:

Ortolani & Barlow tests.

ble clunks and not audible clicks are cons


• Shortening / limitation
of hip abduction can be
detected in unilateral
cases with established
dislocation. DDH
( CDH )
• This test examine the
strength of the gluteus
medius. Normally, in a one
legged stance, the pelvis is
raised up on the unsupported
side. If the weight bearing hip
is unstable, the pelvis drops
on the unsupported side, to
avoid falling the patient has
to throw his or her body
towards the loaded side.
• In the classic test, the
examiner stands behind the
patient. If the patient stands
on a healthy hip the gluteal
fold on this side drops.
• If the patient stands on a Trendelenburg sign
diseased leg the gluteal fold
on the opposite side drops
The causes
(the Soundof positive
Side Sags). Trendelenburg test are:-
1.. Weakness of the hip abductors e.g. poliomyelitis
2.. Shortening of femoral neck e.g. coxa vara.
3. Dislocation or subluxation of the hip

FALSE POSITIVE: Pain on weight bearing


Clinical findings
In fractures
• History of trauma
• Pain
• Loss of active movment
• Abnormal movment
• Painful passive movment
• Crepitus at injured area
• Deformity of the limb:
• external rotation ; severe in intertrochanteric fractures and
moderate in fracture of the neck
• Flexion,abduction, external rotation in anterior dislocation
• Flexion,adduction,internal rotation in posterior dislocation
HIP REGION PROBLEMS
TRAUMA
INFECTIONS
DEGENERATIVE
NEOPLASTIC
CONGENITAL
PARALYTIC
METABOLIC
COMMON INJURIES
AROUND THE HIP
Coxa vara

Neck shaft angle


CDH or
DDH
BILATERAL

UNILATERAL
Slipped Upper Femoral
Epiphysis
Common in boys 10-17 
.yrs
.Bilateral in 1/3 of pts 
Possible underlying 
endocrine disease eg
.hypothyroidism
Pt may present with 
knee
.pain
:AP view
Line tangent to superior 
border of neck normally
.cuts through epiphysis
Perthes’
Disease
Most common inboys 4-8
.yrs
Self limiting disease
characterised by AVN of
.femoral head
Completerevascularization
of
epiphysis occurs without
any
.ttt,but may take 3 yrs
Deformation of epiphysis
occurs during
revascularization
.in some patients
PERTHES DISEASE
DEGENERATIVE
ARTHROSIS
AVN
T Y
I P AS
H L
O P
HR
RT
A
Chronic Osteomyelitis
osteochondroma
Multiple Myeloma
Multiple Myeloma
NERVE ENTRAPMENT SYNDROME

DEFINITION
COMPRESSION NEUROPATHIES
TRANSIENT
PERMNANT
•NERVE ROOT
• PLEXUS
PERIPHERAL NERVE
SYMPATHETIC TRUNK
LEADS TO

,SENENSORY

,MOTOR

REFLEX

SUDOMOTOR CHANGES
SPECIAL
INVESTIGATIONS
CT
CT & 3D-CT
BONE SCAN
US examination

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