Flashcards in MSK Session 8 Deck (31):
What does the hip joint do?
Supports body weight in standing
Involved in locomotion
Ball and socket : large range of motion
Strong joint: takes a lot to disrupt, most stable joint in the body
What does the ligament of head of femur have?
Contains small arterial blood supply to the head of femur
What are the three hip bones? When do the begin to fuse and when is fusion complete?
i) Ilium, Ischium and Pubis
ii) Begins to fuse at 15-17 years, fusion complete by 20-25 years
Where is the margin of the acetabulum incomplete? What is this called? What is this strengthened by?
Acetabular notch - strengthened bu transverse acetabular ligament
What is the acetabular labrum made of? What does it do?
Fibrocartilaginous rim attached to margin of acetabulum
Increases the articular contact area by 10% (more than 50% of head of femur fits in)
Where does the joint capsule of the hip attach anteriorly and posteriorly?
Ant - intertrochanteric line
Post - lateral part of neck is extra-capsular
What are the three ligaments that strengthen the joint capsule? Which is the weakest?
Ischiofemoral - weakest, positioned posteriorly
What are the accessory ligaments of the hip joint?
Ligament of head of femur
Transverse acetabular ligament
What protection does the iliofemoral and pubofemoral ligaments give? What does the pubofemoral prevent?
Iliofemoral - protects anteriorly and superiorly
Pubofemoral - protects ant + inf, prevents over abduction
What are the main flexors of the hip joint?
Iliopsoas - iliacus + psoas major
What are the main hip adductors ?
Adductor : magnus, brevis, longus
What are the main hip extensors?
Long head of biceps femoris
What are the main hip abductors?
Tensor fasciae latae
What are the main hip lateral rotators?
What is hilton's law?
Nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles
What are the five major nerves that supply the anterior and posterior compartments of the thigh?
3) Nerve to quadratus femoris
4) Superior gluteal
5) Inferior gluteal
What is the main blood supply to the hip joint?
Major source (deep femoral artery)
- medial circumflex femoral artery
-lateral circumflex femoral artery
Minor source (adult)
-obturator artery (via ligament of head of femur)
What can be the problem of a fracture of the neck of femur?
Tear retinacula arteries causing avascular necrosis
What is hip dysplasia? Where and what is the problem?
Abnormal growth of the hip
Bilateral in approx half of cases
Can be dislocated at birth or sometime later
Problem with bony structures:
- Head of femur
or supporting capsule
Promblems range from:
-subluxation to dislocation
What is a slipped upper femoral epiphysis?
Fracture through epiphysis
Ages 10-16 years most affected
Rest of femur rides up and forward up relation to epiphysis
Describe features of acquired hip dislocations?
Uncommon because stable articulation
Posterior dislocation in RT
Capsule and acetabulum disrupted
Limb shortened/medially rotated
Possible sciatic nerve damage
What are the features of a femoral neck fracture?
Mainly elferly affected
Blood supply may be disrupted (circumflex arteries)
Px : shortened/externally rotated
Tx: depends on age and health >>> replacement if old
Describe trochanteric fractures ?
Less risk of osteonecrosis
Usually treated with a dynamic hip screw
What are the three main bursae around the hip joint?
Describe the trochanteric bursa?
Situated between gluteus maximus and greater trochanter
Can occur in arthritis or as separate entity
Describe the iliopsoas bursa?
Lies deep to iliopsoas
In 15% there is communication with hip joint
May present as swelling below inguinal ligament (Ddx: femoral hernia)
Describe the ischiogluteal bursa>
Situated near ischial tuberosity
Sitting down can inflame it!
Bike or horse riding
How can the three bursa within the hip joint become inflamed?
These bursae can become inflammed
- repetitive strain
Results in pain on movement
Pain on direct pressure
What is arthritis of the hip?
Inflammation of the joint in the synovium
Damage to cartilage
Usually pain early on is due to inflammation
Later on it can become more of a mechanical process
What is osteoarthritis of the hip?
Mainly cartilaginous damage
Pain is from mechanical grinding
Previous joint injuries may predispose to this condition
Increased mechanical load makes things worse
Hip commonly affected