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Department
of Podiatry
Hip
Joint
Anatomy
- pelvic
girdle comprised of 3 joints: sacroiliac, pubic symphysis, acetabulofemoral
- acetabulofemoral joint is a true polyaxial joint which is capable
of significant motion in all three planes
- abduction / adduction
- inversion
/ eversion
- extension / flexion
- also capable of complex triplanar motion: circumduction
- three major ligaments: pubo-femoral ligament, ilio-femoral ligament,
ischiofemoral ligament
Muscles
acting at hip joint
- very
complex
- most muscles crossing the hip have more than one action
- difficult to isolate clinically
- we are most concerned about the effect of contracture in the transverse
plane
Anterior internal rotators
- iliopsoas
consists of psoas major and iliacus
originates from the anterior aspect of the lower lumbar spine and
iliac crest
inserts into lesser trochanter of femur
primarily a hip flexor
Posterior internal rotators
- adductors: adductor longus, brevis, magnus
- originate from pubic ramus and insert into linea aspera, medial
condyle of femur
- primarily adduct the hip joint
- g. medius and minimus
Anterior external rotators
- sartorius
- originates from ASIS, inserts into pes anserinus (medial surface
of proximal tibia)
- flexes, externally rotates and abducts the hip joint
Posterior external rotators
- gluteus maximus
- originates from gluteal line of ileum, inserts into ilio-tibial
band and gluteal tuberosity of femur
- extends, externally rotates and adducts hip joint
- piriformis
Deep hip muscles
- obturator internus / externus, gemelli
- anterior fibres
- posterior fibres
- piriformis
Clinical
assessment
Two techniques
Root et al
- pt. supine, knee extended
- palpate femoral condyles
- internally and externally rotate leg
- measure with gravity goniometer
McCrea
- pt. supine, knee flexed
- leg used as pendulum
- internally and externally rotate leg
- visualise upside-down protractor
- estimate ROM
NB: in both cases, normal ROM is 45 degrees internal and external
- limited internal rotation - tight external rotators
- limited external rotation - tight internal rotators
- hip extended - anterior muscles taut
- hip flexed - posterior muscles taut
- no difference: femoral torsion problem
- difficult to DDx between ligamentous and osseus contracture
eg: limited internal rotation with hip extended > tight anterior
external rotator (sartorius)
Trendelenburg
test
- test
for weak hip abductors (gl. medius)
- stand on one leg: unsupported hip should be level or slightly higher
than supported side
- if unsupported side drops, weak gl. medius on supported side
- see
MedNet
hip pages for further description
Trendelenburg
gait
Because
of failure of the hip abductors, the pelvis tilts downwards on the
opposite side during stance phase. In order not to fall, the patient
compensates by shifting his center of gravity towards the affected
side. The result is a gait with a lateral lurch towards the affected
side. If both sides are affected, there is a bilateral lateral lurch
or "waddling" gait.
Foot
mechanics and hip pain
- mainly
related to limb length
discrepancy
- osteoarthritis due to relative coxa vara
- malalignment of sacro-iliac joint
- piriformis syndrome
Piriformis
syndrome
- compression of sciatic nerve as a result of spasm, oedema and contracture
of piriformis, which passes through the greater sciatic foramen
- usually unilateral, with a limp on the affected side
- pain on resistance of external rotation
- unilateral XS pronation of the foot leads to XS internal rotation
of femur
- > stretch / overuse of piriformis > inflammation / hypertrophy
To
learn more about piriformis syndrome, click here
Summary
- anatomy
/ ROM
- mainly concerned with transverse plane position
- clinical tests
- McCrea technique of choice
- Trendelenburg sign
- hamstring flexibility
- referral to physio / myotherapist
- LLD, XS pronation and hip pain
 References
Julsrud
ME (1989) Piriformis syndrome. Journal of the American Podiatric Medical
Association 79(3): 128-131.
Sgarlato TE (1971) A compendium of podiatric biomechanics. CCPM, San
Francisco, pp.330-344.
Schuit D, McPoil TG, Mulesa P (1989) Incidence of sacroiliac malalignment
in leg length discrepancies. Journal of the American Podiatric Medical
Association 79(8): 380-383.
Links
to relevant web pages
For a
very detailed, beautifully illustrated summary of hip joint examination,
follow the link to the MedNet
hip pages.
(http://www.echo.uqam.ca/mednet/anglais/hermes_a/hip/hip_ind.html)
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