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PLL #2- The Hip:

PLL #2- The Hip:. Anatomy, Disease, Injury, and Repair By: Phil Kemp, Andrew Thistle, Tim Hersey, Brian Wilson, John Bocchino BNG 345 Professor Currey. Learning Objectives. To be able to label the parts associated with the hip joint on both the femoral and pelvic sides

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PLL #2- The Hip:

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  1. PLL #2- The Hip: Anatomy, Disease, Injury, and Repair By: Phil Kemp, Andrew Thistle, Tim Hersey, Brian Wilson, John Bocchino BNG 345 Professor Currey

  2. Learning Objectives • To be able to label the parts associated with the hip joint on both the femoral and pelvic sides • To be able to explain how the muscles and ligaments in the hip allow for movement • To deduce and identify common diseases and injuries of the hip • To compare the methods of repairing common hip diseases and injuries, both biologically and surgically

  3. Anatomy of the Hip

  4. Bones That Make up the Hip Ball and Socket joint composed of: Ilium Ishcium Pubis Femur

  5. Acetabulum Formed by the Ilium, ischium, and pubis. Deep Socket on the outer edge of the pelvis The depth of the acetabulum is further increased by a fibrocartilagenous labrum attached to the acetabulum.

  6. Femur The large round head of the femur rotates and glides within the acetabulum. The neck of the femur connects the femoral head with the shaft of the femur. The neck ends at the greater and lesser trochanter prominences.

  7. Trochanters • Greater Trochanter • Bump on the femur and easy to feel on outside of your thigh • Site for tendons of several muscles to attach. • The lesser trochanter is also a the site for tendon attachment.

  8. Biomechanics As the joint bears more weight, the contact of the surface areas increases as does joint stability. When standing, the body’s center of gravity passes through the center of the acetabulum.

  9. Muscles of the Hip Quadriceps Hamstrings Gluteal Group Adductor Group Illiopsoas Group Lateral Rotator Group

  10. Quadriceps The quads make up about 70% of the thigh’s muscle mass. The purpose of the quads is flexion (bending) of the hip and extension (straightening) of the knee.

  11. Hamstrings Has a large moment aiding in hip extension.

  12. Gluteal Group Gluteus maximus – main hip extensor and keeps the head of the femur from sliding forward in the hip socket Gluteus medius – helps keep the pelvis level when walking and helps to abduct the thigh Gluteus minimus – Works with medius to help abduct the thigh

  13. Adductor Group Made up of: adductor brevis, adductor longus, adductor magnus, pectineus, and the gracilis muscles. Originate on the pubis and insert on the medial, posterior surface of the femur. Muscles aid in adduction, hence “adductor group.”

  14. Iliopsoas Group Comprised of the iliacus and psoas major. The strongest of the hip flexors. Important in standing, walking, and running.

  15. Lateral Rotator Group Made up of the externus and internusobturators, the piriformis, the superior and inferior gemelli, and the quadratusfemoris. Originate at or below the acetabulum of the ilium and insert on or near the greater trochantor. Aid lateral rotation of the hip.

  16. Hip Tendons and Ligaments

  17. IT Band (Tendon) • IT Band (Iliotibial Band) • Runs along femur from hip to knee Hip Anatomy,Iliotibial Band

  18. Ligaments • Connect bones to bones • Joint Capsule • Pubo-femoral • Iliofemoral • Ischiofemoral • Provides Stability • ligamentumteres- connects femoral head to acetabulum & supplies femoral head with blood

  19. Ligaments 2 • Labrum • Facilitate keeping femoral head in the acetabulum

  20. Nerves • Sciatic nerve • large, travels under the gluteus maximus down the back of the leg and further onto the foot.

  21. Bursae Sacs of liquid that allow for lubrication between bones, muscles and tendons

  22. Jeopardy http://www.superteachertools.com/jeopardy/usergames/Feb201306/game1360011345.php

  23. Common Hip Injuries

  24. Common Hip Injuries • Hip Dislocation • Hip Fracture • Athletic Hip Injuries • Trochanteric Bursitis • Hip Pointer • Labral Tear • Stress Fracture • Muscle/Ligament Strain

  25. Hip Dislocation • Difficult to do • Ball and Socket joint very stable • Can be acquired or congenital (hip dysplasia) • Easy to diagnose

  26. Famous example of hip dislocation… Bo Jackson http://www.ddotomen.com/2012/12/10/30-for-30-you-dont-know-bo-full-episode/

  27. Hip Fracture Serious problem in elderly population Requires surgical repair or replacement Can lead to further complications

  28. Fracture-Surgical Methods of Repair http://orthoinfo.aaos.org/topic.cfm?topic=A00392 • Method of Repair depends on: • Placement of fracture • Surgeons Discretion

  29. Athletic Injuries Trochanteric Bursitis Hip Pointer Labral Tear Stress Fracture Muscle/Ligament Strain

  30. Trochanteric Bursitis

  31. Hip Pointer

  32. Labral Tear

  33. Stress Fracture

  34. Hip Strain/Sprain

  35. Common Hip Diseases

  36. Osteoarthritis (OA) • Most common form of hip arthritis • Chronic condition characterized by the breakdown of cartilage that cushions the ends of the bones where they meet to form joints • “Wear and Tear” Arthritis • Results in pain, stiffness, loss of movement, and potential formation of bone spurs http://www.joint-pain-expert.net/images/hip-osteoarthritis.JPG

  37. Rheumatoid Arthritis Chronic Inflammatory Disease affecting 1.3 million Americans Causes: Unknown, but genetics, environmental factors, and hormones have been speculated as potential causes Results in pain, redness, inflammation, and potentially loss of function and disability

  38. X-Ray: RA

  39. Arthritis-Methods of Repair Surgical Treatments Joint Resurfacing Joint replacement Basic Treatments • Rest • Exercise • Cane/walker • Anti-inflammatory Drugs • Cortisone shots • Rest and exercise?

  40. Hip Dysplasia AKA Developmental Dysplasia of the Hip (DDH) Lifelong condition 1:1000 people Ranges from barely detectable to severely malformed or dislocated

  41. Hip Dysplasia X-Ray

  42. Hip Dysplasia-Methods of Repair • Treatment depends on age of diagnosis • Infants: brace • 6 months to 10 years: full body brace • Older children & adults: Surgical bone remodeling and/or total joint replacement

  43. Avascular Necrosis Proposed causes: chemotherapy, alcoholism, excessive steroid use, and many others Most commonly affects the ends of long bones, thus the hip joint is commonly affected by AN Usually affects people between 30 and 50; about 10-20 thousand people develop AN at the head of the femur each year

  44. Avascular Necrosis

  45. Avascular Necrosis-Methods of Repair • Most cases eventually require surgery • Bone grafts • Osteotomy • Total Joint replacement • Core Decompression • Vascularized bone graft

  46. Total Hip Replacement

  47. Components: http://www.exac.com/patients-caregivers/images/img_patients_hip_components.jpg/image_product

  48. Variation in Femoral Stem

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