[Music] hello guys today in this session we are going to talk about one of the important joint of the lower limb which is the hip joint the hip joint is formed like a ball and the socket therefore it is called as ball and socket joint which rotates on more than one axis and is classified under synovial joint as you can see in this image here the ball of the hip joint is comprised of head of the femur which articulates with the acetabulum which is a cup like depression within the pelvic bone and the hip joint connects the axial skeleton to the lower extremities and functions to support the static that is standing and the dynamic that is walking running and weight bearing we can say now let us concentrate more on the joint capsule of the hip joint or in simple terminology we can call it as the capsule of the hip joint as you can see here right the capsule of the hip joint is pretty strong and it is fibrous but loose enough to accommodate wide range of movements it attaches to the acetabular labrum the transverse acetabular ligament and the intertrochanteric line of the femur these are the attachments of the hip joint capsule and if we talk about the ligaments what we can see in this image here focus on the ligament known as iliofemoral ligament the iliofemoral ligament the pubofemoral ligament and the ischiofemoral ligament all these three important ligaments all act to strengthen the mobile capsule of the joint or we can say these ligaments strengthens the joint capsule right so therefore it is very much important for us to concentrate more on the ligaments of the hip joint because these are very very important for you to know so first let us concentrate on the outer ligaments in the outer ligaments the first one is the ilio femoral ligament this iliofemoral ligament attaches superiorly to the anterior inferior iliac spine and to the acetabulum and inferiorly to the intertrochanteric line therefore creating a pretty much y shape so what is the important function of this ligament it prevents excessive lateral rotation and hyper extension of the hip this is a very important point that you need to highlight especially when the subject is in the standing position and another important point you need to remember is it is the strongest ligament of the human body and second important ligament is the ischiofemoral ligament and this ischiofemoral ligament originates in the rim of the acetabulum and inserts over the infra medial aspect of the greater trochanter of the femur and it reinforces the fibrous capsule anteriorly therefore it functions in coherence with the iliofemoral ligament and also fixates the femoral head in the acetabulum this is the main function so therefore we can say that it prevents excessive medial rotation and extension of the thigh that is the important function of this ligament and next is the pubo femoral ligament the name itself says that puber femoral meaning it arises from the pubic ramus and merges infrared laterally into the iliofemoral ligament but may also have an attachment to the femoral neck and it reinforces the fibrous capsule inferiorly and this ligament tightens during extension and abduction in order to limit abduction and extension of the thigh so these are the outer ligaments of the hip joint and what about the inner ligaments the first important ligament will be that transverse acetabular ligament right you can see here and this transverse acetabular ligament runs over the acetabular notch and joins up with the inferior end of the labrum and it is the fibrous structure on the lower part of the acetabulum that converts the acetabular notch into an acetabular foramen therefore it allows the passage of the vessels and nerves into the joint space and another important ligament is the ligament of the head of the femur so this ligament of the head of the femur is situated within the capsule but it is extra synovial in nature it arises mainly from the acetabular notch and inserts upon the phobia of the femur and carefully you can see let's zoom this image and you can see very carefully that within the ligament it gives pathway for the foveolar artery to the head of the femur so these are about the outer as well as inner ligaments of the hip joint so after discussing about the ligaments it is very important for us to know about the hip joint movements and biomechanics you have to focus one of the very important point related to the hip joint is no muscles attach directly to the femoral head but many muscles crosses the hip joint and allow flexion extension abduction adduction internal rotation and external rotation of the thigh okay let us focus on the muscles involved and the movements of the hip joint the psoas major iliacus sartorius rectus femoris and bacterius allows for flexion but the psoas major iliacus and sartorius also aids in abduction as well as internal rotation and another important muscle called as gluteus maximus and hamstring muscles examples like semimembranosus semitendinosus and biceps femoris these are the muscles responsible for extension of the hip joint and the gluteus medius and minimus and another important muscle called as tensor fasciae latae allow for abduction and internal rotation of the hip and the adductors called as aduktar longus adductor brevis and adductor madness along with this graceless and pectineus allows for the adduction of the hip joint and the muscles like obturator muscles gemellas quadratus femoris gluteus maximus and piriformis responsible for the external rotation of the hip joint so these are the muscles which are responsible for various movements of the hip joint and when we mark the range of movements of the hip joint which are precisely marked in degrees and these are categorized by name and these range of movement occur when the knee is flexed at the right angle that is 90 degrees flexion 140 degrees extension 15 degrees abduction 40 degrees adduction 25 degrees internal rotation 35 degrees and external rotation 45 degrees right yeah so therefore we know what are the movements which are performed by the hip joint and what are the muscles which are involved in these movements now let us concentrate on the blood supply of the hip joint so let us focus on the image again there is a beautiful image which is clearly explained the complete blood supply of the hip joint right here let us focus on two sets of arteries that contribute either majorly or minorly to the vascularization of the joint capsule of the hip the major contributing arteries are the medial and the lateral circumflex arteries which arise from deep branch of the femoral artery so indirectly we can say that the branches from the femoral artery has the major contribution and the minor contribution set singularly of the artery of the head of the femur right so these are the two sets of the arteries which gives blood supply to the hip joint so whenever we talk about especially the blood supply of the femoral head because which is clinically very important and the blood supply of the femoral head is quite variable the three main arteries supply the femoral head one is the lateral epi facial branch of the medial circumflex femoral artery and the ascending branch of the lateral circumflex femoral artery both ascends from deep femoral artery right these are the two important branches this leaves the femoral head vulnerable to avascular necrosis in the presence of the femoral neck fracture because these vessels are easily ruptured with the femoral neck fractures another important artery is the ligamentum theories artery so focus here this ligamentum teres artery distance from the posterior branch of the obturator artery and attaches at the phobia and this artery is commonly disrupted with the dislocations of the hip joint and remember that point that it is the main blood supply to the femoral head in children as an anatomical variant the inferior gluteal artery is the main blood supply to the femoral head in smaller portion of the patients so this is what is about the blood supply of the hip joint and what is about the nerve supply after discussing the blood supply let us concentrate on the nerve supply of the hip joint the innervation of the hip joint comes anteriorly from the femoral nerve which is the mainer and inferiorly from the anterior division of the obturate turner and laterally from the articular branch of the sciatic nerve and posteriorly from the nerve that runs to the quadratus femoris as well as the superior gluteal nerve so but whatever it may be the main nerve is the femoral nerve that is what you have to remember for the innervation of the hip joint now let us discuss about the clinical anatomy of the hip joint and this first let us talk about hip dislocation so a hip dislocation is a disruption of the joint between the femur and the pelvis and specifically it is when the ball shaped head of the femur comes out of the cup shaped acetabulum of the pelvis right so what are the symptoms symptoms typically include the pain and inability to move the hip and the complications may include a vascular necrosis of the hip injury to the sciatic nerve femoral nerve or maybe arthritis and these dislocations are categorized or either posterior dislocation or anterior dislocation based on the location of the head of the femur so first let us concentrate on posterior dislocation remember the point guys 9 out of 10 hip dislocations or posterior meaning posterior dislocations are pretty common here the affected limb will be in the position of flexion adduction and internally rotated and the knee and foot will be in towards the middle of the body and most often in such a type of dislocation a sciatic nerve palsy is present approximately in eight to twenty percent of the cases so posterior dislocation causes injury to the sciatic nerve in approximately eight to twenty percent of the cases and now is about the anterior dislocation in the anterior dislocation the limb of the patient is held by the person in externally rotated and mild flexion and abduction and in such a dislocation because it is anterior dislocation the nerve which is present which is the femoral nerve so femoral nerve pulses can be present in anterior dislocation and sciatic nerve palsy can be present in posterior dislocation but anterior dislocation of the hip joint is pretty uncommon now what are the major causes of hip dislocations here dislocation of the hip typically take a high degree of force almost about 65 percent of the cases are related to motor vehicle collisions with false and sports injuries being the cause of many of the rest but major will be motor vehicle accident or dashboard injuries we can say and what will be the diagnosis let us concentrate on the diagnosis part here the anterior posterior x-rays of the pelvis and anterior posterior and lateral views of the femur including the knee or ordered for the diagnosis and the size of the head of the femur is then compared across both the sides of the pelvis and the affected femoral head will appear larger if the dislocation is anterior and it appears smaller if the dislocation is posterior and a ct scan may also be ordered to clarify the pattern of the fracture so this is what is about hip dislocation