Understanding Hip Joint and Its Disorders

Understanding Hip Joint and Its Disorders

The hip joint, one of the most crucial weight-bearing joints in the human body, is a marvel of engineering. It enables smooth and precise movements, allowing us to walk, run, jump, and perform various activities with ease.

This joint’s remarkable functionality lies in its intricate anatomical design and the interplay between bones, ligaments, and muscles.

In this comprehensive blog post, we will delve into the applied anatomy of the hip joint, exploring its osseous, ligamentous, and muscular components.

By understanding the inner workings of this joint, we can gain insights into various orthogenic, myogenic, and neurogenic disorders that may affect it.

We will also introduce special tests used by medical professionals to diagnose and assess hip joint conditions.

Let’s learn!

Applied Anatomy of the Hip Joint

Osseous Anatomy

  • Hip joint involves the articulation between the spherical femoral head and the concave acetabulum of the pelvis.
  • Femoral head, covered by hyaline articular cartilage, is attached to the femoral neck.
  • Acetabulum is composed of the ilium, ischium, and pubis bones, forming a deep socket. The labrum, a fibrocartilaginous ring, enhances joint congruity and stability by deepening the acetabulum.

Ligamentous Anatomy

  • Iliofemoral ligament, the strongest ligament of the body, prevents hyperextension and maintains an upright posture.
  • Pubofemoral ligament stabilizes the joint in the frontal plane and resists excessive abduction.
  • Ischiofemoral ligament reinforces the posterior aspect of the joint, limiting extension and external rotation.

Muscular Anatomy

  • Flexors: The hip flexors include the iliopsoas (iliacus and psoas major), rectus femoris, sartorius, and tensor fasciae latae.
  • Extensors: The primary extensor of the hip joint is the gluteus maximus, which generates force during activities like walking, running, and climbing stairs. The hamstrings (biceps femoris, semitendinosus, and semimembranosus) also contribute to hip extension.
  • Abductors: The gluteus medius and gluteus minimus play a crucial role in hip abduction, keeping the pelvis level during single-leg support and preventing a Trendelenburg gait pattern.
  • Adductors: The adductor muscles (adductor longus, adductor brevis, adductor magnus, pectineus, and gracilis) act collectively to adduct the hip joint, bringing the thigh toward the midline of the body.
  • Rotators: The external rotators (piriformis, obturator internus, gemellus superior, gemellus inferior, quadratus femoris) and internal rotators (gluteus medius and minimus) ensure proper rotational movements of the hip joint.

Orthogenic Disorders of the Hip Joint

Osteoarthritis

  • Osteoarthritis is a degenerative joint disease that affects the hip joint.
  • It is characterized by the gradual breakdown of articular cartilage, leading to pain, stiffness, and reduced range of motion.
  • Risk factors include advanced age, obesity, joint trauma, and genetic predisposition. Diagnosis is based on patient history, physical examination, and imaging studies such as X-rays and MRI scans.

Hip Fractures

  • Hip fractures commonly occur in elderly individuals, often as a result of falls or osteoporosis-related fragility.
  • These fractures can involve the femoral neck or the intertrochanteric region.

Developmental Dysplasia of the Hip (DDH)

  • DDH is a spectrum of congenital hip abnormalities characterized by an improperly formed hip joint.
  • It may involve dysplasia of the acetabulum, subluxation, or complete dislocation of the femoral head.

Avascular Necrosis

  • Osteonecrosis is disruption of blood supply to the femoral head, resulting in bone death.
  • Common causes include trauma, prolonged corticosteroid use, excessive alcohol consumption, or certain medical conditions such as sickle cell disease.

Myogenic Disorders of the Hip Joint

Muscle Strains

  • Muscle strains in the hip joint commonly involve the hip flexors, adductors, or gluteal muscles. They occur due to overstretching or tearing of muscle fibers, typically from sudden movements, repetitive strain, or direct trauma.
  • Clinical presentation includes pain, tenderness, swelling, and restricted range of motion.

Trochanteric Bursitis

  • Trochanteric bursitis involves inflammation of the bursae located around the greater trochanter of the femur.
  • It typically occurs due to repetitive friction, overuse, or direct trauma.
    Patients often present with lateral hip pain, tenderness, and localized swelling.

Neurogenic Disorders of the Hip Joint

Sciatica

  • Sciatica is compression or irritation of the sciatic nerve, which runs from the lower back down through the buttocks and legs.
  • It can result from various causes, including herniated discs, spinal stenosis, or piriformis syndrome. Patients typically experience pain, tingling, or numbness radiating along the path of the sciatic nerve.

Femoral Neuropathy

  • Femoral neuropathy involves compression or damage to the femoral nerve, resulting in weakness or numbness in the front of the thigh and difficulty walking or standing.
  • Common causes include trauma, compression due to prolonged pressure, or underlying medical conditions such as diabetes.

Special Tests for Hip Joint Disorders

Bryant's Triangle Test

  • The Bryant’s Triangle test is utilized to evaluate hip dislocation or developmental dysplasia of the hip (DDH) in infants and young children.
  • It helps identify potential hip instability or subluxation.

Procedure:

  • The infant is placed supine on an examination table with the legs flexed at the hips and knees.
  • The examiner uses their thumbs to stabilize the pelvis and holds the knees together, allowing the hips to flex passively.
  • The angle formed between the longitudinal axis of the thigh and the examination table is measured bilaterally.

Interpretation:

In normal hip development, both hips should exhibit equal flexion angles. If there is hip instability or subluxation, one hip may demonstrate increased flexion compared to the other.

Craig's Test

Craig’s Test is a valuable tool for assessing hip joint range of motion and identifying abnormalities such as femoral anteversion or retroversion. It helps determine the rotational alignment of the femur.

Procedure:

  • The patient lies prone on an examination table with the knee flexed to 90 degrees.
  • The examiner palpates the greater trochanter and rotates the leg internally and externally.
  • The angle at which the greater trochanter is maximally prominent is measured using a goniometer.

Interpretation:

  • The measured angle in Craig’s Test indicates the degree of femoral version.
  • Normal values range from 8 to 15 degrees of anteversion. Excessive anteversion (greater than 15 degrees) can lead to an increased risk of hip instability, while retroversion (less than 8 degrees) may contribute to limited internal rotation.

Distal Radioulnar Joint Instability (DRI) Test

  • The DRI test is employed to evaluate the integrity of the distal radioulnar joint (DRUJ) and assess for instability or ligamentous injury.
  • It aids in diagnosing conditions such as triangular fibrocartilage complex (TFCC) tears or ulnar-sided wrist.

Procedure:

  • The patient’s forearm is positioned in pronation or neutral on an examination table.
  • The examiner stabilizes the radius while applying an axial load to the ulna and rotates the forearm.
  • Any pain, crepitus, or excessive movement at the DRUJ is noted.

Interpretation:

Positive findings during the DRI test may indicate DRUJ instability or ligamentous injury. Further imaging, such as MRI or arthroscopy, may be necessary to confirm the diagnosis and guide appropriate treatment.

Patrick's Test (FABER Test)

The Patrick’s test is a physical examination maneuver designed to assess hip joint pathology, including intra-articular disorders, sacroiliac joint dysfunction, and certain neurogenic conditions.

Procedure:

Patient Positioning: The patient lies supine on an examination table.

Test Execution:

  • Flexion: The hip is flexed to approximately 90 degrees.
  • Abduction: The hip is abducted, with the knee held in a flexed position.
  • External Rotation: The leg is externally rotated by applying gentle pressure on the medial aspect of the knee.
  • Test Interpretation: The examiner observes for pain, limitations in range of motion, and reproduction of symptoms.

Negative Test Result:

  • Absence of pain or symptoms during the test may indicate that the hip joint and surrounding structures are not the primary source of the patient’s discomfort.

Interpretation:

Positive Test Result:

  • Hip Pain: Pain in the groin or anterior hip during the test suggests hip joint pathology, such as osteoarthritis, labral tears, or femoroacetabular impingement.
  • Sacroiliac Joint Dysfunction: Pain elicited in the sacroiliac joint region may indicate sacroiliac joint dysfunction or inflammation.
  • Neurogenic Conditions: Radiating pain or discomfort along the sciatic nerve distribution may indicate nerve compression or irritation, such as sciatica or lumbar radiculopathy.

Pedriatic Tests

  • Hart’s sign
  • Barlow’s Test
  • Galeazzi Test
  • Piston Test

To Wrap Up

The hip joint is an intricate masterpiece, combining articular surfaces, ligaments, and muscles to facilitate fluid movements and provide support to the entire body. Understanding its applied anatomy is essential in comprehending the various disorders that may arise and their impact on daily life.

From osteoarthritis to sciatica, each disorder presents unique challenges that demand prompt diagnosis and appropriate treatment. Special tests like Bryant’s Triangle, Craig’s Test, Patrick’s Test, and others aid medical professionals in accurately assessing hip joint conditions.

By arming ourselves with knowledge about the hip joint and its potential disorders, we can take proactive steps to maintain its health and enjoy an active and fulfilling life. Stay tuned for more informative content on maintaining a healthy and pain-free hip joint!

Taiba Anwer

Student Contributor

Recent posts

Anorexia: A Comprehensive Guide to Awareness, Diagnosis, and Recovery

Anorexia: A Comprehensive Guide to Awareness, Diagnosis, and Recovery

Welcome to MBBCH – where we explore pressing health concerns affecting our community.  Today, we spotlight on a critical and often…
The Intersection of Anxiety and Loneliness with Strategies for Total Wellness

The Intersection of Anxiety and Loneliness with Strategies for…

Anxiety and loneliness are complex and interconnected emotional experiences, and they can often coexist.  Some research suggests that loneliness is associated with…
Navigating Life in the Shadows: Understanding and Coping with Seasonal Depression

Navigating Life in the Shadows: Understanding and Coping with…

As the seasons change and the days grow shorter, many individuals find themselves struggling with a phenomenon known as Seasonal Affective…