Clinical Anatomy of the Hip

Will CollettPeer Support 2014

Avascular necrosis Superior Gluteal Nerve Injury Inferior Gluteal Nerve Injury Thomas Test Injection Site

Objectives

What makes the femoral head susceptible to AVN?

Medial and lateral circumflex arteries and ligamentum teres artery

Intracapsular Vs Extracapsular How can we injure the hip causing AVN?

# NOF Car crash

What are the signs and symptoms of AVN? # NOF – shortened and externally rotated Pain, reduced movement, Weight bearing

Avascular Necrois

Diagnosis?

Avascular necrosis

Intracapsular

Extracapsular

Innervates?

Lost ability to? Abduct the hip

Trendelenburg gait or sign?

Superior Gluteal Nerve Injury

Superior gluteal nerve (L4-L5)

Gluteus Medius & Minimus(L4-L5)

SIGN

GAIT

Innervates?

Lost ability to? ◦ Prevent trunk tipping forwards during gait◦ Extend the hip

Gait? ◦ lurching backward when the weaker limb is on the floor during walking (heel strike)◦ Buttock wasting◦ Hamstring Compensation

Inferior Gluteal Nerve Gluteus Maximus

(L5-S1)

Thomas Test

Method 1 - Vertical line through

highest point of iliac crest - Horizontal line midway

between ischial tuberosity and highest point of iliac crest

Intramuscular Injection Method 2

- Vertical line through highest point of crest- Line from PSIS to the greater trochanter