Osteopathic Evaluation of the Hip Joint
Our hip joint is vital for ambulation
And so patients with hip pathologies
and problems will come in
and we need to understand the
and how to evaluate the joint
in order to help better treat our
patients with hip problems.
The hip joint itself consists of 2 bones.
It’s the articulation between the
innominate and the femur.
So taking a closer look at the femur itself,
there is a femoral head,
a greater and lesser trochanter,
and also a lateral
and medial condyle which
articulates with the knee.
The hip joint itself is a
and so the surface of the hip
articulates in the acetabulum.
And it’s really deep
and provides more stability and
is adaptive for high loads.
This is relatively different compared
to the shoulder
where the glenoid fossa is
and it’s also a ball-and-socket
but is not as deep.
So the hip joint, having more
of a deep socket,
helps to be more stable
but does give it less range of motion
compared to the our shoulder joint.
The capsule extends from the
femur to the acetabulum
and each part of the innominate.
The ilium, ischium, and the pubis
meet at the acetabulum
and forms the articulation
of the hip joint with the femur.
There are many different ligaments
that help to stabilize
the hip joint itself
to keep the femoral head to the acetabulum.
So anteriorly there’s an iliofemoral
and pubofemoral ligament
and posteriorly there’s ischiofemoral
And these ligaments make the capsule
to help stabilize
and keep the femur
attached to the acetabulum.
There are 6 major muscle groups
surrounding the hip joint itself.
We have our flexor and extensors,
abductor and adductors, and
So these muscles are large muscles.
They help to
provide motion and movement
at the hip joint.
So let’s have a closer look
at the different muscle groups.
Our hip flexors
tend to lie more on the anterior
portion of our hip,
and so, the iliopsoas is the
primary hip flexor.
It attaches from the anterior bodies
of the lumbar spine,
blends with the iliacus surrounding
and attaches into the lesser
trochanter of the femur.
And so when that muscle,
is injured or spasmodically contracted,
that could cause a lot of hip pain.
And it could also cause the hip to
be stuck more in flexion
because it attaches to the spine that
could prevent someone from
straightening out or the pain is worse when
they try to straighten out their back.
The rectus femoris, sartorius,
pectineus, tensor fascia latae,
and also the gracilis help to make up
the primary flexors of the hip.
The hip extensors
tend to lie on the posterior
aspect of the hip.
And here you have your gluteus maximus,
your hamstring muscles which
include the biceps femoris,
the semitendinosus, and semimembranosus,
and also the adductor magnus.
Your hip abductors include
your gluteus medius,
tensor fascia latae,
Our hip adductors include
the adductor brevis,
and the adductor magnus.
There’s the gracilis,
and also the obturator externus.
There’s no true pure internal
rotators of the hip.
They have contributions from the
gluteus medius and minimus
and also contributions from the
adductor magnus and longus
which help with internal rotation.
Our hip external rotators include
the piriformis muscle,
the superior and inferior gemellus,
the internal and external obturators,
the quadratus femoris,
and the gluteus maximus.
We need to consider blood supply to the hip
because sometimes the hip might be suspect
to a decrease in blood supply,
such as the femoral head,
and that could potentially lead
to avascular necrosis.
So in general, the hip joint does
get good blood supply
but the femoral head itself
tends to have less blood flow.
There is a retinacular arterial system
that runs along the neck of the femur
and the femoral head itself
does get some perforating branches
from the medial and lateral
Lymphatics of the lower extremity
have to flow upward and
pass through the hip.
The hip region is where we try to assess
for any lymphadenopathy
or swelling of those lymph nodes
whenever there’s infection.
So if someone had a cellulitis
of the lower extremity,
or someone had some sort of malignancy
or anything that really causes
infection that inflames the lymph nodes,
what we do is we palpate for
those swollen lymph nodes
along the inguinal canal
along the attachments of the hip.
This is also an important place to
look at osteopathically
because any sort of musculoskeletal
restrictions at the hip
and the fascia around the hip,
may decrease lymphatic flow
from the extremities.
So it’s important to treat the hip area
in order to allow for optimal