Test Your Knowledge: Hip Pain Not From the Hip

See if you can answer the questions below about anterior hip pain. Answers are provided below.

1. Name the 3 joint complexes in the hip

2. Name the muscles of the anterior pelvis and describe their function

3. Name the muscles of the anterolateral pelvis and describe their function

4. Name the muscles of the lateral compartment of the pelvis and describe their function

5. Name the muscles of the medial compartment of the pelvis and describe their function

6. What are the components of the femoral triangle?

7. What is hip impingement syndrome?

ANSWERS:

1. The three joint complexes in the hip are: a) SI Joints b) Symphysis Pubis c) Hip Joints

2. The muscles of the anterior pelvis include the Iliopsoas, which is made up of the Psoas and Iliacus. This muscle flexes the hip but also flexes the spine of the pelvis when the leg is fixed. This is a relevant postural muscle. It is used when meditating or deep breathing in sitting. The Iliacus flexes the hip, and tilts the pelvis anteriorly when the leg is fixed. The Psoas minor flexes the pelvis on the spine. The fascia of the psoas is thick and continuous with the Transversalis Fascia. Why do we care about this? Because of the interconnected fascia from the abdomen to the hip, infections can travel along the fascia into the hip.

3. The muscles of the anterolateral pelvis include the Rectus Femoris, the Sartorius and the Tensor Fascia Latae (TFL). The Rectus Femoris flexes the hip, extending the knee. Imaging of these muscles is difficult because there are many anatomical differences and tendons are continuous. Pain can be diffuse because tendon connections can be diffuse. It is not "cut and dry" like it looks in the anatomy books. Therefore, something that happens with Rectus Femoris can relate to the lateral thigh because of the connecting fascia.

4. The lateral compartment of the pelvis includes the Sartorius, which flexes the knee and flexes, abducts and laterally rotates the hip. The TFL contributes to knee lateral stability and pelvic balance. The TFL is innervated by the Superior Gluteal nerve. During surgery, this nerve can be cut and can contribute to lateral stability issues.

5. The medial compartment of the hip includes the Adductor Longus, which can adduct the hip and contribute to flexion of the thigh. The Gracilis can adduct and flex the internally rotated leg. This muscle can also be used for ACL reconstructions. The Pectineus can adduct the thigh, flex and internally rotate the thigh, and can be injured when a person over-extends their thigh.

6. The femoral triangle consists of the Inguinal Ligament superiorly, the Adductor Longus medially and the Sartorius laterally.

7. Impingement syndromes can be divided into 3 categories:

a) Intra-articular impingements, which include labral or ligament tears, loose bodies and the synovium.

b) Extra-articular impingement syndromes include the Iliopsoas tendon and the lateral Iliotibial band.

c) Femoral acetabular impingement is an abnormal contact between the proximal femur and the acetabular rim or pelvis.

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