NEUROBIOMECNICA

DE
CADERA

EQUIPO DE KINESIOLOGA Y MOVIMIENTO HUMANO

Aspectos Osteolgicos
Recuerdo Anatmico
Aspectos Osteolgicos
Recuerdo Anatmico
Aspectos Osteolgicos
Recuerdo Anatmico

Ar9culacin
Aspectos Artrolgicos
Coxofemoral
Tipo: Sinovial,
esferoidea.
-Supercies ar<culares:
Cabeza femoral
Acetbulo (faceta
semilunar)
-Rodete ar<cular
-Cpsula brosa:
Robusta y densa.

 There are several landmarks on the femur, distal to the hip
joint proper, that are relevant to the function of the hip
Orientacin espacial sup. articulares
Femoral head
Aspectos Osteolgicos
Greater trochanter
Adulto normal: 125
Recin nacido: 140-150
mur forms approximately two
Deformidades en plano frontal
surface is not perfectly spherical.
Coxa valga: >125
Coxa vara: <125

the femoral head and of the

hickest in the body. Reported
3.6 mm, with the greatest thick- Axis of head and neck
A
e anterosuperior aspect of the
Femoral head
abular and femoral articular car-
ncongruities in shape, thickness,
ilitate cartilage lubrication and
also contribute to degenerative
age [2,12].
uities between the femoral head Greater trochanter
f the hip joint are generally con-
he congruency is improved even 15
e. This congruency provides two
congruency allows larger areas B
one another throughout the nat- Figure 38.5: Orientation of the femoral head. A. Anterior view
of the femur reveals that it faces medially and superiorly.
ans that the loads sustained dur-
B. Superior view of the femur reveals that it faces anteriorly.
read across larger surface areas,
 inclination ismity
typically
moves reported
theThe to be
trochanter 125.
farther from themity
jointofcenter,
the designed
hip (Fig.
effec- es to This
38.15). normal adult values
deformity throughout
directs growth. During
the femoral
on the hip
Figure for
38.13: treatment of
Pavlik splint is osteoarthritis and
one of a variety of splints aseptic tonecrosis
position the infants hips in flexion and abduction to facilitate
development when the femoral neck has a maximum
port an averagetively
angle of 131 inthe
lengthening
normal development a ofsample
moment ofarm
the femoral 32head
of thehead
and hip more superiorly
abductors.
acetabulum. ThisTecklinin
(From JS:the acetabulum.
Pediatric Many
Physical Therapy. biomechanical
Baltimore: Lippincott William
[17,25].
puts However,
the hip coxa
abductors vara
at a tends
mechanical to increase
advantage the
and medial
may pull (con
ns [72]. A hip with an excessive frontal plane
& Wilkins, 1999)
Orientacin espacial sup. articulares
alterations appear to result from a coxa valga [34,42,53]. The
actually reduce the force they are required to exert during
stance, thusplane
transverse reducing the joint
orientation of thereaction force.AsOrthopaedic
femoral neck. stated ear- angle is said to have a coxa valga deformity, or valgus def
surgeons use the positive effect of altering the femoral neck
Aspectos Osteolgicos
lier, the angle of inclination is typically reported to be 125. mity of the hip (Fig. 38.15). This deformity directs the femo
alignment
Yoshioka etand improving
al. report the mechanical
an average angle of 131 advantage of 32
in a sample of the head more superiorly in the acetabulum. Many biomechani
abductor
cadaver muscles
specimensin[72].
surgical
A hiposteotomies to reduce
with an excessive theplane
frontal loads alterations appear to result
F from a coxa valga [34,42,53]. T
J
on the hip for treatment of osteoarthritis and aseptic necrosis FS
[17,25]. However, coxa vara tends to increase the medial pull
XVL
XN J
XN

XVR XVL
XN
M
XN
125 M 125
>125
XVR <125 125
>125

125 A
<125 Figure 38.17: Mechanics of a slip
young child, the femur exhibits a
A B
A and the capital epiphysis is appr
Figure 38.17: Mechanics of a slipped capital epiphysis. A
A B A
young child, the joint
Bfemurreaction
exhibits Baforce (F). alignment
coxa valga B. As then
and the capitaldecreases and the epiphysis
epiphysis is approximately is no
perpendicular
joint reaction force Aon
FigureFigure
38.16:the
38.14:femur
In The
a coxa (J) exerts
joint reaction a
vara deformity, the angle
B on the femur
force ofa inclination
(J) exerts joint reaction force
joint reaction force. In this case,v
(F). B. As the child grows, the coxa
(M) on theisneck of thenormal.
femur,
momentcreating
(M) on thetensile Figure 38.15: decreases
Frontal Figure
plane and
alignment
38.15: theof
Frontal epiphysis is no
thealignment
hip. A. longer
The perpendicular
of theangle A. The anglet
less bending
than neck of the femur, creating tensile
Figure 38.16: In a coxa vara deformity, the angle of inclination
of plane
both a compressive hip.
force
joint reaction force. In this case, the joint reaction force
(FC )
forces
erior surface of the on the neck
femoral superiorandsurface of the femoralof
compres- neck and compres-
inclination of inclination
in normal alignment in normal alignment is approximately
is approximately 125130. 125130.
is less
sive than
forcesnormal.
on its inferior surface. B. of bothvalga,
In coxa a compressive
the angle force (FC ) andisagreater
of inclination shear (F ) force.
than norma
nferior surface. B. In coxa valga, the angle of inclination is greater than normal.S
Aspectos Osteolgicos Orientacin espacial sup. articulares

Anteversin normal 15
Rango entre 10 y 30
 CARGAS APLICADAS SOBRE LA CADERA

Aspectos Osteolgicos

ACETABULO Superior

! Un 48% en la parte superior

! Un 28% en la parte anterior
Anterior Posterior
! Un 24% en la parte posterior

Inferior
PATRON DE CARGA

! La zona de mayor contacto de la coxofemoral en bipedestacin es

la porcin anterosuperior del cotilo.

! En sedestacin es la parte inferior de la cabeza la que contacta con

el acetbulo.
 Sistema trabecular
Aspectos Osteolgicos

En la Cabeza Femoral existe un

sistema principal compuesto
por 2 sistemas:
A) Fascculo arciforme: de
traccin , nace en la cor9cal
externa de la disis femoral y
termina en la zona inferior de la
cor9cal de la Cabeza Femoral

B) Fascculo ceflico, es de
compresin desde la cor9cal
interna de la disis e inferior del
cuello femoral, a la parte superior
de la cor9cal de la C.F.
Aspectos Osteolgicos

Sistema Accesorio

! Fascculo trocantreo, desde

la cor<cal diasiaria interna de la
base del cuello.

Fascculo con bras paralelas y

!
ver<cales a la cor<cal del
trocnter.

Los sistemas trabeculares de

!
traccin estn en si<os de
insercin de msculos y
ligamentos potentes , por
ejemplo el trocnter mayor.
 Oatis_CH38_685-704.qxd 4/15/07 extension
capsule. It, too, limits excessive 2:36 PMROM.
Page 692
Additionally, consist of longitudinal and circumferential fibers criss-crossing

SISTEMA CAPSULOLIGAMENTOSO SISTEMA C PSULOLIGAMENTOSO

it helps to prevent too much abduction ROM.
Additional Ligaments
The hip also contains an intraarticular ligament known as the
ligament to the head of the femur, or ligamentum teres
(Fig. 38.10). This ligament lies deep within the joint and runs
692 the acetabular fovea to the pit of the head of the femur.
from
one another. This fiber arrangement allows the capsule to
function much like a Chinese finger puzzle that, when
stretched, clamps down on the structures within. As the hip is
extended, the fibers of the capsule clamp down on the bony
contents within, firmly holding the femoral head in the acetab-
ulum (Fig. 38.11). In contrast, hip flexion slackens the joint
capsule. Like the glenohumeral joint, the hip may gain addi-
tional stability from a negative
Part intraarticular
IV | KINESIOLOGY OF pressure
THE LOWER[31].
EXTRE

Clinical Relevance
FRACTURES OF THE FEMORAL NECK: Disruption of
hip joint capsule at the base of the femoral neck or injur
the neck itself may disrupt the blood supply of the femor
Ligament of
head of femur head and endanger the integrity of the head itself. A seri
potential sequela of a femoral neck fracture is avascular
necrosis of the femoral head, which can result when the
Acetabular femoral head is separated from its blood supply in the
labrum
femoral neck. When the displacement of the femoral nec
severe or when the time between injury and intervention
several hours or more, the risk of avascular necrosis increa
In such cases, the orthopaedic surgeon may choose to
perform a partial or total joint replacement (arthroplasty)
rather than try to repair the fracture with pins or screws
[62]. Arthroplasty is particularly advantageous when the
fracture cannot be reduced readily or when it occurs in a
frail patient. In contrast, intertrochanteric and sub-
trochanteric fractures present considerably less risk to the
Figure 38.10: The ligament to the head of the femur arises from Figurevascular
38.11: The fibersbecause
supply of the capsule and surrounding
the capsule liga-
and femoral neck a
Figure
the floor38.8: The
of the hip joint capsule
acetabulum attaches
and attaches to the
to the acetabulum
fovea on the ments function like a Chinese finger puzzle, clamping down
consequently, the blood supply to the femoral head are u
proximally
head and to the intertrochanteric crest and line distally.
of the femur. on the joint as the joint surfaces are distracted.
ally spared [61,63]. Therefore, these fractures are more
amenable to treatment by internal fixation.
SISTEMA CAPSULOLIGAMENTOSO SISTEMA CPSULOLIGAMENTOSO

ISQUIOFEMORAL
ILIOFEMORAL
PUBOFEMORAL
SISTEMA CAPSULOLIGAMENTOSO

Cartilago:
! mas grueso en la periferia
! Labrum acetabular

Labrum

Es triangular, con su cara

intrarticular cubierta por cartlago.

Aumenta la profundidad del

cotilo.

Abarca la Cabeza femoral y la

mantiene dentro del cotilo.

ESTABILIDAD
 Rangos de Movimiento Normal
Rango de Movimiento para los 3 planos (grados)
Osteocinem9ca

Flexin/ Extensin (plano Abduccin/Aduccin Rotacin Interna/Externa

sagital) (plano frontal) (plano horizontal)

Flexin: 120 Abduccin: 40 Rotacin Interna: 35

Extensin: 20 Aduccin: 25 Rotacin Externa: 45

 Extensin
Osteocinem9ca

Est limitada por la tensin de los ligamentos.

Se favorece con:
! Extensin de la rodilla
! Con rodilla extendida: 20
! Con flexin de rodilla: 10
! Aumento de la hiperlordosis
! Rotacin externa.

ROM: 0-20
 Flexin
Osteocinem9ca

!Depende de la posicin de la rodilla y

de la lordosis lumbar

! La mxima amplitud se consigue con

la rodilla en flexin y disminucin de la
lordosis lumbar

!Con rodilla en extensin alcanza los

90.
ROM: 0-140
 Abduccin/Aduccin
Osteocinem9ca

Abduccin:
Objetiva mxima 45
Subjetiva 90
Est limitada por la tensin del ligamento pubofemoral
Mxima abduccin se consigue con rotacin externa

Aduccin:
Se combina con una flexin o extensin de cadera.


ROM ABD: 0-45
ROM ADD: 0-30
 Cadena cintica abierta v/s cerrada
Osteocinem9ca
 Tipo de Movimiento
Artrocinem<co
Atrocinem9ca
 ACCIONES MUSCULARES
Mecnica Muscular
 Una visin lateral muestra las
Mecnica Muscular

lneas de fuerzas de varios

msculos de la cadera en el
plano sagital. El eje de la
rotacin (crculo verde) se
dirige en la direccin medio-
lateral a travs de la cabeza
femoral. Los flexores son
indicados por las flechas
slidas y los extensores por
las flechas rayadas. El brazo
de momento interno usado por
el msculo recto femoral se
muestra como lnea negra
gruesa, desde el eje de la
rotacin
 Acciones musculares
MUSCULOS FLEXORES
Mecnica Muscular

Psoas iliaco
Flexor y rotador externo de cadera

TFL
flexor de cadera
rotador interno de cadera.

Recto anterior del cuadriceps

flexor de cadera
(extensor de rodilla)

Sartorio
flexor de cadera
rotador externo
(flexor de rodilla)
 Acciones musculares
MUSCULOS EXTENSORES
Mecnica Muscular

Glteo mayor

participa en la estabilidad
anteroposterior



Isqiotibiales

ademas son flexores de
rodilla

Mecnica Muscular
 Acciones musculares
MUSCULOS ABDUCTORES
Mecnica Muscular

Glteo medio
Mas potente
Aporta casi toda la vascularizacin al
trocanter mayor

TFL
! Menos importantes:
Piramidal
Obturadores

Una coxa vara disminuye la eficacia

mecnica de los abductores y tambin
la coaptacin articular

 Acciones musculares
MUSCULOS ADUCTORES
Mecnica Muscular

Aductores
Mayor, medio y menor
Recto interno
Pectineo
Gminos
Cuadrado crural
Psoas
Mecnica Muscular
 Acciones musculares
ROTADORES INTERNOS
Mecnica Muscular

Glteo menor
TFL
Gluteo medio
Haces anteriores
Aductores
cuando el miembro inferior est
en rotacin externa.
 Acciones musculares
ROTADORES EXTERNOS
Mecnica Muscular

Piramidal
Gminos
Psoas
Cuadrado crural
pectineo
Glteos
Sartorio

Aductores:
por su insercin en la lnea spera
del fmur
 ROTADORES INTERNOS- EXTERNOS
Mecnica Muscular
Patomecnica
 La Balanza de Pauwells

Sistema de palanca de primer

Patomecnica

gnero. El punto de apoyo es la

cabeza femoral. La resistencia es el
peso del cuerpo (P) y la potencia
por la fuerza del glteo medio
(GM).

La fuerza del glteo medio permite

mantener la pelvis horizontal,
ademas est asistido por el tensor
de la fascia lata (TFL)

 FUERZAS APLICADAS SOBRE LA CADERA

El peso del cuerpo genera un momento

aductor (a izquierda) proporcional a su
Patomecnica

brazo de palanca (dp).

La musculatura Abductora genera un

momento abductor tambin proporcional a
su brazo de palanca (dm), esto permite
neutralizar el momento aductor del peso.

La fuerza de reaccin experimentada por la

articulacin resulta de la suma de ambos
vectores de fuerza. La magnitud de esta
fuerza de reaccin depende de sus
componentes y de sus respectivos brazos de
palanca
 Signo deTrendelemburg
Insuficiencia del glteo medio
Patomecnica
 Signo deTrendelemburg
Insuficiencia del glteo medio
Patomecnica