The medial synovial fold is well known for its utility as a landmark during arthroscopic trans capsular release of the iliopsoas through the peripheral compartment. The level of the herniation appears to be related to the thickest portion of the capsule and the ligaments in the hip joint, where the fibers of the zona orbicularis cross and intermingle with the iliofemoral ligament. (B) Computed tomography (CT) scan reveals impaction fractures of the femoral head and posterior wall of the acetabulum (arrowheads) as well as fracture fragments from the posterior wall (arrows). Arthroscopic release of the iliopsoas can be performed for treatment of an internal snapping hip, which is … ... – positive impingement test (pain @ 90° flexion, adduction and internal rotation) • Etiology – reduced concavity of anterior femoral head-neck junction or prominent acetabular rim The iliopsoas tendon is intimately related to the anterior aspect of the hip joint. "The zona orbicularis is the arthroscopic landmark for access to the iliopsoas. The internal fibers comprise the circular zona orbicularis, which forms a collar around the femoral neck.2, 3 The fibers of the zona orbicularis are partially blended with fibers from the ischiofemoral ligament. Hip Zona Orbicularis Mr. fracture fragments adjacent to the lateral acetabulum (arrow). The capsule is composed of internal and external fibers. We go over causes that can affect you, whether it's a condition in the bones, muscles, or nerves. 16,17 It is located at the boundary of … Hip pain when you're walking can really take you out of your day. The zona orbicularis is a circular or horseshoe-shaped region of the capsule that runs perpendicular to the femoral neck axis. 12 Pectineofoveal impingement may be symptomatic when an abnormally shaped medial synovial fold impinges against overlying soft tissue, primarily the zona orbicularis. 5) Pectineofoveal impingement: pain occurs when the medial synovial fold impinges against overlying soft tissue, primarily the zona orbicularis. --zona orbicularis encircles capsule @ base of neck 1 Doris Wenger, M.D. It is also known as the orbicular zone, ring ligament, and zonular band. This ring has no direct attachment to the bone and is seen arthroscopically as a capsular condensation projecting into the synovial lining, embracing the distracted femoral head . (The problem is not a lumbar disc problem but rather soft tissue damage and instability in the pelvis). 4) Deep gluteal syndrome: pain occurs in the buttock due to the entrapment of the sciatic nerve in the deep gluteal space. Although unclear, mechanical stress is thought to be responsible. Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. 4 The internal fibers of the capsule are lined with synovium and contact the femoral head. ... Hip and groin pain with symptoms that occur during hip flexion and/or internal rotation Structure. The zona orbicularis or annular ligament is a ligament on the neck of the femur formed by the circular fibers of the articular capsule of the hip joint. Zona Orbicularis The circular fibers are named zona orbicularis (Figure 8.22) and are of arthroscopic interest because they form a ring around the neck of the femur. This area becomes tightest in extension and internal rotation. Hip Capsule –Zona Orbicularis increases stability during extension Zona orbicularis (thick ring in capsule) tightens in extension Courtesy of Damian Griffin MD (United Kingdom) JBJS Am 2014. A deep layer of circularly oriented fibers known as the zona orbicularis encircles the capsule at the base of the femoral neck.
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