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MSK 1 > 10/14 - Anatomy of Hip Complex > Flashcards

10/14 - Anatomy of Hip Complex Flashcards

1
Q

what type of joints comprise the SIJ

A

planar synovial joints

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2
Q

what is the composition of the pubic symphysis

A

fibrocartilaginous disc

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3
Q

what are 3 sites for tendinous attachments on the pelvic complex and what are the attachments

A
  1. ASIS - sartorius
  2. AIIS - rectus fem
  3. IT - hamstrings
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4
Q

how does SIJ pathology usually present

A

post joint pain

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5
Q

what is the significance of the tendinous attachments in the hip complex in a younger pt population

A

common places for avulsions
- not really true fx

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6
Q

what ms directly attach to the sacrum

A

piriformis is the ONLY MUSCLE

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7
Q

what contributes to making the pelvic complex so stable

A

extensive ligamentous support
- sacrotuberous - post
- sacrospinous - ant

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8
Q

how many degrees of freedome are allowed by the bony anatomy of the pelvis

A

3

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9
Q

what is the function of the proximal femur in WB

A

prox femur transmits greater tensile & compressive load than anywhere in body

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10
Q

how is the acetabulum oriented

A

ant
lat
inf

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11
Q

due to the orientation of the acetabulum, what directions will the hip have more stability in

A

sup and post

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12
Q

what structures deepen the hip socket and how

A

acetabular labrum
transverse ligament
- ligament completes inf portion of the acetabular labrum

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13
Q

what is the orientation of the capsule fibers and why is this significant

A

longitudinal
oblique
arcuate
circular

4 different orientations - this is what makes the hip more stable than shoulder and also less mobile

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14
Q

what are the intra-articular ligaments

A

ligamentum teres
transverse ligament

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15
Q

what is the function of ligamentum teres

A

encloses the obturator a. to the femoral head
- this is significant in the pediatric population

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16
Q

what is the function of the transverse ligament

A
  • crosses acetabular fossa
  • completes 180deg rim around acetabulum (w the labrum)
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17
Q

what are the extra-articular ligaments

A

iliofemoral (Y-ligament)
pubofemoral
ischiofemoral

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18
Q

location and function of the iliofemoral ligament

A

ant - 2 bands
limits - ext, ER, ADD

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19
Q

location and function of the pubofemoral ligament

A

ant
limits ABD

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20
Q

location and function of the ischiofemoral ligament

A

post
limits IR, ext

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21
Q

what are the clinically significant bursa and why

A

trochanteric
iliopectineal
ischiogluteal

clinically significant bc more common to see sx of true inflammatory irritation, tendinopathy, tendon irritation

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22
Q

where is the trochanteric bursa located

A

b/w ITB, glut med, glut min -AND- greater troch

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23
Q

where is the iliopectineal bursa located

A

b/w iliopsoas -AND- iliopectineal eminence along sup rim of acetabulum

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24
Q

where is the ischiogluteal bursa located

A

b/w common hamstring tendon -AND- ischial tub

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25
Q

what does lateral hip pain usually indicate

A

gluteal tendinopathy (limited inflammation)
- can usually have more than one gluteal tendon impacted

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26
Q

how does trochanteric bursitis typically present

A

globally uncomfortable at the joint, not just tendon attachments

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27
Q

what are the contents of the femoral triangle

A

femoral v
femoral a
femoral n

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28
Q

what are the borders and floor of the femoral triangle

A

lat border - sartorius
med - ADD longus
sup - inguinal ligament

floor - iliopsoas, pectineus

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29
Q

what specific mobs should be done cautiously d/t location of femoral triangle

A

an ant-post force
- careful not to drive force into this triangle

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30
Q

flex ROM norm

A

120

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31
Q

ext ROM norm

A

20

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32
Q

ABD ROM norm

A

40

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33
Q

ADD ROM norm

A

25

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34
Q

IR (@0 and 90) ROM norm

A

35

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35
Q

ER (@0 and 90) ROM norm

A

45

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36
Q

arthokinematics of hip joint

A

convex fem head on concave acetabulum

flex and IR = post glide
ext and ER = ant glide

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37
Q

when are the arthrokinematics of the hip especially applicable

A

when considering THA approach and precautions

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38
Q

what is the significance of the open-packed position

A

greatest laxity
- position for joint mobilization and assessment

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39
Q

what is the open pack position of the hip

A

30 flex
30 ABD
5 ER

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40
Q

what is the significance of the closed packed position of the hip

A

max tension on capsuloligamentous structures

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41
Q

what position is the closed pack position for the hip

A

full ext
slight ABD

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42
Q

what are transverse plane abnormalities

A

version
torsion

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43
Q

version vs torsion

A

VERSION = position in space relative to a body plane
- fem head/neck w frontal plane

TORSION = twist of bone along longitudinal axis
- fem head/neck w fem condyles

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44
Q

norm angle for version and torsion?

A

12deg for both
- are often used interchangeably but how you get there is different

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45
Q

what is the normal position of the femoral head/neck relative to distal femoral condyles

A

angle of inclination is ant
- normal 8-20deg

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46
Q

what is anteversion

A

angle of inclination of fem head/neck is more ant relative to frontal plane >15deg

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47
Q

what body compensations are seen as a result of anteversion

A

position yields ER
compensatory IR to seat head in acetabulum
- limited ER ROM d/t shortened IR musculature

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48
Q

what is antetorsion

A

angle of inclination of femoral head/neck is more ant relative to distal fem condyles >15deg

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49
Q

what body compensations are seen as a result of antetorsion

A

position yields IR
- evidenced by toe-in posture
limited ER ROM d/t shortened IR musculature

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50
Q

what are reasons up the chain for toe in (4)

A

anteversion
shortened hip IR
lengthened hip ER
internal rotation at knee (down the chain)

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51
Q

why are anteversion and antetorsion grouped together

A

will see the same compensations
- IR with IR ms shortening and limited ER ROM

52
Q

what are 3 functional impacts of anteversion/antetorsion

A
  1. inc demand on posterolateral hip & thigh soft tissues
  2. trochlear groove of femur faces medially = “squinting”
  3. angle of gait dec
53
Q

what soft tissues of the hip does anteversion/antetorsion impose and inc demand on

A

post-lat ms:
- ITB
- vastus lateralis
- biceps fem

54
Q

resulting ms weakness and tightness d/t anteversion/antetorsion?

A

tight hip IRs
weak hip ERs

55
Q

what is a common sx that can be seen as a result of “squinting” (medially facing trochlear groove)

A

ant knee pain or patello-femoral pain

56
Q

what are sx of the functional effects of anteversion/antorsion (4)

A

ITB
piriformis
trochanteric bursitis
patellofemoral dysfunction

57
Q

how can anteversion/antetorsion functionally impact gait

A

late phase supination d/t progression of WB forces

58
Q

what is the significance of “W” sitting in children

A

may accentuate altered position during development
“miserable misalignment”

open physis - putting the femur in position of anteversion and when physis close can close w femur IR and tibia ER

59
Q

what pt population do you see “W” sitting a lot in

A

kids w low tone
- creates a wider BOS and is more stable

60
Q

what is retroversion and the resulting compensations

A

angle of inclination of fem head/neck is more post relative to frontal plane <15deg

yields IR
- compensatory ER to seat head in acetabulum
limited IR ROM
- ER ms shortened

61
Q

what is retrotorsion and the resulting compensations

A

angle of inclination of fem head/neck is more post relative to distal fem condyles <15deg

position yields ER
- evidenced by toe out posture
limited IR ROM
- ER ms shortened

62
Q

what are 3 functional effects of retroversion/retrotorsion

A
  1. inc demand on anteromedial hip and thigh soft tissues
  2. trochlear groove of femur faces laterally - “frog eyed”
  3. angle of gait inc
63
Q

why are retroversion/retrotorsion often grouped together

A

result in same compensations
- ER w shortened ER ms and limited IR ROM

64
Q

what is squinting

A

when trochlear groove of femur faces medially

65
Q

what is frog eyed

A

trochlear groove of femur faces laterally

66
Q

what ms weakness and tightness will you see d/t retroversion/retrotorsion

A

tight hip ERs
weak hip IRs

67
Q

what soft tissues does retroversion/retrotorsion place an inc demand on

A

ant-med tissues
- iliopsoas
- ADD
- rectus fem

68
Q

what are common sx from the functional effects of retroversion/retrotorsion (3)

A

iliopsoas strain
ADD strain
psoas bursitis

69
Q

how does gait change as a result of retroversion/retrotorsion

A

late phase pronation d/t progression of WB forces

70
Q

what is the take home of the impact of transverse plane abnormalities

A

changes the angle of gait

71
Q

in-toeing in early and late stances of gait

A

early stance = pronation
- talus ADD at contact

late stance = supination
- COM lat to STJ axis

72
Q

out-toeing in early and late stances of gait

A

early stance = supination
- talus ABD at lat heel strike

late stance = pronation
- COM med to STJ axis

73
Q

what is the normal femoral position in the frontal plane

A

angle of inclination of fem neck to shaft is approx 120-125deg

74
Q

what is coxa valga

A

angle of inclination >135

75
Q

how does the body compensate for coxa valga

A

fem ABD needed to seat head in acetabulum
- resultant genu varum

76
Q

what is coxa valga primarily associated with

A

inherent joint instability

77
Q

what are 4 functional implications of coxa valga

A
  1. narrow BOS
  2. inc need for STJ pronation to bring medial calcaneus to ground during gait
  3. medial knee compression
  4. lateral knee tension
78
Q

what is coxa vara

A

angle of inclination <120deg

79
Q

how does the body compensate for coxa vara

A

fem ADD needed to seat fem head in acetabulum
- resultant genu valgum

80
Q

what is coxa vara primarily associated with

A

limping gait d/t functional hip ABD weakness

81
Q

what are 5 functional implications of coxa vara

A
  1. wider BOS
  2. inc need for STJ supination to bring lateral calcaneus to ground during gait
  3. “forced” pronation if loading is medial to STJ axis
  4. medial knee tension
  5. lateral knee compression
82
Q

transverse vs frontal plane abnormalities’ impact on gait

A

transverse = angle of gait
frontal = base of gait

83
Q

how does sagittal plane dysfunction present during gait

A

vertical displacement

84
Q

what phase of gait do you typically see sagittal plane abnormalities present

A

during late stance
- ability to smoothly transition over foot in gait cycle is impaired

85
Q

what are the primary vs secondary hip flexors

A

PRIMARY
- iliopsoas
- rectus fem

SECONDARY
- sartorius
- TFL
- adductor longus
- pectineus

86
Q

what ab primary hip flexors should be noted with regard to the proximity to hip joint

A

in close proximity to ant capsule and labrum
- in close proximity to joint itself

87
Q

for hip flexion to occur, what ms work in combination with the hip flexors

A

coordinated contraction of abs

88
Q

what impact does the close proximity of the hip flexors to the joint itself have on the diagnostic process of ant hip pain

A

people w ant capsule issues can be misdiagnosed w hip flexor tendinopathy early on
- dt close proximity of structures

89
Q

what ms operate in the sagittal plane

A

hip flex and ext

90
Q

what are the primary hip extensors

A

glut max
hamstrings
- semimembranosus
- semitendinosus
- biceps femoris

91
Q

what are secondary hip extensors

A

glut med
- middle and post fibers
adductor magnus
- ant head

92
Q

what is a common MOI for hamstring tendinopathy

A

overuse of hamstrings if glut max is weak
- hamstrings have an important function at the knee

93
Q

what force couple is seen in the sagittal plane

A

hip ext and abdominals
- post tilt of pelvis

94
Q

what ms act in the transverse plane

A

ER and IR

95
Q

what are primary ERs (6)

A

glut max
piriformis
obturator externus/internus
gemellus sup
gemellus inf
quad fem

96
Q

what are 4 secondary hip ERs

A

glut med (post fibers)
glut min (post fibers)
sartorius
biceps fem (long head)

97
Q

what do you see if hip ER doesn’t work eccentrically to decelerate IR

A

more valgus at knee
force at tibia
pronation at foot

98
Q

what position is the hip in when you land

A

IR

99
Q

what is the function of the ERs

A

joint compression
- like the RC of the hip

100
Q

what is the largest hip ms

A

glut max

101
Q

how does the approach for a THA impact the ERs

A

post approach disrupts ER tendons

102
Q

what does it meant that ERs have a reversal of action

A

d/t orientation of fibers depending on position of the hip
- ER can work as IR when hip flex

103
Q

how does the priformis’s function change with varying levels of hip flex

A

<60deg flex - piriformis ER
60-90 - pure ABD
>90 - IR

104
Q

how does the glut max funciton change w varying levels of hip flex

A

<45-60 = ER
>90 = IR

105
Q

what position is optimal for piriformis stretching given the properties of reversal of action

A

seated
- inc length compared to upright standing

106
Q

when do hip ERs work as IR

A

when hip in varying levels of flexion

107
Q

what passes thru the greater sciatic foramen

A

piriformis (only ms to do so)
7 nerves (ie sciatic n.)
3 arteries
3 veins

108
Q

what can post pain be indicative of and what should be noted ab this

A

can indicate piriformis syndrome
- but not necessarily always piriformis when in pain

109
Q

what should be suspected if sx of nerve involvement present post on the hip

A

sciatica
- but not always

110
Q

what are the primary internal rotators

A

n/a

need eccentric control of IR by using ER

111
Q

what are the secondary internal rotators (6)

A

glut min (ant fibers)
glut med (ant fibers)
TFL
ADD longus
ADD brevis
pectineus

112
Q

what ms act in the frontal plane

A

ADD and ABD

113
Q

what are primary ADDs (4)

A

ADD longus & brevis
ADD magnus
pectineus
gracilis

114
Q

what are secondary ADDs

A

n/a

115
Q

what secondary functions do ADD longus and brevis have to ADD

A

hip flex when in hip ext
hip ext when in hip flex

116
Q

what secondary function does ADD magnus have to ADD

A

hip ext

117
Q

what are primary ABDs

A

glut med (all fibers)
glut min (all fibers)

118
Q

what are secondary ABDs

A

TFL
glut max
piriformis
sartorius

119
Q

why do we care so much ab glut med and what is so significant about its function

A

it prevents trendelenberg in SLS
- keeping pelvis/hip stable on limb

120
Q

why do we care so much ab glut med and what is so significant about its function

A

it prevents trendelenberg in SLS
- keeping pelvis/hip stable on limb

significant - 2x body weight is required to prevent trendelenburg in SLS (its giving girlboss)

121
Q

where would ABD pain present

A

laterally
- prob at greater troch attachment point

122
Q

what can tears & degeneration of glut med/min be misdiagnosed as

A

trochanteric bursitis

123
Q

what ms have the greatest hip ABD cross sectional area

A

glut med - 60%
glut min - 20%
TFL - 11%

124
Q

why is glut med such a primary ABD

A

largest hip ABD
largest ABD moment arm

125
Q

what positions in the frontal plane does the hip have the greatest and least torque? what are the significance of these positions?

A

greatest - 10deg ADD
- SLS phase of gait

least - 40deg ABD
- position of MMT

126
Q

what is a trendelenburg test

A

SLS
hike pelvis on unweighted limb

(-) level
(+) dropped

MSK 1 (31 decks)

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