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BR 3rd Ed > Ch 4 - MSK: Hip and Pelvis > Flashcards

Ch 4 - MSK: Hip and Pelvis Flashcards

1
Q

What are the 5 joints of the pelvic girdle?

A 
Bilateral femoroacetabular (hip) joints
Pubic symphysis
Bilateral sacroiliac (SI) joints
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2
Q

What is the angle between the femoral neck and shaft of the femur?

A

Males: 125°
Females: 115°–120°

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3
Q

What is Coxa vara?

A

Femoral neck and shaft angle is decreased
Affected leg is shortened
Hip abduction limited
Knee valgus deformity

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4
Q

What is Coxa valga?

A

Femoral neck and shaft angle is increased
Affected leg is lengthened
Knee varus deformity

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5
Q

Describe muscles and innervation of hip flexion.

A
  • Iliopsoas (nerve to iliopsoas or femoral nerve: L1, L2, L3)
  • Sartorius (femoral n: L2, L3, L4)
  • Rectus femoris (femoral n: L2, L3, L4)
  • Pectineus (femoral n: L2, L3, L4)
  • Tensor fasciae lata (TFL) (superior gluteal n: L4, L5, S1)
  • Adductor brevis (obturator n: L2, L3, L4)
  • Adductor longus (obturator n: L2, L3, L4)
  • Adductor magnus (obturator and sciatic [tibial division] nerves: L2, L3, L4, L5, S1)
  • Gracilis (obturator n: L2, L3, L4
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6
Q

Describe muscles and innervation of anteriorly placed hip adductors.

A
  • Gracilis (obturator n: L2, L3, L4)
  • Pectineus (femoral n: L2, L3, L4)
  • Adductor longus (obturator n: L2, L3, L4)
  • Adductor brevis (obturator n: L2, L3, L4)
  • Adductor magnus (obturator and sciatic [tibial division] n: L2, L3, L4, L5, S1)
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7
Q

Describe muscles and innervation of posteriorly placed hip adductors.

A
  • Gluteus maximus (inferior gluteal n: L5, S1, S2)
  • Obturator externus (obturator n: L3, L4)
  • Gracilis (obturator n: L2, L3, L4)
  • Long head of the biceps femoris (sciatic n [tibial division]: L5, S1, S2)
  • Semitendinosus (sciatic n [tibial division]: L4, L5, S1, S2)
  • Semimembranosus (sciatic n [tibial division]: L5, S1, S2)
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8
Q

Describe muscles and innervation of hip abduction.

A
  • Gluteus medius (superior gluteal n: L4, L5, S1)

* Gluteus minimus (superior gluteal nerve: L4, L5, S1)

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9
Q

Describe muscles and innervation of hip internal rotators and abductors.

A

• TFL (superior gluteal n: L4, L5, S1)
• Sartorius (femoral ne: L, L3, L4)
• Piriformis (nerve to piriformis: L5, S1, S2)
• Gluteus max, superior fibers (inferior
gluteal n: L5, S1, S2)

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10
Q

Describe muscles and innervation of hip extension.

A

• Gluteus max (inferior gluteal n: L5, S1, S2)
• Gluteus med, posterior fibers (superior gluteal n: L4, L5, S1)
• Gluteus min, posterior fibers (superior gluteal nerve: L4, L5, S1)
• Piriformis (nerve to piriformis: S1, S2)
• Adductor magnus (sciatic-innervated part: L2, L3, L4)
• Hamstring muscles (tibial division of the sciatic n):
– Long head of the biceps femoris (L5, S1, S2)
– Semimembranosus (L5, S1, S2)
– Semitendinosus (L4, L5, S1, S2

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11
Q

Describe muscles and innervation of hip external rotation.

A
  • Piriformis (nerve to the piriformis: S1, S2)
  • Obturator internus (nerve to the obturator internus: L5, S1)
  • Superior gemellus (nerve to the superior gemellus: L5, S1, S2)
  • Inferior gemellus (nerve to the inferior gemellus: L5, S1, S2)
  • Obturator externus (L5, S1, S2)
  • Quadratus femoris (nerve to the quadratus femoris: L4, L5, S1)
  • Gluteus max (inferior gluteal n: L5, S1, S2)
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12
Q

Describe muscles and innervation of hip internal rotation.

A

“TAGGGSS”
• TFL (superior gluteal n: L4, L5, S1)
• Adductor magnus (obturator n and sciatic [tibial division] n: L2, L3, L4, L5, S1)
• Adductor longus and adductor brevis (obturator n: L2, L3, L4)
• Gluteus med (superior gluteal n: L4, L5, S1)
• Gluteus min (superior gluteal n: L4, L5, S1)
• Gracilis (obturator n: L2, L3, L4)
• Semitendinosus (sciatic n [tibial division]: L5, S1, S2)
• Semimembranosus (sciatic n [tibial division]: L5, S1, S2)

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13
Q

What is the function of the acetabular labrum?

A

Deepen the acetabulum and hold femoral head in place

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14
Q

Where does the acetabular fibrous capsule extend?

A

Acetabular rim to intertrochanteric crest

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15
Q

What is the strongest ligament in the body?

A

Iliofemoral ligament (Y-ligament of Bigelow)

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16
Q

Where does the Iliofemoral ligament extend?

A

ASIS to intertrochanteric line

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17
Q

What is the function of the Iliofemoral ligament?

A

Limit extension, abduction, and external rotation of the hip

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18
Q

Where does the Ischiofemoral ligament extend?

A

From the ischium behind the acetabulum to blend with the capsule

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19
Q

What is the function of the Ischiofemoral ligament?

A

Limit hip abduction

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20
Q

Where does the capitus femoris ligament extend?

A

Acetabular notch to the femur

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21
Q

What is the function of the capitus femoris ligament?

A

80% carry small artery to femoral head

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22
Q

Describe normal ROM of the hip.

A
  • Flexion: 120°
  • Extension: 30°
  • Abduction: 45° to 50°
  • Adduction: 0° to 30°
  • ER: 35°
  • IR 45°
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23
Q

What hip ROM direction will be limited by OA first?

A

Internal rotation

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24
Q

What is Patrick’s Test?

A

Provocative maneuver to assess for intra-articular hip pathology or SI joint dysfunction
Motion: FABRE
(+) Groin pain: hip
(+) Posterior pain: SI

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25
Q

What is Thomas’ Test?

A

Assesses hip contractures
Pt supine, one hip flexed
(+) Opposite hip doesn’t extend

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26
Q

What is Ober’s Test?

A

Test for ITB tightness
Pt side lying with involved leg knee flexed to 90°, hip extended to 0°, and abduct the involved leg as far as possible
(+) leg remains abducted

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27
Q

What does Trendelenburg test assess?

A

Gluteus medius weakness

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28
Q

What are causes of gluteus medius weakness?

A 
– Radiculopathies
– Poliomyelitis
– Meningomyelocele
– Fx of the greater trochanter
– SCFE
– Congenital hip dislocation
– Deconditioning
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29
Q

What is Ely’s test?

A

Assesses femoral nerve irritation
Pt prone with knee > 90° and hip extended
(+) Anterior thigh pain

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30
Q

How is true leg length discrepancy assessed?

A

Patient supine, measure from the umbilicus to the medial malleoli

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31
Q

How is pelvic obliquity assessed?

A

Observing the levelness of the ASISs or PSISs

32
Q

What is the normal strength ratio of hamrstings to quadriceps?

A

3:5

33
Q

When are hamstrings placed under maximal stretch?

A

Hip is forced into flexion and knee into extension

34
Q

When and where do hamstring injuries typically occur?

A

Eccentric phase Myotendinous junction

Lateral hamstrings

35
Q

What are risk factors for hamstring strain?

A 
Inadequate warm-up
Poor flexibility
Exercise fatigue
Poor conditioning
Muscle imbalance
(Rehab focuses on these and core strengthening)
36
Q

What are the grades of hamstring strains?

A

Grade I: strain
Grade II: partial tear
Grade III: complete tear

37
Q

Who is commonly affected by hamstring strains?

A

Gymnasts

Track athletes

38
Q

What are clinical features of hamstring strains?

A
  • Pain w loss of function
  • TTP over the muscle belly or origin
  • Ecchymosis may descend to the thigh and present at the distal thigh or back of the knee or calf
  • Ischial pain with knee flexion
39
Q

When can athletes RTP after hamstring strain?

A

Variable

3 weeks to 6 months depending on severity of injury

40
Q

What sports are hip flexor strains typically seen in?

A 
Sprinting
Soccer
Baseball
Football
Gymnastics
41
Q

What causes hip flexor strain?

A

Eccentric overload of psoas muscle or as the athlete tries to flex the fully extended hip, such as in hurdling or kicking

42
Q

What is the clinical presentation of a hip flexor strain?

A

TTP over the area and with resisted hip flexion and passive hip extension

43
Q

What imaging should be done in a hip flexor strain?

A

AP and frog leg lateral views are used to exclude bony injury such as an apophyseal avulsion fracture

44
Q

Where are avulsion fractures seen with hip flexor strain?

A 
ASIS
AIIS
Ischial tuberosity
Lesser trochanter
Iliac crest
45
Q

What can occur in adolescents with hip flexor strain?

A

Injury to the apophyseal plate

46
Q

What are treatments of hip flexor strain?

A

• Protected weight bearing, icing, and gentle active ROM as soon as possible
• Strengthening exercises when gait is nonantalgic and ROM is full and pain free
• Strength: closed to open kinetic chain
• Eccentric and
plyometric training to prevent recurrent injury

47
Q

What is the clinical presentation of piriformis syndrome?

A
  • Pain in lateral buttock, posterior hip, proximal posterior thigh, SI
  • Exacerbated by walking up stairs, hip IR and poor body mechanics
48
Q

What exam test evaluations piriformis syndrome?

A

Pain with hip Flexion, Adduction, and Internal Rotation (FAIR)

49
Q

What does rehab seek to do in piriformis syndrome?

A

Reduce pain/ spasm Recover full hip IR

50
Q

What is the clinical presentation of Iliopsoas bursitis/tendonitis?

A

Pain with resisted hip flexion
Hip snapping with hip flexion
TTP over iliopsoas

51
Q

What is External snapping hip syndrome?

A

Tight ITB or gluteus maximus snapping over the greater trochanter

52
Q

What is Internal snapping hip syndrome?

A

– Tight iliopsoas tendon snapping over the iliopectineal prominence of the pelvis
– Less commonly, acetabular labral tear or loose body in the hip joint

53
Q

What are provocative tests for External snapping hip syndrome?

A

IR and ER the hip passively while the patient is in the lateral decubitus position

54
Q

What are provocative tests for Internal snapping hip syndrome?

A

Extend, abduct, and ER the affected hip

55
Q

What is the cause of adductor groin strain?

A

Resisted forceful abduction of the hip

56
Q

What are risk factors of adductor groin strain?

A

Relative weakness and tightness of the adductor muscle groups

57
Q

What is important to differentiate adductor groin strain from?

A

Adductor avulsion fracture with x-rays

58
Q

What is the clinical presentation of adductor groin strain?

A

Pain in the adductors distal to their origin at the ramus or adductor tubercle

59
Q

What is greater trochanter bursitis?

A

Inflammation of the bursa located over the greater trochanter, which is located deep to the gluteus medius and gluteus minimus and TFL

60
Q

What conditions are associated with greater trochanter bursitis?

A 
Altered gait mechanics
Muscle imbalance
Reduced flexibility
Hip OA
Obesity
Leg length discrepancy
Direct trauma
Overuse
Herniated lumbar disc
Hemiparesis
61
Q

What is the clinical presentation of greater trochanter bursitis?

A 
Night pain
Unable to lie on the affected side
TTP over GT
Pain with moving from full extension to flexion
Snap over GT
62
Q

What is the most common type of hip dislocation?

A

90% posterior

63
Q

What is the cause of posterior hip dislocation?

A

automobile accident MVA hip is flexed, adducted, and medially rotated.
Knee strikes dashboard diving femur posterior

64
Q

What can be injured with hip dislocation?

A

Sciatic nerve can be compressed or stretched

65
Q

What is the clinical presentation of posterior hip dislocation?

A
  • Hip flex, ADD, and IR • Affected leg shorter d/t dislocated femoral head higher
  • Inability to ABD hip
66
Q

What is the cause of avascular necrosis of the femoral head?

A

Interruption of the vascular supply

67
Q

What conditions are associated with avascular necrosis of the femoral head?

A

Alcohol abuse

Steroid use

68
Q

What is the clinical presentation of avascular necrosis of the femoral head?

A
  • Pain in groin, anterior thigh, or knee
  • Insidious onset of sx
  • Short swing and stance phase on the affected side
  • Loss of ER and IR
  • Hip ER on flexion
  • Pain with ROM
69
Q

How does AVN of the femoral head appear on radiographs?

A

Irregular or mottled femoral head

70
Q

What imaging is indicated in AVN of the femoral head?

A

MRI of both hips

MRI more sensitive to early changes than bone scan

71
Q

What is seen on T1 MRI images in AVN of the femoral head?

A

Low signal intensity that may appear as rings, wedges, or irregular configurations

72
Q

What is seen on T2 MRI images in AVN of the femoral head?

A

Double line sign with a high signal intensity zone inside of a low signal intensity margin

73
Q

What is the main objective in treatment of AVN of the femoral head?

A

Maintain the femoral head within the acetabulum while healing and remodeling occur

74
Q

What is the treatment of AVN of the femoral head in pediatric patients?

A

Bracing and casting

75
Q

When is osteotomy used for the treatment of AVN of the femoral head?

A

Osteotomy of the femoral head and pelvis may be used to treat patients sx and if the disease is not significantly advance

BR 3rd Ed (92 decks)

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