figures table and new Flashcards
describe how the femoral head shape changes with development
children have a conical shaped femoral head that changes into a spherical shaped femoral as weight bearing increases
- weight bearing changes from the edges to deep into the joint
Describe how the femoral neck angle changes with development
Femoral neck angle starts out at about 150 degrees but decreases to 120-130 as we age. Coxa vara less than 120 degrees
what is the center edge angle of the hip
x-ray measurement for the depth of the acetabulum
- angle between a vertical line from the center of the head and line from the center of the femoral head to the edge of the acetabulum
- normal is 25-30, greater than 30 marked arthritic changes, less than 25 may indicate hip dysplasia
how does the retroversion angle change with development
children start with about 40 degrees and we grow men will decrease to about 10 and women to about 15
Describe the vascularization of the hip labrum
- outer margins are well vascularized
- superior labrum less vascularized than other parts
What are the three layers of the hip capsule
- longitudinal from bone to bone
- transverse circular fibers around the capsule creating “zona obicularis” or the narrow region in the middle of the capsule (chinese finger cuff)
- arcuate - loop at the insertion reenforcing capsule and labrum
Describe the branches of the iliofemoral ligament
- pars inferioris - iliac outer wall to the intertrochanteric line anteriorly
- pars superioris - same starting point to the front of the greater trochanter
what is the inguinal canal and what structure if found there
- distal end of the inguinal ligament
- connect the abdomen to the scrotum or labia majora
- male contains spermatic cord and ioloinguinal nerve
- female contains the round ligament of the uterus and ilioinguinal nerve
Where is the AIIS relative to the ASIS
about 2 cm distal and 1 cm medial to ASIS
describe the innervation of the pubic symphysis
- anterior - L2-4 and refers pain to the groin
- posterior - S3-S5 genital pain
Describe the peak forces on the joint surfaces during gait
1.8 to 3.8 body weight and increases with greater degrees of anteversion
Describe the joint loading pattern of the hip during stance a propulsion
1- stance dorsal lateral region takes most of the load
2- ventrolateral region in propulsion
legg-calve-perthes
avascular necrosis (AVN) of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. LCPD usually occurs in children aged 4-10 years. The disease has an insidious onset and may occur after an injury to the hip
Osteochondritis dissecans
joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone.
- 15-25 years old
what is the active straight leg raise test
- test for mechanical stability
- supine, lift one leg off the table, if it produces pain, mechanically stabilize the pelvis and repeat the leg raise, if this resolves the pain this suggest mechanical pathology of the pelvis or lumbar spine
What is the CPR for hip OA
3 of 5
- squatting increases symptoms
- active hip flexion causes lateral hip pain
- scour test positive for pain
- active hip extension increases pain
- PROM IR less than 25 degrees
What is SCFE
Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and pre-teens who are still growing.
- the ball at the head of the femur slips off the neck of the bone in a backwards direction.
- The condition usually develops gradually over time and is more common in boys than girls.
- male 13-15, female 11-13
= non capulsuar
Describe treatment for LCPD
- decrease risk of future OA
- hip traction in abduction, serial casting, and orthosis to maintain hip in abduciton and IR during weight bearing
what is the sign of the buttock
- painful SLR and
- painful hip flexion
Suggestive other hip pathology or space occupying lesion
what percentage of people have a sciatic nerve passing through their piriformis?
14%
Describe the differential for pudendal nerve entrapment
- can be entrapped between the sacrubus and sacrospinous ligament, pudendal canal or in in tis course as it crossed the faliciform process of the sacrotuberous ligment
- lower quadrant glut pain with burning pain in the perineal region with sitting that improves with standing
What is a sports hernia
- Sports hernias often occur where the abdominals and adductors attach at the pubic bone. Traditional hernias occur in the inguinal canal.
- The soft tissues most frequently affected by sports hernia are the oblique muscles in the lower abdomen. Especially vulnerable are the tendons that attach the oblique muscles to the pubic bone. In many cases of sports hernia, the tendons that attach the thigh muscles to the pubic bone (adductors) are also stretched or torn.
Signs and symptoms of hip labral tear
- groin pain
- low back or SIJ pain
- difficulyt with activities requiring hip rotation
- subjective reports of weakness and decreased stability
- decreased ROM
- painful clickign
- difficulty transitioning from sit to stand
- difficulty with prolonged sitting
What type of MRI can be used to ID labral tears
Gadolinium enhanced MRI
what disease process is a must to know? 5 signs
LEgg Clave Perthes disease
- aspeptic bone necrosis
- 3-10 years old
- hip motion limit in capsular pattern
- groin anterior thigh or knee pain
- femoral head can colapse
- draimen sign movement associated with muscle guarding cause abduction with flexion
- frog leg position with radiographs
what is osteochondritis and who gets it
- cartilage and subchondral bone inflammation
- 15-25 year olds
what is the difference between CAM and PINCER FAI
CAM femoral head change
PINCER acetabular change
What PROM would you expect to produce pain with pubic symphysis pathology
45 degree flexion with add
