Final - Hip Flashcards
what is the pelvis
bony ring with 2 bones - sacrum and coccyx
4 functions of pelvis
support spine
transfer weight to lower limbs
provide attachment site for muscles
protection of pelvic organs
sacrum
triangular, connects to coccyx
4 ligaments supporting the sacroiliac joint
sacroiliac
iliolumbar
sacrospinal
sacrotuberal
3 motions of the sacroiliac joint
superior inferior
lateral medial
flex forward and backward
being able to move in three different ways means that the sacroiliac joint moves about
3 axis
strongest bone of the hip
femur
purpose of femur
max mobility and support during locomotion and weight bearing activity
proximal femur
articulates with acetabulum of pelvis to form hip jt
distal femur
condules articulate with tibial plateau for knee jt
Hip jt
synovial - multi axial
ball and socket
very stable with labrum
labrum
function
fibrocartilage that surrounds the acetabulum
deepens the socket and increase articular surface area by 10%
ROM hip flexion
135
ROM hip extension
30
ROM hip abduction
45-50
ROM hip adduction
20-30
ROM hip external rotation
45
ROM hip internal rotation
35
Hip jt capsule - 2
strong but loose
thick parts of fibrous layer makes the ligs - spiral apperance and run from femoral neck to acetabular rim
role of hip capsule
stability - during extension increases the spiraling and tighten the capsule to draw the head into acetabulum
mobility - flexion unwinds spiraling ligs and fibers
3 ant hip ligs - 3
oblique trajectory, winding around the femoral nect - lose in flexion and tight in extension - rotating plates with strings in between, tighter when the plate approximates one another
illiofemoral - ant and up
pubofemoral - ant and inf
ishiofemoral lig - pos
illiofemoral lig - 3
strongest
y
prevent hyperextension when standing - locks and restict internal and external rotation
pubofemoral lig - 2
blend with iliofemoral
restrict hip abduction and extention
ishiofemoral lig - 2
weakest
excessive internal rotation and adduction
bursa - 2
greater trochanteric - between greater trochanter and deep fibers of glute max
women running or poor gait
ischial - glute muslces and ischial tub
ant muscles of the hip - 5
psoas iliacus tensor fascia lata satorius quads
psoas - 3
lumber vertebrae to femur
hip flexion
major goes to the front of your spine - trunk flexor and hip flexor
tight hip flexors can give you
back pain
illiacus - 2
blends with psoas tendon
acts with psoas major - hip flexion
tensor fascia lata - 2
upperanterolat of thigh, inserts into ITB
hip stabilization and hip abduction
satorius - 3
longest muscle
ASIS to anteromedial tib
faber
quads - 2
Vastii MLI
knee extension
RF - 2
Hip flexion and knee extension
5 medial hip muslces
pectineus
adductor brevis and longus
adductor magnus,
gracilis
pectineus
hip flexion and adduction
adductor longus, magnus, and gracilis
adduction
adductor brevis
hip adduction and hip flexion
4 pos gluteal muscles
gluteus maximus, medius, minimus, and piriformis
glute max
main hip extensor
glute med
abduction
glute min
hip medial rotation
piriformis
lat hip rotation
weak groin often gets confused with
imbalance of glute max and med
3 hamstrings
semimembranosis
semitendinosis
biceps femoris
semimembranosis and semi tendinosis - 3
hip extension, med tib rotation, knee flexion
biceps femoris
hip extension, knee flexion and lat tib rotation
what to strengthen for spondylosis
strategy
spondylosis - weak glute max can activate hip extenders for back
technique then weight
comprehensive movement tests for the hip - 3
sit to stand
squat
step
What do you look for in hip injuries - 3
diff in compensation
alignment
callus
two types of muscles you are looking to treat
long and weak
short and tight
rectus femoris/illiopsoas differentiation test - 3
hip flexors and RF
lay supine and knee bent over and pull one knee to chest
90 degrees or tightness
Thomas test - 4
RF/ hip flexor contracture
supine, leg extended, one knee to chest
flat or tightness
*put hand under their back
FABER test - 4
flexion, abduction, external rotation
- Hip/SI jt
- supine and FABER
asymptomatic - dont change
obers
contracture of TFL/ITB lie on unaffected side abduct thigh as far as possible drop in adduction not full adduction (past table) - contracture false neg - side flexed
nobels compression
obers with finger on side of knee and flex/extend
tripod test
hamstring contracture
sit at edge of table - passively/actively raise one leg
- lean back to accomodate - tight hamstrings
long sit with straight back
you need a good back
trendelenburgs sign
abductor/glute med
stand and look for pelvis to remian level - drop = weakness on opposite side (stance)
what to strengthen for greater trochanteric
glute med
straight leg raise
supine
active/passive hip flex ROM for hams
neurotension from straight leg raise
supine
hip flex passively up to 45 then dorsiflex and lift head
- psychiatica/disc herniation/pressure on nerve in lumbar area
femoral nerve tension
prone
lift heel to bum
Groin strain
MOI - 3
S&S - 3
Management - 4
poor flexibility and strength
hip extension, lat rotation and abduction
general pain, weakness, “twinge” during movement/after
PIER, flexibility, strengthen adductors
protect with hip spica
pain with abduction, flexion and tender over adductors
groin strain
half marathoner with increased left lap hip pain, full ROM and strength and point tender over greater trochanter
greater trochanteric bursitis
Greater trochanteric bursitis
MOI: Chronic vs acute
S&S - 5
management - 5
weak glute med - more you walk the worse it is
irritation of greater trochanter from ITB/glute attachment
landing on greater trochanter
pain over greater trochanter, difficulty walking, pain with lying on affected side, pain sitting, localized swelling
PIER, protection from further, stretches, strengthening, proprioceptive and stability
hip across illiac crest - obvious discomfort and pain
hip pointer
hip pointer
MOI
S&S- 6
Management - 4
blow - pinching of soft tissues
immediate pain, muscle spasm, transitory paralysis of trunk, pain with trunk rotation and hip flexion, bruising and tenderness, ok when you flex forward but terrible backwards
PIER, rule out fracture, rest from sport, protective pad
hit across right quad and only weight bearing on left, no ROM at knee due to pain and muslce spasm
quad contusion
how to walk away from a quad contusion
cant bend to 90 dont run on it, single leg squat and you can go
quad contusion MOI S&S G1 G2 G3 Management
impact on thigh that compresses muscle against femur
pain, loss of function, tissue bleeding, limping, swelling, tenderness
intramuscular bruise, milkd hemorrhage, little pain, no swelling, mild point tenderness, full ROM
mod pain, swelling and pt tender, cant flex beyond 90, limp
pain, swelling, hematoma, ROM 45-90, limp, fascia may be split and muscle protrudes, divit for fascia damage
put knee in flexion with ic pack and add compression- passive stretch to avoid muscle shorten and ensure normal ROM
ice for hemorrahge
crutches above G2
protect from further damage with pads
painfree ROM ex with gentle isometric strength and stretches
webbing tape - till no more potential energy in tape and moves swelling
milk massage
ultrasound
myositis ossificans tramatica
MOI
S&S
Management
bony growth into muscle
severe/repeated blows and dont let swelling go away, disrupt muscle fibers and periosteum, running off, too vig treatment - direct massage
pain, weakness, swelling, decreased muscle function, point tenderness
decrease ROM, conservative, may require surgical intervention to remove bone (after 1 year)
quad strain
MOI
S&S
management
sudden stretch/contraction, may be related to muscle weakness
bleeding, pain, pt tenderness, spasm, loss of function, possible bruising and deformity, reduced ROM and strength, TOP
PIER, NWB with crutches, gentle ROM, pressure with neoprene sleeve
TOP
tender on palpation
hamstring strains MOI S&S - G1 G2 G3 management - 3
lots
lots, general 6040 quad ham, improper firing of hams and quads (weak hams), quick change from knee stabilizer to hip extensor, poor strength, deceleration of hams
muslce soreness during movement, point tender, stiff/sore after
partial tear, sudden tear/snap with severe pain, loss of function, possible palpable defect
rupture of tendinous/muscle, major hemorrhage and disability, severe edema, tender, loss of function, ecchymosis and palpable/visible defect
PIER, rest, no explosive stretching
Caution with glute and ham injuries
overestimate and wait one week longer because ppl always try to rush back and reinjury rate is high - closed kinetic chain ex for hamstrings
months of right hip pain, pain with pivoting, radiate to groin and stiffness/catching, clicking internal rotation
hip labral tear
what do people confuse labral tears with
groin strain
hip labral tear
MOI: Acute and chronic
S&S
management
dislocation
repetitive movements - running, pivoting
asymptomatic, catching, locking, clicking, pain/stiffness, loss of motion
improve ROM, hip strengthening/stability, activity modification, surgery may be warranted but difficult
legg calve perthes disease
MOI
S&S - 3
management - 4
flat femur head
insidious, children 3-12, more boys, loss of blood to head - avascular necrosis
general leg pain - knee or hip. limping (exaggerated with running), loss of hip ROM, no response to rest or soft tissue treatment
xrays - physician
rest and brase
may be surgery
may have hip pathology later in life - osteoarthritis
slipped capital femoral epiphysis
MOI
S&S
management
more common in boys 10-17, obesity/rapid growth- too much weight for skeleton
abnormal movement along growth plate
gradual onset, no MOI, altered gait, restricted movement
rest, NWB, left untreated - legg calve perthes and surgery
4 major regions of the brain
cerebral hemispheres
diencephalon - thalamus, hypothalamus, epithalamus and pituitary gland
brain stem
cerebellum
3 layers of the meninges
covers brain and spinal cord
- dura mater
- arachonoid mater
- pia mater
cranial nerves
12 pairs, 2 from forebrain and 10 from midbrain and brain stem
major vessels of the head and face
carotid
internal
external
vertebra
SS of skull fractures
battle sign
blood or CSF may leak from nose or ear canal
focal cerebral injuries
intercranial bleed
50% mortality rate
localized collection of blood or hematoma - alterations in neurological function
intracerebral hematoma
serious
focal injury with small hemorrage within cortex, brainstem or cerebellum
LOC then alert - neurological exam normal but dizziness and nausea
epidural hematoma
blow to head or skull fracture causes tear of meningeal arteries - arterial BP and accumulation makes the creation of hematoma extremely fast
LOC, symptoms worsen, headpain, dizziness, nausea, dilation of 1 pupil or sleepiness
life threatening
rare
almost always skull fracture
will be caught by SCAT 5 in their cerebral function
LOC at the time and lucid interval when they feel normal but conditions worsen so dont go to bed
10-20 mins declind in mental status occurs - increase headahce, drowsiness, nausea, vomiting, decreased lvl of consciousness, dilated pupil on side of hematoma, contralateral weakness and decerebrate posture
EMS
ABC
surgery to decompress and control arterial bleeding
subdural hematoma
more frequent than epi acceleration force of head venous bleed - SS more slowly simple - no injury to cerebrum or complex - yes inercranial pressure - 20 vs 50% mortality LOC life threatening in 1-2 hrs symptoms may not become apparent for hours, days or weeks EMS ABC shock
cerebral contusion
focal microhemorrahaging strike to frontal lobe LOC normal neurological exam but headahce, dizziness, nausea ER
SS of second impact syndrome
management
may be no LOC
15 seconds to several mins - worsen rapidly with dilated pupils, loss of eye movement , LOC to coma, respiratory failure
prevent injury from occuring, observe athletes as they come off the field of play
EMS
stitches
more than 1.25 in length and 0.3 cm in depth
3 -oculomotor nerve
constriction of pupil - equal round and reactive to light
4 -trochlear nerve
sup/inf movement of eye
6- abducens nerve
lateral eye movements
8- vestibulocochlear nerve
hearing and equilibrium - right or left
2- optic
vision
