Functional Anatomy and Biomechanics of Hip and Pelvis Region Flashcards
1
Q
Introduction
A
- hip is 2nd largest joint in body
- hip establishes link between LE and trunk: absorbs high forces, supports body’s mass
- LE links with trunk at pelvic girdle
- any movement in trunk pelvis or LE involves/influences hip joint
- important to evaluate movement and actions of both limbs, pelvis, and trunk: rather than to focus on single joint, improves evaluation, treatment, and outcomes
- one area in ____ system with noticeable differences between sexes: female pelvis typically lighter, thinner and wider than in males; this can affect motion in the trunk, pelvis, and LE
2
Q
Osteology
A
- pelvis: fibrous union of 3 bones
- ilium superior, ischium posteroinferior, pubis anterior inferior
- separate at birth but typically fused by 15-17 years
- proximal femur
3
Q
The Pelvis
A
- ilium, pubis, and ischium
- right and left sides joint sacrum to form a ring or hoop aka pelvis or pelvic girdle
- connect anteriorly through pubic symphysis
- connect posteriorly through sacrum
4
Q
Ilium
A
- landmarks of note on external surface: ASIS and AIIS, iliac crest, PSIS and PIIS, greater sciatic notch and greater sciatic foramen
- landmark on ote on internal surface: iliac fossa, auricular surface, iliac tuberosity
5
Q
Pubis
A
- landmarks of note:
- superior pubic ramus
- body
- pectineal line
- pubic tubercle
- inferior pubic ramus
- symphysis pubis
6
Q
Ischium
A
- landmarks of note:
- ischial spine
- lesser sciatic notch
- lesser sciatic foramen
- ischial tuberosity
- ischial ramus
7
Q
Acetabulum
A
- formed at junction of the 3 bones in hip
- located above obturator foramen
- concave joint surface
- joins with femoral head
8
Q
Acetabular Orientation
A
- center edge angle: aka angle of wilberg 35-50* provides best containment of femoral head
- acetabular anteversion angle ~20* marked variation of this angle can contribute to dislocation
9
Q
Femur
A
- landmarks of note:
- femoral head
- femoral neck
- intertrochanteric line
- greater trochanter
- lesser trochanter
- intertrochanteric crest
- quadrate tubercle
- linea aspera
- spiral line
- gluteal tuberosity
- adductor tubercle
10
Q
Femoral Angle of Inclination
A
- measured angle
- between femoral neck and medial side of femoral shaft
- typically ~125* in mature skeleton ~140-150* at birth
- influences: effectiveness of hip abductors, limb length, forces imposed on hip joint
- variations in adulthood: coxa vara (<125) coxa valgus (>125)
11
Q
Femoral Torsion Angle
A
- another measured angle
- describes the “twist” between femoral neck and femoral shaft
- normal anteversion ~10-15* anterior to frontal plane
- some have structural variation from normal anteversion: may affect individual movement patterns or function
- excessive anteversion ~35* anterior to frontal plane
- retroversion ~0* to frontal plane
- individual may demonstrate some NM compensations for structural variations
12
Q
Key Points on Angle of Inclination/Femoral Torsion
A
- both identified with diagnosti imaging
- neither can changed by PT in adults
- we can change movement patterns: place less stress on area, better help to compensate for structural variation, etc; strengthen target muscles, stretch target muscles
- important to differentiate things PT can change from those it can’t
13
Q
Pubic Symphysis
A
- site where right and left sides of pelvis connect
- cartilaginous joint with fibrocartilage joint
- end of each pubis covered with hyaline cartilage
- pubic ligament supports pubic symphysis: anterior, posterior, and superior sides of joint
- limited motion at pubic symphysis
14
Q
Sacroiliac Joint
A
- connects pelvis to sacrum
- synovial joint with strong ligamentous support
- these ligaments are the strongest in the body
- transmits force between LE and spine
- movement occurs at SI joint: varies considerably between individuals and sexes
- males: have thicker stronger ligaments; 3 of 10 have fused SI joints
- females: have greater ligamentous laxity
15
Q
SI Joint Motion
A
- sacrum is actually 5 fused vertebrae
- top of sacrum is base
- sacral flexion occurs when base moves anteriorly aka nutation, occurs with lumbar extension
- sacral extension occurs when base moves posteriorly aka counternutation occurs with lumbar flexion
- sacral torsion occurs with rotation of the left and right halves about the medial lateral axis: right rotation occurs if anterior surface of sacrum faces right, left rotation occurs if anterior surface of sacrum faces left
16
Q
Movements of the Pelvis
A
- described by monitoring ASIS/AIIS
- anterior tilt is forward tilting and downward movement of the pelvis
- occurs when: the trunk flexes as in standing forward bend, sitting with exaggerated lumbar arch
- posterior tilt: occurs when the trunk extends as in standing back bend, sitting in slouched position
- tuck butt (posterior tilt) vs. duck butt (anterior tilt)
- lateral tilt: right or left, aka pelvic obliquity, controlled by muscles
- rotation occurs about longitudinal axis in the horizontal plane
- as R leg swings forward pelvis rotates to the L vice versa when L leg swings forward
17
Q
Hip Joint
A
- ball and socket joint
- 3 degrees of freedom
- femoral head: 2/3 of a perfect sphere, entire head is covered by cartilage (except fovea)
- ligamentum teres attach fovea to acetabulum
- acetabulum is incomplete near inferior acetabular ligament
- a labrum helps to deepen this joint
- spongy trabecular bone in femoral head and acetabulum helps to absorb forces
- articular cartilage on femoral head is thickest centrally-most load supported here
- 70% of femoral head articulates with acetabulum 25% in glenohumeral joint
18
Q
Ligaments in Hip Joint
A
- loose but strong capsule surrounds the joint
- reinforced by iliofemoral, pubofemoral, and ischiofemoral ligaments
19
Q
Osteokinematics at Hip Joint
A
- hip flexion: 120* with flexed knee 80* with extended knee
- hip extension: 20* with extended knee 10* with flexed knee
- hip abduction 40-45*
- hip adduction 25* past midline
- hip internal rotation 35*
- hip external rotation 45*
20
Q
Arthrokinematics at Hip Joint
A
- joint orientation: acetabulum-anterior, lateral, inferior; femoral head-posterior, medial, superior
- concave surface: acetabulum
- loose-pack position: 30* flexion, 30* abduction, slight LR
- close-pack position: full extension, abduction, and MR
- flexion/extension: spinning, little or no roll or glide
- abduction: upward roll, downward glide
- adduction: downward roll upward glide
- IR: femoral head rolls anteriorly, glides posteriorly
- ER: femoral head rolls posteriorly, glides anteriorly
21
Q
Lumbopelvic Rhythm
A
- occurs with forward bend
- coordinated movement of pelvis and lumbar spine
- spinal flexion and anterior pelvic tilt
22
Q
Gross Hip ROM and Functional Activities
A
- 80* flexion/extension needed for stand to sit
- 100* flexion/extension need for sit to stand
- 60* flexion needed to climb a stair
- 24-30* needed for descent of same stair
- during walking 35-40* flexion during late swing, full extension during heel off
- abduction/adduction: most activities require 20* or less, walking requires 12, full squat requires 18-20 abd: tie shoes, etc
- IR/ER: both increase with thigh flexion; full squat requires 10-15* ER, tie shoes etc
23
Q
Innervation in Hip Region
A
-supplied by lumbosacral plexus
24
Q
Muscular Control of the Pelvic Girdle
A
- sit of muscular attachment of 28 trunk and thigh muscles: none positioned to act solely on pelvic girdle
- proper positioning of pelvic girdle necessary and thigh necessary for efficient movement
25
Hip Flexors
- primary: iliopsoas, rectus femoris, TFL, sartorius, adductor longus, pectineus
- secondary: adductor brevis, gracilis, gluteus minimus
26
Hip Extensors
- primary: glute max, biceps femoris, semitendinosus, semimembranosus, adductor magnus
- secondary: gluteus medius
27
Hip Abductors
- primary: glute medius, minimus, TFL
| - secondary: piriformis, sartorius
28
Hip Adductors
- primary: adductor longus, adductor brevis, pectineus, gracilis, adductor magnus
- secondary: biceps femoris, quadratus femoris, glute max
29
Internal Rotators of Hip
-glute min, med, TFL, adductor longus, adductor brevis, pectineus, semitendinosus, semimembranosus
30
External Rotators of Hip
- primary: glute max, piriformis, obturator internus, gemelli, quadratus femoris, sartorius
- secondary: glute med, min, obturator externus, biceps femoris
31
Muscular Actions in Hip Region-Flexion
- important in activities requiring quick leg action
- elite athletes usually stronger hip flexors and abs
- fatigue may lead to altered running gait, increased risk of injury
- iliopsoas is strongest hip flexor
- contribution of rectus femoris depends on knee joint position
32
Muscular Actions in Hip Region-Extension
- hip mm are strongest in extension
- important supporter of body weight for many functional tasks
- counteracts gravitational pull during walking, running, jumping, etc
- hamstrings contribute to hip extension at all points (can generate more force when knee extended)
- hamstring problems can create postural problems and lessen quality of movement
- glut max recruited if more vigorous action needed-helps to prevent trunk flexion at foot strike
- loss of glut max not as detrimental compared to loss of hamstring
33
Muscular Actions in Hip Region-Abduction
- greatest ABD force at neutral
- important in dance and gymnastic skills
- hip stabilization during gait
- glute med weakens presents as trendelenburg gait
- glute min, TFL, piriformis also contribute
34
Muscular Actions in Hip Region-Adduction
- muscles bring thigh to body's midline
- collectively form large muscle mass
- also work to maintain stability in frontal plane during gait
35
Muscular Actions in Hip Region-External Rotation
- preparation for power production
| - preventing excessive IR during loading response, landing
36
Muscular Actions in Hip Region-Internal Rotation
-weakest of hip motions
37
Therapeutic Exercise for Hip Region
- complete isolation specific muscle very difficult
- secondary to many LE muscles work in combo functionally
- modify modify modify
38
Contusions in Hip Region
- MOI: blunt trauma
- common at iliac crest, buttocks, femoral triangle, trochanter
- clinical presentation: antalgic gait, ecchymosis, loss of ROM secondary to pain, palpation painful to specific tissues
39
Groin Strain
- may involve many tissues
- common
- attachment of iliopsoas at l trochanter common site
- hx: often related to extension force to thigh
- common findings: ROM often painful with IR and/or with passive extension; resisted is painful with hip flexion
40
Bursitis in Hip Region
- many bursa located here
- commonly seen in PT...
- trochanteric bursitis-under glut max over trochanter
- iliopectineal bursitis-under iliopsoas, over anterior ligaments
- ischial gluteal bursitis-may be caused by prolonged sitting
41
DJD in Hip
- osteoarthritis
- common condition secondary to wt bearing stress
- leads to deterioration of articular cartilage, overgrowth of periarticular bone
- x-rays show decreased joint space and osteophytes
42
Pelvic Fractures
- less common in kids d/t elasticity in bones, usually requires severe trauma
- adults d/t violent impacts
- stable: non-displaced
- unstable: often require fixation (characterized by complete separation of symphysis pubis and opening in pelvic ring)
43
Femoral Fractures
- intracapsular and trochanteric 2 most common
- 80% in 60+ more often in women
- 20% die within 1 year status post
- common MOI: osteoporosis --> fracture --> pt falls
