hip Flashcards
what is the pelvic girdle comprised of?
2 sets of hip bones, connected in my middle by sacrum and coccyx
where do the sacral nerves pass through?
holes in the lateral sacrum, formed by fusing of the transverse processes
what is each hip bone made of?
(also called innominate bone)
ilium: has iliac crest and the ala (wing like area), forms superior acetabulum
pubis: forms anteromedial acetabulum
ischium: forms inferior acetabulum
what are the components of the ischium?
ramus: fuses with the pubic ramus to form posterior border of obturator foramen
tuberosity: sit bones, when hamstrings attach
spine: process that separates greater and lesser sciatic notches
what is the lunate surface of the acetabulum?
horseshoe shaped articular surface on peripheral edges, made of articular cartilage
what is the acetabular fossa?
non-articular surface, filled with fat
what is the femoral head covered in?
articular cartilage
articulates with the lunate surface of the acetabulum
what is the greater trochanter the attachment site for?
gluteus medius and minimus, obturator internus and piriformis
what is the lesser trochanter the attachment site for?
iliopsoas muscle
where is the greater trochanteric bursa?
deep to the gluteus maximus, in between the minimus and medius on the greater trochanter
where is the iliopsoas bursa?
between the iliopsoas and anterior joint capsule
(closer to acetabulum)
where is the anterior hip recess?
where does the anterior hip capsule extend to?
superficial and inferior to femoral head, superficial to femoral neck
extends inferiorly to the intertrochanteric line
what should the measurement for the anterior hip capsule be?
<7mm
evaluate for fluid build up
where does the iliopsoas tendon insert and what is the function?
inserts medially on the lesser trochanter, flexes the hip joint
where does the rectus femoris muscle originate and insert, and what is the function?
origin on anterior/inferior iliac crest, inserts on the tibia
extends the hip joint
what does NAVEL stand for?
nerve, artery, vein, empty space, lymphatic
for the femoral neurovascular bundle medial to the iliopsoas tendon
what are the 3 adductor muscles/tendons of the medial hip?
adductor longus: only one assessed with ultrasound
adductor brevis
adductor magnus
(all originate on pubic ramus)
where do the gluteus medius and minimus insert? what is their function?
minimus: anterior facet of greater trochanter
medius: lateral facet of greater trochanter
medially rotate and abduct the hip
what 3 muscles make up the hamstrings?
biceps femoris
semitendinosus
semimembranosus
extend the thigh and flex the knee
what is the largest nerve in the body?
where does it divide?
sciatic nerve
divides just above the pop fossa
what does the sciatic nerve innervate?
hamstring muscles and short head of the biceps femoris
what is the most common pediatric presentation in orthopedic practices?
irritable hip
what is the most common cause of irritable hip? what is the presentation?
transient synovitis
happens typically between 5-8 years old with painful hip and unable to bear weight
what measurement is considered joint effusion in a pediatric hip?
> 5mm in the anterior joint space
> 2mm difference from the contralateral hip is abn
what are the most common causes of joint effusion in peds?
transient synovitis***, septic arthritis or Perthe’s disease
larger effusions are more commonly associated with synovitis
what is transient synovitis defined by?
(what is it? what causes it)
inflammation of the synovial joint capsule from an upper resp infection moving to the hip
when is transient synovitis more common, girls or boys?
boys
what is the clinical presentation for transient synovitis?
1-7 days of pain and limping with refusal to bear weight, resolution in 2 weeks
what should be considered if the transient synovitis does not resolve on its own?
Perthe’s disease
what is septic arthritis?
bacterial infection of the hip, can lead to rapid cartilage and tendon deterioration and bone damage
how does septic arthritis appear?
thickened anterior capsule and complex joint effusion due to presence of pus
very similar to transient tenosynovitis
what is Perthe’s disease?
blood supply to the femoral head is interrupted and bone cells begin to necrosis, causing a flattened head
how does Perthe’s disease appear?
effusion, thickening of the femoral head articular cartilage, fragmentation of the epiphysis
difference of 3mm to the contralateral side is abn
is Perthe’s disease a chronic or temporary disease?
temporary, blood supply returns and bone grows back
what is the measurement for adult hip effusion?
anterior joint capsule >5mm
What is synovial chondromatosis?
synovial villi develop ossified bodies, may break off and become loose in the joint
what is pigmented villonodular synovitis? (PVNS)
overgrowth and thickening of the synovium, is a type of giant cell tumor
most common in 40-60yo’s, can present as a large synovial mass in the hip joint
what is the most common finding of trochanteric bursitis?
thin portion of thickened synovium, difficult to differentiate
compare with contralateral side, large effusions here are uncommon
what is DDH?
developmental dysplasia of the hip
caused by shallow acetabulum where the femoral head can slip out of the socket
what is the window of opportunity to treat DDH?
what happens when left untreated?
within first 6 months of life
can develop into inability to walk when child is 1yo
- or limp/abn gait in childhood and a lifetime of limited ROM
what are the risk factors of DDH?
F: female
F: first born
F: family hx
B: breech
O: oligohydramnios
what is Graf’s method?
focuses on measuring the shape and size of the acetabulum, measurements taken when coronal image is taken
measurements are the base line, roof line, and labrum line
for Graf’s method:
what is the alpha angle?
beta angle?
alpha: between roof and base line, >60 is normal
beta: between labrum and base line, >55 is normal
what is Morin’s method?
using same image as Graf’s method, 2 lines are drawn 90* to the base line
1st line: from baseline to bottom of femoral head
2nd: from top to bottom of femoral head
what is the normal % for Morin’s method?
52% and above is considered normal
how often are hip ultrasounds done on a neonate once DDH is diagnosed?
every 2 weeks to see if it resolves on its own
if the DDH hip remains unstable, what is the treatment?
splint therapy
if severe or diagnosed late, sx reduction of the femoral head into acetabulum is considered
