Hip Flashcards
pectineus
femoral, accessory obturator nerve
L2-3
psoas major
femoral nerve
L2-3
iliacus
L1
attaches distal at pectineal line
sartorius
attaches at ASIS-> superior medial surface of tibia
femoral nerve
L2-3
rec fem
AIIS -> quad tendon
femoral nerve, L2-4
vastus lateralis
prox: greatecr trochanter and lateral lip of linea aspera
femoral nerve L2-4
vastus medialis
intertrochanteric line & medial lip of linea aspera
femoral nerve L2-4
vastus intermedius
anterior/lateral surfaces of femur shaft
femoral nerve L2-4
adductor longus
body of pubis inferior to pubic crest–> middle third of linea aspera
obturator nerve (anterior branch), L2-4
adductor brevis
body and inferor ramus of pubs–> pectineal line & proximal linea aspera
obturator (anterior) L2-4
adductor magnus
adductor part: inferior pubic rami/ischium rami-> linea aspera medial, gluteal tuberosity
hamstring part: ischial tuberosity-> adductor tubercle
adductor part:: obturator (posterior) L2-4
hamstring: tibial nerve
gracilis
body/inferior ramus of pubis-> superior part of medial surface of tibia
obturator nerve (anterior) L2-3
obturator externus
obturator nerve (posterior) L3-4
quadratus femoris
lateral ischial tuberosity -> quadrate tubercle on intertrochanteric crest
nerve to quadratus femoralis & inferior gemellus
L5-S1
obturator internus
trochanteric fossa (distal attachment)
nerve to obturator internus & superior gemellus
L5-S1
glut med
ilium between anterior & posterior gluteal lines –> anterior surface of greater trochanter
superior gluteal nerve L4-S1
piriformis
anterior sacrum/sacrotuberous ligament –> superior border of greater trochanter
nerve to piriformis
L5-S2
gemellus superior
ischial spine -> trochanteric fossa
nerve to obturator internus & gemellus superior L5-S1
ligamentum teres
superior part of femoral head, attaches to transverse ligament. strong instrinsic stabilizer
femoral head vascular supply
MFCA- medial femoral circumflex artery
transverse ligament
inferior border of acetabular fossa
attaches to anterior inferior portion of labrum
angle of inclination
angle between neck and shaft of femur
125-130 deg in adults
coxa valga vs vara
coxa valga
displaced more superiorly
140 deg
coxa vara
100 deg
anteversion- normal & increased
normal: 12-15 deg
increased: increased IR or toe in gait
increased pronation, medial femoral/tibial torsion, lateral patellar subluxation
retroversion
toe out or increased ER, supination
may compensate with medial rotation at knee, lumbar rotation on opposite side
craigs test
8-15 deg is normal
hip joint ligament capsule
iliofemoral
ischiofemoral
pubofemoral
iliofemoral
starts at AIIS, 2 distinct bands
restricts hip extension & ER
ischiofemoral
posterior acetab rim, along iliofemoral –> medial femoral neck
restricts IR
restricts add when hip is flexed
pubofemoral
superior pubic ramus-> intertrochanteric line
restricts hyperabd & ER
snapping psoas vs ITB
snapping- clunk occurs as hip comes from flex+abd+ER into Ext +IR, eminates from groin
-can hear across room
ITB: symptoms more lateral, TFL moves over greater trochanter with hip rotation
-see across room
log roll test
most SP for intra articular
NOT SN
reproduce anterior groin pain
FABER
ASLR
Dial test
Ober
FABER- anterior hip pain- joint problem; SI- feel more posterior
Dial- anterior laxity
Increased ER vs other when lying in extension supine
athletic pubalgia vs sporst hernia
passive flexion+IR would exacerbate joint problem but not sports hernia
alpha angle
between midline of femoral neck, and lien from center of femoral head to junction that first deviates from spherity of femoral head
> 50 may indicate CAM
(normal 45)
center edge angle
normal = 20-25 deg *** borderline hip dysplasia NOT normal
less = dysplasia
CAM FAI - anatomy
poor shape of femoral head
Pincer FAI - anatomy
extra rim/overhang
may be associated with retroversion
SCFE (slipped capital femoral epiphysis)
teens
sudden displacement of femoral neck from CFE- failure of growth place occurs due to shear forces
head typically stays in place due to ligamentum teres while neck comes up and outward
glut min
ilium–> anterio surface of greater trochanter (same as glut med)
superior gluteal nerve
L4-S1
TFL
ASIS & anterior part of iliac crest –> IT tract
superior gluteal nerve
L4-S1
glut max
posterior ilium, dorsal surface of sacrum/coccyx, sacrotuberus ligament –> IT tract & gluteal tuberosity
inferior gluteal nerve
L5-S2
biceps femoris
long head origin: ischial tuberosity
short head origin: linea aspera/lateral supracondylar line
attachment: lateral side of fibular head, tendon split by LCL
n: long head tibial nerve, short head common peroneal
L5-S2
semitendinosus
ischial tuberosity–> medial surface of superior part of tibia
tibial nerve L5-S2
semimembranosus
ischial tuberosity–>posterior part of medial tibial condyle; reflected attachment form oblique popliteal ligament
tibial nerve L5-S2
stress fracture
risk factors: female, previous fracture
sudden increase in volume
vague thigh pain that may radiate to hip/knee
patellar pubic percussion
fulcrum test 1 SP & 1 SN
hip AVN special testing
hip ext <15
hip ER <60
pain with IR
Cam vs pincer M vs F
Cam- often young athletic male
pincer- often active middle age women
FAI special testing
FADDIR: SN 0.91-.99
Flexion IR test: .96 SN
CPG - intervention for FAI
most have level evidence F (manual, education, ther ex, neuro re ed)
hip labral special testing
fitzgerald test SN 0.7-.98
Thomas test SN .11-.89, SP .67-.92
Impingement provocation test SN 1.0
hip OA special testing
resisted hip abd (pain) SP .9
FABER (groin pain) - not great test
Scour - not great test
CPR for hip OA
-squatting aggravating
-+ scour for groin/lateral hip pain
-active hip flexion causing lateral hip pain
-passive IR </=25 deg
-Active hip ext causing hip pain
3+ = SP .86
4/5 = SP 0.98
OA CPG interventinos level of evidence
manual A
flexbility, strength, endurance: A
modalities: B
pt edu: B
functional, gait, balance training: C
athletic pubalgia - 4 regions
adductor
hip flexor
inguinal
pubic
risk factors for athletic pubalgia
previous groin injury
higher level of play
decreased hip abd/add strength
lower level of sport specific training
MOI- kicking, change of direction, stretching, sprinting/running
inguinal athletic pubalgia- testing/symptoms
-TTP inguinal canal
-resistance testing of ab muscles = pain (sit up, thomast + reisted hip flexion, vaslavla/coughing)
hip flexor related athletic pubalgia testing
resisted hip flexion 90 .79 SP
thomas test resisted knee ext SP .82
thomas test + passive hip ext or knee flex SP .75/.89
adductor related athletic pubalgia testing
single adductor testing
bilateral adducotr
resisted outer range adduction
squeeze test (0 and 45 deg)
^^ most with sp >0.9
greater trochanteric pain syndrome (GTPS) testing
SLS for 30 sec
external derotation SN .88
obers
FABER - lateral hip pain
FADER + resistance
ADD + resistance
*all .85-0.9+ SP
hip OA guidelines
hip pain
flexion <110
IR <15
pain with IR
AM stiffness <60 min
>50 y/o
ludloff sign
ilipsoas strain or avulsion fracture
pain with hip flexion when seated
test for various layers of impingement at hip
trochanteric sub-spine impingement: 30 deg flexion, 30 deg abd * IR
S/l hip ext: poserior impingement
ER & extension: ischiofemoral impingement
flexion, abd & ER: superior-lateral acetabular impingement
what muscle targets glutes and minimizes activation of TFL
clamshells
crossover sign (xray)
suggests pincer impingement at rim due to acetabulum projecting laterally
gilmore groin
athletic pubalgia - tear in external oblique aponeurosis and conjoint tendon
Hip OA Clusters
I
II
I:
hip pain
IR <15 deg
flexion < 115
II, if IR > 15:
pain with IR
age >50
AM stiffness >60 min
Hip OA CPR
squatting is aggravating
flexion ROM-> lateral hip pain
scour+add->lateral/groin pain
extension ROM pain
IR <25
*If all 5 = 98 SP
SCFE
frog leg xray, Kleins line
epihphysis in acetabulum + metaphysis moves anterosuperior
Freibergs test
Passive internal rotation of the extended hip places tension on the piriformis, which would result in a positive Freiberg’s test.
