Hip Flashcards
What are the normal values for hip flexion?
0-120
What are the normal values for hip extension?
0-20
What position may you get less hip extension and why?
Knee flexed because rectus femoris is tight
What is the normal value of abduction?
0-45
What is the normal values of hip adduction?
0-30
What position of the leg will limit hip abduction and why?
Gracilis (a weak knee flexor & hip abductor) is tight when the knee is extended
What are the normal values for IR when in anatomical neutral?
0-55
What are the normal values for ER when in anatomical neutral?
0-55
What is the normal values of IR when the hip is flexed to 90?
0-45
What is the normal values of ER when the hip is flexed to 90?
0-45
What are the normal ranges in gait for flexion, extension, ABD/ADD & IR/ER?
Flexion- 30
Extension- 10
ABD/ADD- 5
IR/ER- 5
What are the arthrokinematics during hip abduction?
Superior Roll
Inferior Glide
What are the arthrokinematics during hip adduction?
Inferior Roll
Superior Glide
What are the arthokinematics during hip IR?
Medial Roll
Lateral Slide
or
Anterior roll
Posterior slide
What are the arthrokinematics during his ER?
Lateral Roll
Medial Glide
or
Posterior Roll
Anterior Slide
What are the arthokinematic for hip flexion?
Anterior Roll, Posterior Glide
(he likes spin)
What are the arthrokinematics for hip extension?
Posterior Roll, Anterior Glide
(he likes spin)
what are the sagital motions of the pelvis at the hip?
Posterior Tilting & Anterior Tilting
What are the frontal plane motions of the pelvis at the hip?
Hemi-Pelvic Depression & Elevation
OKC IR rotation means what>
Femur moving on fixed pelvis
Femur turned toward pelvis
OKC ER rotation means what?
Femur turned away from pelvis
What are the motions of the pelvis at the hip joint in the transverse plane?
Forward & Backward Rotation
What is OKC of the hip?
All segments move in same direction
What happens in CKC motions?
System strives to keep head & trunk upright
- Lumbar spine & pelvis motion will generally be opposite of that during lumbar pelvic rhythm
what are closed chain hip movements?
Anterior & Posterior Pelvic Tilt
With posterior pelvic tilt does the lumbar become more lordotic or kyphotic?
More lordotic
Lumbar extension
With anterior pelvic tilt does the lumbar spine become more lordotic or kyphotic?
More kyphotic
Lumbar Flexion
What makes up the Osseous structure of the Acetabulum?
Pubis 1/5
Ischium 2/5
Ilium 2/5
What age range is there full ossification of the acetabulum?
15-25 yr old
What is the shape of the acetabulum>
Horseshoe
What ligament spans the articular gap of the acetabulum and forms the roof of tunnel?
Transverse acetabular ligament
What makes the hip joint so strong?
Depth
- pressure
Fibrocartialgenous labrum
What is the orientation of the acetabular?
Faces:
Laterally
Anteriorly
Inferiorly
Does the center edge angle increase or decrease as we age and why>
Increases b/c Wolffe’s Law, cyclic compression promotes bone growth
As we age how is there an increased central stability?
Ossification of the articulation of 3 bones of the pelvis
As we age what causes a reduced co-aptation?
Decreased acetabular roundness
As we age what increases superior stability?
Increase center edges angle
What is the spatial orientation of the proximal femur?
Projects:
Medial
Superior
Anterior
What is the significance of tearing of the Ligamentum teres?
This ligament carries acetabular branch of obturator artery so tearing can lead to AVN
What is the angle of inclination and what does it contribute to?
- Frontal plane angulation b/w the shaft & neck of femur
- Contributes to normal valve position of the knee
What is the normal angle of inclination in early infancy, adults & elderly?
Early Infancy: 150
Adults: 125
Elderly: 120
An increased angle of inclination what is that indicative of?
Coxa Valga
A decreased angle of inclination is indicative of?
Coxa Vara
What are the 3 things caused by Coxa Valga?
- Increased leg length produces hip adduction
- Increase pre load of hit abductors
- Decrease moment arm of abductors
What are the 5 things caused by Coxa Vara?
- Decrease leg length
- Relative hip abduction
- Poor hip abductor length tension relationship
- Impingement may limit adduction ROM
- Sress concentration superior contact area
Coxa vara caused poor hip abductor length tension relationship so was does this compromise?
Ability to generate torque
What ways can coxa vara be caused?
Congenital
Developmental
Traumatic
If the angle of version is >8-15° what does this indicate?
Anteversion or medial femoral torsion
What will uncompensated anterversion cause?
Expose significant amount of femoral head anteriorly
If someone is compensating for an excessive ante version will be IR or ER and what will this cause?
IR
Toed in
If the angle of version is less than <8-15° what does this indicate?
Retroversion or lateral femoral torsion
What will uncompensated Retroversion cause?
May expose excessive head of femur posteriorly
If someone is compensating for an excessive retroversion will leg be ER or IR and what will this cause?
ER
-Appear toed out
What position does the hip have the greatest congruency?
Combined position of:
Flexion
Abduction
Lateral Rotation
Is the position that the hip has the greatest congruency is this the closed pack position?
No
The position of hip flexion. lateral rotation & abduction may be the position of greatest congruency but it is the open pack position, why?
This position tends to uncoil supporting his ligaments
What is the closed pack position of the hip?
Hip Extension & IR because the hip ligaments are tightened
What causes decreased superior stability of the hip?
- Inferior angulation of acetabulum is < the superior angle of femoral neck
so - Significant portion of head remains uncovered
What contributes to reduced anterior stability of the hip?
- Femoral neck & acetabulum are both directed anterior
so - Significant portion of anterior head is exposed
A tight Psoas major will cause what and why?
- Increase lumbar lordosis
- Because the muscle is attached to anterior lumbar vertebra
A tight iliacus will cause what and why?
- Increased anterior pelvic tilt
- Because the muscle is attached to iliac fossa
What are the main action of the tensor Fascia Lata?
Flex & IR hip
When can the tensor fascia lata abduct the hip?
If the hip is already flexed
What is the most important contribution of the TFL?
To maintain tension in the ITB
What is considered to assist in relieving the femur of some of the tensile loads on the shaft?
ITB
How does the TFL enhance the ITB function?
Tales up some of the slack
What are the 3 parts of the glut medius and what is the action of all of them?
Anterior, middle & posterior
- All fibers abduct
What do the anterior fibers of the glute medius do?
Flex & IR
What does the posterior fibers of the glute medius do?
Extend & ER
What is the only adductor muscle of the hip to cross the knee?
Gracilis
Is there any muscle that has the primary function of hip medial rotation?
No
What contributes to medial hip rotation?
Muscles with lines of pull anterior to the hip joint axis at some point of the ROM may contribute to activity
What are the most significant hip medial rotators?
TFL & anterior gluteus medius
When can the piriformis play a role in hip medial rotation?
Hip is flexed >90
What are the 6 primary lateral hip rotators?
Obturator internus
- Obturator externus
- Gemellus superior
- Gemellus Inferior
- Quadratus femoris
- Piriformis
What are the 2 secondary lateral rotators?
Posterior gluteus medius
Superior gluteus maximus