Hip Flashcards
The gluteal region, or buttock, is bounded superiorly by the ___ and inferiorly by the ____.
The gluteal region, or buttock, is bounded superiorly by the iliac crest and inferiorly by the fold of the buttock.
T or F
The superficial fascia is thick, especially in women, and is impregnated with large quantities of fat. It contributes to the prominence of the buttock.
TRUE
On the lateral surface of the thigh, the fascia is thickened to form a strong, wide band, called the?
It forms a sheath for the tensor fasciae latae muscle and receives the greater part of the insertion of the gluteus maximus.
iliotibial tract
★ The largest of the 3 hip bones
★ Forms superior 2/5 of the acetabulum
★ The wing (ala) spans from PSIS to ASIS
ILIUM
Bones of the Hip (innominate bones)
The ilium, ischium, and pubis form the hip bone
The ilium, ischium, and pubis form the hip bone where do they meet?
They meet one another at the acetabulum.
What type of joint is the COXOFEMORAL JOINT?
Multiaxial Synovial Ball and Socket
What is the articulation of the coxofemoral joint?
Head of the femur to the lunate surface of the acetabulum
Movements of the coxofemoral joint?
Flexion and Extension;
Abduction and Adduction;
Internal and External Rotation
★ Serves as the insertion of iliacus
★ Anterior forms a fossa that serves as a proximal attachment to gluteus medius
ILIUM
★ There is also a ligament, which is sacrospinous and sacrotuberous
★ The spine serves as an attachment to gemellus superior
ISCHIUM
★ The smallest of the 3 hip bones
★ Forms the anterior 5th of the acetabulum
PUBIS
★ Forms the posterior 2/5 of the acetabulum
★ Ischial tuberosity is a landmark for palpation since several muscles are attached to it
ISCHIUM
T or F
ACETABULUM is also called the butter cup
FALSE
The ACETABULUM is Also called Vinegar’s Cup
Orientation of the ACETABULUM
O: Faces laterally, inferiorly, and anteriorly
★ Coverage of the femoral head by the acetabulum is measured by the ___________. Normal = 30
○ Undercoverage = <20 (Coxa Profunda)
○ Overcoverage = >43 (Protrusio Acetabuli)
★ Coverage of the femoral head by the acetabulum is measured by the Central Edge Angle (CEA) of Wiberg. Normal = 30
CEA of Wiberg, normal value=
○ Undercoverage = <20 is called?
○ Overcoverage = >43 is called?
Normal value = 30
○ Undercoverage = <20 (Coxa Profunda)
○ Overcoverage = >43 (Protrusio Acetabuli)
At what age is the acetabulum fully ossified?
Full ossification – 15 – 25 y/o
The femur holds how many percent of the body’s weight?
20%
Strongest and longest bone in the bod
Femur
Orientation of the Femur
Angled Anteriorly, superiorly, medially
Trabecular bone and neck – designed to ____?
Trabecular bone and neck – designed to withstand high loads
When is the Iliofemoral ligament taught?
Taut during extension and ER
Inferior band tautest during extension
Strongest ligament in the body
★ Reinforces anterior aspect of the hip
ILIOFEMORAL LIGAMENT
site of osteoporotic fracture
Ward triangle
Y Ligament of Bigelow
★ 2 parts
○ Inferior (Medial)
○ Superior (lateral)
ILIOFEMORAL LIGAMENT
What movement does the ILIOFEMORAL LIGAMENT limit? +its function
Limits: overextension during standing
★ With the pubofemoral ligament, it helps maintain upright posture, reducing the need of the hip extensors contraction
★ Posterior thickening of the capsule
★ Taut during IR when the hip is at flexion and extension, flexion with adduction
ISCHIOFEMORAL LIGAMENT
T or F the ilium is smooth anteriorly and rough post
TRUE
spiral shaped and is attached to the body of the ischium near the acetabular margin
ISCHIOFEMORAL LIGAMENT
If the Synovial fluid is gone/less what condition could it result to?
Osteoarthritis 9narrowing of joint space)
★ Taut during extension, and ER (Ligament)
PUBOFEMORAL LIGAMENT
Composition of Synovial Fluuid
Lubricin
Collagen
Hyaluronic acid (main)
What hormone causes lax of ligament for the pelvis for increase pelvic outlet for child birth?
Relaxin
Reinforces joint capsule along the medial surface
★ limits extension and abduction
★ Base: attaches to the superior ramus of the pubis
★ Apex: lower part of the intertrochanteric line
PUBOFEMORAL LIGAMENT
placed on tensile load during weight bearing when the head of the femur relocates in the acetabulum and widens the acetabular notch
★ acetabular labrum as it bridges the acetabular notch
★ converts the notch into a tunnel through which the blood vessels and nerves enter the joint
TRANSVERSE ACETABULAR LIGAMENT
★ A semicircular ring consisting of fibrocartilage and dense connective tissue
★ Functions as a force distributor and shock absorber
ACETABULAR LABRUM
★ Capitis Femoris Ligament
★ Edges of the Acetabular notch attaching to the Fovea Capitis
LIGAMENTUM TERES
Orientation of PUBOFEMORAL LIGAMENT?
Orientation is inferior-medial
LIGAMENTUM TERES attaches to?
Fovea Capitis
When is the LIGAMENTUM TERES taught?
Taut during weight bearing
BURSA in the hips
ILIOPSOAS BURSA
TROCHANTERIC BURSA\
ISCHIOGLUTEAL BURSA
Bursa
★ Largest and most constant
★ Inflammation > RA
ILIOPSOAS BURSA
T or F
Proposed function of the collagen is to improve the mobility of the hip by providing an elastic alternative to the bony rim
FALSE
Proposed function of the labrum is to improve the mobility of the hip by providing an elastic alternative to the bony rim
Bursa:
Ischium and Gmax
★ Weaver’s Bottom
ISCHIOGLUTEAL BURSA
triangular depression situated in the upper part of the medial aspect of the thigh just below the inguinal ligament
FEMORAL TRIANGLE
★ Medial Floor and Lateral Floor: (femoral triangle)
Roof: Skin and fasciae of the thigh
○ Gutter shaped and formed from lateral to medial by the iliopsoas, the pectineus, and the adductor longus
Roof: Skin and fasciae of the thigh
★ Subgluteus medius Bursa
○ Glut Med and Great Troc
★ Subgluteus maximus Bursa
○ Gmax and ITB
TROCHANTERIC BURSA
boarders of the femoral triangle
Superior
Medial
Lateral
Superior: Inguinal ligament
Medial: Adductor longus muscle
Lateral: Sartorius muscle
HIP BIOMECHANICS
OPEN-PACKED POSITION:
CLOSE-PACKED POSITION:
OPEN-PACKED POSITION: 30 degrees flexion, 30 degrees abduction, slight ER
CLOSE-PACKED POSITION: Full extension, medial rotation, abduction
★ The major contents of the femoral triangle are
○ Femoral nerve and its terminal branches
○ Femoral sheath
○ Femoral artery and its branches
○ Femoral vein and its tributaries
○ Deep inguinal lymph nodes
HIP BIOMECHANICS
CAPSULAR PATTERN:
STABILITY:
CAPSULAR PATTERN: Flexion, abduction, and medial rotation (but in some cases, it is limited)
STABILITY: 27 muscles that crosses the hip joint act as: PRIMARY MOVERS and STABILIZERS
How manty degrees?
Coxa Vara=
Coxa Valga =
Coxa Vara= less than 120 (110)
Coxa Valga = greater than 140
Hip Angulations
Normal anteversion: __degrees
- Excessive: above __ degrees
- Retroversion: below __ degrees
Normal anteversion: 10-15 degrees
- Excessive: above 15 degrees
- Retroversion: below 10 degrees
How many muscles crosses the hip?
27
T or F
The extensor group of muscles is more powerful than the flexor group, and the lateral rotators are more powerful than the medial rotators.
TRUE
Accounts for substantial morbidity, mortality, and healthcare costs in aging population
■ Type 2 osteoporosis of 75 y/o
Idiopathic Transient Osteoporosis of the Hip
■ One of many causes of hip and groin pain in aging patients.
■ Diagnosis
● Confirmed by radiograph;
● jt space width of 2.5 mm or less
● Osteophytes
● Subchondral bone sclerosis
● Cyst
Osteoarthritis
Systemic, inflammatory, chronic, idiopathic,
auto-immune
Rheumatoid Arthritis
Infection of the hip joint
■ Standard treatment
● Open/arthroscopic arthrotomy
● Irrigation and debridement
Septic Arthritis
