hip Flashcards
iliofemoral ligament
anterior and superior; prevents posterior tilt of the pelvis during erect standing and limits extension of the hip
ischiofemoral ligament
reinforces the posterior capsule, limits excessive medial rotation, abduction and extension
stability of the pelvis in coronal plane
due to simultaneous contraction of the ipsilateral and contralateral adductors and abductors
if there is an imbalance, the pelvis will tilt laterally to the side of adductor predominance
ROM of hip
flexion: 120
extension: 30
abduction: 45-50
adduction: 20-30
internal rotation: 35
external rotation: 45
legg-calve-perthes disease
remodeling of the femoral head as a result of interruption to the blood flow to the region (medial femoral circumflex artery)
avasular necrosis
etiology of legg-calve-perthes disease
unclear; sometimes trauma, subcapital fracture, posterior hip dislocation, boys age 4-9, not genetic
commonly associated conditions of LCPD
short stature, delayed bone age, hypercoagulable states, GI anomalies, inguinal hernia
s/s of LCPD
painless limp or waddling gait, pain in affected hip, limited ROM, hip stiffness, ipsilateral knee pain, persistent thigh or groin pain, wasting of muscles in upper thigh, apparent shortening of leg, or unequal leg length
4 stages of LCPD
initial
fragmentation/resorptive phase
re-ossification
healed
initial stage of LCPD
AVN, loss of blood supply
fragmentation/resorptive phase of LCPD
osteoclasts remove dead tissue which weakens the bone and leads to collapse, can last 1-2 years
re-ossification stage of LCPD
osteoblasts replace destroyed bone, can last up to 3-5 years
healed stage of LCPD
younger children tend to go through the stages more quickly than older children
examination of LCPD
rule out fracture, infection, endocrine disorders, clotting disorders
observe limping, muscle atrophy, leg length
limited ROM
ortho tests for LCPD
trendelenburg
actual leg length: ASIS to medial malleolus
apparent leg length: umbilicus to medial malleolus
MSR, PARTS, Special tests for LCPD
weak hip muscles especially internal rotators and abductors, tenderness over femoral head, leg length discrepancy, loss of ROM, hypotonicity of quadriceps, x-ray or MRI
DDx (of LCPD) if pain is unilateral
septic arthritis, toxic synovitis, juvenile RA
DDx (LCPD) if pain is bilateral
spondyloepiphyseal dysplasia, metaphysial dysplasia
DDX (for LCPD) if systematic symptoms
hypothyroidism
treatment goals for LCPD
pain relief, maintaining proper hip mechanics, gait and ROM
gait training, strength training, ROM exercises
contraindication to adjusting
subtrochanteric bursitis
common problem that causes pain over the outside of the upper thigh, does NOT cross knee; bursa rests between greater trochanter and iliotibial band
greater trochanteric pain syndrome
lateral hip pain; pain over greater trochanter into lateral thigh
cause/risk of subtrochanteric bursitis
running, biking, soccer, football
direct trauma to region, following hip fractures or hip replacement surgery
examination of subtrochanteric bursitis
observation of swelling over region, limping, antalgic gait, loss of internal rotation
