Hip Flashcards by Tori Chatman

Coxofemoral Joint

-synovial, diarthrodial, ball and socket
-flx/ext, ab/ad, IR/ER
-weight bearing and support

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Acetabulum

-fuse ilium, ischium, pubis
-50 deg inferior and 20 deg anterior

-luneate surface: hyaline cartilage articulating with femur
-acetabular notch + transverse acetabular lig: creates tunnel for BVs
-Acetabular fossa: deepest, does not touch femur

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Acetabular Dysplasia

shallow acetabulum, prone to instability

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Coxa Profunda

over coverage of acetabulum leading to impingement

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Anterversion

-more than 20 deg
-positioned more ant
-instability

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Retroversion

-less than 20 deg
-positioned more post
-over coverage`

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Center Edge Angle

-coverage of the femortal head by acetabulum
-lat rim of acetabulu, to center of femoral head
-Norm: 22-50

<acetabular>pincer- type impingement
</acetabular>

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Acatabular Inclination

-measure of debth
-line parallel to teardrops to lat acetabulum

Norm: 32-45

> acetabular inclination

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Acetabular Labrum

-ring of fibrocartilage; blends with acetabular lig
-deepens socket
-negative pressurre
-proprioceptive nerves

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Femoral Head

-hyaline cartilage
-medial, superiorly, anteriorly
-lig teres attached to foeva

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Angle of Inclination

-frontal plane measurement, smaller in women, greater during childhood

Norm: 125

> 125: Coxa valga: straighter in relation to shaft, less shear on neck, decreases MA of abductors, decreases coverage of acetabulum, associated with genu varum (kids with CP and spasticity have valgum)

<125: Coxa Vara: increased stability and MA, increased shearing forces on neck, associated with genu valgum and SCFE

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Angle of Torsion

-transverse plane measurement
-axis through head and neck and femoral condyles

Norm: 10-20deg
Anteversion: >15-20; increased internal rotation to compensate, decreased stability; toe in

Restroversion: < 10-15; increased external to compensate rotation; toe out

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Most Congruence

-flexion, ab, slight ER

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Joint Capsule

-irregular; dense fibrous tissue
-retinacular fibers: carry BVs
-Femoral neck is intracapsular
-Trochanters are extracapsular

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Hip Bursae

Lateral:
-trochanteric, reduce friction btwn post facet, glut max, IITB and greater troch

Anterior:
-glut med bursa
-iliopsoas bursa

Posterior:
-ischiogluteal

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Ligaments

Ligamentum Teres:
-ligament of the head of the femur
-reisits rotation in 90 deg of flexion
-intrarticular but extrasynovial
-attaches from acetabular notch, transverse acetabular lig, to fovea
-secondary blood supply (avascular necrosis)

Iliofemoral Lig:
-Y lig
-ASIS to intertrochanteric line
-anterior stability
-reists ER

Pubofemoral Lig:
-pubis to iliopectineal eminence
-supports inferior femoral neck
-resists ER in Ext

Ischiofemoral Lig:
-posterior acetabulum and labrum to greater troch
-resist IR

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Capsuligamentous Tension

Close packed: ext, abd, IR
Loose packed: flx, abd, mid-rotation

-ligs taut in ext
-capsule and ligs suport 2/3 body weight w/o muscles
-LoG is post to hip, slight ext
-most vulnerable to post dislocation in flx and abd

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Bony Architecture

-trabeculae line up along stress lines
-weightbearing stress passes from SI to acetabulum
-femoral head transfers forces to shaft, bending the neck (superior tensile forces and inferior compressive forces)
-Head, arms and trunk create shearing forces with ground reaction forces

Trabeculae Systems

Medial:
-Superior to inferior
-reissts vertical compressive forces

Lateral:
-Lateral to medial
-resists shear forces of HAT and GRF

Zone of weakness:
-lateral and superior to lesser trocanter

Joint Pressures

-peak pressure in single limb stances on superior acetabulum
-smaller area in women = higher peak stress
-greatest prevalance of degeneration

Femur on Acetabulum

-convex on concave

Flx: head spins posteriorly
ext: head spins anteriorly
Abd: head rolls superior, glides inferiorly
Add: head rolls inferior, glides superiorly
IR: head rolls anterior; glide posterior
ER: head rolls posterior; glide anterior

ROM

Flexion: 90 w/ ext and 120 w/ flx
Extension: 10-30
Abduction: 45-50
Adduction: 20-30
IR & ER: 40-50

Normal Gait ROM Requirements

flx: 30
ext: 10
Ab/ad: 5
IR/ER: 5

Pelvis on Femur

-concave on convex

Anterior Pelvic Tilt: hip Flex

Posterior pelvic tilt: hip ext

Lateral Pelvic Tilt: ABd or ADD
-opposite pelvic hike= stance hip ABD
-Opposite pelvic drop= stance hip ADD

Lateral Pelvic Shift: ADD on shift side, ABD on opposite

Forward Rotation: NWB pelvis moves anteriorly, WB moves IR

Backward Rotation: NWB pelvis moves posteriorly, WB moves ER

Pelvifemoral Motion

Forward Bending: spinal flx, APT, hi flx Sidlying Leg lift: hip abd, LPT, lumbar sine bend

Hip Flexors

-bring swing limb forward -resist extension -iliopsoas, rec fem, TFL, Sartorius

Hip Adductors

-stabilize hip in standing -flex hip from extension -extend from flexed -pectineus: resist flx and abd -add brev, long, mag -gracilis: add and IR of tibia

Hip Extensors

-glute max (best MA when hip flexed 70) -hamstrings (least MA when knee flex >90) Assissted by: pos glute med, piriformis, post add mag

Hip Abductors

-counteract adds Glute med -abd in all positions -ant flx, IR -post ext, ER -hip flx all IR GLute min: -abd and flx -capsular tightening Assisted by: -glute max, sartorius

Hip External Rotators

-ob internus and externus (decreased MA with hip flx, always ER) -gemelli -quad femoris (ER always) -piriformis (hip flx, IR)

Hip Internal Rotators

-no primary Assissted by: ant glute med and min, tfl, adductors

Hip in Bilateral Stance

-BW distributed equally -1/2 HAT throough pelvis and femoral head -LOG creates extensor -class 1 lever

Hip in Unilateral Stance

-stance hip supports compression for HAT and opp leg and abductors -2-3x BW Reduction of forces: -lat lean of trunk tooward stance dec MA -cane ipsi transfers forces -cane contra releaves body weight forces and assist abductors

Coxa Valga

-greater angle of inclination >125 -straighter -dec MA of abd -increase dislocation -genu varum

Coxa Varum

-lesser angle of inclination <125 -inc MA of Abd -improved congruence -more stress on neck -genu valgum

Anteversion

-greater torsion than normal >20 -more joint pressure -less stability -dec MA of abd -head more anterior -more IR, toe in

Retroversion

-lesser torsion than normal <10 -stable -head more posterior -more ER, toe out

Femoral Acetabular Impingement

-FAI -bony overgrowth on femur and acetabulum -can lead to labral tears s/s: groin pain, dull aching, stiffness CAM: head and neck, athletes, pistol grip Pincer: pelvis and acetabulum, females

Hip Labral Tear

-dec center edge angle, retroversion, coxa vara -trauma s/s: sharp ant pain, clicking, stiffness

SCFE

-slipped capital femoral eiphysis -epiphysis slips down and back S/S: -klein's line -drehmann sign (hip flx with ER) -leg length diff -FAI

Swayback

-Glute max paralysis with thoracic kyphosis -pos pelvic tilt -LOG behind greater troch

Growth Plates

Femoral head/neck: 18 G troch: 18 Lesser troch: 18 Distal femur: 20

Anterior Pelvic Tilt

-tight errectors and hip flexors -weak glutes and abs -increased hip flx -lumbar lordosis -LOG ant to hip

Posterior Pelvic Tilt

-weak errectors and hip flexors -tight glutes and abs