Hip Flashcards
3 functions of the pelvis
- common attachment point for many large muscles of lower extremity and trunk
- transmits weight of upper body and trunk either to ischial tuberosities during sitting or to lower extremities during standing and walking
- supports organs involved with bowel, bladder, and reproductive functions
The femoral head projects _____ and slightly ______ for an articulation with acetabulum
medially
anteriorly
The shaft of the femur displays slight _____ convexity.
anterior
What is the angle of inclination?
The angle within frontal plane between the femoral neck and medial side of the femoral shaft
What is the angle of inclination at birth?
What is the normal adulthood value?
140°-150°
125°
Coxa vara describes an angle of inclination ____ than 125°.
Coxa valga describes an angle of inclination ____ than 125°.
less
greater
What is femoral torsion?
The relative rotation (twist) between the bone’s shaft and neck
Normally, the femoral neck projects about __° anterior to a ML axis through femoral condyles. What is this called?
15°
Anteversion
Excessive anteversion is described as greater than __°.
Retroversion is described as less than __°.
35°
5°
Does excessive anteversion lead to toeing in or toeing out?
Toeing in
Excessive anteversion is common in what types of patients?
Persons with cerebral palsy
Describe acetabular alignment
It projects laterally from the pelvis with varying amount of inferior and anterior tilt
A dysplastic acetabulum often times leads to what?
chronic dislocation and increased stress, often times leading to degeneration or OA
What are the two measurements commonly used to describe the extent to which the acetabulum naturally covers and helps secure the femoral head?
Center-edge angle and acetabular anteversion angle
What is the average center-edge angle in adults?
35°
A significantly lower central-edge angle ____ acetabular coverage of femoral head which tends to lead to what?
Decreases
Increased risk of dislocation and decreases contact area within the joint
A central-edge angle of only 15° reduces normal contact area by as much as __%
35
What is the acetabular anteversion angle?
The angle at which the acetabulum projects anteriorly within horizontal plane, relative to pelvis
What is the average acetabular anteversion angle in adults?
20°
A hip demonstrating excessive acetabular anteversion is more exposed in what direction?
anteriorly
An acetabulum that projects directly laterally, or even slightly posterior-laterally, within horizontal plane is described as being abnormally _____.
retroverted
The center-edge angle defines the extent to which the acetabulum covers the ___ of the femoral head
top
The acetabular anteversion angle indicates the extent to which the acetabulum covers the ____ of the femoral head
front
Which tissues are taught during hip flexion with the knee extended?
Hamstrings
Which tissues are taught during hip flexion with the knee flexed?
- Inferior and posterior capsule
- Gluteus maximus
Which tissues are taught during hip extension with the knee extended?
- Primarily iliofemoral ligament
- Some fibers of the pubofemoral and ischiofemoral ligaments
- Psoas major
Which tissues are taught during hip extension with the knee flexed?
Rectus femoris
Which tissues are taught during hip abduction?
- Pubofemoral ligament
- Adductor muscles
Which tissues are taught during hip adduction?
- Superior fibers of ischiofemoral ligament
- Iliotibial band
- Abductor muscles such as the tensor fasciae latae and gluteus medius
Which tissues are taught during hip internal rotation?
- Ischiofemoral ligament
- External rotator muscles, such as the piriformis or gluteus maximus
Which tissues are taught during hip external rotation?
- Iliofemoral and pubofemoral ligaments
- Internal rotator muscles, such as the tensor fasciae latae or gluteus minimus
What is the close-packed position of the hip?
Full extension, slight internal rotation and abduction
Is the hip’s close-packed position associated with its position of maximal joint congruency?
NO
In what position does the hip joint surfaces fit most congruently?
90° of flexion with moderate abduction and external rotation
What are the 2 terms used to describe kinematics at hip?
- Femoral-on-pelvic hip osteokinematics which describes rotation of the femur about a relatively fixed pelvis
- Pelvic-on-femoral hip osteokinematics which describes rotation of the pelvis, and often superimposed trunk, over relatively fixed femurs
What way does the pelvis tilt during flexion? What way does it tilt during extension?
Flexion = anterior Extension = posterior
What type of movement occurs at the hip joint during flexion and extension?
spin
During abduction there is _____ roll and _____ slide
superior
inferior
During adduction there is _____ roll and _____ slide
inferior
superior
During internal rotation there is _____ roll and _____ slide
anterior
posterior
During external rotation there is _____ roll and _____ slide
posterior
anterior
What is lumbopelvic rhythm?
Configuration of the lumbar spine as a consequence of pelvic rotation
Describe ipsidirectional lumbopelvic rhythm
movement in which lumbar spine and pelvis rotate in same direction, thus amplifying overall trunk motion
Describe contradirectional lumbopelvic rhythm
movement in which lumbar spine and pelvis rotate in opposite directions
Pelvic-on-femoral osteokinematics represent con___-on-con___ movement
concave
convex
In pelvic-on-femoral osteokinematics the concave surface rolls and slides in ____ directions
similar
What are the primary hip flexors?
- Iliopsoas
- Sartorius
- Tensor fasciae latae
- Rectus femoris
- Adductor longus
- Pectineus
What are the secondary hip flexors?
- Adductor brevis
- Gracilis
- Gluteus minimus (anterior fibers)
What are the primary hip adductors?
- Pectineus
- Adductor longus
- Gracilis
- Adductor brevis
- Adductor magnus
What are the secondary hip adductors?
- Biceps femoris (long head)
- Gluteus maximus (lower fibers)
- Quadratus femoris
Are there any primary hip internal rotators?
NO
What are the secondary hip internal rotators?
- Gluteus minimus (anterior fibers)
- Gluteus medius (anterior fibers)
- Tensor fasciae latae
- Adductor longus
- Adductor brevis
- Pectineus
What are the primary hip extensors?
- Gluteus maximus
- Biceps femoris (long head)
- Semitendinosus
- Semimembranosus
- Adductor magnus (posterior head)
What are the secondary hip extensors?
- Gluteus medius (posterior fibers)
- Adductor magnus (anterior head)
What are the primary hip abductors?
- Gluteus medius
- Gluteus minimus
- Tensor fasciae latae
What are the secondary hip abductors?
- Piriformis
- Sartorius
What are the primary hip external rotators?
- Gluteus maximus
- Piriformis
- Obturator internus
- Gemellus superior
- Gemellus inferior
- Quadratus femoris
What are the secondary hip external rotators?
- Gluteus medius (posterior fibers)
- Gluteus minimus (posterior fibers)
- Obturator externus
- Sartorius
- Biceps femoris (long head)
What are the 2 positive consequences of coxa vara?
- increased moment arm for hip abductor force
- alignment may improve joint stability
What are the 2 negative consequences of coxa vara?
- there is increased bending in the moment arm which increases the shear force across the femoral neck
- decreased functional length of the hip abductor muscles
What are the 2 positive consequences of coxa valga?
- there is decreased bending in the moment arm which decreases the shear force across the femoral neck
- increased functional length of the hip abductor muscles
What are the 2 negative consequences of coxa valga?
- decreased moment arm for hip abductor force
- alignment may favor joint dislocation