Hip Flashcards
ROM normal values of hip Flexion, Extension, Abduction, Adduction, IR, and ER
Flexion: knee ext; 0-90 degrees;
*flexed knee: 0-120 degrees
Extension: 0-20 degrees
Abduction: 0-45 degrees
Adduction: 0-40 degrees
IR & ER: 0-45 degrees
What type of Joint is the hip joint?
multiaxial, ball and socket joint
*aka COXOFEMORAL JOINT
Capsular Pattern of the hip joint
Flexion, Abduction, Medial rotation [FABIR]
Resting position of the hip joint
FABER [30 Flex, 30 ABd, slight ER]
Closed packed position of the Hip joint
Full extension, Medial Rotation, Abduction [EABIR]
What is the most common direction of dislocation of the Hip joint?
Posterior
Triad of Dashboard injury
Injury over the knee (PCL injury)
Injury over the symphysis pubis
Posterior hip dislocation
The “vinegar cup is formed by the innominate bones, what are the exact bones?
Formed by 3 bones:
1/5 pubis
⅖ ilium
⅖ ischium
Line formed at the lateral edge of the acetabulum as compared to vertical line forming femoral head
Normal (?) degrees
Center edge angle: WIBERG
Normal: 25-45 degrees
CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
ACETABULAR COVERING IN RELATION TO FEMUR: Covers the front of the femoral head
ACETABULAR ANTERVERSION ANGLE
Normal value of the Acetabular anteversion angle
Normal: 15-20
Orientation of the accetabulum
Anterior-lateral-inferior
*Orientation: “ALIng Ceta”
all of these describes the ACETABULAR LABRUM, EXCEPT:
- Dense, horseshoe-shaped fibrocartilaginous
stabilizes the hip during extreme ROM
- Provides proprioceptive information for dynamic stability
- Increases Knee area and volume for acetabulum
- Creates a seal for the central compartment, part of the intra-articular hip joint
- Increases Knee area and volume for acetabulum
*Increases articular surface area and volume for acetabulum
CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
DECREASED
Retroverted over coverage
Coxa profunda
Acetabular protrusion
LOM and impingement
ACETABULAR ANTERVERSION ANGLE
T or F
LEGG CALVE-PERTHES DISEASE: 3-12 y/o boys
SCFE: 10-17 yrs old, boys
TRUE
CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
LANDMARKS
Oblique line from lateral rim of acetabulum
Vertical line form center of fem head
CENTER EDGE ANGLE
What is the main blood supply of the Femur?
(in children and in adults)
Child: Retinacular artery
.
Adult: Retinacular artery and Obturator artery via ligamentum teres and metaphysial
CORRELATED POSTURE
Toeing out, Subtalar supination, Lateral tibial torsion, Lateral femoral torsion
EXCESSIVE RETROVERSION
CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
INCREASED
Over coverage:
Coxa profunda
Acetabular protrusion
LOM and impingement
CENTER EDGE ANGLE
MOI: land on the outside of the hip
Trochanteric bursitis (possible)
CORRELATED POSTURE
Toeing in, Subtalar pronation, Lateral patellar sublaxation, Medial tibial torsion, Medial femoral torsion
EXCESSIVE ANTERVERSION
Avascular necrosis in child? In adult?
Child: LCPD (Legg-Calvé-Perthes disease)
Adult: Chander’s dse
Values of Coxa valga and Coxa vara
Coxa valga (>135 degrees)
Coxa vara (<120 degrees)
Where is the Elicitation of pain for these:
ANTERO-POSTERIOR IMPINGEMENT
Posteroinferior Impingement:
ANTERO-POSTERIOR IMPINGEMENT: Elicitation of pain: flexion and IR
.
Posteroinferior Impingement: Elicitation of pain: extension and ER
These are advantage of Coxa?
Improve hip joint stability
Increases coverage from acetabulum
Good length tension relationship for hip abductors
Coxa vara (<120 degrees)
Orientaion of the Femur
Superior, Anterior, Medial
T or F
Subluxation, acetabular, labral tear:land on or hit the knee, thus jarring the hip
Femoral stress fracture: land on or hit the knee, thus jarring the hip
FALSE
Subluxation, acetabular, labral tear: land on or hit the knee, thus jarring the hip
Femoral stress fracture: involved in repetitive loading activity
CORRELATED POSTURE
Pronated subtalar joint, Medial rot of leg, Short ipsilateral leg, Anterior pelvic rot
COXA VARA
PNI, What nerve is affected?
Cause of injury:
during child birth
ant disloc of hip
Surgery over the hip (hernia)
Manifestation:
affectation/ weak quads
Paresthesia over the distribution
FEMORAL NERVE
PNI, What nerve is affected?
Site of management over inferior border of gluteus minimus muscle or sometimes piriformis
Manifestation: trendelenberg sign (pelvis drop)
SUPERIOR GLUTEAL NERVE
The disadvantage of Coxa vara
Prone to femoral neck fx
Prone to slipped capital femoral epiphysis
Leg length discrepancy d/t shortened leg
CORRELATED POSTURE
Supinated subtalar joint, Lateral rotation of the leg
Long ipsilateral leg, Posterior pelvic tilt
COXA VALGA
PNI, What nerve is affected?
Cause of injury
impingement during pregnancy, fx, tumor, surgery, direct trauma, pain over the groin
Manifestation:
pt will experience weakness over adductor muscle grp
Paresthesia over obturator nerve distribution
OBTURATOR NERVE
PNI, What nerve is affected?
Largest
Pelvis or upper femur area
Piriformis syndrome
Pain and weakness on abd and ER of hip
Sign of pace and Nagel
Freiberg sign
Impingement of
SCIATIC NERVE
What are and the structure affected :
True leg length
Apparent leg length
True leg legnth/true shortening (bone is affected)
Apparent leg length/functional shortening (muscle is affected)
