Hip Flashcards
Gluteus Maximus
O-outer surface of ilium, sacrum and coccyx
I-iliotibial tract of fascia Lata, gluteal tuberosity of femur
A- abducts and laterally rotates thigh
N-inferior gluteal
Describe the hamstrings
Composed of the the biceps femoris, semi tendinosis and semi membranosus.
The conjoint tendon is comprised of the biceps femoris and the semi tendinosis arising from medial facet
Gluteus medius
O-outer surface of ilium inferior to iliac crest
I- posterior superior facet of greater trochanter of femur
A- abducts femur at hip, rotates thigh medially
N-superior gluteal N
Gluteus minimums
O-outer surface of ilium between the middle and inferior gluteal lines
I-anterior facet of GT of femur
A-abducts femur at hip joint and medially rotates thigh
N-superior gluteal N
Tensor Fasciae Latae
O-outer edge of iliac crest between ASIS and iliac tubercle
I-iliotibial tract on upper part of thigh
A-Flexes, abducts thigh
N-superior gluteal N
Sartorius
O-ASIS
I-at Pes Anserinus medial tibia
A-flexes, abducts and laterally rotates hip joint.flexes knee
N-femoral N
Rectus Femoris
O-ASIS, ilium above acetabulum
I-patella via quadriceps tendon then by patella tendon to tuberosity of tibia
A-extends leg at knee, flexes thigh at hip joint
N-femoral N
Describe semimembranosus
O-lateral facet of the ischial tuberosity adjacent to the conjoint tendon
It passes anteriorly to ST muscle
I-posterior part of medial condyle of tibia
A-extends thigh at hip, flexes and slightly medially rotates knee
N- sciatic N
Describe Adductor Magnus
O- inferior army’s of pubis and lower part of ischial tuberosity
I- linea aspera and adductor tubercle of medial femur
A- adducts extends thigh
N- obtuartor and sciatic N
Where is the Ischial bursa?
It lies between the gluteus Maximus and ischial tuberosity in the region of the adductor Magnus and conjoint tendon
Where is the sacro- tuberous ligament
O- ileum, sacrum and coccyx
I- ischial tuberosity with fibres melding with the origin of biceps femoris
Describe the pathway of the sciatic nerve
The SN passes anteriorly over the pisiform is muscle.
At the ischial tuberosity the SN lies lateral to the hamstring origin
Name the lateral rotators of the hip
Superior to Inferior
- pirifomis
- superior gemellus
- obturator internus
- inferior gemellus
- quadrant us femoris
Semitendinosis
O-ischial tuberosity ( common tendon with LH of biceps femoris)
Longest of the hamstring muscles
I- medial shaft of tibia ( Pes Anserinus )
A- extends thigh at hip joint, flexes and slightly medially rotates knee
N- tibial portion of sciatic N
Semimembranosus
O- ischial tuberosity
I - posterior part of medial condyle of tibia
A- extends thigh at hip joint, flexes and slightly medially rotates knee
N- tibial portion of the sciatic N
Biceps Femoris
O- LH ischial tuberosity
SH. Linea aspera, lateral supracondylar ridge, lateral inter muscular septum
I- lateral head of fibula and lateral condyle of tibia
A- extends thighs at hip joint and flexes knee
N- sciatic nerve
Describe muscle fibres
Type1 red Fibres ( slow twitch fibres). Small diameter, more blood vessels and myoglobin, better suited to slow and prolonged contractions.
Type2 white fibres ( fast twitch fibres) Are larger in size, have fewer blood vessels and lower myoglobin content and are capable of powerful contractions of short durations
Indications for trauma and pain in the athlete
- evaluate for muscle, tendon, bursal pathology and for hernias
- apophyseal avulsions in adolescents
Indications for hip pain in the elderly and prosthetic hip
- Evaluate for effusions, or synovitis
- bursal or peri-articular fluid collections
- tendinopathic gluteal insertions
Indications for snapping, clicking or locking hip
- snapping of iliopsaoas tendon or ITB
- loose bodies
- anterior Labral pathology
Indications for groin pain
- hernias
- muscle, tendon or bursal pathology
Indications for pirifomis syndrome
- compression of sciatic nerve by the pirifomis muscle
- leg weakness and pain
Indications for a palpable lump
- enlarged bursa
- solid neoplasm
- hernia
- undescended testis
- lymphadenopathy
- femoral artery aneurysm
- varices
Indications for Rheumatoid arthritis
- bursal pathology
- capsular thickening
Indications for infection
-joint effusion
_capsular thickening
Clinical test/ patient symptoms
Pain when kicking- iliopsoas or rectus femoris strain
Pain twisting- adductor muscle strain
Pain with sit ups- rectus abdominus injury or hernia
Hip pain associated with lis back or buttock pain - referred from lumbar spine, sacroiliac joint or tho rich-lumbar junction
Rheumatoid arthritis- joint effusions
Snapping hip syndrome-painful, audible snap anteriorly during hip motion
Iliotibial band syndrome- painful snap laterally over greater trochante
Superficial ring?
The superficial ring can be identified just medial and superficial to the lateral margin of the pubic tubercle. The ingiunal canal runs obliquely towards the ASIS
Deep ring?
The deep ring can be identified superior and lateral to the origin of the inferior epigrastric artery from the terminal portion of the external iliac artery before it passes under the ingiunal ligament
The femoral canal?
The femoral canal is approximately 2 cm proximal to the SFJ, just inferior to the ingiunal ligament
Joint effusions
- common finding in patient with hip pain
- can be due to avascular necrosis, trauma, neoplastic conditions
Intra-articular loose bodies
- echogenic foci within joint
Intra-articular fluid collections
- bursitis- enlarged anechoic or hypoechoic bursa
- subgluteus Maximus bursa ( trochanteric bursa)
- subgluteus medius and minimus bursitis
- iliopsaoas bursa between hip capsule and iliopsaoas muscles, communicates with joint 15% of cases
- ischial bursa
- prosthetic hip - intra-articular fluid effusion > 3.2 mm measured at the prosthesis- bone junction with an associated extra-articular fluid collectionis indicative of infection
- bursal communication of GTB, iliopsoas bursa and supra-acetabular region is common with painful hip arthropod sty
Extra-articular fluid collections - mixed hyper and anechoic areas
- abscesses
- haematomas
- sermoma
Muscle and tendon pathology
- Tendinopathy-TFL Tendinopathy can be a cause of groin pain
- partial/ complete tear- gluteal insertions, adductor muscles
- rupture- measure retracted ends
- avulsion fractures- rectus femoris, hamstrings
- Calcific tendinitis- gluteal muscles
- muscular contusion,strain- swollen muscle with increased echogenicity
Snapping, locking or clicking hip- due to external and internal aetiologies
External- iliotibial band syndrome- friction of gluteus Maximus or tensor fascia Lata over GT
Internal- intra- articular loose bodies
- synovial osteochondromatosis
-Labral tears
-articular surface abnormalities
-snapping hip syndrome - abnormal, jerky lateral to medial movement of iliopsaoas tendon as the patient straightens their leg with a palpable click felt when scanning. Thickening of iliopsoas tendon or bursa not always present. Iliopsoas tendon flattens at the end of the jerk
-meralgia parasthetica - lateral hip pain
- rubbing of lateral femoral cutaneous nerve over anterior iliac crest causes swelling of the nerve
Hernias symptoms
- weakness in anterior abdominal wall through which men’s enteric fat, peritoneum,momentum or bowel may pass
- May be bilateral and asymptomatic
Indirect hernia symptoms
- protrusion of tissue through the deep ring while straining
- tissue is seen to emerge through the deep ring and travel along the canal towards the superficial ring
- May be present at rest and reduce with probe pressure
- in transverse section through the canal ballooning of the AP diameter is seen
- in longitudinal section through the canal abnormal longitudinal glide is seen
Direct hernia appearance
- occur anywhere along the posterior wall of the canal between the superficial ring and the inferior epigrastric artery
- shadowing at the posterior wall is sometimes present at the site of the hernia
- can travel along canal
Lipoma in the canal appearance
- cannot be pushed out of the canal
- no ballooning is seen with straining
- can coexist with a hernia
Femoral hernia appearance
- protrusion of bowel through femoral ring into femoral canal with compression of CFV
- fluid is sometimes seen in the canal
- can become strangulated cutting off blood supply to the herniated intestine
