Hip Flashcards
What type of articulation is the hip?
Femoral-acetabular articulation
What is another name for the hip?
Coxofemoral joint
Which bones make up the hip joint?
Head of the femur and acetabulum of the pelvis
What type of joint is it?
A diarthrodial ball and socket joint
What is another name for this type of joint?
Enarthrodial
What is a diarthrodial or enarthrodial joint?
Multiaxial with three degrees of freedom
What is the hip joint designed for?
Maximal stability while providing considerable mobility
Which joint is more mobile shoulder or hip?
Shoulder, because the hip has a deeper socket arrangement
What are the primary function of the hip?
Weight bearing of the upper body during static and dynamic upright postures
Force transmission pathway for ground reaction forces
From what other pathologies can pain in the hip come from?
Lumbo-sacral region
Knee
Where can the hip pathologies refer pain?
Groin Anterior-medial-lateral thigh Knee Buttock (Foot /ankle)
When can hip pathologies be seen?
During gait
What is the resting position of the hip?
30 degrees Flexion
30 degrees abduction
0 degrees or slight ER
What is the closed packed position of the hip and what phase of gait does it occur?
Extension
Internal Rotation
Abduction
During Terminal Stance
What is the capsular pattern of the hip and what angle is it in?
When the capsule is tight due to the ligaments
Flexion
Abduction
Medial (internal) rotation
What type of pattern does the acetabular bone have?
Concave pattern
What is the acetabulum’s orientation?
Lateral
Anterior
Inferior
What type of articular surface the acetabulum have and what is it covered with?
Horseshoes-shape articular surface
Covered in hyaline cartilage
What finishes the horseshoes articulation of the acetabulum?
Deep acetabular fossa that contains a synovial covered fibroelastic fat pad
What deepens the socket increasing the concavity?
Acetabular labrum
A wedge shaped fibro-cartilage
Inferior to transverse acetabular ligament
What pattern does the femoral head make?
Distal convex articular pattern
2/3 of a sphere
What is the femoral head fully lined with?
Hyaline cartilage except for the fovea capitus
What is the common orientation of the femur?
Medial
Anterior
Superior
What is the capsule of the hip?
Strong and Dense
Contributes to joint stability
Where does the capsule of the hip attach?
Proximally to entire rim of the acetabulum and distally to the base of the femoral neck
What does the capsule of the hip form?
Zona Orbicularis (orbital zone) Due to multilayering
Where is the capsule thick and thin?
Thick-Anteriosuperiorly
Thin-Loosely attached Posterioinferioly
What does the capsule of the hip restrict?
Joint distraction
What is the capsule of the hip reinforced by?
Strong ligaments
What is the capsule considered as?
Extensive synovial lining
What do the ligaments of the hip do?
Contribute to stability
Where are the ligaments located?
2 anterior
1 posterior
What are the primary ligaments of the hip?
Iliofemoral (y ligament of bigelow)
Ischialfemoral
Pubofemoral
What are the additional ligaments of the hip?
Ligament of the head of the femur (ligamentum teres)
Transverse acetabular ligament
When are the ligaments strong?
When pulled fast
Where are the iliofemoral ligament attachments?
Proximal-Lower portion of ASIS. Area on ilium proximal to superior and posteriosuperior rim of Acetabulum
Distal-Intertrochanteric line
Lateral-anterior aspect of greater trochanter
Medial-Anterior portion of the lesser trochanter
What does the iliofemoral ligament primarily do?
Checks extension and internal rotation
Where does the ischiofemoral ligament attach?
Proximal-Area on ischium, posterior and inferior to rim of acetabulum
Distal- Posterior superior aspect of the neck of femur near greater trochanter
Which way do the ischiofemoral fibers run?
Upward and laterally
What does the Ishciofemoral ligament do?
Pulls tight on extension and internal rotation
Where does the pubofemoral ligament attach?
Proximal-Pubic bone near acetabulum
Distal-Onto femur anterior to lesser trochanter
What does the pubofemoral ligament do?
Tightens primarily on abduction, extension, and internal rotation
What does the ligamentum teres contain?
Branch of obturator artery
Provides blood supply to the top of femoral head
What is Bursa?
Small fluid filled sacks that act to decrease friction and provide cushion between the structures they sit between
What are the four bursas of the hip?
Trochanteric
Iliopectineal
Iliopsoas
Ischiogluteal
What is the trochantric bursa?
Most extensive,
Posteriorlateral to greater trochanter
Decreases friction between ITB, Glut min, and Greater trochanter
Tight ITB can lead to trochantric bursitis
What is the iliopectineal bursa?
Continuous with joint capsule anteriorly
Between iliopsoas and iliopectineal eminence of bone
Superior acetabular rim
Presents as deep groin pain when injured
What is the iliopsoas bursa?
Often overlooked
Close to the insertion of the muscle
Between ischial tuberosity and hamstring tendon
Common in people who sit on hard surfaces
What is the ischiogluteal bursa?
Weavers bottom
Axial of ischial tuberosity
What are the two pathways for the vascular structures?
Ligamentum teres
neck of femur
What can cause loss of circulation?
Fracture,
Capsular tension
Constriction
What are the medial and lateral circulflex arteries?
Derived from femoral and deep femoral arteries
Supply the intra and extracapsular arterial rings ascending the neck of the femur
What does the obturator artery provide?
Braching that migrates to the femoral head by way of the ligamentum teres
What nerve roots innervate the hip?
L2 to S1
Primary L3
Significant potential referral pattern of pain to and from the hip
Where does the femoral nerve innervate
Quadriceps
What nerve roots are with femoral nerve?
L2-4
What is the path of the femoral nerve?
Descends through psoas major
Passes between the iliacus and iliac fascia
Runs beneath the inguinal ligament into the thigh
What injury could injury femoral nerve?
Fracture of ASIS
What does the sciatic nerve innervate?
Hamstrings
What are the nerve roots of the sciatic nerve?
L4-S3
What is the path of the sciatic nerve?
Exits below piriformis and above gemellus
70% below piriformis
What pathology could occur with sciatic nerve?
Sciatica
What does the obturator nerve innervate?
Adductors
What nerve roots are with obturator nerve?
L2-4
What is the obturator nerve path?
Through psoas major
Emerge through brim of pelvis
Enters thigh through obturator canal
What must be considered with the hip muscles?
2 joint muscles
Multiple actions
Position of the hip
What muscles produce flexion of hip?
psoas major/minor
Iliacus
What muscles produce extension of the hip?
Glut max
Hamstring
What muscles produce abduction of hip?
glut med.
What muscles produce adduction of hip?
adductors
Gracilis
What muscles produce medial rotation of hip?
glut min
TFL
What muscle produce lateral rotation of hip?
External rotators
What is the ratio for quads and hamstrings?
60% rule
What occurs with flexion contracture?
Rotate with posterior rotation through SI joint instead
What is an adductor gait?
Scissor gait
Is there joint play in the hip?
Yes, passively
Not often used
How can true distraction or traction occur in the hip joint?
Inferior-lateral direction
What glides occur in Flexion, abduction, and Medial/lateral rotation?
Flexion-PI glide
Abduction-I glide
Lateral-A glide
Medial-P glide
What is the angle of inclination?
Frontal Plane reference angulation of the femur
Femoral Neck shaft angle
What is the angle of torsion?
Transverse plane referenced angulation of femur
Refered as anteversion or retroversion
What is the normal angle of inclination of the hip?
120-130 degrees
What is an increase in the angle of inclination of the hip?
Coxa Valga
Inside angle gets bigger
What are the aspects of coxa valga of the hip?
Increased leg length
Increased compression forces
Abnormal location of joint contact points
Mechanical disadvantage of hip abductors (shorter lever arm)
What is a decrease in the angle of inclination of the hip?
Coxa Varum
Inside angle gets smaller
What are the aspects of coxa varum of the hip?
Decreased leg length
Increased shearing forces
Abnormal location of joint contact points
Mechanical advantage for hip abductors (longer lever arm)
What is an increase in the angle of torsion?
Femoral anteversion
How does femoral anteversion present?
Excessive medial roation
Decreased lateral rotation
Squinting patella-knees point in (pronators)
What is a decrease in the angle of torsion?
Femoral retroversion
How does femoral retroversion present?
Excessive lateral rotation
Decreased medial rotation
Frog eyes patella-patellas point out
What are the aspects of hip stability in bilateral stance?
LOG falls posterior to hip joint
Extension moment torque
Posterior pelvic tilt on femoral heads
Kept in check by capsuloligamentous structures
What accounts for 2/3 of body weight?
head
Trunk
Arms
How much weight is distributed in each hip joint?
1/3 body weight
What are the aspects of hip stability in unilateral stance?
Frontal plane disruption of hip
5/6 of body weight on single limb
Additional compression forces due to the contraction of hip musculature
How much body weight is adjusted in unilateral standing compared to bilateral in quiet standing, stance phase of gait, and stair climbing?
Quiet standing-2.5-3 times
Stance phase-3-4 times
Stair-7 times
What two forms of gait occur with abductor muscle weakness?
Gluteus medius gait (compensated)-Trunk lean to reduce weight arm and increased mechanical advantage Pelvic drop (uncompensated)
What can help reduce the compressive forces?
Decreased weight- one point reduction decreases forces by 2.5-7 pounds
Assistive devices ipsilateral-reduce force but cause other problems
Assistive devices contralateral-reduce 40% of forces
What are the pelvic, hip and lumbar motions?
Anterior tilt-flexion-extension
Posterior tilt-extension-flexion
Pelvic drop-R adduction-R lateral flexion
Hip hike-R abduction-L lateral flexion
Forward rotation-Internal rotation-L rotation
backward rotation-external rotation-r rotation
Not quiz-
What are the other neuromuscular causes of hip pain?
Low back pain- S1 pain peripheral nerve entrapment Femoral hernia Stress fractures Fasciatis Knee OA
Not Quiz-
What ar ethe systemic causes of hip pain?
Cancer/bone mets Bone tumors Cardiovascular arterial insufficiency urological or renal disorders Inflammatory disease like reiters, crohn's disease, abdominal or peritoneal inflammation, ankylosing spondylitis
Not quiz-
What are hints of systemic pain?
Aids/TB/Sickle cell anemia/hemophilia Hip/groin pain with gastro symptoms Hip pain worse at night and alleviated with activity enlargement of lymph nodes Men age 18-24 hip groin pain Rebound tenderness
Not quiz-
What are referred patterns of hip pain?
Femoral nerve distribution Obturator nerve distribution Ilioinguinal nerve Genitofemoral nerve Lateral cutaneous nerve
