Hip Flashcards
Q: Describe the transfer of forces in the hip.
From sacrum to pelvis to femur
Diagram: Articular Structures of the Hip (2)
Labrum, and synovial fluid act like shock absorber
Diagram: Ligament Structures of the Hip
Iliofemoral ligament = one of strongest in the body (with the help of the labrum)
Diagram: Posterior Musculature of the Hip (6)
Large muscles used for movement (walking)
Deep muscles:
- mimic RC
- hold you in extension to keep femoral head in socket
- Can cause a posterior tilt
- ER that act as extensors when contract together
Diagram: Anterior Musculature of the Hip (2)
All the adductors (which also do IR)
Constantly contracted, can effect posture - anterior tilt
Q: Which set of muscule balance the hip?
ER and IR
Content: External Rotators (6)
- Piriformis (< 60 degrees)
- Superior/inferior gemellus
- Obturator internus/externus
- Quadratus femoris
- Gluteus maximus
- Gluteus medius/minimus (flexed)
Q: Which ER might become tight and then weak and cause posterior tilt? (5)
- Superior gemellus
- Obturator internus
- Inferior gemellus
- Obturator externus
- Quadratus femoris
Content: Internal Rotators (8)
- Piriformis (at 90)
- Semitendinosus
- Semimembranosus
- Adductors
- Pectineus
- Tensor fasica latae
- Gluteus medius (extended)
- Gluteus minimus (extended)
Diagram: Bursae of the Hip (2)
Ischial and Iliopsoas
Ischial = can be inflammed with prolonged sitting/trauma
Q: How much flexion can be appreciated at the hip?
110-120 degrees
Q: How much extension can be appreciated at the hip?
10-15 degrees
Q: How much abduction can be appreciated at the hip?
30-50 degrees
Q: How much adduction can be appreciated at the hip?
30
Q: How much external rotation can be appreciated at the hip?
40-60 degrees
Q: How much internal rotation can be appreciated at the hip?
30-40 degrees
Q: Describe the roll and glide with hip flexion.
R = anterior
G = posterior
Q: Describe the roll and glide with hip extension.
R = posterior
G = anterior
Q: Describe the roll and glide with hip abduction
R = lateral (superior)
G = inferior
Q: Describe the roll and glide with hip adduction
R = medial (inferior)
G = superior
Q: Describe the roll and glide with hip IR.
R = medial (anterior)
G = posterior
Q: Describe the roll and glide with hip ER.
R = lateral (posterior)
G = anterior
Q: Which hip motions have an end feel of tissue approximation (or stretch)? (2)
- Flexion
- Adduction
Q: Which hip motions have an end feel of tissue stretch? (4)
- Extension
- Abduction
- IR
- ER
Q: What functional range is required for shoe tying?
120 of flexion
Q: What functional range is required for sitting (average seat height)?
112 of flexion
Q: What functional range is required for stooping?
125 of flexion
Q: What functional range is required for squatting?
115 of flexion
20 of abduction
20 of IR
Q: What functional range is required for ascending stairs (average stair height)
67 of flexion
Q: What functional range is required for descending stairs (average stair height)?
36 of flexion
Q: What functional range is required for putting foot on opposite thigh?
120 of flexion
20 of abduction
20 of ER
Q: What functional range is required for putting on pants?
90 of flexion
Content: 3 types of femoral head orentation
- Coxa valgus
- Coxa varus
- Anteversion
Content: Coxa valgus (4)
- Increase joint reaction force
- Muscles in mechanical disadvantage
- Modify angle at knee joint
- ~170 (greater than norm of 125)
Content: Coxa varus (4)
- Decrease joint reaction force
- Increase the shear forces on the femoral head/neck
- Damage at the epiphyseal plate
- ~ 100 (less than norm of 125)
Diagram: Coxa valugs and varus
Q: What is normal femoral anteversion?
8-15 degrees
Diagram: Hip Anteversion/Retroversion (2)
Anterversion = Increasing medial femoral torsion
Retroversion = Increasing lateral femoral torsion
Q: What test is used to measure femoral anteversion?
Craig’s test
Content: SE (for Hip) (4)
- Profile
- Location/distribution pain (body chart)
- Behavior of symptoms (agg./easing)
- Hx (injury/insidious)
Content: OE (for Hip) (6)
- Observation
- Palpation
- AROM/PROM
- Length
- Strength
- Special tests
Q: What are the degenerative changes seen in OA? (3)
- Articular cartilage break down/loss
- Capsular fibrosis
- Osteophyte formation on the joint margins
Term: The shortest distance between the femoral head margin and the acetabulum
Minimal joint space
Q: What is normal and hip OA joint space (in mm)?
Norm = ~4.5
Hip OA = < or equal to 2.5
Content: Kellgren and Lawrence scale for Osteoarthritis (4)
Grade 1 = Doubtful narrowing of joint space and possible osteophytic lipping
Grade 2 = Definite osteophytes, definite narrowing of joint space
Grade 3 = Multiple moderate osteophyites, definites joint space narrowing, some sclerosis and possible deformity of contour
Grae 4 = Large osteophytes, marked joint space narrowing, severe sclerosis, and definited deformity of bone contour
Diagram: Nonpharmacologic recommendations for the management of hip osteoarthritis (from the american college of RA)
Recommend: aerobic exercise, weight loss
Conditionally recommended: self manage, manual therapy, supervised exercise, thermal agents, walking aids
Not recommended: balance + strength, tai chi, manual therapy alone
T/F: The optimal OA treatment program should consist of both medications and non-drug treatments.
True
Content: Non-drug treatments for OA (11 - general idea)
- Education and self-management
- Reulgar telephone contact (promotting self-care)
- Physical therapy
- Aerobic, muscle strengthening and water-based exercises
- Weight loss
- Walking aids
- Footwear and insoles
- Knee braces (in case of OA)
- Heat and cold
- TENS
- Acupuncture
T/F: Patients often see one health care provider and then receive a definitive diagnosis of a labral tear.
False: Seen by multiple health care providers before obtaining a definitive diangosis (can take 2 years)
Content: Facts on Atraumatic Labral Tear (7)
- Gender
- Age
- Hx
- Pain
- Limp
- Dr’s seen
- Previous Dx
- 71% female
- Mean age = 38
- Typically no hx of trauma
- 86% in mod-severe pain
- 39% were limping
- On average has seen 3.3 practitioners over 21 mos
- Usually had diagnosis of “soft tissue injury”
Content: OE for Labral Tears (5)
- Standing alignment: Posterior pelvic tilt and knee hyperextension
- Precision of both active/passive hip flexion
- In prone, pattern of hip extension (indicates relative participation of hmas and glute max)
- Muscle strength: hip ABD, glute max, iliopsoas, deep ER when not painful
- Gait with hyperEXT and ER
- Increased accessory/joint motion
Content: Provocative Hip Tests (4)
lol “provocative”
- FABER test
- Scour test
- Resisted SLR (hip in 30 flexion)
- Flex-Add-IR (most appropriate for interior lesion = pain and clicking)
Q: What is the normal angle of inclination of the femoral head?
125 degrees
