HIP Flashcards
part of the hip bone that is a major attachment site for the glutes
ilium
labrum is what shape
horse shoe
labrum is a_____
vascular
weakest part of hip joint is where
area without a labrum (pos and inf)
most labral tears occur where
sup portion of hip bc labrum is thickest there
Y lig is aka
Iliofemeral lig
strongest lig in body
Y lig
Y lig limits what motion
hip extension
the other lig resisting hip ext
pubofemoral
pubofemoral lig also tightens with what motion
abd
so pubofemoral lig limits what motions
hip ext and hip abd
on a pic, the pubofemoral lig is ant, the most
inf one
most injured lig in hip
ischiofemoral
why is ischiofemoral lig most injured
bc most pple have weak ER, and IR more common
the main post lig in hip
ischiofemoral
lig teres tightens with what motions
add, ER, flexion
lig teres attaches what 2 structures
femoral head to inf acetabular rim
where are the BV and nerves to the femoral head located
in sheath of lig teres
3 main bursa in hip
iliopsoas
trochanteric
ischiogluteal
coxa vara
like an upside down L
almost like a straight right angle
what’s lengthened or stressed with coxa vara
glutes
coxa valga
like a wide V
what is shortened and tight with coxa valga
ER are really tight
explain anteversion
increased angle
with anteversion, they will compensate by doing what
toe in
with anteversion, they will have lots of ____ and lack ____
lots of IR and lack ER (more end range ER)
Retroversion, they will lack ___ and have lots of ___
lack IR, but have lots of ER
Retroversion is toe ____
out
Obturator N segments
L2, L3, L4
Femoral N segments
L2, L3, L4
sciatic N segments
L4, L5
S1-S3
Lateral cutaneous to thigh N segments
L2-L3 (no motor function for lat cut to thigh N)
femoral hypo mobility syndrome is associated with what pathologies
deg disease
decreased joint space
OA
sx of femoral hypomobility syndrome
deep groin or deep hip px referred px to medial knee px with wt bearing or px with sit to stand stiffness in the morn sx after the age of 55
often times, those with femoral hypo mobility syndrome will have what kind of gait
trendelenberg gait
what posture will be associated with femoral hypomobility syndrome
ant pelvic tilt
Legg calve perth disease, px is where
medial knee
Legg calve perth disease, these motions are limited
mainly ext and ABD
SCFE stands for
slipped capital femoral epiphysis
px for SCFE is where
referred to knee or thigh
motions limited by SCFE
mainly IR and ABD and flexion (IR MAINLY)
2 tests that should be pos with snapping hip or ITB syndrome
obers and GT bursitis tests
px with AVN is usually described as
dull, achy, throbby
constant low back/buttocks px with same sided groin px for a person over 55 would make you want to look into
OA
lateral thigh px that increases with sit to stand, think
GT bursitis
SHARP px in ant sup groin area, look into
FAI
You also have to look into sx review with groin/hip px, list some possiblities
hernia, female issues, GI probs
how to find iliopsoas
1/3 way btwn umbilicus and ASIS
normal hip flexion is
120
normal hip ext is
20
CRAIGS test is for
retro/anteversion
explain CRAIGS
prone, feel at GT as you IR and ER . at the “pop out” point you measure the tibial crest and perp to floor angle
normal CRAIGS should be
8-15
which type of ____version usually goes along with squinting patella
anteversion
the patellar/pubic percussion test has very hight
sens and spec
True LL is measured from ___ to ____
ASIS to lat mall
hamstring strain is most often felt at
ischial tub (attachment)
glut med strain is most often felt at
GT
is snapping hip px ful at rest (usually)
no
px at the sup, ant hip, look into
FAI
what 2 motions really hurt with ITB syndrome
adduction and flexion
if pt had trauma 2-4 weeks ago and there is still px and bruising at the site, with palpable hard bumps at site, look into
myositis ossificans (refer out)
if you suspect myositis ossificans, you NEVER do what
stretch
PRICEMEM
protect, rest, ice, compress, elevate, manual therapy, early motion
hamstrings trains often occur bc what muscle imbalance
the pt usually uses the hams for the primary hip flexor instead of glut max
distinguishing diff adductors - which one is pos with leg straigth (for px)
gracilis
distinguishing diff adductors - which one is pos with hip at 45 deg (for px)
add longus or brevis
if hip is at 90 degress and there is px with adduction
pectineus
bursitis is common with what other pathologies
arthritic
why is piriformis syndrome prevalent
20 % of pop actually has their sciatic pierce through that muscle
piriformis syndrome will usually yield a pos ___test
fadir
age range for AVN
30-50
how can a displaced femoral neck fx lead to AVN
lack of blood supply
what motions cause px with AVN
ALL
is there a loss of ROM with labral tears (usually)
no
reporting a feeling of giving out or clicking/popping =
labral tear (possible)
what is C sign
putting a C around your hip, this is common px pattern with OA
which movement sx impairment dx is hip OA
femoral hypomobility syndrome
steriods, alchohol, trauma or chemo can be related with what pathology
AVN
where is most common spot for labral tear
ant/sup
weakest part of the hip
inf/post
what motions aggravate labral tears
compression, adduction and any rotation
type of impingment when the femoral head is larger than the acetabulum
cam
type of impingement when the acetabulum overcovers the femoral head
pincer
main test for FAI
scour/FADIR (scour can also be used for labral tear)
anteverted people have very little
ER
anteverted pple are toe _
in
Retroverted pple lack ___
IR
boney open packed position of the hip
30⁰ flexion, 30⁰ abduction, slight ER
boney closed pack of hip
Maximum extension, IR, slight abduction
Inf glides help with what motions
ABD (main one)
flexion
and IR when hip is at 90
post glides help with
flexion (main one)
IR
and add when hip is at 90
POST = FID
Ant glides help with
EXT **
ER
abd when hip is at 90
ANT = XEB
lateral glides help with
IR
ADD
overall px
femoral accessory hypermobility syndrome is associated with what pathologies
- Labral tear
* Early DJD
Femoral anterior glide syndrome (movement sx impairment) is associated with what pathologis
- Femoral-acetabular impingement
- Iliopsoas tendinopathy
- Iliopsoas bursitis
hip extension and knee ext dysfunction (movement sx impairment) is assct with what pathologies? also, explain this dysfunction
- Sciatica
- Hamstrings strain
- Piriformis syndrome
- Ischiogluteal bursitis
hip extension is the primary movement dysfunction, associated with a dominance of the hamstring muscles over the gluteus maximus.
with ant pelvic tilt, what is tight and what is weak
- Tight hip flexors
- Weak abdominals
- Weak gluts
tx options for ant pelvic tilt (things to correct)
Tx options: Strengthen hamstrings Strengthen gluts Strengthing abs Strengthen calves Stretch hip flexors Stretch quads
before doing your resisted motion test, pt should be in ____ position
resting (30 deg flexion and abd and slight ER)
hold trendelenburg stance for ___ sec
30
explain the GT bursitis test (motions you put their hip in)
they are sidelying with knee flexed, you pull them into hip ext, then drop their leg in hip adduction, then hip flexion
explain the side lying (straight abd only) hip muscle imbalance test
Patient in sidelying (affected side up) with knee extended. Have patient abduct hip. stabalize at their hip, Observe their movement pattern. If the leg moves into hip flexion or internal rotation, suspect hip flexor/TFL dominance.
explain the side lying (abd with ER) hip muscle imbalance test
o Place the leg into an abducted, extended, externally rotated position. Ask them to actively hold the leg in that position. If the leg internally rotates or flexes again, suspect hip flexor/TFL dominance.
What are you looking for with the SLR test (where you feel their GT as they raise their leg in supine)
feeling for movement of the GT
Positive: if the axis moves anteriorly > ½” , suspect muscle imbalance around hip, possible posterior hip joint capsular tightness
scour test follows the same patten as
FADIR
the WOMAC outcome measure is used to test for
OA (higher score is worse)
for what assessment or mobs do you need a towel under the sacrum
for post assessement and mob
for the “quick and dirty” ant assessment
when doing a post mob, your motion should go
down and out
when doing prone ant mob, your motion should go
down and in
when doing an inf mob (that is similar to the distraction technique) you pull ___
straight down
when doing distraction, you pull
down and out a little
good parameters for distraction
30-60 sec holds, 3-5 times
most pple have more ____ motion in hip than ____
more ant than post (so post mobs are more used usually)
what typically happens with a lateral femoral cutaneous N injury
it gets trapped under the inguianal lig
stable vs non stable pelvic fxs
stable - no separation at pubic symphysis
unstable - there is separation and probably WB restrictions
plates and screws are used with what type of fixation
ORIF (open reduction)
list the post hip precautions
flexion, IR, add
list ant hip precautions
ext, abd, ER
hip precautions time frame usually
6 mos to a year
surgical reshaping of bone
osteomy
anterior displacement of the femoral neck due to the most superior part of the femoral head slipping (happens alot with obese children)
SFCE
slipped femoral capital epiphysis
childhood condition where there is lack of blood supply to femoral head, causing it to flatten and limp is usually noted
Legg Calve Perths disease
most common cause of hip px in kids
synovitis
which type of femoral fx has an increased rate of AVN and non union
displaced femoral neck
special test for FAI
FADIRR
special test for labral tear
scour
special test for piriformis syndrome
FADDIR
naturally, the acetabulum faces what directions
ant
lat
inf
dislocations usually occur in what direction
post
list the grading scale to assess joint motion
0-6 (0 is nothing, 6 is unstable)
3 is normal
If IT band is tight, what is probably weak
glut med (all gluts really) bc that means IT band is doing most of the work
what pathology often has an MOI related to twisting or torsion
labral tear
what pathology can have associations with alcohol use, or sterioids
AVN
what is the capsular pattern
flexion
abd
IR
femoral hypomobility syndrome is associated with what pathologies
DJD (early on)
what direction does the ilium move in hip flexion
post
normal femoral acetabular angle should be
125
Less than is coxa vara, more than is coxa valga
sup gluteal N innervates
TFL
glut med
glut min
segments to sup gluteal N
L4, L5, S1
what peripheral N are both sensory and motor (10)
obturator femoral sciatic pudendal tibial common fib medial plantar lat plantar deep fibular superficial fibular
N to fibularis longus and brevis
superficial fibular
N to fibuarlis tertius
deep fibular
extensors of lower leg are what N
deep fibular
segments to deep fibular N
L4, L5, S1
the cutaneous N are ____ only
sensory
Inf gluteal N segments
L5, S1, S2
N to quad femoris and gemellus Inf segments (these are motor only)
L5, S1, S2
tibial N segments
L4, L5, S1, S2, S3
N to post calf is
tibial N
ischiofemoral lig limits what motions
IR
common MOI for labral tears
compression or rotational forces (golf is an ex of rotational)
arthrokinematics for hip flexion
femoral head rolls anteriorly and glides posteriorly on acetabulum
hip extensors
primary - glut max
secondary - glut med and hamstrings
hip abductors
Gluteus Minimus
Gluteus Medius
Tensor Fascia Latae
Gluteus Maximus
hip IR (list)
Gluteus Minimus (anterior fibers) Gluteus Medius (anterior fibers) Tensor Fascia Latae Adductor Longus Pectineus Gracilis
hip ER (list)
Gluteus Maximus Gluteus Medius Piriformis Gemellus Superior/Inferior Obturator Internus/Externus Quadratus Femoris
the aggravating factor for the 2 pediatric conditions
walking - causes an antalgic gait
what would be a common hx for a strain
overdominance of the muscle
adductor strain would be what mvmt dx
hypomobility
list the movement dx categories for hip
hypomobility hypermobility femoral ant glide syndrome hip ext with knee ext hip ext with medial rotation hip adduction (with or without medial rotation) lateral rotation syndrome
hypermobility is what pathologies
labrum tear and early DJD
femoral ant glide syndrome is what pathologies
- Femoral-acetabular impingement
- Iliopsoas tendinopathy
- Iliopsoas bursitis
hip ext/knee ext is what pathologies
- Sciatica
- Hamstrings strain
- Piriformis syndrome
- Ischiogluteal bursitis
hip ext with medial rotation is what pathologies
- Hamstrings strain
- Lengthened piriformis syndrome
- Sciatica
hip adduction syndrome is what pathologies
Pathology • Trochanteric bursitis • Snapping hip syndrome • Sciatica • ITB faciitis
lateral rotation syndrome is what pathologies
- Hamstring muscle strain
- Piriformis syndrome
- Sciatica
main mvmt dx associated with piriformis syndrome
lateral rotation syndrome
In this movement dysfunction, there is insufficient posterior glide of the femur during hip flexion. It is associated with stiffness of the hip extensors and posterior hip joint structures and excessive flexibility of anterior hip joint structures which create a path of least resistance of anterior glide.
femoral ant glide
how might you differentiate GT bursitis from glut med strain
often times bursitis has a squishy feel on palpation
femoral hypermobility px would be with
WB - compression (bc of dx in this category)
list the mvmt dx for hip
hypomobility hypermobility Adduction Ant glide LR ext with IR ext and ext
what pathologies are associated with femoral ant glide
impingement iliopsoas pathology (bursitis or tendon pathology)
pathologies with ext ext
sciatica
hamstring strain
piriformis syndrome
ischiogluteal bursitis
the only thing different about pathologies for ext with IR is
no ischiogluteal bursitis (others are same as ext ext)
pathologies for hip adduction syndrome, everything is on the ___lateral
ITB
GT bursitis
Snapping hip
both LR and ext with IR have what pathologies
hamstring strain
sciatica
piriformis
areas for bursitis
iliopectineal
ishial gluteal
GT
Constant low back/buttock pain and same-side groin pain, what might you think
OA
Lateral thigh pain exacerbated when moving from sitting to standing, irritation when sleeping on one side….what might you think
GT bursitis
sharp px in ant groin area
sharp - impingment
FABER is for
OA
scour is for
OA, labral tear
what is craigs test
checks for ante/retroversion
feel when GT “pops” out the most
measure perp to floor against tibial crest when they are prone (8-15 normal)
patellar pubic percussion test has very high
sens and spec
true leg length is from ___ to ___
asis to lateral malleolus
list segmental leg length markers and what they mean
- Iliac crest -> greater trochanter (suggesting coxa vara or coxa valgus)
- Greater trochanter -> lateral knee joint line (suggesting femoral shortening)
- Medial knee joint line -> medial malleolus (suggesting tibial shortening)
with LEFS ___ score is worse
lower
increased femoral adduction during a mini squat may indicate weak
glut med
which has a larger angle, anteversion or retro
anteversion
labral tears typically have no restriction in
ROM
observational test for adduction syndrome
good one is single leg stance (watch if they adduct)
ischial bursitis is what movment pattern
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