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Ortho Tx 700 > Hip > Flashcards

Hip Flashcards

1
Q

Functions of hip movements

A
  1. Positions lower limb in space
  2. Lowers/raises body from ground
  3. Brings foot closer to trunk.
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2
Q

Coaptation force of hip

A

How much it sucks. (About 25lbs)

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3
Q

Femoral triangle

A

Superior: inguinal ligament
Medial: add long
Laterally: sartorius
Floor: pectineus and iliopsoas

Through which the femoral artery passes

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4
Q

Iliacus

A

O: inner surface of iliac fossa and sacral ala
I: lesser trochanter

Flexion and lateral rotation of the hip, anterior pelvic tilt

Femoral new (L2-3)
Internal iliac artery
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5
Q

Psoas

A

Origin: TVPs L1-5, vertebral bodies of T12-L5, intervertebral discs

I: lesser trochanter

Hip flexion and lateral rotation.
Spinal flexion and lateral rotation
Anterior pelvic tilt

Lumbar plexus ventral rami (L1-3)
Iliolumbar artery

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6
Q

Gluteus Maximus

A

O: posterior iliac crest, sacrum, coccyx, sacrotuberous ligament

I: gluteal tuberosity, ITB

Hip extension and lateral rotation
Upper 1/3: abduction
Lower 1/3: adduction

Inferior gluteal nerve (L5-S2)
Inferior and superior gluteal arteries

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7
Q

Sartorius

A

O: ASIS
I: pes anserine

Knee flexion, medial rotation
Hip flexion, external rotation, abduction

Femoral nerve

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8
Q

Tensor Fascia Latae

A

O: ASIS and anterior iliac crest
I: ITB (1/3 way down thigh)

Hip flexion, abduction, internal rotation

Superior Gluteal Nerve (L4-S1)
Superior Gluteal and Deep Femoral Arteries

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9
Q

According to Muscolino, what is the most important function of the TFL?

A

Isometric stabilization of the pelvis while walking – preventing depression of limb on CL swing side by maintaining pelvic depression of IL stance side.

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10
Q

Sartorius

A

O: ASIS
I: Pes Anserine

Hip flexion, abduction, external rotation.
Knee flexion
Anterior Pelvic tilt

Femoral nerve (L2-3)
Femoral artery
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11
Q

Piriformis

A

O: anterior sacrum and anterior sacrotuberous ligament
I: greater trochanter (superomedial)

Hip lateral rotation, extension
(past a certain degree of flexion – 60º? – may act as internal rotator)

Nerve to piriformis (L5-S2)
Superior and Inferior Gluteal arteries

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12
Q

Palpate piriformis

A

Prone
Palpate 1/2 way between PSIS and apex of sacrum
Flex knee. Externally rotate leg (foot coming medially) against resistance.
Palpate towards greater trochanter

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13
Q

Palpate PSIS

A

Most posterior aspect of iliac crest. Approx 2 inches from midline of sacrum.
Just lateral to dimples
Glute max attachment – hip extend or IR/ER to feel

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14
Q

Adductor Magnus

A

Anterior Head: Inferior pubic ramus and ramus of ischium to gluteal tuberosity and medial supracondylar line

Posterior Head: Ischial tuberosity to adductor tuberosity

Hip adduction, extension
Posterior pelvic tilt

Obturator (anterior) and sciatic (posterior) nerves (L2-4)
Femoral, deep femoral, and obturator arteries

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15
Q

Adductor Longus

A

O: Pubis (anterior body)
I: Linea aspera (mid 1/3)

Hip adduction and flexion. Anterior pelvic tilt.

Obturator nerve (L2-4)
Femoral, deep femoral, and obturator arteries
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16
Q

Gracilis

A

O: Pubis (anterior body and inferior ramus)
I: Pes Anserine

Hip adduction, flexion
Knee flexion
Anterior pelvic tilt

Obturator nerve (L2-3)
Deep femoral and obturator artery
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17
Q

Semitendinosis

A

O: ischial tuberosity
I: pes anserine

Knee flexion
Hip extension
Posterior pelvic tilt

Sciatic nerve (L5-S2)
Inferior gluteal, deep femoral and obturator arteries
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18
Q

What movements are common to all the muscles that attach to the pes anserine?

A

Knee flexion and medial rotation

Help stabilize knee against valgus forces (medial buckling)

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19
Q

Semimembranosus

A

O: ischial tuberosity
I: posterior surface of medial condyle of the tibia

Knee flexion
Hip extension

Sciatic nerve (L5-S2)
Inferior gluteal, deep femoral and obturator arteries. Plus popliteal
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20
Q

Biceps femoris

A

Long Head: ischial tuberosity and sacrotuberous ligament
Short Head: linea aspera and lateral supracondylar line of the femur

I: head of fibula, lateral tibial condyle

Knee flexion
Hip extension
Posterior pelvic tilt

Sciatic nerve (L5-S2)
Inferior gluteal, obturator, deep femoral and popliteal arteries.
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21
Q

Gluteus medius

A

External ilium (in between anterior and posterior gluteal lines) to Greater Trochanter (lateral)

Whole muscle: hip abduction
Posterior fibres: hip extension, lateral rotation. Posterior pelvic tilt
Anterior fibres: hip flexion, medial rotation. Anterior pelvic tilt

IL hip depression
CL hip rotation

Superior gluteal nerve (L4-S1)
Superior gluteal artery

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22
Q

Gluteus minimus

A

External ilium (between anterior and inferior gluteal lines) to Greater Trochanter (anterior)

Whole muscle: hip abduction
Posterior fibres: hip extension, lateral rotation. Posterior pelvic tilt
Anterior fibres: hip flexion, medial rotation. Anterior pelvic tilt

IL hip depression
CL hip rotation

Superior gluteal nerve (L4-S1)
Superior gluteal artery

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23
Q

Iliopectineal bursa

A

Anterior hip joint and pubis, deep to iliopsoas.
Large

Can communicate with hip joint anteriorly through a space between pubofemoral and iliofemoral ligaments

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24
Q

Pain in groin
Radiates down medial thigh
Insidious onset
Pain with resisted flexion and passive extension

A

Iliopectineal bursitis

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25
Q

Trochanteric Bursa

A

Between greater trochanter and gluteals(reduces friction between the two)
Superficial to joint capsule
Most extensive posterolaterally
Most commonly inflamed

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26
Q

Pain over lateral hip
Possible referral to lateral knee and thigh
Possible snapping
Pain going up stairs, sitting cross legged, sleeping on affected side.

A

Trochanteric bursitis

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27
Q

Ishiogluteal Bursa

A

Between ischial tuberosity and gluteus maximus; adds cushioning
Often affected in people in wheelchairs who have constant pressure and atrophied glutes

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28
Q

Anteversion (according to H&K)

A

“… a positional change in which wither the acetabulum or the head and neck of the femur are directly anterior relative to the frontal plane”

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29
Q

Normal angle of anteversion

A

8-15º

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30
Q

Anteverted Hip: Presentation

A

Excess medial rotation and decreased external rotation

Toe-in gait

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31
Q

Pain and tenderness over or just about ischial tuberosity
Possible referral down hamstrings
Pain with sitting, walking, climbing stairs, hip and trunk flexion

A

Ischiogluteal bursitis

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32
Q

Retroverted Hip: Presentation

A

Excess external rotation and decreased internal rotation

Toe-out gait

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33
Q

Angle of Inclination

A

Angle of the femoral neck vs angle of femoral shaft
Frontal plane
Normally 125º in adults (150º in children)

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34
Q

Coxa Valgum

A

Increased angle of inclination (150º)

Leads to genu varus

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35
Q

Coxa Varum

A

Decreased angle of inclination (110º)

Leads to genu valgus

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36
Q

Angle of Torsion/Declination (according to H&K)

A

The angle of the axis of the head and neck of the femur vis a vis the transcondylar axis
Normally 15º

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37
Q

Antetorsion

A

Osseus anomaly
Increased angle of torsion/declination (30º) caused by medial twist in the femur (distal on proximal)
Presents with toe in (non compensatory) or compensatory toe out gait

Medially displaced (“winking”) patella

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38
Q

Retrotorsion

A

Osseus anomaly

Decreased angle of torsion/declination (5º) caused by a lateral twist in the femur (distal on proximal)

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39
Q

The intrinsic stability of the hip is provided by:

A
  1. the acetabulum and labrum
  2. coaptation force
  3. ligaments
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40
Q

The Hip: Coaptation Force

A

The vacuum force created because of the large surface area of contact between the acetabulum and the femur.
Approximately 25 kg of atmospheric pressure

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41
Q

Hip: Ligaments

A 
Iliofemoral
Ischiofemoral
Pubofemoral
Ligamentum Teres
Transverse
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42
Q

Iliofemoral ligament

A

AKA Y ligament, ligament of Bigelow

Lower AIIS and post-sup rim of acetabulum –> intertrochanteric line of the femur

Twists around anterior joint.

Strongest ligament in the body

Checks EXT and IR

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43
Q

Ischiofemoral ligament

A

Post-inf rim of acetabulum –> post-sup neck of the femur

Checks EXT and IR

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44
Q

Pubofemoral ligament

A

Pubis –> just anterior to lesser trochanter

Checks EXT, IR and mayber ABD

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45
Q

What three ligaments check EXT and IR in the AF joint?

A

Iliofemoral
Ischiofemoral
Pubofemoral

46
Q

Ligamentum Teres (hip)

A

AKA Capitus femoris/ligement of the head of the femur

Lies in the nonarticular surface of the acetabulum –> head of the femur

Mechanically checks ADD, but most importantly supplies synovial fluid and vascularization to the head of the femur

47
Q

Transverse ligament (hip)

A

Crosses acetabular notch to form a foramen for the acetabular artery (which then becomes the artery of the ligament of the head of the femur)

48
Q

The head of the femur points

A

Anterior
Medial
Superior

49
Q

The acetabulum points

A

Anterior
Lateral
Inferior

50
Q

AF joint: Capsular Pattern

A

Flex-Abd-IR >

Ext - Add - ER

51
Q

Hip: Resting position

A

30º flexion
30º abduction
Slight ER

52
Q

Hip: Closed Pack Position

A

Extension
Abduction
IR

53
Q

When standing on one leg, the stance leg …

A

… must support 3x the body weight

54
Q

Increased angled of anteversion can lead to

A

DJD (less alignment between axes –> less effective contact between joint surfaces

55
Q

ADL to help with Trendelenburg’s Gait/lurch

A

Cane on unaffected side

Carry shopping on affected side

56
Q

Nelatons Line

A

Between Ischeal tuberosity and ASIS
Normal: superior greater trochanter should be just on line.
If well above –> coxa varum

57
Q

L4 reflex

A

Knee jerk (also L2,3)

58
Q

L5 reflex

A

medial hamstring

59
Q

S1 reflex

A

ankle jerk/Achilles (also S2)

60
Q

L1 Dermatome

A

Groin, hip

61
Q

L2 Dermatome

A

Anterior thigh

62
Q

L3 Dermatome

A

Medial thigh, knee

63
Q

L4 Dermatome

A

Medial calf

64
Q

L5 Dermatome

A

Lateral calf, dorsum of foot (D1-3)

65
Q

S1 Dermatome

A

Heel, plantar surface of foot, lateral dorsum

66
Q

S2 Dermatome

A

Medial posterior leg

67
Q

Femoral Triangle

A

Superior: inguinal ligament
Medial: adductus longus
Lateral: sartorius
Floor: pectineus and iliopsoas

68
Q

Route of Sciatic Nerve

A

L4-S3 –> midline of glute –> in between ish tub and greater trochanter –> bifurcates just before popliteal fossa

69
Q

Route of femoral nerve

A

L2-4 –> under inguinal ligament –> bifurcates just distal to inguinal ligament

70
Q

Acetabulofemoral Joint

A

Synovial, ball & socket

Head of the femur (convex) on acetabulum

Strong capsular strength

3 degrees of freedom (flex/ext; abd/adduction/rotation)

71
Q

Direction of strongest hip strength

A

Anterosuperior

72
Q

Acetabular Labrum

A

Fibrocartilage that extends from the rim of the acetabulum, allowing it to enclose more than half of the femoral head.

Increases congruency of joint by deepening acetabulum

73
Q

Intrinsic stability of the hip is provided by:

A
  1. acetabulum and labrum
  2. coaptation force
  3. strong ligaments
74
Q

When standing on one leg, the stance leg must support how much more weight?

A

x 3

75
Q

What positions align the axes of the femoral neck and acetabulum?

A
  1. 90º hip flexion, slight ER, abduction

2. extension, abduction and internal rotation (closed pack)

76
Q

Pain in inguinal area, anterior hip/thigh

A

acetabular femoral origin

77
Q

Pain in posterior hip, post-lat thigh

A

spinal, SI jt issues

78
Q

Bicep Femoris Strain: pain, movement

A

Pain posterior thigh, usually proximal or middle third

Pain with AROM hip flexion, RROM knee flexion

79
Q

Bicep Femoris Strain: special tests

A

SLR

MMT biceps femoris vs semimem/tem

80
Q

Bicep Femoris Strain: ReMex

A

Eccentric training of hamstrings
Increase iliopsoas flexibility
Activate glutes

81
Q

Rectus femoris strain: pain, movment

A

origin, insertion, mid-muscle

Pain with AROM hip extension, RROM knee extension/flexion

82
Q

Rectus femoris strain: special test:

A

Ely’s
Thomas
MMT vs VMO, vast lat

83
Q

Adductor Longus strain: pain, movement

A

Musculotendinous junction, 5 cm from pubis

Pain with AROM abduction, RROM adduction

84
Q

Adductor Longus strain: special test:

A

Adductor length test

MMT adductor group

85
Q

ITB Sprain: MOI

A

Excessive adduction

Dancers, athletes, fall on hip

86
Q

ITB Sprain: pain, movement

A

Localized pain in trochanteric area (just behind or above)

Pain witih CL side flexion of the trunk

87
Q

ITB Sprain: Special Tests

A

Ober’s
Thomas
Standing ITB stretch

88
Q

DDx: ITB sprain vs trochanteric bursitis

A

ITB sprain: pain post-sup to trochanter

Bursitis: pain local to trochanter

89
Q

ITB fasciitis

A

Inflammation of the fascial band from overuse of TFL
Pain may be limited to area covered by the fascia along the lateral surface of the thigh, or may extend upward over the hip.

90
Q

Upper Rectus Femoris Tendonitis: pain, movement

A

Just below AIIS (or sometimes proximal muscle belly)

Pain on RROM knee extension, PROM knee flexion
May also be unable to flex knee more than 120º

91
Q

Upper Rectus Femoris Tendonitis: special tests

A

Ely’s
Thomas
Tendonitis Differentiation Test (test as hip flexor, not knee extensor)

92
Q

Psoas Tendonitis: MOI

A

RSI triggered by overactive contraction. Hip flexion then taken into forceful extension

93
Q

Psoas Tendonitis: Pain and movement

A

Pain in anterior hip/thight (lesser trochanter) – dull, achy, with possible snapping at and/med hip

Pain with RROM hip flexion, PROM hip extension, flexion, and adduction (for the latter two – tendon may be compressed against acetabular rim)

94
Q

Tronchanteric Bursitis: Special test

A

Ober’s (intense local pain over trochanter)

95
Q

Femoral head fracture

A

Usually result of high energy trauma, and often occurs with dislocation

96
Q

Which arteries are compromised in the avascular necrosis of the femoral head?

A 
Circumflex arteries
(especially with femoral neck fracture, or with conditions that increase intracapsular pressure -- OA, RA -- that cause ischemia)
97
Q

Primary OA (hip)

A

idiopathic (age)

noninflammatory

98
Q

Secondary OA (hip)

A

altered biomechanics/alignment
trauma
immobilization

inflammatory

99
Q

Hip OA: Sx

A

Stiffness with long periods of rest
Reduced IR, extension, which progresses to capsular pattern (Flex/Abd/IR > Ext/Add/ER)

Achy pain over inguinal region

100
Q

Hip OA: Special tests

A 
** Scouring CI's if already Dx **
Fabers
Stinchfield
Trendelenberg
Thomas
101
Q

After hip replacement, what is totally CI’d:

A

Adduction past neutral and flexion past 90º for at least 3 months (no sidelying!)

102
Q

In which position is the hip most likely to dislocate?

A

When ligaments are most lax (flexion) and joint out of congruency (abduction, IR).

103
Q

Capsular Sprain: MOI

A

Insidious, or doing the twist
Hip hypermobility, altered mechanic
Most commonly affects athletes and dancers

104
Q

Capsular Sprain: Sx

A

Pain in anterior hip, groin, maybe buttocks
Painful ambulating

Capsular pattern of restriction

105
Q

Capsular Sprain: Movement

A

Weak lateral rotators

Pain with flexion, medial rotation

106
Q

Capsular Sprain: Special Test

A

Fabers
Scouring
Stinchfield

107
Q

Piriformis Syndrome

A

Compression of the sciatic nerve by the piriformis muscle

108
Q

Piriformis Syndrome: Sx

A

Unilateral
Pain in lumbosacral area, posterior thigh, referring to calf and sole of foot
Possible loss of proprioception, foot drop, ataxic gain

109
Q

Piriformis Syndrom: Special tests

A 
Piriformis Test (provokes neurological pain)
SLR
Freiberg Sign (pain with adduction, internal rotation)
110
Q

Via the ITB what is glute Max’s action on the knee?

A

Extension.

111
Q

Via the ITB what is glute Max’s action on the knee?

A

Extension.

Ortho Tx 700 (12 decks)

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