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movement analysis ii > Hip > Flashcards

Hip Flashcards

1
Q

What is the angle of inclination at birth? As an adult?

A

140-150 degrees

125 degrees

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2
Q

Coxa vara

A

Angle is less than 125 degrees.
Disturbs length tension relationship of gluteus medius
Positive: Increased moment arm for hip abductor force, alignment can improve joint stability.
Negative: increase moment arm bending and sheering forces across the femoral neck, especially bad for people with osteoporosis because their femoral neck is already weak.
Overall decreased functional length of hip abductor muscles (going to be shorter), going to be harder to control trendelenberg gait

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3
Q

Coxa valga

A

Angle is greater than 125 degrees
Disturbs length tension relationship of gluteus medius
Positive: decreased bending moment arm and decreases shearing forces across femoral neck
Increased functional length of hip abductor muscles
Negative: decreased moment arm for hip abductor force
Alignment may favor joint dislocation

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4
Q

Normal torsion angle of femoral neck

A

10-15 degrees anteversion

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5
Q

Excessive anteversion

A

Greater than 15 degrees
Femoral head moves anteriorly and greater trochanter moves posteriorly. Shaft of femur does not move.
Disturbs length tension relationship of gluteus medius.
If body compensates, the whole lower extremity will internally rotate and person will walk with a toes in position. If child compensates then they correct for that proximally and maintain length tension relationship (good).
Can go undiagnosed if child doesn’t compensate

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6
Q

Retroversion

A

Less than 10 degrees
Femoral head moves posteriorly and greater trochanter moves anteriorly
Out toeing

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7
Q

Femoral head is located

A

Just inferior to middle 1/3 of inguinal ligament
Head has a fovea with ligamentum teres
Branch of obturator artery brings small blood supply to femoral head

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8
Q

Acetabular labrum

A

Fibrocartilage

Deepens the socket

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9
Q

Cartilage of the dome is thickest

A

Along the superior/inferior region because this is where weight bearing happens

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10
Q

Iliofemoral ligament

A

AIIS to intertrochanteric line
Full extension stretches the ligament and full ER stretches the lateral bundle of the ligament
If someone cuts this ligament you will get huge increase in extension, if it scars down you won’t get any extension
One of the strongest ligaments in the body

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11
Q

Ischiofemoral ligament

A

Ischium to greater trochanter
Superficial fibers get taut with extension and IR
Superior fibers get taut with adduction
Inferior fibers get taut with flexion

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12
Q

Pubofemoral ligament

A

Anterior/inferior rim of acetabulum, superior pubic ramus and then blends with medial fibers of iliofemoral ligament
Taut with hip extension and abduction

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13
Q

Closed pack position of the hip

A

Extension, IR, abduction

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14
Q

Position of maximal congruency for the hip

A

90 degrees hip flexion, moderate ER, and abduction

Little passive tension to the ligaments in this position

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15
Q

Full hip flexion

A

120 degrees with knees bent
80 degrees with knees straight because hamstring is short

If you bend your knee and it’s still that still happens it’s a capsular issue, have to mobilize here

Slackens most ligaments but stretches inferior capsule

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16
Q

Hip extension

A

20 degrees beyond neutral with knee straight
Limited to neutral with knee bent (because rectus is on full stretch)
Stretches all ligaments and hip flexor muscles

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17
Q

Abduction

A

40 degrees

Limited by tension in the pubofemoral ligament

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18
Q

Adduction

A

25 degrees beyond neutral

Limited by hip abductor muscles, contralateral limb, and superficial fibers ischiofemoral ligament and ITB

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19
Q

Hip internal rotation

A

35 degrees
Unchanged by flexion/extension of hip
Limited by piriformis and parts of the ischiofemoral ligament

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20
Q

Hip external rotation

A

45 degrees
Limited with increased amounts of hip flexion (because soft tissues in post gluteal region are wound up in this position)
Limited by TFL and lateral fibers of the iliofemoral ligament

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21
Q

Ipsidirectional lumbopelvic rhythm

A

Pelvis and spine rotate in the same direction

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22
Q

Contra-directional lumbopelvic rhythm

A

Pelvis rotates in one direction while lumbar spine rotates in the opposite direction
So pelvis goes forward into anterior tilt and lumbar spine goes back into extension

Osteokinematics of pelvis on femoral movement all use contra-direction lumbopelvic rhythm

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23
Q

Force couple anterior tilt

A

Between erector spinae in the back and iliopsoas and rectus femoris in the front
Increase in lumbar lordosis
Greater lordosis will increase compression forces at the facet joints

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24
Q

Force couple posterior tilt

A

Between the abdominals in the front and gluts and hamstrings in the back
Reduces lumbar lordosis
Example SLR exercise
Requires forceful contraction of the abdominals
If someone has exaggerated lumbar lordosis, their abs may be really weak, unlikely except for polio patients

25
Q

Closed chain abduction

A

Support hip abduction occurs as you’re raising or hiking iliac crest on the nonsupport hip

Lumbar spine bends in the direction opposite of the rotating pelvis

26
Q

Closed chain adduction

A

Support hip adduction occurs as you lower iliac crest on the nonsupport hip

27
Q

Closed chain IR

Closed chain ER

A

Closed chain IR of the support hip occurs as the nonsupport hip rotates forward
Closed chain ER of the support hip occurs as the nonsupport hip rotates backward

28
Q

Primary hip flexors

A

Iliopsoas, sartorius, TFL, rectus femoris, pectineus, adductor longus

29
Q

Secondary hip flexors

A

Adductor brevis, gracilis, anterior fibers of glut minimis

30
Q

In the abducted position the iliopsoas can assist in

A

External rotation

31
Q

Rectus femoris is responsible for

A

1/3 of total isometric flexor torque at the hip

32
Q

The axis of rotation is

A

Behind the hip joint and anterior to the knee joint normally
Osteoarthritis causes anterior tilt so the axis of rotation moves in front of hip and posterior to the knee
Changed the way body weight should fall through lower extremity
Iliofemoral ligament and psoas major and hamstrings get really short

33
Q

Primary hip adductors

A

Pectineus, adductor longus, brevis, Magnus, gracilis

34
Q

Secondary hip adductors

A

Long head biceps femoris, gluteus maximus inferior fibers, quadratus femoris

35
Q

Superficial on cadaver, middle, and deep

A

Pectineus, AL, gracilis

Adductor brevis

Adductor Magnus (biggest)

36
Q

Why do soccer and hockey players pull their groin?

A

Because it is constant stop and go. Muscles are vulnerable here

37
Q

What happens when you kick leg across body (in adduction)

A

Right leg is open chain adduction, concentric contraction, needs to produce a lot of force
Left leg closed chain adduction because right pelvis dropping down, glut med on this side may be eccentrically lengthening to control some of the closed chain adduction that may be happening on opposite pelvis
Also adductor Magnus on right side trying to stabilize so we don’t get hip flexion

38
Q

Sagittal plane adductors

A

Regardless of hip position the post fibers of add Magnus are always a potent extensor of the hip, too far posterior

39
Q

Remaining adductors can become

A

Flexors or extensors depending on position

40
Q

In hip flexion adductor longus

In hip extension

A

Is posterior to the axis of rotation so it becomes a hip extensor

Is anterior to the axis of rotation so it becomes a hip flexor

41
Q

Secondary internal rotators of hip

A

Anterior fibers of gluteus minimis, glut medius, TFL, AL, AB, pectineus, semitendinosis, semimembranosis

42
Q

What happens to secondary internal rotates when hip is flexed 90 degrees

A

The line of force becomes perpendicular to the axis of rotation which increase torque potential so they become primary internal rotators

43
Q

In an anatomical position most adductors can

A

Produce modest amount of IR of the hip

44
Q

Linear aspera is

A

Anterior to the longitudinal axis of rotation, because of this the adductors have the ability to produce IR
The more hip flexion the more torque you can produce

45
Q

If you want to strengthen internal rotators

A

Put hip in flexed position first, especially if they had a bad groin pull)
So if you want gluteus minimis to function as hip internal rotators you need to put it in hip flexion

46
Q

Greatest glut medius EMG activity is found

A

In side lying and internal rotation in the position of a clam shell

47
Q

Primary hip extensors

A

Glut max, hamstrings, posterior head of adductor Magnus

48
Q

Secondary hip extensors

A

Posterior fibers glut medius and adductors with hip flexed more than 50 degrees

49
Q

From about 75 degrees of hip flexion adductor Magnus and hamstrings

A

Produce equal extension torque

50
Q

Primary hip abductors

A

Glut medius, minimis, TFL

51
Q

Secondary hip abductors

A

Sartorius, piriformis

52
Q

Which muscle has greater abductor moment arm and largest cross sectional area

A

Gluteus medius

53
Q

Gluteus medius is broken up into

A

Anterior fibers: IR/flexion
Posterior fibers: ER/extension
Middle fibers

54
Q

If you want to strengthen glut medius

A

Stay away from hip flexion, in hip flexion they will get stronger as IR

55
Q

Why and when are the hip abductors important during gait

A

During swing phase when the stance side hip abductors keeps the pelvis from dropping (trendelenburg)

The quadratus lumborum on the swing phase will concentrically fire to assist

56
Q

Primary hip external rotators

A

Glut max, sartorius, piriformis, obturator internus, sup/inf gemellus, quadratus femoris

57
Q

Secondary hip external rotators

A

Post fibers of glut medius, glut minimis, long head biceps femoris, obturator externus

58
Q

Why is the obturator externus secondary

A

Sine line of force only milimeters posterior from axis of rotation (small MA)

movement analysis ii (4 decks)

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