Hip Flashcards
what type of joint
synovial
ball and socket
Acetabulum faces
ant, inf, and lat
Labrum function
deepens the acetabulum
increases stability
Angle of inclination
through neck of femur, down shaft of femur
Angle of inclination - small
coxa vara
greater shear force on the neck of the femur
abduction ROM decreases
Angle of inclination - large
coxa valga
Angle of anteversion
HOW TO MEASURE
40 in infants
12-14 in adults
Angle of anteversion - small
Retroversion
toe out
Angle of anteversion - large
Anteversion
toe in
Articular capsule - strong in what way
dense and strong ant
thin and loose post
Iliofemoral ligament
limts add
excessive ext
ER
Pubofemoral
limits abd
ext
Ischiofemoral
limits excessive ext
IR
add
Transverse acetabular lig
inc stability in inf direction
prevents dislocation with abd
LIgamentum capitis
protects blood supply
Osteokinematics - open chain
femur on pelvis
convex on concave
OPP
Osteokinematics - closed chain
pelvis on femur
concave on convex
SAME
Most congruent/stable position is what
ext, abd, IR
Intracapsular pressure
less than atmospheric - stabilizes
Area with no trabeculae
Wards triangle
Joint reaction force with gait
high just after heel strike and during toe off
With knee extended, hip flexion is
limited by passive insufficiency of the hamstrings
active insufficiency of the rectus femoris
moment arm of gravity
With knee flexed, hip extension is
limited by active insufficiency of the hamstrings, passive insufficiency of the rectus femoris
Trendelenburg SIGN
Lean towards side of pain and instability
dec JRF
unload the painful side
Pelvis will drop to other side because of weakness
Flexors are innevated by
femoral nerve
Flexors
psoas major iliacus TFL sartorius rectus femoris
Extensors are innervated by
sciatic nerve
Extensors
glut max glut med semitendinosus semimembranosus biceps femoris
Adductors are innervated by
obturator nerve
Adductors
adductor magnus adductor longus adductor brevis gracilis quadratus femoris
Abductors are innervated by
gluteal nerve
ER
glut max piriformis obturator internus and externus gemelli quad femoris sartorius iliopsoas post glut med and min biceps femoris
IR
ant glut med and min TFL adductor longus adductor brevis pectineus semitendinosus semimembranosus
Hip pain can be referral from
lumbar SI viscera testicle hernia lymphadenopathy ovaries pelvic inflammatory disease prostatitis UTI systemic disease
Common path based on age - 0 to 2
congenital dysplagia/dislocation
importnatn to catch early
Common path based on age - 2 to 5
transient synovitis
infections
Common path based on age - 5 to 10
legg calve perthes disease
transient synovitis
slipped femoral epiphysis
Common path based on age - 10 to 20
OA from injury
hip fracture from trauma
labral tear
Common path based on age - 20 to 50
OA from injury
hip fracture from trauma
labral tear
OP
Common path based on age - over 50
OA
hip fracture from fall
OP
barlow maneuver
listen for click while mvoing baby hp down
ortolani
listen for click rotating hip in/out
Tx for congenital hip dislocations
neo - hip abd, ER, flex (pavlik)
6m - 6yrs = reduction is needed (LE immobilized)
7-10 yrs = maybe surgery depending
11+ = usually surgery
Leg calve perthes is what
osteochondritis of the femoral capital epiphysis
ossification center necrosis
cause is unknown
eipphyseal plate breaks down and become necrotic
Leg calve perthes - more common in
males (5x)
ages 2 to 12
caucasians
Leg calve perthes s/s
pain with ambulation
gradual insidious onset of pain, aching in hip, thigh, knee and tender hip casule
Slipped capital femoral epiphysis
displacement of the femoral head on the femoral neck
painless and weak
Idiopathic
Slipped capital femoral epiphysis s/s
minimal vague pain
referred pain to the knee
Dec hip IR, abd, flex
antalgic gait - but not painful
Transient synovitis
idiopathic, inflammation of synovial membrane
quick onset
very severe pain
immediate flare up
Transient synovitis - who does it happen to
males before puberty
Transient synovitis - presentation
limping, hip pain, possible low grade
Inflammatory synovitis
history of RA
ankylosing spondylitis
systemic lupus erythematosus
Avascular necrosis
lack of blood circulation to the head of the femur
usually is secondary to something else
asymptomatic at first and then deep throbbing pain in hip/groin/thigh
loss of ROM
mm spasm
Septic arthritis
infection of the joint
acute pain
extremely painful
if not caught early can destory the joint
Degenerative joint disease (OA)
groin/throchanteric pain
morning sitffness, dec ROM
mm spasm, crepitus, pain with ambulation
OA - pos exam findings
Scour FABER tight iliopsoas and rectus weak hip abd antalgic gait radiographs
OA - tx - acute
decrease inflammation
increase ROM
unload joint (aquatic)
OA - tx - subacute
inc ROM
exercise mm to slow disease process
HEP wthopen chain exercises
OA - tx - chronic
close chain gentle ex
functional
HIp arthroscopy
remove loose bodies and treat acetabular labral lesions
Hip arthrodesis
fusion
indicated for youn (less than 30-35)
active pt with unilateral disease
gets rid of pain
Hanging hip
soft tissue procedure
mm release for OA
dec pain and inc function
Hip osteotomies
make larger area to absorb pressure
femoral (less than 50)
pelvic/acetabular - stringent pt population
Hemiarthroplasty
take femoral head off femur,step down shaft, replace with new metal head
Hip resurfacing
bone preserving alternative to THA for young pt
Labral tears - usual MOA
twisting/turning
will hear a click or other noises
Labral tears - clinical presentation
pain, clicking, locking, giving way
Snapping hip syndrome
hear a pop every time the pt moves a certain way
can be benign
Snapping hip syndrome - external
glut max tendon or ITB moving over the greater troch
Snapping hip syndrome - internal
iliopsoas tendon over lesser trochanter or anterior acetabulum
Iliofemoral lig over femoral head
Snapping hip syndrome - clinical presentation
dull, aching pain, associated with certain movements but no discrete area of tenderness
audible or palpable snap
normal imaging
Greater trochanteric bursitis
overuse injury
forceful adduction is a contributor
quicker onset nd more difuse than tendonitis
GT bursitis clinical presentation
achy diffuse tenderness at GT
pain with WB over surfaces in sidelying
pain with resisted abd, passive flex, passive add
pos obers
Iliopsoas/iliopectineal bursitis clinical presentation
localized pain/snapping with resisted hip flex or passive hip ext
tough to lift leg straight up, pain in lower abdomen
pt often thinks it is a hernia
Piriformis syndrome
compression of the sciatic nerve as it moves through piriformis
Piriformis syndrome - clinical presentation
pain with palpation, radiates down leg
dull/achy pain in buttock and point tenderness in buttock
sitting and walking inc pain, going upstairs is painful
paresthesias and weakness
Ischial bursitis
often happens in sprinters using hamstrings to push off
overuse injury
can also be from prolonged sitting
Classification for hip mm strain/tear
grade I - little tissue damage, mild inflammation, pain with normal strength
grade II - dec strength, ROM, significant pain, disruption of fibers
grade III - complete rupture, loss of strength, limited pain, palpable defect
Adductor mm strain - caused by
forceful stretch of mm
most commonly gracillis or adductor longus
acute proximal pain over medial thigh, might radiate into rectus abdominis
Adductor mm strain - pain with
active and passive ROM, palpation
Hamstring mm strain
most commonly strained mm
usually at origin
Inc risk with excessive hip flex and knee ext
eccentric force injury is common
Quad mm strain
often rectus femoris
often from rapid deceleration
Osteitis pubis
inflammation of pubic symphesis from repetitive stress
pain in groing, mm spasm
Iliac crest contusion (hip pointer)
contusion of iliac crest, ASIS, or both
pain and tenerness
if tender at insertion - need xray to rule out avulsion
Avulsion fractures are most common in who
adolescents
Femoral neck fracture - clinical pres
acute onset of pain
unable to WB
shortened and ER LE
Femoral neck fracture - classes
class I - incomplete class II - complete, non displaced class III - complete, partial displacement class IV - complete, total displacement
Intertrochanteric fracture- description
between trochanters
Intertrochanteric fracture - types
I - a line
II - displaced a little bit
III - spiral
IV - total displacement
Subtrochanteric fracture - description
righ tbelow the trochanters
classified by degree of displacement and number of fragments
Hip dislocations - anterior from what movement
forced into abd, ER, ext
less common
Hip dislocation - posterior from what
forced into add and flex
more common
Meralgia paresthetica
abnodmal distribution of lateral femoral cutaneous nerve on sensory exam
lateral tight goes numb
Capsular pattern
IR then flex then abd then ext
If strong and painless
normal or isolated minor pathology
If strong and painnful
minor/mod pathology of mm, tendon, or burssa
If weak and painful
more acute or major path of mm tendon or burs
could also be fracture
If weak and painless
serious pathology
nervous system
tumor
Trendelenberg sign
weakness of glut med
pt standing and asked to lift leg
(+) if ipsilateral hip drops
90/90 hamstring test - pos if what
knee is unable to reach 10 degrees from neutral (lacking 10 or more of extension)
Craigs test
abnormal femoral anteversion angle
pt pron with knee flexed to 90
palpate GT and slowly move hip through IR/ER
when GT feels most lateral stop and measure the angle - normal is 8-15 of IR
less than 8 = retroversion
greater than 15 = anteversion
Resting hip position (loose packed)
30 flex
30 abd
Slight ER
CLose packed hip
max ext, IR, and Abd
