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Hip Flashcards

1
Q

Acetabulum

A

Pubis: 25% of acetabulum anteriorly

Ischium and ilium together: 75% of acetabulum

  • Ischium: posteriorly
  • Ilium: superiorly

Incomplete rim inferiorly = acetabulum notch, spanned by transverse acetabular ligament

Opening allows us to have a lot of mobility as femoral head rolls/glides around acetabulum

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2
Q

Acetabular Dysplasia

A

Malformed acetabulum leads to lack of femoral head coverage

Acetabulum not formed properly - instability in joint (surfaces are not big enough)

Altered stresses b/c surface area is congruent or smaller surface area

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3
Q

Acetabular Alignment - Center Edge Angle

A

Describes orientation of the acetabulum

Fixed angle of acetabulum in frontal plane (orientation of acetabulum in frontal plane)

Measures from hip joint center to rim of acetabulum (measure how much acetabular rims covers femoral head)

Too little coverage - dysplastic hip (dislocate)

Too much coverage can cause pinching and discomfort as head rolls out into abduction (pinching b/w acetabulum and femoral neck)

Looking at superior edge of femoral head and how much coverage acetabulum is giving

<16 degrees - markedly reduced acetabular coverage-dysplasia, increased stress

16-25 - reduced acetabular coverage - possible dysplasia, increased stress

35-40 - normal

> 40 - too much coverage

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4
Q

Acetabular Alignment - Acetabular ante- and retro version

A

Transverse/horizontal plane

What direction acetabulum face

Anteversion

  • Acetabulum faces too far anteriorly (dislocate hip anteriorly)
  • Can lead to unstable hip
  • Opening up joint
  • Ball is going to pop out of socket anteriorly

Retro version

  • Acetabulum faces too far posteriorly
  • Can lead to over-coverage, impingement b/w acetabulum and femoral head, abnormal stresses

Position can’t be created

Normal - 20 degrees
Anteversion - more than 20 degrees
Retroversion - less than 20 degrees

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5
Q

Labrum

A

Fibrocartilaginous ring functions to deepened acetabulum b/c it’s not deep enough

Provides stability, but more mobility

Increases contact area

Decreases stress

Labral tears are known source of pain

  • Poor vascularization
  • Doesn’t head well
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6
Q

Angle of Inclination

A

Frontal plane angle b/w femoral neck and femoral shaft

Normally 125 degrees

Coxa valga and coxa vara

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7
Q

Coxa Valga

A

Pathological increase (angle of inclination is more than 125 degrees)

Vertical orientation - moment arm of hip abductors is smaller - less mechanically advantageous - need to work harder

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8
Q

Coxa Vara

A

Pathological decrease (angle of inclination is less than 125 degrees)

Put more pressure on neck - more bending moment

Suffer from neck fractures

Abductors can function better here - moment arm increases (greater force can be generated, less work needs to be done) - greater mechanical advantage

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9
Q

Angle of Torsion

A

Femoral torsion describes relative motion (twist) b/w shaft and neck

Line thru femoral neck, condyles, head

Normally, 15 degrees anterior to frontal plane

Independent of acetabulum - occur on femur

Position of neck relative to femur

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10
Q

Excessive Anteversion

A

Angle of torsion

Increase in torsion - femur sits anteriorly

Less congruency b/w jt surfaces

Neck is more anterior to line from trochanter through femoral head

Individuals turn toes in, so that femoral head can IR and roll backward to increase joint congruency in acetabulum

Can be caused by W sitting in kids

Walk pigeon toes and can’t ER

More than 15 degrees

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11
Q

Retroversion

A

Angle of torsion

Line projects closely to frontal plane

Less than 15 degrees

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12
Q

Proximal Femur Internal Structure

A

Large bending moments at femoral neck

Bending moments reinforced by thick cortical bone/organized arrays of cancellous/trabecular bone

Cancellous bone extends from shaft to neck and head in organized arrays

Thick compact bone in cortex of lower femoral neck and in shaft

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13
Q

Capsule

A

Contributes substantially to stability

Thickened anteriorly/superiorly, thin posteriorly/inferiorly

Femoral neck - intracapsular

Greater/lesser troch - extracapsular

Synovial membrane

Mostly oriented parallel from neck to femur

Blood supply occurs here at the attachment of capsule to bone – vessels carrying blood to femoral neck and head

More likely to get femoral neck fractures b/c there is not a good blood supply to that region (just vessels to that area)

Hip is more likely to dislocate posteriorly b/c capsule is thinner

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14
Q

Ligaments

A

Reinforce capsule

Limites extreme motion

Iliofemoral, pubofemoral, ischiofemoral

End ROM of hip – defined by ligaments, capsules, muscles

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15
Q

Iliofemoral Ligament

A

Y ligament

Resists hip extension

Fan shaped, resembles inverted Y

Anterior

Provides stability when hip is extending (femoral head goes anterior)

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16
Q

Pubofemoral Ligament

A

Anterior

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17
Q

Ischiofemoral Ligament

A

Posterior

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18
Q

Hip Joint Stability

A

Achieved due to:

  • Bony configuration
  • Strong capsule
  • Reinforcing ligaments

Most congruent position - 90 degrees hip flex, slight abduction, ER

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19
Q

Close-Packed Position

A

Full ext, slight IR, abduction

Elongates most of capsule, not the most congruent

Most taut

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20
Q

Open-Packed Position

A

30 degrees of hip flex, slight abduction, ER

Most space in capsule

Feeling good for patient who is swollen/edema (room for fluid to move)

Can shorten hip flexors and cause contracture

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21
Q

Hip Joint Mobility - Osteokinematics

A

Mostly osteokinematic motion

Some arthrokinematic motion (translation present)

Relative alignment of acetabulum and femoral head dictates available motion of hip

Normal: head of femur oriented anteriorly and superiorly in the acetabulum, exposes anterior femoral head and leaving large articular surface available for flexion, limits maximal extension

22
Q

Glides

A

Used as intervention to improve osteokinematic motion

Lack hip flexion - posterior glide

Lack hip extension - anterior glide

23
Q

Femur on Pelvis Osteokinematics

A

Ball and socket joint

Hip flex/ext - M/L AoR - sagittal plane

Abd/add - A/P AoR - frontal plane

IR/ER - vertical AoR - transverse plane

24
Q

Pelvis on Femur Osteokinematics

A

Anterior and posterior pelvic tilt (flexes/extends hip) - sagittal plane - M/L AoR

Lateral pelvic tilt (abd/add hip) - frontal plane - A/P AoR - restricted to about 30 degrees

Pelvic rotation (IR/ER hip) - transverse plane - vertical AoR

25
Anterior and Posterior Pelvic Tilt
Anterior - hip flexion Posterior - hip extension Vertical line will intersect ASIS and public symphysis
26
Lateral Pelvic Tilt
Hip hike - stance leg is abducting Hip drop - stance leg is adducting
27
Pelvic Rotation
Pelvis moving, stationary leg Rotate pelvis toward stationary leg - stationary leg toes in - IR Rotate pelvis away from stationary leg - stationary leg toes out - ER
28
Interaction of Hip and L/S Motion
May explain differences in normal hip ROM (femur-on-pelvis) Posterior pelvic tilt can contribute to hip flexion (move into flexion - reach hip end ROM - continue to push - pelvis tilt posteriorly - lumbar flexes, pelvis rotates - augments hip flexion) Anterior pelvic tilt contributes to apparent ext (move into ext - continue to push - pelvis tilts anteriorly - lumbar ext - augments hip ext) Trunk sidebend and frontal plane pelvic motion contributes to apparent abduction When we walk, long stride length - combo of pelvic rotation and lumbar rotation - gives hip ext
29
Lumbopelvic Rhythm
Pelvic motion on femur affects lumbar spine motion and vice versa - due to distal spine attachment to pelvis Ipsilateral and contralateral
30
Ipsidirectional Lumbopelvic Rhythm
Flex forward - take slack of each vertebrate until end ROM - continue to bend - pull of lumbar spine causes pull of sacrum - causes ipsidirectional anterior rotation of pelvis
31
Contralateral Lumbopelvic Rhythm
Keeps head above trunk when standing Anteriorly tilt pelvic – opposite direction motion (pelvis rotates anteriorly, lumbar spine extending) Keep us upright
32
Arthrokinematic (Convex-Concave) Rules
If convex joint surface moves on concave surface, roll and glide occur in OPPOSITE directions If concave joint surface moves on convex surface, roll and glide occur in the SAME direction Femoral head will glide within the acetabulum in a direction OPPOSITE the motion of the distal femur Roll - direction of distal femur -Ext: femur back, head rolls back, head glides anterior
33
Arthrokinematics (Spin)
Hip flexion/extension mostly spin -Posterior in flexion, anterior in extension Hip flex/ext combined with abd/add or IR/ER- both spinning and gliding Closed chain motion= concave on convex - Flexion (Pelvis moving anteriorly on femur): anterior glide, anterior roll - Extension: posterior glide, posterior roll
34
Double Limb Stance
Hips in neutral, weight is distributed evenly LOG is just posterior to the M/L AoR for flex/ext Body weight is transmitted thru the SIJ to femoral heads If in alignment, no muscular force is needed Glux max is not contracted - when you move, the LOG moves anterior, which causes it to fire Standing normal - muscles are quiet Capsules, ligaments, tendons keep us upright
35
Single Limb Stance
One hip joints carries full body weight Weight of NWB leg is hanging BW causes compression as well as torque - compression at hip, adduction torque as gravity works to drop pelvis Requires counter torque or pelvis will drop (abductors) Standing on one leg - add rotational torque (gluts fire to keep me stabilized on one leg)
36
Single Limb Stance - What if Abductors Can't Generate Enough Torque?
Lateral trunk lean - Toward the side of weakness/pain - Brings LOG closer to hip joint AoR Trendelenberg -Contralateral pelvic drop (NWB pelvis drops) w/ or w/o lateral lean Contralateral cane - Provides counter torque to assist abductors - Reduces compressive forces by decreasing force generation from abductors
37
Trendelenberg
Gluts not strong Opposite pelvis drop Shift trunk over leg to compensate for weak gluts Shift body, so that trunk is lateral to AoR AoR is ant/post, but body shifts lateral to this line
38
Hip Flexors
Iliopsoas, sartorius, TFL, rectus femoris, adductor longus and pectineus Pelvic-on-femur hip flex - anterior pelvic tilt (force couple = iliopsoas and erector spinae) Femur-on-pelvis hip flex - demands abdominal muscles to stabilise L/S when hip flexion is performed w/ knee ext (SLR) - would result in lumbar ext if abs did not stabilize spine
39
Hip Extensors
Glut max, hamstrings, adductor magnus Pelvic-on-femur hip ext - Posterior pelvic tilt (force couple = hamstrings and abs) - Control trunk in forward lean (tilt body forward - glut max is helping to stabilize hip, so we don't fall into flexion) Femur-on-pelvis hip ext - Flexed position favors increased extensor torque generation from glut max, adductors, hamstrings (able t do more mvt) - Glut max is quiet is standing (b/c HAT weight extends hip) - Glut max activity in single limb squat, mini squat, ascending stairs - Glut max and hamstrings active during terminal swing and beginning of stance (eccentric contraction)
40
Hip Adductors
Pectineus, gracilis, adductor longus, adductor brevis, adductor magnus Produces torques in multiple planes - Frontal: pelvic-on-femur, femur-on-pelvis - Sagittal: act as either flexors or extensors, depending on position of hip Important role in stabilizing pelvis during weight shifting from one limb to another Position of flex - adductors in posterior position of M/L AoR to assist w/ hip ext Position of ext - adductors anterior to M/L AoR will help with flex
41
Hip Abductors
Glut med, glut min, TFL Essential during gait - Control of single limb stance (pelvis on femur) - Responsible for producing force 2X BW during gait - Produce greatest torque in slight add/neutral position - Least torque in fully shortened position (test muscles in this position b/c pts generate least force)
42
Internal Rotators
Glut med, glut min, TFL, adductor longus/brevis, medial hamstrings Greatest torque when hip is flexed to 90 degrees b/c it moves the LOA perpendicular to AoR (MMT in this position) Visible functionally in stance phase of gait (pelvis comes forward) No prime muscle that does IR - fibers of other muscle that works to IR
43
External Rotators
Glut max, sartorius, piriformis, gemelli, obturator internus, quadratus femoris Most evident during pelvic-on-femur rotation (planting and cutting maneuver) LOA oriented toward horizontal plane Piriformis - changes functions from ER to IR after 90 degrees b/w line of pull is changed to anterior AoR
44
Special Tests
Part of examination Selected specific to joint/structure - "Provocative in nature" - Confirms suspected diagnosis - Assists w/ differential diagnosis - Differentiates b/w structures Always test uninvolved side first - baseline comparison
45
Ely's Test
Purpose: to test for rec fem tightness Procedure: patient prone, PT brings foot to butt while stabilizing pelvis and checking for anterior pelvic tilt Positive: anterior pelvic tilt/ipsilateral hip flex spontaneously occurs Negative: no pelvic mvt, heel touches or approximates butt
46
FABER Test (Flex, Abd, ER)
Purpose: to test for iliopsoas spasm or SI joint intervention Procedure: patient supine, PT passively flexes knee, places foot on knee of opposite leg (Figure 4), PT slowly drops knee Positive: knee doesn't drop below level of opposite thigh Negative: knee lowers to level of table or level of opposite thigh
47
Ober Test
Purpose: to screen for IT band contracture Procedure: pt sidelying w/ bottom hip/knee flexed, PT stabilizes pelvis and passively abducts and extends top hip, and then slowly lowers legs Positive: test thigh doesn't lower past horizontal (remains abducted) Negative: test thigh lowers into hip add
48
Thomas Test
Purpose: to screen for hip flexor contracture Procedure: pt supine w/ knee flexed to chest, PT assess straight leg for position relative to table Positive: straight leg will raise off exam table (muscle stretch may be felt) Negative: straight leg rests on exam table Often performed w/ patient at edge of table, allowing hip to extend, knee to flex and providing PT w/ additional info regarding rec fem (extended knee - rec fem causing hip contracture)
49
Trendelenberg
Purpose: to screen for hip stability/hip abd weakness Procedure: pt standing, stand on unaffected first, then stand on affected side while PT watches contralateral pelvic drop Positive: Contralateral pelvic drops when standing on affected leg suggesting markedly weak gluteus medius or an unstable hip Negative: Contralateral pelvic rises or stays level
50
Weber-Barstow Manuever
Purpose: to screen for limb length asymmetry Procedure: pt supine w/ hips and knees flexed, find medial malleoli and go distal, pt bridges, PT extends legs and reassesses symmetry Positive: asymmetrical position of medial malleoli Negative: symmetrical position of medial malleoli

Kinesiology (5 decks)

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