Hip Flashcards
Hip OA CPR
- Squatting as aggravating factor
- (+) Scour Test for groin or lateral hip pain
- Active hip flexion causing lateral hip pain
- Passve internal rotation < 25 degrees
- Active hip extension causing hip pain
Sartorius insertion point and possible pathology
ASIS
Avulsion fracture in adolescent athlete.
Muscles and ligaments that attach to pubic tubercle
Rectus abdominis
Adductor longus
Ilioinguinal ligament
Adductor magnus insertion and relevance to pathology
Inferior pubic ramus, inferior ischial ramus, and ischial tuberosity (medial portion)
Too broad to be a source of tendinopathy
Is predisposed to traumatic avulsion esp. at ischial tuberosity
Description of where hamstrings attach on ischial tuberosity
Lateral surface.
Semimembranosus inserts most laterally.
Shape of acetabulum/ changes with age
Starts more conical, transitions to spherical shape with weight bearing.
Faces ventral, lateral, caudal
Deeper acetabulum associated with more spherical femoral head.
Collodiaphyseal angle
Angle between femoral neck and diaphysis.
Starts at 150 deg, decreases to 120-130 by adulthood due to weight bearing.
<120 = coxa vara >130 = coxa valga
Center edge angle
Measures femoral head coverage by acetabulum
Normal = 30 deg.
<30 - dysplasia
Femoral angle of torsion
Normal ~15 deg anteversion in adulthood (Up to 40 deg in children)
Excessive anteversion -> Increased IR, decreased ER. Increases compression forces on hip cartilage, can predispose patient to tendinopathies. Best remedied with positional adaption before puberty
Decreased angle (Retroversion) -> Decreased IR, increased ER. Can lead to degenerative changes in anterior labrum. May be associated with instability. May be associated with pincer deformity.
Sometimes a complimentary acetabular torsion exists.
Area of acetabulum where cartilage is most developed
Posterior and anterior superior surfaces - greatest contact/ loading from femoral head during gait.
Acetabular dysplasia can lead to:
Ligament laxity
Instability
Early degenerative femoral head flattening and notching.
Labrum neurovascularization
- Has a variety of nerve endings > important in proprioception
- More vascularized on outer margins
- Superior labrum is less vascularized > susceptible to traumatic and degenerative tears
Plica folds in hip capsule
- At inferior edge of femoral head
- Can swell after trauma
- Trauma can lead to femoral head necrosis - recurrent blood supply from femoral artery courses deep to the plica on the way to the head
Ligamentum teres
Aids capsule in maintaing the reduction of femoral head
Conduit for neurovascular supply to femoral head.
High association rate between tears of ligamentum teres, labrum, and cartilage injury. Ligamentum teres rupture rare - 8%.
Can be a significant source of pain and mechanical sxs
Ligaments that are important in hip stability during quiet stance
Iliofemoral (Y), pubofemoral, ischofemoral ligaments. All taught in the upright position.
Which directions for dislocation are most likely
anterior inferior
posterior
Inguinal canal
Connects abdomen and scrotum/labia majora.
Males: Passageway for testes/ sperm cord
Females: Contains round ligament of uterus
Created by folding over of external oblique aponeurosis. This aponeurosis also creates a superficial inguinal ring, which can be the site of a direct inguinal hernia
Conjoint tendon
Posterior to the superficial inguinal ring. Created by fibers of internal oblique and TA muscles.
Hip joint innervation and location of referred pain
Anterior hip: Femoral, obturator nerves. Pain in groin
Posterior hip: Sacral plexus. Pain in buttock, trochanter
Rectus femoris insertion
AIIS
Predisposed to avulsion fx
Injury to reflected head can > superior labral lesion, similar to SLAP tear.
Prevalence of painless tears in glute med in individuals > 60 yo
10%
Pubic symphysis innervation and location of referred pain
Anterior: L2-L4 > Groin pain
Posterior: S3-S5> Genital pain
Movement of femoral head with cardinal plane motions
3 dimension movement due to oblique orientation of acetabulum.
Cardinal plane hip movement also creates movement in SIJ and lumbar spine.
Epiphysiolysis demographics
Females 11-13
Males 13-15