Hip - ANATOMY AND KINESIOLOGY part 2 Flashcards
Center-edge angle
- indicate how much of the fem head is covered
“Angle of Wiberg”
- reference ( vertical)
- lateral aspect of the
acetabulum
ABN:
<____deg= ____
>____deg= ____(pincer)
“Angle of Wiberg”
- reference ( vertical)
- lateral aspect of the
acetabulum
ABN:
<25 deg= dysplasia
>39 deg= FAI (pincer)
FAI- Femoral Acetab impingement
Acetabular Anteversion angle
Ref: ____
> ____ degrees (Ant) = instability/
dislocation
< ____degrees (Post) = excessive
coverage
Normal acetabular anteversion angle is ____
Ref: post acetabulum & post and ant
acetabulum
> 20 degrees (Ant) = instability/
dislocation
< 15 degrees (Post) = excessive
coverage
Normal acetabular anteversion angle is 15° to 20°.
Femoral Head epiphysis
Young: ____
Adult: ____
Fx fem neck : ____ interruption of blood supply
Young: small branch obturator aa
Adult: med fem circumflex aa
Fx fem neck : interference/ complete interruption of blood supply
Angle of Anteversion
Inc anteversion= ____
Retroversion= ____
Inc anteversion= shaft femur rotate medially
Retroversion= shaft of femur rotate laterally
Angle of Torsion of Femur
- Angle made by the femoral
neck with the femoral
condyle
Normal = ____°
* At birth, the mean angle is approximately ____°
* In the adult, the mean
angle is ____° to ____°
- Angle made by the femoral
neck with the femoral
condyle
Normal = 13-15°
* At birth, the mean angle is
approximately 30°
* In the adult, the mean
angle is 8° to 15°
Angle of Anteversion
Angle >15°
what happens to the shaft of femur?
◦Shaft of the
femur rotated
medially
Angle of Anteversion
Excessive anteversion
Related Posture?
Possible Compensatory
Postures?
Related Posture:
Toeing in
Subtalar pronation
Lateral patellar subluxation
Medial tibial torsion
Medial femoral torsion
Possible Compensatory
Postures:
Lateral tibial torsion
Lateral rotation at knee
Lateral rotation of tibia,
femur, and/or pelvis
Lumbar rotation on same side
Angle of Anteversion
Angle <13°
what happens to the shaft of femur?
◦Shaft of the
femur rotated
laterally
Angle of Anteversion
Excessive
retroversion
Related Posture?
Possible Compensatory Postures?
Related Posture
Toeing out
Subtalar supination
Lateral tibial torsion
Lateral femoral torsion
Possible Compensatory Postures
Medial rotation at knee
Medial rotation of tibia,
femur, and/or pelvis
Lumbar rotation on opposite
side
Craig’s test/ Ryder method
Test for Anteversion
Procedure:
(+):
Indication:
- Prone with the knee flexed
to 90° - Palpates greater trochanter
- Passive IR and ER until
greater troch is parallel to
table or most lateral position.
Neck Shaft Angle
Normal?
Coxa Valga degrees?
Coxa Vara?
Normal - 120°-135°
Coxa Valga - >135°
Coxa Vara - <120°
Neck Shaft Angle
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HIP JOINT
- Multiaxial ball-and-socket joint
- Synovial joint
- Very stable joint
- Femoral head is ____
- Acetabulum is ____
- Multiaxial ball-and-socket joint
- Synovial joint
- Very stable joint
- Femoral head is convex
- Acetabulum is concave
Coxa Valga: Longer
- limb ____
- hip ____
- Inc/dec? leverage abductor
Coxa Valga: Longer
- limb lengthening
- hip instab
- dec leverage abductor
Coxa Vara: Shorter
- limb ____
- increase ____
- Arthritic changes
Coxa Vara: Shorter
- limb shortening
- increase tensile forces- fem neck fx
- Arthritic changes
Compensatory: Valga
A. ipsi Valga- ____
B. C/L unaffected - ____
Compensatory: Valga
A. ipsi Valga- shorten the longer valga side
B. C/L unaffected - lengthen
Compensation: Vara
A. Ipsi Vara: ____
B. C/L : ____
Compensation: Vara
A. Ipsi Vara: to lengthen
B. C/L : shorten
PJM to Increase
Hip flexion
Posterior
PJM to Increase
Hip extension
Anterior
PJM to Increase
Hip internal rotation
Posterior
PJM to Increase
Hip external rotation
Anterior
PJM to Increase
Hip abduction
Inferior
PJM to Increase
Hip adduction
Superior
HIP Resting position
30° flexion, 30° abduction, slight ER
HIP Close pack position
Extension, abduction, IR
HIP Capsular pattern
Flexion, abduction, and IR
HIP Capsular pattern
Flexion, abduction, and IR
HIP ROM
Flexion
Extension
Abduction
Adduction
Lateral rotation
Medial rotation
Flexion - 110°-120°
Extension - 10°-15°
Abduction - 30°-50°
Adduction - 30°
Lateral rotation - 40°-60°
Medial rotation - 30°-40°
HIP JOINT
Average Range of Motion Necessary
Shoe tying
Sitting (average seat height)
Stooping
Squatting
Ascending stairs (average stair height)
Descending stairs (average stair height)
Putting foot on opposite thigh
Putting on trousers
Shoe tying - 120° of flexion
Sitting (average seat height) - 112° of flexion
Stooping - 125° of flexion
Squatting - 115° of flexion, 20° abduction, 20° of
medial rotation
Ascending stairs (average stair height) - 67° of flexion
Descending stairs (average stair height) - 36° of flexion
Putting foot on opposite thigh - 120° of flexion, 20° of abduction, 20° of
lateral rotation
Putting on trousers - 90° of flexion
Forces on the Hip
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Forces on the Hip
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LIGAMENTS OF THE HIP
- ______femoral
- ______femoral
- ______femoral
- Iliofemoral
- Pubofemoral
- Ischiofemoral
Iliofemoral Ligament
- Strongest ligament
- Inverted Y-shaped ligament
- Superior band limits: ______
- Inferior band limits: ______
- Prevents ______ during standing
- Strongest ligament
- Inverted Y-shaped ligament
- Superior band limits: adduction,
extension - Inferior band limits: abduction,
extension - Prevents overextension during
standing
Pubofemoral Ligament
- Triangular shaped
- Limits: ______
- Ipsi/Conra? pelvic tilt
- Triangular shaped
- Limits: extension,
abduction and ER - Ipsilateral pelvic tilt
LIGAMENTS OF THE HIP
- Spiral shaped
- Limits: ______
- Spiral shaped
- Limits: extension,
abduction and IR
FEMORAL TRIANGLE
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FEMORAL TRIANGLE
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ADDUCTOR TRIANGLE
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MUSCLES OF THE HIP
Flexors
1. I
2. P
3. S
4. TFL
5. RF
6. P
Flexors
1. Iliacus
2. Psoas major
3. Sartorius
4. Tensor fascia lata
5. Rectus Femoris
6. Pectineus
Iliacus
Nerve?
Action?
Nerve supply: Femoral (L1-L4)
A: Hip flexion, APT
Psoas major
Nerve?
Action?
Nerve supply: Lumbar plexus
( L1-L3)
A: Hip flexion, APT
THOMAS TEST
Procedure:
(+):
Indication:
- Prone, PT flexes knee
- Pt holds position
(+) leg rises off the table
* Tested leg pushed down=
inc lordosis
= Hip flexion contracture
(+) J sign/stroke- Abd
= Tight ITB
Sartorius
Nerve?
Action?
Nerve supply: femoral ( L2-L3)
A: Flexion, abduction,
external rotation of the hip
Tensor Fascia Lata
Nerve?
Action?
Nerve supply: SGN (L4-S1)
A: Flexion and abduction of
the hip, IR
OBER’S TEST
Procedure:
(+):
Indication:
Knee flexed? Inc stress on what
structure?
- S/L
- Passively Abd + ext c knee
ext/ flexed to 90 - PT slowly lowers leg
(+) Does not fall on table
= ITB contracture
flexed knee: stress on Fem nn
Rectus Femoris
Nerve?
Action?
Active : ______
passive insufficiency: ______
Nerve supply: Femoral (L2-L4)
A: Hip flexion, Extends knee
Active : too shortened
passive insufficiency: too elongated
“Rectus Femely”
KENDALL TEST
- aka RF contracture test
- Patient does KTC and
holds
Procedure:
(+):
Indication:
- aka RF contracture test
- Patient does KTC and
holds
N: angle of test knee
should remain at 90 deg
(+) knee extends
ELY’S TEST
Nerve?
Action?
- PT flexes knee
(+) Hip flexion on same side
= RF tightness
Pectineus
Nerve?
Action?
Nerve supply: Femoral ( L2-
L4)
A: Flexion, adduction, IR of
the hip
Adductors
1. Adductor longus
2. Adductor brevis
3. Adductor magnus
4. Gracilis
5. Pectineus
Adductors:
Hip neutral: ______
Hip already flexed: ______
- Adductor longus
- Adductor brevis
- Adductor magnus
- Gracilis
- Pectineus
Hip neutral: Hip flexor
Hip already flexed: assist in hip extension
Adductor longus
Nerve?
Action?
Add longus
______in extension
______in other position
Nerve supply: Obturator (L3-L4)
A: Adduction and flexion
Add longus:
ER in extension
IR in other position
Adductor brevis
Nerve?
Action?
Nerve supply: Obturator ( L3-
L4)
A: Adduction
Adductor Magnus
Nerve?
Action?
Nerve supply:
- Adductor portion: Obturator nn (L2-
L4)
- Hamstring portion: Sciatic nn (L4-S3)
A: Adduction
Gracilis
Nerve?
Action?
Nerve supply: Obturator ( L2-L3)
A: Adduction of hip and flexion of
knee
“Phelps Gracilis”
PHELP’S TEST
Procedure:
(+):
Indication:
- Prone c knees
extended -> Abd leg - Knees flexed 90 deg ->
abd further
(+) abd increases
= Gracilis tightness
Extensors
1. Gluteus maximus
2. Hamstrings
a) Biceps femoris
b) Semimembranosus
c) Semitendinosus
3. Adductor magnus
Extensors
1. Gluteus maximus
2. Hamstrings
a) Biceps femoris
b) Semimembranosus
c) Semitendinosus
3. Adductor magnus
Gluteus Maximus
Nerve?
Action?
MMT: G max
- ______
- ______
- Pt will ______
- PT will ______
- further flexion of knee = greater use of hamstrings
Nerve supply: IGN (L5-S2)
A: Extension of hip, lateral rotation,
PPT
MMT: G max
- prone
- hip straight c knee flexed to 90
- Pt will extend hip
- PT will put ant force on the post thigh
- further flexion of knee = greater use of hamstrings
Biceps Femoris
Nerve?
Action?
Nerve supply:
- Long head: Tibial portion of the sciatic
- Short head: Common peroneal of sciatic
A: Extension of the hip, flexion and lateral
rotation of the knee
TAKING OFF THE SHOE TEST
Procedure:
(+):
Indication:
- Take off the shoes of test side
- Place the heel at med longitudinal arch of opp leg
- (+) sharp pain at biceps fem - 1st or 2nd degree mm strain
Abductors
1. Gluteus medius
2. Gluteus minimus
3. Tensor fascia lata
Abductors
1. Gluteus medius
2. Gluteus minimus
3. Tensor fascia lata
Gluteus med
Nerve?
Action?
Anterior: ______
Post: ______
- as a whole: ______
Nerve supply: SGN ( L4-S1)
A: Abduction of the hip
Anterior: flexor and IR
Post: extensor and ER
- as a whole: abducts hip
Semitendinosus and
Semimembranosus
Nerve?
Action?
Nerve supply: tibial portion of
Sciatic nn ( L4-S2)
A: Extension of the hip, flexion
and medial rotation of the knee
Gluteus Minimus
Nerve?
Action?
Nerve supply: SGN ( L4- S1)
A: Abduction and internal
rotation of the hip
Tensor Fascia Lata
Nerve?
Action?
Nerve supply: SGN (L4-S1)
A: Flexion and abduction of the
hip, IR
External Rotators
1. Gluteus maximus
2. Sartorius
3. Piriformis
4. Gemellus superior
5. Gemellus inferior
6. Obturator internus
7. Obturator externus
8. Quadratus femoris
Piriformis
Nerve?
Action?
Nerve supply: 1st and 2nd sacral
nn (L5-S2)
A: Internal and external rotation
of the hip
