Hip and pelvis Flashcards
ball and socket joint of the hip allows for what movement
3 DF
Flex and extension
abd and add
ER and IR
fovea
attachment for the ligamentum teres
two planes for the femoral neck
angle of inclination
torsional angle
what plane angle of inclination
frontal
normal angle of inclination
120 - 125
coxa valga
greater the 125
not stable - too mobile
coxa vara
less than 120
not mobile enough
torsional angle plane
transverse plane
normal torsional angle
8-14 degrees ant from neutral reference
anterversion
increased torsional angle
femoral head settles into joint
feet turned inwards
retroversion
decrease in torsional angle
joint is not stable enough
feet turn outwards
angle of inclination and torsional at birth
All these angles start higher at birth and get lower w/ age
arcuate bundles
Primarily handles tensile stress, follows the path of Femoral neck
Supporting Bundle
Primarily handles compressive loads
head of the femur
Trochanteric Bundle
A secondary accommodator of compressive loads
between the trochanters
Accessory Bundle
where we have lots of attachments
on the greater trochanter
Zone of Weakness
Common site of femoral neck fractures, there is not a lot of pressure
in the middle of the neck
what way does the ace face
ALI
anterior
lateral
inferior
Acetabular Notch
the inferior interruption of the acetabulum
is the femoral head completely covered by the ace
no
- the femoral head and the acetabulum are both oriented anteriorly
center edge angle
the amount of overhang of the ace over the femoral head
normal: 30 - 40
Acetabular Fossa
The central, deepest portion of the acetabulum
Not covered by articular cartilage
Contains fibroelastic fat pad
Transverse Ligament
Spans the acetabular notch, completes the circle with the labrum
articular cart innervation and blood vessels
avascular and minimally innervated
no healing or pain
Femoral Articular Cartilage
Thickest superiorly-posteriorly
Thinnest inferior
Fovea Capitis- Articular Cartilage
area devoid of articular cartilage
Acetabular Articular Cartilage
Horseshoe shaped lining of the periphery of the acetabulum
Thickest superiorly
Acetabular Labrum
Horseshoe shaped fibrocartilage ring attached to periphery of the acetabulum
Acetabular Labrum Internal Surface
Attached to acetabular rim and transverse acetabular ligament
Acetabular Labrum Central Surface
Lined by articular cartilage continuous with that of the acetabulum
Acetabular Labrum Peripheral Surface
Attaches to joint capsule at the base
role of the labrum
helps provide more joint stability - more overhang
labrum and stress
spreads the impact of force of a larger area of the joint surface
what make hip joint suction effect
labrum and joint capsule
BV of labrum
poor - therefore bad healing
joint capsule
Dense, relatively inelastic, fibrous capsule
2/3 of the femoral neck is intracapsular
proximal and distal parts of hip joint capsule
Proximal: Acetabular rim
Distal: Base of femoral neck
most important capsule fiber
Circular deep fibers (zona orbicularis),
Forms a collar around the femoral neck
Provide the stability to the joint
Ligamentous Reinforcement of the hip joint
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Anterior Ligaments
Iliofemoral Ligament
Pubofemoral Ligament
Iliofemoral Ligament position
AIIS –> intertrochanteric line
primary role of Iliofemoral Ligament
Limits hip extension & external rotation
Iliofemoral Ligament 2ndary function
Inferior band can limit abduction;
superior band can limit adduction
what is the strongest ligament in the hip
Iliofemoral Ligament
Pubofemoral Ligament local
Runs from pubic ramus to the intertrochanteric fossa
Pubofemoral Ligament primary function
Limits abduction
Pubofemoral Ligament Secondary function
Limits extension and possibly external rotation
Ischiofemoral Ligament local
ischium posterior surface of acetabulum to the medial surface of the greater trochanter
Primary Ischiofemoral Ligament
Limits internal rotation
Secondary Ischiofemoral Ligament
: Limits extension and adduction
Ligamentum Teres local
Attaches to the fovea of the femoral head
Ligamentum Teres function
ligament may help stabilize the hip joint in hypermobile individuals
Factors Enhancing hip Stability
Atmospheric pressure (vacuum effect of joint)
Gravity (in standing position)
Ace compressing on the femur
Capsule and ligaments*
Acetabular labrum*
Bursae
Fluid-filled structures that function to reduce friction between tissues of the body
Primary bursae of hip/pelvic region
Iliopsoas/iliopectineal
Trochanetric
Ischial
Ignore
Bursae
bursitis
when the bursae become inflammed and painful
Iliopsoas/ Iliopectineal bursea location
Deep to the iliopsoas on the floor of the femoral triangle, just anterior to the hip joint
Trochanteric bursea
Superficial, between the greater trochanter and iliotibial band
Ischial bursa
Overlies the ischial tuberosity just covered by edge of the gluteus maximus
loos packed position for the hip joint/open packed
30 degrees flexion, 30 degrees abduction, & slight external rotation
what do we look at in Loose-Packed Position
often preferred position to apply joint distraction or initially apply joint mobilization techniques when delivering manual therapy
Closed-Packed Position for the hip joint
Extension with slight abduction and internal rotation (other sources suggest external rotation)
Closed-Packed Position meaning
This is the position of maximal ligamentous tension
is the closed packed position the position of maximal articular congruency
no, Quadruped is
Quadruped
90 degrees flexion
Slight abduction
External Rotation
Position of maximal concordance/congruency
Non Weight Bearing Arthrokinematics
Roll and glide occur in opposite directions
Weight Bearing Arthrokinematics
Roll and glide will occur in the same direction
rolling movement compared to glide
Because of the inherent stability of the hip joint (deep socket), rolling movement is proportionately greater than glide
Femoral head roll is close to a
spin
External Rotation NWB
Roll: posterior
Glide: anterior
Internal Rotation NMB
Roll: anterior
Glide: posterior
Forward Flexion WB
Roll: anterior & inferior
Glide: anterior & inferior
Standing Extension
Roll: posterior & superior
Glide: posterior & superior
where do we Apply manual glide on the hip
medial and inferior direction
Ambulation swing phase
non weight bearing
Ambulation stance phase
WB
what plane is ambulation in
sagittal
Single Limb Stance center of mass
body lies posterior and medial to the hip joint
Single Limb Stance center of mass results on the hip
this creates a rotatory moment about the hip into adduction and some extension
To provide normal stability; the hip abductors must overcome this moment - abductors must contract with considerable force to achieve this
Single Limb Stance abductor response
The abductor muscle group contraction force creates a joint reaction force at the hip that is up to 3x an individual’s bodyweight
painful hip in single limb stance
the body will attempt to decrease this force via decreasing the need for the abductors to contract.
Trendelenburg Sign in single leg stance
in a single limb stance, the pelvis drops to the opposite side of the stance leg; observed with abductor weakness or inhibition
This may also be accomplished by shifting the weight over the stance limb (compensation)
Sagittal Plane gait mechanics
Flexed at heel strike
Extends through stance phase
Begins flexing again as heel raises off ground
Flexes through swing phase
Frontal Plane gait mechanics
Neutral to slight adduction at heel strike
Abducts to neutral or slight abduction throughout stance phase
Abducts through swing phase (begins after contralateral heel strike)
not as much movement in this plane - a wide deviation in movement can be observed in normal gait
transverse plane gait mechanics
Neutral before heel strike
Rapid but not extreme internal rotation in early stance
Slow external rotation throughout stance to neutral at heel lift
is normal gait the same for everyone
no normal gait is varible
three joint of the Innominate
Left and right sacroiliac joints
The pubic symphysis
Innominate function
Transmit forces between the lower extremities and the spine
The boney architecture of the pelvis favors
stability
Sacrum made out of
Consists of five fused vertebrae
Contains 4 pairs of sacral foramina
Sacrum location
Located in a wedge-like fashion between the innominates
Lateral surfaces of sacrum articulate with
the ilia (forming the sacroiliac joints)
Base of sacrum articulates with
L5
Apex of sacrum articulates with
the coccyx
Sacroiliac Joints - joint type
Planar synovial joints
Pubic Symphysis location
Anterior midline joint
connection in the pubic symphysis
Connected by fibrocartilage disc structure with additional ligamentous reinforcement
Sacral hiatus is the access for what
the epidural space used for caudal nerve blocks
why do we mainly see differnce in male and female pelvis
(XX)female give brith
gender difference pubic arch
50-80 degrees (m)
> 90 degrees (f)
Gender difference hip height
Taller (m)
Shorter (f)
Concavity gender differnce
Conical (m)
Cylindrical (f)
gender differnce Sacrum
Longer/narrower (m)
Shorter/wider (f)
gender differnce Sacral concavity
Shallower (m)
Deeper (f)
Gender difference Sciatic notch
Narrower (m)
Wider (f)
Gender difference Acetabular distance
Narrower (m)
Wider (f)
Iliolumbar Ligament location
Runs from the transverse process of L4 and L5 attaching distally to the iliac crest, anterior sacrum, and sacroiliac joint region
Iliolumbar Ligament function
Provides stability to the lumbrosacral junction via resisting posterior rotation of innominate and forward glide of L5 on the sacrum
Sacrotuberous Ligament location
Travels from the ischial tuberosity to the inferior portion of the sacrum
Sacrotuberous Ligament function
Provides resistance to posterior rotation of the innominate and sacral nutation
Muscular Involvement of sacrotuberous ligament
This ligament serves as an origin for fibers of the gluteus maximus and the hamstrings
Sacrospinous Ligament location
Connects the ischial spine and the anterior and lateral borders of the sacrum
Sacrospinous Ligament function
Functions to resist posterior rotation of the innominate and sacral nutation
Sciatic Foramina formed by
Formed in part by the sacrospinous and sacrotuberous ligaments
Greater Sciatic Foramen:
Bounded anterior and superior by the greater sciatic notch, posterior by the sacrotuberous ligament, and inferiorly by the sacrospinous ligament
Partially filled by the piriformis muscle and nerves of the sacral plexus
Lesser Sciatic Foramen
Bounded anterior by the body of the ischium, superior by the sacrospinous ligament, and posterior by the sacrotuberous ligament
Anterior Sacroiliac Ligament
Thickens the anterior sacroiliac joint capsule
Has a contribution from the iliopsoas muscle
Relatively strong at the level of the SI joint; but thin and relatively weak elsewhere
Susceptible to tearing from traum
Interosseous Ligament
Spans the syndesmotic portion of the sacroiliac joint
Extremely Strong; resists separation of the joint surfaces
Posterior Sacroiliac Ligament location
Located in depression between sacrum and ilium
Posterior Sacroiliac Ligament superior portion/short band
Oriented horizontally
Attachments to 1st and 2nd sacral tubercles and the tuberosity of the ilium
Posterior Sacroiliac Ligament inferior portion/long band
Oriented obliquely
Attachments to 3rd and 4th tubercles of the sacrum and the PSIS
Blends with the sacrotuberous ligament inferiorly, and with the fibers of the mutifidus and erector spinae aponeurosis medially
Functions to resist counternutation of the sacrum and anterior innominate rotation
what happens to the ligaments during pregnecy
Ligaments more relaxed during pregnancy
This allows more movement through sacroiliac and symphysis joints
Hypermobility after child birth is common for 5-6 weeks
movement of the pelvis complex
Iliosacral Movement:
Sacroiliac Movement
Iliosacral Movement
Innominate moving on fixed sacrum
Occurs primarily in the sagittal plane
Sacroiliac Movement
Sacrum rotating within fixed/stable innominate
Movement described to occur about variable axes and is debatable
Anterior Rotation - Iliosacral Movement
ASIS moves inferior
PSIS moves superior
Posterior Rotation - Iliosacral Movement
ASIS moves superior
PSIS moves inferior
Nutation - Sacroiliac Movement
flexion
Sacral base moves anterior/inferior
anterior
counternutation - Sacroiliac Movement
extension
Sacral base moves posterior/superior
posterior
The muscle most commonly considered in SI joint movement is
the piriformis
attaches to the front of the sacrum
What is the primary casue of movement in the sacroiliac joint
The effects of the spine and gravity are more commonly the cause of movement
Iliopsoas/Rectus Femoris influence on the si joint
May cause anterior rotation of the innominate
Hamstring Group influence on the si joint
May cause posterior rotation of the innominate
Gluteus Maximus influence on thr si joint
Contraction of this muscle may cause posterior rotation of the innominate secondary to attachments to the long posterior and sacrotuberous ligaments
piriformis
unilateral contraction of tightness has the potential to cause torsion of the sacrum
muscle plus tightness in the SI
test for muscle tightness may prove useful if you think the problem is coming from the SI joint
contraction of certain muscle can be used to reach positional faults by creating movement in a specific direction
