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MSI - Post Midterms > Hip and Pelvis > Flashcards

Hip and Pelvis Flashcards

1
Q

What is the innominate formed from?

A

3 bones of the pelvis: Illium, Ischium, and Pubis

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2
Q

What are the important features of the ilium?

A

gluteal lines, ASIS, AIIS, PSIS, PIIS, iliac crest, iliac fossa

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3
Q

What are the important features of the Ischium?

A

ischial spine, greater and lesser sciatic notch, ischial tuberosity

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4
Q

What are the important features of the pubis?

A

superior pubic ramus, body, crest, pectineal line, pubic symphysis, inferior pubic ramus

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5
Q

What is the acetabular orientation? And what is it’s goal?

A

Acetabular orientation
Lateral
Inferior
Slightly anterior (20º)

Goal: provide OPTIMAL femoral head coverage

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6
Q

What part of the acetabulum is nonarticular?

A

Acetabular fossa

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7
Q

What part of the acetabulum is non-articular?

A

Acetabular fossa

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8
Q

What is the purpose of the acetabular labrum?

A

Stability: deepens and seals

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9
Q

What is the femoral head covered with?

A

Articular cartilage

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10
Q

What attaches to the fovea capitis

A

ligament of head of femur (ligamentum teres)

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11
Q

What is the orientation of the femoral head?

A

slightly anteriorly, medially and superiorly

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12
Q

What is the position of the femoral shaft prior to 8 weeks in utero?

A

abducted, flexed and laterally rotated position (relative to neck)

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13
Q

What is the position of the lowers limbs after 8 weeks in utero? What is this for?

A

After week 8: lower limbs adduct and medially rotate

Parallel position of LE in erect stance
Brings condyles anteriorly

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14
Q

What is the Angle of inclination?

A

Angle through femoral head/neck and shaft
NORM = 125° (± 5°)

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15
Q

What does the angle of inclination start out as after birth?

A

165°

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16
Q

What is coxa valga

A

Angle of inclination > 125°

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17
Q

What is coxa vara?

A

Angle of inclination < 125°

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18
Q

What are the resultant stresses of coxa valga?

A

Valga = < bending < MA of abductors

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19
Q

What are the resultant stresses of coxa vara?

A

Vara = > bending > MA of abductors

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20
Q

What is the angle of torsion and what are its norms?

A

Medially rotated position of distal femoral condyles and shaft in relation to the head and neck (in utero)
Axis through femoral head/neck and DISTAL femoral condyles
NORM = 15-20°

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21
Q

What is anteversion? What degrees and what stresses does it cause?

A

Anteversion > 20°
Changes in:
IR>ER ratio
Comprises Hip stability
Stresses on distal joints

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22
Q

What is a toeing in gait compensation for?

A

Excessive anteversion, knee MR to improve coverage of femoral head

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23
Q

What can lateral tibial torsion be a result of?

A

Compensation from toeing in gait: Keeps feet straight in stance, but still has underlying excessive anteversion

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24
Q

What is retroversion? What degrees and what stresses does it cause?

A

Retroversion <15°

Implicated with FAI (femoral acetabular impingement) & labral pathology
Over-coverage!

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25
Q

What is the Center edge angle? (CEA)

A

Degree to which acetabulum covers femoral head

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26
Q

What is the acetabular anteversion angle?

A

Degree to which acetabulum faces anteriorly

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27
Q

What is the anatomic axis of the hip joint?

A

Line through femoral shaft

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28
Q

What is the mechanical axis of the hip joint?

A

Vertical; connects center of hip and knee joint

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29
Q

What kind of forces are created from the disconnect between the anatomic and mechanical axis of the hip joint?

A

Creates bending force through shaft of femur
Vertical loading results in bending forces
Tensile forces laterally
Compressive forces medially

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30
Q

What kind of force (weight) is transferred through the femoral head?

A

HAT (head, arms, and trunk)

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31
Q

What kind of force is transferred through the shaft of the femur?

A

GRF (gravitation reaction force)

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32
Q

What is the net result of the HAT and GRF at the femur?

A

2 forces parallel & opposite in direction BENDING moment

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33
Q

What are trabeculae?

A

Calcified plates of tissue within cancellous bone allowing femoral head/neck to absorb stresses and resist bending moments produced by HAT and GRF

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34
Q

What are the two main trabeculae of the femur?

A

Medial (principal) compressive
Lateral (principal) tensile (arcuate)

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35
Q

What are the 3 minor trabeculae of the femur?

A

Secondary compressive, secondary tensile, trochanteric

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36
Q

What are the strongest parts of the adaptive trabeculae?

A

Areas of crossing

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37
Q

What is the weakest part of the femur head known as? Where is it?

A

Zone of weakness

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38
Q

What is the primary WB surface of the acetabulum?

A

Superior lunate surface

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39
Q

Where is the articular cartilage the thickest?

A

Thickest over superior aspect of head of femur and superior lunate surface

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40
Q

How does the articular cartilage of the hip joint get its nutrition?

A

Nutrition maintained by WB
Compression and release of load

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41
Q

What happens when we change alignment of the hip joint?

A

ALTERED Stresses

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42
Q

Where will degenerative changes most likely occur?

A

In the areas of the joint that receive the most load from misalignment (or in general)

43
Q

In what position is there max articular contact in the hip joint?

A

Flexion, Abd, ER (slight)

44
Q

What is the close pack position of the hip joint?

A

hip extension, slight abd, IR

45
Q

What structures contribute to the stability of the hip?

A

Acetabular fossa
Capsuloligamentous structures
Labrum

46
Q

Where is the capsule of the hip and what are some of its features?

A

Proximal to acetabulum and labrum & distally to femoral neck
Thickest & strongest anteriorly and superiorly
Lined with synovium

47
Q

What is the lowest ligamentous tension position of the hip joint?

A

flexion, slight abd and ER

48
Q

What is the strongest hip ligament?

A

Iliofemoral ligament

49
Q

Where are the attachments of the iliofemoral ligament?

A

AIIS  intertrochanteric line of femur

50
Q

What are the two bands of the iliofemoral ligament?

A

medial and lateral fasciuli

51
Q

What does the iliofemoral ligament resist?

A

Extension & ER
Taught in standing

52
Q

Where is the center of gravity in relation to the iliofemoral ligament?

A

Superior, and posterior

53
Q

Where does the Pubofemoral ligament attach?

A

Anterior pubic ramus anterior intertrochanteric line

54
Q

What does the pubofemoral ligament resist?

A

Hip abduction and extension and to a lesser degree ER

55
Q

Where does the ischiofemoral ligament attach?

A

Posterior surface of acetabular rim and labrum inner portion of greater trochanter

56
Q

What is the weakest of the 3 extra-articular ligaments?

A

Ischiofemoral ligament

57
Q

What does the ischiofemoral ligament resist?

A

Resists IR (esp combined with abd) and slightly taught in extension

58
Q

What is the intra-articular ligament of the hip called and where does it attach?

A

Ligamentum teres
,Acetabular notch  fovea of femur

59
Q

What is the purpose of the Ligamentum teres

A

Conduit for blood supply to femoral head (in children)
Contributes to hip stability

60
Q

What is the acetabular labrum?

A

Triangular shaped fibrocartilagenous structure surrounding periphery of acetabulum

61
Q

What are some functions of the acetabular labrum

A

Innervated
Function
Deepen socket
Stability- forms seal
Proprioception

62
Q

What is Lumbopelvic rhythm and what kind of motion is it?

A

kinematic relationship between movement of the pelvis over the femoral heads which changes the position or configuration of the lumbar spine

Pelvis on Femur Motion

63
Q

What are the two types of lumbopelvic rhythem?

A

Ipsidirectional vs. contradirectional

64
Q

What pelvic on femur motion occurs in the sagittal plane?

A

Anterior/posterior pelvic tilt

Ant relative hip flexion & lumbar hyperextension
Post relative hip extension & lumbar flexion

65
Q

What pelvic on femur motion occurs in the frontal plane?

A

Lateral pelvic tilt / hip hike
Frontal plane motion
One hip is axis of motion for the other
Mostly in SLS

66
Q

What pelvic on femur motion occurs in the transverse plane?

A

Forward / backward rotation
Occurs in SLS with one WB hip joint (axis); motion named for NWB hip

67
Q

What are the arthrokinematics of the hip?

A

Convex on concave with femur on pelvis motion
Flex/ext mostly pure spin
IR/ER & abd/add include roll and glide

68
Q

What are the 4 primary flexors of the hip?

A

Iliopsoas**
Rectus femoris
also EXT knee
Sartorius
Tensor fascia latae
Flex, abd and IR hip*
Maintain tension in ITB to reduce tensile stresses on femur

69
Q

What is the innervation of the rectus femoris and the sartorius?

A

Femoral n

70
Q

What is the innervation of the ilipsoas?

A

lumbar plexus L1-4; femoral n

71
Q

What is the innervation of the TFL?

A

Superior gluteal

72
Q

What are the secondary flexors of the hip?

A

Pectineus, Adductor Longus, Adductor Magnus and Gracilis

73
Q

What are the muscle actions with femur on pelvis hip flexion?

A

Occurs with knee flexion during swing phase of walking and running
Requires activation of abdominals

74
Q

What are the muscle actions with pelvis on femur sagittal motion?

A

Anterior pelvic tilt- combined action of hip flexors and lumbar extensors

75
Q

What are the adductors of the hip?

A

Superficial layer: Pectineus, Adductor longus, gracilis
Middle layer: Adductor brevis
Deep layer: Adductor magnus

76
Q

Action of hip adductors in frontal plane?

A

Frontal plane function
Adduct the femur
Provide stability for pelvis in stance

77
Q

Action of the hip adductors in the sagittal plane?

A

Flexion and/or extension depending on position of the hip

78
Q

What are the extensors of the hip?

A

Gluteus maximus
Extends the hip and ER hip in neutral extension
Strong extensor
Hamstrings
3 muscles
All extend the hip and flex the knee joint
Origin: ischial tuberosity
Posterior (hamstring) portion of adductor magnus

79
Q

What is the innervation of the extensors?

A

Glut. Max - inferior gluteal nerve
Hamstrings and Posterior (hamstring) portion of adductor magnus
- Greater Sciatic

80
Q

What are the positions of the hip and lumbar spine in posterior pelvic tilt?

A
81
Q

How do the hamstings control the forward lean of the body?

A

hamstrings contract eccentrically; lengthened across both attachments

82
Q

What happens in femur on pelvis hip extensor action?

A

Produces large and powerful hip extension torque to rapidly accelerate the body forward and upward
Flexed position of the hip favors greater extension torque

83
Q

How does the gluteus medius function as a hip abductor?

A

Abductors Gluteus medius
3 portions (ant, middle and posterior)
Abduct always; 2nd Action dependent on position of hip
In FLEXION All IR
In Neutral
Ant/middle IR
Posterior ER
(superior gluteal nerve innervation)

84
Q

What does the gluteus minimus do? What is it’s inneveration

A

Deep and anterior to the medius
Abduction and flexion
(Superior gluteal nerve)

85
Q

What is the function of the hip abductors in standing (closed chain)

A

maintain LEVEL pelvis in SLS
Critical for frontal plane stability during walking (single limb stance)

86
Q

What are the external rotators of the hip?

A

Obturator internus & externus
Gemellus superior & inferior
Quadratus femoris
Piriformis

87
Q

What is the innervation of the external rotators of the hip?

A

Obturator nerve

88
Q

What is the femur on pelvis action of the external rotators?

A

External rotation of the hip

89
Q

What role do the extra rotators of the hip provide and pelvis on femur motion?

A

Provide stability in WB
Creates compressive moment throughout hip ROM
Move acetabulum on fixed femur in gait (pelvic ER) stance limb contracts to rotate pelvis AWAY

90
Q

True or false, no single muscle performs internal rotation of the hip

A

True

91
Q

What are the largest contributors to internal rotation at the hip joint?

A

Anterior fibers of gluteus medius
Gluteus minimus
TFL
Adductors (adductor longus, brevis and pectineus)

92
Q

What is the important function of internal rotation and gait in the hip joint?

A

Produces IR of the pelvis on femur in the early part of stance

93
Q

What is the most optimal position for internal rotation of the hip?

A

Increased IR torque (3x) with hip flexion compared to hip extended position

94
Q

How much of the HAT is supported by the pelvis and how is that divided?

A

Pelvis supports 2/3 HAT
1/3 body weight on each hip
Gravitational torque equal on both hips WR x DR = WL x DL

95
Q

What happens to the hip joint in a unilateral stance?

A

Joint compression forces:
Body weight compression force (Fbw)
Muscular compression (Fm):
Moment produced around 1 hip
Abductor muscle contraction to counter adduction moment
Prevents pelvic drop in SLS
Total force at hip is approximately 2.4-2.6 x body weight

96
Q

What is a result of gluteus medias weakness?

A

Excessive drop termed Trendelenburg
Compensated for by the trunk lateral lean towards affected side

97
Q

As a result of gluteus maximus weakness?

A

Posterior lean towards affected side as compensation

98
Q

What is an Antalgic Gait?

A

Lateral trunk lean resulting from painful hip joint

also called gluteus medius gait if due to hip abductor weakness

99
Q

What does ipsilateral trunk lean do?

A

IPSILATERAL trunk lean will decrease MA

100
Q

How should you use a cane for the hip joint?

A

One of the most effective methods to reduce compressive loads at the hip is to use a cane in the OPPOSITE side of the affected hip

101
Q

Why does using a cane on the opposite side work?

A

Use of the cane reduces the activation of the hip abductor muscles
Pressure through the UE and cane produces a counter-torque in the same rotary direction as that produced by the hip abd muscles

102
Q

How does carrying loads affect the contralateral side?

A

Carrying loads on the contralateral side increases the MA for gravitational torque about R hip

103
Q

How does external loads affect the hip abductors?

A

Hip abductors must generate a larger countertorque to maintain frontal plane stability of the hip

104
Q

What advice would you give patients with hip weakness and/or pain for carrying loads?

A

Avoid carrying heavy items if possible
When carrying items carry the loads on involved side or split loads evenly between two UE

MSI - Post Midterms (5 decks)

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