Hip and Pelvis Flashcards by Nikolas Leventis

Functions of Pelvis

LE muscle attachments
Transmits weight
Supports bowel, bladder, and repro. organs

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Weight transmission of pelvis

weight of upper body/trunk to ischial tuberosities when sitting, or LEs when standing/walking

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Describe the characteristics of the Hip Joint (stability during mvmt)

Provides stability during standing by transmitting force of lower limb into pelvis

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Describe the characteristics of the Hip Joint (femoral head stability)

Stabilized deep in socket w/ labrum and capsule

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Describe the characteristics of the Hip Joint (muscles)

Large forceful muscles accelerate/decelerate the body from the hip

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What other joints may benefit from strengthening the hip muscles?

Knee joints

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Femoral neck characteristics

Permits spacing to avoid bony impingement against pelvis
Subject to large tensile and compressive forces
Reinforced by thick cortical and trabecular bone
Frequent fracture site
Almost completely enclosed in capsule

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Femur characteristics

Provides long lever for torque/power and long stride

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Shape of femoral shaft

Convex Anteriorly (tension)
Concave Posteriorly (Compression)

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Importance of femoral shaft shape

allows for bowing and incorporating forces through bone

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Which hip angle is more prone to dislocation in newborns and young children

Coxa Vara

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Angle of inclination stages

birth 165-170
normal adult 125
elderly adult 120

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Which sex has greater AOI

Men

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Coxa Varum Value

<125°

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Coxa Varum Presentation

Adducted femur
Genu Valgum
Pronated Foot
Shorter Ipsilateral LE

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Coxa Valgum Value

> 125°

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Coxa Valgum Presentations

Abducte femur
Genu Varum
Supinated Foot
Longer Ipsilateral LE

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Femoral torsion occurs in which plane?

Transverse

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Describe femoral torsion

Relative rotation or twist within shaft of femur, called anteversion

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Normal anteversion?

15°

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Excessive anteversion can lead to?

Internal rotation of the tibia/ankle during growth and development to compensate for feet pointing out

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Infants are born with ___ anteversion

40°

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At what age does it often reduce to 15°

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An exaggeration of LE IR during gait may indicate what?

Potential compensation of excessive anteversion to improve hip congruency

How does excessive anteversion alter function of the muscles?

Moment arm of hip abductors increased, which can be in response to reduced abduction torque seen with excessive anteversion

Anteversion seen in CP?

Excessive anteversion of 25-45 In toeing persists

What muscular issues may contribute to in toeing in CP?

spasticity or tightness of hip int. rotators or adductors

Presentation of anteverion

In toeing Increased q angle Increased pronation of STJ Medial torsions

Presentation of retroversion

Out toeing Decreased q angle Increased supination of STJ Lateral torsions

Hip Joint Type

Ball and socket

Femoral head is coverd with

articular cartilage

Location and thickness of thickest cartilage on femoral head

Thickest portion is 3.5mm and superior and anterior to fovea, areas of weight bearing

Role of ligamentum teres

protective sheath for acetabular artery supplies femoral head of neonate

Primary circulation comes from?

Circumflex arteries

Direction of Acetabulum

obliquely anterior, lateral and inferior

Lunate surface of acetabulum

horseshoe shape surface of rim that contacts femoral head

Describe the inferior rim

it is incomplete inferiorly, 60-70° acetabular notch

How is the rim closed?

By transverse acetabular ligament

Thickest area of acetabular cartilage?

3.5mm Matches that of femoral head contact

Acetabular Labrum

strong, flexible, fibrocartilage ring that surrounds most of acetabulum

What area is not covered by the labrum?

area covered by transverse acetabular ligament

Labrochondral junction

where labrum blends with articular cartilage

Labrum deepens the socket by how much?

5mm

Pressure of labrum

Negative intraarticular pressure

Labrum vascularization-poor or good?

Poor, with limited healing

Labrum nerve supply- poor or good?

Good, afferent nerves, feel proprioreception and pain

Iliofemoral ligament

strongest and stiffest hip ligament anterior stability prevents hyper extension

Ischiofemoral ligament

Weakest of hip ligaments

Hip Axis of Rotation

Center of femoral head

Axis of ER/IR

extra-medullary influenced by bowing of shaft

Close pack position of the hip

Full extension Slight IR ABD

Max congruency of hip

90° flexion Mod. ABD ER

Open pack position of the hip

30° flexion 30° ABD Slight ER

Capsular pattern of hip

Flexion>ABD>IR (sometimes IR has greatest limitation)

Sagittal Plane,M/L axis

Femur on pelvis: Hip flex/ext Pelvis on femur: A/P pevlic tilt

Frontal Plane, A/P axis

Femur on Pelvis: Hip ABD/ADD Pelvis on Femur: Contralateral Hip Hike/drop

Horizontal Plane, Vertical axis

Femur on pelvis: Hip Int/Ext rotation Pelvis on Femur: Pelvic rotation CW/CCW