Hip and Pelvis Flashcards
What is charm pain?
superficial
What can we observe from the hip and pelvis?
pelvic alignment
What is anteversion?
- toed in
- whole leg is rotated in
What is retroversion?
whole leg is rotated out
What is structural deviation?
thats how they are forever- we cannot change it
What is functional deviation?
- tight external hip rotators
- function of the muscle
- muscles are tight and creating a pull
- muscles can be changed
What movements occur at the hip?
- flexion/ extension
- abduction/adduction
- external/internal rotation
What ligament is more likely to be sprained in the hip?
- very rare
- any ligament can be sprained
What is the MOI of a hip sprain?
very violent ROM
How do the signs and symptoms of a hip sprain differ from the signs and symptoms of acute sprains?
- this is happening way inside your hip
- not going to see inflammation and bruising at
the surface, it is all deep inside
What are the signs and symptoms of a grade 1 hip sprain?
- can walk
- deep pain deep inside
- cannot touch where it hurts
What are the signs and symptoms of a grade 2 hip sprain?
can walk with noticeable limp
What are the signs and symptoms of a grade 3 hip sprain?
- something torn
- not able to walk
- feel like there hip is popping out of the socket
- go to hospital
- need imaging to sort it out
How do we manage a hip sprain?
- joint kept stable
- very conservative
- weight bearing structure
- manage pain
What is the Faber test?
- flexion, abduction, external rotation
- negative test if can cross ankle over knee
What is the squat test?
- checking to see if hips can bear weight
- squat down as far as possible
- bounce lightly a few times, come back up
What is the MOI of a hip pointer/contusion to the ilium?
blunt force trauma
What are the signs and symptoms of a hip pointer/contusion to the ilium?
- significant bruising
- muscle guarding
- partially contraction would cause further damage and more pain, inflammation, bruising, heat, redness
Describe a grade 3 hip pointer/contusion to the ilium.
- possibly fractured iliac
- could cause rupture in the ab or glute muscles at sight of attachment if hit hard enough
- feel deformity
- pain with laughing, coughing, sneezing etc
What is the special test for a hip pointer/contusion to the ilium?
does not have a special test
How do we manage a hip pointer/contusion to the ilium?
- calm down muscle swelling and muscle guarding
- stay more inactive
In a hip flexor or adductor strain, what do we need to be aware of?
femoral artery running on the inside
What is the MOI of a hip flexor or adductor strain?
- extensive stretch
- forceful contraction and muscle wasn’t ready
What are the symptoms like for a grade 1 hip flexor or adductor strain?
mild symptoms
What are the symptoms like for a grade 2 hip flexor or adductor strain?
- moderate symptoms
- pain with weakness
What are the signs and symptoms for a grade 3 hip flexor or adductor strain?
- significant tears
- incredibly painful to walk
- pain and weakness
How do we manage hip flexor or adductor strains?
- calm down inflammation and pain
- strengthen muscles
- get full ROM back
- sports specific activities
What are special tests for hip flexors and adductor strains?
- kendall test
- resisted ROM
When are you more prone to suffering a hip flexor strain?
if you’re hip flexors are tight
Describe the circulation for the iliotibial band.
- no circulation
- no blood vessels run through it
How big is the IT band?
as big as a deck of cards
IT band attaches to ________.
the glute max
IT band has ______ conditions.
chronic
What is the snapping hip or the snapping knee?
- called snapping because of the sound they make
- IT band rolls over the greater trochanter causing the snapping noise
- for Knee it is rolling and snapping over a bony structure of a knee
When do you get tight IT bands?
when you run and jump a lot
How do you fix a tight IT band?
roll, massage
What are the special tests for IT bands?
- ober test: on side, floating leg is positive test
- Trendelenburg: standing on one foot and hips stay level it is a negative test, hips slide out to the side its a positive test
Between the hamstrings and the quads, which one is tighter and which one is stronger?
- hamstrings usually tighter
- quads are stronger
Between the hip flexors and glutes, which ones are typically tighter and which ones are stronger?
- gluten are generally stronger
- hip flexors are tighter
What is gait?
the pattern or the way we walk
What are the 2 phases of gait?
- stance phase
- swing phase
What happens during the stance phase?
Heel strike/initial contact → midstance → terminal stance → toe off (for 1 leg)
The stance phase takes up __% of the cycle.
60%
In which phase of gait do people generally have problems with pressure/injury?
stance phase
What happens during the swing phase?
Preswing → midswing → terminal swing
The swing phase takes up __% of the cycle?
40%
What is 1 cycle of gait?
one leg starting at whichever step and coming back to it.
While one leg is doing stance phase, the other leg is doing ____ phase.
swing
What happens with reference to gait when we are walking?
one leg is always in contact with the ground
What happens to gait when we are running?
- Reduced time frame of each phase
- A section is added where there is no contact with the ground
- 30% in stance phase
- 30% in swing phase
- 30% where there is no contact with the ground
Name some reasons to have abnormal gait.
- Injury
- Pain
- Disability
- Pelvis unalignment
- Uneven leg length
- Arthritis
- Cerebral palsy etc. (conditions)
- Pigeon toed (legs out)
- Any structural or functional abnormality
What is trendelenburg? How does it affect gait?
- Positive test: glutened weakness or injury
- Can’t hold the person steady when leg comes up during swing phase
- Hip falls to side to one or both side
What is antalgic? How does it affect gait?
- Antalgic = pain
- Gait that has been changed because of pain
- Limping due to pain
- Will make their own accommodations
What happens to gait when people limp due to pain?
- Try to avoid weight bearing
- try to cut down stance phase from 60% to as little as
possible (very short stance phase on painful side, very long stance phase on uninjured stance) - People try to avoid that by taking big steps
- Less ROM of joint, less ROM of muscle
What should you watch for when assessing gait?
- Arms swing in opposite pattern
- Watch for legs swinging around (less ROM in knees and ankles or tight hip)
- Arms swinging in anatomical position (thumbs forward)
- Head should sit on top of shoulder and neck
What are the 3 bones in the pelvis?
- Ilium
- Ishium
- Pubic bones
What is the sacrum?
last 7 vertebrae fused together
What are SI joints?
- 2, one on each side
- Back of body
- SI ligaments on back side as well as front side of that joint
What are the landmarks for the hip and pelvis?
- iliac crest
- PSIS (posterior superior iliac spine)
- ASIS (anterior superior iliac spine)
What are the muscles that affect the pelvis?
- Ilial psoas
- Tensor fascia latte
- Pelvic muscles attach to pubic bone, can pull it down
- Glute muscles (maximus, minimus, medius)
- Deep muscles (periformis)
Where do glute muscles attach?
sacrum and pubis
Where does leg length start and end?
starts at iliac crest and goes down to feet
What is considered normal in variation of leg length?
- anything under a inch
- body can adapt without causing problems
Describe anatomical causes of leg length variation.
One of the bones in the leg is physically longer than the same bone on the other side
Describe functional causes of leg length variation and give an example.
- Created by the body, generally the muscles
- Most muscles that do this is from the knees to the rib cage
- Not permanent: reduce spasm = reduce discrepancy
- Ex. injury in hip, spasm muscles can pull bones, make them in a tighter position in a joint
How do we check for leg length discrepancy?
- Landmark on body
- Mark iliac crest on both sides (look for one being higher or lower)
- Check greater trochanter
- Check head of fibula
- Check either malleolus (each is measuring top and bottom of bone)
How can we tell if the leg length discrepancy is structural or functional?
need x-ray and physical measurements
What do we do for leg length discrepancy if they have no pain?
nothing
What are the landmarks for pelvic malalignment?
- ASIS
- Iliac crest
- PSIS
What are the causes for the pelvis pulling up (malalignment)?
- Tight obliques
- Tight lower back muscles
- Tight psoas
What are the causes for the pelvis pulling down (malalignment)?
- Tight hamstrings
- Tight glutes
- Tight adductors
- Tight IT band
If the pelvis is not aligned, what else will be affected?
back will not be aligned
