Hip Assessment and Pathology Flashcards
What is the angle of inclination and what are the clinical manifestations of Coxa Vara and Coxa Valga
The angle of shaft, to the neck of the femur
Coxa Vara = >125 degrees (hip dysplasia more common)
Coxa Valga = <125 degrees (fractures more common)
What is the angle of torsion and what are the clinical manifestations of excessive anteversion and retroversion?
The rotation the head of femur must do to fit into the capsule
Excessive anteversion = >15 degrees, medial rotates the tibia causing toe in gate
Retroversion = <15 degrees, toe out gate and lateral rotation of tibia
True or false. The foot can point forward, but the femur can be internally rotated and the tibia can be externally rotated?
True!
What is hip ante torsion?
Head and neck of the femur is rotated anteriorly, excessive medial hip rotation and limited lateral hip rotation
What is hip retro torsion?
Head and neck of the femur is rotated posteriorly, causing excessive lateral hip rotation with limited medial rotation
What types of joint are the:
- Femoracetabular joint
- Pubic symphysis
- Sacroiliac
- Femoracetabular = synovial, multiaxial ball and socket
- Pubic symphysis = secondary cartilaginous
- Sacroiliac = anterior synovial, posterior fibrous
What are the main ligaments of the hip?
Iliofemoral Pubofemoral Ischiofemoral Iliolumbar Anterior and posterior ligaments Sacrotubal ligaments Sacrospinous
What muscles are responsible for hip flexion?
o Psaos major o Iliacus o TFL o Sartorius o Rectus femoris o Gluteus medius (anterior fibers) o Gluteus minimus o Adductor longus (assists) o Pectineus (assists) o Adductor brevis (assists) o Adductor magnus (assists)
What muscles are responsible for hip extension?
o Gluteus maximus (all fibers) o Biceps femoris (long head) o Semitendinosus o Semimembranosus o Adductor magnus (posterior fibers) o Gluteus medius (posterior fibers)
What muscles are responsible for hip medial rotation?
• Medial rotation o Gluteus medius (anterior fibers) o Gluteus minimus o TFL o Adductor magnus o Adductor longus o Adductor brevis o Pectineus o Gracilis o Semitendinosus (assists) o Semimembranosus (assists)
What muscles are responsible for hip lateral rotation?
o Gluteus maximus o Piriformis o Quadratus femoris o Obturator internus/ externus o Gemellus superior/ inferior o Gluteus medius (posterior) o Psaos major o Iliacus o Sartorius o Bicep femoris (long head)
What muscles are responsible for hip abduction?
o Gluteus maximus o Gluteus medius o Gluteus minimus o TFL o Sartorius o Piriformis when hip is flexed
What muscles are responsible for hip adduction?
o Adductor magnus, brevis, longus
o Pectineus
o Gracilis
o Gluteus maximus (lowest fibers)
What is hip OA and what are some signs?
- Worn cartilage, bone spurs, reduced joint space
- Stiffness in the morning, pain over groin or lateral hip, catching
What are some objective signs of hip OA?
- Global loss of ROM
- Reduced Thomas test
- Weakness of hip extensors and abductors
- Tightness through hip adductors and hip flexors
What is femoroacetabular impingement?
Cam impingement = excessive bone on anterior neck of femur
Pincer impingement = acetabular has extended part like a pincer and it affects rotation
What FAI predicts OA?
Cam deformative
What three things need to be done to confirm an FAI?
- Current signs
- Clinical signs
- Imaging confirmation
What are subjective signs of an FAI?
- Pain in anterior hip and groin especially in deep hip flexion
- Clicking, catching, locking, stiffness, loss of ROM
- Reduced hip flexion and internal rotation
What percentage of athletes with groin pain have labral tears?
22%
What percentage of people with hip pain have labrum tears?
55%
What is lateral hip pain?
Underdeveloped gluteus muscles that cause the leg to adduct - placing more compressive load
What are signs of lateral hip pain?
-Painful when lying on affected side, pain when sleeping on opposite side without support in legs, pain when sitting in a low chair, pain with running, pain and stiffness in the morning, positive trendelenburg, painful Obers or FADIR and FABER
What rehab should you target in patients with lateral hip pain?
Glute muscles, TFL
What percentage of hamstring injuries are biceps femoris long head?
80%
What are the two types of hamstring injury mechanisms?
Dancers (type II) = over stretch
Sprinters (type I) = high force
If Jim suffered a hamstring strain 2 days ago and he can walk fine now pain free. How long would he expect to miss out before returning to play?
2 weeks
True or false. The more proximal the hamstring injury, the shorter sit out time?
False. The more proximal, the more tendon there is and less vasculature for recovery
Where is the most common site of quadricep strain?
Distal musculotendinous junction of the rectus femoris
True or false. Proximal rectus femoris injuries are straightforward rehab?
False, distal is.
What is the difference between a tendinopathy and an enthesopathy?
A tendinopathy relates to the tendon of a muscle and an enthesopathy relates to the tendon joint part which connects to the bone
What are typical signs of an adductor strain?
Gradual onset of pain which worsens with loading, pain with running or kicking, pain and weakness with groin squeeze test, reduced hip abduction flexibility, pain on palpation and during a sit-up
