Hip Complex Lecture and Lab Flashcards
Memorize basic information to apply later
Iliofemoral ligament
Y ligament, superior, limits extension
pubofemoral ligament
pubis-femur, limits: extension, ER and abduction, posterior capsule
Ischialfemoral ligament
limits flexion, IR (some)
Hip Joint amount of movement
allows 3 degrees of movement
Depth?
is deeper than the shoulder, almost entire femoral head fits.
What still grows past puberty in the hip?
the Acteabular fisures
What is the ligament Teres?
A round ligament enters the fovea capitis in the femoral head, which allows blood vessels (obturator artery) to supply the femur.
Osteonecrosis
when the ligament teres is damaged from a dislocation / subluxation of the femur.
What parts of the labrum in the hip has nerve endings and arterial supply?
The superior and inferior parts (nerve) and 1/3 have adequate blood supply.
Hydrostatic Pressure of the hip?
The labrum closes the joint, creating a vacuum to seal the head of the femur in the joint. This keeps fluid in the joint. It helps keep the hip from braking down and distribute the forces adequately.
Center Edge Angle
Angle between
- vertical line from the center of the femoral head
-line connecting the center of the femoral head and the lateral rim of the acetabulum
<16 Center Edge Angle
definite dysplasia (really small)
16 to 25 Center Edge Angle
possible dysplasia
> 25 Center Edge Angle
Normal
> 40 Center Edge Angle
possible excessive acetabular coverage (coxa profunda or protrusion acetabular)
Acetabular Dysplasia
Is
Angle of Inclination
is the angle formed between the femoral neck and the shaft of the femur
Normal Angle of Inclination
approximately 125 degrees
110 to 140 in children is normal
Load through life creates it.
Coxa Valga
more than 140 degrees, increases the load on the bone, can cause arthritic changes, and changes in length-tension relationships of muscles and moment arm decreases. abduction
Coxa Vara
less than 110 degrees, increases moment arm, abductors, stresses on head/neck of femur, and epiphyseal plate shearing forces. (bending forces)
can cause fracture and slipped femur head.
Angle of torsion
twist of the whole femur. the degree of twist or rotation along the longitudinal axis of a bone, essentially measuring how much a bone is “twisted” relative to its normal alignment, most commonly used when discussing the femur (thigh bone) in the hip joint, where an abnormal angle of torsion can affect movement and potentially lead to joint issues like osteoarthritis; a higher angle is called “anteversion” while a lower angle is called “retroversion” when discussing the femur.
version
is the position o the femur within the acetabulum
Normal angle of torsion
10-20 degrees. For joint congruency.
Anteversion
> 35 degrees increased IR and Decreased ER so the hip sits in more internal rotation to keep joint congruency
Retroversion
less than 10 degrees, the patella sits outward, in more external rotation for joint congruency.
Acetabular Labrum
shock absorber, creates negative pressure in the joint, increases depth by 20% more surface area for force distribution.
Labral Tears Mechanism
anterior labral tears are more common, direct trauma, sports with frequent external rotation or hyperextension, twisting movements, hyper abduction, hyperextension, hyperextension with ER
Labral Tear Symptoms
often deep groin pain can be trochanteric and buttock region, constant dull pain, periods of sharp pain, pain worsens with activity, and can be nighttime.
Aggravated by walking, pivoting, prolonged sitting, and impact activities.
Clicking, locking or catching or giving away can be reported (not significant)
Range of motion not restricted but can be painful at end range.
Osteoarthritis
the leading cause of disability worldwide.
Osteoarthritis characteristics
degeneration of articular cartilage in synovial joints
disease of the whole joint
most common in the knee and hip
cartilage cannot be regenrated
comorbidities are common.
Hip osteoarthritis common patient presentation 1
Hip internal rotation <15 degree
Hip flexion <_ 115 degree
Age > 50 years old
Hip osteoarthritis common patient presentation 2
Hip internal rotation >- 15 degree
Pain with hip internal rotation
Duration of morning stiffness of hip less than or equal to 60 min
Age > 50 years old
Type 1 hamstring strain
high speed running
usually involve the long head of the biceps femoris, most common at the proximal muscle-tendon junction.
Type 2 hamstring strain
excessive lengthening of the hamstring in hip flexion with knee extension (kicking)
typically located close to the ischial tuberosity and involves the proximal free tendon of semimembranosus
Symptoms of a hamstring strain
Localized tenderness and swelling at the site of injury
Ecchymosis
Restricted knee extension and straight leg raise
Palpapble divot in the injured hamstring
Positive tripod sign
High Hamstring tendonopathy
runners, athletes in sports with frequent change of direction, non-athletes
Gradual onset
Deep aches in the gluteal region, can radiate
Pain worsens during or after repetitive activity
Provoked by deeper hip flexion activities (squat) long periods of sitting, exessive stretching
Femoral Neck Stress Fracture
Compressive fractures
Hip/groin pain
Oedema
Pain worse with weight-bearing
Point tenderness on palpation
Painful and limited active and passive hip flexion, IR, and Extension
Pain increases during activity
Antalgic gait
Hip Fracture
Severe groin pain anterior thigh pain and tenderness
Osteoporosis
Symptoms:
pain
limited mobility
possible bruising
hip might look twisted or rotated
Femoral Acetabular Impingement Syndrom FAIS
Important cause of hip pain in young and middle-aged adults
OKC Hip Flexion Arthro
anterior roll and posterior glide
OKC Hip Extension Arthro
posterior roll and anterior glide
OKC Hip Abduciton Arthro
lateral roll and inferior glide
OKC Hip Adduction Arthro
medial roll and superior glide
OKC Hip Internal Rotation Arthro
medial roll and posterior glide
OKC Hip External Rotation Arthro
lateral roll and anterior glide
CKC Hip Flexion Arthro
anterior roll and glide
CKC Hip Extension Arthro
posterior roll and glide
CKC Hip Abduction Arthro
lateral roll and superior glide
CKC Hip Adduction Arthro
medial roll and inferior glide
CKC Hip Internal Rotation Arthro
medial roll and anterior gilde
CKC Hip External Rotation Arthro
lateral roll and posterior glide
FAIS Cam morphology
“pistol grip”
male predominant
athletes have a higher prevalence
Poor clearance of the femur in flexion and abduction
