Hip Joint Biomechanics Flashcards
1
Q
Name 3 general aspects of the Lower Limb
A
1- adapted to bipedal locomotion
2- provide a stable platform for movement to occur
3- designed to support the entire weight of the trunk and upper extremities
2
Q
Define “Plane”
A
Movement can be describe with reference to 3 imaginary planes passing through the center of gravity and being perpendicular to each other’s.
3
Q
What are the different planes of motion ?
A
- sagittal (antero-posterior) plane : dividing the body in left and right parts
- frontal (coronal) plane : dividing the body in anterior and posterior parts
- transverse (horizontal) plane : dividing the body in superior and inferior parts
4
Q
Define “Axis”
A
An imaginary line where a rotation can occur. Axis of motion can be defined as the intersection between 2 planes. They are perpendicular to the planes.
5
Q
What are the different axis of motion
A
- Antero-posterior (sagittal) axis : passes from back to front and is the intersection between the sagittal and the transversal planes and is perpendicular to the frontal plane
- Transveral (frontal) axis : passes from left to right and is the intersection between frontal and transversal planes and is perpendicular to the sagittal plane
- Longitudinal (vertical) axis : passes from up to down and is the intersection between sagittal and frontal planes and is perpendicular to the transversal plane
6
Q
What are the general hip joint features ?
A
- diarthrose
- powerful weight bearing ball and socket joint
- the acetabulum is concave while the femoral head is convex
- auricular surfaces are curved but the hip joint consists into 2 incongruent shapes : an arched acetabulum and a rounded femoral head
7
Q
Which part of the acetabulum articulates with the head of the femur ?
A
Only the lunate surface of the acetabulum is covered with hyaline cartilage and articulates with the head of the femur
8
Q
Describe the lunate surface
A
It is discontinuous as the inferior margin of the lunate is interrupted by the acetabular notch spanned by the transverse acetabular ligament that connects the 2 ends (and merges with the ligamentum teres)
9
Q
Describe the orientation of the acetabulum
A
It is oriented inferiorly, laterally and anteriorly
10
Q
How can you assess the orientation of the acetabulum ?
A
From radiographies, you can determine the angle of Wiberg and the angle of acetabular anteversion
11
Q
Define the angle of Wiberg and what it measures
A
Is a way to determine the magnitude of inferior orientation of the acetabulum, using a line connecting the lateral rim of the acetabulum to the center of the femoral head. This line forms an angle with the vertical called angle of Wiberg.
It measures the the amount of inferior tilt of the acetabulum and also the amount of coverage of the femoral head.
12
Q
What is the usual angle of Wiberg in Women and Men ?
A
- Women : 35°
- Men : 38°
13
Q
What is the angle of acetabular anteversion
A
It measures the magnitude of anterior orientation of the acetabulum
14
Q
What is the angle of acetabular anteversion in Women and Men ?
A
Women : 21,5°
Men : 18,5°
15
Q
Give 3 features of the femoral head
A
- it is 2/3 of a sphere
- the fovea capitis is not covered by articular cartilage as this is where the ligamentum teres is attached
- is attached to the femoral neck
16
Q
What is the orientation of the femoral head
A
The femoral head faces medially, superiorly and anteriorly
17
Q
How can you define the angulation of the femur ?
A
Using radiographies to determine the angle of inclination and the angle of torsion
18
Q
Define the angle of inclination
A
- Is the neck-to-shaft angle
- occurs in the frontal plane
- occurs between an axis through the femoral head and the femoral shaft
- ranging from 115° to 140° in adults (greater in infancy)
- decline in elderly
19
Q
What pathologic aspects can be determined using the angle of inclination ?
A
Coxa Vara : pathologic decrease of the the angle of inclination of the femur
Coxa Valga : pathologic increase of the angle of inclination of the femur
20
Q
What is the angle of torsion ?
A
- can be determined looking down the length of the femur
- using an axis through the femoral head and neck in the transverse plane making an angle with an axis through the femoral condyles
- average angle : 15° to 20° in adults
21
Q
What pathologic aspects can be determined by the angle of torsion ?
A
- pathologic increase causes excessive anteversion
- pathologic decrease causes retroversion
22
Q
What are the motions happening in the hip joints
A
As the hip joint is a ball and socket joint, the femur moves through 3 degrees of freedom :
- flexion/extension
- Abduction/adduction
- internal/external rotation
23
Q
Describe hip joint flexion/extension (femoral on pelvic hip rotation)
A
Plane : sagittal Axis : frontal Flexion knee flexed : 140° Limited by : - posterior inferior capsule - gluteus Maximus resistance Extension : 15° Limited by : - posas major and rectus femoris resistance - illiofemoral ligament
24
Q
Describe hip Abduction/Adduction
A
Plane : frontal Axis : sagittal Abduction : 40°-50° Limited by : - Pubofemoral ligament - Adductor brevis and adductor longus resistance Adduction : 20°-30° Limited by : - Piriformis, gluteus medius and TFL + illiotibial tract resistance
25
Describe external/internal hip rotation
```
Plane : transverse
Axis : longitudinal
Internal rotation : 35°-40°
Limited by :
- Piriformis resistance
- ischiofemoral ligament
External rotation : 45°-50°
Limited by :
- illiofemoral and pubofemoral ligaments
```
26
What are the different amplitudes of the hip flexion ?
- natural (knee bent) : 120°
- pressing the knee close to trunk (knee bent) : 145°
- leg straight : 90°
27
What are the extracapsular ligaments of the hip joint ?
- illiofemoral ligament
- ischiofemoral ligament
- pubofemoral ligament
28
Describe the illiofemoral ligament
- Y shaped with two portions : superior and inferior
- strongest ligament of the 3 composing the complex
- origin : AIIS
- insertion : inter trochanteric line
- prevents excessive posterior tilt of the pelvis
29
Describe the ischiofemoral ligament
Origin : ischium
| Insertion : greater trochanter
30
Describe the pubofemoral ligament
Origine : superior ramus of the pubis
| Insertion : intertrochanteric line (passing under the illiofemoral ligament)
31
Describe the state of the various hip ligaments involved during upright standing
Illiofemoral, pubofemoral and ischiofemoral ligaments are all under moderate tension
32
Describe the state of ligaments involved during hip flexion
Illiofemoral, pubofemoral and ischiofemoral ligaments are all relaxed
33
Describe the state of ligaments involved during hip extension
All ligaments are in tension with the illiofemoral ligament being under the greatest tension as it runs almost vertically and is responsible for preventing excessive posterior tilt of the pelvis.
34
Describe the state of ligaments involved during hip abduction/adduction
During Adduction : illiofemoral ligament is taut while ischiofemoral and pubofemoral slacken
During Abduction : illiofemoral ligament slacken while ischiofemoral and pubofemoral are taut
35
Describe the state of ligaments involved during hip external/internal rotation
External rotation : Illiofemoral and pubofemoral ligaments are taut while ischiofemoral ligament slacken
Internal rotation : illiofemoral and pubofemoral ligaments slacken while ischiofemoral ligament is taut
36
Explain the Convex/Concave rules
They are used to determine the direction of the mobilizing force when gliding techniques are used to increase joint motion.
- Concave on Convex : a concave surface sliding on a convex surface glides in the same direction as the movement
- Convex on Concave : a convex surface sliding on a concave surface glides in the opposite direction to the movement
37
Describe the arthrokinematics of hip flexion
- Convex femoral head glides on concave acetabulum
| - glide is antero-posterior (opposite to flexion movement direction)
38
Describe the arthorkinematics of hip extension
- Convex femoral head gliding on concave acetabulum
| - gliding is posterior-anterior (opposite to flexion movement direction )
39
Describe the arthrokinematics of hip abduction
- convex femoral head glides on concave acetabulum
| - glide is inferior (opposite to hip abduction movement direction )
40
Describe the kinematic of hip adduction
- convex femoral head glides on concave acetabulum
| - glide is superior (opposite to adduction movement orientation )
41
Describe the arthrokinematics of hip external rotation
- convex femoral head gliding on concave acetabulum
| - glide is postero-anterior (opposite to external rotation movement direction )
42
Describe the arthrokinematics of hip internal rotation
- convex femoral head glides on concave acetabulum
| - glide antero-posterior (opposite to internal rotation movement)
43
What is the effect of hip antero-posterior glide ?
It increases hip flexion and internal rotation
44
What is the effect of hip postero-anterior glide ?
It increases hip extension and external rotation
45
What is the usual direction of the line of pull ?
From insertion towards the origin of the considered muscle
46
Give a general description of the lines of pull of the muscles of the hip joint
- they are weight bearing during many movements as they transmit the weight of the body above via the lower limb to the ground
- they play a dual role :
They are capable of immediate controlled power when needed for sudden powerful activities
They have the ability to maintain a set position for long periods of time
47
Name the agonists of hip flexion
1) Illiacus
- origin: iliac fossa
- insertion : lesser trochanter of femur
2) Psoas (major)
- origin: transverse processes L1 to L5, vertebral bodies from T12 to L5
- insertion : lesser trochanter of femur
3) Tensor fascia latae
- origin : illiac crest and ASIIS
- insertion : illiotibial tract
4) Rectus femoris
- origine : AIIS
- insertion tibial tuberosity via tendon of quadriceps femoris and patellar ligament
5) Adductor longus
- origin : pubic tubercle
- insertion medial lip of linea aspera
6) Pectineus
- origin : superior ramus of the pubis
- insertion : pectineal line of the femur
48
Name the Synergists of hip flexion
1) adductor brevis
- origin : inferior ramus of the pubis
- insertion : pectineal line and medial lip of the linea aspera of femur
2) gracilis
- origin : inferior ramus of the pubis
- insertion : proximal, medial shaft of the tibia, pes anserinus tendon
3) anterior fibers of gluteus minimus
- origin : gluteal surface of illium, between anterior and inferior gluteal lines
- insertion : anterior aspect of greater trochanter
49
Name the antagonists of hip flexion
They perform hip extension
1) Gluteus Maximus
Origin : Coccyx, edge of sacrum, posterior illiac crest, sacrotuberous and sacroiliac ligaments
Insertion : illiotibial tract and gluteal tuberosity
2) Gluteus Medius (posterior fibers)
Origin : gluteal surface of illium, between posterior and anterior gluteal lines just below the illiac crest
Insertion : lateral aspect of greater trochanter
3) Hamstring group :
A) biceps femoris
Origin : long head - ischbial tuberosity / short head - lateral lip of linea aspera
Insertion : head of fibula
B) semimebranosus
Origin : Ischial tuberosity
Insertion : posterior aspect of medial condyle of tibia
C) semitendinosus
Origin : ischial tuberosity
Insertion : proximal medial shaft of the tibial at pes anserinus tendon
50
Name the agonists of hip extension
1) gluteus Maximus
Origin : coccyx, edge of sacrum, posterior illiac crest, sacrotuberus and sacroiliac ligaments
Insertion : illiotibial tract and gluteal tuberosity
2) biceps femoris (long head)
Origin : ischial tuberosity
Insertion : head of fibula
3) semitendinosus
Origin : ischial tuberosity
Insertion : proximal medial shaft of tibia at pes anserinus tendon
4) semimembranosus
Origin: ischial tuberosity
Insertion : posterior aspects of medial condyle of tibia
5) adductor magnus (posterior head)
Origin : inferior ramus of pubis, ramus of ischium and ischial tuberosity
Insertion : medial lip of linea aspera and adductor tubercle
51
Name the synergists of hip extension
1) gluteus medius
Origin : Gluteal surface of illium, between posterior and anterior gluteal line, just below the illiac crest
Insertion : lateral aspect of greater trochanter
2) adductor magnus (anterior head)
Origin: inferior ramus of pubis, ramus of ischium, ischial tuberosity
Insertion : medial lip of linea aspera, adductor tubercle
52
Name the antagonists of hip extension
1) Illiacus
Origin : illiac fossa
Insertion : lesser trochanter
2) Psoas major
Origin : transverse processes L1 to L5 and vertebral bodies T12 to L5
Insertion : lesser trochanter
3) rectus femoris
Origin : AIIS
Insertion : tibial tuberosity through quadriceps tendon and patellar ligament
4) Tensor fasciae latae
Origin : illiac crest, posterior to ASIS
Insertion : illiotibial tract
53
Is it possible to increase the range of hip abduction, how ?
Yes, by flexing the knee it can reach 80° instead of 50°
54
Name the agonists of hip abduction
1) Gluteus minimus
Origin : gluteal surface of illium, between anterior and inferior gluteal lines
Insertion : anterior aspect of greater trochanter
2) Gluteus medius
Origin : gluteal surface of illium, between anterior and posterior gluteal lines just bellow the illiac crest
Insertion : lateral aspect of greater trochanter
3) Tensor fasciae latae
Origin : illiac crest, posterior to ASIS
Insertion : illiotibial tract
55
Name the synergists of hip abduction
1) Piriformis
Origin : anterior surface of sacrum
Insertion : superior aspect of greater trochanter
2) Sartorius
Origin : ASIS
Insertion : proximal medial shaft of the tibia at pes anserinus tendon
3) rectus femoris
Origin : AIIS
Insertion : tibial tuberosity through quadriceps tendon and patellar ligament
4) gluteus Maximus
Origin : coccyx, edge of sacrum, posterior illiac crest, sacrotuberus and sacroilliac ligaments
Insertion : illiotibial tract and gluteal tuberosity
56
Name the antagonists of hip abduction
1) pectineus
Origin : superior ramus of pubis
Insertion : pectineal line of femur
2) adductor longus
Origin : pubic tubercle
Insertion : medial lip of linea aspera
3) adductor brevis
Origin : inferior ramus of the pubis
Insertion : pectineal line and medial lip of linea aspera
4) adductor magnus
Origin : inferior ramus of the pubis, ramus of the ischium, ischial tuberosity
Insertion : medial lip of linea aspera and adductor tubercle
57
Name the agonists of hip adduction
1) pectineus
Origin : superior ramus of the pubis
Insertion : pectineal line of the femur
2) adductor longus
Origin : pubic tubercle
Insertion : medial lip of linea aspera
3) gracilis
Origin : inferior ramus of the pubis
Insertion : proximal medial shaft of the tibial, pes anserinus tendon
4) adductor brevis
Origin : inferior ramus of the pubis
Insertion : pectineal line and medial lip of linea aspera
5) adductor magnus
Origin : inferior ramus of pubis, ramus of the ischium, ischial tuberosity
Insertion : medial lip of linea aspera and adductor tubercle
58
Name the synergists of hip adduction
1) Biceps femoris (long head)
Origin : ischial tuberosity
Insertion : head of fibula
2) gluteus Maximus
Origin : coccyx, edge of sacrum, posterior illiac crest, sacrotuberus and sacro illiac ligaments
Insertion : illiotibial tract and gluteal tuberosity
3) quadratus femoris
Origin : lateral border of ischial tuberosity
Insertion : intertrochanteric crest
4) obturator externus
Origin : rami of pubis and ischium, obturator membrane
Insertion : torchanteric fossa of femur
59
Name the antagonists of hip adduction
1) gluteus medius
Origin : gluteal surface of illium, between posterior and anterior gluteal lines just below the illiac crest
Insertion : illiotibial tract and gluteal tuberosity
2) gluteus minimus
Origin : gluteal surface of illium, between anterior and inferior gluteal lines
Insertion : anterior aspect of greater trochanter
3) tensor fasciae latae
Origin : illiac crest, posterior to ASIS
Insertion : illiotibial tract
4) gluteus Maximus (superior fibers)
Origin : posterior illiac crest
Insertion : illiotibial tract and gluteal tuberosity
60
Name the agonists of hip internal rotation
1) gluteus medius
Origin : gluteal surface of illium, between posterior and anterior gluteal lines just below the illiac crest
Insertion : lateral aspect of greater trochanter
2) gluteus minimus
Origin : gluteal surface of illium, between anterior and inferior gluteal lines
Insertion : anterior aspect of the greater trochanter
3) tensor fascia latae
Origin : illiac crest, posterior to ASIS
Insertion : illiotibial tract
4) adductor longus
Origin : pubic tubercle
Insertion : medial lip of linea aspera
5) adductor brevis
Origin : inferior ramus of pubis
Insertion : pectineal line and medial lip of linea aspera
6) pectineus
Origin : superior ramus of pubis
Insertion : pectineal line
61
Name the synergists of hip internal rotation
1) semimembranosus
Origin : ischial tuberosity
Insertion : posterior aspects of medial condyle of tibia
2) semitendinosus
Origin : ischial tuberosity
Insertion : proximal and medial shaft of the tibial at pes anserinus tendon
62
Name the antagonists of hip internal rotation
1) obturator internus
Origin : obturator membrane and inferior surface of obturator foremen
Insertion : medial surface of greater trochanter
2) quadratus femoris
Origin : lateral border of ischial tuberosity
Insertion : intertrochanteric crest
3) superior gemellus
Origin : ischial spine
Insertion : medial surface of greater trochanter
4) inferior gemellus
Origin : ischial tuberosity
Insertion : medial surface of greater trochanter
5) gluteus Maximus (inferior fibers)
Origin : coccyx, edge of sacrum, posterior illiac crest, sacrotuberus and sacroiliac ligaments
Insertion : illiotibial tract and gluteal tuberosity
63
Name the synergists of hip internal rotation
1) semimembranosus
Origin : ischial tuberosity
Insertion : posterior aspects of medial condyle of tibia
2) semitendinosus
Origin : ischial tuberosity
Insertion : pes anserinus tendon
64
Name the antagonists of hip internal rotation
1) obturator internus
Origin : obturator membrane and inferior surface of obturator foremen
Insertion : medial surface of greater trochanter
2) quadratus femoris
Origin: lateral border of ischial tuberosity
Insertion : intertrochanteric crest
3) superior gemellus
Origin : ischial spine
Insertion : medial surface of greater trochanter
4) inferior gemellus
Origin : ischial tuberosity
Insertion : medial surface of greater trochanter
5) gluteus Maximus (inferior fibers)
65
Name the agonists muscles of hip external rotation
1) gluteus Maximus
Origin : Coccyx, edge of sacrum, posterior illiac crest, sacrotuberous and sacro illiac ligaments
Insertion : illiotibial tract, gluteal tuberosity
2) Piriformis
Origin : anterior surface of sacrum
Insertion : superior aspect of greater trochanter
3) obturator internus
Origin : obturator membrane and inferior surface of obturator foremen
Insertion : medial surface of greater trochanter
4) inferior gemellus
Origin : ischial tuberosity
Insertion : medial surface of greater trochanter
5) superior gemellus
Origin : ischial spine
Insertion : medial surface of greater trochanter
6) quadratus femoris
Origin : lateral border of ischial tuberosity
Insertion : intertrochanteric crest, between the greater and lesser trochanter
66
Name the synergists of hip external rotation
1) gluteus medius
Origin : gluteal surface of illium, between posterior and anterior gluteal lines, just below the illiac crest
Insertion : lateral aspect of greater trochanter
2) gluteus minimus
Origin : gluteal surface of illium, between, anterior and inferior gluteal lines
Insertion : anterior aspect of greater trochanter
3) obturator externus
Origin : rami of pubis and ischium, obturator membrane
Insertion : intertrochanteric fossa
4) sartorius
Origin : ASIS
Insertion : pes anserinus tendon
5) biceps femoris (long head)
Origin : ischial tuberosity
Insertion : head of fibula
67
Name the antagonists of hip external rotation
1) adductor longus
Origin : pubic tubercle
Insertion : medial lip of linea aspera
2) adductor brevis
Origin : inferior ramus of pubis
Insertion : pectineal line and medial lip of linea aspera
3) pectineus
Origin : superior ramus of pubis
Insertion : pectineal line
68
Define pelvis rotation
It is the motion of the entire pelvic ring in the transverse plane along a vertical axis
69
Describe the forward rotation of the pelvis
It occurs in unilateral stance when the side of the pelvis opposite to the supporting hip move anteriorly. It produces internal rotation of the supporting hip joint.
70
Describe the backward rotation of the pelvis
It occurs when the side of the pelvis opposite to the supporting hip moves posteriorly. It produces an external rotation of the supporting hip joint.
71
Name the different motions of the pelvis on the femur
- anterior and posterior pelvic tilt
- lateral pelvic tilt
- lateral pelvic shift
72
Describe anterior and posterior pelvic tilts
They are motion of the entire pelvic ring in the sagittal plane along a coronal axis.
Anterior tilt of the pelvis on the fixed femur results in hip flexion.
Posterior tilt of the pelvis on the fixed femur results in hip extension.
73
Describe the lateral pelvic tilt
It takes place in the frontal plane along the anteroposterior axis.
During unilateral stance, the opposite side of the pelvis can elevate (pelvis hiking) or drop (pelvis drop).
Pelvis hike equals to supporting hip abduction
Pelvis drop equals to supporting hip adduction
74
Describe lateral pelvic shift
It takes place in the frontal plane along the anteroposterior axis.
It can also occur during bilateral stance when both feet are on the ground, but the hip and knee of one leg are flexed, so the opposite leg is weight bearing.
If the pelvis is shifted to the right then the left side drops, the right hip is adducted while the left hip joint is abducted
