Hip Joint Complex Flashcards
Max Bony Congruence
• Flexion, abduction, and external rotation (frog legged
position)
• Not position of highest stability
Most Stable Position
- Extension, slight abduction, Internal Rotation
* Extension further tightens capsular ligaments
Least Stable Position
Flexion with Adduction
Ischiofemoral
Taught with hip Extension
Iliofemoral
Fan shaped ligament resembles inverted
Y, strongest ligament at the hip. Checks hyperextension
Pubofemoral
Taught in hip abduction and in extension. With the iliofemoral ligament it form a Z on the anterior capsule
Femoral Neck
Angulates superiorly, anteriorly, and medially
Angle of Wiberg/Center Edge Angle
Angle drawn between vertical and a line drawn from the center of the femoral to the bony edge/rim of the acetabulum; normally 35-38 degrees; smaller Angle of Wilberg increases risk of dislocation due to smaller load bearing surface
Smaller Angle of Wiberg
Increased likelihood for superior dislocation; smaller load-bearing surface
Inclination Angle
Neck to shaft angle; Superior/inferior inclination; Angle varies from individual to individual; Decreases with age for both genders; smaller angle for females (more cantilevered neck)
Angle of Anteversion/Torsion
Anterior/posterior angulation; formed by the intersection of the long axis of the femoral head
and the transverse axis of the femoral condyles; measures medial torsion from proximal to distal end
Normal Inclination Angle
125⁰
Coxa Valga- Pathologically Larger Inclination Angle
> 125⁰; Larger/Steeper Inclination Angle; Causes higher than normal Joint Reaction Forces
Coxa Vara- Pathologically Smaller Inclination Angle
<125⁰; Increases moment arm for abductor muscles, so need less muscle force, but creates greater bending and shear stress in the femoral neck and reduces ROM.
Normal Hip Angle of Anteversion
15-20⁰
Anteversion (pathologically high angle)
Toe in; Coxa valga; >20⁰; internal rotation during gait; causes adductor moments at the knee and ankle, also may cause posterior positioning of GRF
during propulsion effectively reducing the lever arm of
the triceps surae; decreases propulsion you get from the triceps surae
Retroversion (pathologically low angle)
Toe out; <20⁰; external rotation during gait (duck-footed walk); may cause posterior positioning of GRF
during propulsion effectively reducing the lever arm of
the triceps surae.
Posterior Pelvic Tilt
Brings pubis up; leads to hip extension and lumbar flexion; often occurs at the deepest part of an individual’s squat
Anterior Pelvic Tilt
Brings anterior superior iliac spine (ASIS) anterior and inferior; leads to hip flexion and lumbar
extension
Hip Flexion
Primary: Iliopsoas
Secondary: Rectus Femoris, Tensor Fascia Latae, Sartorius
Dependent on Hip Position: Pectineus, Adductor longus, Adductor magnus, Gracilis, Gluteus Minimus (anterior fiber)
Hip Extension
Primary: Gluteus Maximus
Secondary: (Hamstrings) Semitendinosus, Semimembranosus, Long Head of Biceps Femoris
Dependent on Hip Position: Gluteus medius (posterior fibers), Adductor magnus (posterior fibers), piriformis
Abduction
Limited by gracilis
Primary: Gluteus medius
Secondary: Gluteus minimus, Tensor fascia latae
Dependent on Hip Position: Piriformis (when Hip is flexed), Sartorius, Rectus Femoris, Superior Fibers of Gluteus Maximus
Adduction
Limited by Tensor Fascia Latae (and associated IT band)
Primary: Adductor magnus
Secondary: Pectineus, Adductor Longus, Adductor Brevis, Gracilis, Obturator Externus
Medial Rotation
42⁰-50⁰; usually measured with hip at 90⁰
Lateral Rotation
42⁰-50⁰; usually measured with hip at 90⁰
Medial Rotation
Anterior Roll and Posterior Gliding
Lateral Rotation
Posterior Roll and Anterior Gliding
Lateral Rotation
Primary: Gluteus maximus, piriformis
Secondary: Quadratus femoris, obturator internus and externus, Gemellus superior and inferior, sartorius
Depending on hip position: Gluteus medius (posterior fibers); long head of biceps femoris
Medial Rotation
NO MUSCLE HAS A PRIMARY ROLE OF MEDIAL ROTATION
Secondary: Tensor Fascia Latae, Gluteus minimus, Gluteus medius (anterior fibers)
Dependent on Hip position: Pectineus, Adductor longus and brevis, adductor magnus (posterior fibers), semimembranosus, semitendinosus
Flexion
Spin
Extension
Spin
Abduction
Superior Roll and Inferior Glide
Adduction
Inferior Roll and Superior Glide
Medial Rotation
Anterior Roll and Posterior Glide
Lateral Rotation
Posterior Roll and Anterior Glide
Angulation of the Femur
Femoral neck angulates so that the head most
commonly faces medially, superiorly, and anteriorly.
Right Hip/Pelvic Drop
Lateral flexion of lumbar spine towards left, left hip joint adducts
Anterior Pelvic Tilt
Right hip: Flexion
Left Hip:
Lumbar spine: Flexion Extension
Posterior Pelvic Tilt
Right Hip: Extension
Left Hip: Extension
Lumbar spine: Flexion
Left Forward Rotation
Right Foot Planted
Right Hip: Medial Rotation
Left Hip: Open chain
Lumbar Spine: Left Rotation
Left Backward Rotation
Right Foot Planted
Right Hip: Lateral Rotation
Left Hip: Open chain
Lumbar Spine: Right Rotation
Pelvifemoral rhythm
like scapulohumeral rhythm of the shoulder. To maximize the apparent range of motion of the distal segment (in this case the head) multiple joints
are used in concert; not pathologic but rather characteristic of normal functional human movement. Caution is only warranted with injuries and heavy loaded human movement.
E.g., touching your toes, roundhouse kick (rhythm allows end effector- toes- to reach higher target)
E.g., Posterior Pelvic tilt at deepest part of squat (achieve apparent ROM of hip flexion)
Lateral trunk lean towards the side of pain or weakness
Helps by:
• Reduces the moment arm of the force of gravity which reduces the required muscle force needed to maintain equilibrium
• Reduces necessary torque generated by the abductor muscles (gluteus medius)
• Reduces the overall joint reaction force at the hip
Cane in Contralateral Hand
• Reduces weight of Head, Arms, Torso (HAT), but also provides a counter torque to
the torque of gravity thus reducing need for abductor muscle force.
• Canes considered to relieve hip of up to 60% of its load in stance
Cane in Ipsilateral Hand
• Still some benefit from alleviating some of the body weight through the cane
• But in theory the force of the cane on the hand causes a torque about the affected
hip in the same direction at the torque due to gravity
• Overall exacerbates the problem
Arthrokinematics during Flexion/Extension of the Hip
Pure Spin
Arthrokinematics During Adduction of the Hip
Inferior Roll and Superior Gliding; Femoral head glides within acetabulum in opposite direction of distal femur
Arthrokinematics During Abduction of the Hip
Superior Roll and Inferior Gliding; Femoral head glides within acetabulum in opposite direction of distal femur
Arthrokinematics During medial Rotation of the Hip
Anterior Roll and Posterior Gliding
Arthrokinematics During Lateral Rotation of the Hip
Posterior Roll and Anterior Gliding
