Hip (New) Flashcards
Functional ROM of hip
0-90 flexion, 20 abduction, 0-20 IR/ER
hip flexion ROM required for walking:
20-40 degrees
Hip flexion ROM required for negotiating steps:
descending: 36 degrees; ascending: 40-67 degrees
hip flexion ROM for sit to stand
104 degrees
hip ROM norms
Flexion: 120-135 (90 with knee extended) Extension: 10-30 Abduction: 30-50 Adduction: 10-30 ER: 45-60 IR 30-45
What type of injury occurs with adductor magnus (proximal) injury? where and why?
Adductor magnus wraps posteriorly to ishchial tuberosity and can avulse the ischial tuberosity. Due to broad origin it won’t develop tendonopathy
Where do the hamstrings attach on the ischial tuberosity?
Laterally
Normal angle of inclination of the hip: (collodiaphyseal angle)
125 degrees
Definition of coxa vara and what it leads to:
Angle of inclination <120 degrees; can increase shearing forces and predispose to SCFE
–G.trochanter displaced more lateral and superior-increases lever arm of hip abductors
Definition of coxa valga and what it leads to:
Angle of inclination >150 degrees; can alter cartilage forces and muscle activity at the joint
–Moment arm of hip abductors shortened, placing these muscles in mechanical disadvantage
Center edge angle:
measured from center of femoral head through lateral acetabulum in frontal plane; normally 30 degrees (if <30 suggests dysplastic changes of joint)
Femoral neck torsion (norms and how to measure):
12-15 degrees normal; measure with Craig’s test
Anteversion: define, what causes it; what is predisposes
Increase in torsion angle (excessive anterior rotation); results in increased hip IR and decreased hip ER; may predispose joint cartilage to increased stress (i.e. early hip OA) and cause increased incidence of LE tendinopathies
Retroversion: define, what causes it, what it predisposes
Decrease in torsion angle; results in increased hip ER and decreased IR; may predispose to anterior superior acetabular labral degeneration
What phase of gait has greatest compressive stress to hip and how can you decrease this?
stance phase; cane can decrease load 40%
Iliofemoral Ligament (Y ligament)
Limits hip EXTENSION, external rotation
- blends with iliopsoas muscle
- strongest ligament in body
Pubofemoral ligament
limits hip extension, ABDUCTION, external rotation
-blends with inferior band of iliofemoral ligament and pectineus muscle
Ischiofemoral ligament
limits hip EXTENSION, INTERNAL ROTATION, abduction
- works with arcuate ligament
- more commonly injured than other hip ligaments
Inversion of muscles: what hip adductors become hip extensors (and at what degree hip flexion)?
- Add longus: becomes hip extensor at >70 deg flexion
- Add brevis: becomes hip extensor at >50 deg flexion
- Gracilis: becomes hip extensor at 40 deg flexion
Inversion of muscles: what happens to the piriformis with hip flexion?
Piriformis is an external rotator until 60 degrees flexion at which point it becomes an internal rotator
Innervation to anterior hip joint and referred pain patterns
Femoral and obturator nerves: groin and anterior thigh pain
Innervation to posterior hip joint and pain patterns
sacral plexus: posterior hip pain
innervation to pubic symphysis and pain pattern
Anterior L2-4 causing referred groin pain
3 fiber systems in the hip JC:
- Longitudinal fibers: course along JC length from prox to distal insertions–creates tensile constraint along JC
- Transverse fibers: course in circular fashion around diameter of JC at neck–creates ring of Webber (JC narrows at neck)
- Arcuate Fibers: create loops at prox insertion at labrum and reinforces that insertion
Teres Ligamentum
Fovea centralis of femoral head –>acetabular rim
-is entirely enclosed in synovial membrane
-conduit for neuvascular supply to femoral head
Important stabilizer esp. when hip ER in flexion or IR in extension
Iliopsoas muscle action and innervation
most powerful hip flexor; weak adductor and ER
-Innervation: Lumbar plexus
Pectineus muscle action and innervation
adductor, flexor and IR of hip
-innervation: femoral or obturator nerve
TFL muscle action and innervation
hip abduction;
- through ITB produces knee flexion moment in knee flexion and extension moment in extension
- innervation: Superior gluteal nerve
Sartorius muscle action and innervation
Flexes, abducts, and ERs hip
-innervation: Femoral nerve
Adductor longus muscle action and innervation
primarily adduction; assists in ER, extension and IR
-Innervation: Obturator nerve
Gracilis muscle action and innervation
adducts and flexes thigh; flex and IR leg
-innervation: obturator nerve
adductor brevis action and innervation
adduction
-innervation: obturator nerve
3 main functions of hamstrings during running
- decelerate knee extension at end of forward swing phase of gait cycle
- @ foot strike elongate to facilitate hip extension through an eccentric contraction (stabilizes leg for WB)
- assists gastrocs in paradoxially extending knee during takeoff phase of running cycle
When in gait cycle do most hamstring injuries occur?
@ end of swing phase or at foot strike
Muscles that attach to the ischial tuberosity (6)
- semimembranosus
- semitendinosus
- LH biceps femoris
- adductor magnus
- quadratus femoris
- gemellus inferior
Muscles that attach to greater trochanter: (6)
- piriformis
- glut med
- glut min
- obturator internus
- gemellus superior
- gemellus inferior
What happens at pelvis during (B) hip flexion?
innominate posterior rotation, adduction and ER
MMT of adductors: what hip flexion angle to test which hip adductor?
0 deg hip flexion = adductor longus, gracilis
45 deg = pubic symphysis
90 deg hip flexion = pectineus
Hip Capsular pattern:
IR most limited; flexion, extension and abduction also limited
Hip OA CPR
3/5+ predict OA:
- Squat increases Sx
- Active hip flexion causes lateral hip pain
- active hip extension causes pain
- scour with add causes lateral hip/groin pain
- PROM IR </= 25 degrees
