hip pathology Flashcards
acetabulum
faces laterally, inferiorly, and anteriorly
labrum
inverted horseshoe shaped cartilage
enhances joint stability, decreased forces transmitted to articular cartilage, provides proprioceptive feedback
majorly avascular
femur
strongest and longest bone
2/3 of head covered in cartilage
head angled ant, sup, and med
ward triangle
point on femur of weakness of trabecular system, common site for osteoporotic fracture
iliofemoral ligament
strongest ligament in the body
limits range of hip extension
allows for maintenance of upright posture
pubofemoral ligament
tightens with extension and abduction
ischiofemoral ligament
tightens with internal rotation
injured more than the other hip ligaments
ligamentum teres
attaches femoral head to inf acetabular rim
tightens during adduction, flexion, and ext rotation
femoral triangle
inguinal ligament add longus sartorius iliopsoas and pectineus femoral vein, artery, nerve
normal coxa
125
coxa vara
coxa valgus
> 140
increases length of LE
increase compressive forces to the joint
shortens moment arm of hip abductors
normal torsion angle
8-15
anteversion
> 15
end range ext rot
compensate with walking toe in
retroversion
open packed position of the hip
30 flexion
30 abduction
slight ext rot
closed packed position
max extension
internal rotation
slight abduction
capsular pattern
flexion=abduction=IR, slight loss extension, little to no loss in ER
hip flexion glide
post
hip extension glide
ant
hip abduction glide
inf
hip add glide
sup
hip int rot glide
post
hip ext rot glide
ant
hip abduction glide with hip at 90
ant
hip add glide with hip at 90
post
hip int rot glide with hip at 90
inf
hip ext rot glide with hip at 90
sup
flex/ext needed for sit to stand
80
100
flexion needed to climb stairs
60
needed for descent of same stair
24-30
flexion during late swing of gait
35-40
ext during heel off
full ext
X-ray of OA
bones will be closer together, cysts or fluid filled cavities form as cartilage destructs
increase bone density or uneven joints (bone spurs)
OA pain
groin, buttock, thigh or knee
aching to sharp
C sign
stiffness
capsular pattern
restriction flexion=abduction=IR, slight loss of extension, little to no loss ER
50 yo
AVN
30-50 years old
pain in groin, proximal thigh or button
loss of ROM in all directions
CORTICOSTEROIDS, chemo, trauma
most common cause mechanical hip symptoms
labral tear (ant sup) ant groin pain, thigh, medial knee, trochanteric or buttock pain pain with active straight leg raise pain at ends of ROM but no loss in ROM clicking, catching, locking
FAI
cam- femoral head has large radius
pincer- over coverage of acetablum
correlated with labral tears
myositis ossificans
can occur post trauma
abnormal formation of bone between muscle fibers
PROM or stretching contradicted bc can tear
one of the most common muscle injuries
hamstring
adductor muscle injury
pain in groin add mag and longus most common increased pain with twisting quick start and stop pain with passive abduction and resisted adduction
add gracilis injury resisted motion
leg straight
add long/brevis resisted motion
hip 45
pectineus resisted motion
hip 90
iliopsoas injury
injury often from forced ext while it is actively flexing
pain with acceleration and high stepping
pain with resisted hip flexion, adduct
gluteus medius injury
pain in button, lat hip, groin
tend gait
weakness
sciatica
restricted in hip adduction, IR
positive FABER
post lat hip approach precautions
no flex past 90
no adduction past midline
no internal rotation past neutral
ant lat approach precautions
may not have restrictions no ext beyond neutral no ext rot beyond neutral no extreme abduction no flexion past 90
slipped femoral capital epiphysis
slow onset ant displacement of femoral neck males 10-17 females 8-15 african americans > whites knee, lower thigh, groin or medial thigh dec int rot, abd, flex may ONLY report pain in MED knee
Legg Calve perthes disease
increased density, fragmentation and flattening of epiphysis center hip, knee, or groin pain insidous onset lower age range than SCFE 2-13 yo males > female usually unilateral
transient synovitis
most common cause of sudden hip pain in children 2-12 yo males > females lasts short time only one limb inflammation and swelling of the tissues unknown cause
