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Lower Extremity Evaluation Lecture > Hip/Pelvis > Flashcards

Hip/Pelvis Flashcards

1
Q

Femur

A

Proximal portion of the femoral shaft forms the greater and lesser trochanter

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2
Q

Innominate (fused) bones of the Pelvis

A
  • Ilium
  • Ischium
  • Pubis
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3
Q

Articulations: Pubis Symphysis

A
  • Articulation between the pubic bones
  • Pubic bones are separated by a
    fibrocartilage disk
  • Minimal distraction, compression, and
    rotation occurs at this joint
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4
Q

Articulations: Sacroiliac Joint

A
  • Articulation between the Sacrum and
    Ilium
  • Very stable
    ~ Support from multiple strong/thick
    anterior and posterior ligaments
    ~ In order for sprains to occur, the MOI
    needs to be extreme: car accident, fall
    from tall height, etc.
  • The Ilium rotates anterior & posterior on
    the Sacrum during movements of lower
    extremity and spine
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5
Q

Articulations: Acetabulofemoral Joint

A
  • Articulation between Acetabulum
    (socket) of Ilium and head of Femur
  • Very stable
    ~ Large muscles
    > Stabilize joint
    ~ Deep socket
    > Features labrum that deepens the
    socket
    ~ Strong ligaments
    > Prevent specific movements
  • Ball and socket joint like the shoulder,
    but not as much movement
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6
Q

Strong ligaments that support the Acetabulofemoral Joint & their purpose

A
  • Iliofemoral (anterior)
    ~ Prevents excess Extension and
    External Rotation
  • Pubofemoral (anterior)
    ~ Prevents excess Abduction &
    Extension
  • Ischiofemoral (posterior)
    ~ Prevents excess Internal Rotation &
    Adduction
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7
Q

Hip Joint movements during functional Loading

A
  • Sagittal: Flexion
  • Frontal: Adduction
  • Transverse: Internal Rotation
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8
Q

Hip Joint movements during functional Unloading

A
  • Sagittal: Extension
  • Frontal: Abduction
  • Transverse: External Rotation
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9
Q

What bone is relative to what bones during functional loading/unloading?

A

Femur relative to Innominate bones

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10
Q

Pectineus

A
  • Origin: Superior Ramus of Pubis
  • Insertion: Distal to Lesser Trochanter
  • Nerve: Femoral
  • Action: Adduction & Flexion of Hip
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11
Q

Adductor Brevis

A
  • Origin: Inferior Ramus of Pubis
  • Insertion: Superior 1/3 of Linea Aspera
  • Nerve: Obturator
  • Action: Adduction & Flexion of Hip
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12
Q

Adductor Longus

A
  • Origin: Pubic Tubercle
  • Insertion: Middle 1/3 of Linea Aspera
  • Nerve: Obturator
  • Action: Adduction, Flexion, & Extension of
    Hip
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13
Q

Adductor Magnus

A
  • Origin: Inferior Ramus of Pubis, Ischial
    Ramus, and Ischial Tuberosity
  • Insertion: Linea Aspera & Adductor
    Tubercle
  • Nerve: Obturator & Tibial
  • Action: Adduction, Flexion, & Extension of
    Hip
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14
Q

Adductor’s Function during functional Loading

A
  • Includes Gracilis, Pectineus, Adductor
    Magnus, Longus, & Brevis
  • They decelerate Flexion & Internal
    Rotation
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15
Q

Piriformis

A
  • Origin: Lateral Sacrum
  • Insertion: Greater Trochanter
  • Nerve: S1 & S2
  • Action: External Rotation of Hip
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16
Q

Obturator Internus

A
  • Origin: Internal surface of Obturator Membrane & Foramen
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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17
Q

Gemellus Inferior

A
  • Origin: Ischial Tuberosity
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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18
Q

Gamellus Superior

A
  • Origin: Ischial Spine
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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19
Q

Obturator Externus

A
  • Origin: External surface of Obturator
    Membrane & Foramen
  • Insertion: Greater Trochanter
  • Nerve: L3 & L4
  • Action: External Rotation of Hip
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20
Q

External Rotator’s Function during functional loading

A
  • Includes Piriformis, Gemellus Superior &
    Inferior, Obturator Externus & Internus
    ~ All these muscles stabilize the
    Acetabulofemoral Joint
  • They decelerate Internal Rotation
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21
Q

Gluteus Minimus

A
  • Origin: Ilium between Inferior & Anterior
    Gluteal Lines
  • Insertion: Greater Trochanter
  • Nerve: Superior Gluteal
  • Action: Hip Abduction & Internal Rotation
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22
Q

Gluteus Medius

A
  • Origin: Lateral surface of Ilium
  • Insertion: Greater Trochanter
  • Nerve: Superior Gluteal
  • Action: Hip Abduction, External & Internal
    Rotation
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23
Q

Tensor Fascia Lata (TFL)

A
  • Origin: Anterior Superior Iliac Spine & Anterior Iliac Crest
  • Insertion: IT Band
  • Nerve: Superior Gluteal
  • Action: Hip Abduction
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24
Q

Hip Abductor’s Function during functional loading at the Hip and Knee

A
  • Includes Gluteus Medius, Minimus, &
    Tensor Fascia Lata
  • They decelerate Adduction and Internal
    Rotation at the Hip
  • They decelerate Internal Rotation at the
    Knee (work with Bicep Femoris)
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25
Q

Gluteus Maximus

A
  • Origin: Posterior Lateral Surface of Ilium
    & Sacrum
  • Insertion: IT Band & Gluteal Tuberosity of
    Femur
  • Nerve: Inferior Gluteal
  • Action: Extension, External Rotation, &
    Abduction of Hip
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26
Q

Gluteus Maximus Function during functional loading at the Hip and Knee

A
  • Decelerates movement in all 3 planes:
    Flexion, Adduction, & Internal Rotation at
    the Hip
  • Decelerates Internal Rotation at the Knee
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27
Q

Psoas Major

A
  • Origin: Bodies and Transverse Processes
    of Lumbar Vertebrae
  • Insertion: Lesser Trochanter
  • Nerve: L 2-4
  • Action: Flexion & Adduction of Hip
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28
Q

Iliacus

A
  • Origin: Iliac Fossa
  • Insertion: Lesser Trochanter
  • Nerve: Femoral
  • Action: Flexion & Adduction of Hip
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29
Q

Hip Flexor’s Function during functional loading

A
  • Includes Psoas Major & Iliacus (Iliopsoas)
  • They decelerate Internal Rotation at the
    Hip
30
Q

Hamstring’s Function during functional loading

A
  • Includes Semimembranosus, Semitendinosus, & Biceps Femoris
  • They decelerate Flexion at the Hip
31
Q

A tight IT Band indicates what?

A

A tight Tensor Fascia Lata

  • Loosen the muscle, and the IT Band will
    loosen
32
Q

A weak Gluteus Maximus pre-disposes you to…?

A

ACL injury

33
Q

A tight Psoas Major causes…?

A

The spine to excessively extend

34
Q

During Anterior Inspection, what should be noticed?

A
  • Knee Alignment: Genu Varum & Valium
    ~ Important to understand Kinetic
    Chain
  • ASIS
    ~ Malalignment
  • Iliac Crest
  • Lower Extremity Positioning
35
Q

During Posterior Inspection, what should be noticed?

A
  • PSIS
    ~ Malalignment
  • Buttock Musculature
  • Spinal Alignment
36
Q

During Lateral Inspection, what should be noticed?

A
  • Iliac Crest
  • Spinal Curves
  • Knee Alignment
    ~ Genu Recurvatum
37
Q

Leg Length Discrepancy: Functional or Apparent

A
  • Leg appears shorter or longer due to
    rotation of the Ilium on the Sacrum
    ~ SI Joint is axis of rotation
    ~ Can be fixed by rotating the opposite
    direction
  • Anterior Rotation (Genu Varus)
    ~ Acetabulum goes down
    ~ Appears Longer
  • Posterior Rotation (Genu Valgum)
    ~ Acetabulum goes up
    ~ Appears Shorter
38
Q

Leg Length Discrepancy: Structural

A
  • Femur or Tibia are physically shorter
  • Can be helped with a heel or foot lift
39
Q

Leg Length Discrepancy: Compensatory

A
  • Change in joint angle causes leg to
    appear shorter
  • Can’t be fixed or helped unless you get
    surgery
40
Q

Can someone get away with a small leg length discrepancy?

A

No! The smallest amount of leg length discrepancy can cause issues.

41
Q

Leg Length Discrepancy Tests

A
  • Measuring True (Structural) Leg Length
    ~ Problematic because of inconsistent
    measuring sites each time
    ~ Measuring tape from ASIS to Medial
    Malleolus
    ~ Measured Block Method
    > Note ASIS starting point
    > Place block under shorter leg until
    ASIS are of equal height
  • Weber-Barstow Maneuver
    ~ Pt. is supine
    ~ Clinician places thumbs on both
    medial malleoli
    ~ Pt. flexes knees with feet flat on table
    ~ Pt. performs a glute bridge
    ~ Clinician passively extends pts. legs
    with feet together
    ~ Clinician compares height of medial
    malleoli based on thumb position
42
Q

Palpation

A
  • Palpation can be done along with
    observation in order to “eye ball” any leg
    length discrepancies
43
Q

Normal Ranges for Active ROM

A
  • Flexion: 120-130 degrees
  • Extension: 10-20 degrees
  • Abduction: 45 degrees
  • Adduction: 30 degrees
  • Internal Rotation: 45 degrees
  • External Rotation: 50 degrees
44
Q

Why is a Neurological Exam important when a pt. complains of hip pain?

A

Injuries to the low back or Sacrum commonly refer symptoms to the hip/pelvis area, therefore it’s important to undergo a Lower Quarter Screen when paresthesia is present.

45
Q

Why is it important to figure out if muscles are tight or weak?

A
  • Tight or weak muscles in the hip/pelvis area can cause a number of biomechanical problems, pain, or discomfort
  • Once this is determined, they can be fixed and the issues resolve
46
Q

Gluteus Medius Weakness Test

A
  • Trendelenburg’s
    ~ Positive test indicated by a lateral hip
    shift to the stance leg side (stance leg
    will adduct)
    ~ Possible to see Trendelenburg’s gait
    with pts. with weak Gluteus Medius
47
Q

Iliotibial Band Tightness Test

A
  • Ober’s
    ~ Positive test indicated by inability to
    adduct the hip
    > Leg will stay in the air
48
Q

Tight Hip Flexor Tests

A
  • Thomas (Psoas)
    ~ Positive test indicated by hip Flexion in
    down leg (leg comes off the table)
    ~ Causes rotation of the pelvis
    ~ If the spine is hyperextended, it can
    cause a false negative because this
    causes the pelvis to anteriorly rotate
  • Kendall (Psoas & Rectus Femoris)
    ~ Positive test for Psoas indicated by
    hip Flexion on the down leg (leg comes
    off table)
    ~ Positive test for Rectus Femoris
    indicated by extension of the down
    knee (leg will extend)
  • Ely’s (Rectus Femoris)
    ~ Positive test indicated by hip Flexion
    as knee is flexed (hip will come off
    table)
49
Q

Hamstring Tightness Test

A
  • 90/90 Straight Leg Raising
    ~ Positive test indicated by greater than
    20 degrees of Flexion when leg is
    extended in the air
50
Q

Piriformis Syndrome (L4-S3)

A
  • Spasm, hypertrophy, or tightness of the
    Piriformis places pressure on the Sciatic
    nerve
    ~ Causes pain, paresthesia, and
    weakness in areas innervated by L4-S3
    > Can be issues with 1, 2, or all
    nerve roots
  • 15% of the population have part or all of
    the Sciatic nerve running through the
    Piriformis
51
Q

Piriformis Syndrome Test

A
  • Piriformis Test
    ~ Positive test indicated by increased
    pain in area of Piriformis or symptoms
    radiating down the leg
52
Q

Iliotibial Band Friction Syndrome

A
  • IT Band is tight and rubs on the femoral
    epicondyle causing LATERAL KNEE PAIN
  • IT band and bursa between the IT band
    and femoral condyle can become
    inflamed
  • Can be caused by excessive knee Flexion
53
Q

IT Band Friction Syndrome Test

A
  • Nobel’s
    ~ Positive test indicated by pain at the
    lateral femoral epicondyle when IT
    Band is compressed
  • Ober’s can be used and will be positive
54
Q

Hip Degeneration

A
  • Blanket term used to suggest a number
    of conditions
    ~ Arthritis
    ~ Osteochondritis Dissecans
    ~ Labrum Tears
  • Often misdiagnosed as lumbar spine or
    sacroiliac pathology
    ~ Pain is referred to these areas
    ~ Needs imaging
55
Q

Femoroacetabular Impingement (FAI)

A
  • Usually detected after labral tear
  • Extra bone gets laid down and causes
    pain
  • Appears similar to hip degeneration
  • S&S:
    ~ Pain in hip, low back, & SI joint
  • 3 General types
    ~ Pincer
    > Extra bone on rim of acetabulum
    that runs into the femoral neck
    ~ Cam
    > Head of femur is abnormally shaped
    ~ Combined
    > Most common
56
Q

Hip Degeneration/FAI Tests

A
  • FABER (Degeneration)
    ~ Positive test indicated by increased
    pain
  • Hip Scouring (Degeneration & FAI)
    ~ Positive test indicated by increased
    pain
  • Anterosuperior Impingement: FADDIR
    (FAI)
    ~ Positive test indicated by pain or
    crepitus with Internal Rotation &
    Adduction
  • Posteroinferior Impingement (FAI)
    ~ Positive test indicated by pain or
    crepitus with External Rotation &
    Extension
57
Q

Sacroiliac (SI) Joint Sprain

A
  • Excess movement of the Ilium on the
    Sacrum can stretch or tear the ligaments
    joining the 2 bones
  • Severe sprains are rare since the SI joint
    is very stable
58
Q

SI joint Sprain Tests

A
  • Gapping/Distraction (push out)
    ~ Positive test indicated by pain at SI
    joint (posterior)
    ~ Indicates sprain of anterior SI ligament
  • Squish/Compression (push in)
    ~ Positive test indicated by pain at SI
    joint
    ~ Indicates sprain of posterior SI
    ligament
  • Approximation
    ~ Positive test indicated by pain at SI
    joint
    ~ Indicates sprain of posterior SI
    ligament
  • Sacral Apex Pressure
    ~ Positive test indicated by pain at SI
    joint
    ~ Indicates sprain of anterior or
    posterior SI ligaments
  • Gaenslen’s
    ~ Positive test indicated by pain at SI
    joint
    ~ Indicates sprain of anterior or
    posterior SI ligaments
59
Q

Sacroiliac Joint Hypomobility

A
  • SI joint is very stable
  • Very little motion occurs here, but the
    motion that does occur is very important
  • Any alteration in SI joint motion can
    cause a number of biomechanical issues
  • Hypomobility goes with malalignment
    and causes discomfort
60
Q

SI Joint Hypomobility Tests

A
  • Gillet’s
    ~ Positive test indicated by a lack of PSIS
    movement
    ~ Indicates the inability of the Ilium to
    rotate posteriorly
  • Standing Flexion & Seated Flexion
    ~ Positive test indicated by increased
    motion in a cephalad direction on the
    side of restriction
    ~ Spine, sacrum, and pelvis all go
    forward with Flexion. If one side of the
    pelvis goes really fast = hypomobility
61
Q

Innominate Rotation/Up Slip

A
  • “Functional” leg length discrepancy
  • Can be caused by tight muscles, trauma, or malalignment
  • Usually paired with SI Hypomobility
  • If anterior rotation: hamstrings will
    shorten and adapt
  • If posterior rotation: hip flexors will
    shorten and adapt
62
Q

Innominate Rotations/Up Slip: Observations/Palpations

A
  • Anterior Rotation
    ~ Low ASIS & High PSIS
  • Posterior Rotation
    ~ High ASIS & Low PSIS
  • Up Slip
    ~ High ASIS & High PSIS
63
Q

Pelvic Rotation Tests

A
  • Long Sit
    ~ Anterior Rotation = Positive test
    indicated by leg being longer when
    supine and shorter when sitting
    ~ Posterior Rotation = Positive test
    indicated by leg being shorter when
    supine and longer when sitting
64
Q

How do you know which side has the rotation?

A
  • Side of discomfort
  • Side with hypomobility
65
Q

Snapping Hip Syndrome

A
  • Chronic inflammation of trochanteric
    bursa causes the IT Band to snap as it
    moves over the Greater Trochanter
  • Limited ROM due to pain since the IT Band naturally moves over the Greater Trochanter during Flexion/Extension and Internal/External Rotation
  • Ober’s Test would be positive
66
Q

Iliac Crest Contusion (“Hip Pointer”)

A
  • Caused by trauma
  • Rotation of trunk and daily activities will
    cause pain
  • Treatment: protect it
67
Q

Legg-Calve Perthes

A
  • Avascular Necrosis of the femoral head
  • Common in adolescents
  • Presents as pain in the hip or referred
    pain to the abdomen or knee
  • Leg length discrepancy: shorter on
    affected side
  • Muscle tightness
68
Q

Slipped Capital Femoral Epiphysis

A
  • Femoral head slips posteriorly and
    inferiorly
  • Commonly seen in boys typically 10-17
    years old
  • Referred pain
  • Leg length discrepancy: shorter on
    affected side
  • Muscle tightness
69
Q

If the Hamstrings are tight, which way does the pelvis tilt?

A

Posteriorly

70
Q

If the Hip Flexor’s are tight, which way does the pelvis tilt?

A

Anteriorly

Lower Extremity Evaluation Lecture (8 decks)

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