Hip/pelvis Flashcards
hip articulation is formed by what
femural heal and acetabulum
hip transmits what types of loads
tensile and compressive
what type of joint is the hip?
ball and socket
what is another name for ball and socket
spheriodal
how many planes of movement does the his go through
3- sagittal, frontal, transvers
sagittal plane of hip movement
flexion extension around transverse axis
frontal plane of hip movement
abduction and adduction around ant/post axis
transverse plane of hip movement
internal/external rotation around vertical axis
os coxa is made up of
ilium, pubis, ischium
ilium forms which portion of os coxa
superior 2/5
ischium forms which portion os coxa
posterior 2/5 acetabulum and ramus
ischium + ramus=
ischial tuberosity
pubis for which portion os coxa
anterior 1/5 acetabulus.
smallest bone of os coxa
pubis
what are the parts of the pubis bone
body, inf and sup rami
by what age is acetabular development complete?
age 8
what of the acetabulum changes at puberty?
acetabular depth
why does the acetabulum increase depth?
development of three secondary ossification centers
which way is the acetabulum angled
lateral, inf, ant
what increases joint stability of the acetabulum?
acetabular rim–> labrum
what lines the acetabulum
hyaline cartilage (articular cartilage)
what part of the acetabulum is not covered with cartilage?
fovea capitis
what three joints make up the pelvic girdle
acetabulofemoral
sacroiliac
pubic symphysis
what is the most stable joint in the body
acetabulofemoral
what is pelvic obliquity
pelvic leveling
excess lordosis in lumbar spine possibly what
weak abs
what tests confirm weak abdominals?
Milgrams test
if milgrams does not confirm weak abs what other tests?
could be space occupying lesion or disc path
valsalva
bechterew
anterior innominate- mazion- advancement sign
SLR
what is an iliac contusion
contusion/avulsion to site of quadratus lumborum or abdominal muscles from the iliac crests. VERY painful. disabling is periosteum is involved
what is an avulsion
pulling of the tendon from the periosteum
what will elicit pain in iliac contusion
lateral flexing away from side of inj and abduction when laying on side
etiology of iliac contusion
trauma- football, lax, hockey
pubic tubercles should be level with what in the inspection
grater trochanters
what could heal wrong causing misalignment?
congenital hip dislocations/ fracture
superior/ inferior pubic rami fractures with separation/ fracture of contralateral SI joint
Bucket handle fracture
separation of the pubic symphysis and both SI joints
sprung pelvis
bilateral superior pubic rami and ischiopubic fracture
straddle fracture
MOI landing hard on butt, falling from a height, horseback riding
straddle fracture
MOI bad infection, appendicitis, trauma, buildup of pressure
sprung pelvis
most common areas of pelvis for avulsion fractures
ASIS, AIIS, ischial tub
avulsion from iliac crest is usually
abdominal muscles
avulsion from ASIS
sartorius
avulsion from AIIS
rectus femoris
avulsion from lesser trochanter
iliopsoas
avulsion from pubic symphysis
adductor group
avulsion from ischial tub
hamstrings
avulsion from greater trochanter
gluteal muscles
strongest and longest bone in the body
femur
portion not covered in smooth layer of cartilage
fovea capitis, ligamentum teres
angle between femoral shaft and neck
inclination angle
average inclination angle
120-130 degrees
how does the inclination angle change with body type
taller person more valgus larger angle
shorter person more varus smaller angle
MOI for femoral head dislocation
dashboard injury
force to knee if hip is adducted may cause
posterior hip dislocation
muscles that insert into greater trochanter
adductor brevis gemelli (inf/sup) gluteus medius gluteus minimus obturator internus piriformis
muscles that insert into lesser trochanter
iliacus
pectineus
psoas major
how is the lesser trochanter created?
pulling of the iliopsoas
what type of bone is in the femoral neck?
trabecular bone
what is it designed to withstand?
high loads
where is the lesser trochanter located
posterior medial junction of the neck and shaft of femur
angle that the femoral neck makes with the acetabulum
angle of anteversion
what is normal anteversion
8-15 degrees
angle between femoral neck and transcondylar axis is greater than 15 degrees
medial femoral torsion
what type of gait is associated with medial femoral torsion
toe in
increased femoral head torsion result in
OA dysplasia or acetabulum susceptibility to anterior femoral dislocation knee joint misalignment patellar dislocations excessive lumbar lordosis external rotation of tibia pronation of feet
angle between femoral neck and transcondylar axis is less than 15 degrees
femoral retroversion
femoral retroversion causes what type of gait
toe out
decreased femoral head torsion may result in
LB SI path
internal rotation of tibia
supination of feet
LCP
legg calve perthes disease
avascular necrosis of the femoral capital epiphysis before the closure of the growth plate
legg calve perthes disease
LCP prominance in which genders and ages
5:1 male, ages 3-12
what history should be indicators for LCP
painful limp reduced mobility and muscle atrophy
an aka for femoral anteversion
medial femoral torsion
what test is positive with legg calve perthes
trendelenberg
MOI for LCP
trauma
heredity
nutritional
circulatory
four stages of LCP during ages
2-8
what are the four stages of LCP
avascularization
revascularization
repair
deformity
when is the peak influence of LCP
5 years (range is 2-14)
is LCP ever bilateral?
in 10% of cases
first sign of LCP
effusion as shown by lateral displacement of femoral head
what population is LCP more prevelant
children who experience second hand smoke frequently
1:100
what is the possible reason causing LCP
nicotine constricting blood vessels in the hip during development
what are the three extra articular ligaments that provide stability in the hip joint
iliofemoral ligament (bertin/bigelow)
pubofemoral
ischiofemoral
how many parts does the iliofemoral ligament have
2: inferior (medial) and superior (lateral)
what is the strongest ligament in the body
iliofemoral ligament
how is iliofemoral oriented
superior laterally
what muscle does the iliofemoral ligament blend with
iliopsoas
what is the orientation of the pubofemoral ligament
inferior-medial
what does the pubofemoral ligament blend with
inferior band or iliofemoral and pectineus muscle
what is the orientation of the ischiofemoral ligament
winds posteriorly around femur, attaches anteriorly
what ligament in the hip is most commonly injured
ischiofemoral
what happens with the three stabilizers when the hip is put into extention
they all tighten
what part of iliofemoral ligament limits adduction
lateral
what part of the iliofemoral ligament limits external rotation
medial band
what does the pubofemoral limit
abduction
what does the ischiofemoral ligament limit
internal rotation
what is the most power hip flexor
iliopsoas
what makes up the iliopsoas
iliacus and psoas
what adducts, flexes, and internally rotates the hip
pectineus
what muscle combines flexion of the hip and extension at the knee
rectus femoris
what is the longest muscle in the body
sartorius
TFL
tensor fascia latae
the TFL does what at the hip
abduct, flex, internally rotate
sartorius responsible for what movement at the hip
flexion, abduction, external rotation and some knee flexion
what is the largest and most important hip extensor and external rotator
gluteus maximus
what is the main abductor of the hip
gluteus medius
weakness of the gluteus medius can be tested with
trendelenburg test
the anterior portion of glute med does what
flex, abduct, internally rot hip
the posterior portion of the glute med does what
extends, externally rotates hip
what is the major internal rotator of the femur
gluteus minimus
what cause weak gluteus muscles
fracture of greater trochanter slipped capital femoral epiphysis congenital hip dislocation poliomyelitis (polio) meningomyelocele
trendelenburg test positive
high iliac crest on supported side and low iliac crest on side of lifted leg
trendelenburg test indicator
weak glute med muscles on supported side
what is slipped femoral capital epiphysis
slipping of the neck on the femoral head as the head remains in the acetabulum
what is the age range for slipped femoral capital epiphysis
10-15
slipped femoral capital epiphysis is more predominant in
males more than females
slipped femoral capital epiphysis is more common in what race
blacks more than white
etiology of slipped femoral capital epiphysis is trauma
50% of the time
the positive on xrays is what for slipped femoral capital epiphysis
kleins line
what action is the piriformis responsible for
external hip rotator at less than 60 degrees.
at 90 degrees of hip flexion what does the piriformis do
reverses its muscle action becoming an internal rotator and abductor.
what are the small external rotators of the hip
obturator externus/internus, inferior gemelli and quadratus femoris
what make up the hamstrings
biceps femoris, semitendinosus, semimembranosus
which hamstring extends the hip flexes the knee and externally rotates the tibia
biceps femoris
which hamstring extend the hip flex the knee and internally rotate the tibia
semimembranosis and semitendinosus
which hip adductor is most frequently injured
adductor longus (groin pull)
what muscles adduct the hip
adductor magnus, longus and the gracillis
how many total bursa are in the hip region?
12
other names for the iliopsoas bursa
iliopectineal, iliac, iliofemoral, subpsoas bursa
largest bursa of the hip
iliopsoas
where is IPB located
deep to iliopsoas tendon cushions tendon from structures anterior aspect of hip jt
what is the most common cause of an inflamed and distended IPB
RA
sub trochanteric bursa is located where
between greater trochanter and TFL
what can cause bursitis of trochanteric bursa
adaptively shortened TFL
what are the borders of the femoral triangle
superiorly > inguinal ligament
medially > adductor longus
laterally > sartorius
floor > parts of iliopsoas(lateral) and pectineus(medial)
inguinal ligament is located between
pubic tubercle and anterior iliac spine
laterally to medially how are the nerves and vascular vessels arranged
Nerve, Artery, Vein
which of the three found in the femoral triangle are not palpable
femoral vein
what provides cutaneous innervation in the posterior gluteal region
subcostal N, dorsal rami of L1-3 and dorsal primary rami (cluneal N) of S1-3
anterior hip region cutaneous N supply superior to inguinal ligament
iliohypogastric N
anterior hip region cutaneous N supply inferior to inguinal ligament
subcostal N and femoral branch of genitofemoral N and iliolingual N
sciatic N is located between
ischial tuberosity and greater trochanter
what may cause tenderness of the sciatic N
disc pathology or trauma
what kind of issue may sciatic N have with piriformis muscle
congenital
what percentage of people have normal location of sciatic N in relation to piriformis
88% Sciatic N passes inferiorly to piriformis
11% of population has what happen with sciatic N and piriformis
common peroneal division goes through the piriformis
0.9% of population has what happen with sciatic N and piriformis
common peroneal division passes superior to piriformis (superficial)
0.1% of population has what happen with sciatic N and piriformis
both divisions pass through piriformis
what occurs during the acute phase of intervention
PRICE (protection, rest, ice, compression, elevation)
goals of acute phase of intervention
restore pain free ROM in entire kinetic chain
decrease pain/inflammation
retard muscle atrophy
min effects of immobilization and activity restriction
maintain gen fitness
patient indep with home exercise program
functional phase of intervention
full ROM normal jt kinematics muscle strength neuromuscular control normal muscle force couple relationships
test for fracture of long bone or hip jt pathology
anvil test
test to determine short leg or femoral neck angle
leg length discrepancy
pediatric test differentiating between congenital hip dislocation or anatomical short leg and contralat anatomical short leg
allis sign
test depicting contracture of hip flexors typically iliopsoas
thomas test
strict test for hip joint patholody
patrick/fabere sign
a test confirming hip joint pathology but also depicting mechanical problem in S-I jt
Laguerre test
what test stresses S-I joints into extension and indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the S-I joint
Gaenslen and Lewin-Gaenslen
test where tester stands side opposite and flexes knee and internally rotates the thigh. the positive: pain in the hip region= hip jt pathology. pain the in buttock/pelvis= S-I jot lesion
Hibb test
test indicating contraction of the IT band or tensor fascia lata usually secondary to synovitis of hip secondary to trauma of the glute med or min
ober test
In this test Dr slight flex in the knee abducts the hip and extends hip lets go of the knee and it should drop. the drop is secondary to trauma of the glute med/min
ober test
pain in either S-I indicating an S-I lesion
pelvic rock/ iliac compression
the test done as a part of the other tests in the process of flexing the knee to the butt
ely sign
deep S-I jt pain. sprain of anterior S-I jt
yeoman test
