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Winter 2023 - Essential Biomechanics and Kinesiology > Hip-WK9 ( Ch12) > Flashcards

Hip-WK9 ( Ch12) Flashcards

1
Q

Compare and contrast angle of inclination vs angle of torsion.

A

Angle of Inclination: an angle in the frontal plane between the femoral neck and medial side of femoral shaft
Angle of Torsion: relative rotation between the bone’s shaft and neck (15 degrees of anteversion is optimal )

See Fig 12.7 A-C and Fig 12.8A-C

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2
Q

Compare and contrast coxa vara, coxa valga, anteversion, and retroversion

A

coxa vara: an angle of inclination <125 degrees
coxa valga: an angle of inclination >125 degrees

anteversion: torsion >15 degrees
retroversion: torsion <15 degrees

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3
Q

What are some potential consequences of excessive femoral anteversion ?

A

increased likelihood of hip dislocation, articular incongruence, increased joint contact stress and increased wear on articular cartilage or acetabular labrum

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4
Q

Why does “ in-toeing” gait pattern occur ?

A

in-toeing occurs as a compensation to excessive anteversion to better align the femoral head in the acetabulum.

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5
Q

Why is it a good thing that the thickest articular cartilage of the acetabulum is in the superior anterior region?

A

This is the region that receives the highest joint force during walking.

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6
Q

What are the special qualities of the acetabular labrum ?

A
  1. the labrum forms a mechanical seal to maintain a negative intra-articular pressure; allowing hip to resist distraction forces.
  2. forms a fluid seal to prevent leakage of synovial fluid
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7
Q

How does the hip’s close packed position compare to the position of most articular congruence ?

A

CPP= slight internal rotation, slight abduction and full extension
Most congruence= 90 degrees of flexion with moderate abduction and ER

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8
Q

What are the planes of motion for: flexion, extension, abduction, adduction, external rotation, internal rotation

A

Flexion and Extension: sagittal
Abduction and Adduction: frontal
ER and IR: horizontal

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9
Q

What are the axes of motion for: flexion, extension, abduction, adduction, external rotation, internal rotation

A

Flexion and Extension: frontal
Abduction and Adduction: sagittal
ER and IR: vertical axis

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10
Q

What are the arthrokinematics of femoral on pelvic: flexion and extension

A

spin

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11
Q

What are the arthrokinematics of femoral on pelvic: abduction and adduction

A

abduction: femur roll superior and slides inferior
Adduction: femur rolls inferior and slides superior

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12
Q

What are the arthrokinematics of femoral on pelvic: ER and IR

A

ER: femur rolls posterior and slides anterior
IR: femur rolls anterior and slides posterior

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13
Q

What are the arthrokinematics of pelvic on femoral: flexion and extension

A

spin

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14
Q

What are the arthrokinematics of pelvic on femoral: abduction and adduction

A

abduction: pelvis rolls and slides laterally
adduction: pelvis roll and slides medially

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15
Q

What are the arthrokinematics of pelvic on femoral: ER and IR

A

ER: pelvis rolls and slides posterior
IR: pelvis roll and slides anterior

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16
Q

How does the ipsidirectional lumbopelvic rhythm differ from contradirectional lumbopelvic rhythm ?

A

-during ipsidirectional lumbopelvic rhythm the trunk and pelvis move in the same direction; like when bending at the hips
- during contralateral lumbopelvic rhythm the trunk and pelvis move in opposite directions.

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17
Q

Describe spinal movement for pelvic on femoral: flexion, extension, abduction, adduction

A

flexion: pelvic anterior tilt, with increased lumbar lordosis
extension: pelvic posterior tilt with lumbar spine flexion and reduced lordosis
abduction: supported hip hiking and spine moves in opposite direction of pelvis; i.e. lateral convexity
adduction: lowering of supported hip and spine forms a lateral concavity toward the adducted hip

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18
Q

What is the “ internal snapping hip syndrome” and why does it occur ?

A
  • internal snapping hip syndrome is when the distal iliopsoas becomes mechanically abraded as it courses distally over the iliopubic eminence
  • in other words, mechanical irritation of the psoas
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19
Q

Explain the force couple about the hip and pelvis in the sagittal plane that can cause anterior/posterior pelvic tilting.

A

hip flexors and low back extensors durring pelvic on femoral hip flexion produce an anterior tilt

the hip extensors, glut max and abdominals provide a force couple which posteriorly tilts the pelvis

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20
Q

Explain how the adductors operate in the sagittal plane.

A

during flexion and extension the adductors become lengthened and their moment arms change allowing them to produce sagittal torques

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21
Q

What happens to the secondary internal rotators when the hip is flexed to 90 degrees.

A

when the hip is flexed to 90 the internal rotators torque potential increases significantly

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22
Q

How is it that some of the adductors can internally rotate the hip ?

A

the femoral shaft has a natural bowing which means that the adductors lie anterior to the axis of rotation producing internal rotation. See Fig12.38

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23
Q

Which muscle is most active in resisting a forward lean in standing and why ?

A

the hamstrings; forward leaning increases the hip extension moment arm of the hamstrings and mechanically optimizes force potential

a forward lean also elongates the muscles at hip and knee

Glut max is reserved for more strenuous activity

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24
Q

List the hip muscle groups in order from the greatest torque potential to least.

A

Extensors>Flexors>Adductors>Abductors> IRs> ERs

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25
Q

Your patient has a hip flexion contracture. Discuss the implications of this impairment on standing posture and joints above/below the hip.

A

disruption of normal biomechanics and thus metabolic efficiency
interferes with patients ability to dissipate compressive forces

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26
Q

How can a patient with a spinal cord injury attain an upright posture without the use of hip extensors ?

A

leaning pelvis and trunk posteriorly moves line of gravity post to hip joints allowing stretch of iliofemoral ligaments gives passive flexion torque to hip extension torque.

stabilizes trunk and pelvis on femur

27
Q

Labral pathology: mechanisms of injury, effects on hip joint ?

A

mechanisms of injury: linked to trauma; during rotational , repetitive near end ROM of the hip; or a single traumatic event

effects on hip joint: bony malformation that degrades joint fit which leads to joint stress

pain in groin, clicking or catching

28
Q

What is femoral acetabular impingement ? ( FAI)

A

cyclic and continued abutement of the proximal femur against the acetabular rim.

29
Q

What is a CAM lesion ? Pincer Lesion ?

A

CAM lesion: excess bone formed on anterior and superior femoral neck leading to labral trauma during IR and flexion

Pincer lesion: excess bone formed on acetabulum with same mechanism as a CAM lesion.

30
Q

What is developmental dysplasia of the Hip ( DDH) ?

A

Hip joint malformation in children
poorly developed acetabulum

31
Q

Describe the pathomechanics involved in greater trochanteric pain syndrome. In what way is it similar to RTC syndrome of the shoulder ?

A

degenerative changes of the distal tendinous attachments of glute med and min
-similar in that they both share tendon degeneration over time

32
Q

What is the difference between the trendelenburg sign and the compensated trendelenburg sign.

A

compensation of the trendelenburg sign will manifest as a patient leaning toward their affected side.

33
Q

Explain how the following reduces hip joint reaction forces; using a cane on the hand of the unaffected sign

A

reduces activation of the hip abductors

34
Q

Explain how the following reduces hip joint reaction forces; carrying a heavy load on the same side

A

so as to not create an unnecessary load with a favorable moment arm to force the contra lateral abductors to contract.

35
Q

List some advice we can give to patients to reduce hip joint reaction forces.

A

light loads, carried in a backpack or by hand ipsilaterally, or divided in half and carried bilaterally

36
Q

Explain the positives of coxa varus osteotomy:

A

(+)- increased mechanical advantage for hip abductors: improved stability
(-)- increased shear force on femoral neck

37
Q

Explain the positives of coxa valgus osteotomy:

A

(+)- decreased shear force on femoral neck
(-) - decreased mechanical advantage for hip abductors; may favor joint dislocation

38
Q

What are some risk factors involved in hip fractures ?

A

age, weight, JRF, OA, osteoporosis, coxa vara.

39
Q

What are some conditions that can lead to hip arthritis ?

A

FAI: cam and pincer
labral tears
inadequate joint forces

40
Q

What are the post operative precautions for a posterior approach THA ? Why don’t these precautions exist for an anterior approach ?

A

no hip flexion less than 90 degrees, no adduction, no IR; to avoid the aggravating the incisions

usually no precautions for anterior approach as precautions aren’t relevant to normal movement

41
Q

Name the O, I, I, A for the following muscle: Iliopsoas

A

O: iliac fossa, and sides of T12-L5 vertebrae and discs between them; transverse processes of all lumbar vertebrae, iliac fossa
I: lesser trochanter
I: psoas major and minor; spinal nerves ( L1-3)
Iliacus; femoral nerve
A: hip flexion

42
Q

Name the O, I, I, A for the following muscle:Sartorius

A

O: ASIS and superior part of notch inferior to it
I: superior part of medial surface of tibia ( pes anserinus )
I: femoral nerve
A: flexion, abduction, lateral hip rotation; flexes knee joint

43
Q

Name the O, I, I, A for the following muscle: Tensor Fascia Latae

A

O: anterior and superior iliac spine; anterior part of iliac crest
I: IT band, which attaches to lateral tibial condyle
I: superior gluteal nerve
A:abduct and medial rotation of hip, stabilization when one leg is weight bearing and the other isn’t

44
Q

Name the O, I, I, A for the following muscle: Rectus Femoris

A

O: AIIS and ilium superior to acetabulum
I: via common quadriceps tendon attaches to patellar tendon
I: femoral nerve
A: extends the knee, steadies hip joint, assists iliopsoas in hip flexion

45
Q

Name the O, I, I, A for the following muscle: Pectineus

A

O: superior ramus of pubis
I: pectineal line of femur, just inferior to less trochanter
I: femoral nerve ( may receive branch from obturator )
A: adducts and slightly flexes hip joint; assists with lateral rotation

46
Q

Name the O, I, I, A for the following muscle: Adductor Longus

A

O: body of pubis inferior to pubic crest
I: middle third of linea aspera of femur
I: obturator nerve
A: adducts hip joint

47
Q

Name the O, I, I, A for the following muscle: Gracilis

A

O: body and inferior ramus of pubis
I: superior part of medial surface of tibia ( part of pes anserinus )
I: obturator nerve
A: adducts hip joint; flexes knee joint

48
Q

Name the O, I, I, A for the following muscle: Adductor Brevis

A

O: body and inferior ramus of pubis
I: pectineal line and proximal part of linea aspera of femur
I: obturator nerve
A: adducts hip joint, and small contribution to flexion of the same

49
Q

Name the O, I, I, A for the following muscle: Adductor Magnus

A

O: Adductor Part: inferior ramus of pubis and ramus of ischium
Hamstring part: ischial tuberosity
I: adductor part: gluteal tuberosity, linea aspera, and medial supracondylar line
hamstring part: adductor of tubercle of femur
I: adductor part: obturator
hamstring part: tibial part of sciatic nerve
A: adducts hip joint; flexes hip joint; extends hip joint

50
Q

Name the O, I, I, A for the following muscle: Gluteus Maximus

A

O: ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament
I: mostly on the IT band which inserts onto lateral epicondyle of tibia, others on tibial tuberosity
I: inferior gluteal nerve
A: extends hip joint, assists in lateral rotation; fixes hip joint and assists in rising from sitting position

51
Q

Name the O, I, I, A for the following muscle: Biceps Femoris

A

O: long head: ischial tuberosity
short head: linea aspera and lateral supracondylar line of femur
I: lateral side of head of fibula. Tendon is split at this site by fibular collateral ligament of knee
I: tibial and fibular divisions of sciatic nerve, long head and short head respectively

52
Q

Name the O, I, I, A for the following muscle: Semitendinosus

A

O: ischial tuberosity
I: superior part of of media surface of tibia ( part of pes anserinus )
I: tibial division of sciatic nerve
A: Extend hip joint; flex knee joint and medially rotate it when flexed. When hip and knee joints are flexed

53
Q

Name the O, I, I, A for the following muscle: Semimembranosus

A

O: ischial tuberosity
I: posterior part of medial epicondyle of tibia
I: tibial division of sciatic nerve
A:Extend hip joint; flex knee joint and medially rotate it when flexed. When hip and knee joints are flexed

54
Q

Name the O, I, I, A for the following muscle:Gluteus Medius

A

O: external surface of ilium between anterior and posterior gluteal lines
I: lateral surface of greater trochanter of femur
I: superior gluteal nerve
A: abduct and medial rotation of hip, stabilization when one leg is weight bearing and the other isn’t

55
Q

Name the O, I, I, A for the following muscle: Gluteus Minimus

A

O: external surface of ilium between anterior and inferior gluteal lines
I: anterior surface of greater trochanter of femur
I: superior gluteal nerve
A:abduct and medial rotation of hip, stabilization when one leg is weight bearing and the other isn’t

56
Q

Name the O, I, I, A for the following muscle: Piriformis

A

O: anterior surface of sacrum; sacrotuberous ligament
I: superior border of greater trochanter of femur
I: nerve to piriformis from S1-2
A: Laterally rotate extended hip joint and abduct hip joint when flexed; stabilize hip joint

57
Q

Name the O, I, I, A for the following muscle: Obturator Internus

A

O: pelvic surface of obturator membrane and surrounding bones
I: medial surface of greater trochanter
I: nerve to obturator internus
A:Laterally rotate extended hip joint and abduct hip joint when flexed; stabilize hip joint

58
Q

Name the O, I, I, A for the following muscle: Superior and Inferior Gemelli

A

O: sup: ischial spine
inf: ischial tuberosity
I: medial surface of greater trochanter
I: sup: nerve to obt internus
inf: nerve to quadratus femoris
A:Laterally rotate extended hip joint and abduct hip joint when flexed; stabilize hip joint

59
Q

Name the O, I, I, A for the following muscle: Quadratus Femoris

A

O: lateral border of ischial tuberosity
I: quadrate tubercle on intertrochanteric crest of femur and area inferior to it
I: nerve to quadratus femoris
A: laterally rotates hip joint, stabilizes hip joint

60
Q

What are the ROM norms for Hip Flexion and Extension:

A

Flexion: 120
Extension: 20

61
Q

What are the ROM norms for Hip Abduction and Adduction:

A

abd: 45
add: 30

62
Q

What are the ROM norms for IR and ER:

A

IR:45
ER: 45

63
Q

What is the CPP and OPP of the coxafemoral joint ?

A

OPP= 30 degrees of flexion, 30 degrees of abduction, slight ER
CPP= full extension, IR, and abduction

Winter 2023 - Essential Biomechanics and Kinesiology (16 decks)

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