Lecture: The Hip Flashcards
the hip articulation is formed b/w the head of the __ and the __ of the pelvic bone.
- femur
- acetabulum
hip joint transmits truly impressive loads, both __ & __.
also provides a wide range of __ __ movement.
- tensile
- & compressive
- lower limb
hip joint is classified as a __ & __ joint.
permits motion in 3 planes:
all 3 of these axes pass thru the center of the __ __.
- ball & socket
- (1)sagittal (flex/ext around a transverse axis)
- (2)frontal (abd/add around an ant.-post. axis)
- (3)transverse (int/ext rot. around a vertical axis)
os coxa (hip bone), initially begins as 3 ind. bones:
- ilium
- ischium
- pubis
the body of the ilium forms the __ 2/5ths of the acetabulum.
the ischium is a __ that contributes to the acetabulum & __, forming the __ 2/5th’s of the acetabulum.
ischium + ramus form the __ tuberosity.
- superior
- body; rams
- posterior
- ischial
pubis is the smallest of the hip bones.
consisting of a __ and __ & __ rami.
it forms the __ 1/5th of the acetabulum.
- body
- inferior & superior
- anterior
the majority of acetabular development is completed by age?
and the __ increases thru puberty
- eight
- depth
the acetabulum is angled laterally, \_\_ & \_\_. acetabular rim (labrum) fxn: the whole of the acetabulum is covered with \_\_ cartilage, except the fovea capitis, b/c?
- inferiorly & anteriorly
- (deeps the acetab.) increasing its stability of the hip jt.
- hyaline
- serves as an attachment site for ligaments
pelvic girdle is composed of 3 joints:
- sacroiliac
- hip joint (acetabularfemoral)
- pubic symphysis
ASIS should be in same horizontal plane, if not= __ __.
which test?
- pelvic obliquity
- leg length discrepancy
the __ tubercle marks the __ point on the iliac crests.
- iliac
- widest
iliac crest contusion:
aka?
contusion at site or an avulsion of the __ __ and/or __ muscles from the crest.
very painful, even disabling if __ is involved.
pt. experiences pain when __ bending __ from the side of injury.
etiology?
- hip pointer
- quadratus lumborum and/or abdominal
- periosteum
- side; away
- trauma
greater trochanters are to be level with?
congenital hip dislocation or hip __ could heal improper and make the levels unequal; which test?
- pubic tubercles
- fracture
- Allis Sign
Bucket Handle Fracture: __ & __ pubic rami frxs w/ a separation or frx of the __-__ SIJ.
MOI?
- superior & inferior
- contra-lateral
- high speed falls (motorcycle, bicycle)
Sprung Pelvis: separation of the __ symphysis & __ SIJ’s.
MOI?
- pubic
- both
- genitourinary injuries, severe constipation (organ rupture), possibly from multiple births.
Straddle Fracture: __lateral __ pubic rami, & ischiopubic fractures.
MOI?
- bilateral
- superior
- falling on butt from high place or w/ great force, or from long time sustained micro trauma (i.e. riding a tractor for years)
most common areas of the pelvis for avulsion fractures are:
- ASIS
- AIIS
- ischial tuberosity
approximately _/_rds of the femoral head is covered with a smooth layer of __, except __ __, (attachment site of __ __)
- 2/3
- cartilage
- fovea capitis
- ligamentum teres
the angle b/w the femoral shaft and the neck is called?
average degree of angle? (varies b/c of diff. body types)
in a tall person the angle is __ (aka __).
the opposite is true with shorter individuals, __.
- inclination angle
- 125-130
- larger; valga
- vara
dashboard injury to the knee will cause __ hip dislocation if the hip is __ at the time of injury.
- posterior
- adducted
the trabecular bone in the femoral neck and head is specifically designed to withstand __ __.
and incorporates both primary & secondary __ & __ patterns.
- high loads
- compressive & tensile
greater trochanter serves as the __ site for several muscles that act on the __ joint.
the lesser trochanter is created from the pull of the __ muscle.
- insertion
- hip
- iliopsoas
the angle the femoral neck makes with the acetabulum is called the angle of __.
normal is?
- anteversion
- 8-15deg.
femoral ANTeversion is when the angle is >__.
= a toe __ gait.
this increased femoral head torsion may result in:
- > 15deg.
- in
- osteoarthritis
- susceptible to ant. femoral dislocation
- knee joint misalignment problems
- patellar dislocations
- excessive lumbar lordosis
- external rotation of the tibia
- pronation of the feet
femoral RETROversion is when the angle is <__.
=a toe __ gait.
this decreased femoral head torsion may result in:
- <15deg.
- out
- low back or SI pathologies
- internal rotation of the tibia
- supination of the feet
Legg-Calve-Perthes Disease: \_\_ necrosis of the femoral capital \_\_ b4 closure of the \_\_ plate. \_\_ = 5:1 predominance ages: \_\_-\_\_, peaking at \_\_ years old. bilateral in \_\_ %. history of: positive in which test? primary causes: 4 stages:
-avascular; epiphysis; growth
-male
-2-14; 5
-10
-painful limp, reduced mobility & muscle atrophy
-trendelenberg test
-trauma, hereditary, nutritional, circulatory
(happens in 1 in 1200, smoking increases that to 1 in 100)
-1=avascularization, 2=revascularization, 3=repair, 4=deformity
3 extra-articular ligaments help provide stability at the hip joint:
(tighten with hip ext.!)
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
the iliofemoral ligament consists of \_\_ parts: it is the \_\_ ligament in the body. oriented superior & \_\_. blends with the \_\_ muscle. limits what movement?
- 2 (inf/med. & sup/lat.)
- strongest
- lateral
- iliopsoas
- lat=adduction & med=ext. rot.
pubofemoral ligament is oriented inferior & __.
blends with the inferior band of the __ & the __ muscle.
limits what movement?
- medial
- iliofemoral & pectineus
- abduction
ischiofemoral ligament winds __ around the femur, and attaches __, strengthening the capsule.
this ligament is more commonly __ that the other hip ligs.
limits what movement?
- posteriorly
- anteriorly
- injured
- internal rotation of the hip
iliopsoas muscle comprised of 2 parts:
innervated by:
the most __ of the hip flexors.
what tests?
- iliacus & psoas major
- femoral nerve
- powerful
- thomas & ely sign
pectineus muscle:
action:
innervated by:
- adductor
- flexor
- & internal rotator of the hip
- femoral nerve
rectus femoris muscle: combines movements of: main \_\_ muscle. innervated by: what test?
- flexion at the hip
- & extension at the knee
- quad.
- femoral nerve
- ely sign +
tensor fascia latae (TFL)
assists in:
innervated by:
what test?
- flexing
- abducting
- & internally rotating the hip
- superior gluteal nerve
- ober +
sartorius
responsible for:
__ muscle in the body.
innervated by:
- flexion
- abduction
- & ext. rot. of the hip
- & some deg. of knee flex.
- longest
- femoral nerve
gluteus maximus
__ & most __ hip extensor & external rotator of the hip.
innervated by?
tested in which nerve root?
- largest; important
- inferior gluteal nerve
- S1
gluteus medius main \_\_ of the hip. weakness of this M. is + on what test? anterior portion action: posterior portion action: innervated by? tested in which nerve root?
- abductor
- trendelenburg
- flexes, abducts & internally rotates hip
- extends & externally rotates hip
- superior gluteal nerve
- L5
gluteus minimus
the major __ __ of the FEMUR
innervated by?
tested in which nerve root?
- internal rotator
- superior gluteal nerve
- L5
what are causes for a weak gluteus muscle?
- fractures of the greater trochanter
- slipped capital femoral epiphysis
- congenital hip dislocation (allis sign)
- poliomyelitis
- meningomyelocele
- nerve root lesion
slipped femoral capital epiphysis:
slipping of the __ on the femoral head, as the head remains in the __.
adolescent ages:
tends to be more in which gender?
tends to be more in which race?
tends to be more in which hip?
bilateral is more common in __?
has a tendency to be more common in __ adolescents.
onset of limp with __ pain referred to the __.
etiology is __ 50% of the time.
alteration in __ line (normal 120).
- neck; acetabulum
- 10-15
- males
- blacks
- left
- females
- overweight
- hip; knee
- trauma
- Klein’s
Piriformis:
an __ rotator of the hip at LESS than __ degrees of hip FLEXion.
at __ degrees of hip flexion, the piriformis reverses muscle action becoming an __ rotator & __ of the hip.
- external
- 60
- 90
- internal & abductor
small external rotators of the hip:
- obturator externus & internus
- superior & inferior gemelli
- & quadratus femoris
hamstrings made up of: (3)
- biceps femoris
- semimembranosus
- semitendinosus
biceps femoris
action:
innervation?
- extends the hip
- flexes the knee
- & INT. rot. the tibia
- fibular branch of sciatic n. (tibial nerve)
semimembranosus & semitendinosus
action:
innervation?
- extends the hip
- flexes the knee
- & INT. rotates the tibia
hip adductors: (4)
- adductor magnus
- adductor longus
- adductor brevis
- gracilis
adductor longus is frequently __ during strenuous activity.
if pulled, called?
most __ adductor.
innervation:
- pulled
- groin pull (strain)
- prominent
- post. division of obturator nerve
there are more than a __ bursae in the hip region.
the iliopsoas (iliopectineal) bursa is located under the __ ligament, b/w the iliopsoas __ and the iliopectineal __ of the superior pubic rams.
osteoarthritis (OA) of the hip commonly causes __ of the __ bursae.
the __ bursae is located between the greater trochanter & __.
- dozen
- inguinal
- tendon
- eminence
- inflammation
- psoas
- subtrochanteric; TFL
femoral triangle aka? superior border? medial border? lateral border? the floor is formed by:
- scarpa’s triangle
- inguinal ligament
- adductor longus
- sartorius
- portions of the iliopsoas on the lateral side
- & pectineus on the medial side
inguinal ligament is located b/w __ & the __ __.
unusual __ along the ligament could indicate an inguinal __.
- ASIS & pelvic tubercle
- bulges
- hernia
femoral artery is normally quite __.
-strong
femoral nerve lies __ to the femoral artery.
aka?
__ branch of lumbar plexus.
formed by branches of ventral rami, from __-__ spinal N.
- lateral
- saphenous n.
- largest
- L2-L4
femoral vein is __ palpable.
-not
apex-inf. = adductor canal
aka?
-hunter’s canal
sciatic nerve is located b/w __ __ & __ __.
tenderness may be due to a disc __ or __.
problem w/sciatic n. may be due to its relationship w/__ M.
it is the __ & __ nerve in the body.
- greater trochanter & ischial tuberosity
- pathology or trauma
- piriformis
- largest & longest
normally the sciatic nerve passes __ to the piriformis m.
__%.
OR the common peroneal division of the sciatic n. will pass either: __ the piriformis (__%)
__ to the piriformis (__%)
OR both divisions pass __ the piriformis m. (__%)
- inferior; 88%
- thru; 11%
- superior; 9%
- thru; .1%
the external __ artery becomes the femoral artery as it passes __ the inguinal ligament.
- iliac
- underneath
the anterior portion of the femoral neck & the anterior portion of the capsule of the hip joint are supplied by:
-lateral femoral circumflex artery
the medial femoral circumflex artery perforates & supplies:
- the posterior hip joint capsule
- & synovium
the hip is a common area of __ & __ pain.
- local
- & referred
weight loss, fatigue, fever & loss of appetite should be sought out b/c they are clues to a:
other examples include:
- systemic illness
- insidious onset of symptoms, evidence of radiculopathy, blower and/or bladder changes, night pain unrelated to movement and severe pain.
use P.R.I.C.E. during what phase?
and what does ‘price’ stand for?
- acute
- protection, rest, ice, compression & elevation
osteoarthritis: (__ common for of arthritis)
aka?
primarily a disorder of __ cartilage & __ bone.
men & women __ affected.
after age?
deep, __ joint pain, after __ or weight bearing, relieved by?
__ may be present on movement.
seen on x-rays as __ of joint space, __ bony deposits in joint space, or joint deformity due to __ or articular damage.
non-inflammatory usually involving __ to a __ joints.
- most
- degenerative joint disease
- hyaline; subchondral
- equally
- 40
- aching; exercise; rest
- crepitation
- narrowing; cyst-like
- degeneration
- one; few
