Lower extremities exam 3- hip Flashcards
normal angle of inclination
125 deg
coxa vara def
decreased angle of inclination
coxa valga
increased angle of inclination
how does the angle of inclination change throughout a human’s lifespan
start w/ high and decreases as weight bearing begins
def angle of inclination
angular relationship of femoral head and femoral shaft of frontal plane (at hip joint_)
angle of torsion def
angular relationship of femoral head and femoral shaft in the transverse plane= amount of twist on the femur
angle of torsion normal degree
15-20
angle of torsion anteversion
greater than 20
angle of torsion retreoversion
less than 15
hip/femoral anteversion degree
greater than 20
what may femoral anteversion lead to
increase of Q angle, internal femoral rotation, squinting patella
hip/femoral retroversion degrees
less than 15
what does femoral retroversion lead to
femoral ER, laterally positioned patella, toe out gait
bones of hip and pelvis
ilium, pubis, ischium, sacrum, coccyx, femur
what 3 bones make up the pubis
superior rami, inferior rami, symphysis
where is the ishium located anatomically
at the fold of the buttcheek where hamstrings insert
innominate bone made up of what 3 hip structures
illium, ishium, pubis
what makes up the socket of the hip joint
acetabulum and labrum
what bone makes up the tail bone
coccyx
what quad muscle crosses at the hip
rectus femoris
what are the anterior muscles of the hip
rectus femoris, sartorius, illiopsoas
medial muscles of hip
adductors, gracilis
lateral muscles at the hip
gluteus medius, IT band, piriformis, quadratus femoris, obturator internus, obturator externus, gemellus superior, gemellus inferior
posterior muscles at the hip
glutes and hamstrings
trochanteric bursa purpose
provides lubrication for where gluteus maximus passes over greater trochanter, IT band, hip abductors
gluteofemoral bursa def
separates gluteus maximus from origin of vastus lateralis
ischial bursa def
weight bearing structure when person is SEATED provides cushioning
iliopsoas bursa
LARGEST bursa in the body, covers AIIS, illiac fossa, lesser trochanter
muscles involved in hip flexion
illiacus, psoas, sartorius, rectus femoris, pectineus, adductor brevis, adductor longus, adductor magnus, gluteus medius, gluteus minimus
muscles involved with hip extension
adductor magnus, gluteus maximus, gluteus medius, biceps femoris, semimembranosus, semiteninosis
what can the clinican do to isolate the glute instead of allowing the hamstring to fire?
have patient lay prone and flex the knee to prevent hamstring from working
muscles involved with abduction
sartorius, tfl, piriformis, gluteus maximus, gluteus minimus, gemellus superior, gemellus inferior, obturator internus
muscles involved with adduction
pectineus, adductor brevis, adductor longus, adductor magnus, gracilis, gluteus maximus
muscles involved with internal rotation
tfl, gluteus medius, gluteus minimus, semimembranosis, semitendinosus
muscles involved with external rotation
psoas, illiacus, sartorius, adductor brevis, gluteus maximus, gluteus medius, piriformis, inferior gemellus, obturator internus, quadratus femoris
what’s the artery at the hip
femoral artery
what does the femoral triangle include
sartorius, adductor longus, inguinal ligament
L1 DTR
L1 & L2 DTR which nerve
femoral nerve
what nerves are involved with the lumbar plexus
femoral, obturator, sacral
special test for angle of torsion set up
prone w/ knee flexed to 90, one hand palpates greater trochanter and uses a goniometer to measure.
special test for angle of torsion do
rotate femur until greater trochanter is maximally prominent, angle is measured by lower leg while knee remains flexed to 90
special test for angle of torsion + test
angle greater than 15 deg created after femur moved= femoral retroversion. angle greater than 20 deg created after femur moved= anteversion
q angle degrees m/f
18 deg F, 13 deg M
q angle def
relationship b/w ASIS, midpoint of patella and tibial tuberosity
leg length discrepancy special test *true
ASIS to medial malleolus
leg length discrepancy special test *apparent
umbilicus to medial malleolus
trendelenburg test set up
patient standing w/ weight evenly distributed on both feet, iliac crests or posterior superior iliac spines should be visible
trendelenburg test do
patient lift leg opposite of side being tested
+ trendelenburg test
pelvis lowers on non-weight bearing side
what does + trendelenburg test indicate
glute medius weakness
thomas test setup
patient supine, passively flex knee to chest and opposite leg rests on table
+ thomas test
involved leg rises off table OR involved knee moves into extension
+ thomas test indicates
tightness of iliopsoas OR rectus femoris
ely’s test set up
patient prone, passively flex knee
ely’s test +
hip on side flexes causing it to rise from the table
ely’s test + indicates
tightness of rectus femoris
faber(patrick’s) test set up
patient supine with involved foot crossed over opposite thigh, one hand on ASIS and other on medial flexed knee
+ patrick’s test
reproduction of symptoms at hip
patrick’s test indicative of
impingement at hip, labral tear,
what test should be done for the labrum of hip
faber (opposite) and anterior impingement (anterior), hip scouring (internal and external rotation), trendelenburg
piriformis test set up
patient laying on side, top leg positioned w/ hips at 60 deg flexion and knee flexion, stabilize pelvis and apply downward pressure at knee
piriformis test +=
pain
piriformis test + indicates
piriformis tightness or piriformis syndrome
anterior impingement test set up
patient supine, flex IR and adduct hip, rotate leg out
+ anterior impingement test
pain or reproduction of symptoms
anterior impingement test indicates
femoral acetabular impingement or labral tear
symptoms of anterior impingement test
pain, pop, click, lock, etc
hip scouring test set up
patient supine and fully flex hip and knee
hip scouring test perform
apply pressure downward along shaft of femur to compress joint surfaces, femur internally and externally rotated w/ hip in multiple angles of flexion
+ hip scouring test
pain, reproduction of symptoms
+ hip scouring test indicates
labral tear or defect in articular cartilage of femur or acetabulum
stress fracture test aka
fulcrum test
stress fracture test set up
patient seated at end of table, one hand under mid to distal thigh, other hand applies downward pressure on proximal knee
+ stress fracture test
pain
what does + stress fracture test indicate
femoral stress fracture
where may contusions of hip occur
illiac crest, greater trochanter, ischial tuberosity, coccyx
hip pointer aka
contusion of illiac crest
MOI hip pointer
direct trauma, fall
s/s hip pointer
pain, tender, pain w/ flexion and rotation, sneeze and cough may increase pain, crepitus upon palpation
tx hip pointer
protect w/ padding, RICE
coccyx contusion MOI
direct trauma, falling, sit hard
s/s coccyx contusion
pain w/ sitting, pt tender, swelling, discoloration
tx coccyx
f/o fracture, donught pillow to sit, RICE
hip strain MOI
overstretching, dynamic overload of muscle
s/s hip strain
pain, swelling, palpable defect
tx hip strain
crutches, appropriate ratio of stretch to strengthen
tendonitis is common where in hip
hip flexors
tendonitis MOI
overuse, repetitive hip flexion, run, kick, insidious onset
s/s tendonitis
pain, swell, tender
tx tendonitis
proper warm up, heat, RICE
trochanteric bursitis MOI
acute blow, overuse, irritation
risk factors trochanter bursitis
hip anteversion, increased Q angle, leg length discrepancy
s/s trochanter bursitis
pain of greater trochanter, pain radiates to butt, pain w/ stairs, discomfort sleeping on side, red, tender, snapping
tx trochanter bursitis
RICE, injection
when should hip be reduced to prevent neurological problems
less than 6 hours after injury
ischial bursitis MOI
acute blow, overuse, repeated shifting and moving while in seated position, rowing, prolonged sitting, biking
ischial bursitis s/s
pain at ischial tuberosity, tender, pain w/ flexion
tx ischial bursitis
RICE, activity modification
legg calve perthes disease def
lesion of femoral head that causes degeneration and flattening of femoral head
legg-calve perthes disease develops when in life
first decade (10 years)
is legg calve perthes more common in girls or boys
boys
MOI legg calve perthes
degenerative, single traumatic or multiple chronic events, disrupt blood supply, blood borne clotting factor, thyroid disease
s/s legg calve perthes
hip or groin pain, limp, decreased ROM, leg may appear shorter
what + test associated w/ legg calve perthes
+ trendelenburg test
tx legg calve perthes disease
confirm w/ x-ray, PT, improve ROM, bracing, surgery
what is most common hip disorder in adolescents
slipped capital femoral epiphysis
slipped capital femoral epiphysis affects boys or girls more
boys
unexplained hip and knee pain in kids could mean
slipped capital femoral epiphysis
what causes slipped capital femoral epiphysis
femoral head remains in acetabulum and femoral neck displaces anteriorly causing toeing out
what are 2 classifications of slipped capital femoral epiphysis
stable or unsable depending on if they are able to bear weight
MOI slipped capital femoral epiphysis
gradual onset or abrupt maneuver
risk factors slipped capital femoral epiphysis
overweight children w/ growth spurt
s/s slipped capital femoral epiphysis
pain that gets worse with activity
femoral stress fracture MOI
overuse due to rapid increase in frequency, intensity or duration
risk factors of femoral stress fracture
female, decreased calcium/vit D intake
s/s femoral stress fracture
deep aching pain, pain when rolling in bed, night pain, limits in extreme ROM
what special test is for femoral stress fracture
+ stress fracture test
tx femoral stress fracture
MRI, modify activity, progressive RTP
osteitis pubis def
inflammation of public symphysis
MOI osteitis pubis
overuse, run, kick
s/s osteitis pubis
groin pain, tender at symphysis, spasm of adductor, pain w/ resisted hip adduction, pain w/ trunk flexion
tx osteitis pubis
activity modification, nsaids
hip dislocation is usually anterior or posterior
posterior
MOI hip dislocation/subluxation
flexion and adduction w/ axial force, fall onto flexed knee w/ hip adducted, jump, stop or pivot, knee to dashboard
s/s hip dislocation
immediate intense pain, femur and lower legs in flexion, inability to WB
tx hip dislocation
immediate transport
avascular necrosis of femoral head def
blood floor interrupted or reduced
what is the major risk of avascular necrosis
bone death
what is most common complication after hip dislocation
avascular necrosis of femoral head
other causes of avascular necrosis
obesity, sickle cell, lupus, history of subluxations
femoral acetabular impingement common population
middle aged athletic individuals
def femoral acetabular impingement
abnormal stresses on surrounding soft tissue and bone resulting in labral tears, chondral degeneration, osteoarthritis
cam lesions def
at femoral head, result from abnormally shaped femoral head repeatedly contacting acetabulum and surrounding labrum
why might cam lesion develop
extensive sports participation during high growth period of adolescence
pincer lesions more common in what population
middle-aged, active females
pincer lesion may develop b/c
result when acetabulum is covering femoral head due to compression during flexion
femoral acetabular impingement MOI
gradual onset, repeated compressive forces from abnormally shaped head
risk factors femoral acetabular impingement
slipped capital femoral epiphysis, legg calve perthes
s/s femoral acetabular impingement
grain pain extends to lateral thigh, pain made worse by activity in flexion, antalgic gait, deep pain
what + tests for femoral acetabular impingement
FABER and anterior impingement
tx femoral acetabular impingement
avoidance of aggravating activities including excessive IR and adduction
labral tear MOI
acute, twisting, falling, mis-step, hyperextension, hyperabduction, dislocation, subluxation, repeated weight bearing
predisposing conditions of labral tear
slipped capital femoral epiphysis, FAI, capsular laxity
s/s labral tear
deep pain in anterior or medial hip, running distance limited
tx labral tear
attempt at conservative treatment, MRI, surgery if necessary
athletic pubalgia aka
sports hernia
sports hernia cause
unbalanced tension b/w upward pull of rectus abdominis and downward lateral pull of adductor muscle group
MOI athletic pubalgia
insidious, repetitive twisting, cutting, running, kicking
s/s athletic pubalgia
deep lower abdominal or groin pain, symptoms return after period of rest, pain w/ palpation of pubic ramus, adductors, pain w/ sit up, pain w/ cough or sneeze
tx athletic pubalgia
MRI, attempt at conservative treatment, surgery
MOI snapping hip syndrome
insidious, internal or external snapping
internal vs external snapping hip syndrome
iliopsoas contacting femoral head or other structure vs IT band catching greater trochanter
risk factors snapping hip syndrome
dancers in teens or 20s
s/s snapping hip syndrome
pain and snapping during running, jumping, cross stepping activities, pt has ability to recreate and palpate popping when hip moves from flexion to extension, bursitis
tx snapping hip syndrome
RICE, activity modification, NSAIDS
where does sciatic nerve usually pass through piriformis (under or over)
under piriformis
what % of population has piriformis problems
15%
where does sciatic nerve pass through to cause piriformis syndrome
through the piriformis muscle
who is piriformis syndrome more common in
women
piriformis syndrome MOI
congenital, overuse, repetitive kicking, running
s/s piriformis syndrome
pubic pain, spasm, tightness, tender, numb and tingle, burn, cough, sneeze causes pain
+ test for piriformis syndrome
piriformis test
tx piriformis syndrome
proper ratio of stretching and strengthening, steroid injection, surgical relase
hip osteoarthritis MOI
age, repetitive trauma, degernation of surfaces
s/s hip osteoarthritis
pain w/ weight bearing, referred pain to low back or knee
+ test for hip osteoarthritis
hip scour
tx hip osteoarthritis
activity modification, weight loss, NSAIDS, calcium, vit D supplements, hip replacement surgery
hip fracture MOI
car accident, high impact activity, direct trauma
s/s hip fracture
immediate pain, loss of function, deformity
