pelvis, hip, thigh Flashcards by N R

what are the hip’s actions

flexion/extension
adduction/abduction
internal and external rotation

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muscles of the hip and thigh

flexion
- rectus femoris
- tensor fascia latae
- sartorius
- pectineus
- iliopsoas

extension
- semitend/memb
- biceps femoris

adduction
- adductor mag/long/brevis
- pectineus
- gracilis

abduction
- piriformis
- glutes
- tensor fascia latae
- sartorius

internal rot
- tensor fascia latae

external rot
- piriformis

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hip pointer

contusion of iliac crest over tensor fascia latae…which attaches to the crest

general name for any contusion over bony hip prominences

S/S = pain, dec ROM, bruising that can appear 2 days later, intramuscular or subcutaneous bleeding

muscles compensate so not stretched i.e. bend forward

IER

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subperiosteal

blood supply of periosteum is damaged w contusion

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quadriceps contusion

grade 1-3, w function loss main differentiator

treat with ICE ON STRETCH…open the space so blood doesn’t collect
- ice to a flexed knee

can be intramuscular hematoma, increased risk for myositis ossificans

can be intermuscular hematoma, less risky

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intramuscular vs intermuscular hematoma

intermuscular hematoma: swelling near intermuscular septa fascia sheaths
- blood disperses, drags w gravity and is visible
- early disperal –> inc healing

intramuscular hematoma: collection of blood WITHIN MUSCLE, swelling is contained w/in fibres instead of blood vessels
- bruising not visible bcs deep, is palpable
- diff to break bcs swelling doesn’t move
- 2-3x healing

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hip strains

most common injury of hip/groin in sport
- hip muscle strains common bcs bi-articular muscles (cross 2 jts) during eccentric contraction

pesanserine: area on media tibia, all muscles that attach there are 2jt muscles
- SGBT: sartorius, gracilis, semitendinosus, pesanserine bursa

strains may be assoc w avulsion in adolescence bcs bone > musc growth

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bi articular muscles

sartorius: ASIS to med tibia
- hip flex and ext rot
- knee flex

rectus femoris: ASIS to tibial tuberosity
- knee extension
- hip flexion

hamstrings: ichial tuberosity to diff insertions
- knee flex
- hip ext

gracilis: public bone to tibia
- adduction

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hip dislocation vs hip subluxation

dislocation = ext rare bcs inherent stability
- MOI = immense force i.e. skiing, more often posterior direction
- S/S = leg appears shortened and int rot

subluxation = not easily recog
- MOI = fall forward on flexed knee, impact from behind while knee planted
- assoc w labral tear or iliofemoral lig tear
- can cause osteochondrosis and avasc necrosis

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hip fractures

pelvic fracture = uncommon, med emergency

femoral fractures = impact forces i.e. skiing
- transverse comminuted bcs high speed impact
- S/S = total function loss, pain, potential compromised dorsal pedal pulse and tibial posterior pulse

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nondisplaced vs displaced fracture

nondisplaced = aligned
displaced = not aligned, needs alignment

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acetabular labrum tear

usually anterior or anterosuperior

MOI = twist, extreme hip rot, after dis/subluxation

labral tears usually need surgical intervention

detect via arthrogram, MRI w dye injection

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FAI

femoral acetabular impingement
- bone spurs on femoral head or acetabulum, only visible w x-ray

pincer lesion: bony defect acetabulm, can be congential or from impact sport that causes bone to extend
- femur bumps into bone

cam lesion: femoral head defect, overdeveloped bone that causes painful ROM

combined lesion: both

chronic or acute, common hockey goalies

S/S = limited hip int rotation (key), groin pain

FADDIR test: flex, add, int rot

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osteitis pubis

inflamed pubic bone

MOI = rep tensile forces occurring at adductors, musc imbalance, running activities bcs rectus abdominus pulls

S/S = insidious onset pain that radiates distally into groin and medial thigh, tender pubic symphysis
- inc w run/kick/ab training

diagnose w xray, treat w rest

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hernias

bulging small intestine thru ab wall bcs weakness and other factors

S/S = aching, dull pain - feel when laugh/sneeze/cough

sequelae: can become strangulated hernia/twisted and gangrenous

valsalva maneuver = clinical test
- inc intra-abdominal pressure, provoking outpouching
- supine w knees bent, then breathe in and bear down
- feel abs contract and palpate inguinal area for sensation/visual

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types of hernia

indirect inguinal = small intestine thru inguinal canal, can go to scrotum
- congenital
- weakness in deep inguinal ring

direct inguinal = intestine extends thru weakness in ab wall

femoral = protrudes posterior to inguinal lig and medial femoral artery
- femoral triangle

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bursitis

in hip, most commonly overuse

ischial bursa = on ischial tuberosity, irritated by fall or hamstring tendonitis
- S/S = sharp pain, pain w SITTING

trochanteric bursa = lateral hip

iliopectineal bursa = largest in body, under iliopsoas musc
- if overused musc irritates bursa i.e. running

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greater trochanteric pain syndrome

aka trochanteric bursitis
- IT band, etc. pulls on bursa on lateral leg

S/S = burning/aching pain over greater trochanter, inc w resisted hip abduction and hip flex/tend in weight bearing

risk factors
- inc Q angle
- ITB syndrome
- running in gutter/side of road…heel hits faster
- excessive foot pronation

Q angle

line b/w tibial tuberosity and long axis of femur

greater in women bcs pelvic size

impacted by poor running mechanics

snapping hip syndrome

not diagnosis…desc of injuries assoc w snapping

intra-articular causes
- synovial chondramatosis
- osteocartilagenous exostosis

extra-articular causes
- ITB friction syndrome
- iliopsoas over ilium
- biceps femoris over ischial tuberosity
- iliofemoral lig over femoral head

osteocartilagenous exostosis

benign tumour, can be seen in ppl under 20

dec adduction if medial tumour

synovial chondramatosis

nodules that become calcified w/in jt, cause snap sound/sensation

break off and become loose bodies w/in jt

abnormal bony block

piriformis syndrome

impacts sciatic nerve

MOI = atypical anatomy of sciatic nerve and piriormis, esp if goes thru musc
- tightness = squeeze nerve
- sciatic nerve can go below, above, thru piriformis or combo

S/S = dull ache in butt that WORSENS AT NIGHT, numb/weak posterior leg

ROM = pain w active hip external rotation, painful passive hip flex/adduct/int rot, resisted ext rot

stress fractures

most common at the neck of femur

bones constantly cycling b/w building and breaking down, balanced
- if inadequate rest, breakdown > building
- weakness

S/S = diffuse/localized aching pain in ant groin or tight, relieved w rest
- night pain
- painful end stress of int rot, add, hip flex

inc w coxa vara

coxa vara vs coxa valga

normal angle = 125-130 coxa vara: dec angle of femoral neck to shaft of femur, less than 125deg - causes i.e. congenital, fracture, slipped capital femoral epiphysis coxa valga = inc angle, more than 145

obturator nerve entrapment

l2-l4 of lumbar plexus, innervates adductors, gracilis, obturator externus MOI = tumors, obturator hernia, fracture, tension S/S = exercise-induced medial thigh pain, vague groin or medial knee pain

legg-calve-perthes disease

avascular necrosis of prox femur epiphysis MOI = idiopathic, can be congenital - more common boys, severe in girls S/S = limp non/painful, gradual, activity-related pain - dec ROM hip abduct, extension, and ext rot bcs of hip adductor spasms - edema/fluid accumulation femoral head osteochondrosis --> not fit properly

slipped capital femoral epiphysis

risk factors = endocrime disorders, thyroid disorders, chemo - boys 12-15, common obesity or tall/lanky when femoral head slips/shears at epiphyseal plate - displaces inferior and posterior to femoral neck S/S = general knee pain w/o MOI, unable to fully flex hip, limp - diff weightbearing

postural assessment

esp helpful for overuse conditions bony landmarks don't ID which side is dysfunctional iliac crests ASIS PSIS spine curvature alignment of spinous processes weightbearing, hyperextension

bilateral rotations

anterior pelvic tilt = leads to inc lumbar lordosis, potentially bcs of rectus femoris tension - inc weight to lower back - facet sprain or effusion posterior pelvic tilt = flat back, potentially bcs of hamstrings tendon

upslip and downslip

upslip = landmarks higher on one side MOI = more common, fall on ischial tuberosity, ilium pushed up downslip = landmarks lower = MOI i.e. tackled and pull on leg

structural vs functional leg length discrepancies

structural/anatomical = actual diff - ID if never level thru assessments - ASIS to medial malleolus, xray functional/apparent = bcs upslip - measure belly button to medial malleolus

femoral torsion

dec angle of torsion = femoral retroversion, femur turned laterally - leg ext rot inc angle of torsion = femoral anteversion, femur twists inwards and causes genu valga

genu valgum vs varum

genu valgum = knock knees, they go inwards genu varum = bowlegged

thomas test

hug knee to chest, full flexion - affected leg lifts off if iliopsoas contracture

ELY test

for rectus femoris contracture lay prone, passively lift leg into knee flexion pos = affected leg lifts off table

hip scour

for general hip pathology, change in ROM adduct leg w compression, then repeat w abduction...thru ROM pos = pain

gaenslen test

for SI pathology unaffected leg hangs off table edge - patient passively lifts affected leg to chest apply pressure to both knees - into chest, off table pos = pain reproduction

FADDIR test

for FAI flex, adduct, int rot (like circular motions) pos = pain, dec int rot

FABER test

for SI pathology flex, abduct, ext rot press down on ASIS

SI compression and distraction

distraction = press ASIS apart inf/lat compression = lay down on side, and press down on iliac crest (just downwards) for sacroiliac pathology, lower back pain/groin

lasegue/straight leg test

sciatic nerve pathology with leg fully straight, passively flex the leg - measure when they feel pain/tightness pos = pan b/w 30-70 deg flexion for SI any greater could be tight muscles

trendelenberg test

for greater trochanteric pain syndrome when patient reports lateral leg pain affected hip moves up bcs cannot contract

piriformis test

for piriformis syndrome pos = pain in glutes/piriformis region