Structures of the Hip Joint Flashcards
week 8
ligaments and joint capsule
the hip joint capsule is tight in what direction and more relaxed in what direction?
tight in extension
more relaxed in flexion
ligaments and joint capsule
the strongest ligament in the body is the iliofemoral ligament - what motion does it prevent?
hyperextension
ligaments and joint capsule
pubofemoral lies anteroinferiorly and prevents excess _____- and _______
abduction and extension
ligaments and joint capsule
which ligament is the weaknest of the hip joint capsular ligaments?
ischiofemoral
ligaments and joint capsule
which ligament consists of a triangular band of fibers that forms the posterior hip joint capsule?
ischiofemoral
the ischiofemoral ligament prevents excess ________?
hip flexion and internal rotation
ligaments and joint capsule
the ligamentum teres is located intracapsular and attaches the apex of the cotyloid notch to the fovea of the femoral head. this serves as a carrier for what artery?
foveal artery (posterior division of the obturator artery)
labrum
the labrum of the hip has three surfaces - what are they?
- internal articular surface (adjacent to the joint-avascular)
- external articular surface (contacting joint capsule - vascular)
- basal surface - attached to the acetabular bone and ligaments
ligaments and joint capsules
what ligament(s) surrounds the hip and helps hold it in place while moving?
transverse ligaments
labum
what arteries supply the outer third of the labrum of the hip?
obturator, superior gluteal and inferior gluteal arteries
labrum
what are the functions ofthe acetabular labrum?
- joint stability - ↑ containment of the femoral head - deepening the joint by 21%. thus allowing a wider area of force distribution and resisting lateral and vertical motion within the acetabulum
- sensitive shock absorber
- joint lubricator (synovial fluid in contact with articular cartilage)
- pressure distributor
- ↓ contact stress between the acetabular and the femoral cartilage
muscles
muscles of the hip joint can be grouped based upon their functions relative to the movemetns of the hip
what are the flexors?
- psoas major
- psoas minor
- iliacus
- pectineus
- rectus femoris
muscles
what are the extensor muscles of the hip joint?
gluteus maximus
semitendinosus
semimembranosus
biceps femoris (long head)
muscles
what are the adductor muscles of the hip joint?
adductor magnus
adductor longus
adductor brevis
gracilis
pectineus
muscles
what are the abductors of the hip joint
gluteus medius
TFL
muscles
what are the internal rotators of the hip joint?
TFL
gluteus minimus
muscles
what are the external rotators of the hip joint?
7 muscles
gluteus maximus
gemellus superior
gemellus inferior
obturator externus
obturatorinternus
quadratus femoris
piriformis
CPP and OPP
what is the Close Packed Position for the hip joint?
why?
full extension
- because this position draws the strong ligaments of the joint tight resulting in stability
CPP and OPP
what is the open packed position for the hip joint?
why?
the hip joint is one of the only joints where the position of optimal articular contact is combined flexion, abduction and external rotation
since flexion and external rotation tend to uncoil the ligametns and make them slack
labrum
what distributes force evenly through labral tissue?
hydrostatic pressure
labrum
what is hydrostatic pressure of the hip labrum?
it is similiar to lung or wall clings
its a closed vaccuum- the synovial fluid suctiosn the hip in
what is center edge angle?
angle between:
- vertical line from the center of the femoral head
- line connecting the center of the femoral head and the lateral rim of the acetabulum
what creates a bigger center edge angle? what creates a smaller one?
why?
- deep acetabulum =bigger
- shallow acetabulum = smaller
the deeper the femoral head sits in the acetabulum the further the line connecting the center of the femoral head and lateral rim of the acetabulum will be from each other resulting in a bigger angle and vice versa for a smaller angle
center edge angle
what degree range categorizes definite dysplasia of the hip?
<16°
center edge angle
what degree category constitutes possible dysplasia of the hip?
16°-25°
center edge angle
what degree category constitutes a normal hip and no dysplasia?
> 25°
center edge angle
what degree category constitutes possible excessive acetabular coverage (coxa profunda or protrusio acetabuli)?
> 40°
angle of inclination
what is the approximate degree of the angle of inclination of the hip?
between what degrees can be considered normal?
approx 125°
between 110°-140° can be normal
angle of inclination
where are the lines draw on the femur to create the angle of inclination?
line through neck and line through shaft of femur
what kind of angle of inclination do people have when they are born? what occurs as we go through puberty?
higher angle when born ~150°. Gravity and weightbearing will bring the angle down during puberty and bone will stop growing post puberty
angle of inclination
what is coxa valga?
of femur
increased angle of inclination
≥140°
angle of inclination
what are the issues with coxa valga of the femur?
- all compressive load
- changes length/tension relationship of muscles
- changes moment arm - increases moment arm –> < in hip adductor strength
- ↑ compressive load through femur = arthritic changes earlier in life and increased risk of fracture
angle of inclination
what is coxa vara?
of femur
decreased angle of inclination
≤105°-110°
angle of inclination
what are the complications of coxa vara of the femur?
- > moment arm of hip adductors
- more vertical load through head of femur
- more shearing force through epiphysial plate or slipped head of femur
- more bending force through neck = neck fractures
angle of torsion
what is the normal degree of angle of torsion for the femur?
10°-20°
angle of torsion
what is anteversion of the femur?
35°
the acetabulum cup faces slightly anterior
angle of torsion
what is retroversion of the femur?
less than 15-20°
acetabular cup faces posteriorly
angle of torsion
what are some complications of anteversion? retroversion?
why?
think girl thinkkkk
acetabular labrum
what is one of the main goals of the hip labrum?
increase surface area
labrum
what type of labral tear is more come in the US and europe?
anterior labral tear
labrum
what are 3 common mechanisms of labral tears in the hip?
- direct trauma
- sports with frequent external rotations or hyperextension (ballet, soccer, hockey, etc)
- twisting movements, hyper abduction, hyper extension, hyper extension with external rotation
labrum
what are 5 symptoms of hip labral tears?
- often anterior groin pain, can be trochanteric and buttock region
- constant dull pain, periods of sharp pain, pain worsens in activity. can be nighttime pain (sleep position in end range positions)
- aggravated by walking, pivoting, prolonged sitting and impact activities
- clicking, locking or catching or giving away can be reported (not considered significant but is common)
- ROM not restricted BUT CAN BE PAINFUL AT END ROM
mri arthrograph can diagnose but expensive
what is the leading cause of disability worldwide?
osteoarthritis !!!!
what are some characteristics of osteoarthrtis (OA)?
- degeneration of articular cartilage in synovial joints
- disease of the whole joint
- most common in the knee and the hip
- cartialge cannot be regenerated
- comorbidities are common (obesity, DM2, etc)
hip osteoarthritis
hip internal rotation _____ (passive rom)
hip flexion _____
age ______
or
hip internal rotation ____ (passive rom)
pain with
duration of morning stiffness of the hip ≤ to ______
age ______
- IR <15°
- flexion ≤ 115°
- age > 50 years
OR
- IR ≥15°
- pain with hip IR
- 60 minutes
- > 50 years
rememer we dont diagnose ppl with OA !
*passive ROM’s doesn’t really matter if its active or passive
hamstring strain
what is a type 1 hamstring strain?
- high speed running
- usually involve the long head of the BICEPS FEMORIS, most commonly at the proximal muscle-tendon junction
strain = muscle/tendon
hamstring strain
what is a type II hamstring strain?
- excessive lengthening of the hamstring in hip flexion with knee extension (kicking, sliding tackle, forward split)
- typically located close to the ischial tuberosity and involve the proximal free tendon of SEMIMEMBRANOSUS
known as the “stretching type”
- tendon is the tissue due to exessive lengthening
hamstring strain
symptoms of hamstring strains
- localized tenderness and swelling at the site of injury
- ecchymosis (frequently)
- restricted kne extension and straight leg raising
- palpable divot in the injured hamstring (more severe injuries -fibers torn)
- positive tripoid sign (ppt or bend backwards = + test)
ecchymosis = brusing - can travel down leg due to gravity
hamstring strain
what is the tripod sign
- seated
- knees 90° flexed off treatment bed
- passively extend 1 knee
- return knee to start and compare to other side
- (+) if patient tries to lean back or slumping in lumbr spine to relief tension
dysfunction of the tendon
what are mechanisms of a high hamstring tendinopathy?
- runners, athletes in sports with frequent cahnge of direction
- non athletes
- gradual onset
dysfunction of the tendon
what are symptoms of a high hamstring tendinopathy?
- deep ache in the gluteal area can radiate down
- pain worse during or after repetitive activity
- provoked by deeper hip flexion activities (squats, lunging)
- provoked by long periods of sitting (especially hard surfaces)
- excessive stretching
things that stretch the tendon or direct pressure on tendon
sitting in APT can exasturbate this as well
dysfunction of the tendon
what is a treatment progression for high hamstring tendinopathy?
first focus on:
- prximal stability
- motor control (muscular including hamstrings)
then focus on:
- hamstring strength
- speed and power
femoral neck stress fracture
compression-sided fractures (inferior-medial neck)
what are signs/symptoms?
- hip/groin pain
- edema (swelling)
- pain worse with weight bearing and IR (ER too but mostly IR)
- point tnederness on palpation
- painful and limited active and passive hip flexion, IR, extension
- pain increase during activity
- antalgic gain (limping, not wanting to load)
*what are we concerned with when someone has this fracture?
femoral neck stress fracture
what population do we see these fractures?
- repetitive high load, chronic overload
- runners, gynmasts
hip fracture
what is an acute hip fracture?
severe groin and anterior thigh pain and tenderness, sometimes trochanteric
osteoporosis more in females
cnacer population -> when it spreads to bone
hip fracture
what are symptoms of an acute hip fracture?
- pain (both passive & acute -> unable to walk)
- limited mobility (almost nill –> fulcrum is not intact)
- possible bruising after a day or two
- hip might look twisted or rotated (or foot)
hip fractures
what are the 2 most common types of hip fractures?
intertrochanteric and femoral neck
- what did the doc do?
- nails
- hemi arthroplasty
- full hip replacement
FAIS
femoroacetabular impingement syndrome is an important cause of pain in what population?
hip pain in young and middle aged adults
FAIS
FAIS is a precursor to what?
idiopathic hip OA
what is a cam morphology? what are 2 types of cam morphologies?
excessive bony growth at neck/head of femur
- pincer and pistol are 2 types
FAIS
cam morphology
talk about it
- “pistol grip” morphology is a change in structure
- male predominance (4:1)
- athletes have a higher prevalence than nonathletes
- poor clearance of the femur, especially with flexion and abduction
FAIS
symptoms of FAIS?
- sharp anterior hip/groin or trochanteric pain
- pain with activites such as walking, pivoting and recreational exercise
- clicking, catching, locking, stiffness, restricted ROM or giving way
- limited hip FLEXION, ABDUCTION and INTERNAL ROTATION rom (FAI)
cam can cause FAIS but one ≠ the other
