The Hip Flashcards
What is the function of the hip?
- to weight bear
- it combines good stability and mobility
What are the bones of the hip?
- femur
- sacrum
- innominate bones: illiul, ischium, pubis
What are the bones on the femur?
- Head
- Neck
- Adductor tubercle
- greater and lesser trochanters
- Fovea capitis
What are the bones of the pelvis?
- illiac crest
- ASIS
- AIIS
- PSIS
- Ischial tuberosity
- Pubic symphysis
- Acetabulum
- Obturator foramen
- Sciatic notch
- Ischiopubic ramus
Describe the acetabulum? and what are its movements?
It is a ball and socket joint (diarthrodial; triaxial); it is a capsular joint (circumducts)
found between the sphericle head of the femur and the acetablum
Movements (3 DFs)
* flexion/extension
* abduction/adduction
* internal/external rotation
What are the normal hip range of motions?
- Flexion: 90 or 120
- Extension: 5 or 35
- Internal rotation: 30-40
- External rotation: 40-50
- Abduction: 45
- Adduction: 25
when the knee is flexed, the rec fem limits the hip from extending more
Describe the pubic symphysis and the sacral illiac joint
Pubic symphysis:
* joint between the 2 pubic bones
* cartlaginous joint
* very little movement
Sacral Illiac: SI joint
* sacrum and illiac
* ligamentous joint
What are the 6 movements of the pelvis?
- anterior rotation/tilt (ASIS goes down)
- posterior rotation/tilt (ASIS goes up)
- lateral tilt
- inflare/outflare
- upslip (whole unit goes up), SI disfunctional
- downslip (whole unit goes down) SI disfunctional
Describe how hip motions can be in opposition or unison?
Both limbs are in opposition
- hips flexed: posterior pelvic tilt
- hip extends: anterior pelvic tilt
Both limbs in unison:
- anterior tilt when both are extended
- posterior tilt when both are flexed
What is the purpose of the acetabulum labrum?
deepens the acetabulum
What are the acetabulofemoral ligaments? and what do they limit?
- Pubofemoral: limits abduction
- Illiofemoral: 2 bands together that bifuracte and together limit hypertext [medial: limits external rotation & lateral: limits adduction]
- Ischiofemoral: limits internal rotation
What does the ligamentum teres do and limit?
- limits adduction, flexion, and external rotation
- vascular supply extends into the femur through the fovea capitis
What are the ligaments of the SI Joint?
- Sacrotuberous
- Sacropinious
- Sacroiliac (anterior and posterior)
What is the OIA of the inguinal ligament (poupart’s ligament)?
- O: ASIS
- I: Pubic tubercle
- A: serves as an attachment site for muscles (External/internal obliques and transverse abdominus) (also is a boarder for the inguinal triangle)
What is the femoral/inguinal triangle made up of and its purpose?
- Sartorius
- Adductor longus
- Inguinal ligament
this is where the femoral artery and vein runs through
What are the hip flexor muscles?
There are really 2 main ones: illiacus and psoas major, but the minor still counts (it is just an accessory tho)
Illiacus:
* O: wing of the illium
* I: lesser trochanter
Psoas Major:
* O: lumbar vertebrae
* I: lesser trochanter
What are the 3 glute muscles and their OIA?
Gluteus Maximus:
* O: posterior illium and sacrum
* I: gluteal tuberosity
* A: extends hip and external rotation
Gluteus Medius:
* O: lateral illiac crest
* I: greater trochanter
* A: abduction of the hip
Gluteus Minimus:
* O: lateral illium
* I: greater trochanter
* A: abduction of hip
What are the 5 adductors?
Add longus:
* O: pubic tubercle
* I: mid femur at linea aspera
Add brevis
* O: pubic ramus
* I: proximally into the femur at linea aspera
Add magnus
* O: ischial ramus
* I: all along the linea aspera AND adductor tubercle
Gacilis
* O: pubic ramus and pubic tubercle
* I: pes anserine
* A: in addition to adduction also knee flexion
Pectineus (dont knee to know OIA
What are the deep 6 and their insertion?
They are all external rotators (deep to glute max)
* Obturator internus: I = greater trochanter
* Obturator externus: I = greater trochanter
* Gemellus superior: I = greater trochanter
* Gemellus inferior: I = greater trochanter
* Piriformis: I = greater trochanter, O: sacrum
* Quaddratus femoris: I = greater trochanter
What are the other 4 muscles that have a function association with the hip?
- Rectus femoris (hip flexion)
- Hamstrings: extension of hip
- Sartorius: Faber muscle: flex the knee, abduct hip, externally rotate hip, flex hip
- TFL: abduct hip
Know that there can be variations in acetebulum stuctures between people
-=
How do you asses acatabulum depth with no x-ray?
- have the person in passive hip flexion
- observe when the pelis rotates and you push hip farther into flexion
- the sooner the pelvis rotates and lifts up, the deeper the acetablum
- nature vs nurture
What is coxa valga vs coxa vara?
Coxa Valga
* more obstuse angle (>135)
Coxa Vara
* more acute angle (<120)
A normal angle is about 130
Describe Coxa valga?
Seen with longer leg, supination of the foot to compenstate, and posterior pelvic tilt to try to shorten the leg
* valgus at top and varum below
Describe coxa vara?
Seen with shorter leg, pronation of foot to try to reach the floor quicker, and anterior pelvic tilt to try to meet the floor better
* varus up top means valgus at the knee)
What is Nelaton’s Line?
It is a clinially used measurment
* line from ASIS to ischial tuberosity
* If the greater trochanter is palpated well above tthe line than = coxa vara
What is the angle of torision?
It measures the femoral neck to the epiconddyles of the femur
* Anteversion: towards the front; causes a person to walk pigeon toed
* Retroversion: towards the back; wadelling walk wi/foot splay
What is the importnat rearch on how q- angle affects the lower body?
- an everted hip = wider q-angle
- q-angle has no correlation w/ foot positioning (pes planus/cavus)
- It doesnt matter how wide or narrow the q-angle is in relationship to navicular height or ant/post tilt
What are the 2 forms of measuring leg length discrepencies?
True:
* measure from ASIS to medial malleolus (coca valga or vera may exist)
Apparent:
* measure from umbillicus to medial malleoulus
* indicates muscle imbalances (SI joint pain)
* it appears teh leg is longer but is just the way the msucle pulls
Important info about leg length inequality from the literature?
- Anatomic LLI is common in about 90%
- the mean value is 5.2 mm
- But no clinical signifcance unles s15-20mm
- usuallyy one side of pelvis is more or less rotated that the other
