The Hip Flashcards
The hip joint is classified as
ball and socket joint
How many planes of motion does the hip joint move in?
3
Sagittal (flexion/extension)
Frontal (abduction/adduction)
transverse (internal/external rotation)
All three axes of hip motion pass through
the center of the femoral head
Os Coxa is made up of
three individual bones
ilium, ischium, pubis
Acetabulum
site where the ilium, ischium, and pubis fuse together
A majority of acetabular development is completed by
the age of 8
Acetabular rim
aka labrum
deepens the acetabulum thereby increasing the stability of the hip joint
The whole of the acetabulum is covered with hyaline cartilage except
the fovea capitis
The pelvic girdle is composed of which three joints
hip (acetabularfemoral)
sacroiliac
public symphysis
Iliac crest contusion
contusion to the site of or an avulsion of the quadratus lumborum and or abdominal muscles from the crest
very painful/disabling if periosteum is involved
With an iliac crest contusion, Patient experiences:
pain when laterally flexing away from the side of injury
pain with abduction of both legs together in side-lying position
Bucket handle fracture
superior and inferior public rami fractures with a separation or fracture of the contralateral SI joint
Sprung Pelvis
separation of the pubic symphysis and both SI joints
Straddle Fracture
bilateral superior pubic rami and ischopubic fractures
Most common areas for pelvis avulsion fractures
ASIS
AIIS
Ischial Tuberosity
Femur
Strongest and longest bone in the body
two thirds of the femoral head is covered in
a smooth layer of cartilage except for the fovea capitis
The fovea capitis is the attachment for what?
ligamentum teres
Inclination angle
angle between the femoral shaft and neck
approximately 125- 130 degrees
The inclination angle in a tall person is
valga
larger
The inclination andle in a short person is
vara
smaller
Femoral Head dislocation
dashboard injury to the knee will cause a posterior hip dislocation if the hip is adducted at the time of injury
the greater trochanter
serves as the insertion site for several muscles that act on the hip joint
the lesser trochanter
located on the posterior-medial junction of the neck and shaft of the femur
created from the pull of the iliopsoas muscle
angle of Anteversion
the angle that the femoral neck makes with the acetabulum
normal angle of anteversion
8-15 degrees
Femoral Anteversion
aka medial femoral torsion
the angle between femoral neck and the transcondylar axis is greater than 15 degrees
What type of gait do you see with femoral anteversion
toe-in gait
Increased medial femoral torsion leads to
OA dysplasia of the acetabulum susceptibility to anterior femoral dislocation knee joint misalignment problems patellar dislocations excessive lumbar lordosis external tibia rotation foot pronation
Femoral retroversion
aka lateral femoral torsion
the angle between the femoral neck and the transcondylar axis is less than 15 degrees
why type of gait fo you see with femoral retroversion
toe out
lateral femoral head torsion may lead to
low back/SI pathologies
internal rotation of the tibia
supination of the feet
Legg-calve-perthes disease
avn of the femoral capital epiphysis before closure of the growth plate
Who predominately experiences legg-calve-perthes diseaes
males (5:1)
ages 3-12
Four stages of Legg-Clave-Perthes disease
avascularization
revascularization
repair
deformity
Primary causes of Legg-Calve-Perthes
trauma
hereditary
nutritional
circulatory
which test will be positive with Legg-Calve- Perthes?
trendelenberg
Legg-Calve Perthes is bilateral in what percentage of cases?
10
How do the odds of experiencing Legg-Calve-Perthes change with a smoker’s household?
change of experiencing this pathology increases from 1 in 1200 to 1 in 100
Three extra-articular ligaments in the hip
iliofemoral ligament of Bertin/Bigelow
Pubofemoral Ligament
Ischiofemoral ligament
Iliofemoral Ligament
made up of two parts: inferior(medial) portion and a superior(lateral) portion
strongest ligament in the body
Which muscle does the iliofemoral ligament blend with
iliopsoas
Pubofemoral Ligament
blends with the inferior band of the iliofemoral and pectineus muscle
Ischiofemoral ligament
winds posteriorly around the femur and attaches anteriorly, strengthening the capsule
What hip ligament in most commonly injured?
ischiofemoral
All extra-articular hip ligaments tighten with:
hip extension
the lateral band of the iliofemoral ligament limits:
adduction
the medial band of the iliofemoral ligament limits:
external rotation
the pubofemoral ligament limits
abduction
the ischiofemoral ligament limits:
internal rotation
Iliopsoas
the most powerful of the hip flexors
iliopsoas is made up of:
iliacus and psoas major
Pectineus
adducts, flexes, and internally rotates the hip
Rectus femoris
combines the movements of hip flexion and knee extension
Tensor fascia latae
assists in flexing, abductiong, and internally rotating the hip
Sartorius
the longest muscle in the body
responsible for flexion, abduction, and external rotation of the hip as well as some degree of knee flexion
Gluteus maximus
largest and most important extensor and external rotator of the hip
gluteus medius
main abductor of the hip
anterior portion of gluteus medius
flexes, abducts and internally rotates the hip
the posterior portion of gluteus medius
extends and externally rotates the hip
Gluteus minimus
the major internal rotator of the femur
Some causes of weak gluteus medius muscles?
fracture of the greater trochanter slipped capital femoral epiphysis congenital hip dislocation poliomyelitis meningomyelocele L5 nerve root lesion
Slipped femoral capital epiphysis
slipping of the neck of the femoral head as the head remains in the acetabulum
Who most commonly experiences a Slipped femoral capital epiphysis
tendency to be with overweight adolescents adolescents 10-15 more males than females more black than white left hip more then right
who would you see a bilateral Slipped femoral capital epiphysis in?
females
What is the common etiology with a Slipped femoral capital epiphysis
trauma 50% of the time
What will you see on xray with a Slipped femoral capital epiphysis
an alteration in klein’s line
Piriformis
an external rotator of the hip at less than 60 deg
at 90 deg of hip flexion, piriformis reverses its action and becomes an internal rotator/abductor of the hip
Small external rotators
obturator externus and internus
superior and inferior gemelli
quadratus femoris
Hamstrings
made up of biceps femoris, semimembranosus, and semitendinosus
Action of biceps femoris
extends the hip, flexes the knee, and externally rotates the tibia
action of semimembranosus and semitendinosus
extends the hip, flexes the knee, and internally rotates the tibia
Hip adductors
adductor magnus, longus, and brevis, and the gracilis
Iliopsoas bursa
aka iliopectineal
located under the inguinal ligament, between the iliopsoas tendon and the iliopectineal eminence of teh superior pubic ramus
What commonly causes inflammation of the psoas bursa?
O/A of the hip
Where is the subtrochanteric bursa?
between the greater trochanter and the TFL
Borders of the femoral triangle
the inguinal ligament, adductor longus, and the sartorius
the floor of the femoral triangle is formed by
portions of the iliopsoas and pectineus
The posterior gluteal region receives innervation by way of:
the subcostal, iliohypogastric nerves and the dorsal rami of L1 L2 and L3 and the cluneal nerves of S1 S2 and S3
Normally the sciatic nerve passes
inferior to the piriformis muscle (88% of people)
The external iliac artery becomes the femoral artery as it passes underneath
the inguinal ligament
the branches of the femoral artery
lateral femoral circumflex artery
medial femoral circumflex artery
The lateral circumflex artery supplies
anterior portion of the of the femoral neck and the anterior hip joint capsule
the medial femoral circumflex artery supplies
perforates and supplies the posterior hip joint capsule and synovium
