The Hip Flashcards
Largest nerve in body
Sciatic nerve
Common at the greater trochanter, high in women with increased angle, leg length discrepancy or insertion of gluteus medius or IT band
Trochanteric bursitis
What is the Obers test?
- Athlete lays in unaffected side
- knee flexed out to 90 degrees
- lift top leg into abduction, slight hip extension
- allow the affected leg to drop into adduction
When is the obers test positive?
If the leg doesn’t drop then you have a tight IT band
What are innominate bones
Sacrum and coccyx
What is the purpose of the pelvis
Support the spine and trunk
Transfer weight to the lower limbs
Placement for bony attachment
What makes up the pelvis
Illium, ischium, pubis
Blow to illiac crest with immediate pain, spasms and transitory paralysis
Hip pointer (contusion)
Rare during sports, major trauma. Femur is adducted and flexed with deformity and nerve damage
Hip dislocation
Sudden acceleration/deceleration of the ischial tuberosity (hamstrings) and the AIIS (rectus femoris) with local pain and limited movement
Avulsion fracture
Repetitive stress on pubis by surrounding muscles with groin pain while running, doing squats or sit-ups
Osteitis pubis
Connects sacrum to illium
Sacroiliac joint
The acetabulum is cushioned by the labrum
Joint capsule
What is the hip joint made of
Femur head and acetabulum
What is the strongest ligament in the body
Y ligament of Bigelow (prevents hyperextension)
Prevents excessive adduction
Pubofemoral
Prevents internal rotation and adduction on posterior aspect
Ischiofemoral
Bridge that allows blood vessels and nerves enter the head of the femur
Ligamentum teres
Strong and protected, seldom injured, violent twisting produced by opponent, foot planted with trunk forced in opposite direction and athlete is unable to circumduct the thigh
Hip sprain
Twists with both feet on ground, stumbles forward, falls backward, steps in a hole with pain over joint, muscle guarding, radiating pain down back
Sacroiliac joint sprain
What is the FABERS/Patrick’s test
Place foot on the opposite extended knee of the painful SI joint and apply pressure downward on the bent knee
Positive FABERS/Patrick’s test
Pain felt in hip or SI joint means SI joint dysfunction
Anterior muscles
Illiacus
Psoas
Sartorius
Rectus femoris
Posterior muscles
Piriformis 3 gluteal muscles Biceps femoris Semitendinosis Semimembranosis
Medial muscles
Gracilis
Pectineus
Adductor longus, brevis, Magnus
Illiacus
Triangular shaped, flexes
Sartorius
Crosses medially across anterior thigh to do hip flexion and external rotation
Rectus femoris
Hip flexion and knee extension
Tensor fascia latae
Hip abduction
Lateral muscles
Tensor fascia latae
Piriformis
External rotation
Gluteus Maximus
Extension, adduction, helps get up from a sitting position
Gluteus medius/minimus
Abduction
Hamstrings (semimembranosis, semitendinosos, biceps femoris)
Hip extension, knee flexion
Gracilis
Adduction, external rotation
Pectineus
Adduction, external rotation
Adductor longus/brevis/Magnus
Adduction, external rotation
Feel twinge or tearing during an AROM, may feel worse the next day with pain, weakness and bruising
Groin strain
Thomas test
Athlete lies supine with legs together. ATC places hand under athletes lumbar curve. One thigh is brought to the chest, flattening the spine. Return bent leg to extended position, lumbar curve should return
Positive test for Thomas
Extended thigh should be flat on the table, if not tight hip flexor
What grade quad contusion has the following symptoms: Superficial bruise, mild hemorrhage, pain, no swelling, point tenderness and full ROM
Grade 1
Quad contusion MOI
Direct blow to thigh
Athlete lies supine with knees off table. Athlete brings one leg to their chest
Kendall test
Positive Kendall test
If thigh comes off table = tight hip flexor
Which quad contusion has the following symptoms: Deeper, pain, swelling, cannot flex knee more than 90 degrees
Grade 2
What grade quad contusion has the following symptoms: moderate pain and swelling, limping, cannot flex
Grade 3
What grade quad contusion has the following symptoms: disability, may split fasciae, severe pain, limited ROM
Grade 4
Severe blow, or repeated blows (usually on the thigh) that produces ectopic bone production
Symptoms: pain, swelling, and decreased function
Myositis ossificans traumatica
Most common injury to thigh, fatigue, faulty posture, leg length discrepancy, tight hamstrings
Symptoms: hemorrhage, pain, loss of function
Hamstring strain
This is caused by repetitive movements in gymnasts, dancers, hurdlers, sprinters and cheerleaders
S/S: imbalance in muscle, IT band moves over greater trochanter pain
Snapping hip
Athlete stands, foot on the unaffected side is limited. Look at the iliac crest to see if it stays level.
Trendelenburg
Positive test for Trendelenburg
If the unaffected side lowers or if standing on leg and the affected hip moves into abduction = weak abductors
Abutment of the acetabular rim and the proximal femur
S/S: anterolateral hip pain with prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports
Femoroacetabular impingement (hip impingement)
How do you test for a hip impingement
FADIR (flexion, addiction, internal rotation of leg)
Positive if anterolateral pain is present
Anterior palpation of the bony sites
ASIS
Iliac crest
Greater trochanter
Pubic tubercle (we don’t do this)
Posterior palpation of the bony sites
PSIS Ischial tuberosity (don’t do this either) Sacroiliac joint
Which special test is this:
Athlete lies supine with legs straight. Measurement is taken between the medial malleolus and ASIS
Bilaterally compare
Anatomical discrepancy: actual bone is shortened
Athlete lies supine with legs straight. Measurement is taken from umbilicus to the medial maleoli.
Bilaterally compare
Functional discrepancy: due to pelvic tilt or deformity
How should you observe the hips during an assessment?
Should observe while standing in all directions, standing on one leg and walking
What could you find looking at the front view of the hips?
If the hip is tilted laterally it could indicate a leg length discrepancy or muscle contraction on one side
What could you find looking at the side view of the hips?
An abnormal tilt of the pelvis could indicate lordosis or flat back
Genu valgrum
Knocked knees
Genu varum
Bow legged
Genu recurvatum
Hyperextended
Even PSIS indicates ….?
A lateral shift of the pelvis
What are you looking for when the athlete stands on one leg
Pain
What are you looking for when the athlete walks
Distortion
Soft tissue palpation sites (don’t do these)
Groin region
Femoral triangle
Sciatic nerve
Major muscles
Groin palpations could be caused by
Swollen lymph nodes, indicating infection
Adductor muscle strain
When palpating muscle what are you looking for
Pain, swelling, or fiber disruption
What muscles do you palpate?
Illiopsoas Sartorius Rectus Femoris at hip joint Gracilis Pectineus Adductors Gluteals Hamstrings
Functional testing
Squatting Going up and down stairs Crossing legs Running straight Running and decelerating Jumping One legged hop
Return to play criteria
Full ROM in all movements
Pain free
Bilateral strength
Stability
What signal will the ref give for blood in wrestling?
Point to nose
List the items to set up for a wrestling match
Gloves Nose plugs Lubricant Paper towels Gauze
How many innings are played in a high school baseball game
7
What does top of the inning mean in softball
First half of the inning
Phase 1 of hip rehab
Isometric contractions ROM Pool rehab (non weight bearing) - running - kicking
Phase 2 of hip rehab
Passive stretching Balancing Isotonic contractions -Squatting -Hamstring curls -Pilates -High knees
Phase 3 of Hip rehab
Static and dynamic stretching Lunges MMTs with band resistance Squatting -on bosu ball Hamstring curls -with weight Pilates High knees
