the hip complex Flashcards
what type of joint is the hip
synovial/ diarthrodial ball and socket
how many DOF does the hip have
3
flex/ext
add/abd
IR/ER
the acetablum is contributes by the fusion of what 3 pelvic bones
ilium, ishium and pubis
the acetablum articulates with the ____ ____ and is covered with what type of cartilage
femoral head
hyaline
what creates a tunnel allowing fibroelastic fat tunnel carrying blood vessels deep into acetabulum
Acetabular notch + transverse acetabular ligament
what part of the acetablum is the deepest portion ?
does it articulate with the femoral head ?
acetabluar fossa
no
what is the normal acetabulum positioning
~50° inferior and ~20° anterior (little anteversion)
what are 4 abnormalities of the acetabulum
acetabular dysplasia
coxa profunda
anteversion
retroversion
what abnormality of the acetabulum is shallow acetabulum, decreased coverage, instability
acetabular dysplasia
what abnormality if the acetabulum is over coverage leading to impingement
coxa profunda
what is the different between anteversion and retroversion
anteversion is more anterior leading to instability and retroversion is more posteriorly leading to over coverage
if the acetablum is angles >20 what is considered
anteversion
if the acetablum is angles <20 what is considered
retroversion
what is the typical center edge angle
22-50°
if the center edge angle is <22-50° what does that indicate
acetabular dysplasia
if the center edge angle is > 22-50° what does that indicate
pincer type of impingement
what is the angle that connects the lateral rim and center of femoral head and is the coverage of the femoral head
center edge angle
what is the typical acetabular inclination
32-45°
what does the acetabular inclination measure
acetabular depth
the acetabular inclination is measured from what to what on an xray
line parallel to the teardrops to lateral acetablum
if the acetabular inclination is > 32-45° what can that indicate
acetabular dysplasia
what is the function of the acetabular labrum
depends the socket and increases concavity and maintains negative pressure to add stability
the nerve ending of the acetabular labrum provided what
proprioceptive and pain sensitivity feedback
what ligament does the acetabular labrum blend what
transverse acetabular ligament
the femoral head is rounded with what type of cartilage
hyaline
what ligament is attached to the fovea
ligamentum teres
is the fovea overhead with hyaline cartilage
no
what way does the femoral head face
medially , superiority and anteriorly with respect to the femoral shaft and condyle
what plane do you measure the angle of inclination in
frontal plane
what is the normal angle of inclination of the femoral angle
~125°
the angle of inclination is greater during ___ and smaller in ____
childhood
women
what are the 2 abnormalities with angle of inclination
coxa valga and vara
what is coxa valga
increased angle of inclination
is someone has coxa valga there is a ___ shear on the neck and ____ MA for abductors
decreased 2x
someone with coxa valga will have a ___ coverage leading to instability , femoracetabular impingement
decreased
coxa valga is associated structurally with what
genu varum ( knees go out)
what is coxa vara
decreased angle of inclination
someone with coxa vara will have ___ stability , ___ MA abductors and ___ bending/shear
increased 3x
someone with coxa vara has increased chance of what
slipped capita femoral epiphysis
coxa vara is structurally associated with what
genu valgum (knee in)
why will Kids with CP tend to have Coxa Valga and will often present with genu valgum when walking/standing
spasticity
what plane is the angle of torsion taken in
transverse plane
the angle of torsion is the axis thru what
femoral head/neck and femoral condyle
what is the normal angle of torsion of the head and neck ?
anteriorly 10-20°
what angle of torsion is considered anteversion
> 15-20 °
someone with anteversion will have ____ medial rotation , ___ lateral rotation and ___ stability
increased
decreased 2x
what degrees of the angle of torsion is considered retroversion
< 10-15 °
someone with retroversion will have ___ lateral rotation and ___ medial rotation
increased
decreased
what has more articular surface the head of the femur or the acetabulum
head of femur
how is the femoral head exposed in standing
anteriorly/superiorly
when does most joint congruence of the hip occur during
flexion , abduction and slight lateral rotation (ER)
(frog legged position)
acetabular dysplasia may be found in ___-
infancy
how many capsular ligaments does the joint capsule of the hip have
3
the joint capsule of the hip is thickest where and thinnest where
thickest : anterior -superorily
thinnest: posterior - inferiorly
what fibers of the joint capsule carry blood vessels that provide nutrition to the femoral head/neck
retinacular fibers
the femoral neck is _____ of the joint capsule
intracapsular (with in)
what is extra capsular of the joint capsule
greater and lesser trochanters
what is the lateral hip bursae called
trochanteric
the lateral bursae reduces friction b/w what
posterior facet, glute max , ITB and GT
what are the 2 anterior bursae’s
glute med and iliopsoas
what is the posterior bursae called
ishiogluteal
what is the ligament of the head of the femur
ligamentum teres
in the ligaments teres intra or extra articular ? is it extra or intra synovial
intra ]
extra
where does the ligamentum teres attach to
acetabular notch , under transverse acetabular ligaments to the fovea
what ligament is secondary blood supply to the femoral head
ligamentum teres
what does the ligament teres provide restraint for
hip medial/lateral rotation when in > 90 ° of hip flexion
if there is no blood supple to the head of the femur what can that lead to
a vascular necrosis
what ligament is considered the Y ligament
iliofemoral lig
the iliofemorla is fan shaped form what to what
AIIS to intertrochanteric line
what is the primary stabilizing component of the anterior hip
iliofemoral ligament
what does the iliofmeoral ligament resist
excessive lateral rotation , especially when the hip is in neutral or in flexion
what ligament is from the pubic portion of the acetabular tim to the iliopectineal eminence
pubofemoral lig
the pubofemoral lig forms a sling that support what and connect fibers between what
supports inferior femoral neck and connects fibers between iliofemoral and ischiofemoral
what does the pubofemoral ligament resist
lateral rotation when hip in EXT
what ligament attaches to the posteior surface of acetabular rim and labrum
ischiofemoral lig
what is the function of the ischiofemoral ligament
primary restraint to medial rotation
the capsuloligamentous tension in closed pack position is what
extension + slight abduction + medial rotation but most congruence is different … flex , abd and ER
what is the loose packed position for capsuloligamentous tension
midrange flexion + slight abduction and mid rotation
capsules and ligaments are ___ in hyperextension
taut
what support 2/3 of body weight without muscular assistance
joint capsule and ligaments
where does the LOG fall? and what does it create
posterior to hip and creates an external moment
when is the hip most vulnerable to dislocation and what type does it result in
flex and add (dashboard innjury)
posterior dislocation
most weight bearing stresses in the pelvis passed from what to what
SI to acetabulum
√ Femoral head transfers forces to shaft – creates a bending moment across the femoral neck resulting in:
superior tensile forces and inferior compressive forces
what kind of force is being created between the head, arms , and trunk and GRF
shear
what does the medial trabecular system resist
vertical compressive forces thru femoral head
what does lateral trabecular system resist
shear forces of body weight of HAT and GRF
what can happen at the zone of weakness
fx
Peak contact pressures during unilateral stance are located near ___ aspect of acetabulum dome
superior
women tend to have a ___ contact area and ___ peak stress
smaller
higher
what shows greatness prevalence of degeneration in the hip
dome
Primary weight bearing area of the femoral head is___
superiorly
pertaining to the motion of the femur on the acetabulum the ___ femoral head is on the ____ acetabulum … what way will the head slide and roll
convex
concave
head will slide/glide anf spin/roll in opposite direction bc convex on concave
pertaining to the femur moving on the acetabulum in open chain what way does it spin during open chain flexion and extension
flex: femoral head spine posterior on acetabulum
ext: femoral head spins anterior on acetabulum
pertaining to the femur moving on the acetabulum in open chain what happens during open chain abduction and adduction of the hip
abd: femoral head will roll superiorly and glide inferiorly
add: femoral head will roll inferiorly and glide superiorly
pertaining to the femur moving on the acetabulum in open chain what happens during open chain medial and lateral rotation or the hip
medial rotation/IR : femoral head will roll anterior and glide posterior
lateral rotation/ ER: femoral head will roll posteriorly and glide anteriorly
normal gait on ground level requires :
Flexion-
extension-
abduction/ adduction -
medial/lateral rotation-
Flexion- 30°
extension- 10°
abduction/ adduction -5°
medial/lateral rotation- 5°
during hip flexion what kind of pelvic tilt will there be ? what about hip extension ?
anterior
posteior
what does lateral pelvic tilt produce
abduction or adduction
if opposite side of pelvis hikes then it is stance hip ___
abduction
if opposite side of pelvis drops then it is stance hip ___
adduction
in lateral pelvic shift in bilateral stance there is ___ on the shifted side and ___ on opposite
add
abd
the pelvis motion on femur occurs in which stance
unilateral
forward rotation of non weight bearing pelvis moves ___
anteriorly
forward rotation of weight bearing hip produces ___ rotation
medial rotation
during backward rotation the non weight bearing pelvis moves ____
posteriorly
backwards rotation of weight bearing hip produces ___ rotation
lateral
what is the order of forward bending
spinal flex
anterior pelvic tilt
hip flexion
what can forward bending be limited by
tight mm
what is the order of sidelying leg lift
hip abd
lateral pelvic tilt
lumbar side bend
the LOG creates and ___ moment that is counterbalance by ____ and ____ tension
extensor
ligaments and iliopsoas
if muscles contract in bilateral stance there will be an ___ force in joint
added
the stance hips in unilateral stance must support what
compression from HAT and opposite legs , compression of abductor mm that counteract the ADD moment
how much body weight in unilateral stance alone
2-3x
lateral lean of trunk toward stance legs ___ MA of head , arms ,trunk and lower limb
decreases
if someone is walking with a lateral trunk lean to the stand leg the use of cane ___ can transfer some BW force to cane
ipsilaterally
Use of cane ____ relieves some of bodyweight force and assist the abductors by providing counter torque theoretically by using what mm
contralaterally
latissimus dorsi
femoroacetabular impingement is a dysfunctional abutment of the what
proximal femur and acetabulum
what type of impingement is pistol grip deformity of the femoral neck which pushes on anterior/superior labrum and cartilage
cam
describe the pincer impingement
increased overcoverage of the acetabulum compression the superior labrum between he acetabulum and the femur
if a patient presents with
• Groin pain, hip, or low back
• Pain may be dull/aching
• Sharp pain with turning, twisting, squatting • Hip joint stiffness
what can we suspect
femoroacetabular impingement
what other hip pathology often occurs with FAI
labral tear
someone with a labral tear will have….
decreased center edge angle
acetabular retroversion
coxa vara
what is the MOI of labral tears
traumatic tears or cumulative microtrauma
someone will a labral tear will have increased stresses with what 2 motion
abduction and ER
if a patient presents with
• Sharp pain in front of hip
• Clicking, locking or feeling of “giving way”
• Stiffness or difficulty moving hip
• Microtrauma - running, ballet, golf, hockey, etc
• Traumatic - fall, MVA, high impact sports
• Normal wear and tear
• h/o developmental hip condition(s): hip dysplasia, FAI, Legg-Calve
Perthes, Slipped Capital Femoral Epiphysis
what can we suspect
labral tear
FAI can also lead to what
OA
a form of arthrosis is what
legg calve perthes
bending forces across the femoral neck in those over 40 will cause what hip path
fx
hip fx are associated with what
decreased bone density
in coxa valga the weight bearing line is closer to what
shaft of femur
what is coxa valga associated with
genu varum
coxa valga decreases___ and risk of ___
stability
dislocation
coxa vara ____ stability
increased
there is an increased __ force to femoral neck of coxa vara patients
shear
anteversion is associated with toe __
in
retroversion is associated with toe ___
out
slipped capital femoral epiphysis is an intracapsular ____ and ___ slippage of the ___ femoral epiphysis on the metaphysis
posteiror and inferior
proximal
what do u look at on xray from SCFE
klein line
what is drehmann sign for SCFE
hip flexion with ER
someone with swayback posture will have what mm paralysis
glute max
someone with sway back will have what kind of pelvis tilt and what at the hip
posterior
hip extension
swayback posture will have compensatory ….
thoracic kyphosis
where does LOG fall for swayback
behind the GT
what type of muscular imbalance does someone have with anterior pelvic tilt
glute max
anterior pelvic tilt is associated with what in the hip
increased hip flexion
anterior pelvic tilt has compensatory …
increased lumbar lordosis
where is the log of anterior pelvic tilt
posteiror to hip
when does the distal femur growth plate close ?
20
when does the growth plate for femoral head/neck, GT and LT close
18
