The Hip/Lumbar Spine Flashcards
The most proximal joint of the lower extremity
The Hip
The femur is the convex ball an the acetabular is the what?
concave socket
The hip is very stable and when you have stability, you sacrifice what?
flexibility
motion in all three planes
Triaxial joint
The four bones of the hips are collectively known as the pelvis
Os coxae x 2 (innominates)
Sacrum
Coccyx
The sacrum is then connected to the ??
coccyx
The two hip bones are connected to each other in the front by the________ _________ and posteriorly to the ________.
- pubic symphysis
- sacrum
The oscoxae is made up of 3 bones together
- Ilium
- ischium
- pubis
large, concave area on the internal surface to which the iliopsoas muscle attaches
Iliac fossa
the bony part of your hips that your hands rest on when you have your hands on your hips
Iliac crest
projection on the anterior end of the iliac crest
TFL, sartorius, inguinal ligament
ASIS
projection just inferior to the ASIS
Rectus femoris
AIIS
posterior projection on the iliac crest
PSIS
just below the PSIS
PIIS
- Iliac fossa
- Iliac crest
- ASIS
- AIIS
- PSIS
- PIIS
Theses are landmarks of what?
Ilium
The posterior, inferior portion of the hip bone?
Ischium
makes up 2/5ths of the acetabulum.
Body
extends medially from the body to connect with the inferior ramus of the pubis
- Adductor magnus
- Obturator externus
- Obturator internus
Ramus
rough, blunt projection of the inferior part of the body
- Weight bearing when you are sitting
- Hamstrings
- Adductor magnus
Ischial tuberosity
Located on the posterior portion of the body between the greater and lesser sciatic notches
Spine
- Body
- Ramus
- Ischial tuberosity
- Spine
Bony landmarks of what?
Ischium
externally forms 1/5th of the acetabulum and internally provides attachments for the obturator internus
Body
lies superior between the acetabulum and the body, provides attachment for the pectineus
Superior Ramus
lies posterior, inferior and lateral to the pubic body,
attachment for
- adductor magnus,
- gracilis,
- adductor brevis
Inferior Ramus
cartilagenous joint connecting the bodies of the two pubic bones
Symphysis pubis
projects anteriorly on the superior ramus near the symphysis pubis and provides attachment for the inguinal ligament
Pubic tubercle
- Body
- Superior ramus
- inferior ramus
- symphysis pubis
- pubic tubercle
bondy landmarks of what?
Pubis
just below the PIIS and is made into a foramen by the sacrospinous ligament.
- Sciatic nerve, piriformis and other structures pass through this foramen
Greater sciatic notch
the longest and strongest bone in the body and a person’s height can be determined by 4 times the length of this bone
- Head – rounded portion covered with articular cartilage
- Neck – narrower portion located between the head and the trochanters
- Greater trochanter – large projection located laterally between the neck and the body
- Provides attachments for gluteus medius, minimus and the deep rotator muscles
femur
smaller projection medial and posterior and just distal to the greater trochanter provides attachments for iliopsoas
lesser trochanter
small projection on the femur just proximal to the medial epicondyle
- A small portion of the adductor magnus attaches here
Adductor tubercle
prominent longitudinal ridge or crest along the posterior length of the bone
Linea aspera
runs from below the lesser trochanter diagonally toward the linea aspera
- Adductor brevis attaches in this area
Pectineal line
between the medial and lateral condyles and articulates with the posterior surface of the patella
Patellar surface
Tibial- large projection at the proximal end in the midline, provides attachment for the patellar tendon
Tibial tuberosity
reinforces the capsule anteriorly and resembles a “y”
- Is typically called the y ligament or the ligament of bigelow
- Limits hyperextension
Iliofemoral ligament
spans the hip medially and inferiorly
- Limits hyperextension
- Limits abduction
Pubofemoral ligament
this ligament covers the capsule posteriorly
- Limits hyperextension
- Limits medial rotation
Ischiofemoral ligament
of minimal importance and its existence is typically questioned
- Becomes taut during adduction/lateral rotation and assists with supplying blood to the head of the femur
- Small in size, this ligament does not significantly assist to add to the joint integrity
Ligamentum teres
located around the rim, deepens the acetabular cavity
Acetabular labrum
no function at the hip joint, it runs from the ASIS to the pubic tubercle and separates the abdominal wall from the thigh
- Finish line for the external iliac artery and vein – once they cross underneath this ligament, they become the femoral artery and vein
Inguinal ligament
long, tendinous portion of the TFL
Iliotibial band
The angle of the neck and the shaft of the femur in the frontal plane
Angle of Inclination
What is the Normal value is of angle of inclination ?
125° - but can vary based on congenital deformities, trauma or disease
angle of inclination is greater than 125°
- Tends to make the hip longer in weight bearing and places the hip in an adducted position & often leads to genu varum
Coxavalga
The angle of inclination is less than 125°
Makes the involved limb shorter, dropping the pelvis in weight bearing & often leads to genu valgum
Coxavara
The angle of the neck and the shaft of the femur in the transverse plane
Normal is approximately 15 – 25°
Angle of Torsion
An increase (\> 25) in this angle is called\_\_\_\_\_\_\_\_\_\_\_ and forces the hip into a medially rotated position Pigeon toed or “toed-in” gait pattern
anteversion
A decrease (\< 15) in this angle is called \_\_\_\_\_\_\_\_\_\_\_ and forces the hip into a laterally rotated position Penguin toed or “toed-out” gait pattern
retroversion
these muscles attach to the ilium and the femur spanning the hip laterally.
Gluteus Minimus and Gluteus Medius
Gluteus Minimus and Gluteus Medius
When you stand on one leg, the femur becomes more stable than the pelvis therefore the origin moves towards the insertion
What type of function is this?
Reversal of Muscle Function
Muscles of the Hip
- Iliopsoas
- Rectus femoris
- Sartorius
- Pectineus
- Adductor brevis
- Adductor longus
- Adductor magnus
- Gracilis
Hip adductor muscles
GMLBP’s – great major league baseball players
- Pectineus
- Adductor brevis
- Adductor longus
- Adductor magnus
- Gracilis
More Muscles of the Hip
- Gluteus maximus
- Gluteus minimus
- Gluteus medius
- Hamstrings
- Semimembranosus
- Semitendinosus
- Biceps femoris
- Deep rotators as a whole
- PGOGOQ
- Piriformis*, gemellus superior, gemellus inferior, obturator internus, obturator externus, quadratus femoris
- Tensor fascia latae
Deep rotators as a whole -PGOGOQ
- Piriformis
- gemellus superior
- gemellus inferior
- obturator internus
- obturator externus
- quadratus femoris
Hamstrings
Semimembranosus
Semitendinosus
Biceps femoris
There are 5 Lumbar Vertebrae and the anterior curve of the lumbar spine makes a convex or concave curve?
convex
The vertebrae are separated anteriorly by an intervertebral________ and the intervertebral foramen is formed by _________joining above and below
- disk
- facets
How many disks are in the spine?
23
what is the function of the vertebrae?
to absorb and transmit shock and maintain flexibility of the vertebral column
All disks make up what % of the total length of the spine?
25%
Lumbar Spine
Muscles to Know(8)
- Rectus Abdominis
- External Oblique
- Internal Oblique
- Transverse Abdominis
- Erector Spinae
- Transversospinalis
- Interspinalis
- Quadratus Lumborum
Common Etiologies of the Hip and L-Spine
- Most frequently found over the outside of the hip or the greater trochanter
- Trochanteric Bursitis
- Can be seen in athletes that do not sufficiently stretch or warm up this area
Bursitis of the Hip
Common Etiologies of the Hip and L-Spine
Signs and Symptoms
- Tenderness over the outside of the hip
- Increased by walking, running or twisting the hip in certain directions
- Palpable bursa/increased inflammation in the area of the greater trochanter
- Pain with palpation
Trochanteric Bursitis
Common Etiologies of the Hip and L-Spine
- Refers to a break at the top part of the femur where it connects to the pelvis
- Classified into 3 different types
- Femoral neck
- Intertrochanteric
- Subtrochanteric
- The majority of these occur in the elderly but can occur in younger populations
- Trauma
- Motor vehicle accidents
- High impact blows
Hip Fractures
Signs and Symptoms:
- Diagnosed with a history of a fall or accident followed by severe hip pain
- Visually appear to be abnormally rotated
- Movement results in significant pain
- X-rays are the definitive diagnostic too
Treatment is by surgical intervention – orthopedic involvement
Hip Fractures
- Most common in sports requiring jumping, kicking or repetitive sprinting
- Most involve the rectus femoris
- Hip flexor may involve the rectus femoris and/or the iliopsoas muscle
- With grade I and II , your main goal is to prevent reinjury and complete disruption (Grade III)
Quadriceps and Hip Flexor Strains
Signs and Symptoms:
- Point tenderness at location
- Notable and palpable deformity in the quadriceps and/or hip flexors
- Bruising or ecchymosis
Treatment
- Icing
- Compression wrapping
- Anti-inflammatory medications
Quadriceps and Hip Flexor Strains
- Commonly called a “pulled hamstring”
- Results from stretching or pulling one or more of the hamstring muscles too far or too fast
- Can range from microtears in a small area of muscle to a complete tear in the muscle or tendons that attach the muscle to the bone
- “Strain” refers to mild or moderate damage in muscle tissue
- Sudden, explosive starts and stops and chronic overuse of the hamstring muscle-tendon unit are the most common causes of pulled hamstrings
Hamstring Strains
Signs and Symptoms:
- Usually cause a sharp pain in the back of the thigh during or soon after sports or strenuous activity
- Bruising
- Swelling
- Loss of strength
- Feeling or audible sound of a “pop” at the time of injury
- Pain is most commonly in the middle of the thigh
Hamstring Strains
Hamstring Strains: tx
- RICE
- Medications
- Physical Therapy
- Common in sporting injuries that require sudden sideways changes in direction
- Skating, soccer, track and field and tennis
- Typically, grade I and II
- Signs and Symptoms
- Groin pain when running or kicking
- Adductors originate on the pelvic bone and insert at intervals along the femur which provide the most power and stability for the hip joint
Adductor (Groin) Strains
Occurs with inflammation of the iliotibial band
- Begins at the hip and extends to the tibia just below the knee joint
- Provides stability to the thigh muscles and to the outside of the knee joint
Iliotibial Band Syndrome
Signs and Symptoms
- Irritation usually over the outside of the knee joint at the lateral epicondyle end of the femur. The IT band crosses bone and muscle at this point.
- A bursa typically assists with gliding of the IT band but sometimes becomes inflamed and causes pain with movement of the knee
- Seen with overuse, overpronation, leg-length discrepancies, bow-legged people
Iliotibial Band Syndrome
- Common in football, rugby, soccer and basketball
- Caused by a direct blow to the thigh from a helmet or knee
- May limit motion
- May affect gait
- Severity is usually graded by the ROM in the hip at the time of evaluation
Quadriceps Contusion
- Painful condition in which an ossifying mass (calcium deposit) forms within a muscle
- Typically a result of recurrent trauma to a quadriceps muscle that was not properly protected after an initial injury
Myositis Ossificans
Signs and Symptoms
- A hard, painful mass in the soft tissue of the thigh and progressive loss of bending motion of the injured knee
- Definitive diagnosis is made through and x-ray but not typically seen until at least 4 weeks after the injury
MyositisOssificans
- Also known as a “hip pointer” and is a very painful injury caused by a direct blow to the hip
- Common in football players that wear improperly fitting hip pads
- Signs and Symptoms
- Extreme tenderness
- Swelling
- Ecchymosis over the iliac crest
Iliac Crest Contusions
- Common in athletes that have focused their efforts on one sport
- Caused by cumulative effects of very low levels of stress – such as the repetitive action of running
- Chronic muscle strains, stress fractures, tendonitis, snapping hip (IT tendon over femur) and bursitis
Overuse Injuries
Signs and Symptoms
- Chronic, ill-defined pain over the groin and thigh
- Initial diagnosis of a muscle strain, but if no acute history is noted, would recommend considering a _________ fracture
Stress Fractures
- A defect in the pars interarticularis of the vertebrae resulting in fractures near the facet joints of the lumbar spine
- If the defect is bilateral or on both sides, it could cause the vertebra to slip forward on the vertebra or sacrum below
- May develop in athletes who undertake in strenuous exercise or competition
- Some medical experts refer to this as a stress fracture and a result of repetitive trauma
- Some medical expert believe spondylolysis to be congenital
Lumbar Spondylolysis
Signs and Symptoms:
- Low back pain with increased activity
- With rest or inactivity, the pain will decrease, only to return again when the activity is resumed
- Radiating pain into the buttocks and upper thighs
- Appearance of the above symptoms and episodes of back pain with activity should warrant a referral to a physician
Lumbar Spondylolysis
- The nucleus pulposus herniates through the annulus fibrosis and presses against the spinal cord or the spinal nerve roots
- Common in the age group of people in their 30s and 40s but can occur in any age group
Intervertebral Disc Herniation
Signs and Symptoms:
- Extreme pain and stiffness in the lower back
- Pain in the buttocks
- A “unique” type of radiating pain in the leg if compression is severe – usually unilateral and follows the route of the sciatic nerve
- Formed by the 4th and 5th lumbar nerves and 1st -> 3rd sacral nerves
- Pattern of radiation depends on nerve roots involved
Intervertebral Disc Herniation
Signs and Symptoms:
- Difficulty sitting for long periods of time
- Difficulty standing with both legs straight
- Difficulty with bending over
- Unilateral muscle weakness
- Unilateral sensory loss
- Loss of a reflex in the leg
Intervertebral Disc Herniation
- Usually sprains that occur as a result of acute or chronic trauma
- Can result from a single maneuver, twist, or awkward movement
- Can result from overuse with poor posture, bad lifting techniques or strenuous maneuvers repeated many times
Sacroiliac Joint Injuries
Signs and Symptoms:
- Stiffness or a consistent soreness of the SI joint area
- Typically better in the morning but gets worse as the day goes on
- No neurological signs but there may be referred pain in the back of the thigh, groin or hamstrings
- Heat and activity may diminish the discomfort, but pain returns as soon as the athlete calms down
Sacroiliac Joint Injuries
If Gluteus medius and minimus muscles did not contract when you stood on one leg, your pelvis would drop
Called the Trendelenberg gait
If your R hip abductors are weak where would you see the drop?
on the left hip
