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EPHE 355 - Final Exam > The Pelvic & Hip Region > Flashcards

The Pelvic & Hip Region Flashcards

1
Q

What are some functions of the pelvis?

A
  • contain and support visceral contents

- transmit and absorb forces (upwards and downwards)

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2
Q

What is the innominate?

A

either of the two bones forming the sides of the pelvis, each consisting of three consolidated bones, the ilium, ischium, and pubis.

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3
Q

What bones make up the pelvic girdle?

A

bones of the innominate (ilium, ischium, pubis) and the sacrum

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4
Q

How are the innominate bones attached at birth vs adulthood?

A

separated by hyaline cartilage at birth - by 25 years of age they are fully grown and fused

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5
Q

The sacrum is a large inverted triangle. Which half is non weight bearing?

A

the inferior half is non weight bearing

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6
Q

Sacrum differences in male vs female?

A

wider and flatter in females

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7
Q

The sacrum consists of # fused vertebrae and it articulates with what?

A

5

Articulates with the lumbar and coccygeal vertebrae

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8
Q

The sacroiliac joint is a ____ joint.

A

synovial

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9
Q

Does the SI joint have hyaline cartilage?

A

Yes - on both articular surfaces of the sacrum and ilium

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10
Q

What happens to the SI with age?

A

becomes stiffer and irregular

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11
Q

What is the movement of the SI joint? When can it be greater?

A

Small motion - 2-4mm approx.

Can be greater during 1st and 3rd trimester of pregnancy, as well as in blondes with fair skin

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12
Q

With age, what contributes to form closure of the SI?

A

reciprocal undulating hyaline articular surfaces on sacrum and ilium as well as ligaments

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13
Q

What are the three components of functional stability at the SI joint?

A

Passive system: osseous, capsule, ligaments

Active System: muscles

Neural System: sensory receptors, nerves, spinal cord and supra-spinal centers, reflexes and/in active system

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14
Q

Form vs Force closure for structural integrity?

A

Form: passive structures - interlocking articular ridges and grooves of the SI joint, reverse keystone configuration of the sacrum within the pelvic ring and fibrous ligaments suspend pelvis

Force: muscle activation - external dynamic forces created by contraction of the stabilizing muscles to produce a “self-locking” mechanism, resulting in increased joint stability

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15
Q

When does the keystone theory not work?

A

when looking from a superior view (as opposed to anterior-posterior)

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16
Q

How is the sacrum held to the ilium from a superior viewpoint?

A

by ligamentous support and force closure

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17
Q

“concept posits that the sacrum is the reverse of a keystone”

A

tensegrity - the sacrum is a hub!

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18
Q

Movements of the sacrum:

  • ____ is sacral anterior rotation (flexion)
  • ___ is sacral posterior rotation (extension)
A

nutation

counternutation

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19
Q

Standing on both legs performing flexion at the trunk we will have _____ of the sacrum and ____ rotation of the inominate

A

nutation

anterior

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20
Q

Standing on left leg while flexing right hip joint the right innominate will ____ rotate and the left inominate will not move, the sacrum will ____ on the right side more than left (indicating movement at SI joint)

A

posteriorly

counternutate

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21
Q

When standing and walking, the weight of the body is where?

A

through the sacrum to the SI joint to the pubic symphysis and the heads of the femurs

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22
Q

When sitting, where is the weight?

A

through the SI joint to the pubic symphysis and ischial tuberosities

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23
Q

the ____ ligaments are between the lateral sacral crest and the inner side of the iliac tuberosity

A

interosseous

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24
Q

Differences between anterior and posterior sacroiliac ligaments?

A

anterior SI ligaments are thinner and not as extensive as posterior ligaments

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25
Q

the anterior and posterior SI and interosseous ligaments act to do what?

A

suspend the sacrum from the ilia

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26
Q

What type of joint is the pubic symphysis?

A

amphiarthrotic cartilaginous symphysis joint

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27
Q

what is the pubic symphysis joint separated by? Does this joint have hyaline cartilage?

A

fibroartilaginous disc

yes, on both pubic bone articulating surfaces

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28
Q

the ___ ___ completes the closure of the pelvic ring

A

symphysis pubis

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29
Q

Explain the mechanical advantage of the femur having a long neck?

A

Mechanical advantage for glut muscles and lateral rotators (force x distance = more torque)

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30
Q

All abductor muscles insert onto what aspect of the femur?

A

Linea aspera - hamstring muscles also come off of here

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31
Q

what is the angle of inclination of the femur?

A

125 degrees with the anatomic axis of the shaft of the femur

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32
Q

anatomic vs mechanical axis of the femur?

A

anatomic = line through the femoral shaft

mechanical = line connecting the centers of the hip and knee joints, which is typically a vertical line in the standing position

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33
Q

____: distal end of the femur is more lateral relative to the midline

A

valgus

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34
Q

____: distal end of the femur is more medial relative to the midline

A

varum

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35
Q

Angle of inclination pathologies: coxa valga?

A
  • excessive angle
  • leg appears longer
  • weaker abductors
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36
Q

Angle of inclination pathologies: coxa vara?

A
  • reduced angle
  • predispose to fracture
  • common later in life
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37
Q

Head of the femur points what way?

A

it is anteverted - points anteriorly by 12-15 degrees

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38
Q

Angle of torsion the femur is in what plane?

A

transverse

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39
Q

What is anteversion?

A

excessive torsion - 25 degree angle = toeing in

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40
Q

What is retroversion?

A

decreased torsion - 8 degree angle = toeing out

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41
Q

Joint classification for the hip? DOF?

A

ball and socket, synovial membrane - 3 DOF

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42
Q

Movements at the hip joint?

A

flexion/extension
abduction/adduction
int./ext. rotation

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43
Q

Osteokinematics of the hip?

A

swing and spin

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44
Q

Where is the hyaline cartilage of the hip?

A

superior, superior anterior, and superior posterior - there is none inferiorly or in the center

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45
Q

What is in the center of the acetabulum?

A

the acetabular fossa that contains mobile fat pad and no articular cartilage

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46
Q

What is the ligament attached to the head of the femur?

A

ligamentum capitis femoris/ ligamentum teres

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47
Q

What is the function of the ligamentum capitis femoris?

A

to carry the vascular supply to the head of the femur

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48
Q

When is there tension on the ligamentum teres?

A

in extreme positions of adduction, flexion, and external rotation or adduction, extension, and internal rotation

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49
Q

the ____ ____ is space for the ligamentum teres

A

acetabular fossa

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50
Q

the acetabular fossa is a reservoir for synovial fluid, how does this help the hip?

A

when it is heavily loaded to fluid comes here, and when forces are decreased the fluid returns to articular surfaces to provide lubrication and nutrition

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51
Q

Where is the labrum and what is itmade of?

A
  • rims the acetabulum, increases the enclosure on the head of the femur
  • fibrocartilaginous
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52
Q

the ____ is a strong structure that attaches the outer rim of the acetabulum to the neck of the femur

A

capsule

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53
Q

how is strong stability provided at the joint?

A

negative atmospheric pressure in the capsule

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54
Q

Arthrokinematics - Convex on concave - during flexion, how does the head move?

A

glides posteriorly

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55
Q

Arthrokinematics - Convex on concave - during abduction, how does the head move?

A

glides inferiorly

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56
Q

Arthrokinematics - Convex on concave - during external rotation, how does the head move?

A

glides anteriorly

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57
Q

The hip joint is supported by three strong ligaments that are embedded within the capsule. What are they? What do they contribute to?

A
  1. Iliofemoral
  2. Ischiofemoral
  3. Pubofemoral

Contribute to ability to stand upright with minimal muscular effort

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58
Q

How does the iliofemoral ligament cover the hip? What movements does it prevent?

A
  • covers anteriorly and superiorly

- prevents excessive hip extension and external rotation

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59
Q

the ____ ligament helps screw the femoral head into the acetabulum

A

iliofemoral ligament

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60
Q

When you move into extension and external rotation, what ligament is getting tightened?

A

iliofemoral ligament

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61
Q

How does the ischiofemoral ligament cover the hip? What does it help prevent?

A
  • covers posterior and inferior hip

- prevents hip hyperextension, abduction and internal rotation

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62
Q

The _____ ligament is tight with extension, abduction, and internal rotation.

A

ischiofemoral ligament

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63
Q

what hip ligament is the weakest of the big three?

A

ischiofemoral

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64
Q

the pubofemoral ligament covers what part of the hip? what does it prevent?

A
  • covers anterior and inferior hip

- prevents over-abduction, and limits extension and external rotation

65
Q

the _____ ligament gets tensioned with extension, abduction and external rotation

A

pubofemoral

66
Q

Degrees and EF: hip flexion with knee extended?

A

70-90 degrees

firm

67
Q

Degrees and EF: hip flexion with knee flexed?

A

____ degrees

soft

68
Q

Degrees and EF: hip extension

A

0-30 degrees

firm

69
Q

Degrees and EF: hip abduction

A 
45 degrees (this seems to vary a lot with age; 53 degrees at 4 yrs --> 21 degrees at age 87)
firm
70
Q

Degrees and EF: hip adduction

A

30-40 minutes

firm

71
Q

Degrees and EF: hip internal rotation

A

40 degrees

firm

72
Q

Degrees and EF: hip external rotation

A

45 degrees

firm

73
Q

nerve supply to the leg: lumbar plexus T__ - L__

A

T12-L4

74
Q

What muscles does the obturator nerve supply?

Lumbar plexus L2-4

A

The adductors - adductor magnus, brevis, longus and gracilis - as well as obturator externus

75
Q

What muscles does the femoral nerve supply?

Lumbar plexus L2-4

A

Quads (RF, VI, VL, VM), sartorius, and pectineus (only adductor not done by obturator

76
Q

What muscles does the superior gluteal nerve supply? (sacral plexus)

A

gluteus minimus and medius and the TFL

77
Q

What muscles does the inferior gluteal nerve supply? (sacral plexus)

A

gluteus maximus

78
Q

What muscles does the sciatic nerve supply? (sacral plexus)

A

branches to semimembranosis, semitendonosis, biceps fem, adductor magnus

79
Q

What muscles does the tibial nerve supply? (sacral plexus)

A

gastrocs (med/lat), soleus, plantaris, tib posterior and flexors of foot

80
Q

What muscles does the common peroneal nerve supply? (sacral plexus)

A

peronei (longus and brevis)

81
Q

What muscles does the deep peroneal nerve supply? (sacral plexus)

A

tibialis anterior, extensor digitorum, extensor hallucis

82
Q

what muscles insert into the IT band and create tension and stability at the knee when they contract?

A

glut max and TFL

83
Q

Glute Max: the upper fibers in conjunction with ____ can help with what action?

A

TFL

abduct

84
Q

Glute Max: the lower fibers help with what action?

A

they are below the joint line so they can help to adduct

85
Q

Action of the glut max?

A
  • extension
  • laterally rotate thigh at hip
  • upper fibers abduct
  • lower fibers adduct
86
Q

Nerve innervation for glute max?

A

inferior gluteal nerve

87
Q

action for the glut med?

A
  • abduct
  • internally rotate
  • posterior fibers extend and laterally rotate
  • anterior fibers flex
  • horizontal abduction when in flexion
88
Q

does the glute med have more anterior or posterior fibers?

A

there are very few posterior fibers relative to anterior fibers

89
Q

nerve supply for the glute med?

A

superior gluteal nerve

90
Q

actions for the glute min and nerve supply?

A

-abduct
-internally rotate
(same as glute med)
-nerve = superior gluteal

91
Q

what nerve innervates the biceps femoris long and short head?

A

sciatic nerve (tibial and common peroneal nerve)

92
Q

what are the say grace before tea muscles?

A

sartorius
gracilis
semitendinosus

93
Q

what nerve innervates the semimembranosus and semitendinosus?

A

sciatic (tibial) nerve

94
Q 
What do all of these muscles have in common:
piriformis
superior gemellus
obturator internus
inferior gemellus
quadratus femoris
obturator externus
A

they are all lateral rotators because they are posterior to the hip joint!

95
Q

If you are in pigeon pose, what muscle are you stretching?

A

piriformis! because you are in a supra-flexed position and laterally rotated

96
Q

The piriformis does lateral rotation and extension of the thigh at the hip , but when you hit ___ degrees of flexion it medially rotates and horizontally extends (abducts) the thigh at the hip

A

60

97
Q

What is piriformis syndrome?

A

pressure on sciatic nerve - this happens cause the sciatic nerve comes from right under the piriformis

98
Q

what nerve supplies the piriformis?

A

the nerve to piriformis from lumbosacral plexus

99
Q

What nerve supplies the superior gemellus?

A

nerve to obturator internus from lumbosacral plexus

100
Q

what nerve supplies the inferior gemellus?

A

nerve to quadratus femoris from lumboscaral plexus

101
Q

When doing the “open-the-gate” warmup in soccer, what muscle are you warming up?

A

the obturator internus

also the piriformis and superior/inferior gemellus

102
Q

what nerve supplies the obturator internus?

A

nerve to obturator internus from lumbosacral plexus

103
Q

what nerve supplies the obturator externus?

A

obturator nerve

104
Q

what nerve supplies the quadratus femoris?

A

nerve to quadratus femoris from lumbosacral plexus

105
Q

Why is the tensor fascia latae considered the charleston muscle?

A

because it does flexion, medial rotation and abduction - just like the dance move from the 1920’s!

106
Q

what nerve supplies the TFL?

A

superior gluteal nerve

107
Q

what muscle is the primary flexor of the hip?

A

iliopsoas

108
Q

what two muscles make up the iliopsoas?

A

psoas major and iliacus - they both have the same insertion (lesser tubercle of femur) so they are considered one muscle generally

109
Q

what muscle would be really tight on someone that has a large anterior pelvic tilt?

A

iliacus

110
Q

what nerve supplies psoas major?

A

branches from lumbar plexus

111
Q

what nerve supplies the iliacus?

A

femoral nerve

112
Q

what nerve supplies rec fem?

A

femoral nerve

113
Q

what nerve supplies the vastus group?

A

femoral nerve

114
Q

how does the sartorius act as a knee flexor?

A

when it wraps around to the front of the tibia it comes posterior to the knee joint and is held in that position, so it helps with flexion

115
Q

which muscle is the criss-cross muscle?

A

sartorius - it does flexion, abduction, and lateral rotation of thigh at hip and flexion of leg at knee

116
Q

what nerve supplies the sartorius?

A

femoral nerve

117
Q

what muscles are in the medial compartment?

A

this is aka the adductor compartment - consists of adductor magnus, longus, brevis, pectineus, and gracilis

118
Q

What nerve supplies all the adductor muscles? What muscle is the exception?

A

Obturator nerve - supplies all except pectineus which is femoral nerve because it originates so high up compared to the others

119
Q

where do the “say grace before tea” muscles all insert?

A

antero-medial aspect of the tibia

120
Q

Pelvic inclination - a forward tilt involves what muscles? Does it increase or decrease lumbar lordosis?

A
  • iliopsoas, rec fem, and erector spinae

- increases lordosis

121
Q

Pelvic inclination - a backward tilt involves what muscles? Does it increase or decrease lumbar lordosis?

A
  • rectus abdominus, most hamstrings, and gluteus maximus

- decreases lordosis

122
Q

If someone has excessive anterior pelvic tilt, what needs to be stretched and strengthened?

A

Stretched: psoas major, iliacus, rectus femoris

Strengthened: hamstrings, gluteus maximus and abdominals

123
Q

If someone has excessive posterior pelvic tilt, what needs to be stretched and strengthened?

A

Stretch: hamstrings, gluteus maximus, and abdominals

Strengthen: psoas major, iliacus, rectus remoris

124
Q

Muscle function can change depending on joint position. How does the action of the following muscles change depending on joint position:

  1. Piriformis
  2. Abductors
  3. Glut Med and TFL
A
  1. Piriformis does external rotation, but when it is in a super-flexed position it switches to internal rotation
  2. Abductors switch to horizontal extension when flexed at hip
  3. Glut Med and TFL are internal rotators of the hip, but their leverage for internal rotation increases further when the hip is flexed to 90 degrees
125
Q

How does the adductor longus perform agonist and antagonistic actions at the hip?

A

It flexes when leg is in an extended position and it extends when the leg is in a flexed position

126
Q

The piriformis, gemelli, ad obturator internus have a good angle of pull for external rotation, but as the hip flexes to 90 degrees, what do they shift to?

A

horizontal extension (abduction)

127
Q

The anterior portions of the gluteus medius and minimus and TFL increase their leverage for ____ ____ when the hip is flexed (to approx. 90 degrees)

A

internal rotation

128
Q

the posterior portions of glut med and min can laterally rotate particularly when leg is in _______

A

extension

129
Q

How do you keep sarcomeres at an ideal mid-length range over a two joint muscle?

A

you need to stretch over one and flex over another

130
Q

What position should the leg be in if the rec fem wants to produce the most force as a hip flexor?

A

the knee should be flexed

think of kicking a soccer ball

131
Q

What position makes the rec fem amore efficient knee extensor?

A

if the hip is extended

132
Q

The hamstrings are more efficient as hip extensors when the knee ____ and are more efficient as knee flexors when the hip is _____

A

extends; flexed

133
Q

Playground example: When you are hanging upside down on the monkey bars by your knees, what muscles are involved and what joint positions can be used to enhance the effectiveness of the muscles needed to keep you hanging there?

A

-dorsiflex so that gastrocnemius are lengthened and
can have more force production

  • also has slight hip flexion - this helps hamstrings
134
Q

What muscles are active when doing a crunch?

A

neck flexors and abdominal muscels perform concentric actions until the trunk is flexed

135
Q

What muscles are active during a full sit-up?

A

neck flexors and abdominal muscles concentrically until the trunk is flexed, and then the iliopsoas become the prime mover to raise trunk and pelvis on the fixed femur

136
Q

what happens when you fix feet during a situp?

A

the hip flexors contribute more! you dont even need to use your abs

137
Q

What happens in a sit-up if your abs aren’t strong enough to maintain lumbar flexion?

A

the great force of the psoas major pulls the lumbar spine into hyperextension (lordosis) and anteriorly tilts the pelvis - this repetitive performance can lead to microtrauma and injury

138
Q

how do you differentiate tightness in iliopsoas vs rec fem vs TFL?

A

do the Thomas test! If the hip stays flexed its iliopsoas, if knee extends its rec fem, and if leg abducts then its tight TFL

139
Q

Four important muscles serve as Hip Extensors in all positions of the hip joint; what are they?

A
  1. Glute Max
  2. Biceps Femoris (long head)
  3. Semimembranosus
  4. Semitendinosus
140
Q

Remember the adductors can also act as extensors when the hip is in what position?

A

flexion

141
Q

During low power hip extension (ie. walking and long distance running, stair ascending and descending, rising from sitting), what hip extensors are primarily active?

A

hamstrings

142
Q

When hip extension motions become more rapid or are accompanied by moderate-max resistance, what muscles assist the hamstrings?

A

glute max also becomes activated - POWER = glute max

143
Q

What muscles will be quite large on a sprinter?

A

glute max

144
Q

Outside of power, what also influences the contributions of hamstrings vs glute max during hip extension?

A

hip joint position relative to knee joint posotion

145
Q

What is the benefit of having the greater trochanter away from the hip joint?

A

allows for greater force production by abductors - this is a mechanical advantage because the fulcrum is longer so more torque = more force

146
Q

When standing on one leg, what is helping bring your pelvis up so it doesn’t drop when you pick up your foot?

A

reverse origin insertion of the hip abductors

147
Q

If someone is walking and you see a right side pelvis drop during stance phase on left foot, what does this mean? What else might you observe in the movement

A
  • weak left hip abductors

- might also see a lean of the trunk to the weak side to counterbalance

148
Q

What type of lever system is the hip abductors around the femoral head during stance phase?

A

first class lever: muscle pulls down, GRF pulls up, body weight pulls down (look at pic if needed - slide 93)

149
Q

Hip abductors are at a mechanical disadvantage relative to body weight and must produce a force greater than __% body weight to maintain equilibrium

A

85%

150
Q

In someone with Trendelenburg Gait, what side should the cane be on?

A

the contralateral side so that you can de-weight the standing leg (side that dips) and then you can keep the pelvis level

151
Q

When retraining hip abductors in a Trendelenburg Gait, what must you be cautious about?

A

that the client doesn’t compensate with quadratus lumborum and psoas major

152
Q

Where do femoral fractures usually occur?

A

at the neck of the femur

153
Q

Why are hip fractures more common in women?

A

due to increased osteoporosis in women after menopause

154
Q

What does it mean if you break a bone from standing height?

A

you are clinically diagnosed with osteoporosis

155
Q

what is a common site for osteoporosis?

A

calcaneus bone? apparently

156
Q

Femoral fractures - fractures of the neck are most common, what is the next most common?

A

intertrochanteric fractures

157
Q

In osteoarthritis we see a narrowing of joint space due to loss of cartilage. What else is seen?

A

Subchondral cysts and chondral bone spurs

158
Q

How would you differentially stretch the rec fem vs iliopsoas?

A

For rec fem you will extend hip and flex at the knee

For iliopsoas you would extend at the hip, posterior pelvic tilt and bend trunk to contralateral side

EPHE 355 - Final Exam (2 decks)

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