Week 7 Flashcards
Plica
- piece of fibrous tissue extending from the joint capsule that is supposed to reabsorb during growth & development
- fibres get in way of joint mimicking a meniscus injury
Key structures of the hip and pelvis
- illiac crest
- ASIS
- AIIS
- PSIS
- ischial tuberosity
- pubic symphysis
- hip joint and articular cartilage
Origin of sartorius
- ASIS
Origin of rectus femoris
- AIIS
Origin of hamstrings
- ischial tuberosity
External obliques origin
- outer surface of ribs 5-12
External obliques insertion
- inferiorly onto anterior 1/2 of iliac crest and medially into linea alba
External obliques action
- trunk rotation
- flexion
- side bending
- compresses abdominal viscera
Hip flexors
- psoas
- iliacus
- sartorius
- rectus femoris
- pectineus
- tensor fascia latae
Which structures insert into top of illiotibial band (IT)?
- glute max
- tensor fascia latae
Importance of rectus femoris
- palpation point
- only quad muscle that also does hip flexion
Insertion of quad muscles
- quad tendon into patella
Action of all quad muscles
- knee extension
Adductors
- pectineus
- adductor longus
- adductor magnus
- adductor brevis
- gracillis
Insertion of sartorius
- medial aspect of prox tibia
What is the acetabular labrum
- fibrous cartilage that rims the acetabulum
Role of the acetabular labrum
- deepens socket
- increase stability of joint
Blood supply of acetabular labrum
- base that attached to bone has some capacity to heal due to blood supply from bone
- free edge has limited blood supply so doesnt heal well
What is a hip pointer?
- contusion of iliac crest (periosteum has lots of sensory nerves)
MOI of hip pointer
- blunt trauma to iliac crest
Signs and symptoms of hip pointer
- severe pain with trunk flexion, rotation, side bending or hip flexion
- bruising
- swelling
- muscle spasm
What other structures may be affected with a hip pointer?
- external obliques
- tensor fascia latae
What else do athletes usually report pain with when they have a hip pointer?
- forced exhalation
- bowel movements
- all functions of external obliques
Acute management of hip pointer
- PIER
- lymph drainage to settle spasm
- donut pad with cover for RTP
Acetabular labral tears MOI
- acute plant and twist or hyperabduction (splits)
- overuse degeneration
Signs and symptoms of acetabular labral tears
- pain
- clicking/catching in hip or groin
- decreased hip ROM
- audible pop/sensation at time of injury
Common descriptor of pain with acetabular labral tears
- “C” sign
- cups area with hand
Special test for acetabular labral tears
- scouring test
Acute management of acetabular labral tears
- ice
- rest
- pain management
- correct mechanics
- proprioception
- refer and surgery if conservative treatment isnt effective
What surgery may be used for acetabular labral tears?
- orthoscopic surgery to trip labral flap
Scouring test
- highly sensitive, but lacks specificity
- good indicator of pathology of joint itself
What does the scouring test for?
- hip labrum tears
- capsulitis
- osteochondral fractures
- acetabular defects
- osteoarthritis
- avascular necrosis
- femoral acetabular impingement syndrome
Avascular necrosis
- bone death from decreased blood supply
Femoral acetabular impingement syndrome
- irregular shape of one or both joint surfaces leading to labrum/cartilage tears
ITB friction syndrome MOI
- ITB friction over lateral femoral condyle second degree to biomechanics causes
What type of condition is ITB friction syndrome?
- overuse from friction over lateral femoral condyle
When is ITB syndrome common?
- sports using continuous knee flexion and extension like running
What is a contributing factor to ITB syndrome?
- weak glute medius
- winter boots/walking in snow
What should be checked to prevent of stop ITB friction syndrome?
- biomechanics
- footwear and wear patterns
Hip flexor tendonitis MOI
- overuse
- repetitive flexion
Who is hip flexor tendonitis common in?
- cyclists
- runners
- gymnasts
Signs and symptoms of hip flexor tendonitis
- pain with active and resisted hip flexion
- stretch pain with passive hip extension
- TOP affected tendon
Acute management of hip flexor tendonitis
- ice
- rest/altered activity
- correct mechanics in sport
- hip flexor wrap
Strains of the hip and thigh
- hip flexors
- quads
- hamstrings
- adductors
MOI of hip flexor strains
- forceful hip flexion
- leg caught in hip extension
MOI of quad strain
- forceful quad contraction
- hip extension with knee flexion
MOI of hamstrings strain
- excessive hip flexion with extended knee
- in sprinting- eccentric hams contraction in late stance phase
MOI of adductors strain
- quick cutting (overstretch with forceful contraction)
- splits type motion
Signs and symptoms of strains of the hip and thigh
- pop or pull sensation
- weakness (gr 2&3)
- bruising (gr 2&3) due to high blood supply
Acute management of strains of the hip and thigh
- PIER
- educate
- NWB
- hip flexor wrap of adductor wrap for daily wear
- effleurage/lymph drainage
Thigh contusions MOI
- blunt trauma
Signs and symptoms of thigh contusions
- discolouration
- muscle weakness
- risk of myositis ossificans
Acute management of thigh contusions
- effleurage
- ice
- no deep tissue massage
- protective padding (donut pad)
Where is the psoas muscle?
- tubular muscle btwn ASIS & umbilicus
Where is the illiacus?
- lines bowl of the pelvis
- medial and inferior to ASIS
Tests for true hip pathology
- labral tears
- osteochondral lesions
- arthritis
- avascular necrosis
What does a negative thomas test look like?
- hamstrings touch the table
- knee in 80 degree flexion
- thigh in midline
- foot straight forward
What does a positive thomas test look like?
- hip flexion (hip flexor tension)
- hip flexion with knee extension (rect fem)
- abducted hip (tight ITB)
- rotated tibia (tight ITB)
Special test for ITB friction syndrome
- noble compression test
Steps to completing Kendall’s resisted muscle testing
- unaffected side first
- have athlete go into starting position
- match my pressure (gradually increase your pressure)
- hold for 5 s
- grade resistance and mark with * if pain
What resisted muscle tests did we do in lab?
- psoas
- rect fem
- adductors (short vs long)
- glutes and hams (hip extensors)
- hamstrings (medial vs lateral)
- post fibres of glute med
