Weeks 8 & 9: Hip & Pelvis Complex

Question 1

Joints

How many joints are there within the hip complex?
What are they?

Answer 1

1. lumbo-sacral jt
2. sacroiliac jt
3. pubic symphysis
4. sacro-coccygeal jt
5. acetabulo-femoral jt

Question 2

Acetabulo-Femoral Jt

What are the four ligaments of this jt?

Which are anterior/posterior?

Answer 2

1. iliofemoral (ant)
2. pubofemoral (ant)
3. ischiofemoral (post)
4. ligamentum teres (post)

Question 3

Acetabulo-Femoral Jt

Where is the iliofemoral ligament attached?
What movement does it limit?

Answer 3

1. AIIS to front of femoral head (Y shape)
2. limits: hyperext

*strongest ligament in the body, rarely ruptures

Question 4

Acetabulo-Femoral Jt

Where is the pubofemoral ligament attached?
What movement does it limit?

Answer 4

1. pubic portion of acetabular rim and underneath the femoral neck
2. limits: AB and hyperextension

*weak ligament

Question 5

Acetabulo-Femoral Jt

Where is the ischiofemoral ligament attached?
What movement does it limit?

Answer 5

1. from ischial portion of acetabular rim around femoral neck and attaches to the greater trochanter (just post to iliofemoral attachment)
2. limits: hyperext

Question 6

Acetabulo-Femoral Jt

Where is the ligamentum teres attached?
What is its function?

Answer 6

1. connect acetabulum to femoral head
2. conduct blood flow to femoral head*

*if ruptured, may lead to avascular necrosis (AVN) leading to a THR

Question 7

Joints

What type of jt is the lumbo-sacral jt?
Where does it articulate?

Answer 7

1. amphiarthrodial (cartilaginous)
2. L5-S1

Question 8

Joints

What type of jt is the sacroiliac jt?
Where does it articulate?

Answer 8

1. part synovial/part fibrous
2. articulates between sacrum and ilium

*works in closed kinematic chain w/pubic symphysis

Question 9

Joints

What type of jt is the sacro-coccygeal jt?
Where does it articulate?

Answer 9

1. amphiartrodial (cartilaginous)
2. sacrum and 1st coccyx

Question 9

Joints

What type of jt is the pubic symphysis?
Where does it articulate?

Answer 9

1. symphysis (cartilaginous)
2. articulates between each innominate pubis

Question 10

Joints

What type of jt is the acetabulo-femoral jt?
Where does it articulate?
What motions does it have?

Answer 10

1. darthrodial (synovial)
2. articulates between convex femoral head and the acetabulum
3. motions: hip flex/ext, ABD/ADD, IR/ER

Question 11

ITB

What is the iliotibial band/tract?
Where does it connect?
What is its muscular component?

Answer 11

1. band of dense fibrous tissue (fascia) along lateral leg
2. connects iliac crest to anteriolateral aspect of tibial condyle
3. TFL (tensor fascia latae)

*ITB Sydrome: common overuse injury in runners

Question 12

Bursas

What are the three bursas of the hip?

Answer 12

1. ischiogluteal
2. iliopectineal
3. trochanteric

Question 13

Bursas

Where is the ischiogluteal bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of the bursa?

Answer 13

1. Lies over ischial tuberosity, covers sciatic nerve
2. irritated by prolonged sitting
3. radiating pn down leg (similar to sciatica)

Question 14

Bursas

Where is the iliopectineal bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of the bursa?

Answer 14

1. deep to iliopsoas, close proximity to femoral nerve
2. tightness in iliopsoas/squatting
3. radiating pn down front thigh

*largest bursa in hip, also referred to as iliopsoas bursa

Question 15

Bursas

Where is the trochanteric bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of this bursa?

Answer 15

1. between glute max and greater trochanter
2. irritated by hip flex/IR
3. pn in outer hip around greater trochanter

*most common site for hip bursitis

Question 16

What is the closed pack position of the hip jt?

Answer 16

full ext and IR

Question 17

Force Couples

What is anterior pelvic tilt?
What motions does it occur with?
Which force couple produces anterior pelvic tilt?

Answer 17

1. ASIS lower than PSIS
2. occurs with lumbar ext and hip flex
3. back extensors/hip flexors

Question 18

What are the normal end feels for the hip jt?

Answer 18

all firm EXCEPT hip flex w/knee flex, which is soft

Question 19

Force Couples

What is posterior pelvic tilt?
What motions does it occur with?
Which force couple produces posterior pelvic tilt?

Answer 19

1. PSIS lower than ASIS
2. occurs with lumbar flex and hip ext
3. trunk flexors/hip extensors

Question 20

Force Couples

What is lateral pelvic tilt?
What force couple produces lateral pelvic tilt?

Answer 20

1. one iliac crest is higher than the other (hip hiking)
2. opposite hip abductors/trunk lateral rotators

Question 21

Innvervations

What are the four main nerves within the hip?

Answer 21

1. obturator (medial)
2. femoral (anterior)
3. sciatic (posterior)
4. inferior gluteal nerve

Question 22

Innervations

Which muscles does the obturator nerve innervate?

Answer 22

adductor brevis
adductor magnus
adductor longus
gracilis
obturator externus

Question 22

Innervations

Which muscles does the femoral nerve innervate?

Answer 22

sartorius
iliacus
psoas
quadriceps*
pectineus

*vastus lateralis, vastus medialis, vastus intermedius, rectus femoris

Question 24

# Innervations Which muscles does the **sciatic nerve** innervate?

Answer 24

hamstrings* | *semitendinosus, semimembranosus, biceps femoris

Question 25

# Innervations Which muscle does the **inferior gluteal nerve** innervate?

Answer 25

glute max

Question 26

# Muscles What are the prime movers for **hip flexion**?

Answer 26

rectus femoris iliopsoas pectineus sartorius

Question 27

# Muscles What are the prime movers for **hip extension**?

Answer 27

glute max glute med hamstrings (gastroc)

Question 28

# Muscles What are the prime movers for **hip ABD**?

Answer 28

glute med glute min piriformis obturator internus TFL

Question 29

# Muscles What are the prime movers for **hip ADD**?

Answer 29

adductor longus adductor brevis adductor magnus gracilis

Question 30

# Muscles What are the prime movers foror **hip IR**? | GGPAT

Answer 30

glute med glute min pectineus adductor longus TFL

Question 31

# Muscles What are the prime movers for **hip ER**? | GGOOPS

Answer 31

glute max obturator internus obturator externus piriformis sartorius gemelli

Question 32

# Muscles What are the motions of the **glute max**?

Answer 32

hip ext, ER

Question 33

# Muscles What are the motions of the **glute med**?

Answer 33

hip ext, ABD, IR

Question 34

# Muscles What are the motions of the **glute min**?

Answer 34

hip ABD, IR

Question 35

# Muscles What are the motions of the **hamstrings**?

Answer 35

hip ext

Question 36

# Muscles What are the motions of the **rectus femoris**?

Answer 36

hip flex

Question 37

# Muslces What are the motions of the **adductor longus**?

Answer 37

hip ADD, IR

Question 38

# Muscles What are the motions of the **sartorius**?

Answer 38

hip flex, ER ## Footnote Muscles

Question 39

# Muscles What are the motions of the **piriformis**?

Answer 39

hip ABD, ER

Question 40

# Muscles What are the motions of the iliopsoas?

Answer 40

hip flex

Question 41

# Muscles What are the motions of the TFL?

Answer 41

hip ABD, IR

Question 42

# THR What are the precautions for a posterior approach?

Answer 42

1. hip flex >90 2. hip ADD past midline 3. hip IR