Weeks 8 & 9: Hip & Pelvis Complex Flashcards
Joints
How many joints are there within the hip complex?
What are they?
- lumbo-sacral jt
- sacroiliac jt
- pubic symphysis
- sacro-coccygeal jt
- acetabulo-femoral jt
Acetabulo-Femoral Jt
What are the four ligaments of this jt?
Which are anterior/posterior?
- iliofemoral (ant)
- pubofemoral (ant)
- ischiofemoral (post)
- ligamentum teres (post)
Acetabulo-Femoral Jt
Where is the iliofemoral ligament attached?
What movement does it limit?
- AIIS to front of femoral head (Y shape)
- limits: hyperext
*strongest ligament in the body, rarely ruptures
Acetabulo-Femoral Jt
Where is the pubofemoral ligament attached?
What movement does it limit?
- pubic portion of acetabular rim and underneath the femoral neck
- limits: AB and hyperextension
*weak ligament
Acetabulo-Femoral Jt
Where is the ischiofemoral ligament attached?
What movement does it limit?
- from ischial portion of acetabular rim around femoral neck and attaches to the greater trochanter (just post to iliofemoral attachment)
- limits: hyperext
Acetabulo-Femoral Jt
Where is the ligamentum teres attached?
What is its function?
- connect acetabulum to femoral head
- conduct blood flow to femoral head*
*if ruptured, may lead to avascular necrosis (AVN) leading to a THR
Joints
What type of jt is the lumbo-sacral jt?
Where does it articulate?
- amphiarthrodial (cartilaginous)
- L5-S1
Joints
What type of jt is the sacroiliac jt?
Where does it articulate?
- part synovial/part fibrous
- articulates between sacrum and ilium
*works in closed kinematic chain w/pubic symphysis
Joints
What type of jt is the sacro-coccygeal jt?
Where does it articulate?
- amphiartrodial (cartilaginous)
- sacrum and 1st coccyx
Joints
What type of jt is the pubic symphysis?
Where does it articulate?
- symphysis (cartilaginous)
- articulates between each innominate pubis
Joints
What type of jt is the acetabulo-femoral jt?
Where does it articulate?
What motions does it have?
- darthrodial (synovial)
- articulates between convex femoral head and the acetabulum
- motions: hip flex/ext, ABD/ADD, IR/ER
ITB
What is the iliotibial band/tract?
Where does it connect?
What is its muscular component?
- band of dense fibrous tissue (fascia) along lateral leg
- connects iliac crest to anteriolateral aspect of tibial condyle
- TFL (tensor fascia latae)
*ITB Sydrome: common overuse injury in runners
Bursas
What are the three bursas of the hip?
- ischiogluteal
- iliopectineal
- trochanteric
Bursas
Where is the ischiogluteal bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of the bursa?
- Lies over ischial tuberosity, covers sciatic nerve
- irritated by prolonged sitting
- radiating pn down leg (similar to sciatica)
Bursas
Where is the iliopectineal bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of the bursa?
- deep to iliopsoas, close proximity to femoral nerve
- tightness in iliopsoas/squatting
- radiating pn down front thigh
*largest bursa in hip, also referred to as iliopsoas bursa
Bursas
Where is the trochanteric bursa located?
What can irritate it?
What kind of pn can be caused by inflammation of this bursa?
- between glute max and greater trochanter
- irritated by hip flex/IR
- pn in outer hip around greater trochanter
*most common site for hip bursitis
What is the closed pack position of the hip jt?
full ext and IR
Force Couples
What is anterior pelvic tilt?
What motions does it occur with?
Which force couple produces anterior pelvic tilt?
- ASIS lower than PSIS
- occurs with lumbar ext and hip flex
- back extensors/hip flexors
What are the normal end feels for the hip jt?
all firm EXCEPT hip flex w/knee flex, which is soft
Force Couples
What is posterior pelvic tilt?
What motions does it occur with?
Which force couple produces posterior pelvic tilt?
- PSIS lower than ASIS
- occurs with lumbar flex and hip ext
- trunk flexors/hip extensors
Force Couples
What is lateral pelvic tilt?
What force couple produces lateral pelvic tilt?
- one iliac crest is higher than the other (hip hiking)
- opposite hip abductors/trunk lateral rotators
Innvervations
What are the four main nerves within the hip?
- obturator (medial)
- femoral (anterior)
- sciatic (posterior)
- inferior gluteal nerve
Innervations
Which muscles does the obturator nerve innervate?
adductor brevis
adductor magnus
adductor longus
gracilis
obturator externus
Innervations
Which muscles does the femoral nerve innervate?
sartorius
iliacus
psoas
quadriceps*
pectineus
*vastus lateralis, vastus medialis, vastus intermedius, rectus femoris
Innervations
Which muscles does the sciatic nerve innervate?
hamstrings*
*semitendinosus, semimembranosus, biceps femoris
Innervations
Which muscle does the inferior gluteal nerve innervate?
glute max
Muscles
What are the prime movers for hip flexion?
rectus femoris
iliopsoas
pectineus
sartorius
Muscles
What are the prime movers for hip extension?
glute max
glute med
hamstrings
(gastroc)
Muscles
What are the prime movers for hip ABD?
glute med
glute min
piriformis
obturator internus
TFL
Muscles
What are the prime movers for hip ADD?
adductor longus
adductor brevis
adductor magnus
gracilis
Muscles
What are the prime movers foror hip IR?
GGPAT
glute med
glute min
pectineus
adductor longus
TFL
Muscles
What are the prime movers for hip ER?
GGOOPS
glute max
obturator internus
obturator externus
piriformis
sartorius
gemelli
Muscles
What are the motions of the glute max?
hip ext, ER
Muscles
What are the motions of the glute med?
hip ext, ABD, IR
Muscles
What are the motions of the glute min?
hip ABD, IR
Muscles
What are the motions of the hamstrings?
hip ext
Muscles
What are the motions of the rectus femoris?
hip flex
Muslces
What are the motions of the adductor longus?
hip ADD, IR
Muscles
What are the motions of the sartorius?
hip flex, ER
Muscles
Muscles
What are the motions of the piriformis?
hip ABD, ER
Muscles
What are the motions of the iliopsoas?
hip flex
Muscles
What are the motions of the TFL?
hip ABD, IR
THR
What are the precautions for a posterior approach?
- hip flex >90
- hip ADD past midline
- hip IR