hip Flashcards by Talia Casarella

Classify the hip joint

-diarthrodial
ball and socket
3 degrees of freedom

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How does the acetabulum face

-faces laterally, slightly inferior and anterior
-anteversion: silt anterior tilt (too much will make it unstable)

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what fraction of the acetabulum does the pelvic bones make up?

ilium: 2/5
ischium: 2/5
pubis 1/5

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acetabulum articular cartailge

horseshoe shaped at the WB parts of the joint (superiorly to posteriorly)

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center edge angle/angle of Wilberg

how much of the acetabulum is present to cover the femur
-35-40%
-men are closer to 40% and wormen are closer to 35%
-anything less than 35% puts you at more of a risk of dislocation

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acetabuluar labrum

goes around the periferi to deepen the socket

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What is the normal angulation of the femur head to the shaft

125
-140-150 at birth but decreases as the baby starts to WB

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coxa valga

when the angulation of the femur head to the shaft is >125
-causes genu vara (knee varus)

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coxa vara

when the angulation of the femur to the shaft is <125
-causes genu valgus

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Femoral head angle of torsion

10-15 normal anteversion
-positioned forward (anterior to frontal plane)
-anything below 10 anteversion is considered retroversion of the femoral head

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excessive anteversion

greater than 15
IR hip so head is firm in the acetabulum and stand with toes pointed in

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retroversion

less than 10 anteversion
-ER the hip so head is firm in the acetabulum and stand with toes out

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when is the hip joint congruent

when the hip is flexed 30, abd 30 and slightly ER

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What are the hip joint ligaments

-capsule:
-iliofemor
-pbofemoral
-ischiofemoral

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hip joint capsule

thick superiorly and acts as sleeve

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iliofemoral ligament

AIIS to intertrochantic line
-shaped like an inverted Y
-taut in ER and Ext

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pubofemoral

pubic ramus to intertrochanteric fossa
-taut in Ext. ER. and abuction

ligamentum teres

fovea of the femur to the acetabulum
-protects the obturator artery
-as the acetabulum moves superiorly the ligament acts as a sling and tenses up to give inferior support
-as you move through ROM is distributes synovial fluid

ischiofemoral

ischial tuberosity to the GT
-limits flexion, extension, IR, Add

Closed pack position and open pack position of the hip joint

close pack: extension (all ligaments are taut)
open pack: flexion - joints are more congruent however

arthrokinematics for the hip joint NWB

-flexion/extension: spinning
-abduction/adduction: upward roll and downward glide or downward roll and upward glide
ER/IR: posterior roll and anterior glide or anterior roll and posterior glide
WB roll and glide are in same direction

Osteokinematics of the hip joint PROM

flexion: 0-80 (knee ext)/0-120 (knee flexed)
extension: 0-20 (knee ext)/0 (knee flexed)
abduction: 0-40
adduction: 0-25
ER: 0-45
IR: 0-35

limits to flexion

-tight glute max and inferior joint capsule

limits to extension

anterior structures
-pubiofemor ligament
ischiofemoral ligament
iliofemoral ligament

limits to abduction

-adductors -pubofemoral ligaments

limits to adduction

abductors -ischiofemoral -lateral hip muscles like glute med

limits to IR

ischiofemoral ligament ER muscles

limits to ER

iliofemroal pubiofemoral

What osteokinematics are required for gait (hip)

flexion: 0-30 needed for terminal swing extension: 0-10 needed for terminal stance IR: 0-5 when in stance and advancing other limb ER: 0-5 when advancing the limb

pelvic osteokinematics

anterior/posterior pelvic tilt (sagittal plane) lateral pelvic tilt - add of hip pelvic rotation - transverse plane

gender differences in pelvis

females: have a more cylindrical shape males: have a taller and more conical shape

ground reactive force force line and management

heel to COM is the force line -musculature help to manage it

joint reactive force

-force across the surface of the joint -from head of the femur to acetabulum -tightness of muscles add compression and so does gravity

hip flexors *= primary

*iliopsas *rectus femoris -sartorius -TFL -pectineus -adductor longus -adductor brevis, gracilus and gluteus min anterior fibers (glute med can assist)

hip extensors *=primary

*glute maximus -biceps femoris -semitendinosus -semimebranosus -adductor magnus -posterior fibers of glute med

Hip Abductors -their contribution to gait

-pass superior to Anterior posterior axis - Gluteus medius* -gluteus minimus -TFL -piriformis -sartorius - control frontal plane hip drop during gait - Ground reaction force causes an adduction force and an abduction internal moment to counter it

Hip adductors -their contribution to gait

-inferior to the anterior posterior axis -gracilis* -pectineus* -adductor, longus, Magnus and brevis * -biceps femoris -gluteus maximus -quadratus femoris -gait: work eccentrically during weight acceptance on the leg that you are leaving and concentrically during weight acceptance during the leg that you are going to

Hip ER -contribution to gait

posterior to vertical axis -gluteus Maximus* -quadratus femoris -GOGO -piriformis -gluteus medius (posterior fibers) -gluteus minimus (posterior fibers) -gait: initial contact to loading response – femur IR to absorb shock so ER decelerate the limb

Hip IR muscles

anterior to vertical axis -gluteus medius (anterior fibers)* -gluteus minimus (anterior fibers)* -TFL* -pectineus -adductor longus -adductor brevis -gait: advance pelvis during swing

What groups are stronger

-Extensors -flexors -adductors -abductors -IR -ER

Adductor longus

- during hip flexion its a hip extensor -during hip extension its a hip flexor

Why do people with weak abductors/painful hip have a compensatory lateral trunk lean towards the weak side

it decreases the joint reaction force and therefore the force at the hip overall -using a cane will also help with joint reaction forces in the contralateral hand