What is the angel of the femur in the transverse plane?
Which direction is the head of the femur angled>
slightly ant, inf and medially
Do female anatomical differences increase risk of any type of injury?
which hip ligaments contribute to stability of the hip?
iliofemoral ligament (Y ligament) checks hiphyperext; pubofemoral ligament checks abd and ext
Normal ROM for hip flexion
Normal ROM for hip ext
Normal ROM for hip abd
Normal ROM for hip add
Normal ROM for hip ER
Normal ROM for IR
Name the hip flexors:
iliopsoas, rectus femoris, tensor fascia latae, sartorious, pectineus, adductor brevis, adductor longus, and oblique fibers of adductor magnus
Name the hip extensors crossing the hip joint:
Glut max, bicep femoris, semimembranous, semitendinous
Name the hip abd crossing the hip joint:
glut med, glut min, tensor fascia latae, upper fibers of glut max
Name the hip add crossing the hip joint:
adductor magnus, adductor longus, adductor brevis, pectinus, gracilis
Name the hip ER crossing the hip joint:
obturator externus, obturator internus, quadratus femoris, piriformis, gemellus superior, gemellus inferior, gluteus maximus, sartorius, and biceps femoris
Name the hip IR crossing the hip joint:
Gluteus min, tensor fascia latae, ant fibers of glut med, semitendinous and semimembranousis
What is inversion of muscle action
muscles that cross a joint with 3 degrees of freedom may have alternate or even opposite actions than their classically described actions
What happens to hip strength with OA?
abd and flexion decrease significantly, and ext also decreases with B hip OA
Describe blood supply to the femoral head:
main supply is the extracapsular ring from the medial femoral circumflex artery, followed by ascending cervical branches, and very little from artery of ligamentum teres
Describe the trochanteric bursa:
1.) between glut max and med tendon 2.) glut max and greater trochanter 3.) glut med and greater trochanter; other bursa can form from excessive friction
Functional ROM of hip:
90 degrees flexion, 20 abd, and IR/ER from 0/20
How are muscle strains classified?
Grade 1: little tissue disruption, low grade inflammatory, strength testing produces pain no weakness, no loss of ROM, grade2: some disruption of muscle fibers but not complete, strength ROM decreased pain significant grade 3: complete rupture loss of strength, palpable or visible defect may be present
MOI for glut med strain?
running producing a seesaw motion, but can occur in swimmers as well; typically tender just above the greater trochanter and painful with resisted abd (which bursitis is not)
What is bald trochanter?
rupture and retraction of the glut med and min tendons; Tx use a cane, NSAIDs, and possible surgery
How do groin pulls occur?
most commonly the adductor longus with quick acceleration or direction changes typically because of a lack of strengthening (abd to add ratio) and stretching of the adductors other factors are previous injury and lack of experience
Tx for groin pull?
8-12 wk of strengthening of the adductors with focus on the eccentrics resistive exercise, balance training, core strengthening and sport specific movements (stretching, massage, and modalities are not supported)
When is surgery necessary for a groin pull?
If symptoms persist after 6 months
What is a sports hernia
overuse syndrome with rectus abdominus insertion, internal obliquis insertion, or the external oblique muscle aponeurosis
What is the most frequently strained muscle in the body?
Are quad strains common?
No, but can happen with rapid deceleration
Thomas test assesses what?
rectus femoris length
Ely's test assesses
How are the oblique muscles injured?
abdominal contraction for side bend
Tx for a muscle strain
stage I: rest ice (24-72 hours) stage II: gentle ROM and isometric ex stage III: isotonic and isokinetic ex, stretching and aerobic activity stage IV: sport specific ex
Describe trochanteric buristis
more common with a wider pelvis, runners who cross midline, runners running on a banked surface, or people with a leg length discrepency get increased friction on the bursa
Symptoms of trochanteric bursitis
snapping at the lateral hip with tightness of the ITB, pain typically is provoked by ascending stairs and laying on the effected side; stretching reproduces pain; active and passive MMT/ROM painful
Tx for trochanteric bursitis
Rest, ice, NSAIDs, injections, activity modificaiton
How does iliopectineal and iliopsoas bursitis develop?
OA and RA, overuse, or direct trauma
What rehab considerations are important after hip fracture?
capsular trauma is common, so hip precautions should be followed even with fracture and ORIF
what features distinguish a stable pelvis fx from an unstable one?
A single break is typically stable, any fractures outside of the pelvic ring are stable (inf pubic rami), the posterior SI ligamentous complex is the most important, double breaks are more likely to be unstable
What is a Malgaigne fx?
double break same side inf and sup pubic rami, often associated with ipsilateral SI dislocation
MOI for pelvic fx
fall for an elderly individual, or high velocity lateral compression or A-P compression
MOI for acetabular fx
Direct loading with a fall or motor vehicle accident
Does neuromuscular stimulation to the quads hasten return to mobility after a hip fx?
Presentation of a hip dislocation?
90% are posterior which will present flexed, adducted, and IR'ed - ant dislocation limb shortened, abducted, ER'ed
Do patients with or without hip precautions after anterolateral THA return to work faster?
What is slipped capital femoral epiphysis?
The femoral head epiphysis slides off the femoral neck, which can lead to variable limits in hip IR and flexion; more common in underweight and underdeveloped male children
Adductor longus and brevis tendinopathy will be painful with what resisted motion?
Adduction from neutral
Gracilis tendinopathy will pain with what resisted motion?
Resisted hip add and resisted knee flexion from neutral
Pectineus tendinopathy will painful with what resisted motion?
hip fleixon and adduction from 90 degree hip flexion
Persistent hip bursitis may indicate what?
calcification of a tendon, will typically present with weak hip abd
Is open mesh or laproscopic repair more superior in sportsman hernia repair
What is typical time for return to sport activity after sportsman hernia surgery?
What is cam impingement?
associated with a nonspherical femoral head and neck relationship, this loss of roundness contributes to abdnormal contact between the head an socket
what is pincer impingement
occurs when the acetabulum has too much coverage around the femoral head and the labrum gets pinched between the rimof the socket and anterior femoral head-neck junction
What is pincer impingement typically caused by?
secondary to retroversion or a turning back of the acetabulum, profunda (socket that is too deep) or protusio (femoral head extends into the pelvis)
What symptoms will a patient with a labral tear complain of?
INcreased pain with sitting and climbing stairs along with possible clicking and locking and/or giving way during WB'ing activities, possible limitation in during passive IR with the hip flexed
A patient presents with resting groin pain after a traumatic fall and has end range passive hip flexion 2/10, FADIR of 6/10 groin pain, and modified circumduction test 8/10 pain - what might she have?
Traumatic acetabular labral tear
Sportsman's hernia potentially involves what fibers
transversalis, conjoined tendon, or internal oblique fibers
What is ostetis pubis?
noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica) causing varying degrees of lower abdominal and pelvic pain, may present with groin pain, reduced passive hip IR and or ER, sclerotic changes, T2 MRI changes strongly correlate with symptoms, and failure with conservative Tx - possible benefit from surgical stabilization
What part of the hip labrum is least susceptible to a tear?
the outer border because of good blood flow and least likley to be exposed to compressive forces - internal substance has poor blood flow, superior region at risk for compressive forces
Psoas tendinopathy will typically be pain free with which resisted motion?
Coxafemoral traumatic arthritis presents in what way?
limited motion and slight pain much like a capsular pattern but occurs after a trauma ie fall
To improve a flexion limitation in the hip what is the best postion for manual therapy tx?
hip flexion, with abd and IR
What conditions will benefit from a high velocity, low amp manipulation of the hip?
intraarticular flake fracture loose body, idiopathic loose body, arthrtic loose body, and/or labral tear
HOw will an individual with intraarticular loose body present?
sharp, shooting pain followed by giving way and a pathological endfeel (ER, add) with no limitation
Best treatment for a SCFE
percutaneous pinning in situ
Hamstring syndrome can present much like hamstring tendinopathy but what is the biggest differentiating factor?
Sciatic nerve entrapment will have neural symptoms - pain with sitting, resisted knee flexion with hip flexed to 90, worsened with ankle DF, resisted hip ext and knee flexion in prone is pain free
Best tx for hamstring syndrome?
neural mobilization, sitting changes, and avoidance of stretching
What tests for pelvic ring instability?
active straight leg raise, which can be repeated once stabilizing the pelvis
What treatments would be inappropriate for a glut med tear?
stretching and cross friction massage, - NSAIDs, heel lift, assistive device, activity modification to include no crossing legs are more appropraite and possible surgery
Aching pain is more associated with what hip issues?
tendinopathy, bursitis, arthritis, and arthrosis
Sharp pain is more associated with what type of hip issues?
Labral tears or articular loose bodies often accompanies by a clicking, giving way, and/or a feeling of joint "catching" or locking
Burning pain is more associated with what type of hip issues?
Nerve entrapments from the femoral head - lat femoral cutaneous, ilioinguinal, genitofemoral, obturator, or sciatic nerves; may be accompanies by parasthesia or numbness
Possible causes for groin pain?
CFJ and labrum injury, symphysis pubis lesion, adductor tendinoapthy, iliopectineal bursitis, incompetent abdominal wall, or any number of urological
Posterior hip or buttock pain causes?
SIJ, gluteal bursitis, hamstring tendinopathy, hamstring syndrome, and/or lumbar pathology
Possible causes for posteriolateral hip pain?
Trochanteric bursitis, gluteal insertion tendinopathy, or disruption
Pain with coughing, sneezing, or straining can suggest what?
hernia, pubic symphyseal affliction, or tendinopathy of the adductor longus, or rectus abdominus
What is the proposed hip capsular pattern?
IR most limited an d painful accompanies by a variable combination of limits in flexion, extension, and abduction
CPR for OA in the hip:
3 of 5 of the following 1) self reported squatting aggravates 2) active hip flexion causing lateral hip pain 3) scour test with add causing lat hip or groin pain 4) active hip ext causing pain 5) passive IR of < or 25 degrees
Micro and macrotrauma synovitis (arthritis) is best treated with what?