Hip Flashcards

(101 cards)

1
Q

What type of articulation is the hip?

A

Femoral-acetabular articulation

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2
Q

What is another name for the hip?

A

Coxofemoral joint

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3
Q

Which bones make up the hip joint?

A

Head of the femur and acetabulum of the pelvis

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4
Q

What type of joint is it?

A

A diarthrodial ball and socket joint

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5
Q

What is another name for this type of joint?

A

Enarthrodial

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6
Q

What is a diarthrodial or enarthrodial joint?

A

Multiaxial with three degrees of freedom

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7
Q

What is the hip joint designed for?

A

Maximal stability while providing considerable mobility

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8
Q

Which joint is more mobile shoulder or hip?

A

Shoulder, because the hip has a deeper socket arrangement

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9
Q

What are the primary function of the hip?

A

Weight bearing of the upper body during static and dynamic upright postures
Force transmission pathway for ground reaction forces

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10
Q

From what other pathologies can pain in the hip come from?

A

Lumbo-sacral region

Knee

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11
Q

Where can the hip pathologies refer pain?

A
Groin
Anterior-medial-lateral thigh
Knee
Buttock
(Foot /ankle)
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12
Q

When can hip pathologies be seen?

A

During gait

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13
Q

What is the resting position of the hip?

A

30 degrees Flexion
30 degrees abduction
0 degrees or slight ER

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14
Q

What is the closed packed position of the hip and what phase of gait does it occur?

A

Extension
Internal Rotation
Abduction
During Terminal Stance

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15
Q

What is the capsular pattern of the hip and what angle is it in?

A

When the capsule is tight due to the ligaments
Flexion
Abduction
Medial (internal) rotation

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16
Q

What type of pattern does the acetabular bone have?

A

Concave pattern

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17
Q

What is the acetabulum’s orientation?

A

Lateral
Anterior
Inferior

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18
Q

What type of articular surface the acetabulum have and what is it covered with?

A

Horseshoes-shape articular surface

Covered in hyaline cartilage

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19
Q

What finishes the horseshoes articulation of the acetabulum?

A

Deep acetabular fossa that contains a synovial covered fibroelastic fat pad

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20
Q

What deepens the socket increasing the concavity?

A

Acetabular labrum
A wedge shaped fibro-cartilage
Inferior to transverse acetabular ligament

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21
Q

What pattern does the femoral head make?

A

Distal convex articular pattern

2/3 of a sphere

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22
Q

What is the femoral head fully lined with?

A

Hyaline cartilage except for the fovea capitus

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23
Q

What is the common orientation of the femur?

A

Medial
Anterior
Superior

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24
Q

What is the capsule of the hip?

A

Strong and Dense

Contributes to joint stability

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25
Where does the capsule of the hip attach?
Proximally to entire rim of the acetabulum and distally to the base of the femoral neck
26
What does the capsule of the hip form?
``` Zona Orbicularis (orbital zone) Due to multilayering ```
27
Where is the capsule thick and thin?
Thick-Anteriosuperiorly | Thin-Loosely attached Posterioinferioly
28
What does the capsule of the hip restrict?
Joint distraction
29
What is the capsule of the hip reinforced by?
Strong ligaments
30
What is the capsule considered as?
Extensive synovial lining
31
What do the ligaments of the hip do?
Contribute to stability
32
Where are the ligaments located?
2 anterior | 1 posterior
33
What are the primary ligaments of the hip?
Iliofemoral (y ligament of bigelow) Ischialfemoral Pubofemoral
34
What are the additional ligaments of the hip?
Ligament of the head of the femur (ligamentum teres) | Transverse acetabular ligament
35
When are the ligaments strong?
When pulled fast
36
Where are the iliofemoral ligament attachments?
Proximal-Lower portion of ASIS. Area on ilium proximal to superior and posteriosuperior rim of Acetabulum Distal-Intertrochanteric line Lateral-anterior aspect of greater trochanter Medial-Anterior portion of the lesser trochanter
37
What does the iliofemoral ligament primarily do?
Checks extension and internal rotation
38
Where does the ischiofemoral ligament attach?
Proximal-Area on ischium, posterior and inferior to rim of acetabulum Distal- Posterior superior aspect of the neck of femur near greater trochanter
39
Which way do the ischiofemoral fibers run?
Upward and laterally
40
What does the Ishciofemoral ligament do?
Pulls tight on extension and internal rotation
41
Where does the pubofemoral ligament attach?
Proximal-Pubic bone near acetabulum | Distal-Onto femur anterior to lesser trochanter
42
What does the pubofemoral ligament do?
Tightens primarily on abduction, extension, and internal rotation
43
What does the ligamentum teres contain?
Branch of obturator artery | Provides blood supply to the top of femoral head
44
What is Bursa?
Small fluid filled sacks that act to decrease friction and provide cushion between the structures they sit between
45
What are the four bursas of the hip?
Trochanteric Iliopectineal Iliopsoas Ischiogluteal
46
What is the trochantric bursa?
Most extensive, Posteriorlateral to greater trochanter Decreases friction between ITB, Glut min, and Greater trochanter Tight ITB can lead to trochantric bursitis
47
What is the iliopectineal bursa?
Continuous with joint capsule anteriorly Between iliopsoas and iliopectineal eminence of bone Superior acetabular rim Presents as deep groin pain when injured
48
What is the iliopsoas bursa?
Often overlooked Close to the insertion of the muscle Between ischial tuberosity and hamstring tendon Common in people who sit on hard surfaces
49
What is the ischiogluteal bursa?
Weavers bottom | Axial of ischial tuberosity
50
What are the two pathways for the vascular structures?
Ligamentum teres | neck of femur
51
What can cause loss of circulation?
Fracture, Capsular tension Constriction
52
What are the medial and lateral circulflex arteries?
Derived from femoral and deep femoral arteries | Supply the intra and extracapsular arterial rings ascending the neck of the femur
53
What does the obturator artery provide?
Braching that migrates to the femoral head by way of the ligamentum teres
54
What nerve roots innervate the hip?
L2 to S1 Primary L3 Significant potential referral pattern of pain to and from the hip
55
Where does the femoral nerve innervate
Quadriceps
56
What nerve roots are with femoral nerve?
L2-4
57
What is the path of the femoral nerve?
Descends through psoas major Passes between the iliacus and iliac fascia Runs beneath the inguinal ligament into the thigh
58
What injury could injury femoral nerve?
Fracture of ASIS
59
What does the sciatic nerve innervate?
Hamstrings
60
What are the nerve roots of the sciatic nerve?
L4-S3
61
What is the path of the sciatic nerve?
Exits below piriformis and above gemellus | 70% below piriformis
62
What pathology could occur with sciatic nerve?
Sciatica
63
What does the obturator nerve innervate?
Adductors
64
What nerve roots are with obturator nerve?
L2-4
65
What is the obturator nerve path?
Through psoas major Emerge through brim of pelvis Enters thigh through obturator canal
66
What must be considered with the hip muscles?
2 joint muscles Multiple actions Position of the hip
67
What muscles produce flexion of hip?
psoas major/minor | Iliacus
68
What muscles produce extension of the hip?
Glut max | Hamstring
69
What muscles produce abduction of hip?
glut med.
70
What muscles produce adduction of hip?
adductors | Gracilis
71
What muscles produce medial rotation of hip?
glut min | TFL
72
What muscle produce lateral rotation of hip?
External rotators
73
What is the ratio for quads and hamstrings?
60% rule
74
What occurs with flexion contracture?
Rotate with posterior rotation through SI joint instead
75
What is an adductor gait?
Scissor gait
76
Is there joint play in the hip?
Yes, passively | Not often used
77
How can true distraction or traction occur in the hip joint?
Inferior-lateral direction
78
What glides occur in Flexion, abduction, and Medial/lateral rotation?
Flexion-PI glide Abduction-I glide Lateral-A glide Medial-P glide
79
What is the angle of inclination?
Frontal Plane reference angulation of the femur | Femoral Neck shaft angle
80
What is the angle of torsion?
Transverse plane referenced angulation of femur | Refered as anteversion or retroversion
81
What is the normal angle of inclination of the hip?
120-130 degrees
82
What is an increase in the angle of inclination of the hip?
Coxa Valga | Inside angle gets bigger
83
What are the aspects of coxa valga of the hip?
Increased leg length Increased compression forces Abnormal location of joint contact points Mechanical disadvantage of hip abductors (shorter lever arm)
84
What is a decrease in the angle of inclination of the hip?
Coxa Varum | Inside angle gets smaller
85
What are the aspects of coxa varum of the hip?
Decreased leg length Increased shearing forces Abnormal location of joint contact points Mechanical advantage for hip abductors (longer lever arm)
86
What is an increase in the angle of torsion?
Femoral anteversion
87
How does femoral anteversion present?
Excessive medial roation Decreased lateral rotation Squinting patella-knees point in (pronators)
88
What is a decrease in the angle of torsion?
Femoral retroversion
89
How does femoral retroversion present?
Excessive lateral rotation Decreased medial rotation Frog eyes patella-patellas point out
90
What are the aspects of hip stability in bilateral stance?
LOG falls posterior to hip joint Extension moment torque Posterior pelvic tilt on femoral heads Kept in check by capsuloligamentous structures
91
What accounts for 2/3 of body weight?
head Trunk Arms
92
How much weight is distributed in each hip joint?
1/3 body weight
93
What are the aspects of hip stability in unilateral stance?
Frontal plane disruption of hip 5/6 of body weight on single limb Additional compression forces due to the contraction of hip musculature
94
How much body weight is adjusted in unilateral standing compared to bilateral in quiet standing, stance phase of gait, and stair climbing?
Quiet standing-2.5-3 times Stance phase-3-4 times Stair-7 times
95
What two forms of gait occur with abductor muscle weakness?
``` Gluteus medius gait (compensated)-Trunk lean to reduce weight arm and increased mechanical advantage Pelvic drop (uncompensated) ```
96
What can help reduce the compressive forces?
Decreased weight- one point reduction decreases forces by 2.5-7 pounds Assistive devices ipsilateral-reduce force but cause other problems Assistive devices contralateral-reduce 40% of forces
97
What are the pelvic, hip and lumbar motions?
Anterior tilt-flexion-extension Posterior tilt-extension-flexion Pelvic drop-R adduction-R lateral flexion Hip hike-R abduction-L lateral flexion Forward rotation-Internal rotation-L rotation backward rotation-external rotation-r rotation
98
Not quiz- | What are the other neuromuscular causes of hip pain?
``` Low back pain- S1 pain peripheral nerve entrapment Femoral hernia Stress fractures Fasciatis Knee OA ```
99
Not Quiz- | What ar ethe systemic causes of hip pain?
``` Cancer/bone mets Bone tumors Cardiovascular arterial insufficiency urological or renal disorders Inflammatory disease like reiters, crohn's disease, abdominal or peritoneal inflammation, ankylosing spondylitis ```
100
Not quiz- | What are hints of systemic pain?
``` Aids/TB/Sickle cell anemia/hemophilia Hip/groin pain with gastro symptoms Hip pain worse at night and alleviated with activity enlargement of lymph nodes Men age 18-24 hip groin pain Rebound tenderness ```
101
Not quiz- | What are referred patterns of hip pain?
``` Femoral nerve distribution Obturator nerve distribution Ilioinguinal nerve Genitofemoral nerve Lateral cutaneous nerve ```