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Ortho Tx 700 > Hip > Flashcards

Hip Flashcards

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1
Q

Functions of hip movements

A
  1. Positions lower limb in space
  2. Lowers/raises body from ground
  3. Brings foot closer to trunk.
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2
Q

Coaptation force of hip

A

How much it sucks. (About 25lbs)

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3
Q

Femoral triangle

A

Superior: inguinal ligament
Medial: add long
Laterally: sartorius
Floor: pectineus and iliopsoas

Through which the femoral artery passes

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4
Q

Iliacus

A

O: inner surface of iliac fossa and sacral ala
I: lesser trochanter

Flexion and lateral rotation of the hip, anterior pelvic tilt

Femoral new (L2-3)
Internal iliac artery
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5
Q

Psoas

A

Origin: TVPs L1-5, vertebral bodies of T12-L5, intervertebral discs

I: lesser trochanter

Hip flexion and lateral rotation.
Spinal flexion and lateral rotation
Anterior pelvic tilt

Lumbar plexus ventral rami (L1-3)
Iliolumbar artery

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6
Q

Gluteus Maximus

A

O: posterior iliac crest, sacrum, coccyx, sacrotuberous ligament

I: gluteal tuberosity, ITB

Hip extension and lateral rotation
Upper 1/3: abduction
Lower 1/3: adduction

Inferior gluteal nerve (L5-S2)
Inferior and superior gluteal arteries

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7
Q

Sartorius

A

O: ASIS
I: pes anserine

Knee flexion, medial rotation
Hip flexion, external rotation, abduction

Femoral nerve

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8
Q

Tensor Fascia Latae

A

O: ASIS and anterior iliac crest
I: ITB (1/3 way down thigh)

Hip flexion, abduction, internal rotation

Superior Gluteal Nerve (L4-S1)
Superior Gluteal and Deep Femoral Arteries

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9
Q

According to Muscolino, what is the most important function of the TFL?

A

Isometric stabilization of the pelvis while walking – preventing depression of limb on CL swing side by maintaining pelvic depression of IL stance side.

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10
Q

Sartorius

A

O: ASIS
I: Pes Anserine

Hip flexion, abduction, external rotation.
Knee flexion
Anterior Pelvic tilt

Femoral nerve (L2-3)
Femoral artery
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11
Q

Piriformis

A

O: anterior sacrum and anterior sacrotuberous ligament
I: greater trochanter (superomedial)

Hip lateral rotation, extension
(past a certain degree of flexion – 60º? – may act as internal rotator)

Nerve to piriformis (L5-S2)
Superior and Inferior Gluteal arteries

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12
Q

Palpate piriformis

A

Prone
Palpate 1/2 way between PSIS and apex of sacrum
Flex knee. Externally rotate leg (foot coming medially) against resistance.
Palpate towards greater trochanter

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13
Q

Palpate PSIS

A

Most posterior aspect of iliac crest. Approx 2 inches from midline of sacrum.
Just lateral to dimples
Glute max attachment – hip extend or IR/ER to feel

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14
Q

Adductor Magnus

A

Anterior Head: Inferior pubic ramus and ramus of ischium to gluteal tuberosity and medial supracondylar line

Posterior Head: Ischial tuberosity to adductor tuberosity

Hip adduction, extension
Posterior pelvic tilt

Obturator (anterior) and sciatic (posterior) nerves (L2-4)
Femoral, deep femoral, and obturator arteries

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15
Q

Adductor Longus

A

O: Pubis (anterior body)
I: Linea aspera (mid 1/3)

Hip adduction and flexion. Anterior pelvic tilt.

Obturator nerve (L2-4)
Femoral, deep femoral, and obturator arteries
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16
Q

Gracilis

A

O: Pubis (anterior body and inferior ramus)
I: Pes Anserine

Hip adduction, flexion
Knee flexion
Anterior pelvic tilt

Obturator nerve (L2-3)
Deep femoral and obturator artery
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17
Q

Semitendinosis

A

O: ischial tuberosity
I: pes anserine

Knee flexion
Hip extension
Posterior pelvic tilt

Sciatic nerve (L5-S2)
Inferior gluteal, deep femoral and obturator arteries
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18
Q

What movements are common to all the muscles that attach to the pes anserine?

A

Knee flexion and medial rotation

Help stabilize knee against valgus forces (medial buckling)

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19
Q

Semimembranosus

A

O: ischial tuberosity
I: posterior surface of medial condyle of the tibia

Knee flexion
Hip extension

Sciatic nerve (L5-S2)
Inferior gluteal, deep femoral and obturator arteries. Plus popliteal
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20
Q

Biceps femoris

A

Long Head: ischial tuberosity and sacrotuberous ligament
Short Head: linea aspera and lateral supracondylar line of the femur

I: head of fibula, lateral tibial condyle

Knee flexion
Hip extension
Posterior pelvic tilt

Sciatic nerve (L5-S2)
Inferior gluteal, obturator, deep femoral and popliteal arteries.
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21
Q

Gluteus medius

A

External ilium (in between anterior and posterior gluteal lines) to Greater Trochanter (lateral)

Whole muscle: hip abduction
Posterior fibres: hip extension, lateral rotation. Posterior pelvic tilt
Anterior fibres: hip flexion, medial rotation. Anterior pelvic tilt

IL hip depression
CL hip rotation

Superior gluteal nerve (L4-S1)
Superior gluteal artery

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22
Q

Gluteus minimus

A

External ilium (between anterior and inferior gluteal lines) to Greater Trochanter (anterior)

Whole muscle: hip abduction
Posterior fibres: hip extension, lateral rotation. Posterior pelvic tilt
Anterior fibres: hip flexion, medial rotation. Anterior pelvic tilt

IL hip depression
CL hip rotation

Superior gluteal nerve (L4-S1)
Superior gluteal artery

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23
Q

Iliopectineal bursa

A

Anterior hip joint and pubis, deep to iliopsoas.
Large

Can communicate with hip joint anteriorly through a space between pubofemoral and iliofemoral ligaments

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24
Q

Pain in groin
Radiates down medial thigh
Insidious onset
Pain with resisted flexion and passive extension

A

Iliopectineal bursitis

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25
Trochanteric Bursa
Between greater trochanter and gluteals(reduces friction between the two) Superficial to joint capsule Most extensive posterolaterally Most commonly inflamed
26
Pain over lateral hip Possible referral to lateral knee and thigh Possible snapping Pain going up stairs, sitting cross legged, sleeping on affected side.
Trochanteric bursitis
27
Ishiogluteal Bursa
Between ischial tuberosity and gluteus maximus; adds cushioning Often affected in people in wheelchairs who have constant pressure and atrophied glutes
28
Anteversion (according to H&K)
"... a positional change in which wither the acetabulum or the head and neck of the femur are directly anterior relative to the frontal plane"
29
Normal angle of anteversion
8-15º
30
Anteverted Hip: Presentation
Excess medial rotation and decreased external rotation | Toe-in gait
31
Pain and tenderness over or just about ischial tuberosity Possible referral down hamstrings Pain with sitting, walking, climbing stairs, hip and trunk flexion
Ischiogluteal bursitis
32
Retroverted Hip: Presentation
Excess external rotation and decreased internal rotation | Toe-out gait
33
Angle of Inclination
Angle of the femoral neck vs angle of femoral shaft Frontal plane Normally 125º in adults (150º in children)
34
Coxa Valgum
Increased angle of inclination (150º) | Leads to genu varus
35
Coxa Varum
Decreased angle of inclination (110º) | Leads to genu valgus
36
Angle of Torsion/Declination (according to H&K)
The angle of the axis of the head and neck of the femur vis a vis the transcondylar axis Normally 15º
37
Antetorsion
Osseus anomaly Increased angle of torsion/declination (30º) caused by medial twist in the femur (distal on proximal) Presents with toe in (non compensatory) or compensatory toe out gait Medially displaced ("winking") patella
38
Retrotorsion
Osseus anomaly | Decreased angle of torsion/declination (5º) caused by a lateral twist in the femur (distal on proximal)
39
The intrinsic stability of the hip is provided by:
1. the acetabulum and labrum 2. coaptation force 3. ligaments
40
The Hip: Coaptation Force
The vacuum force created because of the large surface area of contact between the acetabulum and the femur. Approximately 25 kg of atmospheric pressure
41
Hip: Ligaments
``` Iliofemoral Ischiofemoral Pubofemoral Ligamentum Teres Transverse ```
42
Iliofemoral ligament
AKA Y ligament, ligament of Bigelow Lower AIIS and post-sup rim of acetabulum --> intertrochanteric line of the femur Twists around anterior joint. Strongest ligament in the body Checks EXT and IR
43
Ischiofemoral ligament
Post-inf rim of acetabulum --> post-sup neck of the femur Checks EXT and IR
44
Pubofemoral ligament
Pubis --> just anterior to lesser trochanter | Checks EXT, IR and mayber ABD
45
What three ligaments check EXT and IR in the AF joint?
Iliofemoral Ischiofemoral Pubofemoral
46
Ligamentum Teres (hip)
AKA Capitus femoris/ligement of the head of the femur Lies in the nonarticular surface of the acetabulum --> head of the femur Mechanically checks ADD, but most importantly supplies synovial fluid and vascularization to the head of the femur
47
Transverse ligament (hip)
Crosses acetabular notch to form a foramen for the acetabular artery (which then becomes the artery of the ligament of the head of the femur)
48
The head of the femur points
Anterior Medial Superior
49
The acetabulum points
Anterior Lateral Inferior
50
AF joint: Capsular Pattern
Flex-Abd-IR > | Ext - Add - ER
51
Hip: Resting position
30º flexion 30º abduction Slight ER
52
Hip: Closed Pack Position
Extension Abduction IR
53
When standing on one leg, the stance leg ...
... must support 3x the body weight
54
Increased angled of anteversion can lead to
DJD (less alignment between axes --> less effective contact between joint surfaces
55
ADL to help with Trendelenburg's Gait/lurch
Cane on unaffected side | Carry shopping on affected side
56
Nelatons Line
Between Ischeal tuberosity and ASIS Normal: superior greater trochanter should be just on line. If well above --> coxa varum
57
L4 reflex
Knee jerk (also L2,3)
58
L5 reflex
medial hamstring
59
S1 reflex
ankle jerk/Achilles (also S2)
60
L1 Dermatome
Groin, hip
61
L2 Dermatome
Anterior thigh
62
L3 Dermatome
Medial thigh, knee
63
L4 Dermatome
Medial calf
64
L5 Dermatome
Lateral calf, dorsum of foot (D1-3)
65
S1 Dermatome
Heel, plantar surface of foot, lateral dorsum
66
S2 Dermatome
Medial posterior leg
67
Femoral Triangle
Superior: inguinal ligament Medial: adductus longus Lateral: sartorius Floor: pectineus and iliopsoas
68
Route of Sciatic Nerve
L4-S3 --> midline of glute --> in between ish tub and greater trochanter --> bifurcates just before popliteal fossa
69
Route of femoral nerve
L2-4 --> under inguinal ligament --> bifurcates just distal to inguinal ligament
70
Acetabulofemoral Joint
Synovial, ball & socket Head of the femur (convex) on acetabulum Strong capsular strength 3 degrees of freedom (flex/ext; abd/adduction/rotation)
71
Direction of strongest hip strength
Anterosuperior
72
Acetabular Labrum
Fibrocartilage that extends from the rim of the acetabulum, allowing it to enclose more than half of the femoral head. Increases congruency of joint by deepening acetabulum
73
Intrinsic stability of the hip is provided by:
1. acetabulum and labrum 2. coaptation force 3. strong ligaments
74
When standing on one leg, the stance leg must support how much more weight?
x 3
75
What positions align the axes of the femoral neck and acetabulum?
1. 90º hip flexion, slight ER, abduction | 2. extension, abduction and internal rotation (closed pack)
76
Pain in inguinal area, anterior hip/thigh
acetabular femoral origin
77
Pain in posterior hip, post-lat thigh
spinal, SI jt issues
78
Bicep Femoris Strain: pain, movement
Pain posterior thigh, usually proximal or middle third | Pain with AROM hip flexion, RROM knee flexion
79
Bicep Femoris Strain: special tests
SLR | MMT biceps femoris vs semimem/tem
80
Bicep Femoris Strain: ReMex
Eccentric training of hamstrings Increase iliopsoas flexibility Activate glutes
81
Rectus femoris strain: pain, movment
origin, insertion, mid-muscle | Pain with AROM hip extension, RROM knee extension/flexion
82
Rectus femoris strain: special test:
Ely's Thomas MMT vs VMO, vast lat
83
Adductor Longus strain: pain, movement
Musculotendinous junction, 5 cm from pubis | Pain with AROM abduction, RROM adduction
84
Adductor Longus strain: special test:
Adductor length test | MMT adductor group
85
ITB Sprain: MOI
Excessive adduction | Dancers, athletes, fall on hip
86
ITB Sprain: pain, movement
Localized pain in trochanteric area (just behind or above) | Pain witih CL side flexion of the trunk
87
ITB Sprain: Special Tests
Ober's Thomas Standing ITB stretch
88
DDx: ITB sprain vs trochanteric bursitis
ITB sprain: pain post-sup to trochanter | Bursitis: pain local to trochanter
89
ITB fasciitis
Inflammation of the fascial band from overuse of TFL Pain may be limited to area covered by the fascia along the lateral surface of the thigh, or may extend upward over the hip.
90
Upper Rectus Femoris Tendonitis: pain, movement
Just below AIIS (or sometimes proximal muscle belly) Pain on RROM knee extension, PROM knee flexion May also be unable to flex knee more than 120º
91
Upper Rectus Femoris Tendonitis: special tests
Ely's Thomas Tendonitis Differentiation Test (test as hip flexor, not knee extensor)
92
Psoas Tendonitis: MOI
RSI triggered by overactive contraction. Hip flexion then taken into forceful extension
93
Psoas Tendonitis: Pain and movement
Pain in anterior hip/thight (lesser trochanter) -- dull, achy, with possible snapping at and/med hip Pain with RROM hip flexion, PROM hip extension, flexion, and adduction (for the latter two -- tendon may be compressed against acetabular rim)
94
Tronchanteric Bursitis: Special test
Ober's (intense local pain over trochanter)
95
Femoral head fracture
Usually result of high energy trauma, and often occurs with dislocation
96
Which arteries are compromised in the avascular necrosis of the femoral head?
``` Circumflex arteries (especially with femoral neck fracture, or with conditions that increase intracapsular pressure -- OA, RA -- that cause ischemia) ```
97
Primary OA (hip)
idiopathic (age) noninflammatory
98
Secondary OA (hip)
altered biomechanics/alignment trauma immobilization inflammatory
99
Hip OA: Sx
Stiffness with long periods of rest Reduced IR, extension, which progresses to capsular pattern (Flex/Abd/IR > Ext/Add/ER) Achy pain over inguinal region
100
Hip OA: Special tests
``` ** Scouring CI's if already Dx ** Fabers Stinchfield Trendelenberg Thomas ```
101
After hip replacement, what is totally CI'd:
Adduction past neutral and flexion past 90º for at least 3 months (no sidelying!)
102
In which position is the hip most likely to dislocate?
When ligaments are most lax (flexion) and joint out of congruency (abduction, IR).
103
Capsular Sprain: MOI
Insidious, or doing the twist Hip hypermobility, altered mechanic Most commonly affects athletes and dancers
104
Capsular Sprain: Sx
Pain in anterior hip, groin, maybe buttocks Painful ambulating Capsular pattern of restriction
105
Capsular Sprain: Movement
Weak lateral rotators | Pain with flexion, medial rotation
106
Capsular Sprain: Special Test
Fabers Scouring Stinchfield
107
Piriformis Syndrome
Compression of the sciatic nerve by the piriformis muscle
108
Piriformis Syndrome: Sx
Unilateral Pain in lumbosacral area, posterior thigh, referring to calf and sole of foot Possible loss of proprioception, foot drop, ataxic gain
109
Piriformis Syndrom: Special tests
``` Piriformis Test (provokes neurological pain) SLR Freiberg Sign (pain with adduction, internal rotation) ```
110
Via the ITB what is glute Max's action on the knee?
Extension.
111
Via the ITB what is glute Max's action on the knee?
Extension.

Ortho Tx 700 (12 decks)

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