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Functional Anatomy > Hip Joint > Flashcards

Hip Joint Flashcards

1
Q

Percentage of innominate bones that make up acetabulum

A

Ilium and Ischium: 75%

Pubis: 25%

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2
Q

Which way is the femur’s convexity?

A

Anterior

  • -> Compression force posteriorly
  • -> Tensile force anteriorly
  • -> Increased weight bearing tolerance
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3
Q

Femoral Head

A

Projects medially and slightly anteriorly

2/3 of a nearly perfect sphere

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4
Q

Femoral Neck

A
  • Common site of fx

- Displaces the shaft of the femur away from the joint –> reduces chance of bony impingement

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5
Q

Intertrochanteric line

A
  1. Anterior

2. Attachment of ligaments

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6
Q

Intertrochanteric crest

A
  1. Posterior

2. Joins neck and shaft of femur

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7
Q

Acetabular labrum

A

Increases stability of hip joint - deepens socket

  • Fibrocartilage
  • Semi-circular
  • Thicker medially, superiorly, posteriorly
  • Helps reduce friction between bony surfaces
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8
Q

Femoral Neck Angle of Inclination

A

Angle between longitudinal axis of femoral neck to that of femoral shaft, in frontal plane

Newborn: 140-150
Adults: 125

Coxa Vara: 105
Coxa valga: 140

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9
Q

Femoral Torsion

A

Relative twist between proximal and distal femur

  • Anteversion is normal
  • Measure using Craig’s test

Abnormal torsion common with CP

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10
Q

Femoral Anteversion

A

Normal, > 6 years old: 12-15
Newborn: 30-40 degrees

Excessive anteversion –> Toeing in gait
- Pt will sit comfortable in “w” (hockey goalie) position

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11
Q

Femoral Retroversion

A

Less common than anteversion

–> toe out gait (in order to improve congruency of joint surfaces)

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12
Q

Congenital Hip Dysplasia

A

Can either be:

  1. Dysplastic
  2. Dislocated

Treatment: Pavlik harness (ABD, ER, Flex)

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13
Q

Legg-Calve Perthes Disease

A

Avascular necrosis of femoral head, resulting in flattened femoral head

  • Boys 4-8 years old
  • Insidious onset of intermittent anterior groin pain, may radiate to thigh and knee
  • Antalgic gait
  • Limited IR
  • -> DJD

*Important to catch early

Treatment: Abduction orthosis

  • Keeps femoral head in acetabulum, increasing blood flow
  • May be worn up to 2 years
  • Take off for short periods during day
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14
Q

Slipped Capital Femoral Epiphysis

A

Displacement of epiphyseal plate

  • Males> Females
  • Sudden onset, not necessarily associated with trauma
  • Antalgic gait, leg ER
  • Limited IR
  • Pain can be felt in knee

Management: Stabilization

Often –> LLD

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15
Q

Acetabular Labrum Tears

A
  • Not necessarily assoc. with trauma
  • Young mean age: 38 years
    Presentation:
  • Constant deep ache in groin with periodic sharp pain (can radiate to knee)
  • Mechanical pain (locking, giving way)
  • Frequently present in conjunction with OA

Greater chance of being missed in younger populations

No great special tests
Gold standard for diagnosis: MRArthrograph

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16
Q

Hip OA or DJD

A
  • Often result of previous trauma or wear and tear
  • Pain, stiffness, loss of ROM, limp, or need for assistive device

Treatment: Pain management, muscle balance exercises (strength), THA
- Often tight flexors and adductors, weak extensors and abductors

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17
Q

Imaging signs of hip OA

A
  1. Decreased joint space
  2. Osteophytes (often around rim of acetabulum)
  3. Sclerosis (whitening of bone)
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18
Q

How long does THA last?

A

15-20 years

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19
Q

Most common THA approach:

A

Posterolateral

Lateral approach: Detach glut med, more limp afterward
Anterior approach: B/w TFL and IT band

20
Q

Femoral Fracture

A
  • 20% die within a year, related to fx
  • 80% over 65 are female
  • Risk doubles each decade after 50 (osteoporosis + fall risk)
21
Q

Femoral neck fracture sign

A

Injured limb is externally rotated with a shorten limb length on that side

22
Q

Hip Joint Capsule

A

Attachments: Intertrochanteric line and lateral 1/3 of posterior neck

  • Very strong and thick
  • Forms a cylindrical sleeve
  • Encloses neck
  • -> Can hold everything together if there is a femoral neck fx without displacement
23
Q

Open/ close pack position of hip

A

Open: Flex, ABD, ER
Closed: Ext, ABD, IR

Most congruent: 90 flex, mid range ABD and ER

24
Q

Hip joint ligaments

A

Iliofemoral
Pubfemoral
Ischiofemoral

All 3 wind around femoral head
Limit extension as a whole
Allow for flexion

25
Q

Iliofemoral ligament

A
  • AIIS to intertrochanteric line
  • Anterior lateral capsule
  • Strongest
  • AKA Y ligament
  • Limits extension and ER
  • Passive role in stance
26
Q

Pubofemoral ligament

A
  • Medial inferior capsule surface
  • From superior ramus of pubic to neck of femur
  • Limits extension and abduction
27
Q

Ischiofemoral ligament

A
  • Posterior capsule
  • Posterior acetabulum to femoral neck
  • Limits extension and IR
28
Q

Ligamentum Teres

A

Small intracapsular ligament (from acetabulum to fovea of femur)

Key component to femoral head integrity

  • Arterial supply and innervation
  • Checks lat and sup subluxation
  • Possesses mechanoreceptors
29
Q

Bursas in hip

A

Ilipectineal, trochanteric (multiple), ischial

30
Q

Blood supply to hip joint

A

Branches of medial and lateral circumflex arteries

Ligamentum teres

31
Q

Nerve supply to hip joint

A

Branches from obturator and gluteal nn.
Nerve to quadratus femoris
Representation L2-S1

32
Q

Normal ROM for hip motions

A 
Flexion: 120
Extension: 20 - more likely to lose than flex
Adduction: 25
Abduction: 45
IR: 35
ER: 45
33
Q

Which types of muscles tend to get tight?

A

Two-Joint muscles

34
Q

Iliopsoas attachments

A

Iliac fossa, Anterior T12-L5 –> Lesser trochanter

Action:

  • Hip flexion
  • Ant pelvic tilt
  • Lumbar extension
35
Q

Adductor group attachments

A

Inferior pubic rami –> Adductor tubercle

Control hip and pelvic motion during WB

36
Q

Gluteus Maximus

A
  • Large, single joint, quadrilateral shaped, thick, superficial
  • Posterior sacrum and ilium –> Posterior femur (distal to greater trochanter)
  • Fibers attach to IT band and thoracolumbar fascia
  • Weak glut max often compensate with hamstring
37
Q

Glut Med

A
  • Ilium to greater trochanter
  • Critical in unilateral stance (control and stabilize pelvis)
  • OKC hip abduction (ext and ER)
  • CKC stabilize neutral pelvis
    “Money muscle” of hip
38
Q

TFL

A
  • External lip of iliac crest –> IT tract –> Lateral tibial condyle
  • Flex, IR, ABD (pelvic stabilizer)

Often recruited when pt has weak glut med

39
Q

Piriformis syndrome

A
  • Compression of sciatic nerve due to shortening and/or hypertonicity of piriformis
  • Radicular pain
  • Frequently associated with decrease in function of pelvic stabilizers
  • Sacral torsion can be present
40
Q

Biomechanics of walking : Sagittal plane

A
  • Hip flex/ext: Often lacking ext, may flex knee early to compensate, or affect trunk position (look at arm swing)
  • Lumbar and knee actions
41
Q

Biomechanics of walking: Frontal plane

A
  • Hip abd/ add
    Greatest deviation noted in single limb support
    Look to see pelvic obliquity change
    Trendelenburg gait
42
Q

Biomechanics of walking: Transverse plane

A
  • IR/ER

Initial contact: ER of femur
Loading phase: progression into IR (eccentric ERors)
Terminal stance: Motion back toward ER

Problem: Fails to move into IR or moves into ER too quickly

43
Q

PROM exam for OA:

A
  • Ext often restricted

- Capsular pattern of limitation has been proposed (IR, flex, ABD, ext) - and refuted.

44
Q

Why do a lateral glide of hip?

A

Tight Adductors

45
Q

Why use direct hip traction vs. pulling at ankle?

A

Knee pathology

Functional Anatomy (14 decks)

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