Hip Joint Flashcards
(45 cards)
Parts of the hip joint
Articular cartilage head of the femur ligamentum teres obturator artery transverse acetabular ligament acetabular labrum (fibrocartilagenous)
Hip joint
strong and stable joint
comprised of th articulation between the acetabulum of the innominate bone and the head of the femur
The orientation of the acetabulum and head of the femur
anteverted and the angle is about 15 degrees
-allows for great deal of stability posteriorly
Intertrochanteric region
occurs along the base of the neck of the femur
Blood supply to the head of the femur
Medial circumflex femoris artery actually comes off the profunda femoris in a posterior direction rather than a medial one
Lateral circumflex femoris a. comes around anteriorly not laterally
they both come off profunda and deep femoral a.
also, minor branches from the artery of ligamentum trees
obturator artery
Anastomotic network
the lateral circumflex artery gives off a descending branch along the shaft of the femur and an ascending branch which anastomoses with the medial circumflex. this anastomotic network forms the reticular arteries which are really the main concern in fx of the femoral head and neck
Normal neck-shaft hip angulation
115-135
greater than 135 neck-shaft hip angulation
coxa valga
less than 115 neck-shaft hip angulation
coxa varus
angle of femoral head in kids
higher than 15 = explains why they are pigeo-footed or have a in-toeing gait
the angle will reduce to a value closer to 15 as kids mature
otherwise it is a developmental pathology
angle of acetabulum
anteverted to 15
medial wall of the acetabulum is very thin
does not provide much support but the posterior and anterior columns are very thick
what is the inverted Y of acetabulum
the oblique angle is 45
tilted downward
thinness of the medial wall of the acetabulum
PE of the hip
pain ROM palpation mandatory neurovascular exam leg length discrepancies Trendenlenberg sign Thomas test Faber test
What are the normal HIP ROM
always compare normal vs non normal Extension : 20-30 Flexion: 135 Abduction: 45-50 Adduction: 20-30 Internal rotation: 30-40 External rotation: 30-40
Trendelenberg test
maneuver for assessing hip abductor function
the contralateral iliac crest should rise indicating that the planted side’s gluteus medius is contracting and holding the innominate up
A POSITIVE TEST = contralateral iliac crest dropping down
even if the iliac crests stay medial, the gluteus medius function is abnormal
because the hip is not rising
abductor weakness or hip dysplasia (hip is dying!!)
Galeazzi test
anatomic short leg or functional short leg
useful for kids
assessing the femur by putting the knees in flexion which takes the tibia out of the equation, this person has a shorter femur
Etiology of short leg
hip degeneration
-not actually caused by hip degeneration
degeneration -> pertusio -> short leg
Pertusio
femoral head breaches the ishioilial line (vertical white line seen in XR)
caused by joint degeneration as in the case of osteoarthritis
Thomas test
test hip flexion contracture
Flex the hip and knee and if the opposite thigh elevates off the table then there is a flexion contracture = this is evaluating the extended hip and you must take into account pelvic tilt/lumber lordosis
Maximum flexion is the point at which the elvis begins to rotate - then allow the hip to extend - if the patient has a hip flexion contracture, the pelvis will start to rock before the leg reaches the examination table when extending the leg
Faber test
detects sacroiliac pathology
nonspecific
stress manuever
positive test = increased pain
Flexion
Abduction
Extension
Rotation
What is DTR?
deep tendon reflex
What other physical findings are important for PE of hip?
dermatomes
motor testing
pulses
Etiology of hip pain
extra-articular intra-articular regional extra regional soft tissue defects osseous defects
Ddx of the hip
Trauma - hip fx (IT/neck) ; hip dislocation
Extra-articular - trochanteric bursitis, iliotibial band tendonitis, sacroilitis (+FABER), tumor, inguinal hernia, lumber disc herniation
Intra-articular - labral tears, loose bodies-fragments, synovitis (PVNS), septic arthritis (esp. with replacements), synovial chondromatosis, osteoarthritis, osteoarthritis, osteonecrosis
