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Lower Extremity Evaluation Lecture > Hip/Pelvis > Flashcards

Hip/Pelvis Flashcards

(70 cards)

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1
Q

Femur

A

Proximal portion of the femoral shaft forms the greater and lesser trochanter

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2
Q

Innominate (fused) bones of the Pelvis

A
  • Ilium
  • Ischium
  • Pubis
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3
Q

Articulations: Pubis Symphysis

A
  • Articulation between the pubic bones
  • Pubic bones are separated by a
    fibrocartilage disk
  • Minimal distraction, compression, and
    rotation occurs at this joint
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4
Q

Articulations: Sacroiliac Joint

A
  • Articulation between the Sacrum and
    Ilium
  • Very stable
    ~ Support from multiple strong/thick
    anterior and posterior ligaments
    ~ In order for sprains to occur, the MOI
    needs to be extreme: car accident, fall
    from tall height, etc.
  • The Ilium rotates anterior & posterior on
    the Sacrum during movements of lower
    extremity and spine
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5
Q

Articulations: Acetabulofemoral Joint

A
  • Articulation between Acetabulum
    (socket) of Ilium and head of Femur
  • Very stable
    ~ Large muscles
    > Stabilize joint
    ~ Deep socket
    > Features labrum that deepens the
    socket
    ~ Strong ligaments
    > Prevent specific movements
  • Ball and socket joint like the shoulder,
    but not as much movement
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6
Q

Strong ligaments that support the Acetabulofemoral Joint & their purpose

A
  • Iliofemoral (anterior)
    ~ Prevents excess Extension and
    External Rotation
  • Pubofemoral (anterior)
    ~ Prevents excess Abduction &
    Extension
  • Ischiofemoral (posterior)
    ~ Prevents excess Internal Rotation &
    Adduction
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7
Q

Hip Joint movements during functional Loading

A
  • Sagittal: Flexion
  • Frontal: Adduction
  • Transverse: Internal Rotation
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8
Q

Hip Joint movements during functional Unloading

A
  • Sagittal: Extension
  • Frontal: Abduction
  • Transverse: External Rotation
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9
Q

What bone is relative to what bones during functional loading/unloading?

A

Femur relative to Innominate bones

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10
Q

Pectineus

A
  • Origin: Superior Ramus of Pubis
  • Insertion: Distal to Lesser Trochanter
  • Nerve: Femoral
  • Action: Adduction & Flexion of Hip
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11
Q

Adductor Brevis

A
  • Origin: Inferior Ramus of Pubis
  • Insertion: Superior 1/3 of Linea Aspera
  • Nerve: Obturator
  • Action: Adduction & Flexion of Hip
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12
Q

Adductor Longus

A
  • Origin: Pubic Tubercle
  • Insertion: Middle 1/3 of Linea Aspera
  • Nerve: Obturator
  • Action: Adduction, Flexion, & Extension of
    Hip
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13
Q

Adductor Magnus

A
  • Origin: Inferior Ramus of Pubis, Ischial
    Ramus, and Ischial Tuberosity
  • Insertion: Linea Aspera & Adductor
    Tubercle
  • Nerve: Obturator & Tibial
  • Action: Adduction, Flexion, & Extension of
    Hip
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14
Q

Adductor’s Function during functional Loading

A
  • Includes Gracilis, Pectineus, Adductor
    Magnus, Longus, & Brevis
  • They decelerate Flexion & Internal
    Rotation
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15
Q

Piriformis

A
  • Origin: Lateral Sacrum
  • Insertion: Greater Trochanter
  • Nerve: S1 & S2
  • Action: External Rotation of Hip
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16
Q

Obturator Internus

A
  • Origin: Internal surface of Obturator Membrane & Foramen
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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17
Q

Gemellus Inferior

A
  • Origin: Ischial Tuberosity
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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18
Q

Gamellus Superior

A
  • Origin: Ischial Spine
  • Insertion: Greater Trochanter
  • Nerve: L5 & S1
  • Action: External Rotation of Hip
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19
Q

Obturator Externus

A
  • Origin: External surface of Obturator
    Membrane & Foramen
  • Insertion: Greater Trochanter
  • Nerve: L3 & L4
  • Action: External Rotation of Hip
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20
Q

External Rotator’s Function during functional loading

A
  • Includes Piriformis, Gemellus Superior &
    Inferior, Obturator Externus & Internus
    ~ All these muscles stabilize the
    Acetabulofemoral Joint
  • They decelerate Internal Rotation
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21
Q

Gluteus Minimus

A
  • Origin: Ilium between Inferior & Anterior
    Gluteal Lines
  • Insertion: Greater Trochanter
  • Nerve: Superior Gluteal
  • Action: Hip Abduction & Internal Rotation
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22
Q

Gluteus Medius

A
  • Origin: Lateral surface of Ilium
  • Insertion: Greater Trochanter
  • Nerve: Superior Gluteal
  • Action: Hip Abduction, External & Internal
    Rotation
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23
Q

Tensor Fascia Lata (TFL)

A
  • Origin: Anterior Superior Iliac Spine & Anterior Iliac Crest
  • Insertion: IT Band
  • Nerve: Superior Gluteal
  • Action: Hip Abduction
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24
Q

Hip Abductor’s Function during functional loading at the Hip and Knee

A
  • Includes Gluteus Medius, Minimus, &
    Tensor Fascia Lata
  • They decelerate Adduction and Internal
    Rotation at the Hip
  • They decelerate Internal Rotation at the
    Knee (work with Bicep Femoris)
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25
Gluteus Maximus
- Origin: Posterior Lateral Surface of Ilium & Sacrum - Insertion: IT Band & Gluteal Tuberosity of Femur - Nerve: Inferior Gluteal - Action: Extension, External Rotation, & Abduction of Hip
26
Gluteus Maximus Function during functional loading at the Hip and Knee
- Decelerates movement in all 3 planes: Flexion, Adduction, & Internal Rotation at the Hip - Decelerates Internal Rotation at the Knee
27
Psoas Major
- Origin: Bodies and Transverse Processes of Lumbar Vertebrae - Insertion: Lesser Trochanter - Nerve: L 2-4 - Action: Flexion & Adduction of Hip
28
Iliacus
- Origin: Iliac Fossa - Insertion: Lesser Trochanter - Nerve: Femoral - Action: Flexion & Adduction of Hip
29
Hip Flexor’s Function during functional loading
- Includes Psoas Major & Iliacus (Iliopsoas) - They decelerate Internal Rotation at the Hip
30
Hamstring’s Function during functional loading
- Includes Semimembranosus, Semitendinosus, & Biceps Femoris - They decelerate Flexion at the Hip
31
A tight IT Band indicates what?
A tight Tensor Fascia Lata - Loosen the muscle, and the IT Band will loosen
32
A weak Gluteus Maximus pre-disposes you to…?
ACL injury
33
A tight Psoas Major causes…?
The spine to excessively extend
34
During Anterior Inspection, what should be noticed?
- Knee Alignment: Genu Varum & Valium ~ Important to understand Kinetic Chain - ASIS ~ Malalignment - Iliac Crest - Lower Extremity Positioning
35
During Posterior Inspection, what should be noticed?
- PSIS ~ Malalignment - Buttock Musculature - Spinal Alignment
36
During Lateral Inspection, what should be noticed?
- Iliac Crest - Spinal Curves - Knee Alignment ~ Genu Recurvatum
37
Leg Length Discrepancy: Functional or Apparent
- Leg appears shorter or longer due to rotation of the Ilium on the Sacrum ~ SI Joint is axis of rotation ~ Can be fixed by rotating the opposite direction - Anterior Rotation (Genu Varus) ~ Acetabulum goes down ~ Appears Longer - Posterior Rotation (Genu Valgum) ~ Acetabulum goes up ~ Appears Shorter
38
Leg Length Discrepancy: Structural
- Femur or Tibia are physically shorter - Can be helped with a heel or foot lift
39
Leg Length Discrepancy: Compensatory
- Change in joint angle causes leg to appear shorter - Can’t be fixed or helped unless you get surgery
40
Can someone get away with a small leg length discrepancy?
No! The smallest amount of leg length discrepancy can cause issues.
41
Leg Length Discrepancy Tests
- Measuring True (Structural) Leg Length ~ Problematic because of inconsistent measuring sites each time ~ Measuring tape from ASIS to Medial Malleolus ~ Measured Block Method > Note ASIS starting point > Place block under shorter leg until ASIS are of equal height - Weber-Barstow Maneuver ~ Pt. is supine ~ Clinician places thumbs on both medial malleoli ~ Pt. flexes knees with feet flat on table ~ Pt. performs a glute bridge ~ Clinician passively extends pts. legs with feet together ~ Clinician compares height of medial malleoli based on thumb position
42
Palpation
- Palpation can be done along with observation in order to “eye ball” any leg length discrepancies
43
Normal Ranges for Active ROM
- Flexion: 120-130 degrees - Extension: 10-20 degrees - Abduction: 45 degrees - Adduction: 30 degrees - Internal Rotation: 45 degrees - External Rotation: 50 degrees
44
Why is a Neurological Exam important when a pt. complains of hip pain?
Injuries to the low back or Sacrum commonly refer symptoms to the hip/pelvis area, therefore it’s important to undergo a Lower Quarter Screen when paresthesia is present.
45
Why is it important to figure out if muscles are tight or weak?
- Tight or weak muscles in the hip/pelvis area can cause a number of biomechanical problems, pain, or discomfort - Once this is determined, they can be fixed and the issues resolve
46
Gluteus Medius Weakness Test
- Trendelenburg’s ~ Positive test indicated by a lateral hip shift to the stance leg side (stance leg will adduct) ~ Possible to see Trendelenburg’s gait with pts. with weak Gluteus Medius
47
Iliotibial Band Tightness Test
- Ober’s ~ Positive test indicated by inability to adduct the hip > Leg will stay in the air
48
Tight Hip Flexor Tests
- Thomas (Psoas) ~ Positive test indicated by hip Flexion in down leg (leg comes off the table) ~ Causes rotation of the pelvis ~ If the spine is hyperextended, it can cause a false negative because this causes the pelvis to anteriorly rotate - Kendall (Psoas & Rectus Femoris) ~ Positive test for Psoas indicated by hip Flexion on the down leg (leg comes off table) ~ Positive test for Rectus Femoris indicated by extension of the down knee (leg will extend) - Ely’s (Rectus Femoris) ~ Positive test indicated by hip Flexion as knee is flexed (hip will come off table)
49
Hamstring Tightness Test
- 90/90 Straight Leg Raising ~ Positive test indicated by greater than 20 degrees of Flexion when leg is extended in the air
50
Piriformis Syndrome (L4-S3)
- Spasm, hypertrophy, or tightness of the Piriformis places pressure on the Sciatic nerve ~ Causes pain, paresthesia, and weakness in areas innervated by L4-S3 > Can be issues with 1, 2, or all nerve roots - 15% of the population have part or all of the Sciatic nerve running through the Piriformis
51
Piriformis Syndrome Test
- Piriformis Test ~ Positive test indicated by increased pain in area of Piriformis or symptoms radiating down the leg
52
Iliotibial Band Friction Syndrome
- IT Band is tight and rubs on the femoral epicondyle causing LATERAL KNEE PAIN - IT band and bursa between the IT band and femoral condyle can become inflamed - Can be caused by excessive knee Flexion
53
IT Band Friction Syndrome Test
- Nobel’s ~ Positive test indicated by pain at the lateral femoral epicondyle when IT Band is compressed - Ober’s can be used and will be positive
54
Hip Degeneration
- Blanket term used to suggest a number of conditions ~ Arthritis ~ Osteochondritis Dissecans ~ Labrum Tears - Often misdiagnosed as lumbar spine or sacroiliac pathology ~ Pain is referred to these areas ~ Needs imaging
55
Femoroacetabular Impingement (FAI)
- Usually detected after labral tear - Extra bone gets laid down and causes pain - Appears similar to hip degeneration - S&S: ~ Pain in hip, low back, & SI joint - 3 General types ~ Pincer > Extra bone on rim of acetabulum that runs into the femoral neck ~ Cam > Head of femur is abnormally shaped ~ Combined > Most common
56
Hip Degeneration/FAI Tests
- FABER (Degeneration) ~ Positive test indicated by increased pain - Hip Scouring (Degeneration & FAI) ~ Positive test indicated by increased pain - Anterosuperior Impingement: FADDIR (FAI) ~ Positive test indicated by pain or crepitus with Internal Rotation & Adduction - Posteroinferior Impingement (FAI) ~ Positive test indicated by pain or crepitus with External Rotation & Extension
57
Sacroiliac (SI) Joint Sprain
- Excess movement of the Ilium on the Sacrum can stretch or tear the ligaments joining the 2 bones - Severe sprains are rare since the SI joint is very stable
58
SI joint Sprain Tests
- Gapping/Distraction (push out) ~ Positive test indicated by pain at SI joint (posterior) ~ Indicates sprain of anterior SI ligament - Squish/Compression (push in) ~ Positive test indicated by pain at SI joint ~ Indicates sprain of posterior SI ligament - Approximation ~ Positive test indicated by pain at SI joint ~ Indicates sprain of posterior SI ligament - Sacral Apex Pressure ~ Positive test indicated by pain at SI joint ~ Indicates sprain of anterior or posterior SI ligaments - Gaenslen’s ~ Positive test indicated by pain at SI joint ~ Indicates sprain of anterior or posterior SI ligaments
59
Sacroiliac Joint Hypomobility
- SI joint is very stable - Very little motion occurs here, but the motion that does occur is very important - Any alteration in SI joint motion can cause a number of biomechanical issues - Hypomobility goes with malalignment and causes discomfort
60
SI Joint Hypomobility Tests
- Gillet’s ~ Positive test indicated by a lack of PSIS movement ~ Indicates the inability of the Ilium to rotate posteriorly - Standing Flexion & Seated Flexion ~ Positive test indicated by increased motion in a cephalad direction on the side of restriction ~ Spine, sacrum, and pelvis all go forward with Flexion. If one side of the pelvis goes really fast = hypomobility
61
Innominate Rotation/Up Slip
- “Functional” leg length discrepancy - Can be caused by tight muscles, trauma, or malalignment - Usually paired with SI Hypomobility - If anterior rotation: hamstrings will shorten and adapt - If posterior rotation: hip flexors will shorten and adapt
62
Innominate Rotations/Up Slip: Observations/Palpations
- Anterior Rotation ~ Low ASIS & High PSIS - Posterior Rotation ~ High ASIS & Low PSIS - Up Slip ~ High ASIS & High PSIS
63
Pelvic Rotation Tests
- Long Sit ~ Anterior Rotation = Positive test indicated by leg being longer when supine and shorter when sitting ~ Posterior Rotation = Positive test indicated by leg being shorter when supine and longer when sitting
64
How do you know which side has the rotation?
- Side of discomfort - Side with hypomobility
65
Snapping Hip Syndrome
- Chronic inflammation of trochanteric bursa causes the IT Band to snap as it moves over the Greater Trochanter - Limited ROM due to pain since the IT Band naturally moves over the Greater Trochanter during Flexion/Extension and Internal/External Rotation - Ober’s Test would be positive
66
Iliac Crest Contusion (“Hip Pointer”)
- Caused by trauma - Rotation of trunk and daily activities will cause pain - Treatment: protect it
67
Legg-Calve Perthes
- Avascular Necrosis of the femoral head - Common in adolescents - Presents as pain in the hip or referred pain to the abdomen or knee - Leg length discrepancy: shorter on affected side - Muscle tightness
68
Slipped Capital Femoral Epiphysis
- Femoral head slips posteriorly and inferiorly - Commonly seen in boys typically 10-17 years old - Referred pain - Leg length discrepancy: shorter on affected side - Muscle tightness
69
If the Hamstrings are tight, which way does the pelvis tilt?
Posteriorly
70
If the Hip Flexor’s are tight, which way does the pelvis tilt?
Anteriorly

Lower Extremity Evaluation Lecture (8 decks)

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