The Hip Flashcards by Kamryn Ordes

Largest nerve in body

Sciatic nerve

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Common at the greater trochanter, high in women with increased angle, leg length discrepancy or insertion of gluteus medius or IT band

Trochanteric bursitis

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What is the Obers test?

Athlete lays in unaffected side
knee flexed out to 90 degrees
lift top leg into abduction, slight hip extension
allow the affected leg to drop into adduction

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When is the obers test positive?

If the leg doesn’t drop then you have a tight IT band

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What are innominate bones

Sacrum and coccyx

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What is the purpose of the pelvis

Support the spine and trunk
Transfer weight to the lower limbs
Placement for bony attachment

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What makes up the pelvis

Illium, ischium, pubis

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Blow to illiac crest with immediate pain, spasms and transitory paralysis

Hip pointer (contusion)

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Rare during sports, major trauma. Femur is adducted and flexed with deformity and nerve damage

Hip dislocation

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Sudden acceleration/deceleration of the ischial tuberosity (hamstrings) and the AIIS (rectus femoris) with local pain and limited movement

Avulsion fracture

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Repetitive stress on pubis by surrounding muscles with groin pain while running, doing squats or sit-ups

Osteitis pubis

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Connects sacrum to illium

Sacroiliac joint

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The acetabulum is cushioned by the labrum

Joint capsule

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What is the hip joint made of

Femur head and acetabulum

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What is the strongest ligament in the body

Y ligament of Bigelow (prevents hyperextension)

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Prevents excessive adduction

Pubofemoral

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Prevents internal rotation and adduction on posterior aspect

Ischiofemoral

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Bridge that allows blood vessels and nerves enter the head of the femur

Ligamentum teres

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Strong and protected, seldom injured, violent twisting produced by opponent, foot planted with trunk forced in opposite direction and athlete is unable to circumduct the thigh

Hip sprain

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Twists with both feet on ground, stumbles forward, falls backward, steps in a hole with pain over joint, muscle guarding, radiating pain down back

Sacroiliac joint sprain

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What is the FABERS/Patrick’s test

Place foot on the opposite extended knee of the painful SI joint and apply pressure downward on the bent knee

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Positive FABERS/Patrick’s test

Pain felt in hip or SI joint means SI joint dysfunction

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Anterior muscles

Illiacus
Psoas
Sartorius
Rectus femoris

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Posterior muscles

Piriformis
3 gluteal muscles 
Biceps femoris
Semitendinosis
Semimembranosis

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Medial muscles

Gracilis Pectineus Adductor longus, brevis, Magnus

Illiacus

Triangular shaped, flexes

Sartorius

Crosses medially across anterior thigh to do hip flexion and external rotation

Rectus femoris

Hip flexion and knee extension

Tensor fascia latae

Hip abduction

Lateral muscles

Tensor fascia latae

Piriformis

External rotation

Gluteus Maximus

Extension, adduction, helps get up from a sitting position

Gluteus medius/minimus

Abduction

Hamstrings (semimembranosis, semitendinosos, biceps femoris)

Hip extension, knee flexion

Gracilis

Adduction, external rotation

Pectineus

Adduction, external rotation

Adductor longus/brevis/Magnus

Adduction, external rotation

Feel twinge or tearing during an AROM, may feel worse the next day with pain, weakness and bruising

Groin strain

Thomas test

Athlete lies supine with legs together. ATC places hand under athletes lumbar curve. One thigh is brought to the chest, flattening the spine. Return bent leg to extended position, lumbar curve should return

Positive test for Thomas

Extended thigh should be flat on the table, if not tight hip flexor

What grade quad contusion has the following symptoms: Superficial bruise, mild hemorrhage, pain, no swelling, point tenderness and full ROM

Grade 1

Quad contusion MOI

Direct blow to thigh

Athlete lies supine with knees off table. Athlete brings one leg to their chest

Kendall test

Positive Kendall test

If thigh comes off table = tight hip flexor

Which quad contusion has the following symptoms: Deeper, pain, swelling, cannot flex knee more than 90 degrees

Grade 2

What grade quad contusion has the following symptoms: moderate pain and swelling, limping, cannot flex

Grade 3

What grade quad contusion has the following symptoms: disability, may split fasciae, severe pain, limited ROM

Grade 4

Severe blow, or repeated blows (usually on the thigh) that produces ectopic bone production Symptoms: pain, swelling, and decreased function

Myositis ossificans traumatica

Most common injury to thigh, fatigue, faulty posture, leg length discrepancy, tight hamstrings Symptoms: hemorrhage, pain, loss of function

Hamstring strain

This is caused by repetitive movements in gymnasts, dancers, hurdlers, sprinters and cheerleaders S/S: imbalance in muscle, IT band moves over greater trochanter pain

Snapping hip

Athlete stands, foot on the unaffected side is limited. Look at the iliac crest to see if it stays level.

Trendelenburg

Positive test for Trendelenburg

If the unaffected side lowers or if standing on leg and the affected hip moves into abduction = weak abductors

Abutment of the acetabular rim and the proximal femur S/S: anterolateral hip pain with prolonged sitting, leaning forward, getting in or out of a car, and pivoting in sports

Femoroacetabular impingement (hip impingement)

How do you test for a hip impingement

FADIR (flexion, addiction, internal rotation of leg) Positive if anterolateral pain is present

Anterior palpation of the bony sites

ASIS Iliac crest Greater trochanter Pubic tubercle (we don’t do this)

Posterior palpation of the bony sites

``` PSIS Ischial tuberosity (don’t do this either) Sacroiliac joint ```

Which special test is this: Athlete lies supine with legs straight. Measurement is taken between the medial malleolus and ASIS Bilaterally compare

Anatomical discrepancy: actual bone is shortened

Athlete lies supine with legs straight. Measurement is taken from umbilicus to the medial maleoli. Bilaterally compare

Functional discrepancy: due to pelvic tilt or deformity

How should you observe the hips during an assessment?

Should observe while standing in all directions, standing on one leg and walking

What could you find looking at the front view of the hips?

If the hip is tilted laterally it could indicate a leg length discrepancy or muscle contraction on one side

What could you find looking at the side view of the hips?

An abnormal tilt of the pelvis could indicate lordosis or flat back

Genu valgrum

Knocked knees

Genu varum

Bow legged

Genu recurvatum

Hyperextended

Even PSIS indicates ....?

A lateral shift of the pelvis

What are you looking for when the athlete stands on one leg

Pain

What are you looking for when the athlete walks

Distortion

Soft tissue palpation sites (don’t do these)

Groin region Femoral triangle Sciatic nerve Major muscles

Groin palpations could be caused by

Swollen lymph nodes, indicating infection | Adductor muscle strain

When palpating muscle what are you looking for

Pain, swelling, or fiber disruption

What muscles do you palpate?

``` Illiopsoas Sartorius Rectus Femoris at hip joint Gracilis Pectineus Adductors Gluteals Hamstrings ```

Functional testing

``` Squatting Going up and down stairs Crossing legs Running straight Running and decelerating Jumping One legged hop ```

Return to play criteria

Full ROM in all movements Pain free Bilateral strength Stability

What signal will the ref give for blood in wrestling?

Point to nose

List the items to set up for a wrestling match

``` Gloves Nose plugs Lubricant Paper towels Gauze ```

How many innings are played in a high school baseball game

What does top of the inning mean in softball

First half of the inning

Phase 1 of hip rehab

``` Isometric contractions ROM Pool rehab (non weight bearing) - running - kicking ```

Phase 2 of hip rehab

``` Passive stretching Balancing Isotonic contractions -Squatting -Hamstring curls -Pilates -High knees ```

Phase 3 of Hip rehab

``` Static and dynamic stretching Lunges MMTs with band resistance Squatting -on bosu ball Hamstring curls -with weight Pilates High knees ```

The Hip Flashcards

(80 cards)