Will Blakeney- The Hip Flashcards
(37 cards)
What ligaments make up the hip?
Iliofemoral
Pubofemoral
Ischiofemoral
What muscles are the abductors of the hip?
Superior gluteal nerve:
- Gluteus medius
- Gluteus minimus
Inferior gluteal nerve:
- Gluteus maximus
What are the adductors of the hip?
Mostly obturator nerve
Adductor longus
Adductor magnus: dual innervation because adductor but also posterior so sciatic nerve too
Pectineus: also femoral nerve
Adductor brevis
What muscles are the hip flexors?
Rectus femoris= femoral nerve
Iliopsoas = femoral nerve + lumber L23
What are the extensors of the hip?
Hamstrings = sciatic
Gluteus maximus = inferior gluteal
What are the short external rotators?
Piriformis
Superior gemellus
Inferior gemellus
Obturator internus
Quadratus femoris
What is the blood supply to the femoral head?
medial and lateral femoral artery = extra-capsular arterial ring and the branch going up to the head are the retinacular arteries
The obturator artery provides a branch called foveal artery which goes into the head. This stops being patent by adulthood –> ligamentum teres
What history do you take from the patient?
Age, weight, family Hx
Onset and progression of symptoms
Pain
Stiffness, crepitus, locking
Walking distance, support
Effect on ADLs and job
What are the pain patterns for different hip pain sites?
Anterior:
- Enthesitis of the ASIS
- True hip pain is more around the groin/inguinal ligament, iliopsoasbursitis is also here
- Meralgia paresthetica is lower down the thigh
Posterior:
- Sacro-iliac pain is superior-lateral to the bum crack x
- Buttock pain is referred pain from the lumbosacral plexus
- Bottom of buttock is ischiogluteal bursitis
- Sciatica is going down the lef
- Trochanteric bursitis is basically right where you can feel the greater trochanter
What things should you look for on Ex
Muscle atrophy
Limb asymmetry
Scars
Swelling
Spinal alignment: lumbar lordosis/scoliosis
True and functional leg length discrepancy
Gait
What is antalgic gait
Patient spends less time on the painful limb so that stance phase is reduced when the painful side is in contact with the floor
What is stiff leg gait
When the hip flex/extension is lost or markedly restriction, the patient will circumduct and swing their leg. Achieved by the recruitment of more spinal movement
What is short leg gait
When the patient is weight-bearing on the shorter leg, he or she hips down
What is the trendelenburg gait
With each step forward the patient takes with the affected limb they lurch towards the unaffected limb
‘rolling over’ on their hip as they walk
What is the Trendelenburg test
Finger on each ASIS
pt on one leg
Normal: pelvis on unsupported leg is pulled up (finger goes up)
Positive trendelenburg: pelvis drops on unsupported side (finger falls), they throw their body onto the other side
What are some causes of a positive trendelenburg sign
Normally abductor problems!!
- Problem with the motor
- Abductor muscle weakness
- Superior gluteal nerve palsy - Problem with the lever arm
- Shortening of the femoral neck
- Abductor tendon rupture - Problem with the fulcrum
- Pain from the intra-articular pathology
What is the thomas test
Rule out hip flexion contracture
- Patient supine
- Examiner puts hand under spine to identify lumbar lordosis
- Examiner gets the patient to maximally flex the unaffected hip- obliterate the lumbar lordosis, pelvis should be neutral position
- Examiner then puts the other leg in extension. If deformity you can’t put it in full extension without the pelvis pointing
What is FADDIR
Flexion/Adduction/internal Rotation
- Hip at 90 degrees of flexion, adduction and IR
Positive test: anterior or anteromedial pain
Good for labrum pathology! Indicative of impingement of anterior and anterolateral part of femoral neck against superior and anterior acetabular rim
What is the DDx of hip pain
- Intra-articular hip pathology
- Osteoarthritis of the hip e.g. - Extra-articular hip pathology
e.g. abductor tendonitis - Pathology remote to hip joint
e.g. lumbar spine facet joint osteoarthritis
Other way to think about hip pain DDx
IN MSK
- Trochanteric bursitis (Gmed/min tendon problems)
- GlutMed tendinitis
- Stress #
- Osteitis pubis
- Iliopsoas tendinitis or bursitity
- Iliopsoas abscess
- Adductor longus strain or tendinitis
- Referred from spine
- Metastatic disease
OUTSIDE MSK:
- Inguinal hernia
- Inguinal lymphadenopathy
- GIT
- Genitourinary
- Gynaeo
What are neural causes of hip pain?
Consider which nerve/nerve root is affected
What are some causes of anterior hip pain?
Intra-articular
- OA
- Inflamm arthritis
- Fracture
- Tumour
- Avascular necrosis of fem head
- Acetabular labral tear
- Articular cartilage injuries
- Ligamentum teres injuries
Extra-articular:
- Hip flexor strain
- Iliopsoas bursitis
- Snapping him syndromes
- Avulsions/apophysitis
What are some causes of lateral hip pain
- greater trochanteric bursitits
- Glut med tendinopathy/dysfunction
- IT band syndrome
- meralgia paresthetica
What are some cuases of posterior hip pain
- Referred from lumbar spine
- Piriformis syndrome
- Sacro-iliac joint dysfunction
- High hamstring strain or ischial tuberosity avulsion (lots of bruising)
