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hip and thigh 1
Higgins notes on hip and thigh
| Question | Answer |
|---|---|
| Characteristics | ball and socket joint consisting of the convex femur concave acetabulum hip goes through 10 degrees of extension and 30* of flexion during gait cycle |
| Acetabulofemoral joint | most mobile joints of the body (except glenhumeral) -multiaxial arrangements -bony archetecture provides stability=relatively few hip joint sublux and dislocation -enarthrodial -femoral headinserting to acetabulum-reinforced by extremely strong dense |
| acotabulofemoral joint ligaments | iliofemoral, pubofemoral, teres ligament, ischiofemoral ligament |
| iliofemoral ligament | located anteriorly, prevents hyperextension,check IR and ext, from ASIS and superior rim of acetabulum to anterior aspect of acetabulum(lat fork) and ant to the lesser trochanter(med fork) |
| pubofemoral ligament | located anteromedially and inferiorly, limits excessive extension and ABD, runs from the pubis to the femur just anterior to the lesser trochanter |
| Teres ligament | attaches from deep in acetabulum to a depression in the femoral head, slightly limits ADD, rund from fovea of femoral head to the inferior aspect of acetabulum, helps provide vascularization of femoral head, halps lubricate joing |
| Ischiofemoral ligament | located posteriorly, from ischium to trochanteric fossa of femur, limits ext and IR runs from ischium just posterior to the rim of Acetabulum to posterior superior femur |
| Angle of inclinations | angle formed by the neck and shaft of the femur in the frontal plane-125* in adults-150* in children |
| coxa valgum | an increase in the angle of inclination |
| coxa varum | a decrease in the angle of inclination |
| Angle of torson | angle formed by the femoral neck with the femoral condyles normal is 15* |
| Anteversion | angel greater than 15*, appears to lack ER, had toe in gait |
| Retroversion | angle less than 15*, appears to lack IR, has toe out gait |
| Bursa of hip | iliopectinial, trochanteric, ischial, |
| iliopectinial bursa | lies beneath the illiopsoas muscle as it crosses the hip joint, pain with extension and IR of hip |
| trochanteric bursa | reduces friction between the glutes and the greater trochanter, most extensive posterolateral under the glute max |
| ischial bursa | lies between the ischial tuberosity and the hamstring attachment, from prolonged sitting of trauma to the ischium |
| Anterior muscles | primarily hip flex, iliopsoas, pectineus, rectus femoris, sartorius |
| Medial muscles | adductor brevis, adductor longus, adductor magnus, gracilis |
| posterior muscles | glute max, biceps femoris, semitendinosis, semimembranosis, external rotators |
| lateral muscles | primarily hip ABD, glute med, glute min, external rotators, TFL |
| Pelvic muscles in the iliac region | iliacus, psoas major, psoas minor |
| pelvic musclse in the gluteal region | glute max, glute min, glute med, TFL, six deep external rotators-piriformis, obdurator externis, obdurator internis, gemellus inferior, gemellus superior, quadratis femoris |
| Thigh muscles | divided into three compartents by intermuscular septa |
| Anterior thigh compartment | mainly knee extension-rectus femoris, vastis lateralis, vastis intermedius, vastis medialis, sartorius |
| Posterior thigh compartment | hamstring group-biceps femoris, semimembranosis, semitendinosis |
| medial thigh compartment | adductor brevis, adductor longus, adductor magnus, pectinius, gracilis |
| Lumbar plexis | formed by anterior rami of spinal nerves L1-L4 and some fibers from T12, lower ab and anterior and medial portion of LE |
| Sacral plexis | formed by anterior rami of L4, L5, S1-S4, lower back, pelvis, perineum, posterior surface of thigh and leg, and dorsal plantar surfaces of foot |
| femoral nerve | arises from posterior division of sacral plexus, innervates iliopsoas, rectis femoris, vastis medialis, vastis lateralis, vastis intermedius, pectinius, sartorius, sensation to anterior and lateral thigh, and medial leg and foot |
| Obdurator nerve | arises from anterior division of lumbar plexus, adductor brevis, adductor longus, adductor magnus, gracillis, obdurator externis, sensation to the medial thigh |
| Superior gluteal nerve | part of sacral plexus, arises from L4, L5, &S1, innervates glute med and min, and TFL |
| Inferior gluteal nerve | sacral plexus, arises from L5, S1, S2, innervates glute max |
| Branches from the sacral plexus | piriformis (S1, S2), gemellus superior (L5, S1, S2), genellus inferior and obdurator internis (L4, L5, S1, S2), quadratis femoris (L4, L5, S1) |
| sciatic nerve-tibial division | from sacral plexus, semitendinosis, semimembranosis, long head of biceps femoris, &adductor magnus, sensation to posteriolateral lower leg, and plantar aspect of foot |
| common peroneal tibial division | anteriolateral lower leg and dorsum of foot |
| Hip pointer | involves ASIS or iliac crest & nerves &muscles in area, symptoms may take 30min-1hr to show, etiology-direct blow to asis or illiac crest, presentation-p!, swelling, discoloration, ROM, decreased strength, gait maybe effected in sever cases |
| Piriformis Syndrome | siactic nerve irritation caused by piriformis,nerve runs thru/under,etiology-trauma to butt or tight piriformis, presentation-elimiate lumbar dysfunction w nerve tests, deep butt p! @ sciatic notch w no back p!, p! radiating in leg, gait-decreased stride |
| Bursitis-Trochanteric | bursa lies between glute max & greater trochanter, etiology-can be due to increased Q angle or prolonged adducted running, direct trauma to greater trochanter, presentation-p! to palpation over greater trochanter, abd gait, p! w/ ADD stretch or active ABD |
| groin strain | sartorius, gracilis, and add muscles, etiology-hyperABD w/ ER of hip,running twisting, kicking may cause it, presentation-p! w/ contraction of ADD & w/ stretch of ABD, p! to palpate over muscle depending on severity, activity maybe decreased 2ndary to p! |
| Hip flexor strain | iliopsoas and rectis femoris, etiology-hyper ext of hip w/ knee bent or straigh, running kicking hockey, presentation-p! w/ active hip flex & limited hip ext, maybe P! over muscle belly depending on severity |
| Hamstring Strain | semimem, semi tend, biceps femoris, etiology-quads too strong, over ext of knee w. hip flex, presentation-p! w/ active knee flex/hip ext, decreased stride in gait, p! to palpate over muscle belly depending on severity, decreased ROM |
| Quad strain | vastis lateralis, vastis medialis, vastis intermedius, rectis femoris, etiology-forceful quad contraction, over stretch of quads, presentation-p! w/ active knee ext or quad stretch, P! w/ gait depending on severity, p! over muscle, decreased ROM |
| Hip Dislocation | MEDICAL EMERGENCY! Hip is adducted and internally rotated |
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jwebst1
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