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Pelvic and Hip Joint
Pelvic and Hip Joints
| Question | Answer |
|---|---|
| What does the pelvic girdle support and protect? | Abdominal organs |
| What is the function of the pelvic girdle besides support and protection? | Transmits forces from head and arms and trunk to lower extremities |
| How many joints are formed by the pelvic bones? | 7 |
| What are the joints formed by the pelvic bones? | Lumbosacral Sacroiliac Sacrococcygeal Symphysis pubis Hip joint |
| Which joints are the most stable but mobile? | Hip joint |
| What is the function of hip joints? | Transmits large forces between the trunk and the ground - 3X body weight with each step Locomotion |
| What are the structural classifications of joints? | Fibrous Cartilagenous Synovial |
| Based on the axis of movement, what types of joint are non-axial? | Plane |
| Based on the axis of movement, what types of joint are monoaxial? | Hinge Pivot |
| Based on the axis of movement, what types of joint are biaxial | Ellipsoid Condylar |
| Based on the axis of movement, what types of joint are multiaxial? | Ball/socket Saddle |
| Which axises of movements have circumduction? | Biaxial Multiaxial |
| What are the functional classifications of joints? | Synarthrosis Amphiathrosis Diathrosis/arthrosis/diarthrodial |
| Describe the movement of a synarthrosis joint? | Immovable - all synchrosis |
| Describe the movement of an amphiathrosis joint | Slightly immovable - all symphysis |
| Describe the movement of a diarthrosis/arthrosis/diarthrodial | Moveable - all synovial |
| Which joint is the site of lower back pain? | Sacroiliac joint |
| What would cause lower back pain in the SI joint? | Childbirth Hyper/hypo-mobility Inflammatory conditions |
| What is the SI joint typically classified as? | Synovial planar (gliding)joint |
| What is the functional classification of the SI joint? | Upper 1/3 - syndesmosis Middle 1/3 - symphysis Lower 1/3 - synovial |
| What makes up the posterior side of the sacrum? | Interosseous ligaments that fill the space between the sacrum and inner side of the iliac tuberosity |
| What covers the interosseous ligaments of the SI joint? | Posterior sacroiliac ligaments |
| What is on the anterior side of the SI joint? | Anterior sacroiliac ligaments |
| What is the mechanism of the posterior and anterior sacroiliac ligaments? | Suspend the sacrum from ilia, acting as shock absorbers as weight bearing drives the sacrum distally on ilia |
| What connects the spinous process and ischial tuberosity? | Sacrotuberous and sacrospinous ligaments |
| What is the function of the sacrotuberous and sacrospinous ligaments? | Provides leverage to hold distal aspect of sacrum in place against anterior weight-bearing forces |
| What joint acts as a self locking mechanism? | SI joint |
| How does the SI joint act as a self locking mechanism? | Force increase to cause downward movement of the sacrum on the ilia The posterior SI ligaments and interosseous SI ligaments tighten and pull ilia closer together like a clamp |
| How would you classify a sacrococcygeal joint? | Synovial planar (gliding) - synarthrosis |
| How would you classify intercoccygeal joints? | Synathrosis |
| What causes an increase in motion between coccygeal joints? | Pregnancy and ossification from aging |
| What kind of cartilage covers the surface of the sacroiliac joint? | Sacral surface - hyaline cartilage Iliac surface - fibrocartilage |
| What kind of cartilage covers the articulating surfaces of the pubic bones? | Hyaline cartilage, separated by a fibrocartilage disk |
| What is the joint classification of the pubic symphysis? | Amphiarthrosis cartilaginous symphysis joint |
| What is the structural classification of the hip joint? | Synovial joint, multiaxial, ball/socket |
| What is the functional classification of the hip joint? | Diarthrosis |
| What is the articular surfaces of the hip joint? | Lunar surface of acetabulum Head of femur |
| What is the shape of the femur head? | About 2/3 of a sphere with a diameter of 4-5 cm |
| How does the axis run for the femoral head? | Superiorly, medially, and anteriorly |
| The sphere is bigger for the femur than the humerus, what is the implication for the size? | Bigger in femur - more stability Smaller in humerus - more mobility |
| The angle of inclination is made between the axis of what? | Axis of shaft and axis of neck |
| How big is the angle between the head and shaft of the femur? | 125 degrees |
| What is the function of the angle of inclination of femur? | Place knee under weight bearing line of the head of the femur |
| What is it called when the neck-shaft angle is smaller than 125? | Coxa varus |
| What is it called when the neck-shaft angle is larger than 125? | Coxa valgus |
| What is the result of coxa varus in the neck-shaft angle? | Decrease in leg length |
| What is the result of coxa valgus | Increase in leg length |
| What is the implication on muscle from coxa varus/valgus in neck-shaft angle? | Decreased muscle strength |
| Why is there a decrease in muscle strength when there is a change in neck-shaft angle? | Changes in torque from alterations in muscle lever arms and length-tensio relationships Line of force of muscle will be changed |
| What is the angle of anteversion | Head forming an angle (10-30 degrees) with frontal plane that passes through the shaft |
| What is an increase in the angle of anteversion called? | Anteversion |
| Anteversion is one factor that is considered to cause what phenomenon? | Pigeon toes |
| What is a decrease in the angle of anteversion called? | retroversion |
| Retroversion is one factor that make cause what phenomenon? | Out-toeing |
| Why are orthopedists conservative in treating children who are pigeon toed? | Because the angle of anteversion usually decreases with growth and development of a child |
| The frontal plane passes between what for angle of anteversion? | Shaft and condyles |
| Which direction will the femur shaft twist to increase the angle of anteversion? | Medially |
| Which direction will the femur shaft twist to decrease the angle of anteversion? | Laterally |
| What shape is the acetabulum? | Hemispherical |
| What binds the acetabulum? | Acetabular rim |
| What part of the acetabulum is lined by articular cartilage? | The lunate surface of the acetabulum |
| What is the deeper central part of the cavity that is non-articular? | Acetabular fossa |
| The acetabulum is directed in which directions? | Laterally, inferiorly, anteriorly |
| The acetabular fossa permits movement of what structure? | Ligamentum teres |
| What is the function of the acetabular fossa? | Reservoir for synovial fluid when hip is heavily loaded |
| What happens to the synovial fluid once joint forces are decreased in the hip joint? | Returns to joint space to provide lubrication and nutrition to the articular cartilages |
| The anatomic axis of femur is represented by a line through what? | Femoral shaft |
| The mechanical axis of femur is represented by a line through what? | Connecting centers of hip and knee joint -vertical when standing |
| Is there movement around the mechanical axis? | Yes, because it passes through head of femur |
| Is there movement around the anatomical axis? | No, because it does not pass through head of femur |
| What is the acetabular labrum? | Fibrocartilageinous ring inserted into the acetabular rim |
| What is the function of the acetabular labrum? | Deepens the acetabulum and fills out the various gaps of the acetabular rim |
| What ligament attaches to the acetabular labrum? | Transverse acetabular ligament (TAL) |
| What is the function of the transverse acetabular ligament? | Bridges over acetabular notch Acetabular notch needs a rim because it is open |
| Where does the ligamentum teres arise from? | Acetabular notch |
| Describe the direction of the ligamentum teres from its origin to insertion | Arises from the acetabular notch Runs at floor of acetabular fossa Inserts into fovea femoris capitis |
| What is the ligamentum teres embedded in? | Fibroadipose tissue within acetabular fossa |
| What lines the ligamentum teres? | Synovial membrane |
| How much force can the ligamentum teres tolerate? | 45 Kg weight |
| What is the primary function of the ligamentum teres? | Vascular supply to the head of femur |
| When does tension on the ligamentum teres occur? | Extreme positions of adduction, flexion, and external rotation OR Adduction, extension, and internal rotation |
| Is the head of the femur completely covered by cartilage? | No |
| Is the ligamentum teres the main head blood supply? | No, but does carry vascular supply to head of femur |
| What does the ligamentum teres attach to | Ligamentum teres is y-shaped → arms attach to edges of acetabular notch and other side attaches to femoral head (fovea) |
| What is another function of the ligamentum teres besides vascular supply? | Supports hip joint |
| What is a ligament? | Thickening of joint capsule |
| What is an intrinsic ligament? | Ligaments that are part of the capsule It reinforces capsule |
| What is an extrinsic ligament? | Ligaments that aren't part of the capsule Could be outside or inside |
| If an extrinsic ligament is inside, what is it called? | Intracapsule |
| What is an example of an intracapsular ligament? | Cruciate ligaments |
| If an extrinsic ligament is outside, what is it called? | Extracapsular |
| What is an example of an extracapsular ligament? | Coracoclavicular ligament |
| What kind of ligament is the ligamentum teres? | Extrinsic and intracapsular |
| Where is the hip joint capsule inserted? | Medially - acetabular rim Laterally - line which runs along intertrochanteric line At junction of latera 1/3 l and middle 2/3 of femoral neck |
| The hip joint capsule is strengthened by what three ligaments? | Iliofemoral Pubofemoral Ischiofemoral |
| The movement of flexion and extension passes through what structure? | Head of femur horizontally Frontal plane |
| What degree is reached during active hip flexion when knee is flexed? | 120 |
| What degree is reached during active hip flexion when knee is extended? | 70-90 |
| Why is the range for hip flexion smaller when the knee is extended? | Hamstrings |
| Hyperextension of the hip is limited to 10-20 by which ligament? | Iliofemoral ligament and rectus femoris |
| What is really happening when there is a perceived hyperextension of the hip past 10-20 degrees? | Extension of lumbar vertebrae → increased lumbar lordosis |
| Why is there a decrease in hyperextension of the hip when the knee is flexed? | Hamstrings lose efficacy as extensors of the hip because contraction largely utilized in knee flexion Rectus femoris also being stretched, limiting hip extension |
| What happens to the efficacy of muscles passing at two joints? | Stretch at one end, increases efficacy at other end |
| What influences the efficacy of a two-joint muscle? | Positions of the two involved joints - governing length-tension relationship |
| What is the degree of angle for hip abduction? | 45 |
| Hip adduction between two thighs is 0, how is it possible to have a more negative degree of angle? | Crossing legs |
| Which axis of movement is identical to the mechanical axis of the femur? | Internal/External rotation |
| When is hip rotation easier to observe? | When knee is flexed to 90 and motion of tibia from neutral position is measured |
| Flexor muscles of the hip lie which direction to which plane? | Anterior to frontal plane Passing through center of joint |
| What are the most important muscles for hip flexion | Psoas major Iliacus Sartorius Rectus femoris TFL Pectineus Adductor longus Gracilis Glute med/min (anterior fibers) |
| Which muscle can produce enough tension to flex the hip beyond 90 degrees while sitting? | Iliopsoas |
| What muscles control the vertebrae and pelvis on femur as person leans back and returns to upright position? | Hip flexors Esp Iliopsoas |
| What would happen if there was a bilateral paralysis of the iliopsoas? | Person would fall back as soon as the center of gravity line of the head, arms, and trunk falls behind hip joint axis |
| Extensor muscles of the hip lie which direction to which plane? | Behind frontal plane Passing through center of joint |
| Where is each group of muscles inserted for hip extension? | Femur Vicinity of the knee joint |
| What muscles are in each group responsible for hip extension? | 1st group -glute max -glute med/min (posterior fibers) 2nd group -biceps femoris -semitendinosus -semimembranosus -adductor magnus |
| Rectus femoris can produce more force as a hip flexor if the knee is performing what action? | Flexion |
| Why is the efficacy of two-joint muscles increased when the two joints are functioning similarly? | Permits muscle to contract within a favorable range |
| Abductor muscles of the hip lie which direction to which plane? | Lateral to sagital plane Transverses center of joint |
| What are the main abductor muscles? | Glute med (anterior fibers) Glute min TFL Glute max (upper fibers) |
| What other muscles contribute to the force of abduction? | Sartorius Piriformis Obturator internus Gemelli |
| Adductor muscles lie which direction to which plane? | Medial to sagittal plane Transverses center of joint |
| What are the main hip adductors? | Pectineus Adductor longus/brevis/magnus Gracilis |
| Lateral rotators of the hip lie what direction to what axis? | Posterior to mechanical axis |
| What are the main lateral rotators of the hip joint? | Piriformus Obturator internus/externus Quadratus femoris Glute max/med |
| Medial rotators of the hip lie what direction to what axis? | Anterior to mechanical axis |
| What are the main medial rotator muscles? | TFL Glute med/min (anterior fibers) |
| What other muscle groups that can do external rotation? | Deep gluteal muscles |
| What are the seven joints of the pelvis region? | Lumbosacral, sacroiliac, sacrococcygeal, symphysis pubis, hip |
| Which joints of the pelvis region have two joints? | Sacroiliac and hip |
| What kind of joint is the sacroiliac joint? | Synovial planar |
| What are the articular surfaces of the sacroiliac joint? | Auricular surface of ilium and sacrum |
| What does FISH pertain to and stand for? | Articular surface of sacroiliac joint. F - fibrocartilage; I - iliac surface; S - sacrum; H - hyaline cartilage |
| As the body weight is applied on the spine, what happens to the sacrum? | Spine comes down and tends to push sacrum down |
| What is the implication of the sacrum being pushed down by the spine? | 3 ligaments prevent downside displacement of the sacrum - like it is suspending the sacrum which simultaneously causes the sacrum to tilt anteriorly (nutation) |
| Where are symphysis joints located (including pubic symphysis)? | In the center |
| Where is the sacrococcygeal joint formed | At point where triangular coccyx bone joins sacrum at its apex |
| What is the function of the sacrococcygeal joint? | Typically needed during childbirth and defecation |
| Where is the intercoccygeal joint formed? | Lies between the 3-5 vertebrae that make up the coccyx |
| How is the pubic symphysis joint formed? | Completes pelvic girdle ring by joining right and left pubic bones anteriorly with fibrocartilaginous disk |
| What is the function of the pubic symphysis joint? | Demonstrates little motion but assists SI joint movement |
| What are the movements of the hip joint? | Flexion/extension, abduction/adduction, medial/lateral rotation |
| Movement of flexion and extension of the hip joint are along what planes? | Along frontal plane but movement in sagittal plane |
| Movement of adduction/abduction of hip joint are along what planes | Along sagittal plane but movement along frontal plane |
| Movement of medial/lateral rotation of hip joint are along what planes? | Along vertical plane |
| What is the implication of the femur head running superiorly, medially, and anteriorly? | Head is out of the acetabulum because of axis |
| Describe the hip joint | Has a joint cavity, surfaces are surrounded by cartilage, can produce synovial fluid, and ligamentous structures surround the joint |
| What is occurring in anteversion? | Head is twisted anteriorly but shaft is twisted medially but because head can't actually move out of socket, frontal plane has to move which passes through the shaft |
| What part of the hip joint doesn't articulate with the head of femur? | Acetabular fossa |
| What direction is the axis of acetabulum | Facing laterally and anteriorly |
| Describe the movement of the synovial fluid in the acetabular fossa during decreased joint forces | Movement like standing, the synovial fluid goes back into acetabular fossa, returning to joint space |
| Describe movement of the synovial fluid in the acetabular fossa during increased joint forces | Movements like sitting, the synovial fluid has moved and washes the head of the femur |
| What is significant about the acetabular notch? | Bottom part of acetabulum which interrupts the articular cartilage of the hip joint → open part of it |
| What is the strongest ligament of the hip joint? | Iliofemoral |
| Where does the iliofemoral ligament cover the hip joint? | Anteriorly and superiorly |
| What movement does the iliofemoral ligament limit? | Prevent hyperextension of hip joint - holds upper half body weight |
| Where does the pubofemoral ligament cover the hip joint? | Anteriorly and inferiorly |
| What movement does the pubofemoral ligament limit? | Lateral (external) rotation |
| where does the ischiofemoral ligament cover the hip joint? | Posteriorly and inferiorly |
| What movement does the ischiofemoral ligament limit? | Medial (internal) rotation |
| The iliopectineal bursa facilitates movement by reducing friction between what structures? | Hip capsule and iliopsoas muscle |
| If there is bursitis in the iliopectineal bursa, what kind of movement can trigger pain? | Flexion |
| Where does the axis for rotation pass through? | Identical to mechanical axis of femur - through head of femur and center of knee joint |
| How many degrees can be observed for rotation? | 30 - medial; 60 - lateral |
| Why is the degree of movement for medial rotation half the size of lateral rotation | Because ischiofemoral ligament limits medial rotation |
| What muscle is responsible for hip flexion that goes beyond 90 degrees? | Iliopsoas |
| What is the principle of length-tension relationship for muscles crossing two joints? | Efficacy of two-joint muscle is substantially influenced by positions of the two involved joints |
| Describe the role of rectus femoris in relation to the length-tension relationship | Can produce more force as hip flexor if knee flexes simultaneously with hip because this permits the muscle to contract within a favorable range. For this same reason, it is a more efficiency knee extensor if hip extends simultaneously |
| Describe the role of hamstrings in relation to the length-tension relationship | More efficient as hip extensors when knee extends; more efficient as knee flexors when hip flexes simultaneously |
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nnguyen44
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