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hip and thigh 1

Higgins notes on hip and thigh

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
Created by: jwebst1