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The Hip - 639

What happens when the foot hits the ground? Calcaneus everts, foot pronates
What happens to the tibia as we PF and the arch pronates? Medially rotates, drives into flexion and unlocks the femur= IR, the hip then IR
What kind of adapter is the foot when it pronates? FLEXIBLE adapter
What is a quick stretch before a contraction considered? Plyometrics
Position of the talocrural joint when the foot hits the ground Plantarflexion
What happens to the glute max. when the hip IR? quick stretch!= plyometrics
What must you do when someone comes in with hip pain? check the WHOLE kinetic chain, above and below!
What happens when both ends of the LE are fixed? movement of one link will affect all!
What happens to glute max. if we FIX the femur? pelvis posterior rotator
Hamstrings action classicly: knee flexors
Hamstrings action at the hip: hip extensor
What function does glute max. serve at the hip, knee flexed? (UNFIXED) hip extensor (G max. test=knee flexed)
Components of the acetabulum ilium, ischium, pelvis, lunate surface, labrum
What are the purposes of the labrum? seal, lubricate, nerve endings, position sense, pain perception
Where is the force at the acetabulum when WB? on the lunate surface= superolateral force, not as much lateral though
Head of the femur components head, neck, g. trochanter(L), l. trochanter(M), fovea, trabecular lines
What attaches to the g. trochanter? gluteals, the piriformis, the obturator internus, and the gemelli
What is the purpose of the trabecular lines of the femur? WB and hip function
What purpose do the 'tubes' aka trabecular lines serve? SUPPORT, Take AXIAL load very well!
How many COMPRESSIVE GROUPS of 'tubes' are there in the proximal femur? 2! Primary= head of femur Secondary= neck of femur
What kind of load do the compressive groups take? AXIAL
What bridges the compressive group forces to take the load? Tensile group (dorsally located)
What inserts into the fovea? ligamentum teres
How many degrees is the femur INCLINED? 126*
What many degrees of torsion are present at the femur and in which direction? 15, anteverted
What happens if the angle of the neck of the femur is larger? coxa valga= >126....bowlegged
What happens if the angle of the neck of the femur is smaller? coxa vara= <126.... knock knee
When do you have maximum congruence of the femur? while WB
What is the loose pack position of the hip? 30 flexion, 30 abduction, slight lateral rotation "FROG LEG"= DITKA
What does the loose pack position do for the LE? provides least compression on the surfaces
What does the joint capsule do for the hip? provides stability
What does the ligamentum teres contain? obturator artery, nerves
What happens if the lig. teres is torn? head of femur becomes avascular ~50% supply lost
what happens if you dislocate your femur at the hip? decrease blood flow to the head of femur= AVN
What are the 3 main structural/functional ligaments at the hip? iliofemoral, pubofemoral, ishiofemoral
What does the iliofemoral ligament check? extension
What does the pubofemoral ligament check? abduction
What does the ischiofemoral ligament check? flexion and adduction
What happens to ALL of the ligaments in standing? ALL are TIGHT!
What happens to the ischiofemoral lig. in the LPP? unwinds and checks flexion then
What force do the H-A-T place on the spine? axial
What force is exerted on the SI joint from up and down forces? shear (convoluted)
How many degrees are there of nutation(flexion) and counternutation(ext.) at the sacrum? 7*
Flexion ROM at hip 120
EXT ROM at hip 20
IR at 90* hip flexion 40
ER at 90* hip flexion 45
where does psoas attach? femur and spine?
where does iliacus attach? ilium
Hip arthritis is indicated with capsular pattern of restriction (not symm.)
What is the role of the iliopsoas at the hip? influence hip motion... may cause back pain if weak
What does the lumbar spine do during Ant. Tilt? extend
What does the hip do during Ant. Tilt? flex
What direction does the ASIS point in Ant. Tilt? down
Ant. Tilt may be indicative of what lumbar spine condition? Lordosis
What does the lumbar spine do during Post Tilt? flex
What does the hip do during Post Tilt? extend
What direction does the ASIS point in Post. Tilt? UP
Movement of the sacrum is in how many directions? 3 dimensions
Unilateral pelvis are what axis? oblique, superior R=forward, inferior L=back
Are all the muscles active simulatenously? YES
What is the role of piriformis at 0* ER
what is the role of piriformis at 90* IR
Synergy= redundancy
what are the 3 bursa of the hip trochanteric, iscial, iliopectineal
What is the iliopectineal bursa do? acts as a pulley over which psoas and iliacus run
What is an acetabular dislocation? a fx that did not occur
what is hip tendinitis? cumulative trauma or strain on muscles/tendons
hip oa results from? aging: 60^, incidious onset(~6 mo's worse n worse),
where will hip oa pain be felt? groin= medial, centralized, lateral hip pain is rare!
Rheumatoid arthritis differs how? may affect many other joints, widespread, bilateral hips, hands, shoulders, knees (may be uni.)
high impact hip fractures MVA, must remain stable (NWB), do not mobilize unstable fx's, acetabular fx
what is the rehab for a high impact trauma fx? mobility, motor controlled function over that limb
how is a fx fixed? through the posterior aspect, slash through glutes= motor implications
how long should an individual typically remain NWB with a fx? ~6-8 wks depending where the fx occurred
what are the 3 most common places for an osteoporosis fx to occur? neck, intertrochanteric, subtrochanteric
which out of the 3 or the 2 MOST LIKELY places for a fx to occur? neck and intertrochanteric
High energy dislocations are associated most with: adults, MVA, ^ trauma, ant. or post.
Low energy dislocations are associated most with: under 15 y/o, usually posterior, IR and shortened=skeletal immature, leg short= slip superior
congential dislocations are associated with: infancy= hip dysplasia(femur/socket), corrected with ER
Post hip arthroplasty precations: DO NOT: add. past midline, IR, cross leg, flex past 90*
legg calve perthes bony abnormality, males, 3-5 y/o, temp. avasc., spontaneous regain blood flow, can be miserable
Acquired: Slipped capital femoral epiphysis most common: overwt. adoles. boys, bilat, growth plate pops loose
how do you treat slipped capital femoral epi.? NWB ~8wks, if reduced/screw= less time NWB, perform slide board transfers
Labral tears are common in who? dancers, hockey goalies=butterfly stance, sports,
True or false: OA and labral tears are commonly seen in parallel? TRUE, high finding for THA later in life
what happens to the synovial fluid that leaks during a tear? gets reabsorbed, but there is less lubrication now
Muscle Strains at lesser trochanter psoas: avulsion=will bleed, blood may calcify (MYOCYITIS OSSIFICANS)
muscle strains at ASIS sartorius: soccer players
muscle strains at AIIS: RF: soccer, runners
where do hip contusions commonly occur and to who? g. trochanter, iliac crest...lose ALOT of function! football players...must Tx from the immobilization
Tendinitis: ITB=3D= run over g. trochanter= FRICTION! hip flexors=psoas=hypomobile
What happens if psoas is hypomobile? shortened position results in active insufficiency
where might psoas pain be felt? ant hip from repetitive actions, pain in back
True or False: Sagittal plane changes to the ITB may affect the frontal plane? true!
What are the 3 cause of hip bursitis? progressive, mechanical, night pain
What is the cause of night pain bursitis? ischemic in nature= bad blood flow to the area
What is the cause of mechanical hip bursitis? muscles over the bursa, contusion to bursa= ext. force
true or false: a sprain is liekly with the joint capsule? FALSE!
Inguinal Ligament sprains: hip or ligament, mobility can become problematic, hernias, bones are not static (slight flex.)
Where would you 'poke' for Piriformis Syndrome? gluteal fold--> popliteal space. no pain=no sciatic nerve problem
What nerve would a tight piriformis restrict? sciatic
how much of the sciatic nerve pierces the piriformis? 15-30%
what age/gender does legg calve perthes typically affect? boys 3 to 12 y/o
How specific is groin pain (posterior or lateral) for OA? 92%---RULE IN!
What might snapping or popping of a tendon in the hip indicate? snapping= psoas over the iliopectineal bursa
How sensitive and specific is popping/snapping of the hip for a labral tear? 100% sensitive-- RULE OUT if they DONT have it!.... 85% able to rule in that they DO have it
how might running irritate a bursa? ITB runs over the intertrochanteric bursa= bursitis
Hip OA may be provoked by squatting(flexion), how sensitive is this? 76% pain with squat? no OA
Do the numbers on Metric tests always correspond to goals? NO!.... functional questions help to write the goals! ACTIVITY is the GOAL!
how might the hip affect the back? through hypomobility
Lurches may involve: abductor: glute med. extensor
What happens in lordosis? posture of apathy= in ext. you hang on your Y bigelow (iliofemoral lig)... glute max= weak, abdominals= lengthened
OKC flexion with lateral pain is how specific for OA? 82% specific... you can rule it in!
OKC abd/add with groin pain is how specific for OA? 94% specific...rule in!!!
PASSIVE MOTIONOKC for OA: no restricted movement= 100% sensitive, 100% sure they DO NOT have it., restricted motion in all 3 planes= 92% specific= they do have it!
Lumbar spine motions couple with: force couples with the pelvis
No ext. in hip? work through spine!
none in spine? work through hip
FABER test: SN and SP #'s SN= 60%, SP= 18%
SCOUR test: SN and SP SN= 62%, SP= 75%
FADIR test: SN and SP SN= 78%, SP= 10%
Ant. Labral test: SN and SP SN= 75%, SP=43%
Will an acetabular labral test show up on a plain MRI? NO! use MRI arthrogram= better resolution
Bone scan is good to see: stress fracture (through isotopes), necrosis
what is a DXA scan used for? osteoporosis= bone density= GOLD STANDARD!
Created by: 1158150021



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