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MF Hip

MF Hip Presentation Notes

What type of joint is the hip? Multiaxial ball & socket joint
What forms the acetabulum? Fusion of the ilium, ischium & pubis. Deepened by the labrum.
Compare the hip & shoulder Hip is more stable & dynamic, less ROM; hip ligaments stronger
What comprises the innominate? Ilium + Ischium + Pubis
Which directions does the acetabulum open? Inferiorly, Anteriorly, Laterally
Which directions does the femoral head open? Anteriorly, Medially, Superiorly
What is the "degree above the frontal plane that the femoral neck faces" & what is it's normal measure? Anteversion. Normally b/t 8-15 degrees
More hip anteversion causes what? Toeing in (hip IR)
Hip retroversion causes? Toeing out (hip ER)
What ligament is the strongest of the hip? Iliofemoral (Y ligament of Bigelow)
What motions does the iliofemoral ligament prevent? Excessive extension. Also maintains upright hip posture.
Which hip ligament is the weakest? Ischiofemoral
Which motions does the ischiofemoral ligament prevent? Winds tightly on extension
Which motions does the pubofemoral ligament prevent? Excessive abduction of the femur; also limits extension
All 3 ligaments limit what? Internal Rotation
Resting Position of the Hip 30 deg flexion & abduction; Slight ER
Closed Packed Position of the Hip Extension, IR, Abduction
Capsular Pattern of the Hip Flexion, abduction, IR > Extension, Adduction, ER
Hip Dysplasia occurs more often in whom? Girls, Infants
Legg-Calve-Perthes occurs more often in whom? 3-12 yo boys
Hip OA & femoral neck fx occur more often in whom? Older population, women, usu 2ndary to osteoporosis
If pain is in the anterior hip, what could it be? OA, hip flexor strain, impingement, iliopsoas bursitis, hip fx, stress fx, arthritis, acetabular labral tear, AVN of femoral head
Lateral hip pain is indicative of.... IT band, meralgia paresthetica, lumbar n root pain, trochanteric bursitis
Posterior Hip pain is indicative of... referred pain from L-spine; SI jt dysfxn; Hip extensorrotator m. strain
Clicking is common with what type of injury? Labral Tears
Internal Snapping Hip Iliopsoas tendon over lesser trochanter/anterior acetabulum; Iliofemoral ligament over femoral head; Iliopsoas bursal or capsular thickening
External Snapping Hip Tight IT band; Glut max over greater trochanter; Trochanteric bursitis
Intra-articular Snapping Hip Labral/ligamentum teras; loose bodies; capsular instability (laxity in hip)
Unremitting, long duration pain in the hip is Possible yellow/red flag, esp if close to lower back or large nerve distribution area
What nerve pierces the piriformis in 12% of the population? Sciatic N.
Posture Observations Pelvic obliquity (unequal leg length, mm contractures, scoliosis); Watch spine & hip during AROM/PROM; Does pt stand equally on both legs?; Iliopsoas tightness- deviation of spine to same side
Balance observations Balance on single leg (eyes open, then closed)
Traumatic Posterior hip dislocation Limb is shortened, adducted, medially rotated; greater trochanter is prominent
Anterior hip dislocation Limb is abducted, laterally rotated; May be cyanotic or swollen
Intertrochanteric fractures Limb is shortened & laterally rotated
Shortening of a leg... Spinal scoliosis if present on only 1 lower limb; Shortening may be structural or functional
Anterior View Abnormal bony contour difficult to detect; Swelling hard to see
Lateral View Contour of buttock observed; Hip flexion deformity observed
Posterior View Position of the hip & effect of this position on the spine; Hip flexion contracture may lead to increased lumbar lordosis
Exam- Active Movements Flexion; Extension; Abduction; Adduction; IR; ER
End feel of Passive Movements Flexion; Extension; Abduction; Adductoin; IR; ER--All have tissue approximation/stretch end feel!
Resisted Isometric Mvmts Flexion/extension, Abd/Add, IR/ER of hip; Flexion/Extension of the knee
Patrick's Test aka Faber aka Figure-4 test FABER= flexion, abduction, ER. Position = inability to lower leg; Possible SI involvement
Trendelenberg's Sign Stability of hip abduction; Drop in OPPOSITE pelvis
Craig's Test for femoral anteversion Birth- 30 deg; Adult- 8-15 deg; Pt lies prone & flexes knee
True Leg Length ASIS to Medial Malleolus
Apparent Leg Length Belly button to Medial Malleolus
Thomas Test Supine, knee to chest, flatten L-spine; Rise in other leg at hip &/or knee extension &/or hip abduction
Ober's Test IT band tightness; Stabilize hip while loweirng leg
Piriformis Test (FAIR test) Flexion, Adduction, IR; sidelying, flex hip to 60 deg, knee flexed; Lower leg to increase symptoms
Peripheral Nerve Injury- Sciatic Nerve L4-S3- Piriformis Syndrome
Peripheral Nerve Injury- Superior Gluteal N L4-S1- Acute gluteal pain
Peripheral Nerve Injury- Femoral N. L2-L4
Peripheral Nerve Injury- Obturator N. L2-L4
Created by: 1190550002