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MF Hip
MF Hip Presentation Notes
| Question | Answer |
|---|---|
| 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 |
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