Ch 8- The pelvis and thigh
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| What 3 structures make up the two innominate bones of the pelvis? | Ilium, ischium, and the pubis
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| What is the sacrum? | A broad, thick bone that fixates the spinal column to the pelvis.
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| Define acetabulum. | A downwardly and outwardly directed depression (accepts the femoral head).
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| Define labrum. | A thick ring of fibrocartilage that lines the outer rim of the acetabulum and deepens the articular area.
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| What is the angle of inclination? | The angle between the head of the femur and the femoral neck (usually 125 degrees).
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| What is the angle of torsion? | In the transverse plane, the relationship between the femoral head and femoral shaft.
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| What are the locations of the articulation of the hip? | Pubic symphysis (anterior articulation), SI joints (posterior articulation
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| What are the supporting ligaments of the hip? | Iliofemoral ligament (Y ligament), pubofemoral ligament, ischiofemoral ligament, ligamentum teres (ligament of the head of the humerus), and the inguinal ligament.
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| What are the three degrees of freedom for the coxofemoral joint? | flexion, extension, and abduction.
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| What are the muscles of the anterior musculature? | Rectus femoris, quadriceps femoris group, sartorius, iliopsoas group.
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| What are the muscles of the medial musculature? | Adductor longus, adductor magnus, adductor brevis.
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| What are the muscles of the lateral musculature? | Superficial: gluteus medius and tensor fascia latae. Posterior: piriformis, quadratus femoris, obturator internus, obturator externus, gemellus superior, and gemellus inferior.
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| What are the muscles of the posterior musculature? | Gluteus maximus, and hamstring muscle group.
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| What three things lie in the femoral triangle? | Femoral nerve, femoral artery, and femoral vein.
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| What are the three primary bursae of the hip and pelvis region? | Trochanteric bursa (the site where the gluteus maximus passes over greater trochanter), gluteofemoral bursa (separates the gluteus maximus from the vastus lateralis), and ischial bursa (weight bearing structure when an individual is seated).
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| What should be inspected when dealing with a hip and pelvis injury? | Angle of inclination, angle of torsion (anteverted and retroverted hips), adductor group, hip flexors, illiac crests, nelaton's line (line from ASIS to ischial tuberosity (coxa vara test), PSIS, gluteus maximus, hamstring muscle group, median sacral crest
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| What does the measurements made for angle of torsion implicate? | Angles less than 15 degrees represent femoral retroversion; angles greater than 15 degrees represent anteversion.
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| What medial structures should be palpated? | Adductor longus, adductor magnus, adductor brevis
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| What anterior structures should be palpated? | Pubic bone, anterior superior illiac spine, anterior inferior iliac spine, sartorius, rectus femoris
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| What lateral structures should be palpated? | Iliac crest, tensor fascia latae, gluteus medius, IT band, greater trochanter, trochanteric bursae
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| What posterior structures should be palpated? | Median sacral crests, posterior superior iliac spine, gluteus maximus, ischial tuberosity and bursae, sciatic nerve, hamstring muscle
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| Where should the fulcrum lie when measuring hip flexion and extension? | Over the greater trochanter
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| Where should the stationary arm lie when measuring hip flexion and extension? | Midline of the pelvis
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| Where should the movement arm lie when measuring hip flexion and extension? | Long axis of the femur, lateral epicondyle as a distal reference
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| Where should the fulcrum lie when measuring hip abduction and adduction? | Over the ASIS
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| Where should the stationary arm lie when measuring hip abduction and adduction? | The distal portion of the stationary arm is placed over the opposite ASIS
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| Where should the movement arm lie when measuring hip abduction and adduction? | Long axis of the femur, middle of tthe patella as the distal reference
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| Where should the fulcrum lie when measuring hip internal and external rotation? | Center of patella
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| Where should the stationary arm lie when measuring hip internal and external rotation? | Held perpindicular to the floor
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| Where should the movement arm lie when measuring hip internal and external rotation? | Long axis of the femur, the center of the talocrural joint as the distal reference
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| What constitutes a positive Thomas test? | A)The lower leg moves into extensionB)The involved leg rises off the table
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| What does a positive Thomas test indicate? | A)Tightness of the rectus femorisB)Tightness of the iliopsoas muscle group
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| How do you isolate the iliopsoas during resisted range of motion? | Hip flexion with knee extended
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| How do you isolate the rectus femoris during resisted range of motion? | Hip flexion with knee flexed
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| How do you isolate the hamstrings during resisted range of motion? | Hip extension with knee extended
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| How do you isolate the gluteus maximus during resisted range of motion? | Hip extension with knee flexed
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| What constitutes a positive Trendelenburg's test? | The pelvis lowers on the non-weight bearing side
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| What are the implications of a positive Trendelenburg's test? | Insufficiency of the gluteus medius to support the torso in an errect position, indicating weakness in the muscle or decreased innervation.
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| What are the pain characteristics of Trochanteric bursitis? | Over the greater trochanter, radiating posteriorly to the buttock; pain increased when the patient climbs stairs.
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| What is the MOI of Trochanteric bursitis? | Acute: Direct blow to the greater trochanter.Chronic: Irritation from the IT band passing over the bursa.
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| What would you find on inspection of Trochanteric bursitis? | The area over the greater trochanter is usually unremarkable.
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| What are the pain characteristics of ischial bursitis? | Over the ischial tuberosity in the vicinity of the gluteal fold.
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| What is the MOI of ischial bursitis? | Acute: Direct blow to the ischial tuberosity, such as falling on it.Chronic: Repeated shifting and moving while weight bearing in the seated position (e.g. rowing).
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| What would you find on inspection of ischial bursitis? | Unremarkable.
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| What constitutes a positive hip scouring test? | Pain described or symptoms in the hips reproduced.
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| What does a positive hip scouring test implicate? | A possible defect in the articular cartilage of the femur or acetabulum (e.g. osteochondrial defects, arthritis).
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| What are the pain characteristics of piriformis syndrome? | Pain deep in the posterior aspect of the hip, radiating into the buttocks and down the posterior aspect of the leg; increases upon standing and often decreases with the patient lying supine and the knees flexed.
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| What is the MOI of piriformis syndrome? | Few common traits are associated with the onset of piriformis syndrome; factors such as a blow to the buttock, hyperinternal rotation of the femur, or other trauma may cause spasming of the piriformis muscle.
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| What would you find on inspection of piriformis syndrome? | The patient may present with an atalgic gait. In chronic conditions, atrophy of the gluteus maximus may be noted.
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| What are the pain characteristics of a iliac crest contusion (hip pointer)? | Illiac crest, possibly radiating into the internal and external oblique muscles.
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| What is the MOI of a iliac crest contusion? | Direct blow to an unprotected ilium.
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| What would you find on inspection of a iliac crest contusion? | Rapid onset of swelling and redness; ecchymosis developing over time.
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