The Hip - 639
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| What happens when the foot hits the ground? | Calcaneus everts, foot pronates
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| 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
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| What kind of adapter is the foot when it pronates? | FLEXIBLE adapter
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| What is a quick stretch before a contraction considered? | Plyometrics
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| Position of the talocrural joint when the foot hits the ground | Plantarflexion
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| What happens to the glute max. when the hip IR? | quick stretch!= plyometrics
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| What must you do when someone comes in with hip pain? | check the WHOLE kinetic chain, above and below!
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| What happens when both ends of the LE are fixed? | movement of one link will affect all!
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| What happens to glute max. if we FIX the femur? | pelvis posterior rotator
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| Hamstrings action classicly: | knee flexors
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| Hamstrings action at the hip: | hip extensor
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| What function does glute max. serve at the hip, knee flexed? (UNFIXED) | hip extensor (G max. test=knee flexed)
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| Components of the acetabulum | ilium, ischium, pelvis, lunate surface, labrum
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| What are the purposes of the labrum? | seal, lubricate, nerve endings, position sense, pain perception
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| Where is the force at the acetabulum when WB? | on the lunate surface= superolateral force, not as much lateral though
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| Head of the femur components | head, neck, g. trochanter(L), l. trochanter(M), fovea, trabecular lines
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| What attaches to the g. trochanter? | gluteals, the piriformis, the obturator internus, and the gemelli
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| What is the purpose of the trabecular lines of the femur? | WB and hip function
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| What |
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| What purpose do the 'tubes' aka trabecular lines serve? | SUPPORT, Take AXIAL load very well!
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| How many COMPRESSIVE GROUPS of 'tubes' are there in the proximal femur? | 2!
Primary= head of femur
Secondary= neck of femur
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| What kind of load do the compressive groups take? | AXIAL
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| What bridges the compressive group forces to take the load? | Tensile group (dorsally located)
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| What inserts into the fovea? | ligamentum teres
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| How many degrees is the femur INCLINED? | 126*
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| What many degrees of torsion are present at the femur and in which direction? | 15, anteverted
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| What happens if the angle of the neck of the femur is larger? | coxa valga= >126....bowlegged
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| What happens if the angle of the neck of the femur is smaller? | coxa vara= <126.... knock knee
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| When do you have maximum congruence of the femur? | while WB
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| What is the loose pack position of the hip? | 30 flexion, 30 abduction, slight lateral rotation "FROG LEG"= DITKA
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| What does the loose pack position do for the LE? | provides least compression on the surfaces
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| What does the joint capsule do for the hip? | provides stability
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| What does the ligamentum teres contain? | obturator artery, nerves
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| What happens if the lig. teres is torn? | head of femur becomes avascular ~50% supply lost
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| what happens if you dislocate your femur at the hip? | decrease blood flow to the head of femur= AVN
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| What are the 3 main structural/functional ligaments at the hip? | iliofemoral, pubofemoral, ishiofemoral
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| What does the iliofemoral ligament check? | extension
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| What does the pubofemoral ligament check? | abduction
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| What does the ischiofemoral ligament check? | flexion and adduction
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| What happens to ALL of the ligaments in standing? | ALL are TIGHT!
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| What happens to the ischiofemoral lig. in the LPP? | unwinds and checks flexion then
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| What force do the H-A-T place on the spine? | axial
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| What force is exerted on the SI joint from up and down forces? | shear (convoluted)
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| How many degrees are there of nutation(flexion) and counternutation(ext.) at the sacrum? | 7*
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| Flexion ROM at hip | 120
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| EXT ROM at hip | 20
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| ABD ROM | 45
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| ADD ROM | 25
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| IR at 90* hip flexion | 40
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| ER at 90* hip flexion | 45
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| where does psoas attach? | femur and spine?
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| where does iliacus attach? | ilium
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| Hip arthritis is indicated with | capsular pattern of restriction (not symm.)
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| What is the role of the iliopsoas at the hip? | influence hip motion... may cause back pain if weak
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| What does the lumbar spine do during Ant. Tilt? | extend
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| What does the hip do during Ant. Tilt? | flex
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| What direction does the ASIS point in Ant. Tilt? | down
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| Ant. Tilt may be indicative of what lumbar spine condition? | Lordosis
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| What does the lumbar spine do during Post Tilt? | flex
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| What does the hip do during Post Tilt? | extend
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| What direction does the ASIS point in Post. Tilt? | UP
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| Movement of the sacrum is in how many directions? | 3 dimensions
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| Unilateral pelvis are what axis? | oblique, superior R=forward, inferior L=back
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| Are all the muscles active simulatenously? | YES
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| What is the role of piriformis at 0* | ER
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| what is the role of piriformis at 90* | IR
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| Synergy= | redundancy
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| what are the 3 bursa of the hip | trochanteric, iscial, iliopectineal
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| What is the iliopectineal bursa do? | acts as a pulley over which psoas and iliacus run
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| What is an acetabular dislocation? | a fx that did not occur
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| what is hip tendinitis? | cumulative trauma or strain on muscles/tendons
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| hip oa results from? | aging: 60^, incidious onset(~6 mo's worse n worse),
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| where will hip oa pain be felt? | groin= medial, centralized, lateral hip pain is rare!
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| Rheumatoid arthritis differs how? | may affect many other joints, widespread, bilateral hips, hands, shoulders, knees (may be uni.)
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| high impact hip fractures | MVA, must remain stable (NWB), do not mobilize unstable fx's, acetabular fx
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| what is the rehab for a high impact trauma fx? | mobility, motor controlled function over that limb
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| how is a fx fixed? | through the posterior aspect, slash through glutes= motor implications
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| how long should an individual typically remain NWB with a fx? | ~6-8 wks depending where the fx occurred
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| what are the 3 most common places for an osteoporosis fx to occur? | neck, intertrochanteric, subtrochanteric
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| which out of the 3 or the 2 MOST LIKELY places for a fx to occur? | neck and intertrochanteric
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| High energy dislocations are associated most with: | adults, MVA, ^ trauma, ant. or post.
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| Low energy dislocations are associated most with: | under 15 y/o, usually posterior, IR and shortened=skeletal immature, leg short= slip superior
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| congential dislocations are associated with: | infancy= hip dysplasia(femur/socket), corrected with ER
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| Post hip arthroplasty precations: | DO NOT: add. past midline, IR, cross leg, flex past 90*
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| legg calve perthes | bony abnormality, males, 3-5 y/o, temp. avasc., spontaneous regain blood flow, can be miserable
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| Acquired: Slipped capital femoral epiphysis | most common: overwt. adoles. boys, bilat, growth plate pops loose
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| how do you treat slipped capital femoral epi.? | NWB ~8wks, if reduced/screw= less time NWB, perform slide board transfers
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| Labral tears are common in who? | dancers, hockey goalies=butterfly stance, sports,
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| True or false: OA and labral tears are commonly seen in parallel? | TRUE, high finding for THA later in life
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| what happens to the synovial fluid that leaks during a tear? | gets reabsorbed, but there is less lubrication now
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| Muscle Strains at lesser trochanter | psoas: avulsion=will bleed, blood may calcify (MYOCYITIS OSSIFICANS)
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| muscle strains at ASIS | sartorius: soccer players
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| muscle strains at AIIS: | RF: soccer, runners
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| where do hip contusions commonly occur and to who? | g. trochanter, iliac crest...lose ALOT of function! football players...must Tx from the immobilization
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| Tendinitis: | ITB=3D= run over g. trochanter= FRICTION! hip flexors=psoas=hypomobile
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| What happens if psoas is hypomobile? | shortened position results in active insufficiency
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| where might psoas pain be felt? | ant hip from repetitive actions, pain in back
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| True or False: Sagittal plane changes to the ITB may affect the frontal plane? | true!
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| What are the 3 cause of hip bursitis? | progressive, mechanical, night pain
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| What is the cause of night pain bursitis? | ischemic in nature= bad blood flow to the area
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| What is the cause of mechanical hip bursitis? | muscles over the bursa, contusion to bursa= ext. force
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| true or false: a sprain is liekly with the joint capsule? | FALSE!
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| Inguinal Ligament sprains: | hip or ligament, mobility can become problematic, hernias, bones are not static (slight flex.)
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| Where would you 'poke' for Piriformis Syndrome? | gluteal fold--> popliteal space. no pain=no sciatic nerve problem
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| What nerve would a tight piriformis restrict? | sciatic
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| how much of the sciatic nerve pierces the piriformis? | 15-30%
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| what age/gender does legg calve perthes typically affect? | boys 3 to 12 y/o
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| How specific is groin pain (posterior or lateral) for OA? | 92%---RULE IN!
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| What might snapping or popping of a tendon in the hip indicate? | snapping= psoas over the iliopectineal bursa
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| 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
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| how might running irritate a bursa? | ITB runs over the intertrochanteric bursa= bursitis
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| Hip OA may be provoked by squatting(flexion), how sensitive is this? | 76% sensitive...no pain with squat? no OA
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| Do the numbers on Metric tests always correspond to goals? | NO!.... functional questions help to write the goals! ACTIVITY is the GOAL!
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| how might the hip affect the back? | through hypomobility
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| Lurches may involve: | abductor: glute med.
extensor
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| What happens in lordosis? | posture of apathy= in ext. you hang on your Y bigelow (iliofemoral lig)... glute max= weak, abdominals= lengthened
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| OKC flexion with lateral pain is how specific for OA? | 82% specific... you can rule it in!
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| OKC abd/add with groin pain is how specific for OA? | 94% specific...rule in!!!
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| 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!
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| Lumbar spine motions couple with: | force couples with the pelvis
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| No ext. in hip? | work through spine!
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| none in spine? | work through hip
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| FABER test: SN and SP #'s | SN= 60%, SP= 18%
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| SCOUR test: SN and SP | SN= 62%, SP= 75%
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| FADIR test: SN and SP | SN= 78%, SP= 10%
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| Ant. Labral test: SN and SP | SN= 75%, SP=43%
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| Will an acetabular labral test show up on a plain MRI? | NO! use MRI arthrogram= better resolution
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| Bone scan is good to see: | stress fracture (through isotopes), necrosis
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| what is a DXA scan used for? | osteoporosis= bone density= GOLD STANDARD!
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