MF Hip Presentation Notes
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| What type of joint is the hip? | Multiaxial ball & socket joint
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| What forms the acetabulum? | Fusion of the ilium, ischium & pubis. Deepened by the labrum.
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| Compare the hip & shoulder | Hip is more stable & dynamic, less ROM; hip ligaments stronger
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| What comprises the innominate? | Ilium + Ischium + Pubis
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| Which directions does the acetabulum open? | Inferiorly, Anteriorly, Laterally
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| Which directions does the femoral head open? | Anteriorly, Medially, Superiorly
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| 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
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| More hip anteversion causes what? | Toeing in (hip IR)
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| Hip retroversion causes? | Toeing out (hip ER)
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| What ligament is the strongest of the hip? | Iliofemoral (Y ligament of Bigelow)
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| What motions does the iliofemoral ligament prevent? | Excessive extension. Also maintains upright hip posture.
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| Which hip ligament is the weakest? | Ischiofemoral
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| Which motions does the ischiofemoral ligament prevent? | Winds tightly on extension
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| Which motions does the pubofemoral ligament prevent? | Excessive abduction of the femur; also limits extension
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| All 3 ligaments limit what? | Internal Rotation
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| Resting Position of the Hip | 30 deg flexion & abduction; Slight ER
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| Closed Packed Position of the Hip | Extension, IR, Abduction
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| Capsular Pattern of the Hip | Flexion, abduction, IR > Extension, Adduction, ER
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| Hip Dysplasia occurs more often in whom? | Girls, Infants
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| Legg-Calve-Perthes occurs more often in whom? | 3-12 yo boys
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| Hip OA & femoral neck fx occur more often in whom? | Older population, women, usu 2ndary to osteoporosis
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| 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
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| Lateral hip pain is indicative of.... | IT band, meralgia paresthetica, lumbar n root pain, trochanteric bursitis
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| Posterior Hip pain is indicative of... | referred pain from L-spine; SI jt dysfxn; Hip extensorrotator m. strain
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| Clicking is common with what type of injury? | Labral Tears
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| Internal Snapping Hip | Iliopsoas tendon over lesser trochanter/anterior acetabulum; Iliofemoral ligament over femoral head; Iliopsoas bursal or capsular thickening
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| External Snapping Hip | Tight IT band; Glut max over greater trochanter; Trochanteric bursitis
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| Intra-articular Snapping Hip | Labral/ligamentum teras; loose bodies; capsular instability (laxity in hip)
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| Unremitting, long duration pain in the hip is | Possible yellow/red flag, esp if close to lower back or large nerve distribution area
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| What nerve pierces the piriformis in 12% of the population? | Sciatic N.
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| 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
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| Balance observations | Balance on single leg (eyes open, then closed)
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| Traumatic Posterior hip dislocation | Limb is shortened, adducted, medially rotated; greater trochanter is prominent
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| Anterior hip dislocation | Limb is abducted, laterally rotated; May be cyanotic or swollen
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| Intertrochanteric fractures | Limb is shortened & laterally rotated
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| Shortening of a leg... | Spinal scoliosis if present on only 1 lower limb; Shortening may be structural or functional
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| Anterior View | Abnormal bony contour difficult to detect; Swelling hard to see
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| Lateral View | Contour of buttock observed; Hip flexion deformity observed
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| Posterior View | Position of the hip & effect of this position on the spine; Hip flexion contracture may lead to increased lumbar lordosis
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| Exam- Active Movements | Flexion; Extension; Abduction; Adduction; IR; ER
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| End feel of Passive Movements | Flexion; Extension; Abduction; Adductoin; IR; ER--All have tissue approximation/stretch end feel!
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| Resisted Isometric Mvmts | Flexion/extension, Abd/Add, IR/ER of hip; Flexion/Extension of the knee
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| Patrick's Test aka Faber aka Figure-4 test | FABER= flexion, abduction, ER. Position = inability to lower leg; Possible SI involvement
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| Trendelenberg's Sign | Stability of hip abduction; Drop in OPPOSITE pelvis
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| Craig's Test for femoral anteversion | Birth- 30 deg; Adult- 8-15 deg; Pt lies prone & flexes knee
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| True Leg Length | ASIS to Medial Malleolus
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| Apparent Leg Length | Belly button to Medial Malleolus
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| Thomas Test | Supine, knee to chest, flatten L-spine; Rise in other leg at hip &/or knee extension &/or hip abduction
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| Ober's Test | IT band tightness; Stabilize hip while loweirng leg
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| Piriformis Test (FAIR test) | Flexion, Adduction, IR; sidelying, flex hip to 60 deg, knee flexed; Lower leg to increase symptoms
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| Peripheral Nerve Injury- Sciatic Nerve | L4-S3- Piriformis Syndrome
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| Peripheral Nerve Injury- Superior Gluteal N | L4-S1- Acute gluteal pain
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| Peripheral Nerve Injury- Femoral N. | L2-L4
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| Peripheral Nerve Injury- Obturator N. | L2-L4
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