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Actions: Hip flexion. Origin: iliac crest lumbar vertabre discs and fascic. Insertion: Lesser Trocanter
Actions: Tailer sit Hip flexion knee flexion hip ADD and IR. Origin: ASIS. Insertion: superior medial tibia (pes anserine: Common insertion site for sartorius gracills and semitendonous)
ADDuctors (longus, brevis and magnus)
Actions: ADDuction. Origin: Pubis. Insertion: Lenia Asperia posterior femur
Actions: If hip is extended then ER if the hip is flexed then ABD. Origin: Anterior Sacrum. Insertion: Greater Trochanter
Hamstrings (all except short head of the biceps femoris)
Actions: Hip extension Knee flexion. Origin isial tuberosity. Insertion: superior tibia
Hip pointer pathology
Subcutaneous contusion caused by direct inpact to the iliac crest of ASIS that causes injury to the muscular attachments ( sartorius TFL ABS)
Hip pointer Expceted Sighs/symptoms
pain with the palpation of the ASIS of iliac crest. Limited AROM for side bending away and for trunk rotation bilateral. pt has pain with active hip flexion and is relucant to lift his/her foot on the affected side.
Hip pointer Treatment
Rest, ice, AROM of trunk and hip. Progress to strengthening the affected hip and trunk musculature. Time to recover depends on severity, but is usually 1-3 weeks.
Piriformis Syndrome (AKA- Sciatica)
"Sciatica" refers to burning pain down the posterior LE piriformis syndrome is one possible cause of sciatica. the sciatic nerve can be irritated as it passes underneath or through (10-15%) the piriformis. The most common cause is direct tramua to the butt.
Piriformis Syndrome (AKA- Sciatica) Expected signs/ symptoms
pt complains of deep buttock pain with burning pain down the posterior LE. There is pain with palpation of the sciatic notch. There is pain with passive IR of the hip in prone with resistance to hip ER in prone. Straight leg raise is limited. pt may walk with a shortened stride and lack of heal strike on the affected side.
Piriformis Syndrome (AKA- Sciatica) Treatment
Rest and modalities to decrease pain and inflammation. Pain-free stretching of hamstrings and piriformis.
Other possible cause of sciatica other than piriformis syndrome
Lumbra disk diease- does the pt also have low back pain? ischial bursitis. Injury to the hamstrings. Prolonged pressure from the edge of a chair on back of thigh.
there are 10-12 bursae in the hip region, with 3 in the area of the greater trochanter. These 3 are located near the insertion of the glute med, underneath the iliotibial (IT) band. Bursitis can be caused by direct tramua , or irritation from the IT band . The it band slides ant. and posteriorly over the greater trochanter during hip flexion and extension If the IT band creates a snapping sound as it glides over the greather trochanter, it is called snapping hip syndrome. Snapping hip syndrome can also be caused by other tendons gliding over bony prominences
Contributing factors for trochanteric bursitis
tight IT band running with the LE slightly adducted (running on the side of a crested road) increased Q angle leg length discrepancy crossing feet over midline while running.
Trochanteric Bursitis Expected signs/symptons
Patient reports deep, aching, diffuse lateral hip pain. Pt has pain with palpation of the greater trochanter. Pt reports pain with climbing stairs or rolling onto the affected hip. resisted hip ABDuction causes pain. pt may walk with a slightly abducted LW or shortened WBING phase (antalgic gait).
Trochanteric Bursitis Treatment
Rest, ice, stretching, iontophoresis or phonophoresis may be of benefit orthotics may be used to correct leg length discrepancy.
this bursae is located between the Glute max and the ischial tuberosity. Bursitis can be caused by direct trauma or prolonged sitting
Ischial Bursitis expected signs/symptoms
Palpation of the ischial tuberosity with hip flexed is painful. Pt has pain with uphill walking, climbing stairs or running.
Groin Or hip flexor strain
Injury to the ADDuctors, hip flexors ( sartorius iliospoas, rectus femoris) caused by forceful contraction or excessive stretch.
Groin Or hip flexor strain expected signs/ symptoms
Pt has pain and diffuclty with walking. Hip extension ROM is decreased and there is pain with resistance to hip flexion or ADDuction.
Groin Or hip flexor strain Treatment
Modalities for pain, inflammation and spasm. AROM, pain-free stretching and hip isometrics. Progression to resistive strengthening of hip flexors and ADDuctors. Length of rehab depends on severity- usually 2-3 weeks for a grade II strain.
Common injury with multiple causes, including a sudden, forceful contraction. pt may hear a pop develop bruising over the distal thigh. pt has pain with passive stretch or active contraction of hamstrings.
Caused by a sudden, forceful contraction or overstretch. Pt has pain with passive stretch or active contraction of the quadriceps.
Age of onset is 2-13 years old; more common in males. Usually a unilateral problem. Avascular nercosis of the proxmial femoral epiphysis. Caused is not well understood. Nercrosis causes flatting of the femoral head, which is visible on x-ray. There is a gradual onset of vague ache in the hip,thigh, and knee. Pt loses AROM of hip AB IT and extension. It is a self-limiting condition that lasts 2-5 years. Treatment includes bracing in an abducted and internally rotated position to decrease focal loads on the femoral Head. Can cause premature osteoarthritis in adulthood.
Slipped Capital Femoral Epiphysis
Most common hip disorder in adolescents. Onset in males is age 10-17. Onset in femailes is age 8-15. More common in males and is usually unilateral. Shear stress from weightbearing causes displacement of the proximal femoral epiphysis which can be seen on x-ray. Cause may involve an imbalance between the sex and growth hormones which weakens the epiphyseal plate. pt has vague pain at the hip, thigh and knee. AROM is limited in hip ABD IT flexion. In chronic cases, patient has a trendelenburg gait. Treatment includes internal fixation to prevent further slipping. Causes premature osteoarthritis in adulthood.
Nondisplaced or minimally displaced femoral neck fractures
considered to be the least severe type of hip fracture. treated with ORIF. patients usually have full wbing and no restrictions after surgery.
Displaced femoral neck fractures
blood supply to the femoral head is usually damaged, so it is unstable to heal. Most require a hemiarthoplasty or total hip replacement. These pts will have ROM restrictions after surgery.
Intertrochanteric hip fractures
Treated with ORIF. Even with IF, there is risk of displacement with WB. Therefore, pts are non-wbing or toe-touch after surgery. This places the pt at increasted risk for complications.
Hip fracture treatment after surgery.
Pts are gotten out of bed, if possible the first day after surgery. they are transferred to a chair for upright sitting as tolerated to reduce the risk of complications. pts are instructed in ankle pumps; 10-20 repetitions, every 30 minutes. There are multiple benefits to this exercise, but the most important reason is to prevent DVP and potentially deadly embolism. Other exercises include AAROM/AROM for LE's and isometric hip and knee strengthening. Pts may be given theraband to exercise the UE's while in bed. Most pts will ambulate with a FWW. Unless there are complications pt will transfer to a SNF after 2-3 days. pt are sent home after 1-2 weeks if they are independent with transfers bed mobility ambulation with assistive device. If homebound, the pt will receive home health care after discharge. Other wise, the pt will go to outpatient therapy.
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