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68 terms

KIN(2)-Hip and Thigh Osteology

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the hip joint is also referred to as the
coxofemoral joint
The coxofemoral joint consists of
acetabulum and femoral head
acetabulum
faces anterior, lateral and inferior so it is not in one plane. It contains the lunate surface
Lunate Surface
half moon shaped articular surface with cartilage that is thicker superiorly
what part of the joint is usually not weight bearing and what is there
the inferior portion with a small fat pad and ligament there
what part of the acetabulum is non articulating
the interior portion
transverse acetabular ligament
passes on the inferior portion of the head of the femur; encloses the inferior portion
ligamentum capitis femoris
the ligament to the head of the femur
the head of the femur faces
superior and anteromedial and does not mirror the acetabulum
zenith
the very top and primary weight bearing site where the thickest articular cartilage of the lunate is
ligamentum teres femoris
also called the round ligament; passes from the acetabulum and inserts into the fovea of the head of the femur; it brings blood supply before skeletal maturity
axis of rotation for abduction and adduction of the femur
anterior/posterior line through the head of the femur
axis of rotation for flexion/extension of the femur
medial/lateral line that passes through the center of the head
axis of rotation for internal and external rotation of the femur
a vertical line through the head of the femur that passes through anpther part of the femur and will change depending whether you are weight bearing or non-weight bearing
where in the proximal femur are there not as many cross-sections of arcades
the neck of the femur
iliofemoral ligament
a "y" ligament; attached to the ilium and then splits into a medial and lateral band. Altogether it checks extension; the lateral band checks adduction and external rotation; the medial band checks abduction and internal rotation
ishiofemoral ligament
passes from the ishium and inserts on the base of the femoral neck on the interthrochanteric line; this checks internal rotation and extension
pubofemoral ligament
passes from the pubic ramus and inserts on the base of the femoral neck; checks extension, internal rotation and abduction
zona orbicularis
a circumferential band around the femoral end of the capsule and pulls down tght around the femoral neck; functions as stability for the femoral head and prevents traction of the leg to keep the head in place
flexion PROM is checked by
stretch of the extensor muscles, posterior capsule and compression of the thigh/abdomen soft-tissue mass
extension PROM is checked by
stretch of flexor muscles and the 3 primary capsular ligaments
abduction PROM is checked by
stretching of the adductor muscles and pubofemoral ligament
adduction PROM is checked by
stretch of the abductor muscles and lateral band of the iliofemoral ligament; if the hip is flexed, it is limited by stetch of the posterior portion of the ishiofemoral ligament
external rotation PROM is checked by
stretch on internal rotator muscles, lateral band of the iliofemoral ligament and anterior pubofemoral
internal rotation PROM is checked by
stretch of the external rotator muscles and ishiofemoral ligament
acetabular labrum
an extension of the articular surface (cartilage) and a thickening of the interior capsule; will be pulled with a pull of the femur due to its "intimate" relationship with the proximal capsule
the margins of the attachments of the capsule are
inferior: transverse acetabular ligament; most distal on femur: intertrochanteric line and crest; most distal on the innominate bone: around the brim of the acetabulum
you want to keep the hip joint coapted because
it is the position of stability
what is always present to supply blood to the head of the femur
branches from the deep femoral artery->anterior and posterior circumflex arteries
before puberty what also supplies blood to the head of the femur
a second blood supply from the obturator artery->artery of the head of the femur
the more proximal to the head of the femur you get with a break the more of a chance you lose what
blood supply
femoral angulation
the obtuse angle of the femur and neck to the acetabulum that changes depending on our weight bearing
coxa valga
any angle of angulation 10-15 degrees larger than 125 degrees; the femoral head and neck are more vertical; usually a result of not enough weight bearing and is more unstable and susceptible for subluxations and dislocations
coxa vara
any angle of angulation 10-15 degrees less than 125 degress; the head and neck are more horizontal; associated with a break in the neck of the femur and is more stable but loss of ROM
as a young baby the acetabulum is more
horizontal
as a young baby the head and neck of the femur is more
vertical
in a normal adult the angle ot angulation is about
125 degrees
subluxation of the hip joint
partial loss of contact between the two articular surfaces
disloaction of the hip joint
complete loss of contact between the 2 articular surfaces
as you age your angle becomes
less mobile and more stable
where is the most common fracture site in the femur
at the epiphysis
normal torsion of the femur is
15-16 degrees of anteversion
anteversion
femoral head and neck is anterior where the trochanter is posterior
retroversion
femoral head and neck is more posterior where the tranchanter is more anterior
when we are born are we start our more what in respect to torsion
anteverted and move towards retroversion
if you are too vertical (inclination) what must you do to become more stable
you must abduct the legs
if you have too much anteversion what must you do to become more stable
you will have to internally rotate and abduction your legs
if you have too much retroversion what must you do to become more stable
you will have to externally rotate and adduct you legs
least-packed postion of the hip
flexion: 30 degrees; abdution: 30 degrees; slight external rotation
close-packed postion
maximal extension; max abduction and max internal rotation
how much flexion is required for normal ambulation
30 degrees
how much extension is needed for normal ambulation
10 degrees
how much abd/add, int/ext rotation is required for normal ambulation
5 degrees
PROM for flexion
knee flexed: 120 degrees; knee extended: 80 degrees
the best way to tell the position of the femur is
by looking at the patella
PROM for extension
knee flexed: 10 degrees; knee extended: 20 degrees
PROM abduction
40-45 degrees
PROM adduction
20-30 degrees
internal rotation
30-45 degrees
external rotation
30-45 degrees
capsular pattern of the hip
you will lose the motions that are restricted by the capsule the most first; internal rotation>extension>abduction>flexion>external rotation
position of dislocation
hip flexion, external rotation, adduction and then a blow to the knee
iliopsoas bursa
a piece of the synovium that protrudes between the two bands of the iliofemoral ligament ; it separates the psoas muscle tendon from the pubis and hip joint capsule
trochanteric bursa
on the greater trochanter of the femur beneath the gluteus maximun
ishial bursa
on the ishial tuberosity beneath the gluteus maximus
gluteofemoral bursa
between the gluteus maximum and vastus lateralis and is much smaller
during left hip hiking you get
left side innominate bone abduction and right side adduction to lift that side
during left side posterior rotation you will get (if the right side is stabilized)
you will get internal rotation of the hip on the contralateral side and external rotation on the ipsilateral side