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Terms in this set (76)
What muscle attaches to the trochanteric fossa?
What is the angle of inclination? Normal values?
Frontal plane angle between the femoral neck and femoral shaft
Optimizes alignment of the joint surfaces
Normal: birth (165-170), adult (125)
What is coxa vara?
a change in the normal angle of inclination, markedly less than 125*
Makes the leg "shorter"
What knee alignment would you see with coxa vara?
What are the positive consequences of coxa vara?
Increased moment arm for hip abductor force
Alignment may improve joint stability
What are the negative consequences of coxa vara?
Increased bending moment arm increases bending moment; increases shear force across femoral neck
Decreased functional length of hip abductor muscles
What is coxa valga?
A change in the normal angle of inclination, markedly greater than 125*
Makes the leg "longer"
What knee alignment would you see with coxa valga?
What are the positive consequences of coxa valga?
Decreased bending moment arm; decreases bending moment; decreases shear force across femoral neck
Increased functional length of hip abductor msucle
What are the negative consequences of coxa valga?
Decreased moment arm for hip abductor force
Alignment may favor joint dislocation
What is femoral torsion? Normal values?
Transverse plane twist of the head and neck of the femur on the shaft
Optimizes the alignment and congruence of the joint surfaces
Normal values: infant (40
), adult (15
What is excessive anteversion?
Markedly more than 15* of anteversion
Hip PROM: MR > LR
Alignment: femoral MR
Excessive anteversion increases the likelihood of what?
Increased joint contact stress
Increased wear on articular cartilage or acetabular labrum
What are compensations to correct foot alignment in excessive anteversion?
Lateral tibial torsion
What is retroversion?
Less than 15* anteversion
Hip PROM: LR > MR
Alignment: femoral LR
What are compensations to correct foot alignment in retroversion?
Medial tibial torsion
What does Craig's test check? Normal values?
Degree of anteversion
Normal: 15* MR
What is the center edge angle? Normal values?
Extent to which the acetabulum covers the femoral head in the frontal plane
Normal adult: 25-35*
What does a low center edge angle mean?
Reduced coverage of femoral head
Increased risk of dislocation
Less contact area
What does a high center edge angle mean?
Excessive coverage of femoral head
Increased risk of impingement
Pincer vs Cam Impingement
Pincer impingement- greater center edge angle
Cam impingement- decreased head-neck offset
What is acetabular anteversion? Normal value?
Extent to which the acetabulum faces anteriorly and thus surrounds the femoral head
Normal adult: 20*
What does excessive acetabular anteversion mean?
The acetabulum is facing more anteriorly than it should
Risk of subluxation or dislocation
What does retroverted acetabulum mean?
Acetabular angle is close to 0 or negative (facing more posteriorly than it should)
Creates abnormal stress on joint surface
Acetabular capsule is thickest where? Thinnest?
Most common dislocation or acetabular capsule?
Acetabular capsular pattern?
flexion, abduction, MR
When is iliofemoral ligament taut? Located anterior or posterior?
Taut in extension, ER
When is pubofemoral ligament taut? Located anterior or posterior?
Taut in abduction, extension, ER to a lesser degree
When is ischiofemoral ligament taut? Located anterior or posterior?
Taut in IR, especially in abduction; slightly taut in extension
Close-packed position of the hip?
Full extension, slight IR, slight abduction
Position of decreased accessory motion and maximum tension on capsular ligaments
Position of greatest joint congruency in hip?
90* flexion, slight abduction, slight ER
Open-packed position of the hip?
15* flexion, abduction, lateral rotation
Center of rotation of hip joint?
Near femoral head
Vertical axis (IR/ER)
What plane do hip flexion/extension occur in?
Hip flexion ROM
120* with knee flexes
70-80* with knee extended
Hip flexion arthrokinematics
Hip flexion muscles involved?
Hip flexion limitations?
Knee extended: hamstrings
Knee flexed: posterior and inferior joint capsule, glut max, soft tissue
Hip extension ROM?
20* with knee extended
0* with knee flexed (passive insufficiency of the quads)
Hip extension arthrokinematics?
Hip extension muscles?
Hip extension limitations?
Knee extended: iliofemoral ligament, anterior joint capsule, iliopsoas
Knee flexed: rectus femoris
Anterior pelvic tilt force couple ?
Hip flexion (iliopsoas, sartorius)
Lumbar spine extension (lordosis) (erector spinae)
Posterior pelvic tilt force couple?
Lumbar spine flexes (rectus abdominis, external oblique)
Hip extends (gluteus maximus, hamstrings)
Anterior pelvic tilt force couple mechanics in straight leg raise?
Rectus abdominis generates strong posterior pelvic tilt to neutralize strong anterior pelvic tilt exerted by hip flexors (normal)
Rectus abdominis weak; strong anterior pelvic tilt from hip flexors when unsuccessfully attempt straight leg raise (back arches up from ground)
Hip Abduction ROM, arthrokinematics, muscles, and limitations
open chain- superior roll, inferior glide
Muscles: Glut med and glut max
Limitations: adductor muscles, pubofemoral ligament
Hip Adduction ROM, arthrokinematics, muscles, and limitations
open chain: inferior roll, superior glide
Muscles: adductor muscles
Limitations: abductor muscles
Hip medial rotation ROM, arthrokinematics, muscles, limitations
Arthrokinematics: anterio roll, posterior glide
Muscles: IR muscles
Limitations: ischiofemoral ligament, ER muscles
Hip lateral rotation ROM, arthrokinematics, muscles, limitations
Arthrokinematics: posterior roll, anterior glide
Muscles: ER muscles
Limitations: pubofemoral ligament, IR muscles, iliofemoral ligament
Anterior pelvic tilt arthrokinematics and force couple
Force Couple: hip flexors, erector spinae
Posterior pelvic tilt arthrokinematics and force couple
Force Couple: hamstrings, abdominals
Pelvic rotation in sagittal plane does what motions?
anterior/posterior pelvic tilt
Pelvic rotation in frontal plane does what motions?
Closed chain hip abduction/adduction
Aka lateral/medial tilt
Closed chain hip abduction arthrokinematics
superior roll, superior glide
Closed chain hip adduction arthrokinematics
inferior roll, inferior glide
Pelvic rotation happens in what plane?
Closed-chain hip medial rotation arthrokinematics
anterior roll, anterior glide
Closed-chain hip lateral rotation arthrokinematics
posterior roll, posterior glide
Adductor Longus- hip extensor vs hip flexor
In flexion, acts as extendor
In extension, acts as flexor
Between 40-70*, loses ability to extend as force runs through the AOR
Piriformis- internal vs external rotator
In flexed hip, acts as internal rotator
In extended hip, acts as external rotator
Hip Extension- faulty movement pattern and muscle imbalance
Movement pattern: anterior displacement of femoral head
Muscles: dominance of hamstrings over glut max; shortness of TFL/ITB
Hip Abduction- faulty movement pattern and muscle imbalance
Movement pattern: associated with femoral MR and flexion
Muscles: dominance of TFL over gluteus medius
Hip Rotation- faulty movement pattern and muscle imbalance
Movement pattern: femoral medial rotation
Muscles: dominance of medial rotators over lateral rotators
Opposite side hip drop
May or may not include pain
Gluteus Medius Lurch
Weak abductors (glut med/min)
Shift trunk over weak side to place center of gravity over hip joint
Cane goes on opposite side
Gluteus Maximus Lurch
Weak hip extensors (glut max)
Shift trunk posteriorly (center of gravity moved posteriorly to joint to obtain extensor moment at hip; rely on ligaments instead of muscles)
Hip Dislocation- types and risk factors
Can be congenital or traumatic
Congenital- may cause an abnormally shaped acetabulum or proximal femur, increasing dislocation risk
Traumatic- fibrous capsule is thickest ant/sup and thinnest post/inf (increases risk of dislocation)
Risk factors: steroid use, alcoholism
In children: Legg Calve Perthe disease
Wolff's law: the change in bone shape to match function
An imbalance between bone synthesis and resorption
Primary and secondary compressive group
Primary and secondary tensile group
Ward's triangle- vulnerable, common place for hip fractures in geriatrics
Deterioration of articular cartilage
Risk factors: changes in bony shape and distribution of forces, age, sex, obesity, joint injuries, genetics
Deep hip/groin pain
ROM loss in capsular pattern (flexion, abduction, MR)
Acetabular Labral Tears
Females > males
Ant. groin pain, clicking, catching, buckling sensation
Anterior > posterior > superior or lateral
Causes: idiopathic, trauma, sporting activities (require frequent rotation and end range movements), malformation of acetabulum or proximal femur, repetitive microtrauma
Slipped Capital Femoral Epiphysis
extreme limitations in hip medial rotation
What muscles attach to the lesser trochanter?
What gait deviations might you observe with weak hip abductors?
What is the frontal plane angle between the femoral neck and femoral shaft?
angle of inclination (coxa vara, coxa valga)
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