DPT 642: The Hip

both

is the hip built for stability or mobility?

supports organs and muscles of the bowel, bladder and reproductive system

what is the function of the pelvis?

fovea

only portion of femoral head that is not protected/covered with hyaline cartilage

superior-anterior

region of the femoral head & acetabulum has the most developed cartilage

weight bearing demands

why does the superior-anterior region of the femoral head & acetabulum have the most developed cartilage?

superior-medial anterior

What is the orientation of the femoral neck?

inferior-lateral anterior

what is the orientation of the acetabulum?

anterior bowing

this feature of the femur is important for weight bearing, allowing it to dissipate forces

posterior

compression forces on the femur are dissipated in what direction

anterior

tensile forces on the femur are dissipated in what direction

external rotators

the greater trochanter serves as an attachment point for mainly these kind of muscles

frontal plane stability

muscles that attach to the greater trochanter have a major role in...?

helps maintain negative pressure

what effect does the suction effect between the acetabular labrum and femoral head have on the intraarticular space?

may help develop hip torque to help them flex their hip and help propel them. Keeps them stable and upright

how can a patiet with paraplegia use the iliofemoral ligament to their advantage?

pubofemoral ligament

Limits abduction and extension. Limits some external rotation

iliofemoral ligament or Y ligament

Limits external rotation and extension; consists of 2 bands

ischiofemoral ligament

Limits internal rotation and extension, some adduction

ligamentum teres

Connects femoral head to acetabulum

it is a conduit for blood supply to the femoral head

why is ligamentum teres critical to the pediatric population?

lumbar plexus (L2-L4)

innervation of the anterior compartment muscles

sacral plexus

innervation of the deep muscles

greater sciatic foramem

where the sacral plexus exits out of

sciatic nerve

largest nerve of the sacral plexus

piriformis

sciatic nerve occasionally passes through this muscle, causing compression of the muscle

anterior

primary hip flexors are located on this side

Iliopsoas complex, rectus femoris, tensor fascia latae, sartorius, pectineus, and adductors (depends on leg position)

name the primary hip flexors

slightly flexed

rectus femoris contributes to hip flexion most often when the knee is...?

Adductor brevis, gracilis, anterior fibers of gluteus minimus

name the secondary hip flexors

glutes and hamstrings

what are the primary hip extensors?

extension

the most effective way to target the hamstrings is to place the knee into....?

puts them into active insufficiency

when targeting the hamstrings, if the knee is flexed, what does this do to the hamstrings?

gluteus medius and some adductor magnus

secondary hip flexors

lateral

hip abductors are located on this side

gluteus medius and minimus and tensor fasciae latae

primary hip abductors

side lying leg raise

How would we assess the function of the hip abductors in a non-weight bearing position?

trendelenburg sign

hip drops towards side of weakness during gait; weight-bearing indication of weak abductors

medial

what side are the hip adductors located on?

adductor brevis/longus/magnus

primary hip adductors

gluteus maximus

hip external rotation is mainly controlled by which muscle?

piriformis, obturator internus/externus, superior/inferior gemelli and quadratus femoris

muscles that stabilize & contribute to hip external rotation

No

is any muscles primary action external and/or internal rotation?

tensor fasciae latae, adductor longus/brevis, pectineus and anterior fibers of gluteus medius and minimus

internal rotators of the hip are....?

Full extension, full internal rotation and slight abduction

describe closed-packed position for the hip

30 degrees flexion, 30 degrees abduction and slight external rotation

describe open-packed position for the hip

hamstrings

structures taut in hip flexion- knee extended

posterior and inferior capsule; gluteus maximus

structures taut in hip flexion- knee flexed

primarily iliofemoral ligament, anterior capsule, some fibers of the pubofemoral and ischiofemoral ligaments and iliopsoas

structures taut in hip extension- knee extended

rectus femoris

structures taut in hip extension- knee flexed

pubofemoral ligament, adductor muscles

structures taut in hip abduction

IT band, abductor muscles (TFL & gluteus medius)

structures taut in hip adduction

isciofemoral ligament, external rotator muscles (piriformis and gluteus maximus)

structures taut in hip internal rotation

iliofemoral and pubofemoral ligaments; internal rotator muscles (TFL and gluteus minimus)

structures taut in hip external rotation

angle of inclination

angle between shaft of femur through femoral neck

125 degrees

normal angle of inclination

hip stability

what does angle of inclination affect?

coxa vara

angle of inclination less than 125 degrees

improves joint stability, increases moment arm for hip abductor force

"positive" clinical implications of coxa vara

decreased function length of hip abductor muscles, decreased bending moment

"negative" clinical implications of coxa vara

sheer force across femoral neck, which puts them more at risk for injury

decreased bending moment in coxa vara increases...?

coxa valga

angle of inclination significantly more than 125

less sheer force across femoral neck, increases functional length of femoral muscles

"positive" clinical implications of coxa valga

decreases moment arm for hip abduction, favors joint dislocation and instability

"negative" clinical implications of coxa valga

version (torsion) angle

Angle formed between femoral neck and line distally bisecting femoral condyles in transverse plane

the amount of internal/external rotation ROM of hip

what does version/torsion angle significantly affect?

anteversion

excessive anterior placement of femoral neck in transverse plane.

inward toe pattern to increase hip stability

how would someone with anteversion appear to walk? why?

external rotation

in anteversion there is less...?

retroversion

excessive posterior placement of femoral neck in transverse plane.

decrease

does retroversion increase or decrease version angle?

increase

does anteversion increase or decrease version angle?

externally rotated to increase stability

how would someone with retroversion appear to walk? why?

internal rotation

retroversion may limit....?

acetabular coverage

take center edge angle (center of femoral head through center of acetabulum)

pincer acetabular impingement

Abnormal shape of acetabulum; More excessive coverage of acetabulum on femoral head and neck

Cam Acetabular Impingement

Abnormal shape of the femoral head; Femoral head is abnormally shaped and cannot rotate smoothly in the acetabular labrum

compact bone

dense; located along cortex of lower femoral shaft and entire shaft. Allows for larger shear and torsion forces

cancellous bone

porous, spongy/trabeculae structure. Elasticity allows for repetitive external forces

Wolff's Law

Bone will adapt to the repetitive mechanical stresses it experiences

Plays big role in patients who have bone density issues

spins

during hip flexion and extension, the femoral head ____ on the acetabulum

lateral, medial

during hip abduction, there is a ____ roll and _____ slide

medial, lateral

during hip adduction, there is a ____ roll and _____ slide

posterior, anterior

during hip external rotation, there is a ____ roll and _____ slide

anterior, posterior

during hip internal rotation, there is a ____ roll and _____ slide

hip hike

pelvic on femoral abduction

drop down from hip hike

pelvic on femoral adduction

planted pivot

pelvic on femoral internal/external rotation

anterior pelvic tilt

pelvic on femoral flexion

posterior pelvic tilt

pelvic on femoral extension

clinical applications of a straight leg raise

Psoas and rectus used

Rectus abdominis needs to engage to prevent anterior pelvic tilt

Weak abs increase lumbar lordosis

clinical implications of kicking a ball with the right foot

Right is more of femoral on pelvic adduction

Left is pelvic on femoral adduction

figure 4 stretch

how to stretch piriformis

don't have them round the spine- puts pelvis into posterior tilt

how to maximize the strecth in hamstrings?

Want to engage rectus abdominis and glutes on side stretched to prevent pelvic tilting

when streching quadsm what do you want to engage and why?

to distribute forces to other side and stabilize other side

why are canes used on the opposite side?

for center of gravity purposes to keep them upright

When carrying groceries, why should we have them carry bag on same side?

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