Intro to exercise physio exam 4

What is the hip complex made up of

pelvis and proximal

What is the pelvis made up of

os coxae- ilium, ischium, pubis

What is the acetabulum

the junction of the ilium, ischium, and pubis, with 80% of the area occupied by the ilium and ischium and 20% of the area occupied by the pubis (cant see the articulations)

What is the femur

the largest and strongest bone of the human body, convex (subtle for stability and mobility)

How does the femoral head articulate with the aceatbulum

projects superiorly, medially and anteriorly

What is the acetabular femoral joint

head of the femur and acetabulum (hip joint), synovial, ball and socket joint, wide range of motion potential

How is the acetabular femoral joint stable

bony architecture (how they fit together), strong ligaments, large supportive muscles (stability and mobility depend on bone congruency, problem to these causes hypermobility)

What is the function of the acetabular femoral joint

bear (body) weight, locomotion

What is the sacroiliac joint

SI joint, produce torsinal movement, stability

Is there a lot of connection between the acetabulum and the head of femur

no have a cuff of ligaments

What is pubic symphisitis

inflammation of the pubic symphysis, common in track and field athletes, excessive movement, mylige change, corticosteroid shot, leg length discrepancy

What is pubic symphysis

looks fiberous forms joint between pubic bones, depends on age of skeleton, older looks fibrous

What is the ilium

the largest hip bone and forms the superior part of the acetabulum, prominent bony landmark, q angle (crest), can palpate the crest to estimate body composition

What is the ischium

forms the posteroinferior part of the hip bone as well as the posteroinferior part of the acetabulum

What is the pubis

forms the anteromedial part of the hip bone as well as the anterior part of the acetabulum

What are seen in the acetabulum

concave fossa secures the head of the femur, acetabular labrum, lunate (hyaline) cartilage, fat pad for shock absorption

What is the lunate cartilage

thick and supportive, crescent shape, important because of weight bearing

What is the fat pad

adheres to pelvic bones

What are similarities between the hip and shoulder

both have concave fossa and a labrum

What are differences between the hip and shoulder

hip has lunate cartilage, fat pad, intrinsic stabilizer

What are the types of pelvises

android, gynecoid, anthropoid, platypelloid

What is an android pelvis

male, narrower hip posture

What is the gynecoid pelvis

females, childbirth, wide hip posture

Can you have both android/gynecoid and anthropoid/platypelloid pelvis

yes

What are anthropoid and platypelloid pelvises

ethnic differences, genetics

What can you see when bipedals (humans) are compared to quadrupeds (animals)

the diagonal disposition of the femurs recenters support directly inferior to the trunk which imporves standing and walking (we are set up for speed and center weight on knees)

Narrow pelvis = what

faster

How is the central weight of the body divided and directed

laterally by the bony arch formed by the sacrum and ilia

The sacrum and ilia transfer weight where

femurs

The pubic rami form what

struts which maintain the integrity of the arch

Pubic symphysis and pubic bones are responsible for what

stability translating to mobility potential

How does the pelvis divide the weight

to left and right femurs

Pelvis is what type of structure

dome like, if fx pubic bones can reduce integrity and may be bed ridden for life

What does the head of the femur have

fovea for the ligamental teres (intrinsic stabilizer, can have an absence of it)

The femur shaft is normally what

bowed (convex) anteriorly

What is the angle of inclination

it decreases with age, angle that is made from the neck of the femur and long axis of shaft

What is the q-angle (quadriceps angle)

measured between a line from the anterior superior iliac border to the middle of the patella and the projection of a line from the middle of the patella to the tibial tuberosity

What is the q angle range in females

15-17 degrees

What is the q angle range in males

10-14 degrees

Do male or females have the more optimal q angle for optimal quadriceps femoris muscle function

males because quadriceps femoris muscle function is optimal with an angle closer to 10 degrees (valgus)

What does an increased q-angle cause

pronated foot and it puts valgus stress on the knee

Can a q angle be negative

yes

Are women or males more susceptible to acl and meniscus tears

women because of q angle

What is genu varum

small or negative q angle, more common in males (knees outward)

What is genu valgum

q-angle >17 degrees, more common in females (knees together, L shape from hip to knee to ankle)

Large q-angles (genu valgum) may increase the chance for what

patella tracking laterally within the femoral groove (more in females, wears away cartilage on patella, women more likely dislocates knee)

Patella tracking along with repetitive high magnitude loading increases risk for what

chondromalacia patella, osteoarthritis, overuse injuries, patellofemoral syndrome

Pelvic width and femur length (not gender per se) may cause what

“differences” we see in pathologies by sex

Measurement of q-angle with surface goniometry is what

reliable and precise when quadriceps femoris muscles are contracted and hip, knee, and foot rotations are stringently controlled in relatively lean adults

What are hip complex pathologies

total hip arthroplasty, fx, femoroacetabular impingement, labral tears, ligamentum teres lesions

What is total hip arthroplasty

surgical replacement of acetabulum and femoral head with a (titanium alloy) prosthesis

How many total hip arthroplasty are done each year in the US

approximately 544,000 more commonly with women (lower bone mineral density, fx of femoral neck), mean age 68 years

What are rehabilitation cautions with total hip arthroplasty

against extreme ROM movements, strength training, and other function training (gait), want early rehabilitation

What is a hip fx most likely

femoral neck fx

Why do hip arthroplasty

osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, avascular necrosis, childhood hip disease

What is osteoarthritis

most common, can be extreme, older pts, most common for hip arthroplasty

What is rheumatoid arthritis

autoimmune disease, immune response, young and old pts, fingers, wrist, destroys cartilage and bone

What is post traumatic arthritis

football, make sure joint is good to go before returning because if its not the risk increases for arthritis

What is avascular necrosis

tissue death, fx of femoral neck cause restricted blood flow to head and acetabulum

What is childhood hip disease

dwarfism, calcium disease

What is the second most common reason for a hip arthroplasty

hip fx

What is the 3rd most common reason for a hip arthroplasty

revision surgery (had surgery but something went wrong)

What is the arthroplasty procedure

damaged femoral head removed, replaced with metal stem placed into the hollow center of the femur. Stem may be either cemented or “press fit” into the bone. Metal or ceramic ball is placed on the upper part of the stem. Ball replaces damaged femoral head. Damaged cartilage surface of acetabulum removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. Plastic, ceramic or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface

Why is part of a hip prosthetic rough (below femoral neck)

allows bone to stick to it

What are complications with hip arthroplasty

infection, blood clots, leg length inequality (leg length is sometimes done purposely, orthotics, can fix leg length discrepancy), dislocation, osteolysis (breakdown of bone), implant wear, have to take antibiotics before going for dental work because worried about infection

Is dislocation common with hip arthroplasty

no its uncommon but increased risk in the few months following surgery because it hasn’t healed yet and the tissue is still soft

What are fxs of the hip

femoral neck and intertrochanteric

What is a femoral neck fx

common among older adults and can be related to osteoporosis. May restrict blood supply to femoral head, worse because it can cause avascular necrosis

What is an intertrochanteric fx

does not interrupt bone blood supply, may be easier to repair

What are femoroacetabular impingement

pincer, cam (may have both at same time), abnormal bone shape, dull hip/groin pain, have limited ROM (same sx as labral tear)

What is pincer impingement

(extra) bone extension, crushed labrum, pinched

What is a cam impingement

bumpy, non-round femur head grinds acetabular cartilage

What is a hip labrum tear

direct trauma, repetitive stress (external rotation, be in constant pain that wont get better), frequent cause of anterior hip, groin pain which often goes undiagnosed. pts often seen by multiple health care providers before diagnosis, excessive ROM

How are hip labrum tears diagnosed more frequently

becuase of improvements in MRI, arthoscopy

How to fix a hip labrum tear

debridement surgery, doesnt grow back to 100% but can a little

What are ligamentum teres lesions

once thought to be a vestigial (left over, evolutionary), similar to knee ACL, a strong intrinsic stabilizer that resists joint subluxation forces (some people have ligamentum teres and others dont, a blood vessel runs through it to supply head of femur but very little blood supply)

Abnormalities of ligamentum teres lesions account for what

4%-15% of sports-related injuries and should be considered in the differential diagnosis of pt with hip pain (1 in 5)

Patients with a torn ligamentum teres develop what

subtle hip instability (microinstability). aggravated by running, football, and tennis activites which may damage labrum, cartilage causing ligamentum teres lesion (tear with torsional force)

How to treat ligamentum teres lesions

debridement, radiofrequency ablation

What is radiofrequency ablation

like debridement but not invasive, external, uses heat

What condition of the ligamentum teres is shown

partial tear (watch and see)

What condition of the ligamentum teres is shown

complete tear

What condition of the ligamentum teres is shown

degenerative fraying or injury (older pts, brown spot is lesion or bone spur)

What condition of the ligamentum teres is shown

avulsion fx

What condition of the ligamentum teres is shown

congenital absence

What is the knee

largest and most superficial joint (complex) in the body. Like the hip it is a diarthrodial joint, synovial, (primarily) a hinge joint, mostly closed chain- multi joint, soft tissue dependent

What makes the knee vulnerable to injury

weight bearing + locomotion causes stress, strain, compression, torsion

What bones make up the knee

femur, tibia, patella

What are the articulations of the knee

tibiofemoral, patellofemoral, proximal tibiofibular (patella does not articulate with tibia)

What does the tibia and fibula have

interosseous membrane allowing it to function as a single bone or as 2 bones with rotational/torsional

What is the intercondylar notch

space for ACL and PCL, sex differences larger and wider in males, narrower can contribute to ACL and PCL tears

What is the femur for the knee

most proximal part of the knee is the distal part, has articular cartilage, femoral condyles (lateral, medial), intertercondylar notch (A and U shapes) and anterior cruciate ligament injury

The medial tibial plateau is slightly what

concave, larger contact area, thinner articular cartilage but higher incidence of osteoarthritis (after meniscus injury) on the lateral side

What does the meniscus do

allows femur to fit into tibia

What is the patella

largest sesamoid bone in the body, embedded within extensor mechanism (tendon/ligament), anterior surface is convex, posterior articular cartilage ranges from 1 mm- 5-7 mm thick (peripheral → central, thin → thick ← thin)

What are the knee ligament categories

external (extracapsular), internal (cruciate)

What are the external ligaments of the knee

patellar, fibular collateral, tibial collateral, oblique popliteal, arcuate popliteal

What are the internal ligaments of the knee

anterior cruciate, posterior cruciate (both are susceptible to torsanal force, usually pretty strong, instability in knee), menisci, tendon of popliteus

What is the screw home mechanism

external tibial rotation (10 degrees) that occurs during the last 20 degrees of knee extension, locks the knee (tibial rotation), terminates when medial and lateral condyles lock to form closed-packed position of the knee joint, during flexion from full extension, the knee “unlocks” by the tibia rotating internally, unlock is good for mobility, lock is good for stability

What are knee pathologies

cruciate ligament injuries, tears, injuries to the meniscus, patellar dislocations, patellofemoral syndrome, popliteal (baker) cysts, knee replacement