Hip and Pelvis

bones of hip

pelvis and femur

important associated articulations

lumbosacral, sacroiliac, pubic symphysis, hip joint, sacrococcygeal

pelvis composed of

ilium, ischium, pubis

ilium

wings of pelvic bone

ischium

inferior portion of pelvic bone (part you sit on)

pubis

composed of a body and 2 rami

-pubic symphysis: articulation of 2 pubic bones

important function of pelvis

protect important organs

attachment site for LE muscles

transmits forces

sacroiliac joint

composed of sacrum and 2 ilia, reinforced by ligaments

sacroiliac joint purpose

stress relief and load transfer, diarthrosis but changes throughout life

sacroiliac joint motions

reported 2-3 degrees of freedom: nutation and counternutation

nutation

anterior rotation of pelvis relative to fixed sacrum

counternutation

posterior rotation of pelvis relative to fixed sacrum

Acetabulum

hip socket, articulates with femoral head, three bones of pelvis make up acetabulum

acetabulum labra

Makes joint surfaces fit better; encircles head of femur

acetabular fossa

fat pad, proprioceptors, synovial fluid reservoir

round ligament

inside hip socket that helps joint fit better and has an artery that supplies blood to femur

angle of inclination

The angle between the shaft and the neck of the femur in the frontal plane, provides optimal alignment of joint surfaces

normal angle of inclination

120º-130º

coxa vara angle of inclination

less than 120º

coxa valga angle of inclination

greater than or equal to 130º

torsion angle of femur

The angle at which the Head and Neck of the Femur are turned relative to the Femoral Condyles when looking down the Long axis of the Femur

normal torsion angle

10-15 degrees anteversion

excessive anteversion

angle is greater than 15º

retroversion

angle is less than 15º

motions of hip on fixed femur

anterior/posterior pelvic tilt

lateral tilt

protraction/retraction

motions of hip on fixed pelvis

flexion/extension

abduction/adduction

internal/external rotation

anterior pelvis tilt causes what at lumbar spine

increase lordosis

posterior pelvis tilt causes what at lumbar spine

decrease lordosis

anterior hip ligaments

iliofemoral and pubofemoral: providestability and reinforce joint capsule, limits extreme movement

iliofemoral

from AIIS and acetabulum, holds head of femur into socket; strongest ligament, primarily limits extension and hyperextension

pubofemoral

from pubis and acetabulum, limits extension, abduction, and lateral rotation

posteiror hip ligaments

ischiofemoral

ischiofemoral

from acetabular rim/labrum to femoral neck

-limits medial rotation, extension, abduction, hyperflexion

lumbar plexus

L1-L4, some continue to T12

-muscles of anterior thigh, hip, and some abdominals

sacral plexus

S2-S4, continue from lumbosacral trunk

-musles of posterior hip & thigh, pelvis & reproductive/urinary, lower leg & foot

anterior hip flexors

iliopsoas, sartorius, tensor fasciae latae, rectus femoris, hluteus medius, fluteus minimus, pectineus, and adductor longus brevis and magnus

posterior hip extensors

gluteus maximus, biceps femoris, semitendinosus, semimembranosus, gluteus medius

-when hip is flexed: adductor magnus and longus bring back to neutral

hipp adductors

pectineus, adductor brevis, adductor longus, adductor magnus, gracilis, gluteus maximus

hip abductors

gluteus medius, gluteus minimus, tensor fascia latae

-tailor sit muscle: sartorius

-when hip is flexed: piriformis brings back to neutral

hip abductors are isometrically acitve to

prevent lateral tilt of pelvis

hip abductors enable

stand on one foot in stable manner

hip internal rotators

tensor fasciae latae, gluteus medius, gluteus minimus, pectineus, adductor brevis, adductor longus, adductor magnus, gracilis

Hip External Rotators

gluteus maximus, gluteus medius, illiopsoas, biceps femoris, sartorius (tailor sit)

6 deep external rotators

piriformis

quadratus femoris

superior gemellus

inferior gemellus

obturator internus

obturator externus

two joint muscles of hip

rectus femoris, sartorius, TFL, gracilis, hamstrings

hip fracture

common in women over 65

primary factors of hip fracture

age related osteoporosis and higher incidence of falling

hip fracture possible results

death-systemic problems and hospitilization; avascular necrosis

osteoarthritis/degenerative joint disease

can cause dysfunction of hip

deterioration of joint's articular cartilage

wear and tear or trauma/congenital deformity

OA/DJD signs

pain, synovitis, loss of joint space, muscle atrophy, hypertrophic bone formation, reduced ROM, abnormal gait

total hip arthroplasty

indicated when person has hip disease w/ contsant pain that significantly limits function and quality of life

THR posterolateral precautions (MOST COMMON)

NO - hip flexion past 90º, excessive adduction, internal rotation

anterior THR precautions

NO- excessive abduction, extenral rotation, hyperextension

failure to observe precautions

can result in dislocation 6-8 wks

use of walker

turn in stages

little at time

don't twist body

taking a bath after THR (tub seat)

back up to seat

extend affected leg

slowly lower body

lean back when lifting leg into tub

long handled sponge to wash feet

THR impact on function: in/out of bed

avoid flexion and rotation, firmer mattress is better, may need leg lifter in beginning

THR impact on function: self-care (dressing)

long handled reacher and shoe horn, sock aid, elastic shoe laces, need equipment for putting on pants, socks, and shoes

THR impact on function: homemaking

reacher to pick up objects from floor

THR impact on function: getting into lower cabinets

one hand holds onto stable surface, extend involved leg bckwds to bend trunk fwd to reach lower shelves

Developmental dysplasia of the hip AKA

congenital hip dislocation

congenital hip dislocation

abnormal placement of femoral head in acetabulum, most common congenital skeletal dysfunction

congenital hip dysplasia is most common in

common in firstborn females, those born in breech, runs in families

Congenital Hip Dysplasia splint

pavlik harness

Congenital hip dysplasia OT

education, assistance w/ ADLs, help w/ adaptations for everyday life