The hip part 2

Femoral Triangel Contest Medial to Lateral

Femoral Vein, Artery, Nerve (VAN)

What are the 4 Borders of the Femoral Triangle?

• Lateral: Sartorius

• Medial: Adductor Longus

• Superior: Inguinal Lig

• Floor: Iliopsoas Tendon

3 main Nerves in Hip and what muscles does it innervate?

• Femoral: Quadriceps Group

• Sciatic: HS

• Obturator: Adductors

What are 2 other nerves in the Hip and what muscles do they innervate?

• Superior Gluteal: Glute Med, Glute Min, TFL

• Inferior Gluteal: Glute Max

Where can compression take place for the Lateral Femoral Cutaneous Nerve?

Under inguinal lig

This compression of the Lateral Femoral Cutaneous Nerve can lead to what?

Tingling or numbness in Anterior Lateral Thigh (AKA Meralgia Paresthetica)

Pain Referral: Internal Pain is related to what?

Obturator

Groin Pain Common Sources (50

• Hip jt. • Ilio-inguinal N. Entrapment • L1 nerve root pain • Ilio-psoas strain • Adductor strain

Trochanteric Pain Common Sources: (5)

• Hip • L4-5 referred pain • Trochanteric bursitis • Dural • Lateral Femoral Cutaneous nerve entrapment

Normal Hip ROM (Flex/Ext/ABd/ADd/IR/ER)

• Flexion 120 deg • Extension 30 deg • Abduction 45 deg • Adduction 30 deg • ER 45 deg • IR 45 deg

What 3 hip ranges would a pt loose if they have mobility deficits?

• Flexion 120 deg

• Adduction 30 deg

• IR 45 def

Loss of what range would be a CLEAR indication of pathology of the Hip?

IR

Resting position of Hip Joint?

• 30 deg Flex

• 30 def Abd

• 0-5 deg ER

Why is Hip Joint resting position important? (2)

• Joint Mobility Assessment

• Positioning for Irritable Hip

Closed pack position of Hip

• Full Hip Ext

• IR

• Abduction

Capsular Pattern for Hip Joint

This order may vary in the Hip <<

• Flexion

• Abduction

• IR

Is small loss of extension MORE OR LESS functionally limiting than flexion, abduction, IR?

MORE

What is Anteversion and Retroversion considered?

Transverse plane angle formed between the femoral neck and a line drawn through the femoral condyles

Normal Hip Angle?

8-15 deg

Clinical Antiversion and Retroversion Degrees

• Anteversion: > 25 deg anteversion

• Retroversion: < 5 deg anteversion

Which of the 2 will the pt walk like a duck?

Retroversion

What is Angle of Inclination?

Angle formed at the junction of femoral shaft w neck

Normal Angle of Inclination

120 deg

Coxa Valga and Coxa Vara degrees

• Coxa Valga = Increase in angle > 135 deg

• Coxa Vara = Decrease in angle < 120 deg

Think: Your 57 year old male complains of gradually worsening groin pain. He reports it gets worse with walking and standing.He currently walks with a limp. This clinical pattern is characteristic of what ICF category?

Hip pn w mobility deficits

Think: If a patient reports that they have symptoms like burning or numbness radiating into the lower limb from the hip, what would be a key finding?

Neurodynamic Testing