ATH_302_Hip

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itzlinds
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254865
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ATH_302_Hip
Updated:
2014-01-10 11:24:14
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Chapter 12 Pelvis Thigh pathologies
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Chapter 12 pelvis and thigh pathologies
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  1. which portion of the joint capsule does the iliofemoral ligament reinforce?

    list the fxns/motions that are limited by the iliofemoral ligament?  (anterior, superior, inferior)

    what is the main fxn of the iliofemoral ligament?
    which portion of the joint capsule does the iliofemoral ligament reinforce? anterior

    • limited fxns/motions
    • anteriorly: extention/hyperextension
    • superior fibers: adduction
    • inferior fibers: abduction

    what is the main fxn of the iliofemoral ligament?  allows standing with minimal muscular effort
  2. list the 2 fxns/motins restricted by the pubofemoral ligament:
    • abduction
    • hyperextension

    ... of the hip
  3. list the origin and the attachment site of the ischiofemoral ligament:

    list the fxn/motions restricted by the ischiofemoral ligament:
    • origin: posterior acetabular rim
    • attachment: inner surface of the greater trochanter

    fxn/motions limited: extension and extreme flexion
  4. what is the fxn of the ligamentum teres (ligament of the head of the femur):

    what is the potential tramua that could occur with an injury to the ligamentum teres:
    • fxn: serves as a conduit for the artery
    • mechanism: axial compression of the femoral head or disolocation of the joint
    • trauma: disruption of the medial and lateral circumflex arteries
  5. list the 3 muscles of the iliopsoas group:
    • psoas major
    • psoas minor
    • iliacus
  6. what is the result of tightness in the rectus femoris, sartorisu, and iliacus muscles:
    • increased stress on sacroiliac joint
    • casuses the pelvis to rotate anteriorly on the sacrum
  7. weakness of the right gluteus medius causes the pelvis to lower on the left side when the left leg is not bearing weight, the torso compenstates for the unequal position of the pelvis by leaning to the right known as:
    trendelenburgs gait pattern
  8. what is the primary fxn of the piriformis, quadratus femoris, obturator internus, obturator externus, gemellus superior, and gemellus inferior during an open chain:

    what is the primary fxn of the during the loading response and midstance (closed chain):
    • open chain: externally rotate the hip
    • loading response/midstance: control hip internal rotation
  9. list the structures that make the femoral triangle:

    list the 3 structures that pass thru the femoral triangle:
    • inguinal ligament superiorly
    • sartorius laterally
    • adductor longus medially

    • structures passing thru
    • femoral nerve
    • femoral artery
    • femoral vein

    contains lymph nodes that may become enlarged with an infection or active inflammation in the lower extermity
  10. list and describe the 4 bursae at the hip:
    • trochanteric bursa: lubricates site at which glute max passes over the greater trochanter
    • gluteofemoral: separates glute max from the origin of the vastus lateralis
    • ischial bursa: weight bearing structure when an individual is seated
    • iliopsoas: largest synovial bursa in the body, covers the iliopectinaeal line, AIIS, iliac fossa and lesser trochanter
  11. for which structure does the medial femoral circumflex artery supply:

    lateral femoral circumflex artery:
    • medial femoral circumflex: primary source of the blood femoral head
    • lateral femoral circumflex: primary soucre to the inferior femoral neck and the trochanteric region
  12. history of steriod or alcohol abuse can increase the risk of:
    osteonercrosis, or avascular necrosis: reduced blood flow to bones in the joints
  13. pain and paresthesia in the upper lateral thigh is called:

    which nerve is this neuropathy indicative of?
    pain and paresthesia in the upper lateral thigh is called? meralgia paresthtica

     which nerve is this neuropathy indicative of? lateral femoral cutaneous nerve
  14. anterior pain in the inguinal region coupled with pain during bowel movements or coughing may indicate the presence of:
    a hernia
  15. recent changes in training techniques, espically if the patients running regimen includes training on a banked surface or the addition of hills can lead to which 2 overuse injuires:
    • greater trochanteric bursitis
    • hip flexor tendinopathy
  16. avasucalr necrosis occuring in childern age 3 or 12, causing osteochondritis of the proximal femoral epiphysis and potentially decreasing the range of hip motion in adult life is called:
    legg-calve-perthes disease

    the degenerative process is marked by ischemia (restricted blood supply to tissues, decreased oxygen) that results in resorption, collapse, and repair of the femoral head
  17. displacement of the femoral shaft relative to the femoral head; common in children age 10 to 15, especially in boys is called:
    slipped capital femoral epiphysis
  18. describe the Bonnet's position:
    loose packed position of....

    Flexion, abduction, and external rotation
  19. for a fxnal assessment during walking, list what the following observations can indicate...

    shortened swing phase of gait:
    lateral hip pain coupled with pain during loading response and midstance:
    posterior pain with pushing off during a sprint:
    • shortened swing phase of gait: hamstring strain
    • lateral hip pain coupled with pain during loading response and midstance: gluteus medius involvement
    • posterior pain with pushing off during a sprint: glutues maximus and/or hamstring
  20. an increase in the angle of inclination is called:

    list two ways this can be manifested:
    an increase in the angle of inclination is called: coxa valga

    • 2 causes
    • genu varum
    • laterally positioned patellae
  21. a decrease in the angle of inclination is called:

    list 2 ways this can be manifested:
    a decrease in the angle of inclination is called: coxa vara

    • may lead to
    • genu valgum
    • medially positioned "squinting" patelllae
  22. femur increases greater than 20 degrees in the angle of torsion is called:

    what are the results of this:
    femur increases greater than 20 degrees in the angle of torsion is called: anterverted femur

    • results in
    • internal femoral rotation
    • squinting patella
    • toe in (pigeon toe) gait
  23. when the femur's angle of torsion is less than 15 degrees is called:

     what are the results of this:
    when the femur's angle of torsion is less than 15 degrees is called: retroverted femur

    • results in
    • external femoral rotation
    • toe out (duck footed) gait
    • laterally located patella
  24. a hip pointer that initates a very active inflammatory process occurs where?
    iliac crest
  25. an imaginary line from the ASIS to the iscial tuberosity is called:
    nelaton's line
  26. of which nerve root pathology does the atrophy of the gluteal muscle group indicate?
    L5-S1
  27. an infection over the posterior aspect of the median sacral crests is called:
    pilonidal cysts
  28. the pubic symphysis can become inflamed secondary to overuse injuries and sheer forces leading to:
    osteitis pubis
  29. abnormal masses or tenderness in the inguinal ligament may be indicative of:
     a hernia
  30. a strain of the rectus femoris or an avulsion of its origin can be caused by:
    the knee flexed and the hip forced into extension, resulting in tension
  31. tenderness at the ischial tuberosity and burse may indicate which 2 injuries:
    • an avulsion fx
    • hamstring tendinopahthy
  32. a cord found midway between these ischial tuberosity and the greater trochanter is called:
    the sciatic nerve
  33. list the following ROMs...

    Flexion:
    Extension:
    • Flexion: 120-130
    • Extension: 10 to 20

    total: 130 to 150
  34. list the following ROMs..

    adduction:
    abduction:
    • adduction: 20 to 30
    • abduction: 45 degrees
  35. list the following ROMs...

    internal rotation:
    external rotation:
    • internal rotation: 45 degrees
    • external rotation: 40 to 50 degrees
  36. list the 7 muscles that act on the hip that contribute to hip flexion:
    • gluteus medius (anterior fibers)
    • gluteus minimus
    • iliacus
    • psoas major
    • psoas minor
    • rectus femoris
    • sartorius
  37. list the 4 muscles that act on the hip that contribute to hip abduction:
    • gluteus maximus (lower fibers)
    • gluteus medius
    • gluteus minimus
    • sartorius
  38. list the 5 muscles that contribute to hip internal rotation:
    • adductor brevis
    • adductor longus
    • adductor magnus
    • gluteus medius (anterior fibers)
    • gluteus minimus
  39. list the 5 muscles that contribute to hip extension:
    • biceps femoris
    • gluteus maximus
    • gluteus medius (posterior fibers)
    • gluteus maximus
    • semimembranosus
  40. list the 6 muscles that contribute to hip adduction:
    • adductor brevis
    • adductor longus
    • adductor magnus
    • gluteus maximus (upper fibers)
    • gracilis
    • pectineus
  41. list the 8 muscles that contribute to hip external rotation:
    • gemellus inferior
    • gemellus superior
    • gluteus medius (posterior fibers)
    • obturator extremis
    • obturator internus
    • piriformis
    • quadratus femoris
    • sartorius
  42. hip passive range of motion most frequently results in a ________ end feel resulting from:
    hip passive range of motion most frequently results in a firm end feel resulting from soft tissue stretch or soft tissue approximation
  43. The thompson test  for Hip Flexor Tightness Rectus Femoris Contracture test:

    Patient Position:
    Positive test:
    implications:
    • Patient Position: lying prone on the table or lying supine with knees bent at the end of the table
    • positive test: a) the lower leg moves into extension b) the involved leg rises off the table
    • implication: a) tightness of the rectus femoris b) tightness of the iliopsoas muscle group
  44. Ely's Test

    patient position:
    positive test:
    implications:
    • patient position: lying prone
    • positive test: the hip on the side being tested flexes, causing it to rise from the table
    • implications: tightness of the rectus femoris
  45. describe the position of the hip that is the provocative phase of the straight-leg raise test and may produce sciatic nerve symptoms:
    hip flexion with the knee extened
  46. extension of hip places stretch on which 3 ligaments:
    • iliofemoral
    • pubofemoral
    • ischiofemoral
  47. adducting the hip stresses which ligament?

    abduction of the hip stresses which 2 ligaments?
    adduction: the superior fibers of th iliofemoral ligament

    abduction: pubofemoral ligament and the lower fibers of the iliofemoral ligament
  48. trendelenburg test for gluteus medius weakness:

    patient position:
    positive test:
    implications:
    • patient position: standing with the weight evenly distributed between both feel. the patients shorts are lowered to the point at which the iliac crests or posterior superior iliac spines are visible.
    • positive test: the pelvis lowers on the non-weight bearing side
    • implications: insufficiency of the gluteus medius to support the torso in an erect position, indicating weakness in the muscle
  49. list the following symptoms of a iliac crest contusion (hip pointer)...

    pain characteristics:
    other symptoms:
    mechanism:
    • pain characteristics: iliac crest, possibly radiating into the internal and external oblique muscles
    • other symptoms: paresthesia over the anterolateral thigh
    • mechanism: direct blow to an unprotected ilium
  50. patients suffering from strains of the proximal rectus femoris may obtain relief of the pain by:
    walking up stairs by turning around and walking up backwards
  51. what is the injuring force for a rectus femoris muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force:
    • hyperextension of the hip and flexion of the knee
    • dynamic overload: isometric contraction

    • pain during ROM
    • active: hip flexion; knee extension
    • passive: hip extension; knee flexion
  52. what is the injuring force for a iliopsoas muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force
    • hyperextension of the hip
    • resisted hip flexion

    • pain during ROM
    • active: hip flexion
    • passive: hip extension
  53. what is the injuring force for a quadriceps strain (other than rectus femoris) muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force
    • hyperextension of the knee
    • dynamic overload: resisted knee extension

    • pain during ROM
    • active: knee extension with a flexed hip
    • passive: knee flexion
  54. what is the injuring force for a hamstring muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force
    • dynamic overload: eccentric contraction
    • tensile force: overstretching the muscle

    • pain during ROM
    • active: knee flexion, hip extension with an extended knee
    • passive: knee extension, hip flexion
  55. what is the injuring force for a gluteus maximus muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force
    • dyanmic overload: eccentric contraction
    • isometeric contraction

    • pain during ROM:
    • active: hip extension with a flexed knee
    • passive: hip flexion with a flexed knee
  56. what is the injuring force for a adductor group muscular strain:

    describe the pain or deficit elicited during ROM testing..
    active:
    passsive:
    • injuring force
    • tensile: overstretching the muscle
    • dynamic overload: eccentric contraction & isometric contraction

    • pain during ROM
    • active: hip adduction
    • passive: hip abduction
  57. patients suffering hamstring strains typically report a distinct __________ or ________ sensation when:
    patients suffering hamstring strains typically report a distinct popping or snapping sensation when intially contracting the muscle or quickly increasing running speed. 
  58. in the case of quadricep contusions, maintaining the knee's ROM decreases the possibility of:
    femoral heterotopic ossification (bone formation at an abnormal site, usually soft tissue)
  59. describe the following charcteristics of a slipped capital femoral epiphysis..

    pain (stable/unstable):
    joint/muscle fxn assesement:
    fxn assement:
    • pain
    • stable: pain in the groin or hip that increases with walking. pain may be referred to the anterior distal quadriceps (femoral nerve) adductor area (obturator nerve) or buttocks/hamstrings (sciatic nerve)
    • unstable: pain intense enough to prevent walking

    • joint/muscle fxn assesment:
    • AROM: decreased internal rotation, decreased hip flexion, and abduction
    • MMT: weak internal rotation
    • PROM: decreased internal rotation, decreased hip flexion, abduction

    • fxn assesment
    • stable: during gait femur is externally rotated; antalgic gait (stance phase is shortened releative to swing phase)
    • unstable: pt is unable to bear weight and walking is not possible
  60. describe the following for a femoral neck stress fx...

    pain characteristics:
    other symptoms:
    mechanism:
    predisposing conditions:
    • pain characteristics
    • pain in the femoral triangle that occurs during activity and is relieved by rest
    • pain may briefly increase following the activity but subside with rest

    • other symptoms
    • throbbing
    • burning
    • or paresthesia may be described

    • mechanism
    • repetitive stress/overuse, often with a history of a rapid increase in the frequncy, intensity, and/or duration of activity

    • predisposing conditions
    • a sudden increase in distance training of more than 10% per week
    • the female athlete triad
  61. describe the following exam findings for  femoral neck stress fxs....

    special tests:
    fxna assessment:
    • special tests
    • active straight leg of thea effected leg raise may increase pain
    • an axial load on the femoral head may cause pain (hip scouring test)

    • fxn assesment
    • pain is increased when standing and/or hopping on one leg
    • pain may prohibit acitivty
    • pt may describe pain when rolling over in bed 
  62. the hip scouring test (hip quadrant test)...

    patient position:
    positive test:
    implications:
    • patient position: supine
    • positive test: pain describe or symptoms in the hip is reproduced
    • implications: a possible defect in the articular cartilage of the femur or acetabulum (osteochondral defects, arthritis); this test may also produces pain in  the presence of a labral tear
  63. labral tears...

    pain characteristics:
    other symptoms:
    mechanism:
    • pain characteristics
    • pain is most commonly presents in the anterior or medial hip
    • posterior or lateral pain is reported less frequently

    • other symptoms
    • catching or locking may be described

    • mechanism
    • acute: hip dislocations or subluxations
    • insiduous: repeated subtle subluxations, impingement of the anterior capsule, repeated weight bearing external rotation, hyperabduction, or hyperextension
  64. labral tear examination findings...

    joint/muscle fxn assesment..

    AROM:
    PROM:
    • AROM
    • anterior tear: pain and/or catching when the hip is moved from flexion, external rotations, and abductions to extension, internal rotations, and adduction

    • PROM
    • posterior tear: pain during passive hip flexion and internal rotation while a posterior load is applied
  65. describe 2 mechanisms that would result in a hip subluxation:
    • a fall onto a flexed knee with the hip abducted
    • a jump-stop or pivot that forces the femoral head posteriorly in the acetabulum
  66. the gradual ossification and widening of the pubic symphysis is called:
    osteitis pubis
  67. entrapment of the sciatic nerve by the hamstring muscles is called:
    hamstring syndrome
  68. describe the following for athletic pubalgia..

    pain characteristics:
    mechanism:
    predisposing conditions:
    • pain charactersitcs
    • pain is localized to the pubic bone, pubic symphysis, lower abdominal muscles and/or genitals
    • pain my exacerbated by coughing or sneezing

    • mechanism
    • a tensile force caused by the pull of the adductor muscle group and the lower abdominal muscles
    • hip abduction, adduction, flexion, and extension

    • predisposing conditions
    • weak abdominal muscles
  69. describe the following characteristics of  piriformis syndrome...

    pain characteristics:
    mechanism:
    • pain characteristics
    • pain deep in the posterior aspect of the hip, radiating into the buttocks and down the posterior aspect of the leg
    • increases on standing and decreases while lying supine and the knees flexed

    • mechanism
    • blow to the buttocks
    • hyperinternal rotation of the hip
    • spasm of the piriformis muscle
  70. describe the following joint/muscle fxn assesment for piriformis shyndrome...

    AROM
    MMT:
    PROM:
    • AROM:
    • pain during external rotation owing to the piriformis muscles contracting and placing pressure on the sciatic nerve

    • MMT:
    • pain increased during resisted external hip rotation with pt. in seated position
    • pain also possible with hip abduction

    • PROM
    • passive internal rotation of hip with pt supine
    • symptoms reduced with passive external rotation
  71. describe the following of snapping hip syndrome:

    pain characteristics (external/internal type):
    other symptoms (intra articular):
    • pain characterstics
    • pain associated with the snapping localized over the greater trochanter (external type) and the anterior hip (internal type)
    • pain is usually secondary to bursitis

    • other symptoms
    • intra acticular lesions tend to be described as "clicking" rather than snapping and produce more pain
  72. describe the mechansim for the following of snapping hip syndrome..

    internal:
    external:
    intra articular:
    • internal: the iliopsoas tendon contacting the femoral head or other structures
    • external:the IT band catching on the greater trochanter
    • intra-articular: most commonly associated within the loose body within the joint, labral tear or synovial fluid
    • the motion of hip flexion and extension produces the snapping
  73. describe the following of trochanteric bursitis...

    pain characteristics:
    mechanism:
    other symptoms:
    • pain characterstics
    • over the greater trochanter, radiating posteriorly to the buttocks
    • pain increased when pt climbs stairs

    • mechanism:
    • acute: direct blow to the greater trochanter
    • chronic: irritation from the IT band passive over the bursa

    • other symptoms
    • increased pain or inability to sleep on the involved side
  74. describe the following of ischial bursitis...

    pain charactersitics:
    mehcanism:
    pain characterstiscs: over the ischial tuberosity in the vicinity of the gluteal fold

    • mechanism
    • acute: direct blow to the ischial tuberosity, such as falling on it
    • chronic: repeated shifting and moving while weight bearing in the seated position (rowing)

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