Hip and Pelvis

1
Hip and Pelvis

• Chapter 8

2
Pelvic Bony Anatomy

• What four bones comprise the hip and pelvis?
• What is the name of the two sides of the pelvis?
• What is function of sacrum?
• What is the socket for the femur called?
• Cartilage around the socket?

3
Pelvis

• Name the ligament responsible for supplying blood
  to the femur?
• What are the arteries responsible for supplying
  blood to the femur?
• Lateral and Medial Circumflex arteries
• What injury results if this ligament or blood
  supply is injured?

4
Femoral Bony Importance

• Angle of inclination?
• Angle between head and neck of femur (125 º)
• Figure 8-4, pg 273
• Angle of torsion?
• Rotational relationship between head and shaft
  (15 º)
• Figure 8-5, pg 274

5
Angle of Torsion

• Retroversion
• Normal
• Anteversion
• What type of issues do these structural
  deviations cause?

6
Pubic Symphysis

• Allows the following motions between sides of
  pelvis
• Spreading
• Rotation
• Compression
• Leads to what specific injury?
• Osteitis Pubis
• Due to sheer and overuse
• Often manifests as groin strain
• Differentially diagnosed by radiographs

7
Hip Joint

• Coxofemoral joint
• Three degrees of motion
• Flex/Ext
• Abd/Add
• Int/Ext Rotation

8
Ligaments

• What are the ligaments of the hip joint?
• Iliofemoral
• Y Ligament
• Gives strength to the hip joint during standing
  with minimal muscular activity
• Ischiofemoral
• Pubofemoral
• What ligament originates on ASIS and inserts on
  pubic symphysis?
• It is the superior border of what anatomical
  region?

9
Muscles

• What are _______________ muscles?
• Anterior
• Medial
• Lateral
• Posterior
• Superficial
• Deep
• Piriformis
• Quadratus femoris
• Obturator internus/externus
• Gemellus superior/inferior

10
Femoral Triangle

• Borders?
• Structures in triangle? (Lateral-Medial)
• Femoral Nerve
• Femoral Artery
• Fermoral Vein
• Lymph Nodes

11
Bursae

• Trochanteric
• Gluteus maximus over the greater trochanter
• Gluteofemoral
• Gluteus maximus and vastus lateralis
• Ischial
• Cushions ischial tuberosity

12
Warning!!!!!

• DO NOT PALPATE PUBIC SYMPHYSIS
• USE CAUTION WHEN DEALING WITH GENITAL REGION
• ALWAYS HAVE WITNESS AROUND OR USE SAME GENDER

13
History

• Training techniques alterations in training
  such as banked surfaces (e.g. indoor track) or
  the addition of hills
• May lead to stress fx
• Mechanism direct blow hip pointer
• Figure 8-13, pg 282
• Prior medical
• Legg-Calves-Perthes
• Slipped capital femoral epiphysis

14
Inspection

• Angle of Inclination
• Coxa vara
• May manifest as genu valgum or squinting
  patella
• Coxa valga
• May manifest as genu varum or lateral patella
  (frog eyes)
• Angle of torsion (Box 8-1)
• Anteversion
• Retroversion

15
Lateral Inspection

• Nélatons Line (Fig 8-14, pg 283)
• Line from ASIS to ischial tuberosity
• If greater trochanter lies above the line, then
  indicates coxa vara.
• Definitive diagnosis through radiographs

16
Posterior Inspection

• Atrophy of gluteal on bilateral comparison may
  represent nerve root pathology (L5-S1)

17
Median Sacral Crest

• Pilonidal Cysts
• Often appear as a boil
• Referral is eminent
• A hair is often the culprit of the infections

18
Leg Length Discrepancy

• True vs. Functional
• Greater than 2 cm will generally cause pain in
  some part of kinetic chain
• Greater than 1 cm, alterations must occur to sole
  of shoe and cant be accomplished with heel lift.

19
Palpation

• All structures pg 283-285

20
Range of Motion

• Table 8-3, pg 286
• Passive
• Fig 8-20, 21, 22, 23 pg 288-290
• Resistive
• Box 8-4
• Box 8-5 Trendelenburgs Test
• Test for gluteus medius weakness
• Unaffected hip will drop

21
Ligamentous Testing

• No specific ligamentous testing
• Use passive ROM as method of assessing ligaments
• Hyperextension places all ligs. on stretch
• Adducting stress superior fibers of iliofemoral
  lig
• Abducting places stress on pubofemoral lig and
  inferior fibers of iliofemoral lig

22
Neurological Screening

• Dermatomes and Myotomes of Hip and Pelvis
• Pg 16, Box 1-5 (L1, L2, L3)

23
Special Test

• Trendelenburg

24
Trochanteric Bursitis

• Snapping hip syndrome
• Who is predisposed?
• Why?
• May mimic or mask femoral neck stress fractures

25
Ischial Bursitis

• Rocking motions from sports such as rowing,
  biking, etc.
• Prolonged sitting may exacerbate
• Manual muscle testing of hamstrings may rule out
  ischial avulsion

26
Degenerative Hip Changes

• Scouring Test
• By compressing joint articular surfaces, pain due
  to degenerative changes will be increased
• Similar to theory of Clarks Sign

27
Piriformis Syndrome

• Entrapment of sciatic nerve by piriformis
• Need to differentiate between piriformis
  involvement and lumbar disc involvement
• Women are more susceptible than men
• SS pain, burning, paresthesia, night pain
• If entrapped by the hip, then termed HAMSTRING
  CONTRACTURE SYNDROME!

28
On-the-field Management

• Check for
• Gross deformity
• Palpation of femur in cross-handed pattern will
  help determine fx
• CSM
• AROM

29
Hip Pointers

• Contusion of iliac crest and possible ASIS
• If posterior, may involved paresthesia in the hip
  due to cluneal nerves that run over crest
• Ice and protection are recommended with period of
  rest if sever
• Due to muscular attachment to crest, pain may
  increase with movement if injury is severe.

30
Quad Contusion

• Hematoma generally occurs
• Increases risk for myositis ossificans
• Pain and spasm may limit flexion
• Tx is crucial for first 24 h.
• Ice quad in flexed position
• Helps decrease likelihood of myositis

31
Hip Dislocation

• Flexed, adducted and internally rotated
• Posterior hip dislocation
• Very rare in sport
• Murphys law!!!!

32
Femoral Fracture

• Generally not going to occur in sport
• Weak link theory
• Fracture doesnt have to occur just in the shaft
• May occur in neck as well