Transcript lecture 6 hip

Lecture 6
The Hip
Anatomy Review
Hip Joint
- Multi-axial ball and socket synovial joint
- It has maximum stability because of the
deep socket (acetabulum)for the insertion
of the head of the femur
- Strong ligaments and capsule encase this
joint
- Acetabulum is deepened by a labrium
Hip Ligaments
Iliofemoral
- Prevents excessive extension
- Strongest in body
Ischiofemoral
- Tight in extension
Pubofemoral
- Prevents excessive abduction and
extension
All three limit MR
Hip joint
Resting position 30 degrees flexion
30 degrees abduction and
slight lateral rotation
Forces on the hip
Standing
0.3 X BW
Standing one leg 2.5 X BW
Walking
1.3-5.8 X BW
Upstairs
3 X BW
Running
4.5 X BW
Common problems
- referred pain from back (lumbar spine)
or SI to hip
Nerves
Majority of nerve supply arises from the
Lumbar Plexus
Lumbar Plexus - formed from the first
four lumbar spinal nerves
Largest branch is the Femoral nervesupplies to the muscles and skin of the
anterior thigh
Another branch Obturator nerve which
provides innervation to the adductor
muscles
Sacral plexus - L4 through S4 spinal
nerves
Sciatic nerve arise from the sacral plexus
Sciatic innervate the hamstrings
Rom of Hip / End Feels
Flexion/ Extension
LR/MR
Abduction / Adduction
Muscles?
Special Tests
Thomas Test
 Hip flexors
 Hip flexion contracture
 Athlete is supine with knees hanging over
edge of table
 Athlete brings knee up to chest , examiner
can help push up so it is tight to chest
 Positive test- if the hip flexor (iliopsoas) is
tight on the opposite side the upper leg will lift
up off the table
http://www.youtube.com/watch?v=wv4tYy
RLXv8&feature=related
http://www.youtube.com/watch?v=RDBtb_
IIf_U&feature=related
Rectus Femoris contracture ( Kendall
Test)
Same as above – make sure they are right
on edge of table
Now when they pull the knee to the chest
look at the angle of the knee
If negative the knee should hang at 90
degrees
positive test - if the leg straightens out
Slump Test
Myofacial structures ( Dura)
Athlete is seated with both legs hanging
over the edge of the table, tuck chin to
chest and slump upper body forward
Examiner passively (or can be done
actively by athlete) raises the leg to
extension
Positive test- is pain ( limitations in
Range)
http://www.youtube.com/watch?v=GGGgosp
ax-A&feature=related
Patrick FABER test
SI and General ROM of the hip
- athlete Supine
- foot on opposite knee
- leg lowered in to abduction and LR
- compare Left and right
- positive test- is a difference in ROM and
pain
- http://www.youtube.com/watch?v=f_eQqmBDJE
Tripod sign
Hamstring contracture
- Athlete is seated with both legs hanging
over the edge of the table
- Examiner passively raises the leg to
extension
- Positive test - if the individual leans back
to relieve the stress on the hamstrings
Trendelenburg sign
Weak Glut medius ( on stance side)
- athlete standing on one leg must be
able to stabilize hip
- pelvis is level from left to right
- Positive test - if ASIS ( pelvis) drops
on non-stance side
- Indicates a weakness or instability on
stance side
Tests for leg length
- The leg is anatomically or functionally
shorter
- Spine and pelvis (and others) will be
affected due to kinetic chain
- May lead to scoliosis, pelvic rotations and
neck issues
Anatomical or True Leg length
To test measure from ASIS to medial
malleolus (or lateral if muscle or fat get in
way) heels approx 6 to 8 inches apart
Slight difference acceptable (1-1.3 cm
considered normal)
If more than normal – measure tib and
femur to see where difference is (can
eyeball this
Side view and Front view
Functional or Apparent Leg Length
Results due to a compensation for a
change that may have occurred because
of positioning rather than structure
Unilateral pronation – spinal scoliosis,
pelvic rotations
Can measure from umbilicus to medial
malleolus
The test is only meaningful if the test for
true leg length in negative
Muscle testing
Psoas and iliacus
Hip flexors
- Athlete is seated with knees flexed
- Hands on the edge of the table
- Athlete lifts the upper leg off the table
and examiner applies pressure on
anterior surface of thigh downwards
- Examiner stabilizes opposite side
- Positive test – pain and weakness
Sartorious
Hip flexor, abductor and lateral rotator
- Athlete is sitting or supine
- Athlete brings ankle to opposite knee
- Resistance applied to medial malleolus
and to the lateral side of the thigh by
examiner in an attempt to straighten the
leg
- Positive test – pain and weakness
Gluteus Maximus
Hip extension
- Athlete is prone on table
- Knee is flexed
- Resistance is applied by examiner to the
proximal knee (post thigh) in attempts to
flex the hip
- Stabilize above the hip (low back )
- Gluts work best when knee is flexed
- Positive test – pain and weakness
Gluteus minimus and medius
As a hip abductor
- Athlete is side lying with lower leg and hip
flexed to 90 degrees
- Resistance is applied to the proximal knee
on the lateral side of the thigh
- Movement should be without flexion or
Lateral Rotator
- Pelvis is stabilized
- Positive test – pain and weakness
Gluteus minimus and medius
As a Medial Rotator
- Athlete is supine or sitting
- Knee flexed over the edge of table
- Resistance is applied to the lateral
malleolus pushing the leg medially
- Positive test – pain and weakness
Adductors
Longus, magnus, brevis, gracillis and
pectinus
- Athlete is side lying
- Non test limb is supported by the examiner
- Lower limb is the test limb
- Limb is adducted of the table and
resistance is applied to the proximal knee
joint medial thigh (pushing into abduction)
- Positive test – pain and weakness
Lateral Rotators
Obturator Internus, Obturator Externus,
Superior and Inferior Gemellies and
Piriformis
- Athlete is sitting with knee flexed over
edge of table
- Resistance is applied to the distal leg on
the medial malleolus
- Pushing lower leg laterally
- Positive test – pain and weakness
Sport Specific Functional Tests
walking
going up and down stairs
running straight ahead , and variations
squatting
jumping