Functional Anatomy and Biomechanics of Hip and Pelvis Region Flashcards Preview

DPT 726: Orthopaedic Foundations > Functional Anatomy and Biomechanics of Hip and Pelvis Region > Flashcards

Flashcards in Functional Anatomy and Biomechanics of Hip and Pelvis Region Deck (43)
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1

Introduction

-hip is 2nd largest joint in body
-hip establishes link between LE and trunk: absorbs high forces, supports body's mass
-LE links with trunk at pelvic girdle
-any movement in trunk pelvis or LE involves/influences hip joint
-important to evaluate movement and actions of both limbs, pelvis, and trunk: rather than to focus on single joint, improves evaluation, treatment, and outcomes
-one area in ____ system with noticeable differences between sexes: female pelvis typically lighter, thinner and wider than in males; this can affect motion in the trunk, pelvis, and LE

2

Osteology

-pelvis: fibrous union of 3 bones
-ilium superior, ischium posteroinferior, pubis anterior inferior
-separate at birth but typically fused by 15-17 years
-proximal femur

3

The Pelvis

-ilium, pubis, and ischium
-right and left sides joint sacrum to form a ring or hoop aka pelvis or pelvic girdle
-connect anteriorly through pubic symphysis
-connect posteriorly through sacrum

4

Ilium

-landmarks of note on external surface: ASIS and AIIS, iliac crest, PSIS and PIIS, greater sciatic notch and greater sciatic foramen
-landmark on ote on internal surface: iliac fossa, auricular surface, iliac tuberosity

5

Pubis

-landmarks of note:
-superior pubic ramus
-body
-pectineal line
-pubic tubercle
-inferior pubic ramus
-symphysis pubis

6

Ischium

-landmarks of note:
-ischial spine
-lesser sciatic notch
-lesser sciatic foramen
-ischial tuberosity
-ischial ramus

7

Acetabulum

-formed at junction of the 3 bones in hip
-located above obturator foramen
-concave joint surface
-joins with femoral head

8

Acetabular Orientation

-center edge angle: aka angle of wilberg 35-50* provides best containment of femoral head
-acetabular anteversion angle ~20* marked variation of this angle can contribute to dislocation

9

Femur

-landmarks of note:
-femoral head
-femoral neck
-intertrochanteric line
-greater trochanter
-lesser trochanter
-intertrochanteric crest
-quadrate tubercle
-linea aspera
-spiral line
-gluteal tuberosity
-adductor tubercle

10

Femoral Angle of Inclination

-measured angle
-between femoral neck and medial side of femoral shaft
-typically ~125* in mature skeleton ~140-150* at birth
-influences: effectiveness of hip abductors, limb length, forces imposed on hip joint
-variations in adulthood: coxa vara (<125*) coxa valgus (>125*)

11

Femoral Torsion Angle

-another measured angle
-describes the "twist" between femoral neck and femoral shaft
-normal anteversion ~10-15* anterior to frontal plane
-some have structural variation from normal anteversion: may affect individual movement patterns or function
-excessive anteversion ~35* anterior to frontal plane
-retroversion ~0* to frontal plane
-individual may demonstrate some NM compensations for structural variations

12

Key Points on Angle of Inclination/Femoral Torsion

-both identified with diagnosti imaging
-neither can changed by PT in adults
-we can change movement patterns: place less stress on area, better help to compensate for structural variation, etc; strengthen target muscles, stretch target muscles
-important to differentiate things PT can change from those it can't

13

Pubic Symphysis

-site where right and left sides of pelvis connect
-cartilaginous joint with fibrocartilage joint
-end of each pubis covered with hyaline cartilage
-pubic ligament supports pubic symphysis: anterior, posterior, and superior sides of joint
-limited motion at pubic symphysis

14

Sacroiliac Joint

-connects pelvis to sacrum
-synovial joint with strong ligamentous support
-these ligaments are the strongest in the body
-transmits force between LE and spine
-movement occurs at SI joint: varies considerably between individuals and sexes
-males: have thicker stronger ligaments; 3 of 10 have fused SI joints
-females: have greater ligamentous laxity

15

SI Joint Motion

-sacrum is actually 5 fused vertebrae
-top of sacrum is base
-sacral flexion occurs when base moves anteriorly aka nutation, occurs with lumbar extension
-sacral extension occurs when base moves posteriorly aka counternutation occurs with lumbar flexion
-sacral torsion occurs with rotation of the left and right halves about the medial lateral axis: right rotation occurs if anterior surface of sacrum faces right, left rotation occurs if anterior surface of sacrum faces left

16

Movements of the Pelvis

-described by monitoring ASIS/AIIS
-anterior tilt is forward tilting and downward movement of the pelvis
-occurs when: the trunk flexes as in standing forward bend, sitting with exaggerated lumbar arch
-posterior tilt: occurs when the trunk extends as in standing back bend, sitting in slouched position
-tuck butt (posterior tilt) vs. duck butt (anterior tilt)
-lateral tilt: right or left, aka pelvic obliquity, controlled by muscles
-rotation occurs about longitudinal axis in the horizontal plane
-as R leg swings forward pelvis rotates to the L vice versa when L leg swings forward

17

Hip Joint

-ball and socket joint
-3 degrees of freedom
-femoral head: 2/3 of a perfect sphere, entire head is covered by cartilage (except fovea)
-ligamentum teres attach fovea to acetabulum
-acetabulum is incomplete near inferior acetabular ligament
-a labrum helps to deepen this joint
-spongy trabecular bone in femoral head and acetabulum helps to absorb forces
-articular cartilage on femoral head is thickest centrally-most load supported here
-70% of femoral head articulates with acetabulum 25% in glenohumeral joint

18

Ligaments in Hip Joint

-loose but strong capsule surrounds the joint
-reinforced by iliofemoral, pubofemoral, and ischiofemoral ligaments

19

Osteokinematics at Hip Joint

-hip flexion: 120* with flexed knee 80* with extended knee
-hip extension: 20* with extended knee 10* with flexed knee
-hip abduction 40-45*
-hip adduction 25* past midline
-hip internal rotation 35*
-hip external rotation 45*

20

Arthrokinematics at Hip Joint

-joint orientation: acetabulum-anterior, lateral, inferior; femoral head-posterior, medial, superior
-concave surface: acetabulum
-loose-pack position: 30* flexion, 30* abduction, slight LR
-close-pack position: full extension, abduction, and MR
-flexion/extension: spinning, little or no roll or glide
-abduction: upward roll, downward glide
-adduction: downward roll upward glide
-IR: femoral head rolls anteriorly, glides posteriorly
-ER: femoral head rolls posteriorly, glides anteriorly

21

Lumbopelvic Rhythm

-occurs with forward bend
-coordinated movement of pelvis and lumbar spine
-spinal flexion and anterior pelvic tilt

22

Gross Hip ROM and Functional Activities

-80* flexion/extension needed for stand to sit
-100* flexion/extension need for sit to stand
-60* flexion needed to climb a stair
-24-30* needed for descent of same stair
-during walking 35-40* flexion during late swing, full extension during heel off
-abduction/adduction: most activities require 20* or less, walking requires 12*, full squat requires 18-20* abd: tie shoes, etc
-IR/ER: both increase with thigh flexion; full squat requires 10-15* ER, tie shoes etc

23

Innervation in Hip Region

-supplied by lumbosacral plexus

24

Muscular Control of the Pelvic Girdle

-sit of muscular attachment of 28 trunk and thigh muscles: none positioned to act solely on pelvic girdle
-proper positioning of pelvic girdle necessary and thigh necessary for efficient movement

25

Hip Flexors

-primary: iliopsoas, rectus femoris, TFL, sartorius, adductor longus, pectineus
-secondary: adductor brevis, gracilis, gluteus minimus

26

Hip Extensors

-primary: glute max, biceps femoris, semitendinosus, semimembranosus, adductor magnus
-secondary: gluteus medius

27

Hip Abductors

-primary: glute medius, minimus, TFL
-secondary: piriformis, sartorius

28

Hip Adductors

-primary: adductor longus, adductor brevis, pectineus, gracilis, adductor magnus
-secondary: biceps femoris, quadratus femoris, glute max

29

Internal Rotators of Hip

-glute min, med, TFL, adductor longus, adductor brevis, pectineus, semitendinosus, semimembranosus

30

External Rotators of Hip

-primary: glute max, piriformis, obturator internus, gemelli, quadratus femoris, sartorius
-secondary: glute med, min, obturator externus, biceps femoris