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Hip and Pelvis - Coggle Diagram

- - - - 2nd largest joint in the body
  - - - what can this affect (3)
        
        motion in the trunk, pelvis, and LE
  - - - Pelvis has what 3 bones
        
        Illium
        
        what position is at on the pelvis
        
        superior
        
        landmarks
        
        external surface (7)
        
        iliac crest
        
        PSIS and PIIS
        
        Greater sciatic notch
        
        greater sciatic foramen
        
        ASIS and AIIS
        
        Internal surface (3)
        
        Iliac fossa
        
        Auricular surface
        
        Iliac tuberosity
        
        ischium
        
        what position is at on the pelvis
        
        posteroinferior
        
        landmarks (5)
        
        • Ischial spine
        
        • Lesser sciatic notch
        
        • Lesser sciatic foramen
        
        • Ischial tuberosity
        
        • Ischial ramus
        
        pubis
        
        what position is at on the pelvis
        
        anteroinferior
        
        landmarks (6)
        
        Superior pubic ramus
        
        • Body
        
        • Pectineal line
        
        • Pubic tubercle
        
        where is this
        
        1 more item...
        
        • Inferior pubic ramus
        
        • Symphysis pubis
        
        when does the 3 bones fuse
        
        by 15-17 years
        
        the ring or "hoop" that forms from the pelvic bones fusing creates what (2)
        
        stability and force
        
        how does the ring connect through the sacrum :red_cross:
        
        posteriorly
        
        how does the ring connect through the pubis symphysis :red_cross:
        
        anteriorly
      - Acetabulum
        
        what makes this part
        
        The junction of the 3 bones in the pelvis
        
        where is it located
        
        above obturator foramen
        
        Orientation
        
        center edge angle
        
        description
        
        angle between a line drawn through the center of the femoral head and another line connecting that center to the lateral edge of the acetabulum
        
        what does it assess
        
        measures how well the acetabulum covers the femoral head (assessing the depth of the socket)
        
        aka
        
        “Angle of Wilberg”
        
        what degrees provides best containment of femoral head
        
        • ~ 35-40°
        
        Acetabular anteversion angle
        
        what is the normal degrees
        
        ~ 20°
        
        variation of this angle
        can contribute to what
        
        dislocation
        
        what does it assess
        
        how much the acetabulum (hip socket) is tilted forward in the pelvis
        
        description :red_cross:
      - Femur
        
        landmarks (12)
        
        Femoral head
        
        • Femoral neck
        
        • Intertrochanteric line
        
        • Greater trochanter
        
        • Lesser trochanter
        
        • Trochanteric fossa
        
        • Intertrochanteric crest
        
        • Quadrate tubercle
        
        • Linea aspera
        
        • Spiral line
        
        • Gluteal tuberosity
        
        • Adductor tubercle
        
        Femoral angles (2)
        
        Femoral Angle of Inclination
        
        description
        
        Angle between femoral neck and medial side of femoral shaft
        
        what is the angle in a mature skeleton
        
        ~125°
        
        what is the angle at birth
        
        ~ 140-150° at birth
        
        3 influences
        
        -Effectiveness of hip abductors
        -Limb length
        -Forces imposed on hip joint
        
        what are the 2 variations in adulthood that can occur (angle right after)
        
        Coxa vara
        
        < 125°
        
        how can the patient present
        
        1 more item...
        
        Coxa valgus
        
        more than 125°
        
        how can the patient present
        
        1 more item...
        
        how does this affect the Q-angle
        
        smaller angle of inclination = smaller Q-angle
        
        1 more item...
        
        Femoral Torsion Angle
        
        description
        
        “twist” between the femoral
        neck and femoral shaft
        
        what is the shaft
        
        1 more item...
        
        femur anteversion
        
        description
        
        how much the femur rotates inward against the acetabulum that causes the knees and feet to turn inward as well
        
        2 more items...
        
        Normal anteversion degrees to the frontal plane
        
        ~ 10-15° anterior to
        frontal plane
        
        excessive anteversion
        
        usually how many degrees to the frontal plane
        
        1 more item...
        
        femur retroversion
        
        description
        
        how much the femur rotates outward against the acetabulum that causes the knees and feet to turn outwards as well
        
        2 more items...
        
        Normal retroversion degrees to the frontal plane
        
        ~ 0°to the frontal plane
        
        how are they both identifiable
        
        with diagnostic
        imaging
        
        what can PTs change regarding bone variations (3)
        
        place less stress on area to better help to
        compensate for structural variation
        
        Strengthen target muscles
        
        Stretch target muscles
- - - - • Coordinated movement of pelvis
        and lumbar spine
      - when does it occur
        
        Occurs with forward bend
        
        what happens at the pelvis? what happens at the lumbar spine?
        
        Spinal flexion & anterior pelvic tilt
        
        what type of lumbopelvic rhythm is this
        
        ipsidirectional lumbopelvic rhythm
        
        2 more items...
  - - - ~ 80°
    - - ~100°
      - what are the 3 phases of STS
        
        flexion moment
        
        what occurs
        
        when you start to get up and hip flex occurs, most weight in butt region
        
        transfer moment
        
        what occurs
        
        in the mid of standing you transfer weight towards heels
        
        extension
        
        what occurs
        
        once fully standing, there's extension of the trunk and weight is transferred there
    - - what degrees of flexion needed to climb stair
        
        ~60°
      - what degrees of flexion descent a stair
        
        ~ 24-30°
    - - how many degrees of flexion during late swing
        
        ~ 35-40°
      - what occurs at the hip during heel off
        
        ~ full extension
    - - most activities requires how many degrees of abduction/adduction
        
        20° or less
      - walking requires how many degrees of abduction/adduction
        
        ~ 12°
      - full squat requires how many degrees of abduction
        
        ~ 18-20°
    - - what occurs during hip flex
        
        both IR/ER increases
      - full squat requires how much ER
        
        ~10-15°
  - - - bring femur into acetabulum
    - - primary mm. (6)
        
        • Iliopsoas
        
        which n. lies in between illiacus and psoas major
        
        femoral n.
        
        what two things are right behind the inguinal ligament
        
        femoral vein and artery
        
        • Rectus femoris
        
        • Tensor fascia lata
        
        • Sartorius
        
        • Adductor longus
        
        • Pectineus
        
        what is the strongest hip flexor
        
        illiopsoas
      - secondary mm. (3)
        
        Adductor brevis
        
        • Gracilis
        
        • Gluteus minimus (anterior fibers)
    - - primary mm. (5)
        
        • Gluteus maximus
        
        • Biceps femoris (long head)
        
        • Semitendinosus
        
        • Semimembranosus
        
        • Adductor magnus (posterior fibers)
        
        when does the hamstrings generate more force for hip extension
        
        when knee is extended
        
        which hamstring is more active
        
        biceps femoris
        
        how can a pt posture present w hamstring tightness
        
        in posterior tilt
        
        which mm. are the predominant extensors during walking
        
        hamstrings
        
        when is glute max recruits
        
        when more vigorous action is needed
        
        1 more item...
        
        what is the biggest role of glute max during gait
        
        1 more item...
      - secondary m.
        
        Gluteus medius (posterior fibers)
      - 3 common actions that extensors counteracts gravitational pull
        
        walking, running, jumping
    - - Primary mm. (3)
        
        Gluteus medius
        
        • Gluteus minimus
        
        • Tensor fascia lata
      - secondary mm. (2)
        
        piriformis
        
        sartorius
      - greatest ABD force at what position
        
        neutral position
        
        how much does the force diminish at 25° ABD
        
        50%
      - weakness of these mm. can lead to what
        
        increased shear at SI joint
        
        most important job for abductors during gait
        
        Prevents excessive frontal plane motion
      - these mm. important for what 2 skills
        
        dance and gymnastics
    - - Primary mm. (5)
        
        Adductor longus
        
        • Adductor brevis
        
        • Pectineus
        
        • Gracilis
        
        • Adductor magnus (both heads)
      - secondary mm. (3)
        
        Biceps femoris (long head)
        
        • Quadratus femoris
        
        • Gluteus maximus (lower fibers)
      - what do these mm. do during gait
        
        maintain stability in frontal plane by working w abductors
    - - • Gluteus minimus (anterior fibers)
        
        • Gluteus medius (anterior fibers)
        
        • Tensor Fascia Lata
        
        • Adductor longus
        
        • Adductor brevis
        
        • Pectineus
        
        • Semitendinosus
        
        • Semimembranosus
    - - Primary (7)
        
        • Gluteus maximus
        
        • Piriformis
        
        • Obturator internus
        
        • Gemellus superior
        
        • Gemellus inferior
        
        • Quadratus femoris
        
        • Sartorius
      - Secondary (4)
        
        • Gluteus medius (posterior fibers)
        
        • Gluteus minimus (posterior fibers)
        
        • Obturator externus
        
        • Biceps femoris (longhead)
      - what 2 things are these mm. important for
        
        preparation for power production
        
        Preventing excessive IR during loading response, landing, etc
    - - extension
    - - IR
        
        what percentage stronger is the ER
        
        60% stronger in most positions
  - - - no (why)
        
        many LE muscles work in combination functionally
    - - Stretching, manual resistance, isotonic resistance
- - - - what makes this site
        
        Site where right and left sides of pelvis connect
      - what type of joint is it
        
        fibrocartilage joint
        
        end of each pubis is covered in what
        
        hyaline cartilage
      - what supports it
        
        Pubic ligament
        
        supports from which sides of joint
        
        Anterior, posterior, and superior sides
      - what type of motion occurs
        
        limited motion
    - - Basic info
        
        what does it do (2)
        
        connects the pelvis
        to the sacrum
        
        Transmits force between LE and spine
        
        what type of joint is it
        
        Synovial joint with strong ligamentous
        support
        
        what is important to know about these ligaments
        
        Strongest ligaments in the body
        
        Sex differences (3)
        
        movement at this joint Varies considerably between individuals
        and sexes
        
        Males have thicker, stronger ligaments
        
        3 of 10 males have what kind of SI joints
        
        fused SI joints
        
        Females have greater ligamentous laxity
      - Sacrum
        
        what is it made out of
        
        5 fused vertebrae
        
        top of the sacrum is know as what
        
        the “base”
        
        Movement
        
        Sacral flexion
        
        when does this occur
        
        when the base moves anteriorly
        
        what motion can allow this to happen
        
        1 more item...
        
        aka
        
        “Nutation”
        
        can only be called this when...
        
        1 more item...
        
        what does the trunk do
        
        flex
        
        Sacral extension
        
        when does this occur
        
        when the base moves posteriorly
        
        what motion can allow this to happen
        
        1 more item...
        
        aka
        
        “Counternutation”
        
        can only be called this when...
        
        1 more item...
        
        what does the trunk do
        
        extend
        
        Sacral torsion
        
        when does this occur
        
        with rotation of the left and right halves
        about the medial- lateral axis
        
        right rotation occurs when...
        
        1 more item...
        
        left rotation occurs when...
        
        1 more item...
    - - movement is described by monitoring which landmarks (2)
        
        ASIS/AIIS
      - Tilt
        
        Posterior Tilt
        
        when does it occur
        
        when the trunk flexes, as in standing forward bend
        
        what 4 mm. engage
        
        glue max, hamstrings, external obliques, and rectus abdominis
        
        how does this affect the iliofemoral ligament
        
        causes it to be in taut position
        
        Anterior Tilt
        
        how to describe
        
        what occurs at trunk
        
        extension, as in standing back bend
        
        what 3 mm. engage
        
        errector spinae, illiopsoas, and rectus femoris
        
        forward tilting and downward movement of the pelvis
        
        Trendelenberg
      - Torsion
        
        can go in which directions (2)
        
        anterior or posterior
        
        “Pelvic obliquity”
        
        description
        
        misalignment of the pelvis, typically where one hip is higher than the other
        
        what is it controlled by
        
        mm.
      - Rotation
        
        where does the motion occur
        
        About the longitudinal axis In the transverse plane
        
        describe the longitudnal axis
        
        an imaginary line that runs from the top to the bottom of the body's center, perpendicular to the transverse plane
        
        what happens when the R leg swings forward
        
        Pelvis rotates to the L and vice versa
  - - - articular cartilage
        
        what part of the head is not covered by cartilage
        
        fovea
        
        description
        
        a small, concave pit on the head of the femur that serves as an attachment point for the ligamentum teres
        
        where does ligamentum teres attach to from the fovea
        
        1 more item...
        
        where is the cartilage thickest on the femoral head
        
        centrally (why is that)
        
        Most load supported here
      - what percentage of femoral head articulates with acetabulum
        
        ~70%
      - what is in the inside of the femoral head and acetabulum
        
        Spongy trabecular bone
        
        what does this help with
        
        Helps to absorb forces
    - - the inferior pole
      - what is this part covered by
        
        transverse acetabular ligamen
      - what helps deepen the socket
        
        labrum
    - - Iliofemoral
        
        aka
        
        (Y ligament)
        
        why
        
        bc it has a Y shape from the illeum to the femur
      - Pubofemoral
      - Ischiofemoral
      - what else surrounds the joint
        
        Loose but strong capsule
    - - Motions
        
        Hip flexion degrees
        
        with flexed knee
        
        ~120°
        
        with extended knee
        
        ~ 80°
        
        Hip extension
        
        with flexed knee
        
        ~ 10°
        
        with extended knee
        
        ~ 20°
    - - Joint orientation
        
        femoral head (3)
        
        superior, medial, posterior
        
        acetabulum (3)
        
        Anterior, lateral, inferior
      - Loose-pack position (3 things)
        
        30°flexion, 30° abduction, slight lateral rotation
      - Close-pack position (3)
        
        Full extension, abduction, and medial rotation
      - Motions
        
        Flexion/Extension
        
        what motions occurs
        
        Spinning
        
        Abduction
        
        Superior roll, Inferior glide
        
        Adduction
        
        Inferior roll, Superior glide
        
        Internal Rotation
        
        Femoral Head Rolls Anteriorly and Glides Posteriorly
        
        External Rotation
        
        Femoral Head Rolls Posteriorly and Femoral Glides Anteriorly
- - - - MOI is usually
        
        blunt trauma
      - description
        
        injury to soft tissue that causes bleeding without breaking the skin
      - Common areas (4)
        
        Iliac crest – “hip pointer”
        
        • Buttocks
        
        • Femoral triangle
        
        • Trochanter
      - clinical presentation (4)
        
        Antalgic gait (may use assistive device)
        
        • Ecchymosis
        
        description
        
        bruising
        
        • Loss of ROM 2° to pain
        
        • Palpation painful to specific tissues
    - - Groin strain
        
        common site that it occurs
        
        Attachment of iliopsoas at lesser trochanter
        
        what can it involve
        
        many tissues
        
        common MOI
        
        extension force to thigh
        
        common painful movements (3)
        
        IR ROM and/or with passive extension
        
        resisted hip flex
        
        aka
        
        adductor strain
    - - 3 common pelvic bursitis
        
        trochanteric bursitis
        
        location
        
        under glute max, over greater trochanter
        
        most common in men or women
        
        women
        
        iliopectineal bursitis
        
        location
        
        under iliopsoas, over anterior ligaments
        
        ischiogluteal bursa
        
        location
        
        ischial tuberosity
        
        common cause
        
        prolonged sitting
    - - what are the trochanteric abductors (2)
        
        glute med and min
        
        what does this mean
        
        they both insert on greater trochanter
      - ITB tensioners mm. (3)
        
        what does this mean
        
        when these mm. contract, they compress the IT band
        
        TFL, upper glute max, and vastus lateralis
      - description
        
        when a glute tendon breaks down or deteriotes
        
        which glute is most common for this
        
        glute med
    - - aka
        
        osteoarthritis
      - common MOI
        
        weight bearing stress
      - what 2 things does this lead to
        
        Deterioration of articular cartilage
        • Overgrowth of periarticular bone
        
        what is periarticular bone
        
        the bone surrounding a joint
      - 2 things x-rays typically show
        
        ↓ joint space and osteophytes
        
        what are osteophytes
        
        bone spurs
        
        what do the osteophytes do
        
        Wolf's Law
    - - Pelvic fxs
        
        less common in what population
        
        kids (why)
        
        more elasticity in bones
        
        common MOI
        
        severe trauma
        
        2 types
        
        stable
        
        description
        
        non-displaced
        
        unstable
        
        discription
        
        descriptionoften requires fixation (displaced)
        
        characterized by 2 things
        
        complete separation of symphysis pubis and opening of pelvic ring
      - Femur fxs
        
        2 most common sites
        
        Intracapsular and trochanteric
        
        where specifically intracapsular is common
        
        femoral neck
        
        common age group
        
        more than 60 years old
        
        most common in women or men
        
        women
        
        Common MOI
        
        pt c osteoporosis falls
        
        what % die within 1 yr post status
        
        20%
  - - - 4 important things to educate pts on
        
        a) Sitting
        
        b) Sleeping
        
        c) Standing
        
        d) Exercising
    - - description
        
        type of exercise that is designed to actively reduce pain perception by stimulating the body's natural pain inhibiting mechanisms