Clinical Kinesiology and Anatomy: Hip Joint, Exams of Nursing

Download Clinical Kinesiology and Anatomy: Hip Joint and more Exams Nursing in PDF only on Docsity! Clinical Kinesiology and Anatomy Chapter 18, Hip Joint (Lecture/Lab)QUESTIONS WITH CORRECT ANSWERS Lower extremity - CORRECT ANSWER-Includes pelvis, thigh, leg, and foot. Bones of the pelvis (pelvic girdle) - CORRECT ANSWER-Made of 4 bones. 1. Sacrum 2. Coccyx 3. 2 innominate bones (hip) Innominate bone - CORRECT ANSWER-Ilium, ischium, and pubis, which are fused together. Thigh - CORRECT ANSWER-1. Femur 2. Patella Leg - CORRECT ANSWER-1. Tibia 2. Fibula Foot - CORRECT ANSWER-1. 7 tarsal bones 2. 5 metatarsals 3. 14 phalanges Hip joint type - CORRECT ANSWER-Most proximal of lower extremity joints. Ball and socket joint. Hip joint is important for: - CORRECT ANSWER-Weight bearing and walking activities. Hip joint articulation - CORRECT ANSWER-Concave acetabulum of pelvis articulates with convex (rounded) femoral head. How does convex femoral head move in hip joint? - CORRECT ANSWER-When femur is free, femoral head moves in the opposite direction of the fixed acetabulum. When femur is fixed, femoral head moves in same direction as the fixed acetabulum. Hip joint vs. shoulder joint - CORRECT ANSWER-Hip very stable and less mobile/ROM. Shoulder more ROM, way less stable. Osteokinematic hip joint motions - CORRECT ANSWER-Traxial joint, motion in all 3 planes (sagittal, frontal, transverse). 1. Flexion/extension/hyperextension *palpate* Posterior inferior iliac spine (PIIS) of ilium - CORRECT ANSWER-Inferior to PSIS where the sacrotuberous ligament attaches. Ischium - CORRECT ANSWER-Posterior and inferior portion of the innominate bone. Ischial body of ischium - CORRECT ANSWER-Makes up 2/5 of acetabulum. Ischial ramus of ischium - CORRECT ANSWER-Extends medially from body to connect with inferior ramus of pubis. Where adductor magnus, obturator externus, and obturator internus muscles attach. Ischial tuberosity of ischium - CORRECT ANSWER-The blunt, rough, massive posterior corner of the ischium. Your "sits bones." Where hamstrings and adductor magnus muscles attach. *palpate* Ischial spine of ischium - CORRECT ANSWER-Located on the posterior body and between the greater sciatic and lesser sciatic notches. Where sacrospinous ligament attaches. Pubis - CORRECT ANSWER-Forms the anterior portion of the innominate bone. Can divide into 3 parts, body and two rami. Body of pubis - CORRECT ANSWER-Externally forms 1/5 of acetabulum. Main portion of the pubic bone, between the two projections (rami) superior and inferior. Internally where obturator internus muscle attaches. Superior ramus of pubis - CORRECT ANSWER-Superior projection of the pubic body. Where pectineus muscle attaches. Inferior ramus of pubis - CORRECT ANSWER-Inferior projection of the pubic body. Where adductor magnus, adductor brevis, and gracilis muscles attach. Pubic symphysis joint - CORRECT ANSWER-Cartilaginous joint connecting bodies of two pubic bones at anterior midline. Tubercle of pubis - CORRECT ANSWER-Anterior projection on the superior ramus near the midline. Where inguinal ligament attaches. Acetabulum - CORRECT ANSWER-Deep, cup shaped cavity that articulates with the femur. Nearly equal parts ilium, ischium, and pubis. Obturator foramen - CORRECT ANSWER-Large opening by greater sciatic notch that is surrounded by bodies and rami of ischium and pubic. Below PIIS. Only called this if the ligaments are there. Where blood vessels and nerves pass through. Femur - CORRECT ANSWER-Longest, strongest, and heaviest bone in the body. Articulates with innominate bone to form hip joint. Head of femur - CORRECT ANSWER-Rounded portion covered with articular cartilage articulating with the acetabulum. Neck of femur - CORRECT ANSWER-Narrower portion located between the head and the trochanters. Greater trochanter of femur - CORRECT ANSWER-Large projection located between neck and body of femur. Pateller surface of femur - CORRECT ANSWER-Located between condyles on the anterior surface. Articulates with posterior surface of patella. What bone(s) articulate with the patella? - CORRECT ANSWER-Only the femur, not the tibia! Tibia - CORRECT ANSWER-Isn't truly part of the hip joint but has important landmark. Tibial tuberosity of tibia - CORRECT ANSWER-Large projection at proximal end in the midline. Where patellar tendon attaches. Hip joint ligament and structure overview - CORRECT ANSWER-Surrounded by a thick, strong fibrous joint capsule that covers hip joint in a cylinder. Attaches proximally around lip of acetabulum and distally at neck of femur. Ligaments of the hip joint - CORRECT ANSWER-1. Iliofemoral ligament 2. Pubofemoral ligament 3. Ischiofemoral ligament Iliofemoral ligament - CORRECT ANSWER-Most important ligament that reinforces the hip capsule anteriorly. Ilium to femur. Attaches proximally to AIIS and crosses joint and splits into 2 parts distally which attach to intertrochanteric line of femur. Another name for iliofemoral ligament - CORRECT ANSWER-Ligament of bigelow or Y ligament. Function of iliofemoral ligament - CORRECT ANSWER-Limits hyperextension. Pubofemoral ligament - CORRECT ANSWER-Spans hip joint medially and inferiorly. Pubis to femur. Attaches to medial part of acetabular rim to superior ramus of pubis and runs down and back to attach on neck of femur. Function of pubofemoral ligament - CORRECT ANSWER-Limits hyperextension and abduction. Ischiofemoral ligament - CORRECT ANSWER-Covers the capsule posteriorly. Ischium to femur. Attaches on the ischial portion of the acetabulum, crosses the joint in lateral and superior direction, and attaches on the femoral neck. Function of ischiofemoral ligament - CORRECT ANSWER-Limits hyperextension and internal rotation. Arrangement of iliofemoral ligament, pubofemoral and ischiofemoral ligaments - CORRECT ANSWER-2 anterior, 1 posterior. All 3 attach along rim of acetabulum and cross hip joint in a spiral to attach at femoral neck. Limits hyperextension while allowing full flexion. Movement of iliofemoral ligament, pubofemoral and ischiofemoral ligaments - CORRECT ANSWER-Ligaments slack in hip flexion and become taut in hyperextension. Allows standing upright without using any muscles by resting or hanging on iliofemoral ligament. This is a basis posture for post SCI paralysis. Other structures in or near hip joint - CORRECT ANSWER-1. Acetabular labrum 2. Inguinal ligament 3. Iliotibial band/tract (IT band) Acetabular labrum - CORRECT ANSWER-Lip of fibrocartilage that surrounds outer margin of the acetabulum on the hip bone. Increases depth of acetabulum. Free end of labrum surrounds femoral head and helps hold it in acetabulum. Inguinal ligament - CORRECT ANSWER-No function at the hip joint though but it present. Runs from ASIS to pubic tubercle and is landmark that separates the anterior abdominal wall from the thigh. Nerve: sartorius - CORRECT ANSWER-N: Femoral nerve Pectineus - CORRECT ANSWER-Located medial to iliopsoas and lateral to adductor magnus. Spans hip joint anteriorly and medially. Origin/insertion: pectineus - CORRECT ANSWER-O: Superior ramus of pubis I: Pectineal line of femur Action: pectineus - CORRECT ANSWER-A: Hip flexion and adduction Nerve: pectineus - CORRECT ANSWER-N: Femoral nerve One joint hip adductors - CORRECT ANSWER-1. Adductor longus 2. Adductor brevis 3. Adductor magnus Adductor longus - CORRECT ANSWER-Most superficial of all three hip adductors. Tendon can be easily felt in anteromedial groin. Origin/insertion: adductor longus - CORRECT ANSWER-O: Pubis I: Middle third of linea aspera Action: adductor longus - CORRECT ANSWER-A: Hip adduction Nerve: adductor longus - CORRECT ANSWER-N: Obturator nerve Adductor brevis - CORRECT ANSWER-Shorter than other adductor muscles. Lies deep to adductor longus but superficial to the adductor magnus muscle. Origin/insertion: adductor brevis - CORRECT ANSWER-O: Pubis I: Pectineal line and proximal linea aspera Action: adductor brevis - CORRECT ANSWER-A: Hip adduction Nerve: adductor brevis - CORRECT ANSWER-N: Obturator nerve Adductor magnus - CORRECT ANSWER-Largest and deepest of adductor muscles that makes up most of bulk on medial thigh. Fibers run downward and lateral to insertion. There is an interruption called the adductor hiatus where the femoral artery and vein pass through. Origin/insertion: adductor magnus - CORRECT ANSWER-O: Ischium and pubis I: Entire linea aspera and adductor tubercle Action: adductor magnus - CORRECT ANSWER-A: Hip adduction Nerve: adductor magnus - CORRECT ANSWER-N: Obturator nerve and sciatic nerve Two joint hip adductors - CORRECT ANSWER-1. Gracilis Gracilis - CORRECT ANSWER-Only two joint hip adductor muscle. Descends the thigh medially and superficially before crossing the knee joint posteriorly and curves around to its attachment. Origin/insertion: gracilis - CORRECT ANSWER-O: Pubis I: Anterior medial surface of proximal end of tibia Action: gracilis - CORRECT ANSWER-A: Hip adduction Nerve: gracilis - CORRECT ANSWER-N: Obturator nerve Gluteus maximus - CORRECT ANSWER-Large, thick, one joint, quadrilateral muscle located on superficial buttock. Runs diagonal direction distally and laterally to posterior femur. Origin/insertion: gluteus maximus - CORRECT ANSWER-O: Posterior sacrum and ilium I: Posterior femur distal to greater trochanter and IT band Action: semitendinosus - CORRECT ANSWER-A: Hip extension and knee flexion Nerve: semitendinosus - CORRECT ANSWER-N: Sciatic nerve- tibial division Biceps femoris - CORRECT ANSWER-Has two heads and runs down thigh laterally on the posterior side. Both heads join together to span the knee posteriorly and attach laterally on head of fibula. Origin/insertion: biceps femoris - CORRECT ANSWER-O: Long head- ischial tuberosity Short head- lateral lip of linea aspera I: Fibular head Action: biceps femoris - CORRECT ANSWER-A: Long head- hip extension and knee flexion Short head- knee flexion Nerve: biceps femoris - CORRECT ANSWER-N: Long head- sciatic nerve- tibial division Short head- common fibular nerve Gluteus medius - CORRECT ANSWER-More laterally located gluteal muscle that is triangular and spans the hip laterally. Origin/insertion: gluteus medius - CORRECT ANSWER-O: Outer surface of ilium I: Lateral surface of greater trochanter Action: gluteus medius - CORRECT ANSWER-A: Hip abduction Nerve: gluteus medius - CORRECT ANSWER-N: Superior gluteal nerve Gluteus minimus - CORRECT ANSWER-Smallest and deepest gluteal muscle that lies deep and inferior to Gluteus medius. Also spans the hip laterally. Origin/insertion: gluteus minimus - CORRECT ANSWER-O: Lateral surface of the ilium I: Anterior surface of the greater trochanter Action: gluteus minimus - CORRECT ANSWER-A: Hip abduction and internal rotation Nerve: gluteus minimus - CORRECT ANSWER-N: Superior gluteal nerve Tensor fascia lata (TFL) - CORRECT ANSWER-Very short muscle with a very long tendinous attachment. Crosses the hip laterally and slightly anteriorly then attaches to the iliotibial band (IT band). Origin/insertion: tensor fascia lata (TFL) - CORRECT ANSWER-O: Anterior superior iliac spine (ASIS) I: Lateral condyle of tibia Action: tensor fascia lata (TFL) - CORRECT ANSWER-A: Combined hip flexion and abduction Nerve: tensor fascia lata (TFL) - CORRECT ANSWER-N: Superior gluteal nerve Closed kinetic chain exercise for hamstrings - CORRECT ANSWER-Sitting on a stool while rolling yourself around with legs. Open kinetic chain exercise for hamstrings - CORRECT ANSWER-Leg curl Closed kinetic chain exercise for quads - CORRECT ANSWER-Squats up Open kinetic chain exercise for quads - CORRECT ANSWER-Leg extension Eccentric contraction of adductor magnus - CORRECT ANSWER-Top leg crossed across bottom and lift the bottom leg up. How do you stretch the gluteus maximus? - CORRECT ANSWER-Hip flexion and internal rotation. How do you stretch the semimembranosus? - CORRECT ANSWER-Hip flexion and knee extension. How do you stretch the adductor longus? - CORRECT ANSWER-Hip abduction. Common pathologies of the hip - CORRECT ANSWER-Site of many orthopedic conditions that occur throughout life and can affect lower extremity alignment. Retroversion - CORRECT ANSWER-A decrease in the angle of torsion which forces the hip into a more externally rotated position. People walk "toed-out." Osteoarthritis (OA) - CORRECT ANSWER-Degeneration of the articular cartilage of the joint due to trauma or wear and tear. Usually seen later in life and treated with a Total Hip Arthroplasty (THA). Contraindications for Total Hip Arthroplasty (THA). - CORRECT ANSWER-1. No internal rotation beyong neutral 2. No adduction beyond neutral 3. No hip flex > 90 degrees Hip fracture - CORRECT ANSWER-Fracture of the upper end of the femur (not the pelvis). Common in the elderly due to falls or high impact trauma (car accidents) in younger people. Types of hip fractures - CORRECT ANSWER-1. Intertrochanteric 2. Femoral neck Iliotibial band syndrome - CORRECT ANSWER-An overuse injury causing lateral knee pain, common in runners and bikers. Thought to be result of repeated friction of band rubbing over lateral femoral epicondyle during knee motion. Trochanteric bursitis - CORRECT ANSWER-Inflamed bursa around greater trochanter. There are many bursa here because of all the muscle attachments. Can be due to acute trauma or overuse and common to runners, bikers, or someone with leg length discrepancy. Hamstring strain - CORRECT ANSWER-Most common muscle problem in the body that is often recurrent. Happens as a result from overload of muscle or trying to move too fast. Often seen in soccer players, track and field, football, and rugby. Also called pulled hamstring. Hip pointer - CORRECT ANSWER-A severe bruise caused by direct trauma to the iliac crest of the pelvis. Usually seen in football or other contact sports. For hip muscles, a group of 1 joint muscles does what? - CORRECT ANSWER-Provides most of the control for the hip. For hip muscles, a group of 2 joint muscles does what? - CORRECT ANSWER-Provides the range of motion for the hip. These tend to be longer. Anterior hip muscles tend to be? - CORRECT ANSWER-Flexors because of vertical line of pull. Posterior hip muscles tend to be? - CORRECT ANSWER-Extensors. Lateral hip muscles tend to be? - CORRECT ANSWER-Abductors. Medial hip muscles tend to be? - CORRECT ANSWER-Adductors. Action: Combination of hip flexion and abduction - CORRECT ANSWER-Prime mover: Tensor Fascia Lata (TFL). Action: Combination of hip flexion, abduction and lateral rotation - CORRECT ANSWER-Prime mover: Sartorius. Action: Hip flexion - CORRECT ANSWER-Prime mover: Rectus femoris, Iliopsoas, Pectineus. Action: Hip extension - CORRECT ANSWER-Prime mover: Gluteus maximus, Semitendinosus, Semimembranosus, Biceps femoris (long head). Action: Hip hyperextension - CORRECT ANSWER-Prime mover: Gluteus maximus. Action: Hip abduction - CORRECT ANSWER-Prime mover: Gluteus medius, gluteus minimus