DOCSLIB.ORG

Belmatt Healthcare Training Minor Injuries Course

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Belmatt Healthcare Training Minor Injuries Course Belmatt Healthcare Training www.belmatt.co.uk 0207 692 8709 [email protected] Minor Injuries Course Clinical Approaches to the Lower Limb Contents: Hip Clinical Hip Anatomy Clinical Hip Assessment Clinical Case Studies of the Hip Knee Clinical Knee Anatomy Clinical Knee Assessment Clinical Case Studies of the Knee Ankle and Foot Clinical Ankle and Foot Anatomy Clinical Ankle and Foot Assessment Clinical Case Studies of the Ankle and Foot 2 Clinical Hip: Acetabulum • Lunate surface o Load shifts from periphery to centre of lunate surface under increasing load. • Acetabular labrum Ilium • Anterior, posterior, and inferior gluteal lines o Which muscles attach between the anterior, posterior and inferior gluteal lines? Which gluteal muscles are responsible for internal rotation? External rotation? How does gluteus medius contribute to both internal and external rotation? Pubis • Pubic symphysis • Symphysis mobility during walking o Vertically 2.6mm o Sagittally (Anterior/posterior) 1.3mm o In pregnancy the pubic symphysis width increases 2- 3mm (a total gap of 9mm- similar to a newborn) § Length and height of stride shortens due to this change. § Foot inversion can occur if pelvic loosening causes pain. Ischium • Ischial tuberosity o What muscles attach to this tuberosity? Femur • Head o Why is the hip joint is least stable when both flexed and adducted? • Neck o Most common fracture site in the elderly. • Greater and lesser trochanters Greater 3 o Anterior border § Gluteus minimus § Action: o Lateral border § Gluteus medius § Action: o Posterior border § Obturator internus/externus, superior/inferior gemelli § Action: Lesser o Psoas major, iliacus o Action: Ligaments • Iliofemoral ligament (Y-Shaped) o Tensile strength > 350kg o Is twisted during standing. This helps maintain erect posture without need for muscular activity. o This tension also helps keep femoral head pressed into the acetabulum. o Hip flexion: ligament tension reduced, hip mobility increased. • Pubofemoral ligament o Limits extension and lateral rotation of the hip. • Ischiofemoral ligament o Limits extension and medial rotation of the hip. • Joint Capsule o Thin and loosely attached posteroinferiorly. Musculature Image:https://upload.wikimedia.org/wikipedia/commons/5/55/Posterior_Hip_Muscles 4 Gluteal Compartment: - Abduction, external, internal rotation • Gluteus maximus • Gluteus medius • Gluteus minimus • Piriformis - Small external rotators • Superior and Inferior Gemelli • Obturator internus tendon • Quadratus femoris Posterior Thigh Compartment - Thigh Extension, Knee Flexion, Leg Rotation • Semitendinosus and Semimembranosus • Biceps femoris • Medial Thigh Compartment - Adduction • Adductor longus and Adductor Brevis • Pectineus • Gracilis - Adduction, flexion, extension • Adductor magnus Anterior Thigh Compartment - Hip and Knee flexion • Iliopsoas • Sartorius • Tensor fasciae latae Rectus femoris https://web.duke.edu/anatomy/Lab14/Lab14.html 5 Clinical Hip Assessments: Gait analysis: Trendelenburg gait Antalgic gait Functional Tests: Standing Lift foot onto 20 cm step and return (hip flexion-extension) 0 reps nonfunctional, 1-2 reps functionally poor, 3-4 reps functionally fair, 5+ reps functional Sit in chair and return to standing (hip extension-flexion). 0 reps nonfunctional, 1-2 reps functionally poor, 3-4 reps functionally fair, 5+ reps functional Walk sideways 6m (hip adduction/abduction). 0m nonfunctional, 1-3m one way functionally poor, 3-6m one way functionally fair, 6-8m one way functional. Test leg off floor (patient may hold for balance) and internal rotate non-weight bearing hip. 0 reps nonfunctional, 1-4 reps functionally poor, 5-9 reps functionally fair, 10-12 reps functional Test leg off floor (patient may hold for balance) and externally rotate. 0 reps nonfunctional, 1-4 reps functionally poor, 5-9 reps functionally fair, 10-12 reps functional Special Tests: FABER (Flexion, Abduction, and External Rotation) • Supine patient, test leg has foot on top of the knee of opposite leg • Test leg knee lowered toward table. • Negative test indicated by test leg’s knee falling to the table, positive test indicated by test leg’s knee remaining above opposite straight leg. • Positive indicates hip joint problems, iliopsoas spasm, SI joint issues. FADDIR(Flexion, Adduction, and Internal Rotation) • Tests for anterior-superior impingement syndrome, anterior labral tear, iliopsoas tendinitis. • Supine patient, hip placed into full flexion, lateral rotation, and full abduction to start. • Hip then extended with internal rotation and adduction. • Positive test produces pain, symptom reproduction with or without a click or apprehension Trendelenburg Sign • Assesses hip stability and hip abductor stabilisation. • Patient stands on one limbIf pelvis on opposite side rises, negative test. • If pelvis on opposite side drops, positive test. • Positive test indicated weak gluteus medius or unstable hip. 6 Hip Peripheral Nerve Neuropathy: Nerve: Sciatic (L4-S3) Muscle Weakness: - If injured in pelvis or upper femur area, hamstrings and all muscles below the knee can be affected. Results in a high steppage gait with inability to stand on heel or toes. Sensory Alteration: Entire foot except instep and medial malleolus. Mechanism of Injury: Can be injured anywhere along its path from the lumbosacral spine down the back of the leg to the knee. Is the most commonly injured nerve in the hip region. Nerve: Femoral (L2-4) Muscle Weakness: Patient not able to flex the thigh on the trunk or extend the knee. Deep tendon knee reflex lost. Sensory Alteration: medial aspect of distal thigh and medial aspect of leg and foot (saphenous nerve). Mechanism of Injury: Not commonly injured, though childbirth, anterior femoral dislocation, or hernia surgery, stripping of varicose veins, hip surgery, or fractures may cause. Nerve: Obturator Nerve (L2-4) Muscle Weakness: Weak adduction, knee flexion and hip lateral rotation. Sensory Alteration: Small, involving a small area in the middle medial part of the thigh, although complaints of pain from pubic symphysis to medial aspect of knee are common. Mechanism of Injury: May be compressed as it leaves the pelvis or injured by pelvic or hip surgery, pregnancy, fractures, or tumors, and is a cause of pain in athletes. http://www.onhealth.com/content/1/bursitis_hip_knee_joint 7 A 24 year old man presented with a one week history of right posterior thigh pain following a football injury at the weekend. He reports that he felt severe pain and a ‘twange/pop’ sensation after kicking a ball. He reports no swelling but has noticed a small bruise in the centre of the posterior thigh. He describes that symptoms are worse with activity and in the mornings he notices the muscles are tight but ease with gentle movement and stretches. 1. Which muscles are involved? 2. Why does it hurt more during knee extension? 3. What would you do next? A 72-year-old female, was brought to the emergency room by her son-in-law after falling in her bathtub. She fell upon entering the bathtub when her right leg slipped out from under her; she landed on her right hip. There was no trauma to her head, nor does she complain of right or left wrist pain. However, she reports severe pain in the right hip and upper thigh, and was unable to get up after her fall. She presents with a shortened and externally rotated right leg. 1. What is the diagnosis? 2. What do you do next? 3. Which muscles cause this clinical presentation? A 36-year-old male patient presented with insidious onset of progressive anterior right hip and groin pain of 7 years' duration. 1. What do you do next? 2. What special tests might you do to assess impingement? 3. If femoroacetabular impingement is diagnosed, what options exist for the patient? 8 Clinical Knee Anatomy: • Distal femur: o Femoral condyles § Medial vs. Lateral o Patellar surface § Patellofemoral pain syndrome o Femoral epicondyles • Meniscus o Why are tears of the medial meniscus more common than tears of the lateral meniscus? • Tibia: o Tibial condyles o Tibial plateau o Intercondylar eminence o Tibial tuberosity • Patella: o Articular surface o Patellar ligament vs. Quadriceps tendon Patellar Apprehension Test 9 (http://www.sportsdoc.umn.edu/Clinical_Folder/Knee_Folder/Knee_Exam/lateral%20patellar %20apprehension.htm) • Genu Varum and Genu Valgum o Genu varum (bowleg) is characteristic in certain conditions such as rickets. Excessive pressure is taken by the medial side of the knee joint in this condition. o Genu valgum (knock knee) is normal in children under the age of six. Excessive pressure is taken by the lateral side of the knee joint in this condition o If either of these conditions are not corrected in the adult, they can lead to the development of osteoarthritis. Ligaments • Anterior cruciate ligament o Restraint to anterior tibial displacement. • Posterior cruciate ligament o Restraint to posterior tibial displacement. • Medial (tibial) collateral ligament o Resists valgus o Stronger than LCL (LCL reinforced by iliotibial band). • Lateral (fibular) collateral ligament o Primary restraint to varus load. o More mobile than MCL • If a force applied against the knee when the foot cannot move, ligament injuries are likely. • Tearing of the medial collateral ligament may also tear the medial meniscus due to their firm attachment. This often results from twisting the knee whilst flexed. 10 • Additionally, an “unhappy triad” may occur when the anterior cruciate ligament is also ruptured. What specific movements cause
Load more

Recommended publications
  • The Zona Orbicularis of the Hip Joint: Anatomical Study and Review of the Literature
    Original Article www.anatomy.org.tr Received: November 30, 2017; Accepted: December 7, 2017 doi:10.2399/ana.17.047 The zona orbicularis of the hip joint: anatomical study and review of the literature Alexandra Fayne1, Peter Collin2, Melissa Duran1, Helena Kennedy2, Kiran Matthews3, R. Shane Tubbs4,5, Anthony V. D’Antoni6 1SUNY Downstate College of Medicine, New York, USA 2New York University School of Medicine, New York, USA 3City University New York, New York, USA 4Seattle Science Foundation, Seattle, WA, USA 5Department of Anatomical Sciences, St. George’s University, Grenada, West Indies 6Division of Anatomy, Department of Radiology, Weill Cornell Medical College, New York, USA Abstract Objectives: Although it is used as a landmark during various orthopedic procedures of the hip, few studies have focused on the anatomy of the zona orbicularis. Therefore, the purpose of the present research was to study its morphology to improve our understanding of its structure and potential variation. Methods: Ten adult cadavers (four males and six females) underwent dissection of the left and right hip joints to observe the morphology and location of the zona orbicularis. A digital caliper was used to measure the length and width of the zona orbic- ularis. Results: We found a zona orbicularis on all sides and that when present anteriorly, many of the inferior fibers of the zona orbic- ularis were confluent with the fibers of the iliofemoral ligament. The mean length for right sides was 35.95 mm and the mean length for left sides was 43.93 mm. The mean width for right sides was 3.74 mm and the mean width for left sides was 4.4 mm.
    [Show full text]
  • Netter's Anatomy Flash Cards – Section 7 – List 4Th Edition
    Netter's Anatomy Flash Cards – Section 7 – List 4th Edition https://www.memrise.com/course/1577594/ Section 7 Lower Limb (72 cards) Plate 7-1 Hip (Coxal) Bone: Lateral View 1.1 Posterior superior iliac spine 1.2 Posterior inferior iliac spine 1.3 Greater sciatic notch 1.4 Body of ilium 1.5 Body of ischium 1.6 Ischial tuberosity 1.7 Pubic tubercle 1.8 Acetabulum 1.9 Iliac crest Plate 7-2 Hip (Coxal) Bone: Medial View 2.1 Wing (ala) of ilium (iliac fossa) 2.2 Pecten pubis (pectineal line) 2.3 Ramus of ischium 2.4 Lesser sciatic notch 2.5 Ischial spine 2.6 Articular surface (for sacrum) 2.7 Iliac tuberosity Plate 7-3 Hip Joint: Lateral View 3.1 Lunate (articular) surface of acetabulum 3.2 Articular cartilage 3.3 Head of femur 3.4 Ligament of head of femur (cut) 3.5 Obturator membrane 3.6 Acetabular labrum (fibrocartilaginous) Plate 7-4 Hip Joint: Anterior and Posterior Views 4.1 Iliofemoral ligament (Y ligament of Bigelow) 4.2 Pubofemoral ligament 4.3 Iliofemoral ligament 4.4 Ischiofemoral ligament Plate 7-5 Femur 5.1 Greater trochanter 5.2 Shaft (body) 5.3 Lateral epicondyle 5.4 Lateral condyle 5.5 Medial condyle 5.6 Medial epicondyle 5.7 Adductor tubercle 5.8 Linea aspera (Medial lip; Lateral lip) 5.9 Lesser trochanter 5.10 Intertrochanteric crest 5.11 Neck 5.12 Head Plate 7-6 Tibia and Fibula 6.1 Lateral condyle 6.2 Apex, Head, and Neck of fibula 6.3 Fibula 6.4 Lateral malleolus 6.5 Medial malleolus 6.6 Tibia 6.7 Tibial tuberosity 6.8 Medial condyle 6.9 Superior articular surfaces (medial and lateral facets) 6.10 Malleolar fossa of lateral
    [Show full text]
  • Compiled for Lower Limb
    Updated: December, 9th, 2020 MSI ANATOMY LAB: STRUCTURE LIST Lower Extremity Lower Extremity Osteology Hip bone Tibia • Greater sciatic notch • Medial condyle • Lesser sciatic notch • Lateral condyle • Obturator foramen • Tibial plateau • Acetabulum o Medial tibial plateau o Lunate surface o Lateral tibial plateau o Acetabular notch o Intercondylar eminence • Ischiopubic ramus o Anterior intercondylar area o Posterior intercondylar area Pubic bone (pubis) • Pectineal line • Tibial tuberosity • Pubic tubercle • Medial malleolus • Body • Superior pubic ramus Patella • Inferior pubic ramus Fibula Ischium • Head • Body • Neck • Ramus • Lateral malleolus • Ischial tuberosity • Ischial spine Foot • Calcaneus Ilium o Calcaneal tuberosity • Iliac fossa o Sustentaculum tali (talar shelf) • Anterior superior iliac spine • Anterior inferior iliac spine • Talus o Head • Posterior superior iliac spine o Neck • Posterior inferior iliac spine • Arcuate line • Navicular • Iliac crest • Cuboid • Body • Cuneiforms: medial, intermediate, and lateral Femur • Metatarsals 1-5 • Greater trochanter • Phalanges 1-5 • Lesser trochanter o Proximal • Head o Middle • Neck o Distal • Linea aspera • L • Lateral condyle • L • Intercondylar fossa (notch) • L • Medial condyle • L • Lateral epicondyle • L • Medial epicondyle • L • Adductor tubercle • L • L • L • L • 1 Updated: December, 9th, 2020 Lab 3: Anterior and Medial Thigh Anterior Thigh Medial thigh General Structures Muscles • Fascia lata • Adductor longus m. • Anterior compartment • Adductor brevis m. • Medial compartment • Adductor magnus m. • Great saphenous vein o Adductor hiatus • Femoral sheath o Compartments and contents • Pectineus m. o Femoral canal and ring • Gracilis m. Muscles & Associated Tendons Nerves • Tensor fasciae lata • Obturator nerve • Iliotibial tract (band) • Femoral triangle: Boundaries Vessels o Inguinal ligament • Obturator artery o Sartorius m. • Femoral artery o Adductor longus m.
    [Show full text]
  • Effects of Q-Angle on Lower Extremity Biomechanics And
    EFFECTS OF Q-ANGLE ON LOWER EXTREMITY BIOMECHANICS AND INJURIES IN FEMALE COLLEGIATE TRACK AND FIELD ATHLETES By MYRANDA HOPE HAM Candidate for Master of Science in Engineering, Biomedical Engineering, Mercer University, May 2020 A Thesis Submitted to the Graduate Faculty of Mercer University School of Engineering in Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE IN ENGINEERING MACON, GA 2020 EFFECTS OF Q-ANGLE ON LOWER EXTREMITY BIOMECHANICS AND INJURIES IN FEMALE COLLEGIATE TRACK AND FIELD ATHLETES By MYRANDA HOPE HAM Approved: ______________________________________ Date __________________ Dr. Ha Vo, Advisor ______________________________________ Date __________________ Dr. Edward O’Brien, Committee Member ______________________________________ Date __________________ Dr. Richard Kunz, Committee Member ______________________________________ Date __________________ Dr. Laura Lackey, Dean ACKNOWLEDGEMENTS I would like to first thank Dr. Vo for all his help throughout this project. I would not have been able to complete this study without his guidance. Thank you to Dr. Kunz and Dr. O’Brien for serving as member of my committee. Thank you to Amos Mansfield for approving this study to be conducted with Mercer University student-athletes. Thank you to all the Mercer Women’s Track and Field coaches, including Josh Hayman, Leesa Morales, and Jerod Wims, for being flexible and allowing the athletes to participate in this study around their practice schedule. Thank you to every member of the Mercer Women’s Track and
    [Show full text]
  • Download PDF File
    Folia Morphol. Vol. 70, No. 2, pp. 61–67 Copyright © 2011 Via Medica R E V I E W A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl Human ligaments classification: a new proposal G.K. Paraskevas Department of Anatomy, Medical School, Aristotle University of Thessaloniki, Greece [Received 24 January 2011; Accepted 22 March 2011] A high concern exists among physicians about surgically important ligaments such as cruciate and collateral ligaments of the knee, patellar ligament, tibiofibular syndesmosis, collateral ligaments of the ankle, and coracoclavicular ligament. However, the classification of the ligaments is insufficient in the literature, due to their origin from connective tissue. A new classification is proposed, based on various parameters such as the macroscopic and microscopic features, the function and the nature of their attachment areas. (Folia Morphol 2011; 70, 2: 61–67) Key words: ligaments, classification, Nomina Anatomica INTRODUCTION connective tissue surrounding neurovascular bundles There was always some confusion concerning the or ducts as “true ligaments” [4]. classification of ligaments of the human body, presu- The “false ligaments”, could be subdivided in the mably due to their origin from the connective tissue following categories: that is considered a low quality tissue compared to oth- a) Splachnic ligaments, which are further subdivid- ers. Moreover, orthopaedists are focused only on surgi- ed into “peritoneal” (e.g. phrenocolic ligament), cally important ligaments. For these reasons there is an “pericardiac” (e.g. sternopericardial ligaments), absence of a well-designated classification system that “pleural” (e.g. suprapleural membrane), and subdivides the ligaments into subgroups according to “pure splachnic ligaments” (e.g.
    [Show full text]
  • Lower Extremity-Hip, Thigh, and Pelvis
    Lower Extremity-Hip, Thigh, and Pelvis Basic Areas/Regions Gluteal-of or relating to or near the gluteal muscles Femoral-of or relating to the femur or thigh Pelvis-of or relating to the pelvis The pelvic girdle (pelvis) is made up of the ischium, the ilium and the pubis. On each side, the bones are fused together at the acetabulum. The two sides connect anteriorly at the pubic symphysis and posteriorly at the sacrum at the sacroiliac joints. Bones of the Pelvic Girdle Bone Landmarks Atlas Ilium 1. Iliac crest 2. Iliac tuberosity 3. Iliac fossa 4. Gluteal surface 5. Gluteal lines 6. Auricular surface 7. Arcuate line 8. Greater sciatic notch 9. Acetabulum 10. Acetabular rim 11. Acetabular notch 12. Anterior superior iliac spine (ASIS) 13. Anterior inferior iliac spine (AIIS) 14. Posterior superior iliac spine (PSIS) 15. Posterior inferior iliac spine (PIIS) Ischium 1. Ischial tuberosity 2. Ischial spine 3. Ischial ramus 4. Body of ischium 5. Lesser sciatic notch 6. Obturator foramen Pubis 1. Pubic tubercle 2. Superior pubic ramus 3. Inferior pubic ramus 4. Pubic symphysis 5. Symphyseal surface 6. Pectineal line 7. Body of pubis Femur 1. Head 2. Neck 3. Fovea capitus 4. Greater trochanter 5. Lesser trochanter 6. Intertrochanteric crest 7. Intertrochanteric line 8. Trochanteric fossa 1 9. Shaft of femur 10. Gluteal tuberosity 11. Pectineal line 12. Linea aspera 13. Adductor tubercle 14. Medial condyle 15. Lateral condyle 16. Medial epicondyle 17. Lateral epicondyle 18. Intercondylar notch 19. Intercondylar line 20. Patellar surface 21. Popliteal surface 22. Medial supracondylar line 23.
    [Show full text]
  • The Effectiveness of External Rotators and Ischiofemoral Ligament for the Prevention of Hip Dislocation in Hip Flexion Position: a Cadaveric Study
    The Effectiveness of External Rotators and Ischiofemoral Ligament for the Prevention of Hip Dislocation in Hip Flexion Position: A Cadaveric Study Kazuyoshi Baba ( [email protected] ) Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Daisuke Chiba Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Yu Mori Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Yoshiyuki Kuwahara Sendai city hospital Atsushi Kogure Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Takehiro Sugaya Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Kumi Kamata Iwaki medical center Itsuki Oizumi Iwaki medical center Takayuki Suzuki Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Hiroaki Kurishima Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Soshi Hamada Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Eiji Itoi Tohoku Rosai Hospital: Tohoku Rosai Byoin Toshimi Aizawa Tohoku University School of Medicine: Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu Research Article Page 1/14 Keywords: External rotator, Capsular ligament, Dislocation, Ischiofemoral ligament, Total hip arthroplasty, Cadaveric study, Hip joint Posted Date: July 20th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-716919/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/14 Abstract Background The purpose of this study was to examine the magnitude of the impact of each external rotator muscle and ischiofemoral ligament on prevention of joint dislocation, depending on the hip exion angle. Method Nine normal hips were studied; the pelvis was xed in the lateral decubitus position.
    [Show full text]
  • Hip Joint Capsular Anatomy, Mechanics, and Surgical Management
    2141 COPYRIGHT Ó 2019 THE AUTHORS.PUBLISHED BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED. Current Concepts Review Hip Joint Capsular Anatomy, Mechanics, and Surgical Management K.C. Geoffrey Ng, PhD, Jonathan R.T. Jeffers, PhD, and Paul E. Beaule,´ MD, FRCSC Investigation performed at the Imperial College London, London, United Kingdom, and the Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada ä Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ä The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ä To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ä It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ä During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability. Hip joint capsular ligaments serve a fundamental role in bal- functional anatomy and material characteristics of the hip ancing functional mobility and joint stability. Although the capsule and the effects of different capsular management anatomy of hip capsular ligaments has been well described in techniques during arthroscopic and arthroplasty procedures the literature1-4, the knowledge of its characteristics and con- on joint function.
    [Show full text]
  • Microinstability of the Hip: a Previously Unrecognized Pathology
    Original article Microinstability of the hip: a previously unrecognized pathology Ioanna Bolia 1 The role of the hip joint capsule has gained par - Jorge Chahla 1 ticular research interest during the last years, and Renato Locks 1 its repair or reconstruction during hip arthro - Karen Briggs 1 scopy is considered necessary in order to avoid Marc J. Philippon 1,2 iatrogenic hip microinstability. Various capsular closure/plication techniques have been devel - oped towards this direction with encouraging re - 1 Steadman Philippon Research Institute, Colorado, USA sults. 2 The Steadman Clinic, Colorado, USA Level of evidence: V. KEY WORDS: hip arthroscopy, hip microinstability, hip Corresponding author: dysplasia. Marc J. Philippon, MD Steadman Philippon Research Institute The Steadman Clinic Introduction 181 West Meadow Drive, Suite 400 Vail, Colorado 81657, USA The native hip is a particularly constrained joint with a E-mail: [email protected] powerful suction seal that is imperative for optimal 1,2 function of the joint . The hip capsule is one of the most important static stabilizers of the hip joint 3 and Summary disruption or debridement of the capsule during hip arthroscopy is a potential contributor to postoperative Background : Hip microinstability is an estab - iatrogenic hip instability. Therefore, hip surgeons must lished diagnosis; however, its occurrence is still be thoughtful of hip capsule management as hip debated by many physicians. Diagnosis of hip mi - arthroscopic procedures are increasing exponentially 4. croinstability is often challenging, due to a lack of Unlike other joints in the anatomy, hip instability is specific signs or symptoms, and patients may re - generally defined as extra-physiologic hip motion that main undiagnosed for long periods.
    [Show full text]
  • Hip Joint: Embryology, Anatomy and Biomechanics
    ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.12.002267 Ahmed Zaghloul. Biomed J Sci & Tech Res Review Article Open Access Hip Joint: Embryology, Anatomy and Biomechanics Ahmed Zaghloul1* and Elalfy M Mohamed2 1Assistant Lecturer, Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Mansoura University, Egypt 2Domenstrator, Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Mansoura University, Egypt Received: : December 11, 2018; Published: : December 20, 2018 *Corresponding author: Ahmed Zaghloul, Assistant Lecturer, Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Mansoura University, Egypt Abstract Introduction: Hip joint is matchless developmentally, anatomically and physiologically. It avails both mobility and stability. As the structural linkage between the axial skeleton and lower limbs, it plays a pivotal role in transmitting forces from the ground up and carrying forces from the trunk, head, neck and upper limbs down. This Article reviews the embryology, anatomy and biomechanics of the hip to give a hand in diagnosis, evaluation and treatment of hip disorders. Discussion: Exact knowledge about development, anatomy and biomechanics of hip joint has been a topic of interest and debate in literature dating back to at least middle of 18th century, as Hip joint is liable for several number of pediatric and adult disorders. The proper acting of the hip counts on the normal development and congruence of the articular surfaces of the femoral head (ball) and the acetabulum (socket). It withstands enormous loads from muscular, gravitational and joint reaction forces inherent in weight bearing. Conclusion: The clinician must be familiar with the normal embryological, anatomical and biomechanical features of the hip joint.
    [Show full text]
  • Hip, Knee & Ankle Joints
    Hip, Knee & Ankle joints Lecture 19 Please check our Editing File. {وَﻣَﻦْ ﻳَﺘَﻮَﻛﻞْ ﻋَﻠَﻰ اﻟﻠﻪِ ﻓَﻬُﻮَ ﺣَﺴْﺒُﻪُ} ھﺬا اﻟﻌﻤﻞ ﻻ ﯾﻐﻨﻲ ﻋﻦ اﻟﻤﺼﺪر اﻷﺳﺎﺳﻲ ﻟﻠﻤﺬاﻛﺮة ﻣﻼﺣظﺔ: اﻟﺳﻼﯾدات ﻛﺛﯾرة ﺑس ﺗراھﺎ ﺳﮭﻠﺔ ﻣرة :) Objectives ● List the type & articular surfaces of the hip, knee and ankle joints. ● Describe the capsule and ligaments of the hip, knee and ankle joints. ● Describe movements of hip, knee and ankle joints and list the muscles involved in these movements. ● List important bursae in relation to knee joint. ● Apply Hilton’s law about nerve supply of joints. ● Text in BLUE was found only in the boys’ slides ● Text in PINK was found only in the girls’ slides ● Text in RED is considered important ● Text in GREY is considered extra notes Objectives (Knee Joint) ● List the type & articular surfaces of knee joint. ● List the function of knee joint. ● Describe the capsule of knee joint, its extra- & intra -capsular ligaments. ● List important bursae in relation to knee joint. ● Describe movements of knee joint. ● Describe the stability of knee joint. X-Ray Knee Structures (Identify) Know the difference: ● The Condyle: ○ Is the articular surface, and it’s smooth. ● The Epicondyle: ○ Is a tubercle above the Condyle. Extra: Structures of the Knee Recall Types & Articular Surfaces Knee Joint Function Knee joint is formed of: ● Weight bearing. ● Essential for daily activities: ● Three bones: ○ Standing, walking & climbing ○ (Femur, Patella & Tibia) stairs. ● Three articulations*: ● The main joint responsible for ○ Two Femoro-tibial articulations: sports: ■ Between the 2 femoral condyles & ○ Running, jumping, kicking etc. upper surfaces of the 2 tibial condyles. ● (Type: synovial, modified hinge**).
    [Show full text]
  • Iliofemoral Ligament
    LOWER LIMB Hip Joint: forms the connection between the lower limb & the pelvic girdle Classification: Ball and socket synovial joint Freedom: 3 degree, multiaxial Movement: Flexion, extension, abduction, adduction, medial and lateral rotation and circumduction. Plane: Sagittal (F & E), Frontal (Abd & Add), Transverse (M & L rotation) Axis: Frontal (F & E), Saggital (Abd & Add), Longitudinal (M & L rotation) Static stabiliser: Joint capsule and their ligaments- Pubofemoral ligament, iliofemoral ligament, ischiofemoral ligaments and the actebular labrum (stabilise head of femur into acetabulum) Function: It is designed for stability over a wide range of movement. When standing, the entire weight of the upper body is transmitted through the hip bones to the heads & neck of the femora. Pubofemoral ligament: Attachment: arises from the obturator crest of the pubic bone and passes laterally and inferiorly to merge with the fibrous layer of the joint capsule (textbook) It is the thickened part of the hip joint capsule which extends from the superior ramus of the pubis to the intertrochanteric line of the femur (app) Function: It tightens during both extension and abduction of the hip joint. The pubofemoral ligament prevents overabduction of the hip joint. Stabilizes the hip joint and limits extension and lateral rotation of the hip. Iliofemoral ligament: Attachment: attaches to the anterior inferior iliac spine and the acetabular rim proximally and the intertrochanteric line distally Function: Said to be the body’s strongest ligament, the iliofemoral ligament specifically prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum and it is the main ligament that reinforces and strengthen the joint.
    [Show full text]