Hip Information

Hip Information

1. *The pelvis is broken down into two parts/innominate: Ilium, pubis and ischium connected directly through the pubic symphysis and indirectly through the sacrum. Area where the pubis, ischium and ilium meet creates an acetabulum. The femoral head articulates here. The jt is called the coxafemoral jt (AKA shoulder of the lower extremity->very similar in nature in the arthrokinematics, osteokinematics and the impairments). Coxafemoral jt impairment affects not only the hip but also other areas of the LE.

2. Hip Osteokinematics

   • Hip jt is a diarthrodial ball and socket jt with 3 degrees of freedom
   • Normal AROM coupling Motions: flexion (IR and abd) and extension (ER and add)
   • Actions: flexion->113-134; Magee 110-120; extension->9-28; Magee 10-15; abd->39-48; Magee 30-50; add->26-31; Magee 30; ER->34-48; Magee 40-60; IR->32-47; Magee 30-40

3. Functional AROM

   • Walking: 30-40 flexion with 10-15 extension
   • Descending steps: 45 flexion
   • Ascending steps: 60 flexion
   • Sitting: 90-112 flexion
   • Squatting: 115 flexion and 20 IR and 20 abd
   • Don socks: 120 flexion

4. Resting position: 30 abd and flexion with slight ER

   • Closed pack: extension, IR and abd
   • Capsular pattern: IR, flex, abd
     • Capsular pattern may occur due to some synovitis that produce adhesions in the capsule that restricts joint motion (ex: OA)      

5. Joint play: convex on a concave. Roll and glides opposite.

   • Posterior (average glide 0.8-4.2mm)->improves flexion and IR Anterior (average 0.25-2.9)-> improves extension and ER Inferior->improves pain in those with OA and increases hip abd and flex

6. Muscle Performance

   • Thomas:hip flexor tightness
   • Modifies Thomas: quad tightness (RF)
     • Elys: pt prone. Knee is flexed passively. Assessing RF tightness.
   • Ober: TFL/IT band tightness
   • 90/90 SLR: pt supine with both legs flexed at the hip and knees to 90. Pt then extends the knee of involved side until can no longer extend without extending hip. Assess hamstring tightness.

7. LLD: 5mm difference clinically significant. Pt supine. Measure from ASIS to medial malleolus of ipsilateral side. Have pt do bridge and then look for discreoency

8. Tradelenburg->weakness of hip abd (glute med)

9. Sign of the buttocks: PT perform SLR passively on pt. PT stops at resistance. PT then bends knee and flexes hip to end range. Positive: ROM does not change when knee is flexed->possible osteomyelitis neoplasm, septic arthritis of SIJ, septic bursitis, or Rheumatic fever (refer out)

10. Craig's test: assessing degree of anteversion or retroversion. Pt prone with knee flexed. PT rotates hip until feel most prominance of the greater troch. Measure angle from vertical. Norm: 8-15 anteversion

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