Function of iliofemoral ligament
Anterior/Superior/inferior fibers

Reinforces the anterior joint capsule and allows standing with minimal muscular effort
Anterior: hyperextension
Superior: adduction
Inferior: abduction

Function of pubofemoral ligament

adduction and hyperextension

ischiofemoal ligament function

extension and extreme flexion

Ligamentum Teres

This structure serves little, if any, role in supporting the hip. It serves primarily as a conduit for the passage of the artery of the ligamentum teres

Angle of Inclination

~125-130� in frontal plane\
coxa vara/coxa valga

Coxa Vara

Genu valgum, squinting patellae (105-110�)

Coxa valga

CoxaValga - genu varum, lateral patellae (>130)

Angle of Torsion

15-20� Transverse plane
anteversion/retroversion

Anteversion

IR, Squinting P, Toe in gait

Retroversion

ER, Lateral patellae, Toe out gait

N�laton's Line

This clinical sign is used to determine the presence of coxavara. An imaginary line is drawn from the anterior superior iliac spine to the ischial tuberosity. If the greater tuberosity is located superior to this line, coxavara should be suspected.

Iliac crest contusion

Hip pointer"�Signs and symptoms (S/Sx)
�Disproportionate amount of pain
�Swelling
�Discoloration/ecchymosis
�Subsequent loss of function

Quadriceps contusion

�Death of muscle fibers�Pain and spasm limit knee flexion
�Risk of heterotrophic ossification

Bursitis

Caused by increased friction between a muscle or tendon
�Biomechanical factors, congenital influences, or environmental conditions

Trochanteric bursitis causes & s/sx

Causes:
friction between IT band, glut medius/minimus/max and greater trochanter
common in running w/ improper biomechanics and overtraining
direct blows
S/Sx:
local pain, tenderness over the greater trochanter
evaluate for leg length discrepency, adducto

Ischial bursitis cause and s/sx

Cause:
excessive friction over ischial tuberosity
direct blow (hematoma, scarring)
S/Sx:
pain with sitting, TTP over ischial tuberosity, pain w/ passive hip flexion and active/resistive hip extension

iliopsoas bursitis

Cause: overuse of hip flexors
S/Sx:
anterior hip pain
+/- snap
preferred position of hip in flex/ER
TTP to deep palpation anteriorly
pain with passive hip extension

Athletic pubalgia

Sports hernia"
Often misdiagnosed
Result of increased muscular loads on the pubic bone and/or pubic symphysis
Pain in hernia region without palpable hernia
Muscular imbalances

Piriformis syndrome cause and s/sx

Sciatic nerve passes under or through the piriformis
Cause:
trauma, prolonged sitting, overuse, anomalies in 15-20%
S/Sx:
dull buttock pain +/- radiation into leg
TTP over mid-buttock
Pain worse with passive IR or resisted ER

Piriformis strain vs syndrome

Strain vs. Syndrome
Strain: no sciatica
Syndrome: sciatica

Osteitis pubis cause and s/sx

Cause:
Repetitive trauma to pubic symphysis due to overuse
Running/cutting: seen commonly in soccer, football, basketball
S/Sx:
insidious onset
dull anterior groin pain; may radiate
TTP over PS
+/- pain w/ resisted adduction or passive abduction

Slipped capital femoral epiphysis

Displacement of the femoral head relative to the femoral neck
Femoral head remains in acetabulum
Femoral neck displaces anteriorly
Most common hip disorder in adolescents
Most prevalent ages 9-15, especially overweight
Bilateral up to 50%
Gait pattern wit

SCFE s/sx

S/Sx:
insidious
poorly localized hip/groin pain
+/- radiation to knee
worse w/ activity
may have limited IR

Legg-Calve-Perthes disease
Definition, age, prevalence, pathology.

Avascular necrosis of proximal femoral epiphysis
Commonly seen in ages 3-12 y/o
Most prevalent ages 4-9, males 4:1
The blood supply is interrupted.
The ball of the femoral head will collapse and become flat.

Legg-Calve Perthes disease s/sx

Pain in hip is aggravated with activity, +/- radiating to groin, anterior/medial thigh and knee
Internal hip rotation and abduction are limited
Affected leg may appear shorter, but actual difference is rare

Stress Fractures cause and s/sx

Caused by repetitive overuse stresses
Risk factors:
training errors, females, inadequate footwear, intrinsic factors
S/Sx:
insidious pain w/ activity;
+/- local TTP or pain w/ hop test,
+/- decreased ROM

Femoral neck stress fracture

Tension-side (superior) or compression-side (inferior) fractures
Deep aching pain that increases with duration and intensity of activity
Often result from training errors
Night pain is reported

Femoral shaft stress fracture

Initial symptoms often include anterior thigh pain that increases with activity

Snapping hip syndrome

-Palpable and audible "snapping" within the hip as the joint flexes and extends
-Internal: caused by the iliopsoas tendon catching on the pelvic brim (iliopectineal eminence) or the femoral head
-External: occurs as the iliotibial band snaps over the grea

Acetabular labral tearing causes

Hip dislocations
Repeated subluxations
Slipped capital epiphysis
Acetabular dysplasia
Femoral acetabular impingement
Repeated athletic trauma

Femoroacetaubular Impingement (FAI)

Structural abnormality of femur and/or acetabulum that predispose to early degenerative disease and labral tears

FAI Subtypes

Cam and Pincer

Cam Impingement
Prevalence, pathology, & treatment

More common in younger males.
Results from an abnormal morphology of the anterior femoral head-neck junction.
Premature contact between the femur and the acetabular rim
Injury of the anterosuperior acetabular cartilage
Leads to tear or detachment of the a

Pincer impingement

Caused by acetabular over-coverage
Acetabular retroversion
Osteoarthritis

Degenerative hip changes examples

Arthritis
Osteochondritis dissecans
Acetabular labrum tears
Avascular necrosis

Sacralization

Occurs when the 5th lumbar vertebra becomes fused to the sacrum

Lumbarization

Occurs when the 1st sacral vertebrae fails to unite with the remainder of the sacrum

Intervertebral disks

Compressed elastic material allows compression in all directions along with torsion
Become less resilient with age, injury, or improper use, resulting in a weakened annulus fibrosus

Intervertebral foramina

openings between vertebrae that allow spinal nerves to enter and exit the vertebral column

Lumbar plexus

T12 - L5
Innervates anterior and medial muscles of the thigh, medial leg, and foot
L2 - L4
Posterior branches form the femoral nerve
Anterior branches form the obturator nerve

Sacral plexus

L4-S4
Innervates buttocks, posterior femur muscles, and the entire lower leg
Sciatic nerve in three distinct sections

Erector spinae muscle group

Spinalis, longissimus, & iliocostalis

Nerve Root impingement cause

Narrowing of intervertebral foramen:
Stenosis
Facet joint degeneration
Herniated intervertebral disc