CCHB421 hip.docx

LOWER LIMB BIOMECHANICS We are going to be looking conditions of the lower extremity in all regions also look at the management and treatment of the conditions. There is an overlap between CCHB421 (conditions) and CPPR421 (management and treatment). CCHB421 will be the conditions: 1. Defining o...

LOWER LIMB BIOMECHANICS We are going to be looking conditions of the lower extremity in all regions also look at the management and treatment of the conditions. There is an overlap between CCHB421 (conditions) and CPPR421 (management and treatment). CCHB421 will be the conditions: 1. Defining of the condition 2. Clinical presentation 3. Diagnostic criteria 4. Orthopedic tests 5. Differential diagnoses 6. Pathogenesis of the condition (how the condition occurs) 7. Mechanism of injury 8. Prognosis 9. Compensatory mechanisms 10. other related conditions. CPPR421 will be the treatment of these conditions: 1. Manipulation (spinal, extraspinal (Sacroiliac, extremity) 2. Dry needling (muscles, tendons, bursa)( MYAT) 3. Soft tissue therapy (massage, cross friction) 4. Electrotherapy (ultrasound, IFC, TENS, shockwave) DR V 5. Strapping (rigid, Kinesio-taping 6. Bracing/orthotics 7. Referral (Orthopedic surgeon, Orthotist/Prosthetist, Physiotherapist, Biokineticist) **[LOWER LIMB]** Conditions of the HIP: 1. Osteoarthritis of the hip 2. Femoral acetabular impingement syndrome 3. Trochanteric bursitis 4. Slipped femoral ephiphysis THIGH/ upper leg 1. Hamstring strain/muscle tear 2. Hamstring insertional tendonitis 3. Ishiogluteal busitis 4. Quadriceps muscle strain 5. Adductor muscle strain 6. Iliotibial band syndrome 7. Compartment syndrome Acute KNEE 1. Osteo-arthritis of the knee 2. Patella femoral pain syndrome 3. Chondra malacia patella 4. Meniscus injuries Medial Lateral 5. Ligament injuries Collateral ligaments Medial Lateral Cruciate ligaments Anterior Posterior 6. Osteochondritis desscians 7. Patella dislocation 8. Plica syndrome 9. Superior tib fib joint subluxation/dysfunction LOWER LEG 1. Medial tibial stress syndrome (shin splints) 2. Compartment syndrome 3. Calcaneal/Achillies tendonitis 4. Calcaneal/Achillies tendon rupture 5. Stress fracture ANKLE/FOOT 1. Sprained ankle 2. Heel spurs 3. Fat pad syndrome 4. Plantar fasciitis 5. Pes planus 6. Pes cavus 7. Cuboid syndrome 8. Medial tarsal tunnel syndrome 9. Mortons neuralgia 10. Sesamoiditis 11. Metatarsalagia 12. Hallux valgus/hallux rigidus 13. Tendonitis **THE LOWER LIMB KINEMATIC CHAIN** Kinetic chains are defined as a combination of several successively arranged joints constituting a complex motor unit. Each bony part of the lower limb, like the foot, leg, thigh, and pelvis, can be seen as a solid link, with the subtalar, ankle, knee, and hip joints serving as connections. Open and closed kinematic chains. **Open kinematic chains** have the terminal part free to move. Upper limb is open kinematic chain. **Closed kinematic chain** have the terminal part of the kinematic chain fixed, example is the lower limb. The lower limb kinematic chain is considered closed when weight bearing (the foot is fixed). Therefore, the lower limb kinematic chain is a complex interaction involving all joints and muscles of the lower limb. The muscles and joints effect each other causing a complex compensation throughout the lower limb.  The normal anatomy, bony anatomy, muscle and ligament attachments are important to understand the compensatory mechanisms. Anatomy: Lower Extremity Diagram \| Quizlet Important because: 1. Understanding the condition 2. Preventing development or complications 3. Treating the cause of the condition **1.THE HIP** The hip is the link between the trunk and the lower limb, as such is responsible for transferring weight into the lower extremity. The hip is important in forming a stable base that the body (trunk and upper limbs) can function from. The hip has an important role in stability. Know how the hip gets its stability and transfers weight (joint capsule, acetabulum, labrum) 1. **The normal anatomy of the hip.** The hip joint is the articulation of: 1. Head of the femur 2. Acetabulum of the pelvis Forming a ball and socket joint, that is added by the acetabular labrum.  *The functions of the acetabular labrum are:* - *Joint stability - increases the containment of the femoral head, deepening the joint by 21%, increasing the surface area of the joint by 28%, thus allowing a wider area of force distribution and resisting lateral and vertical motion within the acetabulum* - *Sensitive shock absorber* - *Joint lubricator - sealing mechanism keep the synovial fluid in contact with the articular cartilage* - *Pressure distributor - obstructs fluid flow in and out of the joint through a sealing action which is often referred to as a "suction effect" in view of the resistance generated to distraction of the head from the acetabular socket. This sealing function not only enhances joint stability, but is thought to more uniformly distribute compressive loads applied to the articular surfaces, thereby reducing peak cartilage stresses during weight-bearing.* - *Decreasing contact stress between the acetabular and the femoral cartilage* 2. **Ligaments of the hip** Ligaments are important as they help form the stability of the hip. **Intracapsular:** ligament of head of femur (ligament teres) **Extracapsular:** **Anterior** iliofemoral ligament (ASIS to inter-trochanteric line of trochanter) **Posterior** Ischiofemoral (ischium and greater trochanter) A diagram of the femur Description automatically generated  3. **Muscles and movements** The movements that can be carried out at the hip joint are listed below, along with the principle muscles responsible for each action: - **Flexion **-- iliopsoas, rectus femoris, sartorius, pectineus - **Extension **-- gluteus maximus; semimembranosus, semitendinosus and biceps femoris (the hamstrings) - **Abduction ***-- *gluteus medius, gluteus minimus, piriformis and tensor fascia latae - **Adduction **-- adductors longus, brevis and magnus, pectineus and gracilis - **External rotation **-- biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris. - **Internal rotation **-- anterior fibres of gluteus medius and minimus, tensor fascia latae  The degree to which flexion at the hip can occur depends on whether the knee is flexed -- this relaxes the **hamstring muscles** and increases the range of flexion. Extension at the hip joint is limited by the joint capsule and the **iliofemoral ligament**. These structures become taut during extension to limit further movement. **Close packed position** is full extension 4. **Bursa** Hip Resource-new 5. **General hip pain presentation** Indications in the **CASE HISTORY** to increase your suspicion that there is a hip pathology: 1. Pain on lateral pelvis over the hip region 2. Pain referral into the anterior groin 3. Pain with weightbearing 4. Pain made worse after walking or exercising Indications during the **EXAMINATION** to increase your suspicion that there is a hip pathology: 1. Internally rotated leg when walking 2. Patrick FABER test 3. QUADRANT scouring test 4. Gluteus max stretch causing pain in the anterior groin not stretch in the muscle 6. **OSTEOARTHRITIS OF THE HIP** 1. **Definition** Osteoarthritis is a chronic arthropathy characterized by disruption and potential loss of joint cartilage along with other joint changes, including bone hypertrophy (periarticular osteophyte formation and sclerosis). Symptoms include gradually developing pain aggravated or triggered by activity, stiffness lasting \