Pelvis and Hip Anatomy and Kinesiology PDF

Pelvis and Hip ANATOMY AND KINESIOLOGY  OUTLINE OF TOPICS I. REVIEW OF TERMINOLOGIES II. PELVIS III. SACRUM and SACROILIACJOINT IV. PELVIC AND SACRAL MOVEMENT V. HIP JOINT  REVIEW OF TERMINOLOGIES i. PLANES OF MOTION ii. TYPES OF JOINTS iii. OPEN AND CLOSE PACK POSITIO...

Pelvis and Hip ANATOMY AND KINESIOLOGY  OUTLINE OF TOPICS I. REVIEW OF TERMINOLOGIES II. PELVIS III. SACRUM and SACROILIACJOINT IV. PELVIC AND SACRAL MOVEMENT V. HIP JOINT  REVIEW OF TERMINOLOGIES i. PLANES OF MOTION ii. TYPES OF JOINTS iii. OPEN AND CLOSE PACK POSITION iv. MANUAL MUSCLE TESTING v. END FEEL  I.PLANES OF MOTION Cardinal Planes Axis Movement Frontal/Coronal Z or Horizontal Axis, Abduction, adduction / A-P Axis Inversion, Eversion * Thumb flexion, extension Sagittal X or Transverse Axis, Flexion, extension/ Coronal Axis Plantarflexion, Dorsiflexion * Thumb Abd & Add Horizontal/Transverse Y or Vertical Axis, IR, ER Longitudinal Axis I.PLANES OF MOTION  II. TYPES OF JOINTS Fibrous Joints Cartilaginous Joints Synovial Joints (Diarthroses) (Synarthroses) (Amphiarthroses) Bones that are united by Hyaline/fibrocartilage 5 distinguishing characteristics: fibrous tissue and are non- connects one bone 1. Joint cavity synovial to another 2. Articular cartilage 3. Synovial membrane 4. Synovial fluid 5. Fibrous capsule Movement is minimal to none Slightly movable joints Free movement SUTURE SYNCHONDROSIS (sternum) Uniaxial SYNDESMOSIS (Tibia &fibula) SYMPHYSIS Biaxial GOMPHOSIS (tooth) Multi-axial  III. OPP AND CPP OPEN PACK CLOSE PACK POSITION POSITION JOINT SURFACE Min/partially congruent Max/fully congruent CAPSULE Lax Taut ATTACHMENTS Lax Taut (LIGAMENTS) MOBILIZATION ☑ x  IV. MANUAL MUSCLE TESTING Grade Value Movement Grade 5 Normal (100%) Complete ROM against gravity with maximal resistance 4 Good (75%) Complete ROM against gravity with some (moderate) resistance 3+ Fair + Complete ROM against gravity with minimal resistance 3 Fair (50%) Complete ROM against gravity 3- Fair - Some but not complete ROM against gravity 2+ Poor + Initiates motion against gravity 2 Poor (25%) Complete ROM with gravity eliminated 2- Poor - Initiates motion if gravity is eliminated 1 Trace Evidence of slight contractility but no joint motion 0 Zero No contraction palpated  V. END FEEL End-feel Example 1. Bone to bone (Hard) Elbow extension 2. Soft tissue approximation Knee flexion (Soft) 3. Tissue stretch Ankle dorsiflexion  V. END FEEL End-feel Example 1. Early muscle spasm Protective spasm after injury 2. Late muscle spasm Spasm due to instability 3. “Mushy” tissue stretch Tight muscle 4. Spasticity UMNL 5. Hard capsular Frozen shoulder 6. Soft capsular Synovitis 7. Bone to bone Osteophyte formation 8. Empty Acute subacromial bursitis 9. Springy block Meniscus tear  PELVIS I. ANATOMY II. MOTION III. SPECIAL TESTS PELVIS ILIUM ISCHIUM PUBIS  PELVIS MALE (ANDROID) FEMALE (GYNECOID) HEIGHT Tall Shorter WIDTH Narrower Wider PELVIC OUTLET Smaller Bigger SUPRAPUBIC ARCH Inclination straight Inclination curved  PELVIC TILT Pelvic tilt: ➔angle between a line joining the ASIS and PSIS ➔Horizontal line from ASIS ➔PSIS (1-2 FB superior) > ASIS ➔N: 7-15 Average pelvic tilt is 11°  PELVIC MOTIONS 1. ANTERIOR PELVIC TILT 2. POSTERIOR PELVIC TILT 3. LATERAL PELVIC TILT 4. PELVIC SHIFT 5. PELVIC ROTATION  PELVIC MOTIONS PELVIC MOTION ACCOMPANYING HIP MOTION Anterior pelvic tilt Hip flexion Posterior pelvic tilt Hip extension Lateral pelvic tilt Right hip adduction (L LE Pelvic drop – R LE stance) Lateral pelvic tilt Right hip abduction (L LE Pelvic hike – R LE stance) Forward rotation Right hip medial rotation (R LE stance) Backward rotation Right hip lateral rotation (R LE stance)  ANTERIOR PELVIC TILT Strong muscles: Hip flexors & lumbar extensors -Weak muscles: Hip extensors & abdominals  POSTERIOR PELVIC TILT Strong muscles: Hip extensors & abdominals Weak muscles: Hip flexors & lumbar extensors NEUTRAL PELVIS LOWER CROSSED SYNDROME LATERAL PELVIC TILT LATERAL PELVIC TILT PELVIC ROTATION FORCE COUPLE ACTION DURING UNILATERAL SLR SUPINE TO SIT TEST  SUPINE TO SIT TEST Anterior Innominate Rotation Posterior Innominate Rotation L Supine S Supine Long sitting/Standing with trunk Long sitting/Standing with trunk S flexion L flexion Sitting with reaching the toes S Sitting with reaching toes L ASIS: INF ASIS: SUP PSIS: SUP PSIS: INF  PELVIC DYSFUNCTION Anterior Innominate Posterior Innominate Rotation Rotation Caused by tight iliopsoas muscle Caused by tight gluteus maximus Stretch Iliopsoas Stretch gluteus maximus Strengthen the gluteus maximus Strengthen Iliopsoas  PELVIC DYSFUNCTION Case 1: (R) PSIS higher (R) ASIS lower (R) LE longer in supine  PELVIC DYSFUNCTION Case 2: (L) PSIS lower (L) ASIS higher (L) LE longer in long sitting  PELVIC DYSFUNCTION Case 3: (R) PSIS higher (L) ASIS higher (R) LE shorter when trying to reach the toes  PELVIC DYSFUNCTION Case 4: (L) PSIS higher (L) ASIS higher (R) LE longer in supine INNOMINATE UPSLIP  SACRUM AND SACROILIAC JOINT I. ANATOMY II. MOTION III. MUSCLES IV. SPECIAL TESTS SACRUM SACROILIAC JOINT  SACROILIAC JOINT PRIMARY LIGAMENTS SECONDARY LIGAMENTS I. Anterior sacroiliac I. Sacrotuberous II. Posterior sacroiliac II. Sacrospinous III. Interosseous SACROILIAC JOINT  SACROILIAC JOINT Resting position Neutral Close pack Nutation Open pack Counternutation Capsular pattern Pain when joints are stressed SACRAL MOVEMENT 1. Nutation 2. Counternutation 3. Oblique Axis motion a. Forward torsion b. Backward torsion SACRAL MOVEMENT: Nutation SACRAL MOVEMENT: Counternutation  SACRAL MOVEMENT NUTATION COUNTERNUTATION Sacral Promontory Anteriorly, inferiorly Posteriorly, superiorly Coccyx Posteriorly, superiorly Anteriorly, inferiorly Pelvic Inlet Decreased diameter Increased diameter (Iliac crest) Pelvic Outlet Increased diameter Decreased diameter (Ischial tuberosity) Anterior sacroiliac Short posterior sacroiliac Sacrotuberous Limited by Long posterior sacroiliac Sacrospinous Short posterior sacroiliac  SACRAL MOVEMENT Pelvis Anterior pelvic tilt Posterior pelvic tilt Lumbar spine ↑ lordosis ↓ lordosis Sacrum Counternutation Nutation  PELVIC MOTIONS WITH LUMBAR SPINE MOVEMENT Lumbar Spine Innominate Sacrum Nutation followed by Flexion Anterior rotation counternutation Posterior rotation Extension Nutation (slight) Rotation to Same side: Posterior rotation Rotation Nutation on same side Rotation to Opposite side: Anterior rotation Same side: anterior rotation Side flexion Opposite side: posterior Side bend rotation LUMBO-PELVIC RHYTHM TEST FOR SACROILIAC JOINT INVOLVEMENT APPROXIMATION TEST - Side-lying - Downward pressure over iliac crest - (+) increase pressure felt on SI joint indicates SPRAIN of POSTERIOR SI JOINT LIGAMENT  GAPPING TEST (Transverse Anterior Stress or Distraction Provocation) - Supine (pushes down & outward) - (+) unilateral gluteal pain/posterior leg pain indicates SPRAIN OF THE ANTERIOR SACROILIAC LIGAMENT  SACRAL APEX PRESSURE TEST AKA PRONE SPRINGING TEST / CRANIAL SHEAR / MIDLINE SACRAL THRUST / SACRAL THRUST - Prone -Base of his or her hand at the apex of the patient’s sacrum -> pressure - (+) pain over the joint indicate a SACROILIAC JOINT PROBLEM  THIGH THRUST TEST AKA OOSTAGARD, 4P, SACROTUBEROUS STRESS, OR POSTERIOR PELVIC PAIN PROVOCATION TEST - Supine,90 deg of hip flex - Palpate SI joint, thrust down - (+) pain on SI joint GAENSLEN’S TEST  SACROILIAC ROCKING TEST aka Knee to Shoulder or Sacrotuberous Test - Supine - Flex the knee and hip fully then adduct - (+) Pain in SI joint  SLR (LASEGUE’S TEST) - Patient in supine, passive hip flexion with knee extended - (+) SI joint pathology Confirmed with unilateral SLR – pain is elicited >70 degrees hip flexion Confirmed with bilateral SLR – (+) pain < 70 degrees of hip flexion SLR (LASEGUE’S TEST) SLR (LASEGUE’S TEST)  Supine Active SLR Test - For Postpartum patients with pelvic problems - active SLR with compression (squeezing innominate bones together) - (+) Easier to SLR / pain decreases with compression indicates SI JT PROBLEM - SI belt  Test for Hamstring tightness Tripod Sign - Sitting dangling - Passive extension of each knee - (+) patient extends the trunk or patient leans backward Test for Hamstring tightness 90-90 SLR - 90 hip flex, 90 deg knee flexion - Actively extend each knee - N: within 20 deg of full extension - (+) APT -> PSIS moves up - (+) PSIS moves upward less than the other -> HYPOMOBILE ILIUM ON THE SACRUM  FLAMINGO TEST - aka One leg standing - (+) pain on SI joint or Symphysis pubis - Inc stress: hop on leg GILLET’S TEST (ipsilateral posterior rotation test) - palpate: PSIS & sacrum - One leg stance, ask patient to flex other knee - N: PIR -> PSIS down - (+) PSIS moves minimally or up = hypomobility or block  IPSILATERAL ANTERIOR ROTATION TEST - Palpate: PSIS, sacrum (SI jt) - Ask step back - hip extends - N: AIR -> PSIS up (sup and lat) - (+) no identified movement of PSIS = SI JOINT PROBLEM GOLDTHWAIT’S TEST Patrick’s Test (FABER, “Figure-4” or Jansen’s Test) - patient lies supine - and the examiner places the foot of the patient’s test leg on top of the - A negative test is indicated by the test leg’s knee falling to the table or at least being parallel with the opposite leg. PIEDALLU’S SIGN - Sit on stable and firm surface (stab. Pelvis) Palpate: PSIS Active forward flexion N: sacrum - ant, pelvis - no movement (+) PSIS move up - ant rot of pelvis -> SI JOINT -HYPOMOBILITY  HIP JOINT I. ANATOMY II. MOTION III. MUSCLES IV. SPECIAL TESTS HIP JOINT HIP JOINT  HIP JOINT Center-edge angle “Angle of Wiberg” - reference (vertical) - lateral aspect of the acetabulum ABN: 35 deg= ? Normal Center-edge angle is at least a 25° angle  HIP JOINT Acetabular Anteversion angle Ref: post acetabulum & post and ant acetabulum > 20 degrees (Ant) < 15 degrees (Post) Normal acetabular anteversion angle is 15°to 20°. HIP JOINT  HIP JOINT Angle of Torsion of Femur Femoral torsion describes the relative rotation (twist) between the bone’s shaft and neck In the adult, the mean angle is 8° to 20° N: 15 degrees  HIP JOINT Femoral Torsion Angle >15° ◦Shaft of the femur rotated medially  HIP JOINT Angle of Anteversion Possible Compensatory Malalignment Related Posture Postures Excessive Toeing in Lateral tibial torsion anteversion Subtalar pronation Lateral rotation at knee Lateral patellar subluxation Lateral rotation of tibia, Medial tibial torsion femur, and/or pelvis Medial femoral torsion Lumbar rotation on same side  HIP JOINT Femoral Torsion Angle Abd leg - Knees flexed 90 deg -> abd further (+) abd increases = Gracilis tightness  MUSCLES OF THE HIP Extensors 1. Gluteus maximus 2. Hamstrings a) Biceps femoris b) Semimembranosus c) Semitendinosus 3. Adductor magnus  MUSCLES OF THE HIP Extensors 1. Gluteus Maximus O: Outer surface of the ilium, sacrum, coccyx, sacrotuberous ligament I: ITB tract and gluteal tuberosity of femur Nerve supply: IGN (L5-S2) A: Extension of hip, lateral rotation, PPT WEAKNESS OF GLUTEUS MAXIMUS  MUSCLES OF THE HIP Extensors 2. Biceps Femoris O: Long head – Ischial tuberosity Short head – Lateral lip linea aspera I: Head of fibula Nerve supply: - Long head: Tibial portion of the sciatic - Short head: Common peroneal of sciatic A: Extension of the hip, flexion and lateral rotation of the knee TAKING OFF THE SHOE TEST  MUSCLES OF THE HIP Extensors 3. Semitendinosus and Semimembranosus O: Ischial tuberosity I: Medial surface of shaft of tibia Nerve supply: tibial portion of Sciatic nn ( L4-S2) A: Extension of the hip, flexion and medial rotation of the knee  MUSCLES OF THE HIP Abductors 1. Gluteus medius 2. Gluteus minimus 3. Tensor fascia lata  MUSCLES OF THE HIP Abductors 1. Gluteus medius O: Outer surface of ilium I: Lateral surface of greater trochanter Nerve supply: SGN ( L4-S1) A: Abduction of the hip  MUSCLES OF THE HIP Abductors 1. Gluteus medius  MUSCLES OF THE HIP Abductors 2. Gluteus Minimus O: Outer surface of ilium I: Anterior surface of greater trochanter Nerve supply: SGN ( L4- S1) A: Abduction and internal rotation of the hip  MUSCLES OF THE HIP Abductors 3. Tensor Fascia Lata O: Iliac crest and ASIS I: ITB Nerve supply: SGN (L4-S1) A: Flexion and abduction of the hip, IR  MUSCLES OF THE HIP External Rotators 1. Gluteus maximus 2. Sartorius 3. Piriformis 4. Gemellus superior 5. Gemellus inferior 6. Obturator internus 7. Obturator externus 8. Quadratus femoris  MUSCLES OF THE HIP External Rotators 1. Piriformis O: Anterior surface of sacrum I: Upper border of greater trochanter Nerve supply: 1st and 2nd sacral nn (L5-S2) A: Internal and external rotation of the hip  MUSCLES OF THE HIP Internal Rotators 1. Anterior fibers of gluteus medius* 2. Gluteus minimus* 3. Tensor fascia lata 4. Pectineus 5. Piriformis 6. Adductor group  STUDY HARD !!! "Trust in the LORD with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and He will make your paths straight.“ Proverbs 3:5-6