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OA 1.13 PowerPoint Presentation

OA 1.13

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OA 1.13

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  1. OA 1.13 • Please have your binder out and ready for notes.

  2. Chapter 18 (pp 456-470) The Pelvis & Thigh

  3. Objectives Identify… • The bones of the hip & thigh • The ligaments of the hip & thigh • The muscles of the hip & thigh • Other structures

  4. Skeletal anatomy

  5. The pelvic girdle • Illium, pubis, ischium • Two innominate bones • Acetabulum • Portion of all 3 bones • Sacrum • 5 fused vertebrae • Coccyx • 4-6 fused vertebrae

  6. The pelvic girdle

  7. The pelvic girdle • Ilium • Forms upper2/5 of acetabulum • Ischium • Forms posterior 2/5 of acetabulum • Pubis • Forms anterior1/5 of acetabulum

  8. The pelvic girdle • The ilium • Anterior Superior Iliac Spine (ASIS) • Anterior Inferior Iliac Spine (AIIS) • Posterior Superior Iliac Spine (PSIS) • Posterior Inferior Iliac Spine (PIIS)

  9. The pelvic girdle • The ilium • Iliac fossa (not shown) • Iliac crest • Greater sciatic notch

  10. The pelvic girdle • The ischium • Ischial tuberosity • Ischial tuberosity • Obturator foramen Obturator foramen

  11. The pelvic girdle • The pubis • Pubic symphysis • Pubic tubercle • Obturator foramen

  12. The pelvic girdle • The sacrum • Connects spine to pelvis • Stabilizes pelvis • Coccyx connects inferiorly • Fused vertebra

  13. The femur • Largest, strongest bone in the body • Head • Neck • Greater trochanter • Lesser trochanter

  14. Articulations

  15. ARTICULATIONS • Sacroiliac Joint • Pubic Symphysis • AcetabularJoint

  16. Sacroiliac joint • Fusion of the sacrum and posterior ilium • Immobile

  17. Pubic symphysis • Joining of the two sides of the pelvic girdle • Dense, fibrous connective tissue • Immobile

  18. Acetabular joint • Ball and socket joint • Very stable • Relatively immobile • Fibrous capsule • Encloses the head and most of the neck of the femur

  19. Ligaments &Joint Capsule

  20. Hip joint ligaments • Ligamentumteres • Ligamentumcapitis • Round ligament • Ligament to the head of the femur All same thing!

  21. Inguinal ligament • From ASISto the pubic tubercle • Functions to contain soft tissues as they pass from the trunk to the lower extremities

  22. Joint capsule • Synovial joint • Reinforced by: • Iliofemoral ligament • “Y” ligament • Ligament of Bigelow • Strongest ligament • Pubofemoral ligament • Ischiofemoral ligament

  23. Joint capsule • The acetabulumis surrounded by a labrum • Extension of cartilage to deepen the joint

  24. Muscular anatomy

  25. Anterior hip & thigh Muscles that cross the hip Muscles that don’t cross the hip VastusMedialis VastusIntermedius VastusLateralis VastusMedialis • Iliacus • Psoas major • Rectus femoris (crosses hip & knee) • Sartorius(crosses hip & knee) • Pectineus

  26. Lateral hip & thigh • Tensor Fascia Latae • Gluteus Medius • Gluteus Minimus

  27. OA 1.14 • How are the anterior muscle of the hip & thigh categorized? • List them into their respective categories.

  28. Posterior hip & thigh • Gluteus Maximus • Biceps Femoris • Semitendinosus • Semimembranosus • Posterior fibers of Adductor Magnus

  29. Deep posterior hip & thigh EXTERNAL ROTATORS • Piriformis • ObturatorInternis • GemellusSuperior • GemellusInferior • QuadratusFemoris • ObturatorExternis

  30. Medial hip & thigh • Adductor Longus • Adductor Brevis • Adductor Magnus • Gracilis

  31. Other structures

  32. bursa • Iliopsoas bursa • Trochanteric bursa

  33. Circulatory anatomy • Iliac artery • Femoral artery • Femoral circumflex arteries • Surrounds the head & neck of the femur

  34. Neural anatomy • Femoral nerve • Anterior thigh • Sciatic nerve • Posterior thigh • Tibial and common peroneal • Obturator nerve • Medial thigh

  35. Femoral triangle • Superior: inguinal ligament • Lateral: sartorius • Medial: adductor longus • Femoral artery, femoral vein, femoral nerve, and lymph nodes run through • Palpate femoral pulse

  36. OA 1.21 A basketball player was going up for a lay up and got her feet taken out from under her. She lands hard on her left hip. • What questions would you ask to gather clues about what is going on? • What are some relevant observations to make regarding their body?

  37. History & Observation

  38. objectives Identify… • Pertinent information to gather during a hip & thigh evaluation • Important observations to make during a hip & thigh evaluation ???

  39. introduction • Must understand anatomy & biomechanics • Examination process is on-going • Initial  rehab RTP • Must be systematic and methodical • Must understand differential diagnosis (DDx) • Options that a specific injury could be • Pathologies often have similar S&S • Rule out emergency situations quickly • If unsure, err on side of caution

  40. history • Start with generic history questions • Chief complaint • Age • Occupation / sport / position etc. • General healthcondition • Activity level • Medications

  41. history • History of previous injuries • What happened? • Who did you see? • What did they tell you? • How long were you out? • Has it fully resolved?

  42. history • Mechanism of injury • How did it happen? • Tension = sprain; fracture; strain • Torsion = sprain/labrum; fracture • Compression = contusion; fracture • Shear = fracture; sprain

  43. history • Mechanism of Injury – Hip & Thigh specific • Compression • Internal/External rotation of the femur • Overuse