Ligamentum Teres
- transverse acetabular ligament to fovea capitis
- strong intrinsic stabilizer, more taut with flex/abd/ER
- may have proprioceptive role preventing excessive movement, distribute synovial fluid
- dysfxn = deep ant groin pain, painful with forced flex/IR
Iliofemoral Ligament (Y)
- AIIS/acet rim to introtroch line, 2 bands
- Restricts hip ext allowing erect posture to be maintined
- Primary restraint vs ext/ER
Ischiofemoral Ligament
- Post acet rim to med fem neck/greater troch
- Restricts vs IR; add when flex
Pubofemoral Ligament
- Sup pubic ram to intertroch line
- Primary restraint vs hyperabd and ER
Angle of Inclination
- Angle between neck and fem shaft (normal 125-130 deg)
- Coxa valga (inc angle)
- Coxa vara (dec angle)
Coxa Valga
- fem head directed more superiorly
- joint reaction force now parallel to fem shaft = dec WBing surface
- shortens hip abd, inc overall length of LE
Angle of Torsion
- angle formed by fem neck and transverse axis of fem condyles
- normal 12-15 deg
- anteversion - fem neck excessively ant to condylar axis
- retro - parallal to post
Increased Anteversion
- Inc IR = toe in gait
- toe in, subtalar pro, lat pat sublux
- med tib/fem torsions
- possible lat tib torion, lat rotation at knee, lumbar rot ipsi
Excessive Retroversion
- toe out, subtalar sup
- lateral tib/fem torsions
- possible med tib torsion, lumbar rot contra
Athletic Pubalgia
sports hernia
- dec rot, inc pelvic motion = inc stress on pelvic stabilizers and breakdown
Special Test - HF sore, tender at add, rect abd insert tender origin during palpation of resisted contraction
Passive IR should exacerbate hip joint but not AP
Snapping Iliopsoas tendon
- can be heard, snapping as it crosses ant fem head/capsule or pectineal eminence
- clunk occurs as hip flex/abd/ER toward ext/IR
- FABER into ext/IR = snap
Snapping ITB
- can be seen, TFL flips back/forth over greater troch with hip rot
- Ober Test
Localization of Symptoms
Anterior groin - L3 seg/derm (radiate into med thigh)
C-sign - deep int pain
Lat - bursitis or ITB
Post - lumbar or piriformis (even post intra-articular pathology refers ant to A/L)
Inspection
- irritated hip slight flex while standing = LLD
- seated - slouching and listing to uninvolved side (slight less flex with abd/ER = relaxed capsule)
LLD
> 1.5 cm = significant
Impingement
Cam - head too big, pistol grip
Pincer - acet to big
X-ray Angles
- Alpha - midline of fem neck and line connecting fem head to head/neck junction (normal 45, > 50 - cam)
- Center-Edge - center of fem head and lat corner of acet (20-25 deg, < 20 = dysplasia)
- Angle of Inclincation
- Tonnis Angle - sourcil (sclerotic WBing portion of sup acet); line between med/lat extents and angle to horizontal line parallal to inf aspect of isch tub (> 10 = dysplasia)
Crossover Sign - sup ant rim of acet more lat than post rim = acet retro (pincer)
MRA vs MRI
MRA has greater Sn and less false positive
Craig Test
femoral anteversion (8-15 normal)
Log Roll
most Sp for intra-articular pathology; should produce ant groin pain, may produce sharp/catching
Impingement (special test)
forced flex/IR
- flex/add = approximates fem neck and acet rim
- IR = shear force at labrum = sharp pain if chondral lesion present
- may produce click
Post Impingement
forced ext hip into ER
- ant trans of fem head = ant instability or possible pain trapping ant labral tear
FABER
catching associated with labral/chondral lesions
- restricted abd/ER quantified by knee elevation off table (> fist or 10 cm)
ASLR
forces several times BW across articular surfaces (more force than walking)
