Unlock Your Hip Flexors
The iliopsoas and rectus femoris are the major hip flexors. Repetitive stress on the hip flexor muscles without adequate recovery is the major cause of muscle strain. Improper gait can also create this type of problem. This injury often occurs in running, in cycling, and in kicking and jumping activities. The symptoms include pain, tenderness, and inflammation in the groin area. Dry needling acupuncture is very effective in treating this injury. Needles can be applied to the ARPs on the iliopsoas muscle, the adductor muscles, the rectus femoris muscle, and the iliotibial band. The hamstring muscles may need treatment, too. Two treatment sessions per week should be offered.
Flexion of the hip joint will have been performed with flexion of the knee as already explained. Full extension of the hip joint can only be carried out in prone lying or side lying. In prone lying with the client's foot over the edge of the bed, place one hand on the buttock. The other hand is placed under and above the knee with the client's lower leg supported along the forearm. Figure 9.27 Extension of the hip joint. Figure 9.27 Extension of the hip joint. Figure 9.28 Abduction and adduction of the hip joint. Figure 9.28 Abduction and adduction of the hip joint. With the legs slightly apart but supported on the bed throughout, place one hand on the thigh and the other on the lower leg. Grasp the leg gently and turn it inwards and outwards. For continuity it is suggested that hip joint flexion is carried out with knee joint flexion this is then followed by
It is becoming clear that other enteric bacterial pathogens possess the ability to respond to norepinephrine. NE promotes growth of Campylobacter jejuni in iron-limited media and bacterial uptake of 55Fe (Cogan et al. 2007), as well as growth of the periodontal isolate C. gracilis (Roberts et al. 2002). C. jejuni lacks known siderophores but encodes homologues of siderophore receptors and it has been proposed that NE may bind iron and supply it to Campylobacter directly. In contrast to observations in E. coli (Freestone et al. 2000), no uptake of tritiated NE into C. jejuni cells could be detected (Cogan et al. 2007). Growth of C. jejuni in NE-supplemented medium markedly enhanced its ability to invade Caco-2 cell monolayers and disrupt tight junctions, as detected by a decrease in transepithelial electrical resistance and redistribution of occludin (Cogan et al. 2007). This may partially be explained by the ability of NE to promote motility of C. jejuni (Cogan et al. 2007), which...
D., 36 years old, was a professional longdistance runner. Five years ago she had surgery because of Achilles tendinitis in the left heel. It took 2 years for her to recover to the point of resuming training, but the muscles of her left leg had developed a tendency toward delayed-onset muscle soreness She would feel pain in the lower left abdominal muscles just above the inguinal ligament while running downhill. The routine screening examination revealed that she felt this pain whenever she overextended the left leg. Further examination revealed sensitive and sore areas on the left quadriceps muscles. The treatment included systemic needling of the primary homeostatic acu-reflex points, as well as the symptomatic acu-reflex points on the lower back, hip abductor, and iliopsoas muscles to relieve hip stress. Symptomatic treatment focused on quadriceps, hamstring muscles, adductor muscles, the iliotibial band, and rectus abdominis muscles.
As the experience with hip arthroscopy expands, so, too, will the ability to recognize the various injury patterns to the chondral surfaces of the hip. As our understanding of the pathologic processes contributing to chondral injury of the hip joint improves, perhaps we will be able to intervene preventing the progression to osteoarthritis.
The hip joint can be a source and site of symptoms in itself although in most cases pain originating in the hip will be referred along the third lumbar nerve root down the medial side of the thigh to the knee. Hip disease, whether of an acute or chronic nature, can produce a characteristic discomfort deep in the groin, but not usually where the patient perceives the hip to be. Restoration of even a small part of lost mobility can be very successful in relieving many of the symptoms of hip disorders, even if the progress of the degenerative state has not been changed at all. Technical problems occur mostly due to the deep nature of the joint, and the need to use quite long levers to reach it. There is,
Some football injuries are related to specific positions of the game. Offensive linemen are more prone to lumbar, knee ligament, and shoulder injuries. Wide receivers may have hamstring strains and tears of the anterior cruciate ligament. Defensive backs often have upper extremity injuries, including finger dislocations and hand and wrist sprains from defending or blocking their opponent's offensive players. Neck and shoulder sprains occur during tackling. Both field-goal kickers and punters develop overuse injuries.3 Among kickers, the most common injuries are low back, hip flexor, and hamstring strains.
The rectus fem-oris originates from the pelvis and flexes (bends) the hip joint. It is inserted into the patella and can straighten the knee with the help of the powerful tendon that extends from the patella to the tibia. Three other large extensor muscles, the vastus muscles, are inserted into the knee joint. Rectus femoris also stabilizes hip joint and helps iliopsoas to flex Sartorius rotates thigh at hip joint Gracilis
Napus agriasinapis, 433 Narcissus tazetta, 283-284 Nardostachys gracilis, 285 Nardostachys grandiflora, 285-288 Nardostachys jatamansi, 285 Nasturtium armoracia, 47 Nasturtium fontanum, 289 Nasturtium nasturtium-aquaticum, 289 Nasturtium officinale, 289-293 Nerium indicum, 294 Nerium latifolium, 294 Nerium odorum, 294 Nerium oleander, 294-297 Nigella indica, 298 Nigella sativa, 298-302 Nigella truncata, 298 Nymphaea alba, 303-305 Nymphaea erythrocarpa, 303 Nymphaea exumbonata, 303
Rectus femoris, tendon- Rectus femoris, tendon- Figure 12-2 The ligaments of the hip joint. Figure 12-2 The ligaments of the hip joint. Flexors Iliopsoas Psoas major Pectineus Adductor longus Adductor brevis Acts jointly in flexing thigh at hip joint stabilizes hip joint Acts jointly in flexing thigh at hip joint stabilizes hip joint Abducts and medially rotates thigh stabilizes pelvis Abducts and medially rotates thigh stabilizes pelvis Sartorius Tensor fasciae latae Gluteus medius Iliopsoas Rectus femoris Fascia lata Rectus femoris, tendon Rectus femoris Fascia lata Rectus femoris, tendon Psoas major Promontory Superior pubic ligament Pectineus Adductor longus Gracilis Sartorius
Once the static stabilizers of the hip including the iliofemoral ligament and labrum are injured, the hip must rely more on the dynamic stabilizers for stability. It is hypothesized that when capsular laxity is present, the psoas major, a dynamic stabilizer of the hip, contracts to provide hip stability. Over time, this condition can lead to stiffness, coxa saltans, or flexion contractures of the hip 14 . In addition, due to the origin of this muscle from the lumbar spine, a chronically contracted or tightened psoas major may be a major contributor to low back pain. Thus, hip instability or capsular laxity can trigger a whole spectrum of disorders that the physician must take into consideration when considering various treatment options. Hip flexor
In the one-joint hip flexors (iliopsoas). Prolonged sitting with the knees partially extended places the foot in a position of plantar flexion and may result in adaptive shortening of the soleus. Wearing high-heeled shoes much of the time may also lead to the development of adaptive shortening of the soleus. Adaptive shortening of postural muscles can affect both balance and alignment. When adaptive shortening continues too long, it may become an irreversible histologic contracture.
In the final stages of treatment, disimpaction of the neurocentral core is the ultimate objective. The BackBlock achieves this, and also restores an optimal lumbar hollow. It does this by stretching the front of the hips (the hip flexors) thus reducing an exaggerated lordosis, but it can also correct a pronounced lumbar kyphosis (less commonly a background factor with this condition) by stretching the anterior longitudinal ligament down the front of the spine. While on the Block it is often useful to rotate the pelvis in a minute twisting action which helps disengage the lumbar facets.
Dynamic movement occurs at the hip joint and is characterized and constrained by the anatomy of the region, including osseous, ligamen-tous, and musculotendonous structures. The majority of patients who require hip arthroscopy are young, active individuals with a history of hip or groin pain. In some athletes, the onset of hip pain may be due to a traumatic event such as a fall, tackle, or collision. However, in many sports, athletes suffer a minor hip injury or perform repetitive motions that exacerbate a chronic pathologic or congenital hip condition that leads to increased capsular laxity and labral tears over time. One of the obvious benefits of arthroscopic hip surgery in this population is that it allows the surgeon to perform procedures within the hip joint with a minimal amount of postoperative morbidity, allowing for a return to sporting activities in a shorter time period. This type of surgery is relatively new, with only a few experts advancing in the field worldwide....
(quad-ri-seps eks-ten-sor) The quadriceps is made up of four muscles rectus femoris, vastus lateralis, vastus intermedius, vastus medialis Attached to the pelvic girdle (rectus femoris) and femur (vastus group) at one end and to the patella and tibia at the other end Sartorius Due to its unusual position, the sartorius can flex both the hip and the knee. Over contraction of the sartorius can lead to knee problems because turning the leg outwards puts pressure on the knee Sartorius is also the longest muscle in the human body adductor brevis, adductor longus, adductor magnus and pectineus Gracilis Gracilis muscle is the second longest muscle in the human body Iliopsoas Tensor Fascia Lata Pectineus Adductor longus Rectus femoris Gracilis Sartorius Iliopsoas Tensor Fascia Lata Pectineus Adductor longus Rectus femoris Gracilis Sartorius Pectineus Adductor brevis Pectineus Adductor brevis Adductor longus (cut) Rectus femoris Adductor longus (cut) Rectus femoris
Obesity is frequently complicated by degenerative arthritis (DJD). Increased body weight leads to trauma of the weight-bearing joints and speeds the development of osteoarthritis in obesity. Knee and hip joints are particularly affected. However, obese patients have increased DJD of the hands, perhaps due to cytokines produced by adipose tissue, which may damage the cartilage in joints. Flattening of the arc of the planter surface of the feet (flat feet) occurs more frequently in obese people, presumably due to the stress of carrying excess body weight. Flat feet may lead to unsteady gait and aches and pains after walking. Increased fat deposition, particularly in the abdominal region, can change the natural curvature of the spine, causing lordosis and resulting in backache in obese people.
The hip assumes an essential role in most sports-related activities. The hip is not only responsible for distributing weight between the appendicular and axial skeleton, but it is also the joint from which motion is initiated and executed. It is known that the forces through the hip joint can reach three to five times the body's weight during running and jumping 1,2 . Considering the amount of demand athletes place on their hips, orthopedic surgeons will evaluate them as patients having hip pain. blur the lines in appropriately differentiating between the hip and back 17-22 . Low back pathology involving the paravertebral muscles can lead to an abnormal soft tissue balance, causing an irregular tension absorbed by the hip joint, which leads to knee pain, groin pain, leg length discrepancies, and limited ranges of motion in the hip 23 . Muscle contractures of the hip flexors or extenders as well as leg length discrepancy have also been identified as factors that can cause hip and low...
Musculomechanics of, 171-177, 176t Hip, pelvis, groin injuries, 225-227 avulsion fracture, 225-226 groin strain, 226 hip flexor strain, 225 hip pointer, 225 osteitis pubis, 226 piriformis syndrome, 226 stress fracture, 226 trochanteric bursitis, 226-227 Hippocampus, loss of volume of, 16 Histamine release, 58 Homeostasis
Chuanxiong was administered to dogs to test its efficacy on muscle function, and specifically to see whether the use of a local or systemic treatment on muscle graft will increase the function of the transplanted muscle (22). The investigators subjected adult dogs to an orthotopic replantation of their bilateral rectus femoris muscles by microneurovascular anastomoses and split the subjects into a postoperative treatment group (with without administration of chuanxiong) and a control group. They reported that therapy improved muscle function and morphology and maximal tetanic tension of the transplanted muscle. This study concluded that the combination of localized therapy and systemic injection of chuanxiong had a favorable effect on nerve regeneration as well as muscle function after a muscle transplant.
Sartorius Contraction of sartorius with hip Contraction of rectus femoris with walk with a limp with the affected leg in an externally rotated position. They may have limited internal rotation or abduction and have pain with hip movement. Some will have obligatory external rotation of the hip with flexion of the knee. AP and frog view of the hips show slippage of the epiphysis (Fig. 13). SCFEs need immediate surgical management to prevent further slippage and damage of the hip joint. Adolescents should be made non-weightbearing on crutches and sent for immediate orthopedic evaluation.
The iliotibial band is a nonelastic collagen cord that stretches from the iliac crest, blends with the tensor fasciae latae and gluteus maximus muscles, and then descends to insert into the tubercle on the lateral proximal tibia. The tensor fasciae latae muscle flexes, abducts, and medially rotates the hip joint and stabilizes the knee.
For example, when treating low-back pain, the lumbar muscles, gluteal muscles, hamstring muscles, calf muscles, hip flexor muscles, abdominal muscles, iliotibial band, pectoral muscles, and even neck muscles can be treated in the same session. The same procedure can be repeated in subsequent sessions until complete healing is achieved. The same needling procedure will also be effective with asymptomatic healthy persons for preventing low-back, hip, and neck problems.
Therapy to increase flexibility of the hamstring, quadriceps, and hip flexors along with core body strengthening. Icing after activity for 15 to 20 minutes and NSAIDs on an as needed basis after activity can help control pain. A patellar tendon strap (a Velcro strap placed across the patellar tendon to decrease tension on the tibial tuberosity) may also decrease pain. Athletes may continue to participate in sports as long as they are not limping or having a significant increase in pain. The enlarged tibial tuberosity is a permanent feature of OS that lasts into adulthood. Beware of an athlete presenting with acute OS as he she must be evaluated for a Salter Harris type III fracture of the proximal tibia or tibial avulsion. If an athlete can not perform a straight leg raise concern for a more serious injury such as those listed above or a patellar tendon rupture should be addressed. Rarely, if conservative methods fail, casting in extension or surgical excision of ossicles may be...
Kevin Crawford MDab Marc J Philippon MDcd Jon K Sekiya MDe William G Rodkey DVMc J Richard Steadman MDcd
Technologic advance and refinement of technique have together revolutionized the modern field of hip arthroscopy. These advances have enabled surgeons to address subtle pathology in and around the hip joint that previously was either misdiagnosed or poorly understood. As both the indications and the applications of this surgical technique have expanded, one area of significant interest in the hip joint is articular cartilage injury. Previous authors have shown that articular cartilage defects rarely heal spontaneously regardless of whether acute, chronic, or degenerative 1 . The vast majority of studies addressing the treatment of articular cartilage lesions have involved the knee. Various techniques have been employed in an attempt to treat this difficult problem including abrasion chondroplasty, osteochondral drilling, the use of osteoarticular autograft or allograft plugs, bulk allograft techniques, autologous chondrocyte implantation, and microfracture 2-6 . Microfracture of the...
Stress stimulates the formation and releasing of biogenic amines, in particular epi-nephrine, a hormone produced during stress that affects heart rate, blood circulation and other functions of the body. Microorganisms possess the ability to recognize hormones within the host and utilize them to adapt to their surroundings. Norepinephrine and epinephrine, which are released during human stress responses, may act as environmental cues to alter the growth of individual microbes. The growth stimulation of 43 oral bacteria by norepinephrine and epinephrine was found (Roberts et al. 2002), especially for Actinomyces naeslundii, A.s gerenscse-riae, Eikenella corrodens, and Campylobacter gracilis, and suggest that stress that induces changes in local catecholamine levels in the mouth may play a significant role in the etiology and pathogenesis of periodontal disease. The bacteria-induced enhanced level of the compounds may be recommended as a valuable diagnostic test in medical practice.
Posture is the state of balance and coordination of musculoskeletal and visceral systems. Skeletal asymmetry is a major source of muscle strain inasmuch as compensatory muscular control is necessary to maintain a working posture and to keep the eyes level. For example, a length discrepancy between the lower limbs causes a chain reaction of muscular overloads of the entire musculoskeletal system. The tilted pelvis requires contraction of the quadra-tus lumborum muscle to curve the lumbar spine in order to bring the rest of the body over the pelvis. Consequently, the spine above is tilted to the other side. This tilt requires further compensation of neck muscles such as the sternocleidomastoid and upper trapezius. This sustained contraction and overload facilitates the development of trigger points inside the postural muscles, from gastrocnemius through soleus, adductors, iliotibial band, gluteus muscles, piriformis, iliopsoas, quadratus lumborum, muscles of the shoulder girdle,...
Pathogenesis appears complex, and involves avascular necrosis, followed by resorption, collapse, and subsequent repair of the capital femoral epiphysis, resulting in impaired growth and development of the hip joint. The natural history of the disease is variable, and is largely dependant on the age of onset and the degree of femoral head involvement, but is also greatly influenced by intervention 1 . The younger a child is at the onset of the disease, the greater the time he has for subsequent growth and remodeling 1 . Moreover, in the long term, 50 of those who had childhood Perthes disease who did not receive treatment developed subsequent osteoarthritis in the fifth decade of life 1 . Perthes disease is specific to the hip joint, and typically presents as an insidious, unilateral, painless limp 1 . If pain is present, it is usually mild, is exacerbated by exercise, and is frequently referred to the knee. The most consistent examination findings include reduced internal rotation and...
Arthroscopic surgery of the hip joint. Arthroscopy 1991 7 204-11. 18 Bould M, Edwards D, Villar RN. Arthroscopic diagnosis and treatment of septic arthritis of the hip joint. Arthroscopy 1993 9 707-8. 22 Witwity T, Uhlmann RD, Fischer J. Arthroscopic management of chondromatosis of the hip joint. Arthroscopy 1988 4 55-6.
It is the longest bone in the body and has a shaft and two swellings at each end. The proximal swelling has a rounded head like a ball which fits into the socket of the pelvis to form the hip joint. Below the neck are swellings called trochanters, which are sites for muscle attachment. The distal ends of the femur articulate with the patella or kneecap.
Adductors (5) Adductor magnus Adductor longus Adductor brevis Pectineus Gracilis Work as a group to adduct the hip joint (pull inwards) and rotate it laterally Lies deep, across the hip joint Work as a group to abduct the hip joint and rotate it medially Extends the hip joint
The iliac crest provides attachment for the hip flexors, the abdominal muscles, and the muscles that rotate the hip. Direct impact on the iliac crest can cause contusion, bruising, and inflammation of tissue or even bone fracture. Severe pain can be felt after the injury happens. Dry needling acupuncture is very effective in treating this injury. Needles can be applied to the painful tissues with two to three needles per square centimeter, including the gluteal muscles, iliotibial band, and hip flexors. Two treatment sessions per week should be provided.
Four muscles make up the quadriceps the vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris. The quadriceps is involved in moving the hip and knee and supporting body weight. The rectus femoris is more susceptible to strain injury than the other three muscles. The injury can result from repetitive contraction without adequate relaxation or forceful contraction, which may occur in sprinting, jumping, football, hockey, and weight training.
Postural instability is created by a pattern of weakness, muscular tightness, and standing alignment changes that diminish the patient's ability to control their center of gravity during transfers and gait. A common presentation is that of a stooped forward posture of the upper body with tight anterior chest wall musculature and a crouched lower body posture. A series of stretching exercises designed to diminish kyphosis of the thoracic spine and increase flexibility in the pectoralis major and minor muscles can lead to improved upper body posture and upper limb function. In the lower aspect of the body, strengthening of the lumbar paraspinal musculature and stretching of the hamstring and hip flexor muscles can be used to improve posture. It is important not only to stretch the key muscles in patients with poor posture, but to also strengthen the appropriate muscles to achieve good biomechanical alignment. To improve muscle length, therapists use several techniques, including heat...
Perforation of the gallbladder occurs in 10 or more of cases of AAC,8 either localized into adjacent duodenum or transverse colon (cholecystoenteric fistula) the sub-hepatic space, causing abscess formation or free perforation with generalized peritonitis. Perforation into the liver or biliary tract has been reported rarely in AAC,93,94 as is perforation into the retroperitoneum with iliopsoas abscess.95 The usual immediate cause of death with AAC is severe sepsis with multiple organ dysfunction syndrome.96 Unusual causes of death from gallbladder perforation in AAC include hemorrhage from the liver97 and pulmonary bile embolism.98 Serious complications of gallbladder gangrene without perforation include acute pancrea-titis,99 colon perforation,100 and obstruction of the common hepatic duct.101 Empyema of the gallbladder may also complicate AAC.102
Cup the heel in one hand and place the other hand behind the knee across the popliteal fossa. Give support with this hand to prevent the knee falling into hyperextension. Fully flex the knee and bring the hand from the back of the knee to the front just below the knee to give overpressure. This will also flex the hip joint. The knee is then moved into extension, sliding the hand back to the popliteal fossa for support and preventing hyperextension.
A well-functioning abdominal musculature unloads the back stress during lifting and stabilizes the spinal column, because the abdominal muscles are antagonists to the back muscles. The back muscles are always used during lifting, standing, and sitting. In the majority of people, abdominal muscles are weaker than back muscles. Strong abdominal muscles, hip flexors (iliopsoas, rectus femoris), and back extensors are very important for all sports. There are four abdominal muscles (Table 12-9 and Fig. 12-20).
The piriformis muscle originates at the internal surface of the sacrum and inserts at the superior border of the trochanter of the femur. It functions in helping lateral rotation of the hip joint, abducting the thigh when the hip is flexed, and assisting stability of the head of the femur in the acetabulum. Piriformis syndrome occurs when the piriformis muscle becomes tight and shortened and applies pressure on the sciatic nerve. It is caused by repetitive stress built up in the muscle, such as that engendered by incorrect gait during walking or jogging. The symptoms are similar to sciatica in that pain is felt along the sciatic nerve, triggered in walking up stairs, and increased after prolonged sitting.
Degenerative labral tears (Fig. 3) in the athletic population can be the result of wear-and-tear injuries, and may be associated with degenerative changes of the hip joint. These types of tears can cause mechanical symptoms during athletic participation. Labral tears can also be caused by structural abnormalities of the hip joint, leading to abnormal loading of and irritation to the labrum and adjacent result from anterior impingement and leverage of the head posteromedial into the acetabulum 9 . This process may lead to arthrosis of the hip joint.
The knee has five bursae the suprapatellar, situated between the femur and the quadriceps femoris tendon the subcutaneous prepatellar, situated between the skin and the anterior surface of the patella the superficial infrapatellar, situated between the skin and the patellar tendon the deep infrapatellar, situated between the tibial tuberosity and the patellar ligament and the pes anserinus bursa, situated at the lower inside of the knee joint where the sar-torius, gracilis, and semitendinosus muscles insert jointly as the pes anserinus tendon.
The hamstrings are composed of three separate muscles the biceps femoris laterally and the semi-tendinosus and semimembranosus medially. The three muscles work together to extend the hip and flex the knee. During running, the hamstrings slow down the leg at the end of the forward swing phase and prevent flexion of the trunk at the hip joint.
Inflammation of the pubic symphysis and the surrounding muscles may result from repetitive stress, or imbalance of the adductor muscles, iliotibial bands, or hip flexor muscles. Athletes who perform running, kicking, or rapid lateral movement, such as sprinters, soccer players, and hockey players, are more susceptible to this injury. Major symptoms include pain in the pubic symphysis, lower abdomen, and groin area. Dry needling acupuncture is very effective in alleviating this condition, but healing may take a long time. Fine needles should be used directly on the pubic symphysis, and normal needles should be used on surrounding muscles, including the abdominal muscles, hip flexors, adductors, and iliotibial band. Two treatment sessions per week should be provided.
The range of movements of all extremity joints, as well as the cervical and lumbar spine, are observed with the deficits or asymmetries recorded. A therapist will often use a goniometer and or inclinometer to record exact range of motion (ROM). Precise measurements allow the clinician to establish a baseline to record improvement or disease progression. Flexibility is assessed with particular attention to large muscle groups such as the hamstrings, hip flexors, gastrocnemius-soleus complex, and the pelvic and shoulder girdle muscles (1).
Recent advancements in hip arthroscopy have expanded our knowledge of the management of athletes with hip injury. Adaptations to arthroscopic instrumentation have been established to overcome the constrained hip joint and dense muscular envelope. Flexible instrumentation has also been developed for improving access to the hip joint in both the central and peripheral compartments.
Muscles involved in this problem include the pectineus, adductor brevis, adductor longus, adductor magnus, and gracilis. Groin strain often occurs in sports that require pivoting and quick changes of direction, such as soccer and hockey. The injury may range from mild pain in the adductor muscles to severe pain, tenderness, and inflammation in this area. Damage is usually localized to the musculo-tendinous junction, about 5 cm from the pubis. Dry needling acupuncture is very effective in treating this injury. Needles can be applied to the symptomatic points on the iliopsoas muscle, the adductor muscles, the rectus femoris muscle, and the iliotibial band. The hamstring muscles need treatment, too. Two treatment sessions per week should be offered.
The lumbosacral plexus consists of the lumbar and sacral plexuses. Immediately after L2, L3, and L4 roots of the lumbar plexus split off from their spinal nerves and emerge from the intervertebral foramina, they are embedded in the psoas major muscle because this muscle is attached to the lateral surfaces and transverse process of the lumbar vertebrae. Within the psoas major muscle, the roots split into anterior and posterior divisions, which then reunite to form the branches of the lumbosacral plexus. The posterior divisions emerge from the muscle along either its lateral or medial border. The femoral nerve, formed by the posterior divisions of L2, L3, and L4, descends from the plexus lateral to the psoas muscle. The anterior divisions of the same roots unite to form the obturator nerve, the other major branch of the lumbar part of the plexus. The obturator nerve leaves the psoas major medially. Only a portion of the L4 anterior ramus contributes to the lumbar plexus the remaining...
Until recently, sports-related hip injuries have received little attention. There are three reasons for this. First, perhaps hip injuries are less common than other joints. Second, investigative skills for the hip have been less sophisticated, including clinical assessment and imaging studies. Third, there have been fewer interventional methods available to treat the hip including both surgical techniques and conservative modalities. Thus, there has been little incentive to pursue this area when there were few treatment options available. Operative arthroscopy has revolutionized the management of athletic hip injuries. Numerous intraarticular disorders have been identified that previously went unrecognized and untreated. In the past, athletes were simply resigned to living within the constraints of their symptoms, often ending their competitive careers. This is a work in progress. Clinical assessment skills are improving understanding of hip joint...
The hip joint is a ball and socket joint enveloped in dense capsular tissue. The Y-shaped triradiate cartilage acetabulum covers 170 of the femoral head 3 . The acetabular labrum is a fibrocartilaginous structure that outlines the ace-tabular socket. Labral attachment occurs at the periphery of the labrum to the capsule, and is anchored anteriorly and posteriorly at the acetabular transverse ligament. The posterior labrum has a sulcus that can be mistaken for pathology (Fig. 1). Its free margin articulates with the articular surface. The thickness of the labrum and its morphology may slightly vary, but it is from 2 to 3 mm thick, and extends 2 to 3 mm past the acetabular socket. Neuroreceptors have been identified and may provide propioception to the hip joint 4 . This may explain the decrease in propioception and pain with labral tears. Kelly and colleagues 5 have shown a limited blood supply to the periphery of the labrum (Fig. 2), demonstrating the healing potential for detached...
The iliacus and psoas muscles are often considered as one and may be referred to as iliopsoas Pectineus Gracilis Sartorius Rectus femoris Adductor brevis Buccinator Coracobrachialis Long head of biceps Short head of biceps Pectoralis minor Brachioradialis Internal oblique Transversus abdominis Pectineus Adductor brevis Gracilis Gracilis
Plain radiographs are the most useful imaging tool for the initial evaluation of hip complaints. Radiographs can reveal degenerative disease, bony lesions, dysplastic changes, the presence of loose bodies, and impingement. An MRI allows improved visualization of the soft tissues, early degenerative changes, and osteonecrosis 12,13,18 . Plain MRI does not accurately identify labral or chondral defects primarily because the lack of joint distension makes it more difficult to assess the cartilage surface. Sekiya et al found that plain MRI is not adequate for measuring the articular cartilage of the hip joint in avascular necrosis (AVN) when compared with hip arthroscopy 19 . They suggested that either direct visualization by arthrotomy or arthroscopy of the hip joint is required for accurate evaluation and staging of cartilage, especially in Marcus-Enneking stage IV AVN 19 .
Radiographs are an integral part of the assessment process. Subtle findings may be indicative of significant intraarticular pathology, and the bony morphology can be evaluated for variants such as dysplasia and impingement implicated in hip joint pathology. Conventional MRI is improving, but even high-resolution studies have up to a 42 false negative interpretation 4 . Also, even with imaging evidence of pathology, the clinician must determine whether these findings explain the athlete's symptoms. Gadolinium arthrography combined with MRI has a greater sensitivity. Along with the contrast, bupivicaine should always ( ) be used as the injection diluent. Whether or not the athlete experiences significant pain relief from the anesthetic effect of the injection is the most reliable indicator of the presence of joint pathology.
The focus of rehabilitation following osteoplasty is to avoid impingement of the hip and inflammation of the iliopsoas while restoring full ROM and strength. In cases that involve significant shaving of the femoral neck, caution must also be taken to limit impact activities that may increase risk of femoral neck fracture during the first 8 weeks (Table 2).
Athletic hip injuries leading to disabling intra-articular hip pain most commonly involve labral tears 1,2 . Labral tears in the athletic population can occur from an isolated traumatic event or from repetitive trauma 2 . Structural abnormalities of the hip joint may also place athletes at higher risk for labral pathology. It is uncommon to have isolated labral tears, and they are usually associated with other intra-articular injuries 3 . In this article, identifying lab-ral tears and associated lesions in the hip, arthroscopic management of these injuries, and return to sport are highlighted. Arthroscopic intervention for extraarticular hip injuries is also discussed.
The hip joint has both an intraarticular and a peripheral compartment. Most hip pathology is found within the intraarticular region therefore, distraction is necessary to achieve arthroscopic access. The patient can be placed supine or in the lateral decubitus position for performing the procedure 5,6 . Both techniques are equally effective therefore, the choice is simply dependent on the surgeon's preference. An advantage of the supine approach is its simplicity in patient positioning, while the lateral approach may be preferable for severely obese patients.
Unlock Your Hip Flexors Official Download Page
If you can not wait, then get Unlock Your Hip Flexors now. Your Download will be instantly available for you right after your purchase.