DMSU 221 Infant and Pediatric Hip Key Terms M11

The transducer is maintained in the lateral position while the hip is moved into a 90-degree angle of flexion in the _________ view. During this assessment, the transducer is moved in an AP direction with respect to the body to allow visualization of the entire hip.

coronal/flexion

______________ dislocations occur in utero and are associated with neuromuscular disorders.

Teratogenic

Name the two basic maneuvers that help in diagnosing DDH

The Barlow maneuver= determines whether hip can be dislocated The Ortolani maneuver= determines if the dislocated femoral head can be reduced back into the acetabulum

The contents of the femoral triangle include the femoral _____, the femoral ____ and _____, and the femoral _____.

canal, vein, artery, nerve

The _________ view is performed with the infant in the supine position from the lateral aspect of the hip joint with the plane of the transducer oriented coronally with respect to the hip joint.

coronal/neutral

The basic hip anatomy is imaged in four different views:

coronal/neutral, coronal/flexion, transverse/flexion, transverse/neutral

fascia lata

deep fascia of the thigh

femoral triangle

description of a region at the front of the upper thigh, just below the inguinal ligament

_______________________ of the hip includes dysplastic, subluxated, dislocatable, and dislocated hips.

developmental displacement

The femoral head sits within the acetabulum, which is ______ and has a deep concave configuration.

echogenic

Sonographically , the femoral head is ________ because it is cartilaginous and contains a focal echogenic ossification nucleus.

hypoechoic

When the trochanter moves forward, the femur rotates ________, and when the trochanter moves backward, the femur rotates _______.

medially, laterally

The medial rotators are the anterior fibers of gluteus ________ and ______.

medius and minimus

The gluteus _____ muscle is the immediate cover for the upper part of the hip joint, whereas the obturator externus is found winding below it from front to back.

minimus

Ossification of the femoral head begins between ___ and ____ months of age, occurs earlier in girls than boys, and is often complete by 1 year.

2 and 8

Galeazzi sign

on physical exam, the knee is lower in position on the affected side of the neonate with DDH when the patient is supine and the knees are flexed.

The contents of the femoral triangle are separated from the more deeply lying hip joint by muscles; the ____ is medial, and the ______ is lateral.

pectineus, iliacus

The ______ muscle is immediately posterior to the joint, and the obturator internus and the gemelli and quadratus femoris are lower down.

piriformis

The lateral rotators are the small muscles at the back of the joint: ____, ___________, and _________ femoris, with assistance of the gluteus ___________.

piriformis, obturator internus, and quadratus, maximus

The femoral artery branches in the __ artery, which is the main artery supply for the thigh muscles.

profunda femoris

The primary flexors of the hip are the ____ major, the ____, and the _____ femoris.

psoas, iliacus, rectus

The ____ joints unite the two hip bones with the sacral part of the vertebral column.

sacroiliac

The largest nerve in the upper thigh is the ____ nerve.

sciatic

The femoral vein and artery and the femoral canal are enclosed in a connective tissue sleeve called the femoral ____.

sheath

franck dislocation

the hip is laterally and posteriorly displaced to the extent that the femoral head has no contact with the acetabulum and the normal "U" configuration cannot be obtained on ultrasound

Barlow maneuver

the patient lies in the supine position with the hip flexed 90 degrees and adducted. Downward and outward pressure is applied. If the hip is dislocated, the examiner will feel the femoral head move out of the acetabulum.

developmental displacement of the hip (DDH)

this abnormal condition with the posterior of the hip results in congenital hip dysplasia; includes dysplastic, subluxated, dislocatable, and dislocated hips.

subluxation

this occurs when the femoral head moves posteriorly and remains in contact with the posterior aspect of the acetabulum.

abduction

to move away from the body

adduction

to move toward the body

The transverse plane is rotated 90-degrees and moved posteriorly into a posterolateral position over the hip joint in the ______ view.

transverse/flexion

From the transverse or flexion view, the leg is brought down into a neutral position to the ________ view

transverse/neutral

medial rotation

turning inward

lateral rotation

turning outward

_________ causes of hip dislocation can be traumatic or nontraumatic (i.e. neuromuscular disease).

Acquired

The rounded shape of the femur and the cup shape of the _______ form the "ball and socket" hip joint.

acetabulum

extension

bending backward (straightening a joint)

flexion

bending forward

The deep fascia of the thigh, the __________, forms a tough connective tissue surrounding the muscles.

fascia lata

A normal hip gives the appearance of a "ball on a spoon" in the midacetabulum. The _______ is the ball, the ____ forms the spoon, and the iliac line is the handle.

femoral head, acetabulum

The ______ is formed by the inguinal ligament, the adductor longus (medially), and the sartorius (laterally).

femoral triangle

The bone of the upper thigh is the ___.

femur

Describe the multiple risk factors that may contribute to the development displacement of the hip:

first born child; females; left hip more commonly affected; breech birth; affects Caucasians and Native American more than African Americans; maternal hypertension; fetal growth restriction; oligohydroaminos; prolonged gestation; increased birthweight; Potter's syndrome; neonatal intensive care

pelvic girdle

formation of the hip bones by the ilium, ischium, and pubis

hip joint

formed by the articulation of the head of the femur with the acetabulum of the hip bone

saphenous opening

gap in the fascia lata, which is found 4 cm inferior and lateral to the pubic tubercle

The articulation of the head of the femur with the acetabulum of the hip bone forms the _______.

hip joint

One of the strongest ligaments in the body is the ______; it is very important for standing and maintaining correct upright balance

iliofemoral ligament

The hip bones are the fusion of three separate bones, the _____, the ____, and the ___, which together form the pelvic girdle.

ilium, ischium, and pubis

Two thirds of the head should be covered by the ______

labrum

sciatic nerve

largest nerve in the upper thigh

Sonography of the neonatal hip is performed with a(n) _________ transducer.

linear-array