Examination of the Hip & Pelvic
고관절을구성하는 bone 대퇴골 (femur) - 신체무게지탱, 지면반발력전달 - frontal plane : 대퇴경과대퇴각도약 125 도염전각은 12 도형성 골반 (pelvic) - 관골 : Ilium + pubic bone + Ischium - pubic symphisis, SI joint - closed kinetic chain
http://upload.wikimedia.org/wikipedia/commons/thumb/2/26/blausen_0723_pelvis.png/600px- Blausen_0723_Pelvis.png
http://www.courses.vcu.edu/danc291-003/pelvis_acetab.jpg http://www.courses.vcu.edu/danc291-003/femur%20bone.jpg
고관절의기능해부학 Pelvic girdle 을구성하는 bone ball and socket joint, 운동자유도 3 고관절 : 관골의관골구 (acetabulum) 과 femur head sacroiliac joint: sacrum + ilium pubic symphysis : pubic + pubic fibrous cartlige Immovabel joint running, walking, standing 과같은체중부하에서안정성제공
http://teachmeanatomy.info/wp-content/uploads/bony-surfaces-of-the-hip-joint-head-of-femur-and- Acetabulum.jpg
고관절 (hip joint) concave : acetabulum convex : head of femur 고관절을보강하는인대 - 장골대퇴인대, 치골대퇴인대, 좌골대퇴인대, 원형인대
http://teachmeanatomy.info/wp-content/uploads/extracapsular-ligaments-of-the-hip-joint-1024x522.png
type of joint - ball and socket joint, degree of freedom : 3 - flexion/extension, abd/add, ext/int rot, circumduction
Femoral Neck Angle http://www.scielo.cl/fbpe/img/ijmorphol/v30n1/art46_f1.jpg
연령의증가에따른경사각의변화 출생시에는약 140-150 정도이나성장하여걷게되면체중이대퇴골경에부가되어각도가차츰감소
http://www.healthhype.com/wp-content/uploads/femurangles.jpg
대퇴골염전각 (torsion angle) 비틀림각이라고도하며대퇴경과골간부사이에서형성된상대적인비틀림을말함. 내측및외측대퇴골과 (femoral condyle) 를연결하는대퇴골선과대퇴골경사이에수평면에서이루어진각도 - 고관절회선과관련이있으며각이정상보다크거나작으면안짱다리혹은팔자다리가된다.
https://classconnection.s3.amazonaws.com/177/flashcards/977177/jpg/anteversion1326854678289.jpg
과전경증 후경증 https://classconnection.s3.amazonaws.com/177/flashcards/977177/jpg/anteversion1326854678289.jpg
http://www.iadms.org/associations/2991/files/to1-figure-9.jpg
Inspection( 시진 ) 전면 ASIS의수평검사 1 다리길이의차이 2 골반경사의이상
http://www.pt.ntu.edu.tw/hmchai/kinesiology/kinspine/pelvicgirdle.files/leglengthdiscrepancy.jpg
Inspection( 시진 ) 측면 Lordorsis 상태 (normal 10-15 도 ) 1 고관절의굴곡, 척추기립근구축으로전만증가 2 복근약화
http://www.pt.ntu.edu.tw/hmchai/kinesiology/kinspine/pelvicgirdle.htm
http://www.pt.ntu.edu.tw/hmchai/hglossary/kines.files/sacralangle.png
요추전만증가 : 골반의전방경사증가 - 고관절굴곡근들과척추기립근이짝힘으로작용하여골반의전방경사유발 http://i.imgur.com/rsuha.jpg 전방경사는장요근과기타의고관절굴근에수축에의해서유발 * 고관절굴곡근 - 골반앞부분을전하방으로잡아당김. * 척추기립근 - 골반의후상방부위를상방으로잡아당김.
Inspection( 시진 ) 후면 Gluteal fold ( 둔부의주름 ) 비대칭 1 선천성고관절탈구 2 근위축 3 골반경사 4 하지길이의차이 PSIS 높이비대칭 : 골반경사
http://o.quizlet.com/hvahhw85gmfu07ztahknpq_m.png https://home.comcast.net/~wnor/pelvisposterior.jpg
Bony palpation 전면 : 압통관찰, 양측비교 1 ASIS 2 Iliac crest : L4-5 level 3 Iliac tubercle - ASIS 위쪽 4 Greater trochanter : tensor fascia latae, gluteus medius 로덮여 palpation 이힘듬. 5 Pubic tubercle
Iliac tubercle Iliac crest ASIS
ASIS Grater chanter Pubic tubercle
http://lh4.ggpht.com/_rijx_mg4zvm/thjq4jhjrki/aaaaaaaabme/vhh3szd3ab4/image_thumb7.png?imgmax=800
Bony palpation 후면 1 PSIS 2 greater trochanter 3 Ischial tuberosity - 앉았을때의자에닿는면. - hip ext. 시 palpation 이힘듬 4 sacroiliac Jt : S2 level
Iliac crest Greater trochanter Ischial tuberosity
Soft tissue palpation 제 1 구역 (femoral-triangle) 1 상측 : inguinal crease ( 서혜부피선 ), inguinal lig. ( 서혜부인대 ) 2 내측 : adductor longus - sports injury 가많다. 3 외측 : sartorius - 큰병변은없다. 4 저측 : adductor longus, pectineus, iliopsoas
http://bp0.blogger.com/_15-2o9faece/r-guqnrypdi/aaaaaaaaajk/p5takpj0oh4/s400/femoral+triangle.jpg https://academic.amc.edu/martino/grossanatomy/site/nurses/tutorials/lower%20limb/pictures/femoraltriangle.jpg
Soft tissue palpation inguinal lig --- 1 femoral artery --- 1 의 ½ femoral vein --- 2 의내측 femoral nerve --- 2 의외측 뇌성마비 : add, m.contracture -- hip jt dislocation 위험 Tenotomy
https://academic.amc.edu/martino/grossanatomy/site/nurses/tutorials/lower%20limb/pictures/femoralsheath.jpg
Soft tissue palpation 제 2 구역 (greater trochanter) sidelying 1 trochanteric bursa ( 대전자점액낭 ) bursitis 가있을때만져짐 ( 평상시만져지지않는다 ) 2 gluteus medius greater trochanter 의상외측에위치
https://solomonsseal.files.wordpress.com/2010/03/hipbursitis.jpg?w=240&h=240 https://academic.amc.edu/martino/grossanatomy/site/nurses/tutorials/lower%20limb/pictures/iliotibialtract.jpg
제 3 구역 (sciatic N.) Soft tissue palpation 1 ischial tuberosity 와 greater trochanter 의중간통과 sidelying 에서 hip, knee V 2 ischial tubosity 압통시 bursitis 의심
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19503.jpg
제 4 구역 (iliac crest) Soft tissue palpation 1 cluneal N( 둔피신경 ) PSIS iliac tubercle 사이의피부감각지배 Bone graft 시장골채취실행때 N. 절단 장골능을따라섬유지방조직촉진
https://dw9r2us9jo9xp.cloudfront.net/images/anatomy_term/nervi-cluniumsuperiores/nervi_clunium_superiores_atlas_hjv7tn00un547ojymrzdaw.png
Soft tissue palpation 제 5 구역 (Muscle group) 1 flexor g - iliopsoas, sartorius - rectus femoris 2 joint m. sports injury (avulsion) 2 adductor g - gracilis, pectineus - add. longus, brevis, magnus 3 abductor g - gluteus medius, tensor fascia latae 4 extensor g. gluteus maximus hamstring sidelying 에서 knee V 상태로 ischial 을 touch
https://home.comcast.net/~wnor/thighsection.jpg