The Effect of Hip Position on the Length of Trochanteric Muscles: Potential Implications for Early Postoperative Management of Hip Arthroplasty

Lee, Yu C.; Callary, Stuart A.; Howie, Donald W.; Thewlis, Dominic; Solomon, Lucian B.

doi:10.1016/j.arth.2011.08.023

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…Previous studies have validated the use of shown to increase lengthening of the piriformis, 21 but has a shortening effect when the hip is abducted. 20 By maintaining a neutral frontal plane this current study showed an increase in length change of the short external rotators with 45° of external rotation from 90° of hip flexion (45ER90). Internal rotation from anatomical neutral to 30° has been shown to gradually increase lengthening of the piriformis and obturator internus.…”

Section: Discussionmentioning

confidence: 97%

“…[4][5][6] Previous cadaveric studies have shown that up to 120° of hip flexion increased the excursion of the short hip external rotators and was further increased with the inclusion of adduction and external rotation. 20,21 The greatest increase in lengthening of the piriformis and gemelli-obturator internus complex was observed when the limb was positioned in adduction between 60° and 105° of hip flexion. 21 Similarly, the results of the present study demonstrated the greatest length change of the piriformis and SG when the hip was flexed to 90° with 30° of hip adduction (30ADD90).…”

Section: Discussionmentioning

confidence: 99%

“…Internal rotation from anatomical neutral to 30° has been shown to gradually increase lengthening of the piriformis and obturator internus. 20 The results of the current study a goniometer for measurements of hip flexion and external rotation, 23,24 but no evidence has been presented for evaluation of hip adduction. 13 This study attempted to account for this limitation by stabilizing each cadaver to limit pelvic rotation and tilt as well as the initial neutral positioning of each hip.…”

Section: Discussionmentioning

confidence: 99%

“…21,27 These studies utilized string modeling for representation of musculature, in order to assess the excursion or lengthening of the short external rotators, respectively. 20,21,25,27 The use of string models has previously been validated and demonstrated the effectiveness of dividing muscles into different sections in order to accurately show movement. 25 The present study utilized this technique with only the piriformis being divided into a superior and inferior section based on the origin location of the anterior surface of the sacrum and greater sciatic notch.…”

Section: Discussionmentioning

confidence: 99%

“…Several cadaveric studies have been performed to assess length change in order to evaluate movement of the muscles in relation to the posterior approach for total hip arthroplasty, 20,25,26 as well as peak strength and stretch as it relates to normal, gait-related movements. 21,27 These studies utilized string modeling for representation of musculature, in order to assess the excursion or lengthening of the short external rotators, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Length Change of the Short External Rotators of the Hip in Common Stretch Positions: A Cadaveric Study

McGovern

Kivlan

Martin

2017

Intl J Sports Phys Ther

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Background: Stretching of the deep rotators of the hip is commonly employed in patients with lumbosacral, sacroiliac, posterior hip, and buttock pain. There is limited research demonstrating the effectiveness of common stretching techniques on the short external rotators of the hip. Purpose:The objective of this study was to evaluate length change during stretching of the superior and inferior fibers of the piriformis, superior gemellus, obturator internus, and inferior gemellus.Study Design: Repeated-measures laboratory controlled cadaveric study.Methods: Seventeen hip joints from nine embalmed cadavers (5 male; 4 female) with an age between 49-96 years were skeletonized. Polypropylene strings were attached from the origin to insertion sites of the short external rotators. The change of length (mm) noted by excursion of the strings was used as a proxy for change in muscle length, when the hip was moved from the anatomical position to four specific stretch positions: 1) 45° internal rotation from hip neutral flexion/extension, 2) 45° external rotation from 90° hip and knee flexion, 3) 30° adduction from 90° of hip and knee flexion, and 4) 30° of adduction with the hip and knee flexed so the lateral malleolus contacted the lateral femoral epicondyle of the contralateral limb , were recorded. Results:There was a significant effect on string displacement by stretch position, F (15,166) = 14.67, p < .0005; Wilk's ⌳ = .097, partial n2 = .540. The greatest displacement of the strings corresponding to the superior piriformis, inferior piriformis, and the superior gemellus occurred in 30° adduction from 90° of hip and knee flexion. The obturator internus and inferior gemellus had the largest string displacement with 45° internal rotation from neutral flexion/extension. Conclusions:While all stretch positions caused a significant string displacement indicating length changes of the deep rotators of the hip, the three stretch positions that caused the greatest change were: 1) 30° adduction from 90° of hip and knee flexion, 2) 45° internal rotation from neutral flexion/ extension, and 3) 45° external rotation with 90° hip and knee flexion.Clinical Relevance: This study has clinical implications for the effectiveness of specific stretching techniques on the short external rotators of the hip with the potential to improve the validity of stretching protocols for patients with posterior hip or buttock pain. The piriformis and superior gemellus had a larger change in length when adducting the hip from 90° degrees of hip and knee flexion. The obturator internus and inferior gemellus had a greater length change when internally rotating the hip from neutral flexion/extension. Level of Evidence: 3

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Length Change of the Short External Rotators of the Hip in Common Stretch Positions: A Cadaveric Study

McGovern

Kivlan

Martin

2017

Intl J Sports Phys Ther

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An appraisal of the short lateral rotators of the hip joint

2015

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The short lateral rotators (piriformis, obturator internus, superior and inferior gemelli, obturator internus, and quadratus femoris) are functionally important muscles, significantly contributing to hip joint stability. They act as "postural muscles", holding the femoral head in the acetabulum during hip movements, thus are frequently monitored in gait analysis and for muscle rehabilitation post-injury. Despite the need to precisely identify and repair these muscles for stability postoperatively, clinical complications have resulted from the inadequate and inconsistent understanding of their morphological and functional anatomy. Furthermore, the short lateral rotators have complex entheses (osteotendinous insertions on bone) and may be subject to overuse injury in sport. This study aims to review the reported morphology of the short lateral rotators in order to ascertain whether discrepancies exist in our understanding of these muscles, and if further investigation is required to aid in gait analysis, clinical management of hip pathologies, and prevention of overuse injuries. Following a literature search strategy, 59 primary references were retrieved from three databases, with additional 26 anatomical textbooks selected for critical evaluation. Numerous inaccuracies and inconsistencies in the anatomical descriptions of the attachments, patterns of innervation and actions exist, and often insufficiently supported by primary findings. There is also a paucity of information regarding the architectural pattern of the muscles, which would be useful in clarifying the function of these dynamic stabilizers of the hip joint. A better anatomical understanding of these muscles will better inform hip reconstruction and lead to improved surgical outcomes by reducing post-operative complications.

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