dolor de cadera
DESCRIPTION
Dolor de caderaTRANSCRIPT
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DOLOR DE CADERAJONATAN FLORES ROJAS
RESIDENTE DE MEDICINA FÍSICA Y REHABILITACIÓN
HOSPITAL CAYETANO HEREDIA
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La cadera es la articulación proximal del miembro inferior: situada en su raíz, su función es orientarla en todas las direcciones del espacio◦ Flexión – extensión
◦ Eje: transversal Plano: sagital◦ Abducción – aducción
◦ Eje: AP Plano: coronal◦ Rotación
◦ Longitudinal
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La articulación de la cadera es una articulación sinovial
entre la cabeza del fémur y el acetábulo del hueso coxal
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Arquitectura del fémur y la pelvis
La cabeza, el cuello y la diáfisis forman la mecánica de un voladizo.
El peso corporal se transmite de la cabeza a la diáfisis femoral a través de un brazo de palanca (cuello femoral)
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Función de los ligamentos en la aducción
Haz superior: Tensa
Lig. PF: distiende
Haz inferior: Tensión ligera
Lig. Isquiofemoral:distiende
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Función de los ligamentos en la abducción
Haz superior: Distiende
Lig. PF: Tensa
Haz inferior: distensión ligera
Lig. Isquiofemoral:distiende
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Músculos flexores de la cadera: por delante del plano frontal y del eje transversal
Psoas mayor
Iliaco
Sartorio Recto anterior
Tensor de la fascia lata
Pectíneo
Aductor mediano
Recto interno
Glúteos menor y mediano (fibras
anteriores)
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Músculos extensores de la cadera: por detrás del plano frontal y del eje transversal
Glúteo mediano
Glúteo menor
Glúteo mayor
Biceps F. (porción larga)
Semi tendinoso
Rotadores externos
Semi tendinoso
Ms. isquiotibiales
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Músculos abductores de la cadera: por fuera del plano sagital y del eje AP
G. mediano (haces anteriores)
Ab – Fle – R. Int
AB – EXT – R-EXT
G. mediano (haces posteriores)
G. menor(haces anteriores)
G. menor(haces posteriores)
G. mayor(haces abductores)
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MÚSCULOS ADUCTORESADUCTOR MAYOR
Recto interno
Isquiotibiales: SM, ST, Biceps (porción larga)
Glúteo mayor
Cuadrado crural
PectíneoObturadores (interno y externo)
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ROTADORES EXTERNOS Piramidal
Obturador interno
Obturador externo
Algunos aductores (cuadrado crural, pectíneo, aductor mayo (haces posteriores)
Glúteos ◦ Mayor: superficial y prof.◦ Menor: posteriores◦ Mediano
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ROTADORES INTERNOS TFL
Glúteo menor
Glúteo mediano
Obturador externo
Pectíneo
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Causas
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Pinzamiento femoroacetabular
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Fenómeno dinámico en el que durante la flexoextensión de la cadera el acetábulo (labrum fibrocartílago que recubre el margen libre del acetábulo) es golpeado por la unión craneocervical del fémur; es este “impacto” el que produce dolor y a la larga, daño estructural. El pinzamiento femoroacetabular está identificado hoy como la principal etiología de coxartrosis en el adulto joven
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Clínica
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Clínica Dolor principalmente al estar sentado, y/o al incorporarse desde un asiento
Luego de periodos largos de estar sentado, principalmente en asientos bajos, al subir y/o bajarse de un automóvil.
Es más frecuente en personas deportistas y clásicamente no se produce dolor, al menos inicialmente, durante el desarrollo del ejercicio, sino más bien después de finalizado éste.
Marcha normal (salvo crisis)
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Test de pinzamiento
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DEPORTES Y OA
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Ejercicios Terapéuticos
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Básicos
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Avanzados
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Estiramiento
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