03-10: The Hip Joint

Question 1

Hip joint (Definition; Stability vs. shoulder)

Answer 1

• Ball-and-socket joint
• Like shoulder in movement, but to a lesser degree (less mobility = more stability)
• More stability in hip joint compared to shoulder
• Femur sits in acetabulum of innominate bone

Question 2

Angle of Inclination

Answer 2

• Angle within the frontal plane between the femoral neck and the medial side of the femoral shaft
• Average adult = 125˚
• Newborns = 140-150˚ angle reduces to 125˚ with onset of standing /walking
• Can only be detected via X-ray
• Tested with Craig’s Test

Question 3

Coxa Vara

Answer 3

• A of I markedly less than 125˚
• Distal end moves medially
• Genu valgus - Tibia moves outward
• “knock-kneed”

Question 4

Coxa Valga

Answer 4

• A of I markedly greater than 125˚
• Distal end moves laterally
• Genu vara - Tibia moves inward
• “bow-legged”

Question 5

Normal Antiversion

Answer 5

• Sits at 15˚ angle anterior

- head - refers to head of femur in relation to condyles (greater than 15˚)

Question 6

Antiverted Hip

Answer 6

• Excessive antiversion, results in “toeing”

- Head of femur moves anterior, greater than 15˚

Question 7

Retroverted Hip

Answer 7

• Excessive internal rotation outside of 15˚

- Head of femur moves posterior, less than 15˚

Question 8

Hip joint capsule ligaments (3)

Answer 8

• Limit extreme hip ROM

- Iliofemoral ligament, Ischiofemoral ligament, Pubofemoral ligament

Question 9

Ischiofemoral ligament

Answer 9

Checks excessive internal rotation

Question 10

Pubofemoral ligament

Answer 10

Checks excessive abduction

Question 11

Iliofemoral ligament

Answer 11

• One of the thickest and strongest ligaments
• Prevents extreme hip extension
• Known as “Y” ligament because of pull

Question 12

Capsular Pattern of Hip Joint

Answer 12

IR > EXT > ABD > Flex > ER

• IR most affected, ER least afected
• Limitation when capsule is limited (hip)

Question 13

ROM Hip Flexion

Answer 13

Passive hip flexion limited to 80-90˚ by hamstrings when knee is extended; Knee flexed measures at 120˚

Question 14

ROM Hip Extension

Answer 14

30˚ with extended knee

Question 15

ROM Abduction

Answer 15

45˚ limited by capsular ligaments, adductor and hamstrings

Question 16

ROM Adduction

Answer 16

25˚ due to interference from other limb (45˚ with flexion) and/or due to abductopr muscles, ITB, or hip capsule

Question 17

ROM Internal Rotation

Answer 17

45˚

Question 18

ROM External Rotation

Answer 18

45˚ - may be limited by hip capsule, ITB or TFL

Question 19

Psoas Major

Answer 19

O: TPs, bodies, discs of T12-L5
I: Lesser trochanter of femur
A: Hip Flexor (Primary), External rotation (open kinematic), Anterior Pelvic Tilt (closed kinematic)
N: L2, L3

• Femoral Nerve comes off L2-L4
• Associated with iliacus = iliopsoas

Question 20

Iliacus

Answer 20

O: Iliac fossa, Superior rim of iliac crest
I: Lesser trochanter of femur
A: Hip Flexor (Primary), External rotation (open kinematic), Anterior Pelvic Tilt (closed kinematic)
N: Femoral Nerve (L2-L4)

• Associated with psoas major = iliopsoas
• Stabilizes femur (anterior pelvic tilt) = closed kinematic

Question 21

Rectus Femoris

Answer 21

O: Anterior Inferior Iliac Spine (AIIS)
I: Tibial Tuberosity via patella ligament
A: Hip flexion, knee extension
N: Femoral Nerve (L2-L4)

Question 22

Sartorius

Answer 22

O: Anterior Superior Iliac Spine (ASIS)
I: Pes Anserine (Anterior medial proximal tibia)
A: Hip flexion, external rotation, abduction, knee flexion = tailor’s position
N: Femoral Nerve

• Longest muscle in the body

Question 23

Femoral Triangle

Answer 23

• Femoral Nerve, Femoral Vein, Femoral Artery
• Checked for strength of pulse
• Main blood supplier of lower extermity
• Borders: Lat - Sartorius, Med - Pectineus, Floor - Iliopsoas, Roof - Inguinal ligament

Question 24

Pectineus

Answer 24

O: Superior ramis of pubis
I: Pectineal line of femur (posterior and inferior to lesser trochanter)
A: HIp adduction, also initiates hip flexion
N: Femoral Nerve (L2-L4)

Question 25

Adductor Longus

Answer 25

O: Pubis I: Middle 1/3 of Linea Aspera (Posterior medial) A: Hip adduction and flexion N: Obturator Nerve

Question 26

Adductor Brevis

Answer 26

O: Pubis I: Proximal Linea Aspera A: Hip adduction N: Obturator Nerve

Question 27

Adductor Magnus

Answer 27

O: Ischium and Pubis I: Linea Aspera and adductor tubercle A: Hip adduction N: Obturator and Sciatic Nerve

Question 28

Adductor Magnus - Anterior

Answer 28

O: Pubis I: Entire length of Linea Aspera A: Hip adduction N: Obturator Nerve

Question 29

Adductor Magnus - Posterior

Answer 29

O: Ischium I: Adductor tubercle (medial aspect of epicondyle of femur) A: Hip adduction, hip extension N: Sciatic Nerve

Question 30

Gracilis

Answer 30

O: Pubis I: Pes Anserine (Anterior proximal medial tibia) A: Hip adduction, knee flexion N: Obturator - Most medial muscle of thigh

Question 31

Gluteus Maximus

Answer 31

O: Posterior ilium and sacrum I: Posterior proximal greater trochanter (gluteal line), ITB A: External rotator, hip extension, hip abduction with TFL, knee extension via ITB N: Inferior gluteal nerve (L5, S1, S2) - merges into fibers of ITB - Power muscle for hip extension

Question 32

Gluteus Medius

Answer 32

O: Outer (lateral) crest of ilium I: Lateral and posterior aspect of greater trochanter of femur A: Hip abduction (open kinentic), Stabilizes pelvis (closed kinetic), contributes to external rotation N: Superior gluteal nerve (L4, L5, S1) (RO) - Levels pelvis in closed kinematic - Gluteus medius lurch (lateral lurch) due to weak gluteus medius

Question 33

Gluteus Minimus

Answer 33

O: Outer (lateral) iliac fossa I: Anterior aspect of greater trochanter A: Hip abduction, internal rotation of hip N: Superior gluteal nerve (L4, L5, S1)

Question 34

Trendelenburg Sign

Answer 34

- Lean toward side of weakness - Pelvis drops to contralateral sign of weighbearing - Lateral lurch = Trendelenburg gait - Lurch towards side of weakness

Question 35

Tensor Fascia Lata

Answer 35

O: ASIS, Anterior portion of iliac crest I: Gerdy's Tubercle via ITB A: Hip flexor, internal rotation, hip abduction (with glute maximus), contributes to knee flexion (ITB) N: Superior gluteal nerve (L4, L5, S1)

Question 36

Deep Rotator Cuffs

Answer 36

- Piriformis, Gemellus Superior, Obturator Internus, Gemellus Inferior, Quadratus Femoris O: Sacrum, Ischium, Pubis I: Greater Trochanter A: Hip external rotation N: Obturator Nerve, S1, S2

Question 37

Hip adductors (5)

Answer 37

Pectineus, Gracilis, Adductor Longus, Adductor Brevis, Adductor Magnus

Question 38

Hip abductors (5)

Answer 38

Piriformis, Gemellus Superior, Obturator Internus, Gemellus Inferior, Quadratus Femorus

Question 39

Hip extensors (5)

Answer 39

Sartorius,