hip

Question 1

iliofemoral ligament

Answer 1

anterior and superior; prevents posterior tilt of the pelvis during erect standing and limits extension of the hip

Question 2

ischiofemoral ligament

Answer 2

reinforces the posterior capsule, limits excessive medial rotation, abduction and extension

Question 3

stability of the pelvis in coronal plane

Answer 3

due to simultaneous contraction of the ipsilateral and contralateral adductors and abductors
if there is an imbalance, the pelvis will tilt laterally to the side of adductor predominance

Question 4

ROM of hip

Answer 4

flexion: 120
extension: 30
abduction: 45-50
adduction: 20-30
internal rotation: 35
external rotation: 45

Question 5

legg-calve-perthes disease

Answer 5

remodeling of the femoral head as a result of interruption to the blood flow to the region (medial femoral circumflex artery)
avasular necrosis

Question 6

etiology of legg-calve-perthes disease

Answer 6

unclear; sometimes trauma, subcapital fracture, posterior hip dislocation, boys age 4-9, not genetic

Question 7

commonly associated conditions of LCPD

Answer 7

short stature, delayed bone age, hypercoagulable states, GI anomalies, inguinal hernia

Question 8

s/s of LCPD

Answer 8

painless limp or waddling gait, pain in affected hip, limited ROM, hip stiffness, ipsilateral knee pain, persistent thigh or groin pain, wasting of muscles in upper thigh, apparent shortening of leg, or unequal leg length

Question 9

4 stages of LCPD

Answer 9

initial
fragmentation/resorptive phase
re-ossification
healed

Question 10

initial stage of LCPD

Answer 10

AVN, loss of blood supply

Question 11

fragmentation/resorptive phase of LCPD

Answer 11

osteoclasts remove dead tissue which weakens the bone and leads to collapse, can last 1-2 years

Question 12

re-ossification stage of LCPD

Answer 12

osteoblasts replace destroyed bone, can last up to 3-5 years

Question 13

healed stage of LCPD

Answer 13

younger children tend to go through the stages more quickly than older children

Question 14

examination of LCPD

Answer 14

rule out fracture, infection, endocrine disorders, clotting disorders
observe limping, muscle atrophy, leg length
limited ROM

Question 15

ortho tests for LCPD

Answer 15

trendelenburg
actual leg length: ASIS to medial malleolus
apparent leg length: umbilicus to medial malleolus

Question 16

MSR, PARTS, Special tests for LCPD

Answer 16

weak hip muscles especially internal rotators and abductors, tenderness over femoral head, leg length discrepancy, loss of ROM, hypotonicity of quadriceps, x-ray or MRI

Question 17

DDx (of LCPD) if pain is unilateral

Answer 17

septic arthritis, toxic synovitis, juvenile RA

Question 18

DDx (LCPD) if pain is bilateral

Answer 18

spondyloepiphyseal dysplasia, metaphysial dysplasia

Question 19

DDX (for LCPD) if systematic symptoms

Answer 19

hypothyroidism

Question 20

treatment goals for LCPD

Answer 20

pain relief, maintaining proper hip mechanics, gait and ROM
gait training, strength training, ROM exercises
contraindication to adjusting

Question 21

subtrochanteric bursitis

Answer 21

common problem that causes pain over the outside of the upper thigh, does NOT cross knee; bursa rests between greater trochanter and iliotibial band

Question 22

greater trochanteric pain syndrome

Answer 22

lateral hip pain; pain over greater trochanter into lateral thigh

Question 23

cause/risk of subtrochanteric bursitis

Answer 23

running, biking, soccer, football
direct trauma to region, following hip fractures or hip replacement surgery

Question 24

examination of subtrochanteric bursitis

Answer 24

observation of swelling over region, limping, antalgic gait, loss of internal rotation

Question 25

ortho tests for subtrochanteric bursitis

Answer 25

Ober’s, patrick’s, leg length

Question 26

treatment for subtrochanteric bursitis

Answer 26

decrease pain, decrease welling and inflammation; stretching the IT and hip abductors, isometric glute strengtening, rest area, ice
adjustments

Question 27

osteitis pubis

Answer 27

benign condition of the ilium leading to sclerosis; primary in obese and multiparous women
inflammation of the pubic symphysis and pubic muscles

Question 28

treatment for osteitis pubis

Answer 28

reduce pain, correct mechanical imbalance and gait abnormalities
adjustments–pubic sympysis
strengthen hip flexors, adductors, abdominal muscles, hamstring

Question 29

cause/risk for osteitis pubis

Answer 29

athletes–running, kicking activities
exercise intensity
direct compressive or distractive injury
often from a sudden forced adduction injury
repetitive side-foot kicking
pregnancy

Question 30

s/s of osteitis pubis

Answer 30

adductor pain
lower abdominal pain
clicking sensation
pain with walking, running, kicking

Question 31

examination of osteitis pubis

Answer 31

limping gait, difficulty rising from chair, weak hip adductors and flexors, local pain, x-ray

Question 32

ortho tests for osteitis pubis

Answer 32

compression of ASIS joints toward one another, spring test