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MSK T3 > Hip > Flashcards

Hip Flashcards

1
Q

What is the primary design function of the hip joint?

A

The hip is designed for stability and weight-bearing, while also providing a large amount of mobility.

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2
Q

How does the hip joint support and translate forces in the

A

It supports and translates the weight of the upper body to the lower extremities and also translates forces from the lower extremity to the upper body.

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3
Q

What role does the acetabular labrum play in hip joint stability?

A

The acetabular labrum deepens the articulation and creates a “suction cup” effect to enhance joint stability.

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4
Q

What function does the transverse ligament serve in the hip joint?

A

It converts the acetabular notch into a foramen, allowing nutrient vessels and nerves to enter the joint cavity.

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5
Q

What are the main ligaments that reinforce the hip joint capsule?

A

The iliofemoral, pubofemoral, and ischiofemoral ligaments.

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6
Q

What is the function of the iliofemoral, pubofemoral, and ischiofemoral ligaments in terms of hip movement?

A

They allow large amounts of flexion but limit extension.

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7
Q

How are the hip ligaments positioned when the hip is in a neutral position, and why?

A

They are coiled/twisted in neutral, which helps stabilize the hip joint.

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8
Q

What is the position of increased stability (close-packed position) for the hip joint?

A

Extension (15 degrees), medial rotation (40 degrees), and abduction (50 degrees).

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9
Q

What is the position of decreased stability (loose-packed position) for the hip joint?

A

Flexion, abduction, and external rotation.

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10
Q

What is the typical end feel for hip movements?

A

The normal end feel is often capsular, but hip flexion can elicit a soft tissue approximation end feel.

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11
Q

What is the capsular pattern of the hip joint?

A

Flexion, abduction, and medial rotation (order may vary).

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12
Q

What is the normal range of motion for hip flexion?

A

110-120 degrees.

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13
Q

T/F Acetabular depth is universal it is the same in every person?

A

*False
Acetabular depth is NOT universal it varies person to person

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14
Q

What is the normal range of motion for hip extension?

A

10-15 degrees.

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15
Q

What is the normal range of motion for hip abduction?

A

30-50 degrees.

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16
Q

What is the normal range of motion for hip adduction?

A

30 degrees.

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17
Q

What is the normal range of motion for hip lateral (external) rotation?

A

40-60 degrees.

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18
Q

What is the normal range of motion for hip medial (internal) rotation?

A

35-45 degrees.

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19
Q

Why is it important to assess the pelvis and lumbar spine when investigating hip dysfunction?

A

The pelvis (sacroiliac joints and pubic symphysis) and lumbar spine are closely interconnected with the hip, so dysfunction in one area can affect the others.

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20
Q

What is nutation in iliosacral movement?

A

Nutation, or sacral flexion, is when the sacral base moves anteriorly and the apex moves posteriorly. The innominate bone rotates posteriorly (ASIS moves superiorly, PSIS moves inferiorly).

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21
Q

What is counternutation in iliosacral movement?

A

Counternutation, or sacral extension, is when the sacral base moves posteriorly and the apex moves anteriorly. The innominate bone rotates anteriorly (ASIS moves inferiorly, PSIS moves superiorly).

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22
Q

Which ligaments support the sacroiliac (SI) joints?

A

The anterior and posterior SI ligaments support the SI joints. Additionally, the sacrotuberous and sacrospinous ligaments are accessory ligaments that limit nutation.

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23
Q

Why are the SI joints relevant when discussing hip function?

A

Gluteus maximus, piriformis, and biceps femoris are primary hip movers and are functionally connected to the sacroiliac joint ligaments. Dysfunction in the hip or SI joint can cause or result from dysfunction in the other.

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24
Q

What must we consider to understand the mechanics of the hip?

A

We must consider how the hip functions in both an open kinematic chain (like walking and running) and a closed-chain scenario (like the stance phase in walking/running).

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25
Q

What happens during open-chain hip movements?

A

In an open chain, the prime movers of the hip contract to move the hip through its range of motion. Simultaneously, the abdominal muscles, erector spinae, multifidus, and quadratus lumborum contract to stabilize the pelvis.

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26
Q

How is the hip and pelvis stabilized during the stance phase of walking/running (closed-chain)?

A

The hip and pelvis are stabilized by the contraction of the hip flexors, extensors, abductors, and adductors.

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27
Q

Which muscles stabilize the pelvis when the foot is on the ground (stance phase)?

A

The gluteal muscles stabilize the pelvis when the foot is on the ground.

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28
Q

Which muscles stabilize the pelvis when the foot is in the air (swing phase)?

A

The abdominal muscles stabilize the pelvis when the foot is in the air.

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29
Q

In which plane does lateral pelvic tilt occur?

A

Lateral pelvic tilt occurs in the coronal plane.

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30
Q

What happens during a lateral pelvic tilt?

A

One side of the pelvis elevates (hip hike), while the other side lowers (hip/pelvis drop).

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31
Q

What is a common cause of lateral pelvic tilt?

A

Weakness of the gluteus medius and other hip abductors.

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32
Q

Why is the gluteus medius more valuable as a dynamic stabilizer than as a hip abductor?

A

The gluteus medius stabilizes the pelvis and lower extremity dynamically during activities like walking and running, particularly in maintaining a neutral pelvis during single-leg stance.

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33
Q

What happens when there is a weak right gluteus medius while standing on the right limb?

A

The left hip will drop.

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34
Q

What occurs if the left gluteus medius is weak in terms of pelvic stability?

A

The left hip will hike (adduct), the right hip will drop (abduct), and the spine will laterally flex toward the elevated stance side to prevent falling.

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35
Q

What are patient presentations that may indicate the need to check gluteus medius strength or inhibition?

A

• Abnormal gait (Trendelenberg)
• Knee pain
• Low back pain
• Foot pain
• “Cross-over” with running

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36
Q

What is Trendelenberg gait, and why might it be relevant for assessing gluteus medius strength?

A

Trendelenberg gait is an abnormal gait where the hip drops on the side opposite the stance leg. It may indicate weakness or inhibition of the gluteus medius, which affects the pelvis’ stability during single-leg stance.

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37
Q

Why might a weak or inhibited gluteus medius lead to knee pain?

A

A weak gluteus medius fails to stabilize the pelvis, leading to compensatory movements and potential strain on the knee, contributing to knee pain.

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38
Q

How can gluteus medius weakness impact running form, specifically “cross-over”?

A

With gluteus medius weakness, the pelvis is less stable, potentially causing the legs to cross over the midline during running, which can lead to increased stress on the lower extremities.

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39
Q

What tests can you perform to confirm gluteus medius strength or inhibition?

A

• Trendelenberg Test
• Single Leg Squat Test (Step Up Step Down Test)
• Glute med vs. TFL firing pattern (palpation)
• Glute med strength test on the table
• Bridge test

40
Q

What is arthrogenous weakness, and how does it contribute to muscle weakness or inhibition?

A

Arthrogenous weakness is the inhibition of muscle activity due to joint dysfunction or swelling, which can reduce muscle function and strength.

41
Q

How do trigger points contribute to muscle weakness?

A

Trigger points (TrPs) develop in response to stressors or stimuli and create hyperirritable fiber bands. These bands lower the stimulation threshold unevenly, causing inefficient activation, overuse, early fatigue, and weakness in the muscle.

42
Q

What is stretch weakness, also known as positional weakness?

A

Stretch weakness occurs when prolonged and repeated elongation of a muscle inhibits muscle spindle activation, leading to reduced muscle activation and potential weakness.

43
Q

What is reciprocal inhibition, and how does it affect muscle function?

A

Reciprocal inhibition occurs when increased tone in an antagonist muscle inhibits the force production of the agonist muscle. This can alter joint motion, cause pain, and reduce functional efficiency, as seen in the glute med vs. TFL firing pattern test.

44
Q

Why is it important to consider the low back when treating hip/pelvis issues?

A

Because all muscles that move and stabilize the pelvis originate from the lumbar sacral plexus (L1-S3 nerve roots).

45
Q

Which nerve innervates the iliacus, sartorius, pectineus, and quadriceps?

A

The femoral nerve (L2-L4).

46
Q

What muscles are innervated by the obturator nerve?

A

The obturator externus and the adductors. (Obturator nerve L2-L4)

47
Q

Which nerve innervates the hamstrings?

A

The sciatic nerve (L4-S3).

48
Q

Which muscles are innervated by the superior gluteal nerve?

A

Gluteus medius, gluteus minimus, and tensor fasciae latae (TFL). (Superior gluteal nerve L4-S1)

49
Q

What muscle does the inferior gluteal nerve innervate?

A

Gluteus maximus. (Inferior gluteal nerve L5-S2)

50
Q

How is the psoas muscle innervated?

A

By the anterior rami of L2-L4 from the lumbar plexus, not by a peripheral nerve.

51
Q

What is femoral anteversion?

A

Femoral anteversion is a structural variation where the femoral head is positioned more anteriorly in the acetabular fossa. This is compensated by “toe-ing in” or internally rotating the lower extremity.

52
Q

What is femoral retroversion?

A

Femoral retroversion is a structural variation where the femoral head is positioned more posteriorly in the acetabular fossa. This is compensated by “toe-ing out” or externally rotating the lower extremity.

53
Q

What is the effect of femoral anteversion on the knee?

A

Femoral anteversion increases the Q angle, which can lead to lateral tracking of the patella.

54
Q

How does femoral anteversion affect the glutes?

A

Femoral anteversion places the glutes in a stretched and likely weakened position, potentially reinforcing imbalances with the TFL and gluteus medius, contributing to lumbopelvic instability during gait.

55
Q

How does femoral anteversion impact the knee?

A

It places stress on the medial knee (valgus) and reinforces imbalances between the hip flexors and extensors, increasing tension on the quadriceps tendon and anterior knee structures.

56
Q

What compensatory effects can femoral anteversion have on the tibia and foot?

A

Femoral anteversion can lead to compensatory external tibial torsion and stress on static knee stabilizers, as well as overpronation at the foot and ankle.

57
Q

How can anteversion be tested?

A

Anteversion can be tested through imaging and Craig’s test.

58
Q

What happens when there is a lack of movement at the hip due to joint or muscular restrictions?

A

The body compensates by becoming hypermobile at the joints above or below the restricted area, leading to increased stress on those structures and potentially causing pain and dysfunction.

59
Q

What is the compensation pattern when hip extensors or the joint limit hip flexion?

A

The body compensates by increasing lumbar flexion.

60
Q

What is the compensation pattern when hip flexors limit hip extension?

A

The body compensates by increasing lumbar extension.

61
Q

What happens when hip rotation is limited by the lateral rotators or the joint itself?

A

The body compensates by twisting more through the lumbar spine, which places stress on the intervertebral discs.

62
Q

How would you determine what is causing decreased hip ROM?

A

You can determine the cause of decreased hip ROM through passive relaxed testing and by assessing end feels. Specific muscle length tests like Ely’s test for the rectus femoris, Ober’s test for the TFL/ITB, and the Thomas or Modified Thomas test for hip flexors are also useful.

63
Q

What symptoms are associated with labral tears in the hip?

A

Labral tears can cause pain, stiffness, and other disabling symptoms such as groin pain, clicking, locking, or catching of the hip. Pain may radiate to the buttocks, side of the hip, or down to the knee. Joint stiffness and instability where the hip or leg seems to give away are also common.

64
Q

Which group of people is most often affected by labral tears?

A

Active adults between the ages of 20 and 40 are most often affected by labral tears and often require treatment to stay active and functional.

65
Q

What are the causes of labral tears in the hip?

A

Labral tears can be caused by acute or traumatic injury to the hip or by the accumulation of small repetitive injuries, often from pivoting or repeated flexion.

66
Q

How does femoral acetabular impingement (FAI) relate to labral tears?

A

Femoral acetabular impingement (FAI) often presents before a labral tear. When the hip flexes and internally rotates, the femoral neck squishes against the acetabular rim, pinching the labrum and leading to fraying and tearing over time.

67
Q

What are common symptoms of a labral tear?

A

Pain in the front of the hip (groin area), clicking, locking, or catching of the hip. Pain may radiate to the buttocks, side of the hip, or knee. Symptoms worsen with prolonged standing, sitting, or walking. Pivoting movements may be avoided due to pain.

68
Q

What tests can be used to diagnose a labral tear?

A

• McCarthy Test: Patient flexes both hips and then extends the affected hip. A ‘catch’ suggests a labral tear.
• FABER’s Test: Pain in the hip joint could indicate a labrum injury.
• Anterior Impingement Test: Similar to the scouring test; pain, grinding, or clicking are positive signs.
• Posterior Impingement Test: Patient prone, hip taken into hyperextension, abduction, and external rotation. Pain in the hip is a positive result.

69
Q

What lifestyle modifications can help manage labral tears?

A

To avoid further damage, patients should increase their level of low to moderate physical activity, focus on maintaining proper posture when sitting and standing, and avoid activities that take the hip through full range of motion or reproduce pain.

70
Q

What is the primary focus of therapeutic exercise for labral tears?

A

Strengthening exercises should be emphasized to help stabilize the hip, optimize biomechanics, and prevent pinching of the labrum.

71
Q

How does postural correction play a role in the treatment of labral tears?

A

Postural correction helps to improve alignment and reduce stress on the hip and labrum, preventing further injury.

72
Q

What are the benefits of massage for labral tears?

A

Massage helps correct underlying postural dysfunction leading to stress on the hip and labrum.
It diminishes inflammatory and spasm-related pain.
Joint play techniques are used to diminish pain and promote joint health.

73
Q

Can labral tears heal on their own?

A

Yes, some labral tears can heal on their own if treated properly with rehabilitation, as the labrum has a blood supply.

74
Q

When is surgery necessary for labral tears?

A

Surgery may be necessary if the labrum does not heal with conservative treatment methods such as rehabilitation.

75
Q

What are the main causes of hip osteoarthritis?

A

• Altered biomechanics
• Trauma
• Immobilization

76
Q

What are some contributing factors to hip osteoarthritis?

A

• Genetic predisposition
• Disease/pathology
• Obesity

77
Q

How does hip osteoarthritis affect joint mobility?

A

• Decreased joint and muscle use leads to contractures in the capsule and surrounding muscles.
• Tone increases in the surrounding muscles to stabilize the joint.
• Inflammation and pain limit joint use.
• Bone spur formation in later stages limits joint range.

78
Q

What are the common pain locations in hip osteoarthritis?

A

• Deep groin pain
• Pain referred into the anterior and medial thigh

79
Q

What postural and gait changes are common in hip osteoarthritis?

A

• Rigid posture due to disuse and antalgic gait
• Balance between use and disuse: pain and stiffness relieved with rest, but too much rest increases symptoms
• Pain/stiffness relieved with activity, but too much activity increases symptoms

80
Q

What are key treatment considerations for hip osteoarthritis?

A

• Progressively normalize joint ROM (using all tools except joint mobilizations if osteophytes are present)
• Manage pain
• Improve joint stability by strengthening muscles
• Address causative factors
• Symptom management is often needed
• Referral to the Arthritis Society, nutritional consultation, and weight loss

81
Q

What are some medical interventions for hip osteoarthritis?

A

• Weight reduction
• Medications: NSAIDs, corticosteroid injections
• Surgery (joint replacement)

82
Q

What are self-care tips for managing hip osteoarthritis?

A

• Do not lie on the affected side
• Avoid sitting or standing for more than an hour (change positions frequently)
• Perform activities/chores sitting or standing, and switch between them
• Avoid carrying heavy loads (divide into smaller loads or get help)
• Weight management (consult a naturopath or nutritionist/dietitian)
• Keep warm to prevent muscle contraction and reduce joint stress
• Rock in a rocking chair for 10 minutes daily for gentle hip mobilization
• Best activities: cycling on flat surfaces, tai chi, swimming (low-impact, helps ROM, strength, and cardiovascular health)

83
Q

What is the rule of thumb when prescribing self-care activities for hip osteoarthritis?

A

Any activities should be done without pain during or after the activity. Start in moderation and progress as tolerated.

84
Q

What causes internal snapping in Snapping Hip Syndrome?

A

• Pain/snapping occurs when the hip is at about 45 degrees of flexion and moves from flexion to extension.
• It is often caused by the psoas tendon slipping over the ridge of the lesser trochanter or the iliofemoral ligament riding over the femoral head.

85
Q

What causes external snapping in Snapping Hip Syndrome?

A

• Pain/snapping occurs laterally (outside) of the hip.
• Often caused by a tight ITB or gluteus maximus tendon riding over the greater trochanter of the femur.
• This is typically felt with flexion or extension and can be exacerbated by medial rotation of the hip.
• It can lead to trochanteric bursitis.

86
Q

What is articular snapping and what conditions can cause it?

A

• Articular snapping refers to snapping related to the joint itself.
• It can be associated with labral tears and femoroacetabular impingement (FAI).

87
Q

What are the most common strains associated with Snapping Hip Syndrome?

A

• Groin pulls (iliopsoas or adductors)
• Hamstring strains

88
Q

What are the symptoms of an acute groin strain?

A

• Sudden sharp pain in the groin area, either in the belly of the muscle or higher.
• Rapid swelling and bruising.
• Tears typically occur during sprinting, changing direction, or rapid leg movements (e.g., kicking a ball).
• Repetitive overuse can lead to adductor tendinopathy or inflammation.

89
Q

How are groin strains graded?

A

• Grade 1: Minor injury with only a few fibers torn (may go unnoticed).
• Grade 2: Moderate injury with more fibers torn, swelling, and tenderness.
• Grade 3: Severe injury with a complete tear, significant swelling, bruising, and difficulty with movement.

90
Q

What are common tests for a groin strain?

A

• Palpation: Heat and swelling may be present.
• Passive abduction and resisted adduction may be painful.
• Passive hip extension or resisted hip flexion may also be painful.

91
Q

What are the priorities in treating a groin strain?

A
  1. Reduce pain and swelling
  2. Maintain available ROM and stabilization
  3. Normalize flexibility
  4. Improve strength and endurance
92
Q

What are the common sites for bursitis?

A

• Trochanteric (most common)
• Iliopectineal
• Ischial

93
Q

What are the symptoms of trochanteric bursitis?

A

• Pain and swelling over the side of the hip.
• Referred pain that travels down the outside thigh and may extend to the knee.
• Pain when sleeping on the affected hip.
• Pain when getting up from a deep chair or after prolonged sitting (e.g., in a car).
• Pain when climbing stairs.
• Pain when sitting with legs crossed.
• Increased pain with walking, cycling, or standing for long periods.

94
Q

What causes trochanteric bursitis?

A

• Inflammation of the trochanteric bursa due to friction from muscles or tendons rubbing over the bursa and against the femur.
• Can occur traumatically from a fall or sport-related impact.
• Gradual onset can result from repetitive trauma, such as running (especially with poor muscle control or technique), walking into fatigue, or cycling (especially when the bicycle seat is too high).

95
Q

What is the treatment for trochanteric bursitis?

A

• Manage inflammatory pain.
• Restore normal range of motion (ROM) and strength.

96
Q

What are other causes of pain in the hip region?

A

• Piriformis syndrome
• Hip fractures (more common in elderly patients with osteoporosis, often requiring surgery)

MSK T3 (5 decks)

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