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631: Clinical Management of the Musculoskeletal System I > Hip > Flashcards

Hip Flashcards

1
Q

What is the primary function of the hip?

A

to support the weight of the body

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2
Q

Structurally, the hip is suited for _____ first, then ______.

A

stability

mobility

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3
Q

What are the 6 muscles that attach to the ischial tuberosity?

A
  • Semimembranosus
  • Semitendinosus
  • Long head of the Biceps Femoris
  • Adductor Magnus
  • Quadratus Femoris
  • Gemellus Inferior
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4
Q

What direction does the acetabulum face?

A

laterally
inferiorly
anteriorly

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5
Q

What deepens the concavity of the acetabulum and grasps the head of the femur?

A

acetabulum abrum

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6
Q

What direction does the femoral head face?

A

medially
superiorly
anteriorly

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7
Q

The femoral neck is ______ rotated with respect to the shaft

A

externally

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8
Q

What 6 muscles attach to the greater trochanter?

A
  • Piriformis
  • Gluteus medius
  • Gluteus minimus
  • Obturator internus
  • Gemellus superior
  • Gemellus inferior
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9
Q

Describe the proximal aspect of the hip joint capsule

A

It attaches proximally to the pelvis just lateral to the acetabular labrum

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10
Q

Describe the lateral and anterior aspects of the hip joint capsule

A

Extends laterally over the femoral head and neck to attach to the intertrochanteric line anteriorly

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11
Q

Describe the posterior aspect of the hip joint capsule

A

Posteriorly, the capsule attaches to the lateral one-third of the femoral neck

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12
Q

The articular cartilage found in the joint capsule is thicker in what direction? Why?

A

Anterosuperiorly, where maximal stress & weight-bearing occurs

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13
Q

What are the 3 hip ligaments?

A
  • Iliofemoral ligament
  • Ischiofemoral ligament
  • Pubofemoral ligament
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14
Q

Which hip ligament is the strongest?

A

Iliofemoral ligament

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15
Q

What is the iliofemoral ligament aka?

A

Y ligament of Bigelow

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16
Q

Which hip ligament is the weakest?

A

Ischiofemoral ligament

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17
Q

When is the Ischiofemoral ligament tight?

A

during extension

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18
Q

What does the Pubofemoral ligament prevent and limit?

A

Prevents excessive abduction

Limits extension

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19
Q

What typically is the major limiting factor of hip movement?

A

the joint capsule

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20
Q

What are the 3 bursae of the hip joint?

A
  • Iliopsoas Bursa
  • Trochanteric Bursa
  • Ischiogluteal Bursa
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21
Q

What are the contents of the femoral triangle?

A
  • Femoral nerve
  • Femoral artery
  • Femoral vein
  • Lymphatics
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22
Q

What is the resting (open-packed) position of the hip joint?

A

30 degrees flexion
30 degrees abduction
slight external rotation

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23
Q

What is the closed-packed position of the hip joint?

A

Extension, internal rotation and abduction

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24
Q

What is the capsular pattern of the hip joint?

A

Flexion > abduction > internal rotation

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25
Q

When standing, the forces on the hip are __ times body weight

A

0.3

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26
Q

When standing on 1 limb, the forces on the hip are __ - __ times body weight

A

2.4 - 2.6

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27
Q

When walking, the forces on the hip are __ - __ times body weight

A

1.3 - 5.8

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28
Q

When walking upstairs, the forces on the hip are __ times body weight

A

3

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29
Q

When running, the forces on the hip are __ times body weight

A

4.5 or more

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30
Q

What is normal hip flexion ROM?

A

110 - 120 degrees

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31
Q

What is normal hip extension ROM?

A

10 - 15 degrees

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32
Q

What is normal hip abduction ROM?

A

30 - 50 degrees

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33
Q

What is normal hip adduction ROM?

A

25 - 30 degrees

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34
Q

What is normal hip external rotation ROM?

A

40 - 60 degrees

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35
Q

What is normal hip internal rotation ROM?

A

30 - 40 degrees

36
Q

What does normal end-feel for hip ROM feel like?

A

Tissue approximation or tissue stretch

37
Q

What is the angle between the femoral shaft and the neck called?

A

the angle of inclination

38
Q

What is the normal angle of inclination?

A

125 - 130 degrees

39
Q

An increase in the angle of inclination (> 130 degrees) is called coxa ____.

A

valga

40
Q

Coxa valga causes the femoral head to be directed more ______ in the acetabulum

A

superiorly

41
Q

Coxa valga results in _____ available weight bearing, which results in what?

A

decreased

increase in stress applied across the joint surfaces

42
Q

What muscles are affected by coxa valga? Why?

A

hip abductors, due to a shortened moment arm

43
Q

Because the hip abductors have a shortened moment arm they contract more _____, what does this produce?

A

vigorously, producing increased joint reaction forces

44
Q

A decrease in the angle of inclination (< 130 degrees) is called coxa ____.

A

vara

45
Q

Coxa vara causes the femoral head to be directed more ______ in the acetabulum

A

horizontal

46
Q

What 2 things does coxa vara increase?

A
  • the downward shear forces on the femoral head

- the tensile stretching forces through the superior trabecular bone along the lateral portion of the neck

47
Q

What does coxa vara decrease?

A

joint compression forces

48
Q

What does torsion angle of the femur describe?

A

the relative rotation that exists between the shaft and the neck of the femur

49
Q

Describe what the normal torsion angle is?

A

The femoral neck is 8 -15 degrees anterior to a mediolateral axis to the femoral condyles

50
Q

When the femoral neck is anteriorly oriented in reference to the femoral condyles it is called _______.

A

anteversion

51
Q

Anteversion occurs when the femoral neck is __ degrees anterior to the femoral condyles

A

35

52
Q

Do patients with excessive anteversion usually have more IR or ER? What is the end result?

A

IR, which results in an associated toeing-in with weight bearing

53
Q

When the femoral neck is posteriorly oriented in reference to the femoral condyles it is called _______.

A

retroversion

54
Q

Retroversion occurs when the femoral neck is __ degrees anterior to the femoral condyles

A

5

55
Q

Do patients with excessive retroversion usually have more IR or ER? What is the end result?

A

ER, which results in an associated toeing-out with weight bearing

56
Q

What are the 2 force couples at the hip?

A
  • Rectus abdominis and External obliques

- Gluteus maximus and Hamstrings

57
Q

What are the 7 things that needed to be observed during the tests and measures aspect of a hip evaluation?

A
  • Observation
  • AROM/PROM
  • MMTs
  • Gait
  • Loading tests
  • High Step
  • Unilateral Stance
58
Q

What are 2 types of abnormal lumbopelvic rhythm?

A
  • limited hip flexion and excessive lumbar flexion

- limited lumbar flexion and excessive hip flexion

59
Q

During normal forward bending, the patient should be able to do what 2 things?

A
  • Touch their toes without bending the knees

- Demonstrate a flattening of the lordosis

60
Q

If the hamstrings are adaptively shortened what cannot be accomplished?

A

to touching

61
Q

What are 2 characteristics of the lumbopelvic rhythm that may indicate tightness of the lumbar spine?

A
  • As the patient forward flexes, no flattening of the lordosis occurs
  • The patient is unable to touch the toes even with good hamstring flexibility
62
Q

What are the 5 passive accessory motions that can be performed on the hip?

A
  • distraction
  • leg traction (long axis distraction)
  • posterior glide
  • anterior glide
  • inferior glide
63
Q

What can joint distraction be used for?

A

to assess for pain and hypomobility

64
Q

When performing the scour test pain can result from compression of, or stress to, a number of structures including what 7 things?

A
  • Articular surfaces of the hip joint
  • Labrum
  • Hip joint capsule
  • Insertion site of the TFL, Sartorius, Adductor Longus, or Pectineus
  • Iliopsoas
  • Neurovascular bundle
  • Femoral neck
65
Q

Resistance experienced during the scour test may be caused by what 4 things?

A
  • Capsular tightness
  • Adhesion
  • Myofascial restriction
  • Loss of joint congruity
66
Q

What does the FABER test screen for?

A
  • hip dysfunction
  • lumbar dysfunction
  • SIJ dysfunction
  • iliopsoas spasm
67
Q

What is the Craig test used to assess?

A

femoral anteversion/retroversion

68
Q

While performing the Craig test if the angle is greater than __ degrees, the femur
is considered to be in anteversion.

A

15

69
Q

While performing the Craig test if the angle is less than __ degrees, the femur
is considered to be in retroversion.

A

8

70
Q

The flexion-adduction test is used as a screening test for what?

A

early hip dysplasia

71
Q

What is the supine plank test used to detect?

A

hamstring weakness or injury

72
Q

What is the Trendelenberg sign used to indicate?

A

weakness of the gluteus medius muscle during unilateral weight-bearing

73
Q

What are 4 dysfunctions that can produce the Trendelenburg sign?

A
  • Superior gluteal nerve palsy
  • Lumbar disk herniation
  • Weakness or tear of the gluteus medius
  • Advanced degeneration of the hip
74
Q

During left unilateral weight bearing, what do the left hip abductors do?

A

They contract both isometrically and eccentrically to prevent the right side of the pelvis from being pulled downward by gravity

75
Q

What is Stinchfield’s Test used to determine?

A

the source of a patient’s back, buttock, groin, and/or leg pain

76
Q

What is the Thomas test used to test?

A

the flexibility of the iliopsoas complex

77
Q

When performing the modified Thomas test what is indicated if the thigh is raised compared to the table?

A

There is a decrease in the flexibility of the iliopsoas muscle complex

78
Q

When performing the modified Thomas test what is indicated if the thigh is parallel to the table, but the knee is extended?

A

There is a decrease in the flexibility of the rectus femoris

79
Q

When performing the modified Thomas test what is indicated if there is an increase in hip flexion when knee overpressure is applied?

A

the rectus femoris

80
Q

When performing the modified Thomas test what is indicated if there is no increase in hip flexion when knee overpressure is applied?

A

the iliopsoas

81
Q

What is Ely’s test used to assess?

A

the flexibility of the rectus femoris

82
Q

What is Ober’s test used to evaluate?

A

the flexibility of the ITB and TFL

83
Q

The hamstrings are considered shortened if the leg cannot be raised to an angle of __ degrees, while maintaining the other leg
straight.

A

80

84
Q

What is the 90-90 Straight-Leg Raise used to assess?

A

Hamstring length

85
Q

What is a positive 90-90 Straight-Leg Raise?

A

Inability to straighten the knee to 20 degrees of flexion or less

86
Q

What are the goals of the acute phase?

A
  • Protection of the injury site
  • Decreased pain and inflammation
  • Restoration of pain-free ROM in the entire kinematic chain
  • Improvement of patient comfort by decreasing pain and inflammation
  • Retardation of muscle atrophy
  • Minimization of the detrimental effects of immobilization and activity restriction
  • Scar management, if appropriate (THA)
  • Maintenance of general fitness
  • Independence with HEP
87
Q

What are the goals of the functional phase?

A
  • Restore normal joint kinematics
  • Attain full, pain-free AROM
  • Improving muscle strength to WNL
  • Improving neuromuscular control
  • Restore the normal strength and relationship if the muscle force couples

631: Clinical Management of the Musculoskeletal System I (19 decks)

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