Hip Flashcards
What is the primary function of the hip?
to support the weight of the body
Structurally, the hip is suited for _____ first, then ______.
stability
mobility
What are the 6 muscles that attach to the ischial tuberosity?
- Semimembranosus
- Semitendinosus
- Long head of the Biceps Femoris
- Adductor Magnus
- Quadratus Femoris
- Gemellus Inferior
What direction does the acetabulum face?
laterally
inferiorly
anteriorly
What deepens the concavity of the acetabulum and grasps the head of the femur?
acetabulum abrum
What direction does the femoral head face?
medially
superiorly
anteriorly
The femoral neck is ______ rotated with respect to the shaft
externally
What 6 muscles attach to the greater trochanter?
- Piriformis
- Gluteus medius
- Gluteus minimus
- Obturator internus
- Gemellus superior
- Gemellus inferior
Describe the proximal aspect of the hip joint capsule
It attaches proximally to the pelvis just lateral to the acetabular labrum
Describe the lateral and anterior aspects of the hip joint capsule
Extends laterally over the femoral head and neck to attach to the intertrochanteric line anteriorly
Describe the posterior aspect of the hip joint capsule
Posteriorly, the capsule attaches to the lateral one-third of the femoral neck
The articular cartilage found in the joint capsule is thicker in what direction? Why?
Anterosuperiorly, where maximal stress & weight-bearing occurs
What are the 3 hip ligaments?
- Iliofemoral ligament
- Ischiofemoral ligament
- Pubofemoral ligament
Which hip ligament is the strongest?
Iliofemoral ligament
What is the iliofemoral ligament aka?
Y ligament of Bigelow
Which hip ligament is the weakest?
Ischiofemoral ligament
When is the Ischiofemoral ligament tight?
during extension
What does the Pubofemoral ligament prevent and limit?
Prevents excessive abduction
Limits extension
What typically is the major limiting factor of hip movement?
the joint capsule
What are the 3 bursae of the hip joint?
- Iliopsoas Bursa
- Trochanteric Bursa
- Ischiogluteal Bursa
What are the contents of the femoral triangle?
- Femoral nerve
- Femoral artery
- Femoral vein
- Lymphatics
What is the resting (open-packed) position of the hip joint?
30 degrees flexion
30 degrees abduction
slight external rotation
What is the closed-packed position of the hip joint?
Extension, internal rotation and abduction
What is the capsular pattern of the hip joint?
Flexion > abduction > internal rotation
When standing, the forces on the hip are __ times body weight
0.3
When standing on 1 limb, the forces on the hip are __ - __ times body weight
2.4 - 2.6
When walking, the forces on the hip are __ - __ times body weight
1.3 - 5.8
When walking upstairs, the forces on the hip are __ times body weight
3
When running, the forces on the hip are __ times body weight
4.5 or more
What is normal hip flexion ROM?
110 - 120 degrees
What is normal hip extension ROM?
10 - 15 degrees
What is normal hip abduction ROM?
30 - 50 degrees
What is normal hip adduction ROM?
25 - 30 degrees
What is normal hip external rotation ROM?
40 - 60 degrees
What is normal hip internal rotation ROM?
30 - 40 degrees
What does normal end-feel for hip ROM feel like?
Tissue approximation or tissue stretch
What is the angle between the femoral shaft and the neck called?
the angle of inclination
What is the normal angle of inclination?
125 - 130 degrees
An increase in the angle of inclination (> 130 degrees) is called coxa ____.
valga
Coxa valga causes the femoral head to be directed more ______ in the acetabulum
superiorly
Coxa valga results in _____ available weight bearing, which results in what?
decreased
increase in stress applied across the joint surfaces
What muscles are affected by coxa valga? Why?
hip abductors, due to a shortened moment arm
Because the hip abductors have a shortened moment arm they contract more _____, what does this produce?
vigorously, producing increased joint reaction forces
A decrease in the angle of inclination (< 130 degrees) is called coxa ____.
vara
Coxa vara causes the femoral head to be directed more ______ in the acetabulum
horizontal
What 2 things does coxa vara increase?
- the downward shear forces on the femoral head
- the tensile stretching forces through the superior trabecular bone along the lateral portion of the neck
What does coxa vara decrease?
joint compression forces
What does torsion angle of the femur describe?
the relative rotation that exists between the shaft and the neck of the femur
Describe what the normal torsion angle is?
The femoral neck is 8 -15 degrees anterior to a mediolateral axis to the femoral condyles
When the femoral neck is anteriorly oriented in reference to the femoral condyles it is called _______.
anteversion
Anteversion occurs when the femoral neck is __ degrees anterior to the femoral condyles
35
Do patients with excessive anteversion usually have more IR or ER? What is the end result?
IR, which results in an associated toeing-in with weight bearing
When the femoral neck is posteriorly oriented in reference to the femoral condyles it is called _______.
retroversion
Retroversion occurs when the femoral neck is __ degrees anterior to the femoral condyles
5
Do patients with excessive retroversion usually have more IR or ER? What is the end result?
ER, which results in an associated toeing-out with weight bearing
What are the 2 force couples at the hip?
- Rectus abdominis and External obliques
- Gluteus maximus and Hamstrings
What are the 7 things that needed to be observed during the tests and measures aspect of a hip evaluation?
- Observation
- AROM/PROM
- MMTs
- Gait
- Loading tests
- High Step
- Unilateral Stance
What are 2 types of abnormal lumbopelvic rhythm?
- limited hip flexion and excessive lumbar flexion
- limited lumbar flexion and excessive hip flexion
During normal forward bending, the patient should be able to do what 2 things?
- Touch their toes without bending the knees
- Demonstrate a flattening of the lordosis
If the hamstrings are adaptively shortened what cannot be accomplished?
to touching
What are 2 characteristics of the lumbopelvic rhythm that may indicate tightness of the lumbar spine?
- As the patient forward flexes, no flattening of the lordosis occurs
- The patient is unable to touch the toes even with good hamstring flexibility
What are the 5 passive accessory motions that can be performed on the hip?
- distraction
- leg traction (long axis distraction)
- posterior glide
- anterior glide
- inferior glide
What can joint distraction be used for?
to assess for pain and hypomobility
When performing the scour test pain can result from compression of, or stress to, a number of structures including what 7 things?
- 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
Resistance experienced during the scour test may be caused by what 4 things?
- Capsular tightness
- Adhesion
- Myofascial restriction
- Loss of joint congruity
What does the FABER test screen for?
- hip dysfunction
- lumbar dysfunction
- SIJ dysfunction
- iliopsoas spasm
What is the Craig test used to assess?
femoral anteversion/retroversion
While performing the Craig test if the angle is greater than __ degrees, the femur
is considered to be in anteversion.
15
While performing the Craig test if the angle is less than __ degrees, the femur
is considered to be in retroversion.
8
The flexion-adduction test is used as a screening test for what?
early hip dysplasia
What is the supine plank test used to detect?
hamstring weakness or injury
What is the Trendelenberg sign used to indicate?
weakness of the gluteus medius muscle during unilateral weight-bearing
What are 4 dysfunctions that can produce the Trendelenburg sign?
- Superior gluteal nerve palsy
- Lumbar disk herniation
- Weakness or tear of the gluteus medius
- Advanced degeneration of the hip
During left unilateral weight bearing, what do the left hip abductors do?
They contract both isometrically and eccentrically to prevent the right side of the pelvis from being pulled downward by gravity
What is Stinchfield’s Test used to determine?
the source of a patient’s back, buttock, groin, and/or leg pain
What is the Thomas test used to test?
the flexibility of the iliopsoas complex
When performing the modified Thomas test what is indicated if the thigh is raised compared to the table?
There is a decrease in the flexibility of the iliopsoas muscle complex
When performing the modified Thomas test what is indicated if the thigh is parallel to the table, but the knee is extended?
There is a decrease in the flexibility of the rectus femoris
When performing the modified Thomas test what is indicated if there is an increase in hip flexion when knee overpressure is applied?
the rectus femoris
When performing the modified Thomas test what is indicated if there is no increase in hip flexion when knee overpressure is applied?
the iliopsoas
What is Ely’s test used to assess?
the flexibility of the rectus femoris
What is Ober’s test used to evaluate?
the flexibility of the ITB and TFL
The hamstrings are considered shortened if the leg cannot be raised to an angle of __ degrees, while maintaining the other leg
straight.
80
What is the 90-90 Straight-Leg Raise used to assess?
Hamstring length
What is a positive 90-90 Straight-Leg Raise?
Inability to straighten the knee to 20 degrees of flexion or less
What are the goals of the acute phase?
- 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
What are the goals of the functional phase?
- 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
