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OMS Peripheral > Hip > Flashcards

Hip Flashcards

1
Q

What type of joint is the hip?

A

Synovial ball and socket joint

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2
Q

Which direction does the head of the femur face in order to articulate with the acetabulum?

A

Anteriorly
Superiorly
Medially

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3
Q

What is the closed pack position of the hip?

A

Extension, with a degree of abduction and medial rotation

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4
Q

What is the position of the fibrous hip capsule?

A
  • Surrounds most of the neck of the femur
  • Attaches to the acetabular rim
  • Below the intertrochanteric line anteriorly
  • 1cm above the intertrochanteric crest posteriorly
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5
Q

Where are the joint capsule and articular cartilage thicker?

A

Anterosuperiorly as this is where most stress in weight-bearing is

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6
Q

Where do the synovial plicae lie in the hip joint?

A
  • External surface of the lower medial part of the acetabular labrum (labral plicae)
  • Base of the ligament of the head of the femur
  • Base of the femoral neck
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7
Q

What are the three ligaments which reinforce the hip capsule and control movement?

A

1- Iliofemoral ligament
2- Pubofemoral ligament
3- Ischiofemoral ligament

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8
Q

What is the size of the psoas bursa?

A

5-7cm long

2-4cm wide

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9
Q

Does the psoas bursa articulate with the hip?

A

It does via an aperture between the iliofemoral and the pubofemoral ligaments

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10
Q

What lies around the bursa?

A
  • Anteromedially: femoral artery

- Anteriorly: femoral nerve

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11
Q

Where is the point of location of the iliopsoas bursa?

A

Just distal to the midpoint of the inguinal ligament, deep to the femoral artery

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12
Q

What forms the gluteal bursa?

A

The four bursa that lie within the separate planes of the gluteal muscles as they pass over or attach to the greater trochanter

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13
Q

What is the main gluteal bursa and which muscle is it associated with?

A

The trochanteric bursa is associated with gluteus maximus

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14
Q

What lies within the femoral triangle?

“VAN” (medially –> laterally)

A

1- femoral Vein
2- femoral Artery
3- femoral Nerve

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15
Q

When is the Rectus Femoris most efficient at being a hip flexor?

A

With the knee flexed

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16
Q

What is the origin of Rectus Femoris?

A

1- Straight head: anterior inferior iliac spine

2- Reflected head: just above the acetabular rim

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17
Q

When are the hamstrings most efficient in extending the hip?

A

With the knee locked into extension

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18
Q

Where does gluteus maximus insert?

A

Iliotibial tract and upper femur

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19
Q

Which are the medial and lateral hamstrings?

A
  • Lateral: Biceps femoris

- Medial: Semitendinosus and semimembranosus

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20
Q

Where does the piriformis insert?

A

The upper border of the greater trochanter

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21
Q

What are the lateral rotators of the hip?

“Pretty Girls Often Get Off Quickly”

A 
1- Piriformis
2- Gemelli superior 
3- Obturator internus
4- Gemelli inferior
5- Obturator externus
6- Quadratus femoris
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22
Q

What are the lateral muscles and what are their functions?

A

1- Gluteus medius: main hip abductor
2- Gluteus minimus: together with medius they maintain the opposite side of the pelvis during single leg stance

They are also lateral rotators

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23
Q

What do tensor fascia lata and the anterior fibres of gluteus medius and minimus do?

A

Medial rotation and flexion: they lie anterior to the frontal plane of the hip joint

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24
Q

What do the posterior fibres of gluteus medius and minimus do?

A

Hip extension and lateral rotation

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25
Q

Where does the tensor fascia lata arise from?

A

Anterior 5cm of the outer lip of the iliac crest and the anterior iliac spine

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26
Q

What are the adductors of the hip? (5)

“Three Ducks Peck at the Grass”

A 
1- Adductor longus
2- Adductor brevis
3- Adductor magnus
4- Pectineus
5- Gracilis
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27
Q

What is the iliac crest in line with?

A

Spinous process of L4

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28
Q

What is the PSIS in line with?

A

S2 - approx 4 cm laterally

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29
Q

What arises from the AIIS?

A

Superiorly - the long head of rectus femoris

Inferiorly - part of the iliofemoral ligament

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30
Q

What is in line with the greater trochanter?

A

The pubic tubercle

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31
Q

What attaches to the pubic tubercle?

A

The inguinal ligament

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32
Q

What are the borders of the femoral triangle?

A

Base - inguinal ligament
Lateral border - sartorius
Medial border - adductor longus
Floor - iliopsoas and pectineus

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33
Q

What is meralgia paraesthesia?

A

It is the compression of the femoral nerve as it passed through the femoral triangle. Causes paraesthesia and pain down the lateral aspect of the thigh. Most commonly caused by tight clothing or belts and obese patients.

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34
Q

How do you locate the sciatic nerve?

A

Draw a point midway between a line drawn from the PSIS and the greater trochanter.

Draw another point between a line just medial to a line between the ischial tuberosity and the greater trochanter.

That is the trajectory of the nerve

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35
Q

What are the common hip conditions per age?

Young people

A
  • Perthes’ (3-10 yrs) - osteochondritis of the femoral epiphysis
  • Slipped epiphysis (10-16 yrs) - lateral rotation deformity, tends to be overweight boys, pain on exercise
  • Transient synovitis (under 10 yrs)
  • Juvenile chronic arthritis
  • Avulsion fractures and chronic apophysitis (adolescents), commonly at the long head of the rectus femoris on the AIIS, secondary to excessive muscle contraction in sports with quick direction changes
  • Stress fracture to the femoral neck
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36
Q

What is osteitis pubis?

What does it present with?

A
  • Pathological condition affecting the pubic bone and pubis symphysis.
  • Bilateral hip pain
  • Symptoms aggravated by twisting/exercise/turning/kicking
  • Pain on resisted adduction
  • Weak adductors
  • Tenderness over the pubis
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37
Q

What is the main sensory nerve supply to the hip?

A

The femoral nerve L2-L3

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38
Q

Where else does L2-L3 cover?

A

The upper buttock and so a hip lesion may present as lower back pain

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39
Q

What is the typical duration of symptoms for degenerative hip OA?

A

Hx of gradually worsening episodes of pain

40
Q

What is the typical duration of symptoms for bursitis?

A

Hx of gradual onset of aching pain, which is why patients often don’t seek treatment for many months

41
Q

What is the typical behaviour of muscle sprains and inflamed bursae?

A

Worse with use and eased at rest

42
Q

What are the two main questions to ask in order to rule out the lumbar spine?

A

1- Presence of paraesthesia

2- Pain produced by a cough or sneeze

43
Q

Symptoms and Behaviours of bursae?

A

Pain during activities that squeeze or compress them e.g. lying on the side or sitting

44
Q

Symptoms and Behaviours of the OA of the hip?

A

Aggravated by weight bearing or activity, stiffer in the mornings

45
Q

Symptoms and Behaviours of loose bodies/labral tears in the hip?

A

Catching or giving way on weight bearing, twinging pain

46
Q

Symptoms and Behaviours of early degenerative OA?

A

Night pain

47
Q

What attaches to the greater trochanter?

A

Superiorly - Gluteus medius
Anteriorly - Gluteus minimus
Medially - Gluteus maximus

48
Q

How do you differentiate between lumbar pain and hip pain?

A

If lumbar extension causes pain, then eliminate the hip by putting a foot up on a step (hip flexion), and if this still reproduces pain then it is a lumbar lesion

49
Q

What are the normal end-feels in the hip?

A
  • Flexion: soft
  • Extension: elastic
  • Medial rotation: elastic
  • Lateral rotation: elastic
50
Q

Which three groups of muscles are commonly injured at the hip?

A

1- Adductors
2- Quadriceps
3- Hamstrings

51
Q

What are the four types of arthritis possible at the hip?

A

1- Degenerative OA
2- Traumatic OA
3- Rheumatoid OA
4- Spondyloarthropathies

52
Q

How common is degenerative OA in the hip?

A

50% of the population will have it after the age of 60

53
Q

What is the difference between primary and secondary arthritis?

A

Primary: has no definitive cause, though may have some secondary factors present

Secondary: predisposing factors (e.g. occupational overuse, previous fractures, biomechanics, etc.)

54
Q

Which gender is more predisposed to arthritis in the hip and why?

A

Females

Women have a smaller femoral head and larger acetabulum which would increase the contact stress

55
Q

Is an Xray a good method for diagnosing OA of the hip?

A

No, as changes on Xray are not a good indicator of symptoms. Joint pathology may be present long before or after Xray changes

56
Q

What would the requirements be for surgery due to OA?

A

Rapid deterioration and severe symptoms for 1-2 years

57
Q

What are the main findings for Stage 1 OA of the hip?

A
  • Buttock/groin pain associated with weight bearing activities
  • Pain sometimes disturbs sleep
  • Start of a capsular pattern: loss of medial rotation, flexion and perhaps abduction. Extension not yet lost
  • Limited movements have hard end feel but some elasticity still
58
Q

What would be the treatment for Stage 1 OA of the hip?

A
  • Grade B mobilisations within pain free range

- In conjunction with heat

59
Q

What are the main findings for Stage 2 OA hip?

A
  • Pain present at rest as well as activities
  • Pain radiating down to thigh
  • Moderate to severe capsular pattern
  • Limited movements have hard end feel
60
Q

What would be the treatment for Stage 2 OA hip?

A
  • Injection
61
Q

What are the main findings for Stage 3 OA hip?

A
  • Pain can radiate down to the ankle
  • Extreme pain, especially at night
  • Barely any medial rotation
62
Q

What would be the treatment for Stage 3 OA hip?

A

Surgery - hip resurfacing or replacement

63
Q

What would be the treatment for RA hip?

A
  • Injection
64
Q

Where is pain felt with a loose body in the hip?

A
  • Groin

- Radiates down the front of the leg

65
Q

What are the three type of loose bodies associated with arthrosis?

A

1- Chondral
2- Osteochondral
3- Osseous

66
Q

What other differential diagnosis could it be other than a loose body?

A
  • Labral tears –> young adult, associated with traumatic incidents which may be minor twisting/repetitive flexing/hyperextension injuries
67
Q

What are two labral impingement tests you can do on the hip?

A

1- Forced flexion/adduction/medial rotation

2- Forced flexion/abduction/lateral rotation

68
Q

What are the main findings with a hip loose body?

A
  • Pain at end of range flexion and lateral rotation

- End-feel is springy

69
Q

What is the treatment for a loose body in the hip?

A

Grade A mobilisation under strong traction - moving towards the least painful direction

70
Q

What are the three main bursae of the hip that might cause pain?

A

1- Trochanteric
2- Psoas
3- Ischial (occasionally)

71
Q

What is a common hip bursitis onset?

A

Gradual with no obvious cause (occasionally due to trauma). Pain increases with activity and improves with rest

72
Q

What are the objective findings for hip bursitis?

A
  • Muddled

- Difficult to differentiate from tendinopathy as the fibres are linked

73
Q

What is the site and spread of psoas bursitis?

A
  • Localised to the groin

- Can radiate down L3 dermatome

74
Q

What differential diagnosis should be made with psoas bursitis?

A
  • Exclude lumbar spine involvement and other hip and pelvic pathologies:
  • Stress fractures
  • Gilmore’s groin
75
Q

What is the treatment for hip bursitis?

A

Injection

76
Q

What is a differential diagnosis to make with trochanteric bursitis?

A
  • Piriformis syndrome: pain in similar region and tenderness over sciatic notch and greater trochanter
  • Iliotibial band syndrome: similar pain pattern but this has a positive Ober’s test (side-lying, hip neutral and knee flexed, leg put into extension and adduction, positive for tight ITB if the knee extends when the femur is adducted)
77
Q

What population is most at risk of trochanteric bursitis?

A

Middle-aged obese women

78
Q

What is the site and spread of pain in trochanteric bursitis?

A
  • Diffuse ache/pain or burning pain

- Pain felt down the lateral aspect of the thigh and hip

79
Q

Objective findings for a trochanteric bursitis?

A
  • Tenderness on palpation of greater trochanter

- Muddled passive and resisted tests

80
Q

What are the main findings for ischial bursitis?

A
  • Pain on prolonged sitting and eased with standing
81
Q

What is a positive ‘sign of the buttock’?

A
  • Pain (empty end-feel) with a straight leg raise, increased with further hip and knee flexion.

This signifies a major lesion in the buttock or hip region

82
Q

What is a typical history for sign of the buttock?

A
  • Unwell patient, looks ill, possible fever, night sweats, rigors
  • Unrelenting pain in the buttock/hip/leg
83
Q

What are the objective findings for sign of the buttock?

A
  • Non-capsular pattern
  • Pain increased by lumbar flexion and resisted tests at the hip
  • Positive sign of the buttock
84
Q

Possible causes for a positive sign of the buttock?

A
  • Neoplasm of the upper femur or ilium
  • Fracture of the femur
  • Fracture of the sacrum
  • Ischiorectal abscess
  • Sepsis
  • Septic bursitis/arthritis
  • Osteomyelitis of the upper femur
85
Q

Which hamstring component is most vulnerable to injury and why?

A

Biceps femoris as its peak length exceeds that of the medial hamstrings during the end of the swing phase

86
Q

What are the main findings with a hamstring lesion?

A

Hx:

  • Stiffness, cramps, spasms in the posterior aspect of the distal thigh
  • Weak knee flexion

Objective:

  • Pain on resisted knee flexion
  • Pain on passive straight leg rise
  • Palpation reveals the site of the lesion (chronic: more proximal)
87
Q

What is the only statistically significant risk factor for recurrent hamstring strain?

A

Previous ACL injury

88
Q

What is the treatment for an acute muscle belly hamstring lesion?

A
  • POLICE
  • (first 3 days): gentle friction until some anaesthetic response then 6 deep sweeps –> follow this with some Grade A mobilisations
  • (after 5 days) –> Gently increase depth of friction and Grade As until full range pain free is achieved
89
Q

What does ‘POLICE’ stand for and when to use it?

A 
Protect
Optimally
Load
Ice
Compression
Elevate

Acute injuries

90
Q

What is the aim of hamstring rehabilitation?

A

To cause adaptation in the muscle tendon unit of the hamstrings and the adjacent supporting tissues, allowing the entire system to absorb sufficient energy and to facilitate a return to full function

91
Q

Which muscle in the quadriceps is most often injured and why?

A

Rectus femoris as it covers two joints

92
Q

What is the treatment for a chronic hamstring lesion?

A
  • Friction for chronic muscle belly: Friction 10 min then vigorous Grade As
  • Injection
93
Q

What is the treatment for a quadriceps lesion?

A
  • Friction
94
Q

What is the width of the tendon of Rectus Femoris at its origin?

A

2 fingers

95
Q

Which two sites of adductor longus are most commonly injured?

A

1- Origin from the pubis

2- Musculotendinous junction

96
Q

What is the treatment for a lesion at the origin of adductor longus?

A
  • Friction

- Injection

97
Q

What is the treatment for a lesion at the musculotendinous junction of adductor longus?

A
  • Friction

OMS Peripheral (8 decks)

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