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Musculoskeletal I (second exam/practical) > Hip > Flashcards

Hip Flashcards

1
Q

What are the 2 primary roles of the hip?

A
  • Supports weight of head, arms, and trunk during upright postures and dynamic weight-bearing activities
  • Provides pathway for transmission of forces between the lower extremities and pelvis
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2
Q

What 3 bones combine to form the acetabulum?

A
  • Ilium
  • Ischium
  • Pubis
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3
Q

What is the role of the labrum of the hip?

A
  • Adds stability to the joint
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4
Q

What is the normal angle of inclination of the femoral head? What is the angle of inclination of the femoral head?

A
  • Angle between axis of femoral shaft and axis of head and neck of femur
  • 125 degrees normally
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5
Q

What is the angle of torsion? How many degrees is the angle of torsion typically?

A
  • Angle of axis of femoral head and transverse axis of femoral condyles
  • 12 - 15 degrees
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6
Q

What are the 3 main ligaments of the hip?

A
  • Iliofemoral
  • Pubofemoral
  • Ischiofemoral
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7
Q

What 9 muscles flex the hip?

A
  • Iliopsoas
  • Tensor fascia lata
  • Rectus femoris
  • Sartorius
  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Pectineus
  • Gracilis
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8
Q

What are the 4 hip extensor muscles?

A
  • Gluteus maximus
  • Hamstrings
  • Posterior fibers of gluteus medius
  • Piriformis
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9
Q

What is unique about the muscles that cross the hip joint?

A
  • They have a regional impact

Ex) Iliopsoas affects hip and lumbar spine

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10
Q

What are the 4 hip abductor muscles/ groups?

A
  • Gluteus medius
  • Tensor fascia lata
  • Superior gluteus maximus
  • Gluteus minimus
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11
Q

What are the 6 hip adductor muscles/ groups?

A
  • Adductor group
  • Quadratus femoris
  • Pectineus
  • Obturators
  • Gracilis
  • Medial hamstrings
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12
Q

What hip motion is commonly impaired?

A
  • Hip abduction
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13
Q

What 7 muscles medially rotate the hip?

A
  • Tensor fascia lata
  • Gluteus minimus
  • Anterior fibers of gluteus medius
  • Adductor magnus
  • Adductor longus
  • Semimembranosus
  • Semitendinosis
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14
Q

What 8 muscles laterally rotate the hip?

A
  • Piriformis
  • Obturator internus
  • Obturator externus
  • Gemelli
  • Quadratus femoris
  • Gluteus maximus
  • Posterior fibers of gluteus medius
  • Biceps femoris
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15
Q

What group of muscles typically implicated in impairments of flexibility?

A
  • Medial rotators
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16
Q

What is the nerve supply of the hip?

A
  • Lumbar plexus (L1 - L4)

- Sacral plexus (L4 - S3)

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17
Q

What is the blood supply for the head of the femur?

A
  • Artery of ligamentum teres
  • Medial circumflex artery
  • Lateral circumflex artery
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18
Q

What is normal flexion of the hip? (ROM)

A

120 - 135 degrees

knee flexed 90 degrees

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19
Q

What is normal extension of the hip? (ROM)

A

0 - 15 degrees

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20
Q

What is normal abduction of the hip? (ROM)

A

0 - 30 degrees

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21
Q

What is normal rotation of the hip? (ROM)

A

45 degrees in each direction.

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22
Q

Which gender has more lateral rotation and which has more medial rotation?

A

More LR –> Males

More MR –> Females

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23
Q

What lumbar motion and hip extension is associated with a posterior tilt of the pelvis?

A
  • Lumbar flexion

- Hip extension

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24
Q

What lumbar motion and hip extension is associated with a anterior tilt of the pelvis?

A
  • Lumbar extension

- Hip flexion

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25
Q

What are the combine movements of a lateral pelvic tilt?

A

-

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26
Q

What is the term for an increased angle of inclination?

A

Coxa valga.

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27
Q

What is the term for an decreased angle of inclination?

A

Coxa varus.

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28
Q

What is the term for an increased angle of torsion?

A
  • Anteversion
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29
Q

What is the term for a decreased angle of torsion?

A
  • Retroversion
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30
Q

How do individuals typically compensate for anteversion of the hip?

A
  • IR

- Foot will kick up when running

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31
Q

What is leg length discrepancy?

A
  • Unilateral difference in the total length of one leg compared to another.
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32
Q

What is the difference between anatomic leg length discrepancy and functional leg length discrepancy?

A

Anatomic refers to the length difference between the hemipelvis, femur and tibia of each side, while functional leg length discrepancy refers to the position of the bones during weight-bearing function.

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33
Q

What is the typical force through the hip in bilateral standing?

A
  • 0.3 times body weight
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34
Q

What is the typical force through the hip in unilateral standing?

A
  • 2.4 - 2.6 times body weight
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35
Q

What is the typical force through the hip during walking? (low and high)

A

1.3 - 5.8 times body weight

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36
Q

What is the typical force through the hip walking up stairs?

A

3 times body weight

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37
Q

What is the typical force through the hip during running?

A

More than 4.5 times body weight

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38
Q

What are balance tests usually included in examination of the hip joint?

A
  • High incidence of falls resulting in hip injury
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39
Q

What are 4 functional scales of balance that can be used for the hip?

A
  • BERG balance scale
  • Mini- BESTest of dynamic balance
  • Dynamic gait index
  • Balance self-perception test
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40
Q

Which functional balance test is used for individuals that are higher functioning?

A
  • BESTest
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41
Q

What functional test is used for patients with impaired balance?

A
  • BERG balance scale
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42
Q

Besides functional tests, how else can balance be assessed?

A
  • History

- Type of assisstive device

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43
Q

Besides balance, what other functional test is an important component of the examination of gait?

A
  • Gait analysis
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44
Q

How should the hip be assessed throughout the gait cycle?

A
  • The motion/ position through the 3 planes of movement during each phase of gait, as well as the relationship between the hip and the rest of the kinetic chain
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45
Q

What tool can assist in analyzing gait?

A

Video analysis

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46
Q

What 4 tests should be used to assess hip joint mobility and integrity, and what 3 factors are being assessed during this time?

A
  • Lateral/ medial translation
  • Distraction
  • Compression
  • Anterioposterior/ posterioanterior glides

Assess:

  • Quality of motion
  • End feel
  • Presence/ location of pain
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47
Q

By what 4 methods can muscle performance be measured at the hip?

A
  • MMT
  • Tests at different positions to assess length changes
  • Selective tissue tension (contractile vs non-contractile)
  • Resisted tests (measures severity of tissue lesion or neurologic impairment)
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48
Q

What can be used to determine the source of pain in hip impairment?

A
  • Special tests

- May be beyond scope of PT

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49
Q

What types of alignment about the hip should be assessed when examining posture? What hypothesis can be made about muscles by observing posture?

A
  • Lumbopelvic and lower quadrant alignment in all 3 planes

- May hypothesize muscle length

50
Q

What type of screening may be performed at the hip regarding posture?

A

Leg length discrepency

51
Q

What are 6 quick tests to assess ROM and muscle length at the hip?

A
  • Placing foot on standard step
  • Forward bending
  • Squatting
  • Sitting with leg crossed
  • PROM Open chain
  • AROM Open chain
52
Q

What muscle groups are involved in muscle length assessment at the hip?

A
  • Hamstrings (medial and lateral)
  • Individual hip flexors
  • Hip adductors and abductors
  • Hip rotators
53
Q

How are everyday functional tasks measured for the hip?

A
  • Observation
  • “Show me how you do that”
  • Self-report measures
54
Q

What functional scale is related to OA of the hip?

A

Harris hip function scale

55
Q

What are 7 functional tests of the hip?

A
  • Squatting
  • Reciprocal stairs
  • Crossing ankle to opposite knee in sitting
  • Stairs 2 at a time
  • Running in straight plane and decelerating
  • One legged hop
  • Jumping
56
Q

What are 5 sources of impaired muscle performance?

A
  • Neurologic pathology
  • Muscle strain
  • Altered length-tension relationships
  • General weakness from disuse
  • Pain and inflammation
57
Q

What is neuromusculoskeletal pathology?

A

Pathology at nerve root or peripheral nerve level

58
Q

How is neuromusculoskeletal pathology treated?

A
  • Treat origin of impairment.
59
Q

What muscle strain is common related to the hip?

A
  • Hamstring strain
60
Q

What are 3 causes of muscle strains?

A
  • Muscle imbalance
  • Behavior
  • Training schedule
61
Q

How are hamstring muscle strains treated?

A
  • Treat cause
  • Utilize underused synergists
  • Assess kinetic chain for biomechanical deficits
62
Q

What are 2 synergist muscles of the hamstrings?

A
  • Gluteus maximus

- Hip lateral rotators

63
Q

Describe an exercise that trains the patient to move their hip independent of the spine.

A
  • Lie prone with pillow under stomach
  • Activate core; squeeze “seat” muscles
  • Barely lift thigh off floor
  • Return to floor, and repeat with other leg
64
Q

Describe a technique to train a patient to move the body over the hip efficiently.

A

Level 1:
- Staggered stance, involved leg in front
- Feet straight ahead
- Knees straight ahead with no rotation
- Hips and pelvis forward and level
- Slowly bend front hip and knee leaning towards front leg
- Hold knee at position of foot. Hold for 10”.
- Activate core and squeeze seat muscles
- Tighten quads
- Hold arch of foot up, while toes are down
Level 2:
- Lift back heel upwards and straighten front knee
- Maintain alignment
- Hold for 3 seconds
- Bring back thigh forward and hold single leg stance for 30 seconds
Level 3:
- Staggered stance, with involved leg forward
- Lean toward front limb
- Keep spine, pelvis, hips, knees and ankles steady
- Slowly lower until pelvis tilts or rotates
- Isolate movement at hips and knees
- Hold weight over front limb
- Rise upwards keeping weight forward
- Repeat in position

65
Q

Describe a ther-ex to strengthen spine, hip, knee, ankle, and foot muscles, as well as improve balance.

A

Step-up, step-down

Step-up

  • Lift leg onto step with thigh in midline, pelvis level
  • Check foot (Arch up, big toe down)
  • Lean onto step; keep knee and pelvis in alignment
  • Don’t flex knee past foot and keep trunk and tibia parallel
  • Step up keeping pelvis over toes, arch up; lean into hip without tilting pelvis
  • Can do side step up variation
  • Can toe tap back down keeping weight through quads

Step down

  • Dorsiflex foot of step down leg
  • Bend hip/ knee
  • Lean forward, but do not bend knee past foot
  • Stop before touching floor
  • Hold alignment
  • Can use AD to maintain balance
  • Add arm movement for difficulty
66
Q

How is the step-up movement pattern changed with an upright trunk?

A
  • More focus on quads
67
Q

What force on a muscle can cause a strain?

A
  • Overstretch
68
Q

How is an overlengthened muscle strain treated?

A
  • Strengthen in shortened range
  • Proprioceptive taping
  • Correct posture and movements that hold muscle lengthened
69
Q

Describe a gluteus medius strength progression.

A
  • Line prone with stomachs under abdomen
  • Legs in line with hips and slight ER
  • Activate core to stabilize pelvis
  • Squeeze glutes
  • Slightly lift leg, and abduct until pelvis tilts
  • Hold for 10 seconds
  • Can add theraband for resistance
  • Can also do this in sidebending position
70
Q

What 4 factors can cause disuse and deconditioning?

A
  • Injury
  • Pathology
  • Acquired movement patterns
  • Deconditioned syndergists
71
Q

How is disuse and deconditioning treated?

A
  • Correction of postures and movements
  • Optimize length relationships
  • Restore motor control and relationships
72
Q

What type of movement, and what structural change is related to OA of the hip joint?

A
  • Labral tears

- Hypermobility

73
Q

Diagnosis of labral tears is becoming more common due to increasing use of what imaging technique?

A

Arthroscopy

74
Q

How is hypermobility of a developing hip treated?

A
  • Positioning
  • Bracing
  • Surgery
75
Q

How is hypermobility of the adult hip treated?

A
  • Therapeutic exercise
  • Posture education
  • Movement training
76
Q

What is the theory behind treatment of an OA hip?

A
  • Promote joint stability
  • Prevent continuous stress to overstertched/ torn tissues
  • Posture and movement pattern training
  • Strengthen muscles in short range
  • Improve performance of deep musculature for core stability
77
Q

What should be screened for when excessive medial rotation of the hip is measured? (What is the screening test?)

A
  • Anteversion

- Trochanteric angle test

78
Q

What are the components of treatment for excessive IR of the hip?

A
  • Strengthen deep hip lateral rotators

- Educate on posture habits, and movement patterns

79
Q

Describe a standing position to help teach the patient proper hip/ LE alignment.

A
  • Standing with weight evenly distributed between both feet
  • Pelvis level from side to side
  • Knees in line with feet
  • Feet hip width apart with a slight outpointing
  • Arch elevated with big toe down
  • Pelvis in neutral from sagittal view
  • Knees not bent or locked in sagittal view
  • Ankle below knee, and leg and foot at 90 degree angle
80
Q

Describe 4 pointers you can give your patient related to gait patterns.

A
  • Don’t let your knee lock as your body weight passes over your foot. Knee slightly flexed when your foot hits the floor, and then slightly straightens
  • Squeeze your buttocks when your foot hits the ground to prevent your knees from turning in
  • Use your foot muscles to prevent your arch from dropping as your body moves over your foot
  • Keep your core activated to prevent your pelvis from tilting, especially when your body moves past your foot (your pelvis may tilt instead of your hip extending)
81
Q

What 2 methods can be used to prevent compensation for limited hip ER?

A
  • Coming up from bending forward

- Rising Upward from a Squatting position

82
Q

Describe patient instruction on coming up from bending forward.

A
  • Lead with your hips by activating your seat muscles
  • Do not arch your back by activating your core, and bringing your belly button towards your spine
  • Bring pelvis back to neutral before finishing spine movements
83
Q

Describe patient instruction on rising from a squatting position.

A
  • Fully extend your hips until your pelvis is neutral to complete the position
  • Use inner core to maintain pelvis in neutral
84
Q

What is the capsular pattern of the hip?

A
  • 50 - 55 degrees limitation of Abduction
  • No possible medial rotation
  • 90 degrees limitation of flexion
  • 10 - 30 degrees limitation of extension
  • Normal femoral adduction
85
Q

What should be assessed when examining hypomobility of the hip joint? What are 2 examples?

A
  • Relationships to other links in the kinetic chain
  • Lumbar spines flexbility during foward bending due to limited hip flexion
  • Excess knee flexion during standing knee bends
86
Q

What motion is associated with compensation for stiff hip extension?

A
  • Anterior pelvic tilt
87
Q

What types of tests are necessary to determine exercises to address hypomobility and associated hypermobility?

A
  • Muscle length tests
88
Q

Once optimum muscle length is achieved, how can that the ROM be maintained?

A
  • Train proper movement pattern, such as gait to maintain ROM
89
Q

Describe an exercise used to improve the range of motion of the hips, stretch posterior hip muscles, and train independent movement of the hips, pelvis, and spine.

A

Hand to Knee Rocking

  • Position quadriped with hip over knees and hands under shoulders
  • Knees and ankles hip width apart with feet pointing backwards
  • Spine flat with slight curve in low back
  • Pelvic tilted to form 90 degree angle in hip joint
  • Pt rocks backward at the hip joint only. The movement is stopped when back movement is felt
90
Q

Describe a technique to strength the hip flexors.

A
  • Thomas test
91
Q

What is the leading cause of morbidity in persons older than 65?

A
  • Falls
92
Q

What community activity has been proven to improve posture and stability in the elderly?

A
  • T’ai Chi
93
Q

What clinical technique is commonly used to improve balance in the olderly?

A
  • Force-platform biofeedback systems
94
Q

What is the main concern when evaluating pain?

A
  • What is the cause?

- Do they belong in PT?

95
Q

What are 7 general techniques for pain relief at the hip?

A
  • Activity modification
  • Physical agents
  • Electrotherapeutic modalities
  • Manual therapy
  • Therex
  • Assistive device
  • Weight loss
  • Biomechanical support (orthotics)
96
Q

What is required to treat posture and movement impairment?

A
  • Must first establish basic skills such as: mobility, muscle performance, and motor control at functional levels.
97
Q

Once impairments have reached functional levels, how is posture and movement impairment treated?

A
  • Emphasize optimal posture and movement
98
Q

What are the measurements for mild, moderate, and severe leg length discrepancy?

A

Mild: 0 - 30 mm
Moderate: 30 - 60 mm
Severe: > 60 mm

99
Q

What are 3 examples of functional leg length discrepancy?

A
  • Lengthened or weak posterior gluteus medius or deep hip ERs (hip in lateral rotation)
  • Lengthened or weak foot supinators (Medial collapse)
  • Postural foot pronation or supination
100
Q

What can be used to reduce joint reaction forces when increasing muscle performance in individuals with osteoarthritis?

A
  • Adjuncts
101
Q

What types of activities help stimulate hip extensor recruitment and hip flexion mobility>

A
  • Step-up activities
102
Q

How can proper step-up technique be ensured?

A
  • Alter the step height

- Add resistance

103
Q

What technique should always be including in a muscle strengthening program for a patient with OA of the hip?

A
  • Core activation
104
Q

What should be established before performing balance activities for a patient with OA of the hip?

A
  • Establish muscle balance in single limb stance
105
Q

What 3 methods should patients with hip OA be instructed in relating to posture and movement?

A
  • Positioning
  • Core training
  • Assistive devices in functional activities
106
Q

What adjunctive interventions are recommender for patients with OA of the hip?

A
  • NWB activities such as aquatic therapy
107
Q

What is ITB fascitis?

A
  • Inflammation from overuse
108
Q

What is trochanteric bursitis?

A

Bursa becomes inflamed

109
Q

How does ITB friction syndrome present?

A
  • Pain localized to lateral femoral condyle
110
Q

What knee joint can become affected by the ITB?

A
  • Patellofemoral
111
Q

What can cause a TFL strain?

A
  • Overuse of short or stretched TFL/ ITB
112
Q

What can be an underlying cause of ITB pain?

A
  • Faulty movement patterns
113
Q

What muscle in underused when the anteriormedial TFL dominates hip flexion?

A
  • Iliopsoas
114
Q

What muscles are underused when the psoteriolateral TFL dominates the hip abductor and medial rotator force couple?

A
  • Gluteus medius

- Upper fibers of gluteus maximus and minimus

115
Q

What knee muscle group may be affected by overuse of the ITB?

A

Quadriceps

116
Q

What are 2 ITB stretches?

A
  • Ober’s stretch

- Kneeling squat with a drop in the forward leg, stretching the back leg’s ITB

117
Q

How can the ITB be taped for unloading?

A
  • Place tape anterior to posteriorly along lateral thigh

- Patella may need to taped medially to prevent lateral displacement

118
Q

What are 4 signs of piriformis syndrome?

A
  • Hip flexion with IR
  • Lordosis and anterior pelvic tilt
  • High iliac crest on involved side
  • ER and abduction reduces symptoms
119
Q

What are 7 tests for piriformis syndrome (lengthened piriformis)?

A
  • Standing alignment
  • Tissue tension tests
  • ROM
  • Palpation
  • Positional strength
  • Functional tests
  • Lumbar clearing exam
120
Q

Describe an exercise to strengthen the piriformis?

A
  • Pt prone
  • Hips abducted and laterally rotated with feet together
  • Submaximally isometrically contract feet together (avoid accessory muscle use)
121
Q

What neurological problem does a stretched piriformis mimic?

A

Lumbar radiculopathy

Musculoskeletal I (second exam/practical) (7 decks)

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