Hip Flashcards
What landmark serves as inferior attachment for rectus abdominis, superior attachment for adductor longus?
Pubic tubercle
What is the attachment site of pectineus which can generate groin pain?
Pectin pubis
What is the typical site of a trauamtic avulsion of adductor magnus?
Ischial ramus and tuberosity / sits bones
What directions does the socket face in normal alignment?
Anteriorly, laterally and inferiorly
What angle does the hip start at with birth and then is reduced to by adulthood with WB? (Frontal angle)
150 deg to 120-130 deg
Which angulation of the hip is defined as < 120 deg in the frontal plane?
Coxa varus
Which angulation of the hip is defined as > 120 deg in the frontal plane?
Coxa valgus
In the transverse plane, where does the hip start in anterior rotation and then progress to with adulthood?
40 deg to approx 9 by adulthood (10-25 is considered normal)
What is referred to as excessive anterior rotation of the hip from the transverse plane?
Anteversion - toe in gait
ANTE IN
With Craig’s test, is medial or lateral rotation normal?
8-15 deg of medial/internal rotation = normal anteversion
With Craig’s test, if one finds neutral to more ER with centering the femur, is this anteverted or retroverted alignment?
Retroverted
True/false: the deep fibers of glute max attach on the shaft of the femur.
True - attaches on gluteal tubercle/tuberosity
What lies at the center of the head of the femur?
Teres ligament - neurovascular supply
Is the entire head of the femur covered by hyaline cartilage?
No; center head/teres ligament region is not
Where does the femoral head have the greatest contact in the acetabulum during WB?
Anterior and posterior walls - greatest amt of cartilage here
Does a dysplastic/shallow socket or a deep socket of the acetabulum result in ligamentous laxity?
Dysplastic/shallow socket
How is the labrum vascularized? (inner vs outer)
Similar to meniscus, outer edge well vascularized where inner is much less
Which region of the labrum is not well vascularized and can result in more traumatic and degenerative tears?
Superior portion
Does the labrum have sensory endings?
Yes - proprioceptive endings
Which ligament has two branches, pars inferioris and pars superioris?
Iliofemoral or Y ligament
What motions does the Y ligament restrict?
Extension, adduction, ER
In the transverse fiber system of the joint capsule, the circular encasement around the neck forms what aspect of the joint capsule?
Zona orbicularis - large stability factor in the hip joint
What motion does the pubofemoral ligament restrict?
Abduction, ER - contributes to extension (anterior positioning)
What direction / activity is the ischiofemoral ligament taut in?
In the upright position with quiet standing
What are the two main directions the hip can be dislocated into?
Anterior/inferior - posterior
Where does a Hill Sachs lesion occur in the hip?
Posterior to posterlateral region of the femoral head
What two muscles have contributing fibers to the conjoint tendon?
Internal oblique and transversus abdominis
What muscle contributes to the inguinal canal via its aponeurosis?
External oblique
The pubic symphysis is innervated in anterior / posterior fashion by which two groups of nerves?
Anteriorly by L2-4 (referred groin pain with lumbar)
Posterior by S3-S5 (referral to genital region)
Pathomechanically, is there more force on the hip joint with a larger degree of anteversion or retroversion?
Anteversion - femoral surface experiences majority of pressure on superolateral surface
What direction does the force on the acetabulum shift from and then to with gait?
IC/landing is posterolateral surface to propulsion on the anterolateral surface
What are three pathological indicators for labral tears and/or loose bodies?
1) sharp pain
2) giving way
3) catching/clicking
4) locking
What are differential diagnoses for groin pain with 1) coughing 2) sneezing 3) straining?
Hernia, pubic symphyseal afflication, tendinopathy of adductor magnus/rectus abdominis
How many provocation tests need to be positive to include SIJ as potential diagnosis?
3
Name the SIJ provocation tests - which is most sensitive, which is most specific?
1) SIJ distraction **most specific
2) SIJ compression
3) Thigh thrust ** most sensitive
4) Gaenslens
5) FABER
6) sacral thrust
7) ASLR
When is the ASLR considered positive?
When patient feels weakness and/or pain that limits ability to adequately complete maneuver (lift at least 8 inches/20 cm) -> clinician applies compression to innominates and will result improved ability and less pain
What isometric force should be applied to identify adductor longus and/or gracilis tendinopathy?
Hip in 0 deg flexion with adduction
What isometric force should be applied to identify tendinopathy of the symphysis pubis?
Hip in 45 deg of flexion with adduction
What isometric force should be applied to to identify tendinopathy of the pectineus muscle?
Hip in 90 deg flexion with adduction
What is the capsular pattern for the hip OA?
IR > flexion > extension > abduction (variability with flex, exten, abd)
What are the 5 predictor variables for OA for the hip?
1) self-reported pain with squatting
2) active hip flexion causes lateral hip pain
3) scour test with adduction causes lateral hip/groin pain
4) active hip extension causes pain
5) passive IR = 25 deg **biggest predictor
3 of 5 variables necessary
Which gender has more severe cases of hip OA?
Women > men
What two factors are predictors of good ambulation after THA?
Preoperative hip abduction and knee extension strength
What is the Drehmann sign?
Obligatory abduction and ER with passive hip flexion
What age group and gender is more greatly affected by SCFE?
Males > females (2:1)
13-15
What disease is defined as aseptic bone necrosis of the femoral head, occurring between ages of 3-10?
Legg-Calve-Perthes Disease
What is the clinical triad for labral tears?
1) pathological endfeel
2) sharp shooting pains
3) feeling of giving way
What manual therapy technique is effective for management of loose bodies of any type?
High velocity traction/rotation mobilization/manipulation
Which tendinous groups are prone to developing adaptive shortening causing limitations in ROM?
Myositis ossificans affects iliopsoas and adductors
What is a noncapsular pattern of limitation with concurrent painful limited passive flexion with the knee extended/flexed?
Sign of the buttock - red flag for hip trauma/tumor/cancer etc
Name 5 cancers which commonly metastasize to the hip/pelvis?
1) prostate
2) breast
3) renal cell
4) thyroid
5) lung
Where is intraarticular snapping hip syndrome found?
Iliopsoas snapping over iliopectineal eminece
Where is extraarticular snapping hip syndrome found?
Thickening of ITB at greater trochanter, iliopsoas at pectin pubis, glute max fibrosis in posterior hip, hamstring at ischial tuberoisty
What muscular avulsion can lead to a labral tear?
Rectus femoris
What is the biggest difference in assessment between hamstring pain and hamstring syndrome?
Resisted knee flexion in prone is pan free with hamstring syndrome, neural/dural assessment will be positive in syndrome
What may persistent bursitis of the greater trochanter of the hip progress to in terms of diagnosis?
Calcific tendonitis of glute med
What position is the hip put in for the Hip Lag Sign to be positive?
Sidelying; affected hip on top - 10 deg extension, 20 deg abduction, maximal IR with 45 deg of knee flexion - drops greater than 10 cm = positive
What diagnosis is consistent with pain or burning in the perineal area that worsens with sitting, improves with standing?
Pudendal nerve entrapment
What are three contributing factors for pudendal nerve entrapment?
Childbirth
Pelvic surgery
Bicycling (narrow saddle pressure)
What MMT is valid, sensitive, specific to include a diagnosis of the pubic region?
Bilat resisted hip adduction
How does one rule in/out a rectus abdominis strain with pain in groin region?
Perform resisted trunk flexion in supine
In cases of symphyseal separation, how can one MMT to aid with ruling in this diagnosis?
Resisted hip adduction with hip in 45 deg of flexion
What is the weakening or a tear in the transversalis fascia, conjoined tendon and/or internal oblique fibers?
Sports man’s hernia - athletica pubalgia
What way is a sports man’s hernia/athletica pubalgia exacerbate?
Valsalva or exertion
Where do most labral lesions occur due to compromised mechanical properties?
Anterior superior - posterior superior
Superior region
Which form of FAI is due to a nonspherical femoral head/neck relationship?
CAM
What form of FAI is due to too much acetabular coverage, causing pinching of the labrum between the rim and socket?
Pincer
What form of FAI is typically associated with retroversion / profunda or protrusion?
Pincer
Stress fractures are clinically diagnosed with three tests:
1) WB pain and NWB pain relief
2) One legged hop test
3) Fulcrum test: clinician exerts progressive downward force to distal thigh with forearm under proximal thigh - reproduce sxs
Meralgia paresthetica is due to what cutaneous nerve entrapment?
Lateral femoral cutaneous - local and projected pain with sensory changes in the lateral thigh and knee
