HIP

Question 1

Major hip flexor

Answer 1

Iliopsoas

Question 2

Two major hip extensors

Answer 2

• Gluteus maximus
• Hamstrings

Question 3

Two major hip abductors

Answer 3

• Gluteus medius
• Gluteus minimus

Question 4

A patient presents with this gait two weeks after an intramuscular buttocks injection. What is this sign? What is likely the cause?

Answer 4

Trendelenberg sign: pelvis tilts with walk because weight-bearing leg cannot maintain balance

Caused by superior gluteal nerve injury secondary to IM injection too medially on buttocks.

This nerve supplies abductor muscles of hip.

KEY POINT: IM injections in buttocks should be given in upper outer quadrant to avoid superior gluteal nerve or sciatic nerve injury

Question 5

A woman with cancer is complaining of difficulty standing from a sitting position. On examination she has weakness of hip extension. What is the possible source of this problem?

Answer 5

Damage to inferior gluteal nerve which supplies gluteus maximus. This can be injured by pelvic masses

Question 6

Somebody with a fractured neck of femur who complains of groin pain should be considered as having what complication?

Answer 6

Avascular necrosis

Question 7

Major blood supply of femoral neck is via which artery?

Answer 7

Medial circumflex femoral artery

Question 8

List one drug, an autoimmune condition and a haematological condition that cause avascular necrosis of femoral head

Answer 8

• Corticosteroids
• Lupus
• Sickle-cell anaemia

Question 9

13-year-old child presents with left-sided groin pain and limited range of movement of left leg is likely to have what condition? Describe the condition and the two types

Answer 9

Slipped capital femoral epiphysis (SCFE)

• Normal hip: femoral head moves within socket (acetabulum)
• Growing child: head is divided by growth plate into epiphysis (in acetabulum) + metaphysis
• SCFE: plate weakens during growth spurt and “slips,” off metaphysis

1. Slow slipping of epiphysis: stable SCFE
2. Sudden slipping resulting in severe pain and inability to walk: unstable SCFE

Question 10

What is a serious complication of slipped capital femoral epiphysis?

Answer 10

Avascular necrosis

Question 11

A seven-year-old child presenting with hip pain and limping with no previous trauma should be considered for which condition?

Answer 11

Legg-Calvé-Perthes Disease

Idiopathic avascular necrosis: hip disorder in children (4 to 8 years)