Hip and Pelvis Anatomy

Question 1

Hip ligaments

Answer 1

iliofemoral ligament: strongest ligament in body; limits abduction, external rotation, extension

pubofemoral ligament: limits abduction

ischiofemoral ligament: limits internal rotation

Question 2

Hip flexion (musc, inn)

Answer 2

Iliopsoas (inserts to lesser trochanter)

Sartorius (inserts to pes anserine tendons)

Rectus femoris (inserts to patella w quads)

all inn’d by L2-4 femoral nerve

Question 3

Hip extensors (musc, inn)

Answer 3

Gluteus maximus: L5-S2, inferior gluteal n.

Gluteus medius (posterior fibers): L4-S1, superior gluteal n.

Semimembranosus, semitendinosus: L4-S1, sciatic n. (tibial distribution)

Biceps femoris: L5-S1, sciatic n. (tibial division for long head, fibular division for short head)

Question 4

Hip abduction (musc, inn)

Answer 4

Gluteus mediu
*trendelenberg gait*

Gluteus minimus:

Tensor fascia lata

ALL L4-S1, superior gluteal n.

Question 5

Hip adductors (musc, inn)

Answer 5

Adductor longus, magnus, brevis: L2-L4 obturator n.

Gracilis: L2-L4 obturator n.

Pectineus: L2-4 femoral n.

(magnus has some sciatic n. tibial division)

Question 6

Hip internal rotation (musc, inn)

Answer 6

Adductor longus, magnus, brevis: L2-4 obturator n. (magnus has some sciatic n. tibial division)

*TFL: L4-S1 superior gluteal n.*

Gluteus medius and minimus: TFL: L4-S1 superior gluteal n.

Semimemrbanosus, semitendinosus: TFL: L4-S1 sciatic n. tibial division

Question 7

Hip external rotation (musc, inn)

Answer 7

*piriformis*

gluteus maximus: L5-S2 inferior gluteal n.

“GOGO muscles”:
superior gemellus
obturator internus
inferior gemellus
obturator externus

quadratus femoris

Question 8

hip OA (Px, progression)

Answer 8

principle: groin pain is true hip pain until proven otherwise

internal rotation is lost first with superolateral compartment narrowing

Question 9

ASIS avulsion fracture

Answer 9

ASIS - think anterior sartorius iliac spine → tightness → avulsion fx

Question 10

ASIS v AIIS - muscle attachments

Answer 10

ASIS - anterior sartorius iliac spine

AIIS - rectus femoris

Question 11

hip dislocation - n. inuries

Answer 11

posterior dislocation (most common) - consider sciatic n. injury

anterior dislocation - consider femoral n. injury

Question 12

Garden classification

Answer 12

for femoral neck fractures

stage 1-4

1: incomplete fracture line
2: complete fracture line, non displaced
3: complete, partially displaced
4: complete, fully displaced

Question 13

intertrochanteric hip fx (px)

Answer 13

most common hip fracture

just distal to femoral neck

pain in groin w externally rotated and shortened leg

Question 14

sclipped capital femoral epiphysis

Answer 14

obese adolescent males - groin pain worse w walking

consider endocrine referral (GH deficiency, thyroid disease)

Grading:

1: <33% slippage
2: 33-50% slippage
3: > 50% slippage

Question 15

assessing labral tears

Answer 15

MR arthrogram

Question 16

leg length discrepancy - best test

Answer 16

CT scanogram