Hip Assessment and Pathology

Question 1

What is the angle of inclination and what are the clinical manifestations of Coxa Vara and Coxa Valga

Answer 1

The angle of shaft, to the neck of the femur
Coxa Vara = >125 degrees (hip dysplasia more common)
Coxa Valga = <125 degrees (fractures more common)

Question 2

What is the angle of torsion and what are the clinical manifestations of excessive anteversion and retroversion?

Answer 2

The rotation the head of femur must do to fit into the capsule
Excessive anteversion = >15 degrees, medial rotates the tibia causing toe in gate
Retroversion = <15 degrees, toe out gate and lateral rotation of tibia

Question 3

True or false. The foot can point forward, but the femur can be internally rotated and the tibia can be externally rotated?

Answer 3

True!

Question 4

What is hip ante torsion?

Answer 4

Head and neck of the femur is rotated anteriorly, excessive medial hip rotation and limited lateral hip rotation

Question 5

What is hip retro torsion?

Answer 5

Head and neck of the femur is rotated posteriorly, causing excessive lateral hip rotation with limited medial rotation

Question 6

What types of joint are the:

• Femoracetabular joint
• Pubic symphysis
• Sacroiliac

Answer 6

• Femoracetabular = synovial, multiaxial ball and socket
• Pubic symphysis = secondary cartilaginous
• Sacroiliac = anterior synovial, posterior fibrous

Question 7

What are the main ligaments of the hip?

Answer 7

Iliofemoral 
Pubofemoral
Ischiofemoral
Iliolumbar
Anterior and posterior ligaments
Sacrotubal ligaments
Sacrospinous

Question 8

What muscles are responsible for hip flexion?

Answer 8

o	Psaos major
o	Iliacus
o	TFL
o	Sartorius
o	Rectus femoris
o	Gluteus medius (anterior fibers)
o	Gluteus minimus
o	Adductor longus (assists)
o	Pectineus (assists)
o	Adductor brevis (assists)
o	Adductor magnus (assists)

Question 9

What muscles are responsible for hip extension?

Answer 9

o	Gluteus maximus (all fibers)
o	Biceps femoris (long head)
o	Semitendinosus
o	Semimembranosus
o	Adductor magnus (posterior fibers)
o	Gluteus medius (posterior fibers)

Question 10

What muscles are responsible for hip medial rotation?

Answer 10

•	Medial rotation
o	Gluteus medius (anterior fibers)
o	Gluteus minimus
o	TFL
o	Adductor magnus
o	Adductor longus
o	Adductor brevis
o	Pectineus
o	Gracilis
o	Semitendinosus (assists)
o	Semimembranosus (assists)

Question 11

What muscles are responsible for hip lateral rotation?

Answer 11

o	Gluteus maximus 
o	Piriformis
o	Quadratus femoris
o	Obturator internus/ externus
o	Gemellus superior/ inferior
o	Gluteus medius (posterior)
o	Psaos major
o	Iliacus
o	Sartorius
o	Bicep femoris (long head)

Question 12

What muscles are responsible for hip abduction?

Answer 12

o	Gluteus maximus
o	Gluteus medius
o	Gluteus minimus
o	TFL 
o	Sartorius
o	Piriformis when hip is flexed

Question 13

What muscles are responsible for hip adduction?

Answer 13

o Adductor magnus, brevis, longus
o Pectineus
o Gracilis
o Gluteus maximus (lowest fibers)

Question 14

What is hip OA and what are some signs?

Answer 14

• Worn cartilage, bone spurs, reduced joint space

- Stiffness in the morning, pain over groin or lateral hip, catching

Question 15

What are some objective signs of hip OA?

Answer 15

• Global loss of ROM
• Reduced Thomas test
• Weakness of hip extensors and abductors
• Tightness through hip adductors and hip flexors

Question 16

What is femoroacetabular impingement?

Answer 16

Cam impingement = excessive bone on anterior neck of femur

Pincer impingement = acetabular has extended part like a pincer and it affects rotation

Question 17

What FAI predicts OA?

Answer 17

Cam deformative

Question 18

What three things need to be done to confirm an FAI?

Answer 18

• Current signs
• Clinical signs
• Imaging confirmation

Question 19

What are subjective signs of an FAI?

Answer 19

• Pain in anterior hip and groin especially in deep hip flexion
• Clicking, catching, locking, stiffness, loss of ROM
• Reduced hip flexion and internal rotation

Question 20

What percentage of athletes with groin pain have labral tears?

Answer 20

22%

Question 21

What percentage of people with hip pain have labrum tears?

Answer 21

55%

Question 22

What is lateral hip pain?

Answer 22

Underdeveloped gluteus muscles that cause the leg to adduct - placing more compressive load

Question 23

What are signs of lateral hip pain?

Answer 23

-Painful when lying on affected side, pain when sleeping on opposite side without support in legs, pain when sitting in a low chair, pain with running, pain and stiffness in the morning, positive trendelenburg, painful Obers or FADIR and FABER

Question 24

What rehab should you target in patients with lateral hip pain?

Answer 24

Glute muscles, TFL

Question 25

What percentage of hamstring injuries are biceps femoris long head?

Answer 25

80%

Question 26

What are the two types of hamstring injury mechanisms?

Answer 26

Dancers (type II) = over stretch | Sprinters (type I) = high force

Question 27

If Jim suffered a hamstring strain 2 days ago and he can walk fine now pain free. How long would he expect to miss out before returning to play?

Answer 27

2 weeks

Question 28

True or false. The more proximal the hamstring injury, the shorter sit out time?

Answer 28

False. The more proximal, the more tendon there is and less vasculature for recovery

Question 29

Where is the most common site of quadricep strain?

Answer 29

Distal musculotendinous junction of the rectus femoris

Question 30

True or false. Proximal rectus femoris injuries are straightforward rehab?

Answer 30

False, distal is.

Question 31

What is the difference between a tendinopathy and an enthesopathy?

Answer 31

A tendinopathy relates to the tendon of a muscle and an enthesopathy relates to the tendon joint part which connects to the bone

Question 32

What are typical signs of an adductor strain?

Answer 32

Gradual onset of pain which worsens with loading, pain with running or kicking, pain and weakness with groin squeeze test, reduced hip abduction flexibility, pain on palpation and during a sit-up