Hip Pathologies

Question 1

what type of joint is the hip joint?

Answer 1

ball and socket

multiaxial synovial joint

Question 2

blood supply to the femoral head

Answer 2

Profunda Femoris
-medial circumflex artery
-lateral circumflex artery
Artery to Head of Femur
-branch of obturator artery
-within ligament to head of femur

Question 3

what nerves supply the hip joint?

Answer 3

femoral
obturator
superior gluteal
nerve to quadratus femoris

Question 4

the ____________ fibers of the joint capsule are thicker anteriorly

Answer 4

longitudinal

Question 5

what are the movement of the hip joint?

Answer 5

flexion and extension
abduction and adduction
medial and lateral rotation
circumduction

Question 6

List and demonstrate all the actions of sartorius muscle.

Answer 6

External rotation, abduction, flexion of the femur at the hip, flexion of the leg at the knee

Question 7

Why is psoas minor not a hip flexor?

Answer 7

Attaches distally on the pelvis, does not cross the joint to attach on the femur. According to Moore it is a
It has attachment on the inferior pelvis, it does not have attachment on the femur

Question 8

Which quadricep muscle crosses two joints?

Answer 8

Rectus femoris, attaches to AIIS

Question 9

Innervation of adductors; extensors of leg at knee

Answer 9

Adductors (Gracilis, Adductor: longus brevis, magnus, adductor portion = obturator) Pectineus: femoral
Extensors of the leg at knee: Quads: femoral

Question 10

what are the boundaries of the femoral triangle?

Answer 10

Inguinal ligament as base, sartorius lateral border, adductor longus medial border, pectineus and iliopsoas as floor

Question 11

what is the adductor hiatus?

Answer 11

an opening formed where the Adductor Magnus inserts upon the Adductor Tubercle (distally). It is a gap in the tendon of Adductor Magnus through which the Femoral vessels pass as they proceed inferiorly from anterior medial thigh to the posterior thigh and then the popliteal fossa. The Adductor Canal conducts the Femoral vessels through the middle 1/3 of the thigh.

Question 12

The pulse of the femoral artery is best palpated at which area?

Answer 12

femoral triangle

Question 13

Following a penetrating injury to the femoral triangle, a patient related that walking was impossible because at every step their knee collapses into flexion. Which muscle is paralyzed?

Answer 13

quadriceps femoris

Question 14

The deep femoral artery supplies blood to which compartment of the thigh?

Answer 14

posterior

Question 15

When walking, the action of the iliopsoas results in what motion at the hip joint?

Answer 15

flexion

Question 16

Which muscle must be reflected to expose the adductor canal?

Answer 16

sartorius

Question 17

What are the contents of the adductor canal?

Answer 17

femoral artery, femoral vein, saphenous nerve

Question 18

A patient with a psoas abscess of the femoral triangle eventually recovers and is left with weakness of knee extension and hip flexion. Which nerve is involved?

Answer 18

femoral

Question 19

Your next patient is seeing you for weakness and gait abnormality after he was given an intramuscular immunization in the mid-thigh just deep to the Sartorius. The needle pierced the formal vessels as they lie in the:

Answer 19

adductor canal

Question 20

Of the branches of the internal iliac artery, the one exiting from the greater sciatic foramen superior to the piriformis muscle is the:

Answer 20

superior gluteal artery

Question 21

The femoral artery enters the popliteal fossa to become the popliteal artery by passing through the:

Answer 21

adductor hiatus

Question 22

Scissor gait is a condition in which one lower limb crosses in front of the other during stepping as a result of powerful hip adduction caused by continuous, unwanted nerve activity. From the choices below, which nerve is involved?

Answer 22

obturator

Question 23

true or false: the femoral artery lies medial to the femoral vein

Answer 23

false

Question 24

true or false: the femoral vein lies medial to the femoral artery

Answer 24

true

Question 25

the external iliac veins join to form the inferior vena cava

Answer 25

false

Question 26

from lateral to medial, the structures of the femoral triangle are

Answer 26

femoral nerve, femoral artery, femoral vein, lymph (NAVeL)

Question 27

If the head of the femur were dislocated posterolaterally, which nerve would be compromised?

Answer 27

sciatic

Question 28

name all of the external rotators of the hip

Answer 28

1) Quadratus Femoris 2) Superior Gemellus 3) Inferior Gemellus 4) Obturator Internus 5) Obturator Externus 6) Piriformis 7) Gluteus Maximus PGOGOQ for the DEEP 6

Question 29

After a fall onto the RIGHT buttock, your patient reports she walks with a ‘lurch’. She states when she lifts her LEFT foot off the ground (and thus standing on the right), she must swing the Left LE laterally to prevent tripping. During evaluation, you note her left hip drops and she does indeed circumduct the left limb. All other aspects of her gait are normal including trunk extension. The injured nerve is:

Answer 29

right superior gluteal nerve

Question 30

A soccer player is told she a high hamstring muscle tear by the team physician. This tearing would have occurred closer to the:

Answer 30

ischial tuberosity

Question 31

As a patient with paralyzed gluteus medius and minimus muscles on the left side attempts to stand on the left limb only, the right side of the pelvis typically:

Answer 31

drops

Question 32

A patient who rock climbs presents 4 weeks post a 6-foot fall onto a rocky ledge. He has seen a neurologist and know he has nerve damage but can’t recall the name of the nerve. He presents with weak hip abduction and stabilization in standing. Which nerve is likely injured?

Answer 32

superior gluteal nerve

Question 33

Weakness in climbing stairs or jumping would indicate a lesion of which nerve if the person was able to walk on their toes, adduct the thigh, extend the knees, and hip hike?

Answer 33

inferior gluteal

Question 34

Which muscle passes through the lesser sciatic foramen?

Answer 34

obturator internus

Question 35

In about 12 %, the common fibular nerve passes through the piriformis muscle and may be compressed. Which part of which muscle would this affect?

Answer 35

biceps femoris short head

Question 36

Which ligament is the strongest in limiting extension at the hip joint?

Answer 36

iliofemoral (Y ligament)

Question 37

What is the clinical significance of the pes anserinus?

Answer 37

Pes anserine is the distal attachment of the sartorius, gracilis, and semitendinosus. Pes anserine is located just below the tibial plateau and has bursa that may become irritated. Irritation in this area could be due to the bursa or a tendinopathy. The patients typically at risk for this injury are long distance runners due to the repetitive loading of the hamstring as well as the pronation during gait putting a valgus stress on the knee.

Question 38

How is the Q-angle measured? Is there normally a difference in Q-angle between men and women?

Answer 38

Fulcrum of goniometer over the mid-patella and stationary arm aligned along the anterior thigh towards the ASIS. Moving arm is aligned along the anterior shank over the tibial tubercle. Angle greater than 10° for men and 15° for women is a positive test.

Question 39

how does the knee lock and unlock?

Answer 39

screw-home mechanism

Question 40

the short head of the biceps is innervated by

Answer 40

common fibular

Question 41

what are the biceps femoris long head, semitendinosis, and semimembranosis innervated by?

Answer 41

tibial portion of the sciatic nerve

Question 42

A fracture of the Ischial tuberosity might be expected to most directly impair which lower limb motion?

Answer 42

flexion at the hip