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Orthopedic Diagnosis > Hip/pelvis > Flashcards

Hip/pelvis Flashcards

1
Q

hip articulation is formed by what

A

femural heal and acetabulum

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2
Q

hip transmits what types of loads

A

tensile and compressive

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3
Q

what type of joint is the hip?

A

ball and socket

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4
Q

what is another name for ball and socket

A

spheriodal

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5
Q

how many planes of movement does the his go through

A

3- sagittal, frontal, transvers

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6
Q

sagittal plane of hip movement

A

flexion extension around transverse axis

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7
Q

frontal plane of hip movement

A

abduction and adduction around ant/post axis

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8
Q

transverse plane of hip movement

A

internal/external rotation around vertical axis

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9
Q

os coxa is made up of

A

ilium, pubis, ischium

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10
Q

ilium forms which portion of os coxa

A

superior 2/5

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11
Q

ischium forms which portion os coxa

A

posterior 2/5 acetabulum and ramus

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12
Q

ischium + ramus=

A

ischial tuberosity

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13
Q

pubis for which portion os coxa

A

anterior 1/5 acetabulus.

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14
Q

smallest bone of os coxa

A

pubis

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15
Q

what are the parts of the pubis bone

A

body, inf and sup rami

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16
Q

by what age is acetabular development complete?

A

age 8

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17
Q

what of the acetabulum changes at puberty?

A

acetabular depth

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18
Q

why does the acetabulum increase depth?

A

development of three secondary ossification centers

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19
Q

which way is the acetabulum angled

A

lateral, inf, ant

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20
Q

what increases joint stability of the acetabulum?

A

acetabular rim–> labrum

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21
Q

what lines the acetabulum

A

hyaline cartilage (articular cartilage)

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22
Q

what part of the acetabulum is not covered with cartilage?

A

fovea capitis

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23
Q

what three joints make up the pelvic girdle

A

acetabulofemoral
sacroiliac
pubic symphysis

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24
Q

what is the most stable joint in the body

A

acetabulofemoral

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25
Q

what is pelvic obliquity

A

pelvic leveling

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26
Q

excess lordosis in lumbar spine possibly what

A

weak abs

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27
Q

what tests confirm weak abdominals?

A

Milgrams test

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28
Q

if milgrams does not confirm weak abs what other tests?

A

could be space occupying lesion or disc path
valsalva
bechterew
anterior innominate- mazion- advancement sign
SLR

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29
Q

what is an iliac contusion

A

contusion/avulsion to site of quadratus lumborum or abdominal muscles from the iliac crests. VERY painful. disabling is periosteum is involved

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30
Q

what is an avulsion

A

pulling of the tendon from the periosteum

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31
Q

what will elicit pain in iliac contusion

A

lateral flexing away from side of inj and abduction when laying on side

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32
Q

etiology of iliac contusion

A

trauma- football, lax, hockey

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33
Q

pubic tubercles should be level with what in the inspection

A

grater trochanters

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34
Q

what could heal wrong causing misalignment?

A

congenital hip dislocations/ fracture

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35
Q

superior/ inferior pubic rami fractures with separation/ fracture of contralateral SI joint

A

Bucket handle fracture

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36
Q

separation of the pubic symphysis and both SI joints

A

sprung pelvis

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37
Q

bilateral superior pubic rami and ischiopubic fracture

A

straddle fracture

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38
Q

MOI landing hard on butt, falling from a height, horseback riding

A

straddle fracture

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39
Q

MOI bad infection, appendicitis, trauma, buildup of pressure

A

sprung pelvis

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40
Q

most common areas of pelvis for avulsion fractures

A

ASIS, AIIS, ischial tub

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41
Q

avulsion from iliac crest is usually

A

abdominal muscles

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42
Q

avulsion from ASIS

A

sartorius

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43
Q

avulsion from AIIS

A

rectus femoris

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44
Q

avulsion from lesser trochanter

A

iliopsoas

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45
Q

avulsion from pubic symphysis

A

adductor group

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46
Q

avulsion from ischial tub

A

hamstrings

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47
Q

avulsion from greater trochanter

A

gluteal muscles

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48
Q

strongest and longest bone in the body

A

femur

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49
Q

portion not covered in smooth layer of cartilage

A

fovea capitis, ligamentum teres

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50
Q

angle between femoral shaft and neck

A

inclination angle

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51
Q

average inclination angle

A

120-130 degrees

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52
Q

how does the inclination angle change with body type

A

taller person more valgus larger angle

shorter person more varus smaller angle

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53
Q

MOI for femoral head dislocation

A

dashboard injury

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54
Q

force to knee if hip is adducted may cause

A

posterior hip dislocation

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55
Q

muscles that insert into greater trochanter

A 
adductor brevis
gemelli (inf/sup)
gluteus medius
gluteus minimus
obturator internus
piriformis
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56
Q

muscles that insert into lesser trochanter

A

iliacus
pectineus
psoas major

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57
Q

how is the lesser trochanter created?

A

pulling of the iliopsoas

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58
Q

what type of bone is in the femoral neck?

A

trabecular bone

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59
Q

what is it designed to withstand?

A

high loads

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60
Q

where is the lesser trochanter located

A

posterior medial junction of the neck and shaft of femur

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61
Q

angle that the femoral neck makes with the acetabulum

A

angle of anteversion

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62
Q

what is normal anteversion

A

8-15 degrees

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63
Q

angle between femoral neck and transcondylar axis is greater than 15 degrees

A

medial femoral torsion

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64
Q

what type of gait is associated with medial femoral torsion

A

toe in

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65
Q

increased femoral head torsion result in

A 
OA
dysplasia or acetabulum
susceptibility to anterior femoral dislocation
knee joint misalignment
patellar dislocations
excessive lumbar lordosis
external rotation of tibia
pronation of feet
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66
Q

angle between femoral neck and transcondylar axis is less than 15 degrees

A

femoral retroversion

67
Q

femoral retroversion causes what type of gait

A

toe out

68
Q

decreased femoral head torsion may result in

A

LB SI path
internal rotation of tibia
supination of feet

69
Q

LCP

A

legg calve perthes disease

70
Q

avascular necrosis of the femoral capital epiphysis before the closure of the growth plate

A

legg calve perthes disease

71
Q

LCP prominance in which genders and ages

A

5:1 male, ages 3-12

72
Q

what history should be indicators for LCP

A

painful limp reduced mobility and muscle atrophy

73
Q

an aka for femoral anteversion

A

medial femoral torsion

74
Q

what test is positive with legg calve perthes

A

trendelenberg

75
Q

MOI for LCP

A

trauma
heredity
nutritional
circulatory

76
Q

four stages of LCP during ages

A

2-8

77
Q

what are the four stages of LCP

A

avascularization
revascularization
repair
deformity

78
Q

when is the peak influence of LCP

A

5 years (range is 2-14)

79
Q

is LCP ever bilateral?

A

in 10% of cases

80
Q

first sign of LCP

A

effusion as shown by lateral displacement of femoral head

81
Q

what population is LCP more prevelant

A

children who experience second hand smoke frequently

1:100

82
Q

what is the possible reason causing LCP

A

nicotine constricting blood vessels in the hip during development

83
Q

what are the three extra articular ligaments that provide stability in the hip joint

A

iliofemoral ligament (bertin/bigelow)
pubofemoral
ischiofemoral

84
Q

how many parts does the iliofemoral ligament have

A

2: inferior (medial) and superior (lateral)

85
Q

what is the strongest ligament in the body

A

iliofemoral ligament

86
Q

how is iliofemoral oriented

A

superior laterally

87
Q

what muscle does the iliofemoral ligament blend with

A

iliopsoas

88
Q

what is the orientation of the pubofemoral ligament

A

inferior-medial

89
Q

what does the pubofemoral ligament blend with

A

inferior band or iliofemoral and pectineus muscle

90
Q

what is the orientation of the ischiofemoral ligament

A

winds posteriorly around femur, attaches anteriorly

91
Q

what ligament in the hip is most commonly injured

A

ischiofemoral

92
Q

what happens with the three stabilizers when the hip is put into extention

A

they all tighten

93
Q

what part of iliofemoral ligament limits adduction

A

lateral

94
Q

what part of the iliofemoral ligament limits external rotation

A

medial band

95
Q

what does the pubofemoral limit

A

abduction

96
Q

what does the ischiofemoral ligament limit

A

internal rotation

97
Q

what is the most power hip flexor

A

iliopsoas

98
Q

what makes up the iliopsoas

A

iliacus and psoas

99
Q

what adducts, flexes, and internally rotates the hip

A

pectineus

100
Q

what muscle combines flexion of the hip and extension at the knee

A

rectus femoris

101
Q

what is the longest muscle in the body

A

sartorius

102
Q

TFL

A

tensor fascia latae

103
Q

the TFL does what at the hip

A

abduct, flex, internally rotate

104
Q

sartorius responsible for what movement at the hip

A

flexion, abduction, external rotation and some knee flexion

105
Q

what is the largest and most important hip extensor and external rotator

A

gluteus maximus

106
Q

what is the main abductor of the hip

A

gluteus medius

107
Q

weakness of the gluteus medius can be tested with

A

trendelenburg test

108
Q

the anterior portion of glute med does what

A

flex, abduct, internally rot hip

109
Q

the posterior portion of the glute med does what

A

extends, externally rotates hip

110
Q

what is the major internal rotator of the femur

A

gluteus minimus

111
Q

what cause weak gluteus muscles

A 
fracture of greater trochanter
slipped capital femoral epiphysis
congenital hip dislocation
poliomyelitis (polio)
meningomyelocele
112
Q

trendelenburg test positive

A

high iliac crest on supported side and low iliac crest on side of lifted leg

113
Q

trendelenburg test indicator

A

weak glute med muscles on supported side

114
Q

what is slipped femoral capital epiphysis

A

slipping of the neck on the femoral head as the head remains in the acetabulum

115
Q

what is the age range for slipped femoral capital epiphysis

A

10-15

116
Q

slipped femoral capital epiphysis is more predominant in

A

males more than females

117
Q

slipped femoral capital epiphysis is more common in what race

A

blacks more than white

118
Q

etiology of slipped femoral capital epiphysis is trauma

A

50% of the time

119
Q

the positive on xrays is what for slipped femoral capital epiphysis

A

kleins line

120
Q

what action is the piriformis responsible for

A

external hip rotator at less than 60 degrees.

121
Q

at 90 degrees of hip flexion what does the piriformis do

A

reverses its muscle action becoming an internal rotator and abductor.

122
Q

what are the small external rotators of the hip

A

obturator externus/internus, inferior gemelli and quadratus femoris

123
Q

what make up the hamstrings

A

biceps femoris, semitendinosus, semimembranosus

124
Q

which hamstring extends the hip flexes the knee and externally rotates the tibia

A

biceps femoris

125
Q

which hamstring extend the hip flex the knee and internally rotate the tibia

A

semimembranosis and semitendinosus

126
Q

which hip adductor is most frequently injured

A

adductor longus (groin pull)

127
Q

what muscles adduct the hip

A

adductor magnus, longus and the gracillis

128
Q

how many total bursa are in the hip region?

A

12

129
Q

other names for the iliopsoas bursa

A

iliopectineal, iliac, iliofemoral, subpsoas bursa

130
Q

largest bursa of the hip

A

iliopsoas

131
Q

where is IPB located

A

deep to iliopsoas tendon cushions tendon from structures anterior aspect of hip jt

132
Q

what is the most common cause of an inflamed and distended IPB

A

RA

133
Q

sub trochanteric bursa is located where

A

between greater trochanter and TFL

134
Q

what can cause bursitis of trochanteric bursa

A

adaptively shortened TFL

135
Q

what are the borders of the femoral triangle

A

superiorly > inguinal ligament
medially > adductor longus
laterally > sartorius
floor > parts of iliopsoas(lateral) and pectineus(medial)

136
Q

inguinal ligament is located between

A

pubic tubercle and anterior iliac spine

137
Q

laterally to medially how are the nerves and vascular vessels arranged

A

Nerve, Artery, Vein

138
Q

which of the three found in the femoral triangle are not palpable

A

femoral vein

139
Q

what provides cutaneous innervation in the posterior gluteal region

A

subcostal N, dorsal rami of L1-3 and dorsal primary rami (cluneal N) of S1-3

140
Q

anterior hip region cutaneous N supply superior to inguinal ligament

A

iliohypogastric N

141
Q

anterior hip region cutaneous N supply inferior to inguinal ligament

A

subcostal N and femoral branch of genitofemoral N and iliolingual N

142
Q

sciatic N is located between

A

ischial tuberosity and greater trochanter

143
Q

what may cause tenderness of the sciatic N

A

disc pathology or trauma

144
Q

what kind of issue may sciatic N have with piriformis muscle

A

congenital

145
Q

what percentage of people have normal location of sciatic N in relation to piriformis

A

88% Sciatic N passes inferiorly to piriformis

146
Q

11% of population has what happen with sciatic N and piriformis

A

common peroneal division goes through the piriformis

147
Q

0.9% of population has what happen with sciatic N and piriformis

A

common peroneal division passes superior to piriformis (superficial)

148
Q

0.1% of population has what happen with sciatic N and piriformis

A

both divisions pass through piriformis

149
Q

what occurs during the acute phase of intervention

A

PRICE (protection, rest, ice, compression, elevation)

150
Q

goals of acute phase of intervention

A

restore pain free ROM in entire kinetic chain
decrease pain/inflammation
retard muscle atrophy
min effects of immobilization and activity restriction
maintain gen fitness
patient indep with home exercise program

151
Q

functional phase of intervention

A 
full ROM
normal jt kinematics
muscle strength
neuromuscular control
normal muscle force couple relationships
152
Q

test for fracture of long bone or hip jt pathology

A

anvil test

153
Q

test to determine short leg or femoral neck angle

A

leg length discrepancy

154
Q

pediatric test differentiating between congenital hip dislocation or anatomical short leg and contralat anatomical short leg

A

allis sign

155
Q

test depicting contracture of hip flexors typically iliopsoas

A

thomas test

156
Q

strict test for hip joint patholody

A

patrick/fabere sign

157
Q

a test confirming hip joint pathology but also depicting mechanical problem in S-I jt

A

Laguerre test

158
Q

what test stresses S-I joints into extension and indicates general sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the S-I joint

A

Gaenslen and Lewin-Gaenslen

159
Q

test where tester stands side opposite and flexes knee and internally rotates the thigh. the positive: pain in the hip region= hip jt pathology. pain the in buttock/pelvis= S-I jot lesion

A

Hibb test

160
Q

test indicating contraction of the IT band or tensor fascia lata usually secondary to synovitis of hip secondary to trauma of the glute med or min

A

ober test

161
Q

In this test Dr slight flex in the knee abducts the hip and extends hip lets go of the knee and it should drop. the drop is secondary to trauma of the glute med/min

A

ober test

162
Q

pain in either S-I indicating an S-I lesion

A

pelvic rock/ iliac compression

163
Q

the test done as a part of the other tests in the process of flexing the knee to the butt

A

ely sign

164
Q

deep S-I jt pain. sprain of anterior S-I jt

A

yeoman test

Orthopedic Diagnosis (3 decks)

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