Internal Hip Pathologies Flashcards by Colleen Caribardi

What is the position of the acetabulum?

lateral, inferior, and anterior

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What is the position of the femoral head?

anterior, superior, and medially

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The articular cartilage of the hip is thickest on the _____ portion of the femoral head.

What makes this special compared to the rest of the articular cartilage in the hip?

posterior/superior

It has less degeneration compared to the anterior/superior aspect which is more common for labral tears and osteophytes

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definition: angle formed between the femoral head and acetabulum

angle of anteversion

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What is the normal range of the angle of anteversion?

10-15 degrees

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definition: angle of anteversion > 15 degrees

anteversion/ toe in

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definition: angle of anteversion < 10 degrees

retroversion/toe out

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The ___ portion of the acetabular labrum is continuous with the cartilaginous surface of the acetabulum

center portion of the acetabular labrum

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The ___ portion of the acetabular labrum is continous with the hip joint capsule.

outer portion of the acetabular labrum

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What part of the labrum is vascularized and innervated by sensory nerve fibers?

outer 1/3

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The posterior aspect of the labrum is most stressed in hip ____.

hip flx

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The anterior aspect of the labrum is most stressed with combined ___ and ___.

combined FLX and ADD

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The 3 main ligaments of the hip are taut in ___ and loose in ___.

taut in hip EXT
loose in hip FLX

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What ligament is the strongest ligament in the body?

iliofemoral ligament (Y ligament)

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What does the iliofemoral ligament do?

reinforces the anterior portion of the hip joint
limites hip EXT and anterior gliding of the femur

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What does the pubofemoral ligament do?

Reinforces the medial aspect of the hip joint
limits excessive hip EXT and ER

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What does the iliofemoral ligament blend with?

iliopsoas muscle

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What does the pubofemoral ligament blend with?

pectineus muscle

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The ischiofemoral ligament wraps from the ____ aspect to ___aspect of the hip joint.

posterior to anterior aspect

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What is the open packed position of the hip?

30 of flexion
30 abduction
slight ER

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What is the close packed position of the hip?

Max extension, IR, & abduction

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What is the capsular pattern of the hip?

FLX > IR > ABD

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Describe hip flx and ext.

femoral head spins

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describe hip ABD

femoral head rolls superiorly and glides inferiorly

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describe hip ER

femoral head rolls posteriorly and glides anteriorly

describe hip IR

femoral head rolls anteriorly and glides posteriorly

definition: Progressive disease resulting in degenerative changes to the bony surfaces of the joint

hip OA

What is the common population for hip OA?

age > 50 men = women

What commonly causes hip OA?

abnormalities of loading through the hip joint

What are aggravating activities for hip OA?

- twisting trunk toward involved side, or turning/pivoting in direction of uninvolved side with walking - prolonged sitting (especially with ↑’d hip flexion angle) - sit to stand transfers - ↑↓stairs - getting in and out of car - difficulty putting on socks and shoes

What is the common presentation of hip OA?

- C-sign: pain referral to the groin, buttock, lateral thigh (and sometimes the anteromedial aspect of the knee) - clicking/popping

Describe what a patient's stance looks like when hip OA is present.

ipsilateral hip and knee positioned in slight FLX/ER - slightly on toes on symptomatic side (if severe OA)

Describe what a patient's gait looks like when hip OA is present.

- antalgic w/ hip position in slight FABER - decreased stance phase on INVOLVED side - trendelenburg - decreased hip EXT at terminal stance

Describe what a patient looks like while sitting when hip OA is present.

reclined position or leaning to the uninvolved side with hip ABD (on involved side)

Early hip OA presents with loss of ______.

hip FLX and IR

moderate hip OA presents with loss of ______.

hip FLX, IR, ABD

Severe hip OA presents with loss of ______.

Hip ROM in all directions

Those with hip OA will have (positive/negative) findings on the following tests: - Femoral nerve stretch - passive SLR - slump - neuro signs

negative

Hip OA leads to the tightness of what muscles?

hip FLX and hamstrings

Hip OA leads to the weakness of what muscles?

Hip EXT and ABD

What is considered as the most specific test for internal hip pathology?

log roll test

What is the CPR for diagnosing hip OA?

1. self-reported pain with squatting 2. Active hip FLX causing lateral hip pain 3. scour test w/ ADD causes lateral hip/groin pain 4. active hip EXT causes pain 5. PROM IR < 25 degrees

What is cluster 1 for diagnosing hip OA?

- hip pain - hip IR < 15 degrees - hip FLX < 115 degrees

What is cluser 2 for diagnosing hip OA?

- hip pain - IR < 15 degrees - Pain with IR - morning stiffness < 60 minutes - > 50 y/o

definition: Abnormal contact between the femoral head/neck and the acetabular rim

Femoral acetabular impingement (FAI)

FAI is associated with ___ and ___ damage.

labral and chondral damage

What are the three types of FAI?

1. CAM 2. Pincer 3. mixed

CAM type FAI is the abnormal bony overgrowth of ______ head/neck causing increased bony contact with acetabulum during combined ______.

femoral head/neck combined FLX, ADD, IR

Cam type FAI often leads to ____ labral and chondral lesions.

anterosuperior

What population is Cam type FAI most commonly found in?

young, athletic males

(true/false) many people with CAM type FAI are symptomatic.

false

Pincer type FAI is the bony overgrowth of the _____ rim or deep socket causing increased bony contact with the femoral head.

acetabular rim or deep socker

What motions are painful when Pincer Type FAI is present?

combined hip FLX, ADD, IR

Cam type FAI predisposes an individual to developing hip ___ in the future

(true/false) Pincer type FAI has been shown to predispose an individual with developing hip OA in the future.

false

What population is pincer type FAI most commonly seen in?

Active, middle-aged women

FAI mixed type can lead to injury of the ___.

labrum

What motions are painful when mixed Type FAI is present?

combined hip flx, add, IR

What are aggravating positions for FAI?

- rotational movements of the hip - sitting with increased hip FLX - walking - pivoting - athletic movements

What is the most common cause of mechanical hip symptoms?

labral tear

Labral tears are more common in ____ y/o.

< 40 y/o

What is the most common portion of the labrum that is torn?

anterior labrum

Where is pain present with FAI?

- anterior groin - lateral trochanteric pain - aching or sharp

Where is pain present with labral tears?

- anterior groin - lateral thigh - medial knee

Those with FAI may have pain with lumbar ___ AROM.

FLX b/c it decreases the angle at the hip.