L7 - Hip Joint

Question 1

What type of joint is the hip?

Answer 1

Diarthrotic ball and socket type of synovial joint

Question 2

Which movements can the hip accomplish?

Answer 2

Flexion and extension, abduction and adduction, circumduction, medial and lateral rotation

Question 3

Describe acetabular labrum tears

Answer 3

Can be induced by twisting on a weight bearing hip
Majority have no known direct cause
Pain may becomes diffuse and difficult to pinpoint
Can be repaired arthroscopically

Question 4

Describe acetabular labrum tears in reference to swelling and pain

Answer 4

Not possible to see swelling but inflamed joint may become larger in volume
If the front hip is effected there may be a pinching sensation when the person flexes the hip by bringing the knee up to the chest
Pain may be reproduced during activities that require weight bearing and twisting (i.e. kicking a football)

Question 5

Describe the articular capsule

Answer 5

Proximally attached to edge of acetabulum
Distally attached to neck of femur
Thickened parts of fibrous (articular) capsule are called intrinsic ligaments

Question 6

Some deep fibers in the articular capsule of the hip pass circularly around the neck forming what?

Answer 6

The orbicular zone which forms a collar around the neck helping to hold the femoral neck in the acetabulum

Question 7

Some longitudinal fibers in the articular capsule of the hip form a what?

Answer 7

Retinaculum (L., band or halter) which are reflected superiorly on the neck

Question 8

What are the three intrinsic ligaments of the hip joint?

Answer 8

Iliofemoral, pubofemoral and Ischiofemoral

Question 9

Describe the iliofemoral ligament

Answer 9

Strong Y shaped band that converts anterior aspect of hip
ASIS and acetabular rim to intertrochanteric line
Helps prevent overextension

Question 10

Describe the pubofemoral ligament

Answer 10

Strengthens anterior and inferior parts o fibrous capsule
Arises from obturator crest of pubic bone and passes laterally to blend with joint capsule and iliofemoral ligament
Helps prevent over abduction and over extension

Question 11

Describe the Ischiofemoral ligament

Answer 11

Strengthens joint capsule posteriorly
Arises from ischial part of acetabular rim
Fibers spiral antero-laterally to attach to femoral neck
Helps prevent over extension

Question 12

Where should intragluteal injections be made?

Answer 12

In the superolateral part of the gluteal region in order to avoid the sciatic nerve and other gluteal nerves and vessels

Question 13

What are some names of conditions associated with the gluteus medius and minimus?

Answer 13

Gluteal gait or Duchenne’s limp

Positive Trendelenburg’s sign

Question 14

What is the cause and effect of conditions associated with gluteus medius and minimus?

Answer 14

Cause: superior gluteal nerve injury
Effect: pt loses steadying action of gluteus medius and minimus and they lean toward the effected side during stance phase of gait

Question 15

What are the three different conditions that can occur with the piriformis muscle?

Answer 15

Sciatic nerve can be completely inferior to piriformis
Common fibular nerve can pierce right through the piriformis
Or the sciatic nerve can be superior to the piriformis

Question 16

Describe an anterior hip dislocation

Answer 16

Comprise 10-15% of traumatic dislocations of the hip
Occurs when knee strikes dashboard with thigh abducted, falls from height or from a blow to the back while in a squatted position
Neck of femur or greater trochanter impinges on rim of acetabular and thereby levers head of femur out of acetabulum through tear in anterior hip capsule

Question 17

Describe a posterior hip dislocation

Answer 17

Thigh adducted, medially rotated and flexed
Can cause damage to the sciatic nerve which may result in paralysis of hamstrings and muscles distal to the knee
Sensory changes may occur in the skin over the posterolateral aspect of leg and most of foot

Question 18

What is the hip joint susceptible to?

Answer 18

Degenerative processes such as osteoarthritis

Question 19

Explain processes for hip replacements

Answer 19

Metal prosthesis anchored to femur by bone cement to replace femoral head and neck
Plastic socket cemented to hip bone to replace acetabulum

Question 20

Describe lymphatic drainage in the gluteal region

Answer 20

Superficial lymph which drains to superficial inguinal LNs

To deep inguinal LNs

Question 21

What is the location and sx of trochanteric bursitis?

Answer 21

Sx: pain on the outside of the hip that worse with activities such as standing, walking or running
Location: bursa at the outside (lateral) point of the hip known as the greater trochanter

Question 22

What is the location and sx of ischial bursitis?

Answer 22

Location: bursa that lies between the ischial tuberosity and the gluteus maximus
Sx: aching or stiffness in the pelvis, pain when sitting, trouble sleeping on affected die and redness or swelling around the bursa

Question 23

Which nerve innervates the hip joint?

Answer 23

Sciatic, femoral and obturator nerves

Question 24

What is the major arterial supply to the hip joint?

Answer 24

Medial and lateral circumflex femoral arteries (branches of deep femoral)

Question 25

What will the legs of a pt with a hip fracture look like?

Answer 25

Shortened and laterally rotated on the injured side

Question 26

What will the legs of a pt with a dislocated hip look like?

Answer 26

Knee and foot of the injured side will be pointing inward (medially rotated)