Lower Limb: Hip Joint

Question 1

components of acetabulum of hip joint

Answer 1

made up of ischium, ilium & pubic bones
contains a labrum - deepens sockets, often torn in injury
anterior part = lunate surface = articular surface + thickest cartilage
acetabular fossa covered by fat pad

Question 2

features of HoF

Answer 2

2/3 sphere shaped 
directed upwards, medially & forwards
antiverted - 8-12 degrees
anterior part outside of socket 
fovea = central non-articulating area = ligament attachment

Question 3

anatomical & surgical NoF

Answer 3

anatomical = just below HoF = line of growth plate & capsule attachment

surgical = just below G+L trochanters

Question 4

attachment & function of HJ capsule

Answer 4

attaches at base of NoF

posteriorly doesn’t extend as far distal - limits extension

Question 5

Where do reticular fibres arise & function?

Answer 5

reflections of fibrous capsule towards the HoF
retain tendons & reticular vessels
reinforce capsule

Question 6

Significance of damaged reticular vessels?

Answer 6

supply HoF

damage can lead to disruption of growth plate or necrosis of growth plate during development

Question 7

Muscles that extend the HJ?

Answer 7

gluteus maximus - powerful extensor + stability of joint

hamstrings

Question 8

Muscles that flex the HJ?

Answer 8

iliopsoas

Question 9

Muscles that medially rotate HJ?

Answer 9

Gluteus medius + minimus

hamstrings

Question 10

Muscles that laterally rotation HJ?

Answer 10

Glut max
Iliopsoas
piriformis
obtrurator internus
quadratus femoris

Question 11

Muscles that abduct HJ?

Answer 11

glut med + min
Glut max
Piriformis
Obtrurator internus

Question 12

Presentation of glut med + mini injury

Answer 12

Trendellenberg gait

Question 13

What muscle pathology results in Trendellenberg gait?

Answer 13

Injury of glut med + min

Question 14

What muscle group bony attachment is a common source of bone pain (osteitis pubis)?

Answer 14

Adductor muscles

Question 15

What pathology can occur at the common bony attachment for the adductor muscles?

Answer 15

osteitis pubis (bone pain)

Question 16

three supportive ligaments of the HJ?

Answer 16

iliofemoral
ischiofemoral
pubofemoral

Question 17

anterior supportive ligaments of HJ & function?

Answer 17

iliofemoral = strong = prevents hyperextension (spirals & tightens)
pubofemoral = weaker

Question 18

Posterior supportive ligament/s of HJ?

Answer 18

Ischiofemoral = weaker

(posterior bc sit on your ischial tuberosities)

Question 19

Why is there a greater range of flexion than extension at HJ?

Answer 19

Extension limited due to posterior capsule not extending as far distally as it does anteriorly + strong anterior ligament (iliofemoral) spirals & tightens

Question 20

when does medial rotation of HJ occur?

Answer 20

During extension (3 extra capsular ligaments tighten and bring HoF close to acetabulum = screw home mechanism) + stance phase

Question 21

when does lateral rotation of HJ occur?

Answer 21

during flexion + swing phase

Question 22

what is hilton’s law?

Answer 22

The sensory nervous supply to a joint comes from the branches that supply the muscles that move it

Question 23

What nerves do the articular branches of the HJ arise?

Answer 23

Obturator nerve + femoral nerve

Question 24

What is the main blood supply to the HJ?

Answer 24

Reticular vessels (from the medial circumflex arteries)
Anastomoses from the medial & lateral circumflex arteries that arise from the profunda femoris artery

Question 25

What is the most common dislocation of the HJ, what does it endanger?

Answer 25

Posterior dislocation

Sciatic nerve

Question 26

In fractured NoF what is endangered & what position is the joint in?

Answer 26

Reticular vessels - can cause necrosis of NoF

externally rotated due to spasm of external rotator muscles & gluteal muscles

Question 27

what is the angle of torsion & what are the variations in it called?

Answer 27

angle of inclination of the NoF to the shaft
Normally 130 in adult
> 135 = coxa valga (‘g’ for greater than)
< 135 = coxa vara

Question 28

When is congenital hip dysplasia common, what are its complications & how is it managed?

Answer 28

More common in breech position
Limb & pseudo joint formation can occur above the acetabulum
Child fixed in an abducted position - abductor magnus pulls head back into socket

Question 29

Where is pain commonly referred to the HJ from?

Answer 29

Lumbar spine i.e. with narrowing of intervertebral foramina