MSK Session 8

Question 1

What does the hip joint do?

Answer 1

Supports body weight in standing
Involved in locomotion
Ball and socket : large range of motion
Strong joint: takes a lot to disrupt, most stable joint in the body

Question 2

What does the ligament of head of femur have?

Answer 2

Contains small arterial blood supply to the head of femur

Question 3

What are the three hip bones? When do the begin to fuse and when is fusion complete?

Answer 3

i) Ilium, Ischium and Pubis

ii) Begins to fuse at 15-17 years, fusion complete by 20-25 years

Question 4

Where is the margin of the acetabulum incomplete? What is this called? What is this strengthened by?

Answer 4

Inferiorly

Acetabular notch - strengthened bu transverse acetabular ligament

Question 5

What is the acetabular labrum made of? What does it do?

Answer 5

Fibrocartilaginous rim attached to margin of acetabulum

Increases the articular contact area by 10% (more than 50% of head of femur fits in)

Question 6

Where does the joint capsule of the hip attach anteriorly and posteriorly?

Answer 6

Ant - intertrochanteric line

Post - lateral part of neck is extra-capsular

Question 7

What are the three ligaments that strengthen the joint capsule? Which is the weakest?

Answer 7

Iliofemoral
Pubofemoral
Ischiofemoral - weakest, positioned posteriorly

Question 8

What are the accessory ligaments of the hip joint?

Answer 8

Ligament of head of femur

Transverse acetabular ligament

Question 9

What protection does the iliofemoral and pubofemoral ligaments give? What does the pubofemoral prevent?

Answer 9

Iliofemoral - protects anteriorly and superiorly

Pubofemoral - protects ant + inf, prevents over abduction

Question 10

What are the main flexors of the hip joint?

Answer 10

Iliopsoas - iliacus + psoas major
Rectus femorus
Sartorius

Question 11

What are the main hip adductors ?

Answer 11

Adductor : magnus, brevis, longus
Pectineus
Gracilis
Obturator externus

Question 12

What are the main hip extensors?

Answer 12

Gluteus maximus
Long head of biceps femoris
Semimembranosus
Semitendinosus

Question 13

What are the main hip abductors?

Answer 13

Gluteus medius
Gluteus minimus
Tensor fasciae latae

Question 14

What are the main hip lateral rotators?

Answer 14

Piriformis
Superior gemellus
Obturator internus
Inferior gemellus
Quadratus femoris

Question 15

What is hilton’s law?

Answer 15

Nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles

Question 16

What are the five major nerves that supply the anterior and posterior compartments of the thigh?

Answer 16

1) Femoral
2) Obturator
3) Nerve to quadratus femoris
4) Superior gluteal
5) Inferior gluteal

Question 17

What is the main blood supply to the hip joint?

Answer 17

Major source (deep femoral artery)

• medial circumflex femoral artery
• lateral circumflex femoral artery

Minor source (adult)
-obturator artery (via ligament of head of femur)

Question 18

What can be the problem of a fracture of the neck of femur?

Answer 18

Tear retinacula arteries causing avascular necrosis

Question 19

What is hip dysplasia? Where and what is the problem?

Answer 19

Abnormal growth of the hip
Bilateral in approx half of cases
Can be dislocated at birth or sometime later

Problem with bony structures:
-Acetabulum
- Head of femur
or supporting capsule

Promblems range from:

• subluxation to dislocation
• instability

Question 20

What is a slipped upper femoral epiphysis?

Answer 20

Fracture through epiphysis
Ages 10-16 years most affected
Rest of femur rides up and forward up relation to epiphysis

Question 21

Describe features of acquired hip dislocations?

Answer 21

Uncommon because stable articulation
Posterior dislocation in RT
Capsule and acetabulum disrupted
Limb shortened/medially rotated
Possible sciatic nerve damage

Question 22

What are the features of a femoral neck fracture?

Answer 22

Mainly elferly affected
Intra-capsular
Blood supply may be disrupted (circumflex arteries)
Px : shortened/externally rotated

Tx: depends on age and health&raquo_space;> replacement if old

Question 23

Describe trochanteric fractures ?

Answer 23

Extra-capsular
Less risk of osteonecrosis
Usually treated with a dynamic hip screw

Question 24

What are the three main bursae around the hip joint?

Answer 24

Trochanteric bursa
Iliopsoas bursa
Ischiogluteal bursa

Question 25

Describe the trochanteric bursa?

Answer 25

Largest bursa
Situated between gluteus maximus and greater trochanter
Can occur in arthritis or as separate entity

Question 26

Describe the iliopsoas bursa?

Answer 26

Lies deep to iliopsoas
In 15% there is communication with hip joint
May present as swelling below inguinal ligament (Ddx: femoral hernia)

Question 27

Describe the ischiogluteal bursa>

Answer 27

Situated near ischial tuberosity
Sitting down can inflame it!
Bike or horse riding

Question 28

How can the three bursa within the hip joint become inflamed?

Answer 28

These bursae can become inflammed

• repetitive strain
• direct trauma

Results in pain on movement
Pain on direct pressure

Question 29

What is arthritis of the hip?

Answer 29

Inflammation of the joint in the synovium
Damage to cartilage
Usually pain early on is due to inflammation
Later on it can become more of a mechanical process

Question 30

What is osteoarthritis of the hip?

Answer 30

Mainly cartilaginous damage
Pain is from mechanical grinding
Previous joint injuries may predispose to this condition
Increased mechanical load makes things worse
Hip commonly affected

Question 31

What is RA of the hip?

Answer 31

Problem starts in synovium
Essentially inflammatory
Joint cartilage is destroyed
Problem then becomes mechanical