S3_L1: Examination of the Hip Joint

Question 1

the ff are true about the hip, EXCEPT:

A. Ball and socket type of non-synovial joint

B. Connects the pelvic girdle to the lower limb

C. Made up of femoral head and acetabulum

D. Designed for stability and wide range of movement

E. Covered with a thin layer of hyaline cartilage

Answer 1

A. Ball and socket type of SYNOVIAL joint

Question 2

match the ff parts of the hip

1. The articular surface is horse-shoe shaped and is deficient inferiorly
2. Is a circular layer of cartilage which surrounds the outer part of the acetabulum making the socket
   deeper and so helping provide more stability
3. Gives the covering on the femoral head & provides more stability compared to the shoulder
   counterpart

A. ACETABULAR NOTCH
B. LABRUM
C. CAPSULE

Answer 2

1. A
2. B
3. C

Question 3

match the ff ligaments

1. Aka pubocapsular ligament that attaches the pubis to the femur & blends below with the capsule and the deep surface of the vertical band of the iliofemoral ligament
2. Attaches itself from the inferior side of the hip joint & is also attached above the obturator pes and superior ramus of the pubis to limit hip abduction and extension
3. Found in the inferior border of the notch & bridges the acetabular notch which reinforces the stability of the femoral head & limits the movement of the femoral head inferiorly
4. Aka round ligament of the femur or ligamentum teres femoris that’s flat and triangular in shape & lies within joint, ensheated by synovioum which limits excessive movement of the femoral head

A. ILIOFEMORAL LIGAMENT
B. ISCHIOFEMORAL LIGAMENT
C. PUBOFEMORAL LIGAMENT
D. TRANSVERSE ACETABULAR LIGAMENT
E. LIGAMENT OF HEAD OF FEMUR

Answer 3

1. C
2. C
3. D
4. E

Question 4

match the ff ligaments

1. This is a strong ligament which connects the pelvis to the femur at the front of the joint & resembles a Y shape that stabilizes the hip by limiting hyperextension
2. A ligament which reinforces the posterior aspect of the capsule & attaches the ischium to the two trochanters of the femur & limits internal rotation, and adduction with flexion
3. Attached to the posterior surface of the rim of the acetabulum and the labrum and courses circumferentially around the joint to its insertion on
   the anterior aspect of the femur

A. ILIOFEMORAL LIGAMENT
B. ISCHIOFEMORAL LIGAMENT
C. PUBOFEMORAL LIGAMENT
D. TRANSVERSE ACETABULAR LIGAMENT
E. LIGAMENT OF HEAD OF FEMUR

Answer 4

1. A
2. B
3. B

Question 5

modified T/F

Gluteals attach to the ilium and travel laterally to insert into the greater trochanter of the femur

Gluteus maximus is a strong hip extensor and a lateral rotator of the hip while Gluteus medius and minimus are abductors and internal rotators of the hip

Answer 5

TT

Question 6

which of the ff are true about ILIOPSOAS

A. the primary hip flexor muscle which consists of 2 parts, the iliacus and psoas

B. Attaches superiorly to the lower part of the spine and the inside of the ilium

C. Cross the hip joint and insert to the lesser trochanter of the femur

D. Patients with scoliosis will have a tight iliopsoas

E. All of the above

Answer 6

E

Question 7

match the ff FUNCTIONAL GROUP OF MUSCLES ACTING ON THE HIP

1. Iliopsoas, sartorius, tensor fascia lata, rectus femoris
2. Hamstrings, adductor magnus, gluteus maximus
3. Adductor longus, brevis, and magnus, gracilis, pectineus
4. Gluteus medius, minimus, tensor fascia lata, Gamelli, obturators, piriformis in sitting
5. Obturator externus, internus, piriformis, quadratus femoris, gluteus maximus
6. Gluteus medius, minimus, tensor fascia lata

A. Flexors
B. Extensors
C. Adductors
D. Abductors
E. External rotators
F. Internal rotators

Answer 7

1. A
2. B
3. C
4. D
5. E
6. F

Question 8

modified T/F

Femoral & Obturator nerve root are
(L4, 5, S1, 2)

Sciatic nerve root are (L2, 3, 4)

Answer 8

FF

Femoral & Obturator nerve root are
(L2, 3, 4)

Sciatic nerve root are (L4, 5, S1, 2)

Question 9

match the ff pain site

1. Greater trochanteric bursitis, gluteus medius tear, iliotibial band syndromes, forms of meralgia paresthetica (entrapment of the lateral femoral
   cutaneous nerve)
2. Hip extensor and ER pathology, degenerative disc diseases, spinal stenosis
3. Hip pathology can be referred to the knee as far as the sole of the foot
4. Arthritis, hip flexor muscle strain, iliopsoas bursitis, labral tear

A. Anterior hip pain
B. Lateral hip pain
C. Posterior hip pain
D. Referred pain to knee

Answer 9

1. B
2. C
3. D
4. A

Question 10

match the ff characteristics of pain
(can have multiple answers)

1. Muscle strain/tear, fracture
2. OA
3. RA
4. AVN

A. Sharp
B. Dull
C. Achy

Answer 10

1. A
2. B,C
3. B,C
4. C

Question 11

modified T/F

Sciatica radiates to the lower part of the
extremities going to the popliteal or sole of the foot

Radiates to the groin can imply inguinal
hernia, groin strain, etc.

Answer 11

TT

Question 12

match the ff gait deviations

1. Difficulty dorsiflexing ankle d/t weak anterior tibialis (MMT grade 2 or
   lower) or longer leg d/t to plantarflexion of ankle
2. No heel strike & caused by foot drop, as compensation (increased hip flexion)
3. can also be used as compensation
   d/t weak hip flexors & inability to flex the knee
4. Lift on the other leg to have clearance for the swing leg massive use of gastrocnemius
5. Using quadratus lumborum & Hiking hip up to swing the leg through
6. Heel strike is present but there is no
   eccentric control in foot flat d/t weak anterior tibialis & may lead to foot drop soon

A. Foot drop
B. High steppage gait
C. Circumduction
D. Vaulting
E. Hip hike
F. Foot slap

Answer 12

1. A
2. B
3. C
4. D
5. E
6. F

Question 13

match the ff gait deviations

1. (+) if when standing on one leg, there’s contralateral dropping of pelvis d/t unilateral gluteus medius weakness
2. In painful hip conditions, Pt walks with reduced stance phase on the affected
   side, d/t pain on weight bearing
3. Body sways from side to side on a wide base seen in (B) weakness of gluteus medius, pregnancy
4. Lean forward to slam knee back into
   extension, hyperextending and stretching the posterior
   capsule
5. Lean backward & uses iliofemoral ligament

A. Weakness on quadriceps (stance leg)
B. Weakness on gluteus maximus
C. Trendelenburg gait
D. Antalgic gait
E. Waddling gait

Answer 13

1. C
2. D
3. E
4. A
5. B

Question 14

modified T/F on Trendelenburg gait

Uncompensated pattern = pelvic drop during midstance

Compensated pattern = lean towards weak side (classic waddle)

Answer 14

TT

Question 15

which of the ff are true about Trendelenburg gait

A. Unilateral waddling gait d/t weakness of one glut. med. muscle

B. In double stance, forces are distributed equally over two hips

C. In single stance forces increases 6 fold

D. Patient lurches on the affected (WB) side and pelvis drops on to sound (swing phase) side

E. All of the above

Answer 15

E

Question 16

.

Answer 16

.

Question 17

modified T/F on HIP TELESCOPY

Used in the possibility for hip joint subluxation wherein the head of femur sublax away from the acetabulum & hip is easily pushed out of the socket

Procedure: Flex the hip to 90 degrees, one hand with the thumb on ASIS and the remaining fingers over the soft tissue proximal to femur, other hand at the distal femur then push and pull the femur

Answer 17

TT

Question 18

modified T/F

Barlow’s Maneuver (Dislocation test) is easily performed by adducting the
hip while applying light pressure on the knee, directing the force posteriorly, if the hip is dislocatable – that is, if the hip can be popped out of socket with this maneuver, the test is considered positive

Ortolani Test (Relocation test) is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner’s index fingers placing anterior pressure
on the greater trochanters, gently and smoothly abducting the infant’s legs using the examiner’s thumbs, a positive sign is a distinctive ‘clunk’ which can be
heard and felt as the femoral head relocates anteriorly into the acetabulum

Answer 18

TT

• Ortolani is done first before doing the Barlow’s test

Question 19

match the ff TESTS FOR HIP TIGHTNESS

1. Pt in sidelying (lateral decubitus position), Hip is flexed to 45°, Knee is flexed to 90°, one hand stabilizes the pelvis while the other hand pushes the knee to the floor causing IR of the hip
2. For the contracture of the rectus femoris wherein the pt is in prone with knees extended & PT at the side of the tested leg that uses one hand on lower back and other hand holding pt’s leg at the heel then PT passively flexes one knee rapidly towards pt’s buttocks, (+) test if heel cannot touch the buttocks or hip being tested rises up
3. To detect contracture of the gracilis muscle, done in prone position with the knee extended & passive abduction to the maximum with the extended
   knee, knees are then flexed to relax gracilis
4. Test for iliotibial tract contracture and tightness d/t nflamed TFL wherein the pt is in sidelying as PT moves hip and pelvis towards extension & gently adduct the limbs towards the examination table, (+) test if hip could not adduct
5. Aka iliacus/iliopsoas test to measure flexibility of the hip flexors (iliopsoas, rectus femoris, pectineus, gracilis) & tests for contracture of the hip muscle

A. Thomas test (Thomas Flexion Test)
B. Ober’s test
C. Ely’s test
D. Phelp’s test
E. Piriformis test (FADIR)

Answer 19

1. E
2. C
3. D
4. B
5. A

Question 20

modified T/F on Piriformis test (FADIR)

Pain locally = piriformis tendinitis

Pain radiates down towards the popliteal area/legs = piriformis syndrome/sciatic nerve affectation

Answer 20

TT

Question 21

which of the ff are true about Patrick’s test (FABER)

A. Tend to stress the ipsilateral SI joint
B. Pain in posterior hip = SI arthritis
C. Pain in anterior hip = hip arthritis
D. All of the above

Answer 21

D

Question 22

.

Answer 22

.

Question 23

the ff are true about Fulcrum test, EXCEPT:

A. Tests for the stress fractures of the shaft of femur

B. Done if radiological assessments is not possible

C. Stress is placed on shaft of femur

D. Pain = (+) fracture on site

E. Most common fracture site of femur is shaft and head

Answer 23

E. Most common fracture site of femur is shaft and NECK

Question 24

which of the ff are true about TOTAL HIP REPLACEMENT

A. Done when severe damage from arthritis or injury has made it difficult to perform daily activities

B. Femoral head and acetabulum are replaced with acetabular components (prosthesis)

C. Artificial hip prosthesis consists of a cup called the acetabular component & metal stem called the femoral component

D. All of the above

Answer 24

D

Question 25

the ff are true about the precautions on the posterior approach of THR, EXCEPT:

A. Precaution should be observed to avoid tendon detachment and “joint” dislocation

B. Strictly followed for 5 months after surgery

C. Hip should not go beyond 90 degrees flexion

D. Legs should not cross over the midline

E. Avoid hip rotation beyond capabilities required for gait function

Answer 25

B. Strictly followed for 3 months after surgery

Question 26

modified T/F on anterior approach of THR

Less invasive since the cut is made along the rectus femoris & it’s less likely to dislocate

PRECAUTIONS are avoiding hip extension, abduction, external and internal rotation & avoid extreme rotations other than that of required
for gait and ambulation

Answer 26

TT

Question 27

which of the ff are true about ADVANCED ANTERIOR APPROACH

A. Most minimally invasive technique

B. Muscles are not much touched

C. Better chance of fast recovery and less restriction when it comes to movement

D. All of the above

Answer 27

D

Question 28

the ff are the Procedure of ADVANCED ANTERIOR APPROACH

A. Lateral position with hip flexed 45 degrees and IR 15 degrees with foot on a mayo stand

B. Incision is placed starting on the tip of GT and extending 8 cm proximally exactly inline with the femoral shaft axis

C. Incision is made to the level of the fascia

D. All of the above

Answer 28

D