S3_L1: Kinesiology of the Pelvis and Hip Flashcards
Determine the corresponding descriptions of the ff coxofemoral joint conditions
- Related to limb length discrepancy
- Deepened acetabular socket
- Abnormally shallow acetabulum resulting in a lack of femoral head coverage
- Femoral head projects too medially (inward projection)
- Unstable hip
A. Coxa profunda
B. Acetabular protrusio
C. Acetabular dysplasia
- B
- A
- C
- B
- C
Determine the corresponding descriptions of acetabular anteversion
- Limited ROM, more stability
- Hip instability, but with more ROM
- Increasing coverage of femoral head (overcoverage) and impingement between acetabulum femoral-head neck junction
- Less containment of femoral head
- Anterior border is too lateral
- More stress on hip joint, especially when going down stairs
A. Excessive Acetabular Anteversion
B. Acetabular Retroversion
- B
- A
- B
- A
- B
- A
Determine the corresponding descriptions of abnormalities with the angle of inclination of the femur
- Shortening of LE
- Greater stabilization, however decreased ROM and increased risk for femoral fracture
- Reduces distance of greater trochanter from joint’s axis of motion
- Ankle may go into pes equinus
- Limb is in an adducted position
- Widened base of support
A. Coxa valga
B. Coxa vara
- B
- B
- A
- B
- A
- B
Determine the corresponding
descriptions of abnormalities with the angle of torsion of the femur
- Greater than 15-20°
- Increase in congruence of femur and acetabulum
- Clinically presents with in-toeing
- Joint incongruency & increased medial rotation of hip
- Presents with out-toeing or lateral hip rotation during standing or walking
- Decreased ROM, limited IR
A. Femoral anteversion / antetorsion
B. Femoral retroversion / retrotorsion
- A
- B
- A
- A
- B
- B
Determine the corresponding motions restricted by the hip joint ligaments in the sagittal plane (x-axis)
- Hyperextension
- Hyperflexion
A. Iliofemoral Ligament / Y Ligament of Bigelow
B. Pubofemoral Ligament
C. Ischiofemoral Ligament (Posterior Capsular Ligament)
D. Both A and B
E. All of the above
- E
- C
Determine the corresponding motions restricted by the hip joint ligaments in the frontal plane (z-axis)
- Abduction
- Adduction
A. Iliofemoral Ligament / Y Ligament of Bigelow
B. Pubofemoral Ligament
C. Ischiofemoral Ligament (Posterior Capsular Ligament)
D. Both A and B
E. All of the above
- E
- A
Determine the corresponding motions restricted by the hip joint ligaments in the transverse plane (y-axis)
- Internal Rotation
- External Rotation
A. Iliofemoral Ligament / Y Ligament of Bigelow
B. Pubofemoral Ligament
C. Ischiofemoral Ligament (Posterior Capsular Ligament)
D. Both A and B
E. Both A and C
- E
- D
Determine the corresponding descriptions of the CKC sagittal plane hip movements
- Stimulates hip extension
- Lumbar spine extension, low back becomes lordotic
- Flattening of lumbar spine, particularly seen in sitting
- ASIS moves superiorly (and posteriorly), PSIS moves inferiorly
- Primary muscle responsible is iliopsoas to actively do this motion
- ASIS moves inferiorly (and anteriorly), PSIS moves superiorly
A. Anterior pelvic tilt
B. Posterior pelvic tilt
- B
- A
- B
- B
- A
- A
Determine the corresponding descriptions of the CKC frontal plane hip movements
- Occurs with relative contralateral hip abduction
- Simultaneous hip adduction and hip abduction
- Occurs with relative contralateral hip adduction
- Adducting on the ipsilateral and abducting on the contralateral side
A. Pelvic Hike
B. Pelvic Drop
C. Lateral pelvic shift
- A
- C
- B
- C
Determine the corresponding descriptions of the CKC transverse plane hip movements
- Compensatory lumbar spine rotation to the WB hip
- Relative medial rotation on weight bearing hip
- Compensatory lumbar spine rotation to the non-WB hip
A. Anterior / Forward rotation / Protraction
B. Posterior / Backward rotation / Retraction
- B
- A
- A
Determine the corresponding hip motions occurring in these postural deviations
- Hip hyperextension and posterior pelvic tilt
- Excessive posterior pelvic tilt
- Exaggerate anterior pelvic tilting
A. Lordotic Back
B. Flat Back
C. Forward Shifted Pelvis / Swayback
- C
- B
- A
Compensatory lumbar spine lateral flexion occurs toward the side where the pelvis hikes. Conversely, contralateral lumbar lateral flexion occurs during pelvic drop.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
TRUE OR FALSE: The ligamentum teres / ligament of the head of the femur is an intra-articular and extrasynovial triangular band attached to the peripheral edge of the acetabular notch. It does not communicate with the synovial cavity of the joint.
True
The ligamentum teres / ligament of the head of the femur transmits the blood vessel to contribute as secondary blood supply of the hip. This ligament prevents too much compression forces on the hip joint.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
A. Only the 1st statement is true
it prevents distraction forces
At birth, the normal value of the angle of inclination is ____ degrees.
150
Note: The acetabulum is rather shallow at birth and the hip is in a position of incongruency and relative instability. The acetabulum deepens secondary to WB forces.
TRUE OR FALSE: The full ossification/maturation of the entire pelvis occurs at around 20-25 years of age.
True
TRUE OR FALSE: The acetabulum is a deep sphere-shaped cavity. Although appearing to be spherical, only the upper margin of the acetabulum has a true circular contour.
True
Additional: It is positioned laterally with an inferior and anterior tilt opening of the acetabulum is approximately laterally inclined 50°; anteriorly rotated (anteversion) 20°; and anteriorly tilted 20° in the frontal, transverse, and sagittal planes, respectively.
TRUE OR FALSE: The articular surface of the acetabulum is smaller in women than it is in men.
True
It is the primary blood supply to the femoral head and a branch of the profunda femoris artery (deep femoral artery) of the femoral artery.
Medial femoral circumflex artery
Note: Impeded blood flow results to avascular necrosis of the femoral head. In children (at 7 y/o, common in males), this is known as the Legg Calve Perthes Disease. In adults, it is termed Chandler’s Disease.
Orientation of the acetabular fossa is anterior, lateral, and inferior. Orientation of the femoral head is superior, anterior, and medial.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: In the neutral or standing position, the articular surface of the femoral head remains exposed anteriorly and somewhat superiorly. Since both are facing a bit anteriorly, there is potential instability anteriorly.
The small roughened pit/opening in the femoral head. It is the attachment site of the round ligament/ligamentum teres/ligament of the head of the femur.
Fovea Capitis
Note: Hyaline cartilage is not present in the fovea.
It is the secondary blood supply to the femoral head. It is only present when the bone has matured and is derived from the obturator artery.
Ligamentum teres artery (Small blood vessels passing through the fovea)
The negative atmospheric pressure within the joint must be broken before the hip can be dislocated. Atmospheric pressure in hip flexion activities played a stronger role in stabilization than capsuloligamentous structures.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
TRUE OR FALSE: Hip joint stability is provided by joint congruence, negative atmospheric pressure, and the hip joint capsule.
True
Refers to the ring encircling the base of femoral neck area that provides further stabilization of the hip joint especially when trying to distract the hip joint.
Zona Orbicularis
TRUE OR FALSE: The normal values for the angle of torsion are 15-20°, specifically 15º for males and 18º for females.
True
Additional: During infancy, the angle may reach 40°.
The most common adolescent hip disorder occurring when the femoral head is displaced posteriorly on the femoral neck at the level of the growth plate (physis).
Slipped capital femoral epiphysis (SCFE)
Less inclination (seen in Coxa Vara) and less acetabular anteversion (seen in Acetabular Retroversion) results in ____ hip ROM.
decreased
Normal values of the center edge angle (CE) / angle of Wiberg / vertical center anterior angle (VCA) angle
25-40 degrees
Note: <25 degrees causes dysplasia/dysplastic disease of the hip joint and a decreased acetabular coverage, which makes the hip less stable, with more ROM. Conversely, if the angle is increased, acetabular coverage increases; thus, the hip is more stable with less ROM.
TRUE OR FALSE: In cases of acetabular dysplasia (center edge angle is <25°), definite dysplasia is for less than 16°, possible dysplasia for 16° to 25°, and normal (or no dysplasia) for greater than 25º.
True
Source: Levangie & Norkin, 5th ed.
In transverse plane OKC motions of the coxofemoral joint, the hip rolls inwards and the leg moves outwards during internal rotation. Conversely, the hip rolls outwards and the leg moves inwards during external rotation.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
TRUE OR FALSE: The lumbopelvic rhythm/pelvifemoral motion is a close-kinematic chain integrated and coordinated movement of the femur, pelvis, and spine that is analogous to the scapulohumeral rhythm and allows greater/increased ROM.
True
TRUE OR FALSE: The hip joint capsule is slack/lax in OPP of hip joint (FABER) and taut/tight in the ligamental CPP of hip joint (EABER).
True
TRUE OR FALSE: The hip joint capsule is thick anterosuperiorly
and thin posteroinferiorly.
True
Note: Since both femoral and acetabular heads are somewhat facing anteriorly, the anterior part of the capsule is thick to help prevent instability.
TRUE OR FALSE: The true physiological position of the hip joint according to Kapandji is 90º flexion, slight abduction, and slight external rotation.
True
Note: The position causes increase in articular contact between joint surfaces, not full congruence. This position (also known as the frog-leg position) corresponds to that assumed by the hip joint in a quadruped position (Levangie & Norkin).
TRUE OR FALSE: The acetabulofemoral joint has 3 degrees of freedom (in sagittal, frontal, and transverse planes). During most activities, hip motion occurs as a combination of these 3 planes.
True
TRUE OR FALSE: The acetabulofemoral joint is considered to be a congruent joint, but functions as a incongruent joint in non-weight bearing because the femoral head is larger than the acetabulum.
True
Additional: Under circumstances in which the joint surfaces are neither maximally congruent nor close packed, the hip joint is at greatest risk for traumatic dislocation.
Single-jointed primary hip extensor that is active in any knee position
Gluteus maximus
Largest of the lower extremity muscles; this large and quadrangular muscle alone constitutes 12.8% of the total muscle mass of the lower extremity.
Gluteus maximus
The hamstrings are two-jointed primary hip extensors with or without resistance but the contraction of each muscle is strongly influenced by the tibia’s position. For instance, the biceps femoris contributes to external rotation of the tibia, while the semimembranosus and semitendinosus contribute to internal rotation of the tibia.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Trabecular system: Tendency for bending moment or shear force to concentrate on femoral neck
- Vertically oriented force from weight of body
- Force between greater and lesser trochanters
- Pull of the muscles attaching to the greater trochanter
A. Trochanter system
B. Medial compressive system
C. Secondary compressive system
- B
- C
- A
TRUE OR FALSE: The iliopsoas is the most important primary hip flexor that is recruited during hip flexion regardless of knee position.
True
TRUE OR FALSE: Acetabular labral tears are increasingly recognized as a source of hip pain and as a starting point for degenerative changes at the acetabular rim.
True
Open packed position of the hip joint
30° flexion, 30° abduction, and slight lateral/external rotation (30° FABER)
Bony close packed position of the hip joint
Extension, slight abduction, and medial/internal rotation (EABIR)
TRUE OR FALSE: The 3 hip joint ligaments (iliofemoral, ischiofemoral, & pubofemoral) all act as primary stabilizers during hip distraction.
True
TRUE OR FALSE: In general, the 3 hip joint ligaments (iliofemoral, ischiofemoral, & pubofemoral) control extension, abduction, and external rotation.
True
Ligamental close packed position of the hip joint
extension, abduction, and external rotation (EABER)
In erect standing, the hip joint capsule and ligaments’ tension determines the amount of posterior pelvic tilt. What hip joint ligament has the greatest influence on this movement?
Iliofemoral ligament/Y ligament of Bigelow
TRUE OR FALSE: Anterior pelvic tilt, a motion in the sagittal plane around the x-axis, can also occurs with hip flexion contracture or weak abdominal control.
True
TRUE OR FALSE: In close kinematic chain pelvic motions, the proximal concave acetabulum moves on the fixed distal convex femoral head in the same direction.
True
Additional: Most of the time, LE joints work as a closed chain. Thus, affectation of one LE joint brings about changes/adjustments to the other LE joints.
TRUE OR FALSE: When the knee is extended, the combined action of the gluteus maximus and tensor fasciae latae through iliotibial band will abduct the hip; for adduction, double-jointed gracilis is the primary adductor.
True
TRUE OR FALSE: When the knee is bent, the single-jointed gluteus medius will abduct or the single-jointed short adductors will primarily adduct.
True
TRUE OR FALSE: The combination of hip and trunk flexion is generally sufficient for the hands to reach the ground—as long as the hamstrings and lumbar extensors allow sufficient lengthening.
True
TRUE OR FALSE: When the knee is extended, the multi-jointed rectus femoris contributes to hip flexion and the multi-jointed hamstring contributes to hip extension, acting as the primary muscles.
True
Note: While going towards hip flexion and knee extension, the rectus femoris is active. Its activation starts when the knee is flexed, and ends when the knee is extended.
TRUE OR FALSE: When the knee is bent, the iliopsoas is active during flexion and the gluteus maximus is a primary muscle during extension.
True
The anatomic axis of the hip joint is the line drawn through the femoral shaft. Conversely, the mechanical axis is the line connecting the centers of the hip and knee joints.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Additional: In standing, the mechanical axis is vertical because of angle of inclination. The common hip axis is the line connecting the centers of the femoral heads in standing.
TRUE OR FALSE: In the normally aligned pelvis, the anterior superior iliac spines (ASISs) of the pelvis lie on a horizontal line with the posterior superior iliac spines (PSISs) and on a vertical line with the symphysis pubis.
True
Source: Levangie & Norkin, 5th ed.
Lumbopelvic rhythm / pelvifemoral motion in extension:
a. hip extension > pelvis posterior tilt > lumbar region
b. pelvis posterior tilt > lumbar region > hip extension
c. lumbar region > hip extension > pelvis posterior tilt
a. hip extension > pelvis posterior tilt > lumbar region
Lumbopelvic rhythm / pelvifemoral motion in flexion/bending forward:
a. hip flexion > lumbar region > pelvis anterior tilt/forward tilting
b. pelvis anterior tilt/forward tilting > lumbar region > hip flexion
c. lumbar region > pelvis anterior tilt/forward tilting > hip flexion
c. lumbar region > pelvis anterior tilt/forward tilting > hip flexion
The flexors of the hip joint function primarily as ___ muscles in the open-chain function.
mobility
Enumerate the active & passive insufficiencies of the rectus femoris muscle.
- Active insufficiency: simultaneous hip flexion and knee extension
- Passive insufficiency: simultaneous hip extension and knee flexion
TRUE OR FALSE: The sartorius is a primary hip flexor that is unaffected by the position of the knee.
True
Note: It is a double-jointed narrow muscle on the anterior thigh situated very close to the knee axis, and attached to the proximal area of the medial tibia.
Movement of the iliotibial band anteriorly and posteriorly over the greater trochanter during functional activities has been implicated in (1)___ syndrome and in inflammation of the (2)___ bursae.
- “snapping hip”
- trochanteric
Refers to the area/zone of weakness in the trabecular system that is a potential site of femoral neck fractures.
Ward’s triangle
The piriformis usually has two heads with a tendency to compress the ___ nerve, resulting in the condition known as piriformis syndrome, due to tightness of the piriformis. Symptoms include
paresthesia, numbness, and tingling on the buttocks down to the posterior side of the leg.
sciatic
The primary hip external/lateral rotators are also referred to as the “red carpet” muscles (deep gluteal muscles). Enumerate all 6 muscles.
- Obturator externus 2. Obturator internus
- Gemellus superior 4. Gemellus inferior
- Quadratus femoris
- Piriformis
The piriformis muscle is only an external rotator when the hip is ___.
extended (& from 0 to < 90º of hip flexion - initial ranges of hip flexion)
Note: When the hip is flexed at about 90° or more, the axis of the piriformis shifts forward, thus it becomes an internal rotator.
These 2 muscles are active hip external rotators, regardless of the hip joint position.
- Obturator externus
- Quadratus femoris
The gluteus minimus has a tendinous insertion into the joint capsule that retracts during hip ___ to prevent entrapment.
abduction
This muscle is analogous to the supraspinatus in abduction. It is also analogous to the deltoids in flexion (anterior fibers) and extension (posterior fibers), because it covers a wide portion of the hip joint.
Gluteus medius
Note: The anterior, middle, and posterior parts of the muscle function asynchronously.
This muscle has a compressive function and is analogous to the subscapularis of the shoulder.
Gluteus minimus
Note: This muscle is also a flexor of the hip (anterior fibers) and a medial rotator in the flexed hip.
The primary hip abductors (g. medius & g. minimus) are also referred to as the ___ of the hip.
“rotator cuff”
TRUE OR FALSE: The hip adductors are all located anteromedially
and function not as prime movers but by reflex response to gait activities.
True
Enumerate the 4 single-jointed hip adductors, also known as the short adductors.
- Pectineus
- Adductor brevis
- Adductor longus
- Adductor magnus
Note: Only the GRACILIS MUSCLE is two-jointed, usually activated as an adductor when the knee is extended.
“Force couple” in the hip is described as upward and downward forces creating a bending moment on the femoral neck. The (1)___ force generates tensile force on the superior aspect, while the (2)___ force generates compressive force on the inferior aspect.
- upward (GRF against body weight)
- downward (WB line of HAT on the superior aspect of the femoral head)
Note: Thus when we bend it, we distract the superior and compress the inferior.
TRUE OR FALSE: The primary responsibility of the hip joint is not mobility during OKC activities, rather power production during CKC. Also, the hip region is a major player in the body’s locomotor system.
True
Source: Brunnstrom, 6th ed.
Note: The hip joint is very stable structurally, but is also mobile. It transmits large forces between the trunk and the ground.
TRUE OR FALSE: Hip joint muscles work best in the middle of their contractile range or on a slight stretch.
True, this is their optimal length-tension.
Note: Two-joint muscles generate greatest force when not required to shorten over both joints simultaneously; and tension generation is optimal with eccentric contractions, followed by isometric and then concentric contractions.
What are the only two muscles that cross the sacroiliac joint?
Piriformis and gluteus maximus
The torque-generating capability of the (1)___ rotators increases with increased hip flexion, whereas the torque-generating capacity of the (2)___ rotators decreases with increasing hip flexion.
- medial
- lateral
TRUE OR FALSE: There are no muscles with a primary function of producing medial rotation of the hip joint.
True
Note: There are only secondary hip internal/medial rotators, namely:
1. Gluteus Medius (anterior fibers)
2. Gluteus Minimus (anterior fibers)
3. Tensor fasciae latae
4. Anterior fibers of the single-jointed adductors/short adductors (still controversial*)
During gait in the stance phase:
as we try to propel body forward, the hip starts to move to extension until reaching hyperextension in the sagittal plane, referred to as the ___ phase.
propulsive
Additional: Then in the swing phase, from hyperextension, the hip moves into flexion until we reach initial contact again.
During gait in the stance phase: the hip starts at hip flexion in the sagittal plane, referred to as the ___ phase.
braking
When walking, the hip moves in a series of continuous flexion and extension motions in the ____ plane throughout gait.
sagittal
Each time the pelvis is rotated anteriorly, an associated (1)___ rotation on the hip occurs. Conversely, when the pelvis is rotated posteriorly,
relative (2)___ rotation of the hip occurs.
- external
- internal
Example: The left LE steps forward, the L pelvis rotates anteriorly. There is relative posterior rotation on the right with right hip internal rotation, and external rotation on the left hip.
When we walk, the pelvis drops and hikes, and the contralateral pelvis drops slightly. To prevent excessive dropping, what muscle must contract on the stance side?
gluteus medius (hip abductor)
Note: At midstance, only 1 extremity is weight bearing.
Under normal circumstances, the hip joint, its capsule, and ligaments routinely support ___ of the body weight (the weight of head, arms, and trunk, or HAT), with equal weight distributed on each LE.
two-thirds
Additional: When bilateral stance is not symmetrical, frontal plane muscle activity will be necessary either to control the side-to-side motion or to return the hips to symmetrical stance.
In erect bilateral stance (normal standing position), the LOG passes slightly _____ to the hip joint.
posterior
Note: Thus, the hips are in neutral or slight hyperextension. When the LOG is slightly posterior to the hip joint axis, posterior tilt occurs.
This ligament prevents external rotation, hyperextension and excessive abduction (EABER; ligamentous CPP)
pubofemoral ligament
These 2 ligaments form the Z ligament on the anterior of the hip. The Z ligament prevents hyperextension and too much ER of the hip joint.
- iliofemoral ligament
- pubofemoral ligament
The horizontal fibers of the ischiofemoral ligament (posterior capsular ligament) restrict flexion (hyperflexion), hip internal rotation and hip abduction. The spiral fibers of the ischiofemoral ligament (posterior capsular ligament) restrict hyperextension.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: Spiral fibers are obliquely oriented, while the horizontal fibers insert to the inner surface of the greater trochanter.
The Iliofemoral Ligament / Y Ligament of Bigelow has 2 arms/bands, making an inverted Y or fan shape. The superior band is the strongest and thickest and restricts excessive adduction, while the inferior band restricts excessive abduction.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
If lateral lean and pelvic drop occur during walking, the gait deviation is commonly referred to as the ____.
Trendelenburg gait
Lateral trunk lean due to hip abductor weakness during walking is called (1)____. If the same compensation is due to hip joint pain, it is known as (2)____.
- gluteus medius gait
- antalgic gait
TRUE OR FALSE: When one side of the pelvis laterally tilts, the contralateral hip is the pivot point or axis of motion.
True
Source: Brunnstrom, 6th ed.
Note: Lateral pelvic tilting describes CKC hip abduction. A reciprocal relationship occurs as when one pelvis tilts up, the other slightly drops.
TRUE OR FALSE: The muscles responsible for ipsilateral pelvic hiking and relative contralateral hip abduction is either the ipsilateral quadratus lumborum (mostly in OKC) and/or the contralateral gluteus medius (mostly in CKC).
True
TRUE OR FALSE: In performing CKC lateral pelvic shift in the frontal plane, the pelvis cannot hike, but it can only drop.
True
TRUE OR FALSE: In CKC motions in the transverse plane, the contralateral hip is pivot point.
True
Source: Brunnstrom, 6th ed.
Note: One side protracts and other side retracts for full motion to occur.
The ____ contains the ligamentum teres and a fibroelastic fat pad containing proprioceptors for joint sensory input.
acetabular fossa
Hip joint forces when shifting to the right:
A. Relative (L) hip abduction, relative (R) hip adduction
B. Relative (L) hip adduction, relative (R) hip abduction
C. Relative (L) hip abduction, relative (R) hip adduction
D. Relative (L) hip adduction, relative (R) hip abduction
A. Relative (L) hip abduction, relative (R) hip adduction
When weight shifting to the R from a neutral position, the muscles contract eccentrically to prevent falling from excessive shifting. When moving back into the neutral position, the right hip abductors and left hip adductors contract concentrically.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: Gravity is the primary external force when moving from neutral to right weight shifting.
___ use of a cane is prescribed by PTs because the contralateral latissimus dorsi assists hip abductor (gluteus medius) in producing counter-torque against gravity. Thus, the latissimus dorsi will pull the pelvis up, and compressing the affected hip joint will be avoided as the gluteus medius will not have to contract anymore.
Contralateral
TRUE OR FALSE: Use of a cane reduces about 15% of body weight compressing on the affected hip.
True
Note: The main goal of the use of a cane is to reduce weight bearing on the affected hip joint and direct some of the weight of the HAT on the cane.
TRUE OR FALSE: In unilateral stance, compensatory lateral lean of the trunk / listing occurs to decrease torque in unilateral stance & if the body weight cannot be reduced.
True
TRUE OR FALSE: In unilateral stance, the hip slightly tilts up on the unsupported side to resist the natural downward pull of gravity when the leg is NWB.
True
It is also known as the primary weight-bearing surface of the acetabulum and is located on the superior surface of the lunate surface
Dome of the acetabulum
Note: The superior periphery of the acetabulum is thicker as it is the primary WB area. It is visualized as a horseshoe and lined with hyaline cartilage.
The acetabulum is further deepened by the ____.
acetabular labrum
Enumerate the 7 joints that participate when the pelvis moves.
- Lumbosacral (1)
- Sacrococcygeal (1)
- Left and right sacroiliac joints (2)
- Symphysis pubis (1) - amphiarthrodial, cartilaginous joint
- Left and right hips (2)
Actions of this muscle are flexion, abduction, and external rotation of the hip, and flexion and internal rotation of the knee.
Sartorius
Actions of this muscle are flexion, abduction, and internal rotation of the hip.
Tensor fasciae latae
Specific test for a tight iliotibial band or tensor fasciae latae
Ober’s test
Hip adductors are secondary hip flexors because some of their fibers are found anteriorly. These muscles are capable of producing hip flexion when hip is flexed at __ degrees.
40-50
Note: The gracilis is active only when the knee is fully extended.
In unilateral stance, about 5/6 of body weight is borne on WB/stance LE and some ___ motion is generated on the WB hip joint to direct the CoG to the BoS for stability.
adduction
Note: The adduction torque on WB LE causes counter-torque by hip abductors on WB LE to counterbalance about 85% of BW during each step taken (Brunnstrom). The forces that can elevate the pelvis to counteract the downward force of gravity are the gluteus medius, latissimus dorsi (if pushing down on AD), and quadratus lumborum (mostly OKC).
This ligament is the primary stabilizer on the anterior aspect of the hip that prevents excessive hyperextension. Most fibers also control excessive external rotation.
Iliofemoral Ligament / Y Ligament of Bigelow
Note: In the posterior view, some fibers also are found posteriorly
and this small portion of fibers contributes to control of internal rotation.
Ligament attached from apex at AIIS to the inferior and superior aspects of the intertrochanteric line of the femur
Iliofemoral Ligament / Y Ligament of Bigelow
Ligament attached from the posterior acetabular rim and labrum, then spirals around the femoral neck to attach to the intertrochanteric line.
Ischiofemoral Ligament (Posterior Capsular Ligament)
TRUE OR FALSE: Both coxa vara and coxa valga are deviations in the frontal plane and can lead to abnormal lower extremity biomechanics, altered muscle function, and gait abnormalities that contribute to pathologies such as hip and knee osteoarthritis and slipped capital femoral epiphysis.
True
Ligament attached from the pubic ramus to the intertrochanteric line
Pubofemoral ligament
Coxa vara (<125º) makes the femoral head more congruent with the acetabulum. Its advantage is increasing the moment arm of the gluteus medius by placing it farther from the joint axis, thus increasing its torque generation capacity.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: Coxa vara is more likely to occur later in life as arthritic changes decrease the angle.
Coxa valga (>125º) causes LE lengthening and may result to some knee valgus/genu valgum. In this deviation, the moment arm of gluteus medius is decreased, torque capacity is lowered, and the hip abductors are weak.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: In this deviation, the femoral head can easily go out of socket/dislocate as a result of hip instability. This instability & increased ROM may further lead to femoroacetabular impingement and the progression of labral tearing, loss of joint stability, and eventual arthrosis.
Normal value of the angle of inclination of the femur by age 2 and throughout adulthood or skeletal maturity
120-125º
Note: The angle of inclination is somewhat smaller in women than it is in men. As the child starts to learn how to stand and walk, the angle decreases from 150º to 125º as a result of compressive and tensile forces during infancy and early childhood exerted by muscle tone, contraction and weight bearing. Thus, the acetabulum deepens and angle of inclination decreases, which improve congruency and align muscles for optimal leverage.
The angle of inclination is formed by the axis of the femoral shaft and the axis of the femoral head and neck. The angle of torsion is the innate medial twist of the femoral bone that is formed by a line through the long axis of the femoral head and neck and another line through the ends of the femoral condyles.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
B. Only the 2nd statement is true
Note: Both of these angles improve the femur’s mechanical efficiency.
Normal value of acetabular anteversion when the acetabulum is positioned too far anteriorly in the transverse plane.
20º
Note: This angle is measured by drawing a line from the anterior and posterior edges of the acetabulum and another line facing forward/parallel to the sagittal plane.
The hip joint is formed by the articulation between the convex femoral head and concave acetabulum. The 3 bones forming the innominate bone (os coxa) meet on the concave acetabulum, where it is formed by ⅕ from pubis, ⅖ from ilium, and ⅖ from ischium.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: The os coxa is formed by: ilium (superior), pubis (inferoanterior), and ischium (inferoposterior).
Angle between a vertical line through the center of the femoral head and a second line from the center of the femoral head to the outer/lateral edge of the acetabular roof.
Center edge angle / angle of Wiberg / vertical center anterior angle
The acetabular fossa is the nonarticular center of the socket not lined with hyaline cartilage. It does not bear weight and serves as reservoir for synovial fluid when hip is heavily loaded.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: As the hip joint compresses during WB, synovial fluid is secreted for lubrication. When forces decrease, synovial fluid returns to the reservoir.
The acetabular labrum decreases force transmitted to the articular cartilage and provides proprioceptive feedback. Along with the acetabular fossa, it also enhances joint stability by acting as a seal or partial vacuum to maintain negative intra-articular pressure, creating a suction effect.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: The seal is possible because of joint capsule enclosing the hip joint.
The secondary hip extensors are the gluteus medius (posterior fibers), adductor magnus (posterior fibers), and piriformis. The secondary hip abductors are the gluteus maximus (superior fibers) and sartorius, both active when there is resistance during hip abduction; and the TFL, if hip abduction is simultaneous with hip flexion.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
The femoral head is made up of hyaline cartilage and its articular area is more circular than the acetabulum. The radius of curvature of the femoral head is smaller in women than in men in comparison with the dimensions of the pelvis.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
The acetabular labrum makes the hip joint congruent and increases the concavity of the acetabulum through its triangular shape, grasping the head of the femur to maintain contact with the acetabulum. The labrum is attached to the periphery of the acetabulum by a zone of calcified cartilage with a well-defined tidemark.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: The labrum is strong, fibrocartilaginous, and analogous to the meniscus of the tibiofemoral joint.
The coxofemoral /acetabulofemoral joint is a diarthrodial, triaxial, ball-and-socket/enarthrodial/universal joint. Its primary function is to support the weight of the head, arms, and trunk (HAT) both in static erect posture and in dynamic postures such as ambulation, running, and stair climbing.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: The joint is designed for stability and the joint surfaces of femoral head (2/3 of a sphere) and acetabulum (hemisphere) correspond better and have firmer connections than glenohumeral joint surfaces.
A potential cause of hip instability even though it is not the complete open packed position of hip. It is the usual mechanism of injury for posterior hip dislocation/subluxation, with direct trauma.
flexion, adduction, and internal rotation (W-sitting)
TRUE OR FALSE: The posterior fibers of the gluteus maximus, gluteus medius, and gluteus minimus muscles are secondary hip external rotators.
True
The acetabulum is not fully encircled by the acetabular labrum and has a space inferiorly, known as the acetabular notch. The acetabulum is completed by the transverse acetabular ligament, which contains no cartilage cells.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false
C. Both statements are true
Note: Approx ⅘ is occupied by the labrum, ⅕ left empty (to be occupied by the transverse acetabular ligament).
