S3_L2: Pelvis & Hip Flashcards
TRUE OR FALSE: The normal femoral angle of inclination in adults is 125°.
True
TRUE OR FALSE: The psoas muscle is inserted at the greater trochanter.
False
The psoas muscle inserts at the lesser trochanter.
TRUE OR FALSE: 30° of hip flexion is needed during midswing to initial contact of the gait cycle.
True
TRUE OR FALSE: The central portion of the acetabulum is a non-articulating surface.
True
TRUE OR FALSE: The largest and the most important hip capsule ligament is the iliofemoral ligament.
True
TRUE OR FALSE: Obturator nerve comes from the nerve roots L2, L3, and L4.
True
TRUE OR FALSE: The semitendinosus is most commonly injured in hamstring strain.
False
The short head of the biceps femoris is most commonly
injured in hamstring strain.
TRUE OR FALSE: There is 0° hip adduction during initial contact.
False
There is 10° hip adduction during initial contact.
TRUE OR FALSE: The femoral triangle is formed by the inguinal ligament proximally, sartorius laterally, and adductor magnus medially.
False
The adductor longus forms the medial component of the femoral triangle.
TRUE OR FALSE: On the side of hip drop, there is hip abduction.
True
Each innominate bone of the pelvis is formed by the
union of the (1)____, (2)_____, and (3)____ bones and
therefore is a structural unit.
- ilium
- ischium
- pubic
What is the angle of torsion of the femur?
8° to 25°, with an average angle of 12°
Source: Kisner and Colby, 7th ed.
This pelvic motion results in hip flexion and increased
lumbar spine extension.
Anterior Pelvic Tilt
Source: Kisner and Colby, 7th ed.
The following may cause a unilateral short leg, EXCEPT:
A. Flat foot
B. Anteriorly rotated innominate bone
C. Coxa vara
D. Genu varum
D. Genu varum
Source: Kisner and Colby, 7th ed.
In hip OA, where is the pain usually referred?
L3; medial side of the knee
What gait is expected to be seen in a patient who is diagnosed with degenerative joint disease?
Antalgic Gait
What is the recommended parameters for US in a patient with hip OA? Answer in proper documentation format.
Cont. US using big head x 1 MHz x 1 W/cm^2 x 5 mins
each on ant., post., & lat. aspects of (L) hip to ↓ pain
CASE: S.F. 64 y/o (+) Htn, (-)DM ® handed ♀ who was referred to you for PT eval and mx 2 to S/P (R) THR 8 days ago. Pt also c/o an intermittent dull pain on the ® hip area gr. 4/10 on a subjective pain scale (0=no pain 10=worst possible pain). Aggravated by prolonged WB activities like standing and walking (6/10); relieved by rest. Condition started 9 days ago when pt accidentally slipped inside the bathroom with the ® buttocks and felt a sharp pain on the hip area. Pt was immediately rushed to the ER of Asian Medical Center; x-ray showed femoral neck fx which prompted surgery the following day. Pt had cemented THR, c posterolateral approach 5 days ago. Pt was referred to in-pt rehab for 6 days (bid). PMHx: (+) osteoporosis diagnosed 2 yrs ago. Pt. is a retired teacher who does walking exercises for 30-45 minutes guided by Youtube exercise videos 2x/wk. Pt currently lives c her daughter, sleeps in a bedroom on the first floor; bathroom ~20 steps away, kitchen~20 steps away and living room ~15 steps away. Pt wants to be able to move around s difficulty and return to her own house.
Based on the case, what must be the modality used on the 5th PT session when bluish skin discoloration around surgical site are observable?
Cryotherapy
CASE: S.F. 64 y/o (+) Htn, (-)DM ® handed ♀ who was referred to you for PT eval and mx 2 to S/P (R) THR 8 days ago. Pt also c/o an intermittent dull pain on the ® hip area gr. 4/10 on a subjective pain scale (0=no pain 10=worst possible pain). Aggravated by prolonged WB activities like standing and walking (6/10); relieved by rest. Condition started 9 days ago when pt accidentally slipped inside the bathroom with the ® buttocks and felt a sharp pain on the hip area. Pt was immediately rushed to the ER of Asian Medical Center; x-ray showed femoral neck fx which prompted surgery the following day. Pt had cemented THR, c posterolateral approach 5 days ago. Pt was referred to in-pt rehab for 6 days (bid). PMHx: (+) osteoporosis diagnosed 2 yrs ago. Pt. is a retired teacher who does walking exercises for 30-45 minutes guided by Youtube exercise videos 2x/wk. Pt currently lives c her daughter, sleeps in a bedroom on the first floor; bathroom ~20 steps away, kitchen~20 steps away and living room ~15 steps away. Pt wants to be able to move around s difficulty and return to her own house.
Based on the case, the following PT Education must be taught, EXCEPT:
A. Sit in a high chair
B. Avoid lying on the affected side
C. Always place a pillow between both legs
D. When getting up from bed, use the operated leg first.
E. Feet should be pointed upward when lying down and forward when standing
D. When getting up from bed, use the operated leg first.
In which specific part of the hip do fractures most commonly occur
fractures in the intertrochanteric region
Source: Kisner and Colby, 7th ed., page 740
In cases where hip fracture or dislocation occurs and nonoperative management is the only treatment option, what modality should a PT use for the pt?
Traction
Source: Kisner and Colby, 7th ed., page 741
How many degrees of hip flexion, abduction, and external rotation are necessary to carry out activities of daily living (ADLs) in what is considered a “normal” manner?
Flexion - 120
Abduction - 20
ER - 20
Source: Kisner and Colby, 7th ed., page 714
What is the orientation of the acetabulum?
anterior, lateral, and inferior
Source: Kisner and Colby, 7th ed., page 715
The neck and head of the femur projects in which directions?
anteriorly, medially, and superiorly
Source: Kisner and Colby, 7th ed., page 715
What are the three ligaments that reinforce the hip joint capsule?
iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament
Source: Kisner and Colby, 7th ed., page 715
Determine which movement do the following ligaments restrict.
- external rotation
- abduction
- excessive extension
- internal rotation
- abduction when the hip is flexed
A. ischiofemoral ligament
B. Iliofemoral ligament
C. pubofemoral ligament
D. All
E. None
- B
- C
- D
- A
- A
Source: Kisner and Colby, 7th ed., page 716
Which of the following hip ligaments is also known as the Y Ligament of Bigelow?
iliofemoral ligament
Source: Kisner and Colby, 7th ed., page 715
Determine which describes the following ligaments.
- strongest
- found anteriorly
- found posteriorly
A. ischiofemoral ligament
B. Iliofemoral ligament
C. pubofemoral ligament
D. B & C
E.
- B
- D
- A
Source: Kisner and Colby, 7th ed., page 715
In performing joint mobilization, a PT desires to increase hip IR. What direction of glide must he perform to achieve this goal?
Posterior glide
Source: Kisner and Colby, 7th ed., page 716
Pelvic shifting is often seen with _____ postures
slouched or relaxed
Source: Kisner and Colby, 7th ed., page 718
When one iliac crest elevates, it is called (1)____; when it lowers, it is called (2)_____. On the side that is elevated, there is hip joint (3)____; on the side that is lowered, there is hip joint (4)_____.
- hip hiking
- hip or pelvic drop
- adduction
- abduction
Source: Kisner and Colby, 7th ed., page 718
The (1)_____, also known as lumbopelvic rhythm, is a combined movement occurs between the lumbar spine and pelvis during (2)_____ of the trunk as when reaching toward the floor or the toes
1.Pelvifemoral motion
2. maximum forward bending
Source: Kisner and Colby, 7th ed., page 719
Hip flexion in weight bearing is typically accompanied by knee (1)____ and ankle (2)____.
- flexion
- dorsiflexion
Source: Kisner and Colby, 7th ed., page 719
TRUE OR FALSE: If gluteus medius is weak, there is increased abduction of the femur and increased varus moment at the knee.
False
increase in adduction and knee valgus are observed
Source: Kisner and Colby, 7th ed., page 719
During weight-bearing, you noticed that your pt manifests with pelvic drop and side bending on the (R). In terms of flexibility, which muscle group is tight? Determine the laterality as well.
(R) Adductors
NOTE: The opposite occurs with tight abductors.
TRUE OR FALSE: A unilateral short leg causes lateral pelvic tilting and side-bending of the trunk away from the short side.
True
Source: Kisner and Colby, 7th ed., page 720
Unilateral anteversion results in a relatively ____ leg on that side
shorter
Source: Kisner and Colby, 7th ed., page 720
Determine the amount of movement that is seen in a normal gait cycle.
- 10 degree hip extension
- 10 degree hip adduction
- 30 degree hip flexion
- 5 degree hip abdcuction
A. mid swing and initial contact
B. initial contact
C. initial swing
D. terminal stance
- D
- B
- A
- C
Source: Kisner and Colby, 7th ed., page 720
To compensate for a flexor contracture, a person increases the lumbar (1)____ or walks with the trunk bent (2)____.
- lordosis
- forward
Source: Kisner and Colby, 7th ed., page 721
TRUE OR FALSE: The hip is innervated primarily from the L3 spinal level.
True
Source: Kisner and Colby, 7th ed., page 721
TRUE OR FALSE: With loss of flexor function, an anterior lurch of the trunk to initiate swing may be seen.
False
A posterior lurch is seen
Source: Kisner and Colby, 7th ed., page 721
Where is the sciatic nerve usually entrapped?
deep to the piriformis muscle
Scenario:
On April 1, 2023, A.R., a THR patient, was prescribed for FWB by a MD after 6 months of PT session. MD states that a cane is not necessarily anymore.
On April 2, 2023, you performed gait examination once again and the pt shows min diff in amb,. s cane and a (+) Trendelenburg sign.
As a knowledgeable PT, which of the following decisions will you do?
A. Follow the MDs decision and remove the cane
B. Continue use of cane until (-) Trendelenburg sign is observed
C. Strengthen hip abductors
D. A and C
E. B & C
E. B & C
NOTE: Continue cane use until weight-bearing restrictions are discontinued or if the patient exhibits gait deviations, such as a positive Trendelenburg sign on the operated lower extremity, indicating hip abductor weakness.
Source: Kisner and Colby, 7th ed., page 736
TRUE OR FALSE: In post-op fx alignment, a PT may expect to achieve 80° to 90° of active hip flexion (with the knee flexed) as early as 5-6 weeks postoperatively.
False.
This may already be seen 2 to 4wks post op.
How many weeks is WB restricted in a pt with cementless of hybrid THR?
6-8 weeks
TRUE OR FALSE: In acute phase of DJD, gait training may be initiated.
True
Determine which muscles act as the PRIMARY movers of the following hip movements.
- Gracilis
- TFL
- Gluteus minimus
- Iliopsoas
- Gluteus Maximus
A. Flexion
B. Extension
C. Abduction
D. Adduction
E. Flexion and Abduction
F. Extension and External Rotation
- D
- E
- C
- A
- F
Determine which muscles act as the PRIMARY movers of the following hip movements.
- Pectineus
- Piriformis
- Gemellus superior and inferior
- Sartorius
- Hamstring
A. Flexion
B. Extension
C. Abduction
D. Adduction
E. External Rotation
F. Internal Rotation
- D
- E
- E
- A
- B
What is the common post-op complication in using the posterolateral or back approach in THR patients?
aseptic loosening
Which gait deviations is commonly seen when the lateral or side approach is used in THR patients?
- Trendelenburg gait
- waddling gait
This bursitis occurs d/t prolonged sitting and is also known as Weaver’s Bottom.
Ischiogluteal Bursitis
The following are signs of ORIF failure, EXCEPT:
A. (+) Trendelenburg gait that does not resolve after
strengthening exercise of gluteus medius
B. Progressive limb length discrepancy
C. Blueish discoloration after 10 days post-op
D. Severe, persistent groin, thigh or knee pain that
increases with movement or WB
C. Blueish discoloration after 10 days post-op
This THR surgical approach is indicated for pts affected by stroke or cerebral palsy.
anterolateral or front approach
Determine which descriptions are for cemented or uncemented fixations.
- Porous-coated prosthesis
- For elderly and osteoporotic
- For <60 y/o
- Press-fit technique
- Allows early post-op WB
A. Cement
B. Uncemented
- B
- A
- B
- B
- A
When the TFL is dominant over the gluteus medius, (1) _____ knee pain, (2) ____ syndrome, or (3) ______ pain syndrome may occur.
- Lateral
- IT band
- Patellofemoral
In a unilateral short leg, where the lateral pelvic tilting and side bending of the trunk commonly observed?
LPT - drops on short side
SB - away from short side
Which actions are expected to have the greatest LOM in a patient with hip OA?
Internal rotation and adduction
Prescribing a cane is indicated when?
Pt’s pain scale is low, is able to FWB, and has unilateral affectation
In which side should a cane be held?
Opposite side of affected leg
What surgical approach for THR requires incision through gluteus medius and vastus lateralis?
Lateral / Side Approach
What is the position of comfort commonly seen in pts who have a hip fx?
ER of lower limb
