Hip

Question 1

What is the osteology of the coxofemoral joint and what type of joint is it?

Answer 1

Ilium, ischium, pubis with the femur

Ball and socket

Question 2

Acetabulum has a lunate surface and covered in hyaline cartilage in order to do what?

Answer 2

Articulates with head of femur and increases depth

Question 3

What is the normal angle of inclination?

Why is this angle important?

Answer 3

-Serves to optimize joint surface
-Axis through femoral head/neck and longitudinal axis of femoral shaft
Normal = >125

Question 4

What is coxa valga?

Answer 4

increase in inclination

>125

Question 5

What is coxa vara?

Answer 5

decrease in inclination

<125

Question 6

A decrease in femoral neck-shaft angle (coxa vara) or angle of inclination along with a high body mass index may result in what?

Answer 6

Slipped capital femoral epiphysis in adolescents

Question 7

What is the angle of torsion?

Answer 7

occurs in transverse plane

Axis through femoral head/neck and distal femoral condyles

Question 8

What is the normal degree of anteversion at the hip?

Answer 8

8-20 (15 optimal)

Question 9

What are the ramifications of excessive anteversion?

Answer 9

• Increased angle of torsion
• reduce hip joint stability
• associated with increased hip IR and decreases ER

Question 10

What is retroversion?

Answer 10

• Decreased angle of torsion
• Associated with increased hip ER and decreased IR
• May cause impingement

Question 11

What are the ramifications of Excessive retroversion?

Answer 11

• Excessive anteversion in children may be associated with “in-toeing” gait
• This is a compensation that aims to improve joint congruency (see red dots)
• Overtime this may cause shortening of muscles and ligaments crossing hip and reduced ER of the hip

Question 12

What are some common acetabular abnormalities?

Answer 12

Acetabular dysplasia - shallow acetabulum

Coxa profunda/acetabular overcoverage - acetabulum excessively covers the femoral head

Question 13

What is the difference between a CAM lesion and a pincer lesion in regards to hip impingement?

Answer 13

CAM - extra bone on the femoral head
-Impingement occurs on bulge of femoral head against acetabulum
-IR with flexion max impingement
Pincer - extra bone of anterior-lateral rim of acetabulum
-Flexion and IR causes premature abutment of femur against acetabulum

Question 14

What is the bending moment of the femur?

Answer 14

Superiorly - tensile forces

Inferiorly - compressive forces

Question 15

What are the trabecular systems?

Answer 15

• Provide structural resistance
• Strongest where they cross at right angles
• Zone of weakness = thin and do not cross

Question 16

What structures provide stability at the hip joint?

Hip joint capsule -

Answer 16

• Substantial contributor to hip joint stability

- Thickened anterosuperiorly (predominate stress occurs)

Question 17

What structures provide stability at the hip joint?

Iliofemoral

Answer 17

• Anterior stability
• Controls IR/ER
• Tighten with hyperextension

Question 18

What structures provide stability at the hip joint?Pubofemoral -

Answer 18

• Controls ER in ext

- Tighten with hyperextension

Question 19

What structures provide stability at the hip joint?

Ishiofemoral -

Answer 19

• Restraint to IR

- Tighten with hyperextension

Question 20

What structures provide stability at the hip joint?

Transverse acetabular ligament -

Answer 20

Protects blood vessels that travel beneath to head of femur

Question 21

What structures provide stability at the hip joint?

Acetabular labrum -

Answer 21

• Wedge shaped
• Deepens concavity
• Seal to maintain (-) intra articular pressure

Question 22

What structures provide stability at the hip joint?

Ligamentum Teres -

Answer 22

• Blood supply to femoral head

- Excessive ER can strain/tear

Question 23

Describe the osteo of the hip joint.

Answer 23

Flex/ext
Abd/Add
Er/IR

Question 24

Describe the arthrokinematics of the hip joint.

Answer 24

Flex - Ant roll/post glide
Ext - Post roll/ant glide
Abd - Superior roll/inferior glide  
Add - Inferior roll/superior glide 
IR - Anterior roll/posterior glide
ER - Posterior roll/anterior glide

Question 25

Anterior/Posterior pelvic tilt (motion of pelvis on femur)

Answer 25

Closed kinetic chain: Sagittal plane Anterior tilt = Anterior roll and glide Posterior tilt = posterior roll and glide

Question 26

Lateral tilt (motion of pelvis on femur) If Left leg is stance leg: Right pelvis hike results in - Right pelvic drop results in -

Answer 26

Right pelvis hike results in - abduction at L hip | Right pelvic drop results in - adduction at L hip

Question 27

Lateral tilt (motion of pelvis on femur) arthro -

Answer 27

Closed kinetic chain: Frontal plane Abduction = superior roll and glide Adduction = inferior roll and glide

Question 28

Forward/backward rotation pelvis moving on femur: What plane? When do we see this?

Answer 28

- Transverse plane - Closed kinetic chain - Single limb support during gait

Question 29

Forward rotation pelvis moving on femur arthro -

Answer 29

Forward rotation - side of pelvis opposite stance leg moves anteriorly -> IR of stance hip -Anterior roll and glide

Question 30

Backward rotation of pelvis moving on femur arthro -

Answer 30

Backward rotation - side of pelvis opposite to stance leg moves posteriorly -> ER of stance hip -posterior roll and glide

Question 31

Describe the open pack position and capsular pattern at the hip joint.

Answer 31

Open pack = 30 flexion, 30 abduction, neutral to slight ER | capsular pattern = IR = Flex = Abd

Question 32

What muscles help perform an anterior pelvic tilt?

Answer 32

Anterior - hip flexor and low back extensors work as force-couple -Increased lumbar lordosis

Question 33

what muscles assist with a posterior pelvic tilt?

Answer 33

Posterior - Hip ext and abdominal muscles work as force couple -Decrease lumbar lordosis

Question 34

Why do the abdominals need to fire in order for us to perform a straight leg raise without compensation?

Answer 34

Abdominals must produce strong enough posterior pelvic tilt to neutralize the anterior pelvic tilt exerted by hip flexors

Question 35

What is the Tredelenberg sign? What does it indicate?

Answer 35

- If standing on one leg, pelvis drops on side opposite to stance leg - Glute med/min weakness on stance leg

Question 36

What can you do at the pelvis to maximize a hamstring and/or rectus femoris stretch?

Answer 36

Hamstring - anterior pelvic tilt | Rectus femoris - posterior pelvic tilt