Gluteal Region and Hip Joint

Question 1

Posterior dislocation of the hip

Answer 1

may occur subsequent to trauma during which the limb is flexed and the lower limb is adducted and medially rotated on the hip (e.g. automobile accident). The affected limb is medially rotated (due to unopposed action of adductor muscles) and appears shorter (due to unopposed action of the iliopsoas muscle). Portions of the sciatic nerve may be compromised

Question 2

Congenital dislocation

Answer 2

involves displacement of the femoral head outside

the acetabulum. The affected limb appears shorter and abduction is limited.

Question 3

Femoral neck fracture – “Broken Hip”.

Answer 3

The disruption of the blood supply to the head and neck of the femur (i.e. medial and lateral circumflex arteries) that occurs with a femoral neck fracture may result in avascular necrosis of the femoral head. The affected limb is laterally rotated due to the pull of the muscles attached to the dissociated pieces of bone.

Question 4

Superior Gluteal nerve lesion or Radiculopathy involving L5 nerve root

Answer 4

Impaired abductor muscle function (gluteus medius and gluteus minimus muscles). Muscles are unable to provide necessary stability and pelvis on non-weight-bearing side will “sag”. This is known as a positive Trendelenburg sign.

Question 5

Lesions of L1-L2 ventral rami

Answer 5

Impaired hip flexion and difficulty walking (iliopsoas muscle).

Question 6

Obturator nerve lesion (L2-L4)

Answer 6

Impaired adductor muscle function. During normal adduction of the hip, the foot is placed directly under the pelvis. When adductor muscle function is impaired, the foot is in alignment with the shoulder. This is known as a “waddling gait”.