hip

Question 1

what is the pelvic girdle comprised of?

Answer 1

2 sets of hip bones, connected in my middle by sacrum and coccyx

Question 2

where do the sacral nerves pass through?

Answer 2

holes in the lateral sacrum, formed by fusing of the transverse processes

Question 3

what is each hip bone made of?
(also called innominate bone)

Answer 3

ilium: has iliac crest and the ala (wing like area), forms superior acetabulum
pubis: forms anteromedial acetabulum
ischium: forms inferior acetabulum

Question 4

what are the components of the ischium?

Answer 4

ramus: fuses with the pubic ramus to form posterior border of obturator foramen
tuberosity: sit bones, when hamstrings attach
spine: process that separates greater and lesser sciatic notches

Question 5

what is the lunate surface of the acetabulum?

Answer 5

horseshoe shaped articular surface on peripheral edges, made of articular cartilage

Question 6

what is the acetabular fossa?

Answer 6

non-articular surface, filled with fat

Question 7

what is the femoral head covered in?

Answer 7

articular cartilage
articulates with the lunate surface of the acetabulum

Question 8

what is the greater trochanter the attachment site for?

Answer 8

gluteus medius and minimus, obturator internus and piriformis

Question 9

what is the lesser trochanter the attachment site for?

Answer 9

iliopsoas muscle

Question 10

where is the greater trochanteric bursa?

Answer 10

deep to the gluteus maximus, in between the minimus and medius on the greater trochanter

Question 11

where is the iliopsoas bursa?

Answer 11

between the iliopsoas and anterior joint capsule
(closer to acetabulum)

Question 12

where is the anterior hip recess?
where does the anterior hip capsule extend to?

Answer 12

superficial and inferior to femoral head, superficial to femoral neck

extends inferiorly to the intertrochanteric line

Question 13

what should the measurement for the anterior hip capsule be?

Answer 13

<7mm

evaluate for fluid build up

Question 14

where does the iliopsoas tendon insert and what is the function?

Answer 14

inserts medially on the lesser trochanter, flexes the hip joint

Question 15

where does the rectus femoris muscle originate and insert, and what is the function?

Answer 15

origin on anterior/inferior iliac crest, inserts on the tibia
extends the hip joint

Question 16

what does NAVEL stand for?

Answer 16

nerve, artery, vein, empty space, lymphatic

for the femoral neurovascular bundle medial to the iliopsoas tendon

Question 17

what are the 3 adductor muscles/tendons of the medial hip?

Answer 17

adductor longus: only one assessed with ultrasound
adductor brevis
adductor magnus

(all originate on pubic ramus)

Question 18

where do the gluteus medius and minimus insert? what is their function?

Answer 18

minimus: anterior facet of greater trochanter
medius: lateral facet of greater trochanter

medially rotate and abduct the hip

Question 19

what 3 muscles make up the hamstrings?

Answer 19

biceps femoris
semitendinosus
semimembranosus

extend the thigh and flex the knee

Question 20

what is the largest nerve in the body?
where does it divide?

Answer 20

sciatic nerve
divides just above the pop fossa

Question 21

what does the sciatic nerve innervate?

Answer 21

hamstring muscles and short head of the biceps femoris

Question 22

what is the most common pediatric presentation in orthopedic practices?

Answer 22

irritable hip

Question 23

what is the most common cause of irritable hip? what is the presentation?

Answer 23

transient synovitis

happens typically between 5-8 years old with painful hip and unable to bear weight

Question 24

what measurement is considered joint effusion in a pediatric hip?

Answer 24

> 5mm in the anterior joint space

> 2mm difference from the contralateral hip is abn

Question 25

what are the most common causes of joint effusion in peds?

Answer 25

transient synovitis***, septic arthritis or Perthe's disease larger effusions are more commonly associated with synovitis

Question 26

what is transient synovitis defined by? (what is it? what causes it)

Answer 26

inflammation of the synovial joint capsule from an upper resp infection moving to the hip

Question 27

when is transient synovitis more common, girls or boys?

Answer 27

boys

Question 28

what is the clinical presentation for transient synovitis?

Answer 28

1-7 days of pain and limping with refusal to bear weight, resolution in 2 weeks

Question 29

what should be considered if the transient synovitis does not resolve on its own?

Answer 29

Perthe's disease

Question 30

what is septic arthritis?

Answer 30

bacterial infection of the hip, can lead to rapid cartilage and tendon deterioration and bone damage

Question 31

how does septic arthritis appear?

Answer 31

thickened anterior capsule and complex joint effusion due to presence of pus very similar to transient tenosynovitis

Question 32

what is Perthe's disease?

Answer 32

blood supply to the femoral head is interrupted and bone cells begin to necrosis, causing a flattened head

Question 33

how does Perthe's disease appear?

Answer 33

effusion, thickening of the femoral head articular cartilage, fragmentation of the epiphysis difference of 3mm to the contralateral side is abn

Question 34

is Perthe's disease a chronic or temporary disease?

Answer 34

temporary, blood supply returns and bone grows back

Question 35

what is the measurement for adult hip effusion?

Answer 35

anterior joint capsule >5mm

Question 36

What is synovial chondromatosis?

Answer 36

synovial villi develop ossified bodies, may break off and become loose in the joint

Question 37

what is pigmented villonodular synovitis? (PVNS)

Answer 37

overgrowth and thickening of the synovium, is a type of giant cell tumor most common in 40-60yo's, can present as a large synovial mass in the hip joint

Question 38

what is the most common finding of trochanteric bursitis?

Answer 38

thin portion of thickened synovium, difficult to differentiate compare with contralateral side, large effusions here are uncommon

Question 39

what is DDH?

Answer 39

developmental dysplasia of the hip caused by shallow acetabulum where the femoral head can slip out of the socket

Question 40

what is the window of opportunity to treat DDH? what happens when left untreated?

Answer 40

within first 6 months of life can develop into inability to walk when child is 1yo - or limp/abn gait in childhood and a lifetime of limited ROM

Question 41

what are the risk factors of DDH?

Answer 41

F: female F: first born F: family hx B: breech O: oligohydramnios

Question 42

what is Graf's method?

Answer 42

focuses on measuring the shape and size of the acetabulum, measurements taken when coronal image is taken measurements are the base line, roof line, and labrum line

Question 43

for Graf's method: what is the alpha angle? beta angle?

Answer 43

alpha: between roof and base line, >60 is normal beta: between labrum and base line, >55 is normal

Question 44

what is Morin's method?

Answer 44

using same image as Graf's method, 2 lines are drawn 90* to the base line 1st line: from baseline to bottom of femoral head 2nd: from top to bottom of femoral head

Question 45

what is the normal % for Morin's method?

Answer 45

52% and above is considered normal

Question 46

how often are hip ultrasounds done on a neonate once DDH is diagnosed?

Answer 46

every 2 weeks to see if it resolves on its own

Question 47

if the DDH hip remains unstable, what is the treatment?

Answer 47

splint therapy if severe or diagnosed late, sx reduction of the femoral head into acetabulum is considered