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Flashcards in Hip Deck (81):

What is the angel of the femur in the transverse plane?

12-15 degrees


Which direction is the head of the femur angled>

slightly ant, inf and medially


Do female anatomical differences increase risk of any type of injury?

yes, fracture


which hip ligaments contribute to stability of the hip?

iliofemoral ligament (Y ligament) checks hiphyperext; pubofemoral ligament checks abd and ext


Normal ROM for hip flexion



Normal ROM for hip ext

10-30 degrees


Normal ROM for hip abd



Normal ROM for hip add

10-30 degrees


Normal ROM for hip ER



Normal ROM for IR



Name the hip flexors:

iliopsoas, rectus femoris, tensor fascia latae, sartorious, pectineus, adductor brevis, adductor longus, and oblique fibers of adductor magnus


Name the hip extensors crossing the hip joint:

Glut max, bicep femoris, semimembranous, semitendinous


Name the hip abd crossing the hip joint:

glut med, glut min, tensor fascia latae, upper fibers of glut max


Name the hip add crossing the hip joint:

adductor magnus, adductor longus, adductor brevis, pectinus, gracilis


Name the hip ER crossing the hip joint:

obturator externus, obturator internus, quadratus femoris, piriformis, gemellus superior, gemellus inferior, gluteus maximus, sartorius, and biceps femoris


Name the hip IR crossing the hip joint:

Gluteus min, tensor fascia latae, ant fibers of glut med, semitendinous and semimembranousis


What is inversion of muscle action

muscles that cross a joint with 3 degrees of freedom may have alternate or even opposite actions than their classically described actions


What happens to hip strength with OA?

abd and flexion decrease significantly, and ext also decreases with B hip OA


Describe blood supply to the femoral head:

main supply is the extracapsular ring from the medial femoral circumflex artery, followed by ascending cervical branches, and very little from artery of ligamentum teres


Describe the trochanteric bursa:

1.) between glut max and med tendon 2.) glut max and greater trochanter 3.) glut med and greater trochanter; other bursa can form from excessive friction


Functional ROM of hip:

90 degrees flexion, 20 abd, and IR/ER from 0/20


How are muscle strains classified?

Grade 1: little tissue disruption, low grade inflammatory, strength testing produces pain no weakness, no loss of ROM, grade2: some disruption of muscle fibers but not complete, strength ROM decreased pain significant grade 3: complete rupture loss of strength, palpable or visible defect may be present


MOI for glut med strain?

running producing a seesaw motion, but can occur in swimmers as well; typically tender just above the greater trochanter and painful with resisted abd (which bursitis is not)


What is bald trochanter?

rupture and retraction of the glut med and min tendons; Tx use a cane, NSAIDs, and possible surgery


How do groin pulls occur?

most commonly the adductor longus with quick acceleration or direction changes typically because of a lack of strengthening (abd to add ratio) and stretching of the adductors other factors are previous injury and lack of experience


Tx for groin pull?

8-12 wk of strengthening of the adductors with focus on the eccentrics resistive exercise, balance training, core strengthening and sport specific movements (stretching, massage, and modalities are not supported)


When is surgery necessary for a groin pull?

If symptoms persist after 6 months


What is a sports hernia

overuse syndrome with rectus abdominus insertion, internal obliquis insertion, or the external oblique muscle aponeurosis


What is the most frequently strained muscle in the body?



Are quad strains common?

No, but can happen with rapid deceleration


Thomas test assesses what?

rectus femoris length


Ely's test assesses

quadriceps length


How are the oblique muscles injured?

abdominal contraction for side bend


Tx for a muscle strain

stage I: rest ice (24-72 hours) stage II: gentle ROM and isometric ex stage III: isotonic and isokinetic ex, stretching and aerobic activity stage IV: sport specific ex


Describe trochanteric buristis

more common with a wider pelvis, runners who cross midline, runners running on a banked surface, or people with a leg length discrepency get increased friction on the bursa


Symptoms of trochanteric bursitis

snapping at the lateral hip with tightness of the ITB, pain typically is provoked by ascending stairs and laying on the effected side; stretching reproduces pain; active and passive MMT/ROM painful


Tx for trochanteric bursitis

Rest, ice, NSAIDs, injections, activity modificaiton


How does iliopectineal and iliopsoas bursitis develop?

OA and RA, overuse, or direct trauma


What rehab considerations are important after hip fracture?

capsular trauma is common, so hip precautions should be followed even with fracture and ORIF


what features distinguish a stable pelvis fx from an unstable one?

A single break is typically stable, any fractures outside of the pelvic ring are stable (inf pubic rami), the posterior SI ligamentous complex is the most important, double breaks are more likely to be unstable


What is a Malgaigne fx?

double break same side inf and sup pubic rami, often associated with ipsilateral SI dislocation


MOI for pelvic fx

fall for an elderly individual, or high velocity lateral compression or A-P compression


MOI for acetabular fx

Direct loading with a fall or motor vehicle accident


Does neuromuscular stimulation to the quads hasten return to mobility after a hip fx?



Presentation of a hip dislocation?

90% are posterior which will present flexed, adducted, and IR'ed - ant dislocation limb shortened, abducted, ER'ed


Do patients with or without hip precautions after anterolateral THA return to work faster?

without precautions


What is slipped capital femoral epiphysis?

The femoral head epiphysis slides off the femoral neck, which can lead to variable limits in hip IR and flexion; more common in underweight and underdeveloped male children


Adductor longus and brevis tendinopathy will be painful with what resisted motion?

Adduction from neutral


Gracilis tendinopathy will pain with what resisted motion?

Resisted hip add and resisted knee flexion from neutral


Pectineus tendinopathy will painful with what resisted motion?

hip fleixon and adduction from 90 degree hip flexion


Persistent hip bursitis may indicate what?

calcification of a tendon, will typically present with weak hip abd


Is open mesh or laproscopic repair more superior in sportsman hernia repair

open mesh


What is typical time for return to sport activity after sportsman hernia surgery?

1-2 months


What is cam impingement?

associated with a nonspherical femoral head and neck relationship, this loss of roundness contributes to abdnormal contact between the head an socket


what is pincer impingement

occurs when the acetabulum has too much coverage around the femoral head and the labrum gets pinched between the rimof the socket and anterior femoral head-neck junction


What is pincer impingement typically caused by?

secondary to retroversion or a turning back of the acetabulum, profunda (socket that is too deep) or protusio (femoral head extends into the pelvis)


What symptoms will a patient with a labral tear complain of?

INcreased pain with sitting and climbing stairs along with possible clicking and locking and/or giving way during WB'ing activities, possible limitation in during passive IR with the hip flexed


A patient presents with resting groin pain after a traumatic fall and has end range passive hip flexion 2/10, FADIR of 6/10 groin pain, and modified circumduction test 8/10 pain - what might she have?

Traumatic acetabular labral tear


Sportsman's hernia potentially involves what fibers

transversalis, conjoined tendon, or internal oblique fibers


What is ostetis pubis?

noninfectious inflammation of the pubis symphysis (also known as the pubic symphysis, symphysis pubis, or symphysis pubica) causing varying degrees of lower abdominal and pelvic pain, may present with groin pain, reduced passive hip IR and or ER, sclerotic changes, T2 MRI changes strongly correlate with symptoms, and failure with conservative Tx - possible benefit from surgical stabilization


What part of the hip labrum is least susceptible to a tear?

the outer border because of good blood flow and least likley to be exposed to compressive forces - internal substance has poor blood flow, superior region at risk for compressive forces


Psoas tendinopathy will typically be pain free with which resisted motion?



Coxafemoral traumatic arthritis presents in what way?

limited motion and slight pain much like a capsular pattern but occurs after a trauma ie fall


To improve a flexion limitation in the hip what is the best postion for manual therapy tx?

hip flexion, with abd and IR


What conditions will benefit from a high velocity, low amp manipulation of the hip?

intraarticular flake fracture loose body, idiopathic loose body, arthrtic loose body, and/or labral tear


HOw will an individual with intraarticular loose body present?

sharp, shooting pain followed by giving way and a pathological endfeel (ER, add) with no limitation


Best treatment for a SCFE

percutaneous pinning in situ


Hamstring syndrome can present much like hamstring tendinopathy but what is the biggest differentiating factor?

Sciatic nerve entrapment will have neural symptoms - pain with sitting, resisted knee flexion with hip flexed to 90, worsened with ankle DF, resisted hip ext and knee flexion in prone is pain free


Best tx for hamstring syndrome?

neural mobilization, sitting changes, and avoidance of stretching


What tests for pelvic ring instability?

active straight leg raise, which can be repeated once stabilizing the pelvis


What treatments would be inappropriate for a glut med tear?

stretching and cross friction massage, - NSAIDs, heel lift, assistive device, activity modification to include no crossing legs are more appropraite and possible surgery


Aching pain is more associated with what hip issues?

tendinopathy, bursitis, arthritis, and arthrosis


Sharp pain is more associated with what type of hip issues?

Labral tears or articular loose bodies often accompanies by a clicking, giving way, and/or a feeling of joint "catching" or locking


Burning pain is more associated with what type of hip issues?

Nerve entrapments from the femoral head - lat femoral cutaneous, ilioinguinal, genitofemoral, obturator, or sciatic nerves; may be accompanies by parasthesia or numbness


Possible causes for groin pain?

CFJ and labrum injury, symphysis pubis lesion, adductor tendinoapthy, iliopectineal bursitis, incompetent abdominal wall, or any number of urological


Posterior hip or buttock pain causes?

SIJ, gluteal bursitis, hamstring tendinopathy, hamstring syndrome, and/or lumbar pathology


Possible causes for posteriolateral hip pain?

Trochanteric bursitis, gluteal insertion tendinopathy, or disruption


Pain with coughing, sneezing, or straining can suggest what?

hernia, pubic symphyseal affliction, or tendinopathy of the adductor longus, or rectus abdominus


What is the proposed hip capsular pattern?

IR most limited an d painful accompanies by a variable combination of limits in flexion, extension, and abduction


CPR for OA in the hip:

3 of 5 of the following 1) self reported squatting aggravates 2) active hip flexion causing lateral hip pain 3) scour test with add causing lat hip or groin pain 4) active hip ext causing pain 5) passive IR of < or 25 degrees


Micro and macrotrauma synovitis (arthritis) is best treated with what?

Early mobilization