Hip

Question 1

ROM normal values of hip Flexion, Extension, Abduction, Adduction, IR, and ER

Answer 1

Flexion: knee ext; 0-90 degrees;
*flexed knee: 0-120 degrees
Extension: 0-20 degrees
Abduction: 0-45 degrees
Adduction: 0-40 degrees
IR & ER: 0-45 degrees

Question 1

What type of Joint is the hip joint?

Answer 1

multiaxial, ball and socket joint
*aka COXOFEMORAL JOINT

Question 2

Capsular Pattern of the hip joint

Answer 2

Flexion, Abduction, Medial rotation [FABIR]

Question 3

Resting position of the hip joint

Answer 3

FABER [30 Flex, 30 ABd, slight ER]

Question 4

Closed packed position of the Hip joint

Answer 4

Full extension, Medial Rotation, Abduction [EABIR]

Question 5

What is the most common direction of dislocation of the Hip joint?

Answer 5

Posterior

Question 6

Triad of Dashboard injury

Answer 6

Injury over the knee (PCL injury)
Injury over the symphysis pubis
Posterior hip dislocation

Question 6

The “vinegar cup is formed by the innominate bones, what are the exact bones?

Answer 6

Formed by 3 bones:
1/5 pubis
⅖ ilium
⅖ ischium

Question 7

Line formed at the lateral edge of the acetabulum as compared to vertical line forming femoral head
Normal (?) degrees

Answer 7

Center edge angle: WIBERG
Normal: 25-45 degrees

Question 8

CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
ACETABULAR COVERING IN RELATION TO FEMUR: Covers the front of the femoral head

Answer 8

ACETABULAR ANTERVERSION ANGLE

Question 8

Normal value of the Acetabular anteversion angle

Answer 8

Normal: 15-20

Question 8

Orientation of the accetabulum

Answer 8

Anterior-lateral-inferior
*Orientation: “ALIng Ceta”

Question 8

all of these describes the ACETABULAR LABRUM, EXCEPT:
- Dense, horseshoe-shaped fibrocartilaginous
stabilizes the hip during extreme ROM
- Provides proprioceptive information for dynamic stability
- Increases Knee area and volume for acetabulum
- Creates a seal for the central compartment, part of the intra-articular hip joint

Answer 8

• Increases Knee area and volume for acetabulum
  *Increases articular surface area and volume for acetabulum

Question 8

CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
DECREASED
Retroverted over coverage
Coxa profunda
Acetabular protrusion
LOM and impingement

Answer 8

ACETABULAR ANTERVERSION ANGLE

Question 8

T or F
LEGG CALVE-PERTHES DISEASE: 3-12 y/o boys
SCFE: 10-17 yrs old, boys

Answer 8

TRUE

Question 8

CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE

LANDMARKS
Oblique line from lateral rim of acetabulum
Vertical line form center of fem head

Answer 8

CENTER EDGE ANGLE

Question 8

What is the main blood supply of the Femur?
(in children and in adults)

Answer 8

Child: Retinacular artery
.
Adult: Retinacular artery and Obturator artery via ligamentum teres and metaphysial

Question 8

CORRELATED POSTURE
Toeing out, Subtalar supination, Lateral tibial torsion, Lateral femoral torsion

Answer 8

EXCESSIVE RETROVERSION

Question 8

CENTER EDGE ANGLE or ACETABULAR ANTERVERSION ANGLE
INCREASED
Over coverage:
Coxa profunda
Acetabular protrusion
LOM and impingement

Answer 8

CENTER EDGE ANGLE

Question 8

MOI: land on the outside of the hip

Answer 8

Trochanteric bursitis (possible)

Question 8

CORRELATED POSTURE
Toeing in, Subtalar pronation, Lateral patellar sublaxation, Medial tibial torsion, Medial femoral torsion

Answer 8

EXCESSIVE ANTERVERSION

Question 8

Avascular necrosis in child? In adult?

Answer 8

Child: LCPD (Legg-Calvé-Perthes disease)
Adult: Chander’s dse

Question 8

Values of Coxa valga and Coxa vara

Answer 8

Coxa valga (>135 degrees)
Coxa vara (<120 degrees)

Question 8

Where is the Elicitation of pain for these:
ANTERO-POSTERIOR IMPINGEMENT
Posteroinferior Impingement:

Answer 8

ANTERO-POSTERIOR IMPINGEMENT: Elicitation of pain: flexion and IR
.
Posteroinferior Impingement: Elicitation of pain: extension and ER

Question 8

These are advantage of Coxa?
Improve hip joint stability

Increases coverage from acetabulum

Good length tension relationship for hip abductors

Answer 8

Coxa vara (<120 degrees)

Question 8

Orientaion of the Femur

Answer 8

Superior, Anterior, Medial

Question 8

T or F
Subluxation, acetabular, labral tear:land on or hit the knee, thus jarring the hip
Femoral stress fracture: land on or hit the knee, thus jarring the hip

Answer 8

FALSE
Subluxation, acetabular, labral tear: land on or hit the knee, thus jarring the hip
Femoral stress fracture: involved in repetitive loading activity

Question 9

CORRELATED POSTURE
Pronated subtalar joint, Medial rot of leg, Short ipsilateral leg, Anterior pelvic rot

Answer 9

COXA VARA

Question 9

PNI, What nerve is affected?
Cause of injury:
during child birth
ant disloc of hip
Surgery over the hip (hernia)
Manifestation:
affectation/ weak quads
Paresthesia over the distribution

Answer 9

FEMORAL NERVE

Question 9

PNI, What nerve is affected?
Site of management over inferior border of gluteus minimus muscle or sometimes piriformis
Manifestation: trendelenberg sign (pelvis drop)

Answer 9

SUPERIOR GLUTEAL NERVE

Question 9

The disadvantage of Coxa vara

Answer 9

Prone to femoral neck fx

Prone to slipped capital femoral epiphysis

Leg length discrepancy d/t shortened leg

Question 9

CORRELATED POSTURE

Supinated subtalar joint, Lateral rotation of the leg
Long ipsilateral leg, Posterior pelvic tilt

Answer 9

COXA VALGA

Question 9

PNI, What nerve is affected?
Cause of injury
impingement during pregnancy, fx, tumor, surgery, direct trauma, pain over the groin
Manifestation:
pt will experience weakness over adductor muscle grp
Paresthesia over obturator nerve distribution

Answer 9

OBTURATOR NERVE

Question 9

PNI, What nerve is affected?
Largest
Pelvis or upper femur area
Piriformis syndrome
Pain and weakness on abd and ER of hip
Sign of pace and Nagel
Freiberg sign
Impingement of

Answer 9

SCIATIC NERVE

Question 9

What are and the structure affected :
True leg length
Apparent leg length

Answer 9

True leg legnth/true shortening (bone is affected)
Apparent leg length/functional shortening (muscle is affected)