Hip Joint Complex

Question 1

Max Bony Congruence

Answer 1

• Flexion, abduction, and external rotation (frog legged
position)
• Not position of highest stability

Question 2

Most Stable Position

Answer 2

• Extension, slight abduction, Internal Rotation

* Extension further tightens capsular ligaments

Question 3

Least Stable Position

Answer 3

Flexion with Adduction

Question 4

Ischiofemoral

Answer 4

Taught with hip Extension

Question 5

Iliofemoral

Answer 5

Fan shaped ligament resembles inverted

Y, strongest ligament at the hip. Checks hyperextension

Question 6

Pubofemoral

Answer 6

Taught in hip abduction and in extension. With the iliofemoral ligament it form a Z on the anterior capsule

Question 7

Femoral Neck

Answer 7

Angulates superiorly, anteriorly, and medially

Question 8

Angle of Wiberg/Center Edge Angle

Answer 8

Angle drawn between vertical and a line drawn from the center of the femoral to the bony edge/rim of the acetabulum; normally 35-38 degrees; smaller Angle of Wilberg increases risk of dislocation due to smaller load bearing surface

Question 9

Smaller Angle of Wiberg

Answer 9

Increased likelihood for superior dislocation; smaller load-bearing surface

Question 10

Inclination Angle

Answer 10

Neck to shaft angle; Superior/inferior inclination; Angle varies from individual to individual; Decreases with age for both genders; smaller angle for females (more cantilevered neck)

Question 11

Angle of Anteversion/Torsion

Answer 11

Anterior/posterior angulation; formed by the intersection of the long axis of the femoral head
and the transverse axis of the femoral condyles; measures medial torsion from proximal to distal end

Question 12

Normal Inclination Angle

Answer 12

125⁰

Question 13

Coxa Valga- Pathologically Larger Inclination Angle

Answer 13

> 125⁰; Larger/Steeper Inclination Angle; Causes higher than normal Joint Reaction Forces

Question 14

Coxa Vara- Pathologically Smaller Inclination Angle

Answer 14

<125⁰; Increases moment arm for abductor muscles, so need less muscle force, but creates greater bending and shear stress in the femoral neck and reduces ROM.

Question 15

Normal Hip Angle of Anteversion

Answer 15

15-20⁰

Question 16

Anteversion (pathologically high angle)

Answer 16

Toe in; Coxa valga; >20⁰; internal rotation during gait; causes adductor moments at the knee and ankle, also may cause posterior positioning of GRF
during propulsion effectively reducing the lever arm of
the triceps surae; decreases propulsion you get from the triceps surae

Question 17

Retroversion (pathologically low angle)

Answer 17

Toe out; <20⁰; external rotation during gait (duck-footed walk); may cause posterior positioning of GRF
during propulsion effectively reducing the lever arm of
the triceps surae.

Question 18

Posterior Pelvic Tilt

Answer 18

Brings pubis up; leads to hip extension and lumbar flexion; often occurs at the deepest part of an individual’s squat

Question 19

Anterior Pelvic Tilt

Answer 19

Brings anterior superior iliac spine (ASIS) anterior and inferior; leads to hip flexion and lumbar
extension

Question 20

Hip Flexion

Answer 20

Primary: Iliopsoas
Secondary: Rectus Femoris, Tensor Fascia Latae, Sartorius
Dependent on Hip Position: Pectineus, Adductor longus, Adductor magnus, Gracilis, Gluteus Minimus (anterior fiber)

Question 21

Hip Extension

Answer 21

Primary: Gluteus Maximus
Secondary: (Hamstrings) Semitendinosus, Semimembranosus, Long Head of Biceps Femoris
Dependent on Hip Position: Gluteus medius (posterior fibers), Adductor magnus (posterior fibers), piriformis

Question 22

Abduction

Answer 22

Limited by gracilis
Primary: Gluteus medius
Secondary: Gluteus minimus, Tensor fascia latae
Dependent on Hip Position: Piriformis (when Hip is flexed), Sartorius, Rectus Femoris, Superior Fibers of Gluteus Maximus

Question 23

Adduction

Answer 23

Limited by Tensor Fascia Latae (and associated IT band)
Primary: Adductor magnus
Secondary: Pectineus, Adductor Longus, Adductor Brevis, Gracilis, Obturator Externus

Question 24

Medial Rotation

Answer 24

42⁰-50⁰; usually measured with hip at 90⁰

Question 25

Lateral Rotation

Answer 25

42⁰-50⁰; usually measured with hip at 90⁰

Question 26

Medial Rotation

Answer 26

Anterior Roll and Posterior Gliding

Question 27

Lateral Rotation

Answer 27

Posterior Roll and Anterior Gliding

Question 28

Lateral Rotation

Answer 28

Primary: Gluteus maximus, piriformis Secondary: Quadratus femoris, obturator internus and externus, Gemellus superior and inferior, sartorius Depending on hip position: Gluteus medius (posterior fibers); long head of biceps femoris

Question 29

Medial Rotation

Answer 29

NO MUSCLE HAS A PRIMARY ROLE OF MEDIAL ROTATION Secondary: Tensor Fascia Latae, Gluteus minimus, Gluteus medius (anterior fibers) Dependent on Hip position: Pectineus, Adductor longus and brevis, adductor magnus (posterior fibers), semimembranosus, semitendinosus

Question 30

Flexion

Answer 30

Spin

Question 31

Extension

Answer 31

Spin

Question 32

Abduction

Answer 32

Superior Roll and Inferior Glide

Question 33

Adduction

Answer 33

Inferior Roll and Superior Glide

Question 34

Medial Rotation

Answer 34

Anterior Roll and Posterior Glide

Question 35

Lateral Rotation

Answer 35

Posterior Roll and Anterior Glide

Question 36

Angulation of the Femur

Answer 36

Femoral neck angulates so that the head most | commonly faces medially, superiorly, and anteriorly.

Question 37

Right Hip/Pelvic Drop

Answer 37

Lateral flexion of lumbar spine towards left, left hip joint adducts

Question 38

Anterior Pelvic Tilt

Answer 38

Right hip: Flexion Left Hip: Lumbar spine: Flexion Extension

Question 39

Posterior Pelvic Tilt

Answer 39

Right Hip: Extension Left Hip: Extension Lumbar spine: Flexion

Question 40

Left Forward Rotation | Right Foot Planted

Answer 40

Right Hip: Medial Rotation Left Hip: Open chain Lumbar Spine: Left Rotation

Question 41

Left Backward Rotation | Right Foot Planted

Answer 41

Right Hip: Lateral Rotation Left Hip: Open chain Lumbar Spine: Right Rotation

Question 42

Pelvifemoral rhythm

Answer 42

like scapulohumeral rhythm of the shoulder. To maximize the apparent range of motion of the distal segment (in this case the head) multiple joints are used in concert; not pathologic but rather characteristic of normal functional human movement. Caution is only warranted with injuries and heavy loaded human movement. E.g., touching your toes, roundhouse kick (rhythm allows end effector- toes- to reach higher target) E.g., Posterior Pelvic tilt at deepest part of squat (achieve apparent ROM of hip flexion)

Question 43

Lateral trunk lean towards the side of pain or weakness

Answer 43

Helps by: • Reduces the moment arm of the force of gravity which reduces the required muscle force needed to maintain equilibrium ``` • Reduces necessary torque generated by the abductor muscles (gluteus medius) ``` • Reduces the overall joint reaction force at the hip

Question 44

Cane in Contralateral Hand

Answer 44

• Reduces weight of Head, Arms, Torso (HAT), but also provides a counter torque to the torque of gravity thus reducing need for abductor muscle force. • Canes considered to relieve hip of up to 60% of its load in stance

Question 45

Cane in Ipsilateral Hand

Answer 45

• Still some benefit from alleviating some of the body weight through the cane • But in theory the force of the cane on the hand causes a torque about the affected hip in the same direction at the torque due to gravity • Overall exacerbates the problem

Question 46

Arthrokinematics during Flexion/Extension of the Hip

Answer 46

Pure Spin

Question 47

Arthrokinematics During Adduction of the Hip

Answer 47

Inferior Roll and Superior Gliding; Femoral head glides within acetabulum in opposite direction of distal femur

Question 48

Arthrokinematics During Abduction of the Hip

Answer 48

Superior Roll and Inferior Gliding; Femoral head glides within acetabulum in opposite direction of distal femur

Question 49

Arthrokinematics During medial Rotation of the Hip

Answer 49

Anterior Roll and Posterior Gliding

Question 50

Arthrokinematics During Lateral Rotation of the Hip

Answer 50

Posterior Roll and Anterior Gliding