Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSK Practical Exam > Hip Pathologies > Flashcards

Hip Pathologies Flashcards

(67 cards)

Start Studying
1
Q

What is the acetabulum and what bones form it?

A

Hip joint socket

Ilium, ischium and pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What structures cover the acetabulum and what are their functions?

A

Acetabulum labrum and transverse ligament

Deepen the socket to increase stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name the bony landmarks of the hip

A

Anterior superior iliac spine (ASIS)

Anterior inferior iliac spine (PSIS)

Ischial tuberosity

Posterior superior iliac spine (PSIS)

Iliac crest

Greater trochanter

Lesser trochanter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain the anatomy of the femur

A

Long bone

Femoral and obturator artery

Femoral head and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name the important ligaments of the hip

A

Iliofemoral (Y-shaped) transverse (stops add and ER) and descending (stops IR), strongest ligament - illium to femur

Pubofemoral (stops abd) - Pubis to femur

Ischiofemoral (stops IR) - Ischium to femur, blends in with the posterior capsule

Ligament of head of femur - Head of the femur to the acetabulum, branch of obturator artery

Transverse acetabular ligament - part of the acetabulum

Inguinal ligament - ASIS to pubic tubercle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the anterior muscles of the hip

A

Iliopsoas - iliacus (origin iliac crest) and psoas major (origin - transverse processes of the Lx), both insert into the lesser trochanter - Hip flexion, Lx flexion and side flexion

Rectus femoris - Origin AIIS, Insertion quadricep tendon - Hip flexion and knee extension

Sartorius - Origin ASIS, Insertion pes anserinus - Hip flexion and ER, knee flexion and IR

Adductors
3 ducks, pecking grass
Adductor Magnus - Origin ischial tubersosity, adducotr tubercle - most posterior also helps with hip extension
Adductor Longus - Origin pubis, Insertion femur
Adductor Brevis - Origin pubis, insertion femur
Pectineus - Origin pubis, insertion femur, also hip flexor and IR
Gracilis - Origin pubis, insertion pes anserinus, also knee flexion and IR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the lateral and posterior muscles of the hip

A

Glute max - Origin sacrum and ilium, Insertion gluteal tuberosity and ITB - Hip ext, upper fibres abd and ER lower fibres add and IR

Glute Med - Origin ilium, insertion greater troachanter - Abd and IR

Glute min - Origin ilium, insertion greater troachanter - Abd and IR

Tensor fascia latae (TFL) - origin ASIS, inseriton ITB - Hip

Deep Muscles
Piriformis
Obturator internus and externus
Gemelli superior and inferior
Quadratus femoris

Hamstrings
Long head of bicep femoris
Semitendinosis
Semimembranosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the main nerves of the hip?

A

Femoral nerve (anterior)

Obturator nerve (medial)

Sciatic nerve (posterior)

Superior and inferior gluteal nerve (posterior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the anatomical features of the hip joint and its normal movements?

A

Synovial ball and socket joint - deep so difficult to dislocate

Proxmial - acetbaulum, larbum and transverse ligament

Distal - head of the femur

Movements
Flexion - 140
Extension - 10
Abd - 45
Add - 30
IR - 40
ER - 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the function of the glute med during gait?

A

Activates on the ipsilateral side to maintain a level pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When there is contralateral pelvic drop during gait or single leg stance what is this called?

A

Trendeleburg gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the Duchenne sign?

A

Trunk side flexion towards the stance leg to compensate for pelvic drop and weak glute med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other structures could be contributing to hip pain?

A

Lx

SIJ

Knee and/or ankle

Non MSK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name some common and less common causes of lateral hip pain

A

Common
Greater trochanteric pain syndrome (GTPS)
Glute med tears and tendinopathy
Trochanteric bursitis

Less Common
Referred pain from Lx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What lateral hip pain pathologies are not to be missed?

A

Fracture of neck of femur

Nerve root compression

Tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name some common and less common causes of anterior hip pain

A 
Common
Synovitis
Labral tear
Chondropathy - early onset hip OA
OA
Femoroacetabular impingement (FAI)

Less Common
Calcification of acetabular rim
Ligament of head of the femur tear
Stress fracture
Hip joint instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What anterior hip pain pathologies are not to be missed?

A

Synovial chondromatosis - non-cancerous tumour in the joint

Avascular necrosis of head of femur

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the clinical presentation for Avascular necrosis of the head of the femur?

A

Lamb et al. 2019

Pain >6 weeks

X-ray -ve

Need MRI

Usually Males 22-55 years and older in females

Family Hx of avascular necrosis of femoral head

Heavy smoking, alcohol abuse

Overweight

Circulatory problems

HIV

Steroid abuse

Recent pregnancy

Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the possible causes of groin pain?

A

Doha agreeement

Adductor-related groin pain
Iliopsoas-related groin pain
Inguinal-related groin pain
Pubic-related groin pain
Hip-related groin pain

Hernia
Obturator Nerve entrapment
Referred pain from SIJ or Lx
Avulsion fracture ASIS, AIIS, Pubic bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What groin pain pathologies are not to be missed?

A

Stress fracture of neck of femur, pubic ramus or acetabulum

Avascular necrosis

Intra-abdominal abnormalities e.g. UTI, kidney stones

Ankylosing spondylitis

Tumours

Reactive or infection arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name some common and less common causes of buttock pain

A 
Common
Referred pain from Lx or SIJ
Hamstring origin tendinopathy
Ischiogluteal bursitis
Myofascial pain

Less Common
Quadratis femoris injury
Piriformis conditions (muscle strain/impingement)
Sciatic nerve injury
Prolapsed intervertebral disc
Stress fracture of sacrum
Proximal hamstring avulsion
Glute med tendinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What buttock pain pathologies are not to be missed?

A

Ankylosing spondylitis

Reiteir’s syndome (reactive artritis)

Psoriatic arthritis

Arthritis associtaed with bowel disease

Malignancy

Bone and joint infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What or the most relevant examples of hip pathologies?

A

OA of Hip

Femoroacetabular impingement (FAI)

Greater trochanteric pain syndrome (GTPS)

Groin pain

Hamstring injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the clinical presentation of hip OA?

A

Most common hip pain pathology >38 years

Capsular pattern
Flex more restricted than ext
IR more restricted than ER
Abd more restricted than Add

Loss of muscle strength (Abd, hip flex and ext)

Unclear pain distribution (somatic referred pain)

Pain can be linked to central sensitisation, so screen for psych factors (Willet et al., 2020)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the risk factors of hip OA and what are the factors that predict progression?
``` Risk Factors Age High BMI Previous injury Intense sporting activities Genetics ``` ``` Progression Age Symptomatic Female Intense sport activities ```
26
What is the treatment for hip OA
NICE Guidelines Patient education Strengthening and aerobic exercise Mobilisation Pain relief Gait retraining Severe OA = Hip replacement
27
Name the 2 types of femoroacetabular impingement (FAI)
Cam - flattening or convexity of the femoral neck Pincer - Over-coverage of femoral head by the acetabulum
28
Which is the most common type of FAI?
Combination of pincer and cam
29
What movement is problematic for FAI?
Flexion and IR
30
How can you diagnose a FAI?
Warwick Agreement Diagnosis Symptoms, clinical signs and imaging all be present Symptoms Position/motion related hip or groin pain which also may be felt in the back, buttock or thigh Clicking, catching, locking, stiffness, restricted ROM or giving way Clinical Signs Hip impingement tests reproduce pain Limited hip flex and IR Imaging X-ray - 1st MRI or CT
31
How can you differeniate between FAI and OA?
FAI patients are younger
32
What is the treatment for FAI?
Warwick agreement Conservative Rehab Education Lifestyle and activity modification Improve hip stability, neuromuscular control, strength, ROM and movement patterns Surgery Open or arthroscopic
33
What is the prognosis of FAI?
Patient frequently improve and return to full activity May be associated with hip OA
34
What is the clinical presentation of greater trochanter pain syndrome (GTPS)?
Grimaldi and Fearon, 2015 Most are likely to be gluteal tendinopathy, bursae less likely Pain lying on their side at night, standing, walking, climbing up or down stairs, sitting Psychological factors
35
What causes GTPS (gluteal tendinopathy)?
Grimaldi and Fearon, 2015 Overload (change in activity, increased load) Decreased longitudinal TENSILE load Excessive COMPRESSION Psychological factors
36
How can you increase compressive loading of the gluteal tendon during objective testing?
Grimaldi and Fearon, 2015 Place hip in adduction
37
How does compressive load of the glute med tendon occur?
Tension of the ITB compresses the glute med tendon against the greater trochanter
38
What hip and pelvic positions increase compressive load on the glute med tendon?
Lateral pelvis rotation away from the affected side Increase angle of the femur away from the affected side
39
What is the clinical presentation of adductor-related groin pain?
Doha agreement Adductor tenderness Pain on resisted adduction
40
What is the clinical presentation of iliopsoas-related groin pain?
Doha agreement Iliopsoas tenderness Pain on resisted hip flexion and/or stretching of hip flexors
41
What is the clinical presentation of inguinal-related groin pain?
Doha agreement Pain in the inguinal canal region Tenderness of the inguinal canal No palpable hernia Pain increased with resisted abdominals, cough, sneeze
42
What is the clinical presentation of pubic-related groin pain?
Doha agreement Tenderness on palpation of pubic symphysis and adjacent bone Muscle testing -ve
43
What is the clinical presentation of hip-related groin pain?
Hx (onest, nature, location, mechanical symptoms, catching, locking, clicking, giving way) PROM, FABER, FADIR (same as FAI clinical presentation)
44
Name the injury classification for hamstring injuries
British Athletics Muscle Injury Classification Grade 0 - Generalised muscle pain following exercise Grade 1 - Small muscle tear Grade 2 - Moderate muscle tear Grade 3 - Extensive muscle tear Grade 4 - Full-thickness tear of muscle/tendon
45
What are the special questions to ask for hip pathology?
Clicking, catching, locking, giving way, putting on shoes, squatting, cerpitus, stiffness Hx of trauma
46
What is the 24 hour pattern for someone with hip OA?
Worse in the morning Worse when seated for long periods Eases when they start walking Worse if they walk for too long
47
During the objective assessment what other joints would you test?
Lx and SIJ
48
What are some functional tests for the hip?
Single leg squat Step down test Squat Jumping
49
Should you palpate the iliopsoas and piriformis?
No, because theres too much structures inbetween so cant be sure if your palpating it or not
50
What muscles attach on the clock when palpating the greater trochanter?
12 - Glute med 1:30 - Glute min 3 - Glute max 4:30 - Vastus lateralis 7 - Quadratus femoris 10 - Piriformis
51
What could be restricting PROM hip flex?
Iliopsoas tightness on the contralateral side
52
What combined movement can be used for articular testing?
Flexion and add - resistance or reproduction of symptoms Can add compression
53
What are the muscle length tests for the Hip?
Obers test - Flexed knee = TFL, Ext knee = ITB (inserts on the tibia) Modified Thomas test - Iliopsoas and rec fem length 90/90 hamstring test Remember = Could also stress nerves if these tests are positive. Use neurodynamic testing
54
What position would you muscle test abd?
Side-lying
55
What is the special test for a femoral stress fracture?
Fulcrum test Place hand under thigh with patient in sitting, with other hand press down on femur = creates shear force Positive if patient is apprehensive or reproduces symptoms high sens and spec
56
What are the special tests for Femoroacetabular Iimpingement (FAI)?
FADIR - high sens low spec Anterior impingement test (AIMT) - same as FADIR but 90 degree flex not full flex - high sens low spec FABER - high sens low spec Foot progression angle walking test (FPAW) - moderate sens and spec (IR increases pain, ER reduces pain) Maximal squat test - high sens low spec Passive IR ROM - high spec low sens
57
What are the special tests for Greater Trochanter Pain Syndrome (GTPS)?
Grimaldi et al 2017 Test Battery Positive pain on palpation of the greater trochanter, positive FADIR-R and negative single leg stand (30 sec) = POSITIVE GTPS Positive pain on palpation of the greater trochanter, positive ADD-R, negative FADER-R and negative single leg stand (30 sec) = POSITIVE GTPS Positive pain on palpatino of the greater trochanter but negative ADD-R, FADER-R and single leg stand (30 sec) = NEGATIVE GTPS Single leg stand - 30 seconds - positive if pain and/or pelvic drop FADER-R = Resistance into IR - Positive if symptoms are reproduced ADD-R = Sidelying, let leg drop into add and resist abd - positive if symptoms are reproduced
58
What are the special tests for groin pain?
Adductor squeeze test in 45 degrees flex - low sens high spec Double adductor test, supine extended knees, legs passively lifted - low sens high spec Groin pain Doha statement - contraction and/or stretch of muscle and palpation
59
How can the objective assessment affect your treatment?
Joint above and bellow (Lx, SIJ, Knee) If it is stiff = mobilise it (arthrogenic/myogenic) If it is weak = strengthen it (myogenic)
60
What are the 4 key components for hip conservative treatment?
UK FASHiON conservative treatment (Wall et al., 2016) Patient education and advice Patient assessment Help with pain relief Exercise-based hip programme
61
What exercises have the best EMG activation for glute max?
Neto et al. 2020 Different varieties of step ups > weighted step up Deadlift Hip thrust Squat Done in asymptomatic populations Patients preference
62
What exercises have the best EMG activation for glute med?
GTA Index (Selkowitz et al. 2013) Exercises that have significantly more EMG activation of the glute med compared to the TFL GTPS = TFL overactive because glute med is weak Progress with thera band around legs Clam Bridge Sidestep Quadruped hip ext knee flex or ext Done in asymptomatic populations Patients preference
63
How can you make monster walks more glute med focused?
Put thera band around toes not knees
64
What is the treatment for GTPS?
Education of load management more effective than corticosteroid injection and no treatment (Mellor et al 2018) Grimaldi and Fearon 2015 Abd strengthening progressing from iso to bilat abd and squatting Glute strengthening e.g. bridging Core strength ! Do not increase compressive loads during rehab ! -> Start clam with pillows between legs so patient not in add
65
What is the treatment for adductor-related groin pain?
Prevention program Strengthening of the add, glutes, core and other hip muscles
66
What are some effective passive hip treatment techniques?
Flexion/add mobilisation Mulligan mobilisation lateral glide with belt = decrease pain and increase flex/IR METs Traction mobilisation
67
What are the general red flags?
Hx of cancer Constant progressive unremitting night pain Unexplained weightloss Chemotherapy / Radiotherapy IV drug abuse Long term steroid use Drug and alcohol abuse Epilepsy Asthma Diabetes Osteoporosis Rheumatoid arthritis 5Ds & 3Ns - Diplopia, dysarthria, dysphagia, drop attacks, dizziness, nystagmus, nausea, numbness Hx of trauma Pregnancy Poor general health Cardiac and circulatory problems Cauda equina symptoms Anticoagulants

MSK Practical Exam (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions