MSK INTERVENTIONS- HIP JOINT

APPLICATION QUESTIONS

1. A). When assessing hip passive range of motion which structures limit extremes of motion in flexion?
Extension? Medial rotation? Lateral rotation?

Hip flexion (knee

Hamstrings
extended)
Hip flexion (knee
Inferior and posterior capsule; gluteus maximus
flexed)
Hip extension (knee Primarily iliofemoral ligament, some fibers of the pubofemoral ligaments; psoas
extended) major
Hip extension (knee
Rectus femoris
flexed)
Abduction Pubofemoral ligament; adductor muscles
Superior fibers of ischiofemoral ligament; iliotibial band; and abductor muscles
Adduction
such as the tensor fasciae latae and gluteus medius
Ischiofemoral ligament; external rotator muscles, such as the piriformis or gluteus
Internal rotation
maximus
Iliofemoral and pubofemoral ligaments; internal rotator muscles, such as the
External rotation
tensor fasciae latae or gluteus minimus

2. What angle does femoral anteversion refer to?

Normally, as viewed from above, the femoral neck projects about 15 degrees anterior to a
medial-lateral axis through the femoral condyles. This degree of torsion is called normal
anteversion. In conjunction with the normal angle of inclination, an approximate 15-
degree angle of anteversion affords optimal alignment and joint congruence (see
alignment of red dots in Figure).

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  Laura, 11/f, demonstrates excessive anteversion on the right hip. How would this influence the
degree of toe-angle (foot progression angle) seen in standing at rest?

 Nancy, 3/f, is Laura’s younger sister. Their mom is concerned that Nancy shows the same degree
of toe-angle as Laura and that she might have problems with femoral alignment too. Based on
your knowledge of anatomy and development, are the mom’s fears justified? What would you say
to her?
The mother shouldn’t be concerned because there a normal excessive anteversion (around
30°) until 6 years of age. Anteversion goes back to normal (15°) after that age.

3. A 60 year old patient is suspected of having pelvic-femoral impingement (which is thought to have a
strong association with the development of hip joint osteoarthritis).
The patient suffers pain with the anterior impingement test (hip taken into flexion and internal rotation)
What parts of the pelvis and femur are most likely to come in contact?
Contact at the perifoveal area or at the periphery
Femoral neck and acetabulum

 Which structures are potentially getting impinged to cause this pain?

Femoral acetabular impingement (FAI) = cause impingement of the capsule, ligaments,

rectus femoris, and potentially pectineus, piriformis. Femoral nerve and artery might be
involved.

 What functional activity might cause impingement?

Activities that involve hip flexion and internal rotation (e.g. sit to stand, tying shoes, pivot,
horse riding, kicking a ball etc)

Special test- FAI FABER to FADIR

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4. Describe force couples involved in anterior and posterior pelvic tilt.
 Based on these force couples, explain muscle work involved in maintaining pelvic tilt during
unilateral SLR (straight leg raise).

Rectus abdominis (controls posterior tilt of pelvis). Short hip flexors cause anterior tilt of
pelvis

 A 29 year old female has post-partum weakness of the rectus abdominis. How would this
influence pelvic tilt associated with performing unilateral SLR?
Pelvis will be anteriorly tilted and there will be increased lumbar lordosis when performing
unilateral SLR

 How would you grade the SLR activity to place progressively greater demands on the rectus
abdominis and what would you have the subject monitor when performing the activity?
You could do one leg raise and then two leg raise.
There is need to monitor for neutral position of pelvis (lumbar lordosis) during activity.
Use biofeedback by using BP cuff

5. A 30 year old male patient is performing sit to stand from a normal height chair
 Activity kinematics: Describe hip and knee positions during sit to stand.
Observe Knee flexion and hip flexion during sitting
Then knee and hip start going into extension during chair off phase
Finally, into full knee and hip extension at standing

 Muscle function: How does this combination of hip and knee positions influence biarticular hip
flexors and extensors?

Two-joint muscles act eccentrically at one end and concentrically at the other end. For
example, the function of hamstrings is hip extension and knee flexion. During sit to stand
the motion is hip extension and knee extension, therefore the hamstrings contract at hip (as
their function is hip extension) but they stretch at the knee (as their function is flexion).
Biarticular muscles are also referred to as strap muscles.

 The contribution of which one joint hip extensor will be most affected by the pelvic position
during this activity?
Gluteus maximus

NPTE- The Final Frontier