Deck 20: The Hip

Question 1

When applying mobilization with movement techniques at the hip with the patient lying on a table in the supine position, the primary purpose of the mobilization belt is to:

A)Apply a pain-free inferolateral glide of the femur.
B)Apply a pain-free inferior glide of the femur.
C)Apply a pain-free inferomedial glide of the femur.
D)Support the weight of the leg, making it easier for the therapist to perform the mobilization maneuvers.

Answer 1

A

Question 2

Which of the following signs and symptoms in the hip region and/or lower extremity is most consistent with the finding associated with trochanteric bursitis?

A)Pain along the lateral aspect of the hip joint and possibly along the lateral thigh and knee to the insertion of the iliotibial band; pain typically worsens during long periods of asymmetrical standing with more weight shifted to the involved side
B)Pain that becomes evident during extended periods of sitting, with most pain experienced in the buttock region over the ischial tuberosities
C)Groin and anterior thigh pain that becomes evident or is aggravated during activities that require repetitive hip flexion
D)Groin pain at rest that increases with weight bearing coupled with a positive Trendelenburg sign and pain with hip abduction

Answer 2

A

Question 3

Recent advances in arthroscopy of the hip now allow all of the following procedures to be performed using this less invasive technique except:

A)Microfracture to stimulate fibrocartilage growth.
B)Acetabular labral repair.
C)Resurfacing arthroplasty.
D)Capsulorrhaphy for capsular laxity.

Answer 3

C

Question 4

The term hybrid total hip arthroplasty refers to a(n):

A)Hip replacement with a cemented femoral component and a noncemented acetabular component.
B)Total hip replacement that is all metal.
C)Alternate term for bipolar hemiarthroplasty of the hip.
D)Alternate term for minimally invasive arthroplasty.

Question 5

Each of the following principles is important when designing a therapeutic exercise program to correct hip muscle length/strength imbalances except:

A)When stretching the hip musculature, the spine and pelvis must be stabilized against the force.
B)Contraction of the muscle opposite the range-limiting muscle (i.e., contracting the antagonist of the tight muscle) to assist with the stretching maneuver has the benefit of training the antagonist muscle to function in any newly gained range.
C)Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have "normal" strength of hip musculature.
D)Strengthening exercises should include closed-chain exercises to prepare for functional activities in weight-bearing postures.

Question 6

Which of the following exercises, designed to self-stretch the hamstrings, is the safest and utilizes the most effective stabilization?

A)Patient stands, bends forward, keeping both knees straight, and attempts to touch the nose to the thighs.
B)Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg.
C)Patient sits on the floor in a hurdler's position, keeps the back straight, and reaches toward the foot of the straight leg.
D)Patient sits on the floor in a long-sitting position with the knees straight and does a bilateral toe touch.

Question 7

The clinical prediction rule for the diagnosis of osteoarthritis of the hip developed by Sutlive and colleagues includes consideration of all of the following variables except:

A)Self-reported squatting aggravates symptoms.
B)Walking more than one block causes groin and anterior thigh pain.
C)Passive internal rotation is less than or equal to 25°.
D)Scour test with adduction causes lateral hip or groin pain.

Question 8

You are initiating postoperative treatment for a 78-year-old woman who sustained an intertrochanteric fracture of the proximal femur 3 days ago and immediately underwent open reduction with internal fixation (screw-plate fixation).She has been referred to physical therapy for postoperative exercise and gait/functional training (initially with minimal weight bearing on the operated side).A decision has not yet been made about whether this patient will be discharged directly to home where she lives with her husband or to a subacute skilled nursing facility.Prior to discharge from the hospital during the next few days, which of the following is the lowest priority intervention?

A)Gait training with a walker and transfer/bed mobility training
B)Active-assistive range of motion (A-AROM), progressing to active range of motion (AROM) of the operated hip
C)Open-chain, resistance exercises for the operated lower extremity
D)Closed-chain, resisted exercises for the upper extremities and sound lower extremity, emphasizing extension in functional patterns

Question 9

Which of the following surgical approaches for conventional total hip arthroplasty is associated with the highest risk of postoperative hip dislocation if the hip flexes (passively or actively) beyond 80° to 90° during the early postoperative weeks?

A)Lateral
B)Anterolateral
C)Posterolateral
D)All approaches pose an equally high risk.

Question 10

A patient who underwent a right cemented total hip arthroplasty through a posterolateral conventional incision 3 to 4 weeks ago is permitted to do each of the following except:

A)Flexion of the operated hip to 80° or 90°.
B)Pivot to the right while bearing weight on the operated lower extremity.
C)Ambulation with crutches or a walker, bearing weight on the operated lower extremity as tolerated.
D)Active abduction of the operated hip while standing on the sound lower extremity.

Question 11

Osteoarthritis of the hip is typically characterized by a progressive decrease in range of motion (ROM) of the following movement combinations:

A)External rotation and extension.
B)Internal rotation and extension.
C)External rotation and adduction.
D)Equal loss of internal and external rotation.

Question 12

If a patient stands in a fencer's posture but with the back leg externally rotated and then lunges forward, this self-stretching maneuver primarily stretches which muscle groups of the back leg?

A)Hip abductors and external rotators
B)Hip flexors
C)Hip extensors
D)Hip adductors and internal rotators

Question 13

Which of the following is a correct statement about arthrodesis of the hip?

A)It is the surgery of choice for the elderly (greater than 75 years old) patient with an intertrochanteric fracture.
B)It is commonly performed arthroscopically in young, active individuals.
C)It is the procedure of choice for treating severe osteoarthritis that affects both the acetabular and femoral components of the hip.
D)It is considered a salvage procedure when revision arthroplasty is not an option.

Question 14

Hip flexor structural or functional impairment will result in a change in the normal gait cycle.The therapist should suspect hip flexor dysfunction when observing gait and noting a:

A)Lengthened stride.
B)Posterior lurch of the trunk at foot contact.
C)Lateral shift of the trunk over the stance leg when the opposite leg swings.
D)Forward flexion of the trunk during weight bearing.

Question 15

Your patient had a total hip replacement 3 days ago and will be discharged from the hospital tomorrow.Your home instructions should include, but are not limited to, each of the following except:

A)Avoid moving the hip past midline when moving in bed; do not cross your legs.
B)Perform ankle-pumping exercises on a regular basis throughout the day with the legs elevated.
C)Perform assisted, progressing to active, ROM exercises of the hip and knee within protected ranges.
D)Whenever possible, perform transfers toward the operated side.

Question 16

In an elderly patient, which of the following types of hip fracture is managed most often with hemireplacement of the hip (hemiarthroplasty)?

A)Noncomminuted intertrochanteric fracture
B)Displaced subcapital (intracapsular) fracture
C)Unstable subtrochanteric fracture
D)Hemiarthroplasty is equally indicated for intracapsular and extracapsular fractures.