Question 1

Describe the ligaments of the hip joint.How does the capsule of the joint contribute to joint stability?

Accepted Answer

The capsule of the hip joint is large (given the large range of motion)and very strong.It is attached to the complete periphery of the acetabulum proximally,and to the intertrochanteric ridge and line,thus encompassing the head and neck of the femur up to,but not including,the trochanters.Fibers of the capsule run in several directions,tightening upon distraction.

Question 2

What is the role of the ligamentum teres at the hip joint?

Accepted Answer

The ligamentum teres (or ligament of the head of the femur)arises from the acetabular notch and the transverse acetabular ligament and enters the acetabulum to attach to the fovea capitis of the femur.It varies tremendously in strength among individuals but does not appear to contribute much to hip joint stability.It serves primarily as the pathway for a small branch of the obturator artery,which supplies a small amount of blood directly to the femoral head.Most of the blood supply to the femoral head is obtained through the circumflex arteries,which enter at the trochanters and cross the neck to the head.However,while the capital epiphyseal plate persists or prior to anastomosis between the obturator and circumflex supplies,the blood from the circumflex cannot reach the head.Therefore,the head of the femur in the skeletally immature person is very dependent upon the vessel accompanying the ligamentum teres.Disruption can result in avascular necrosis of the head.

Question 3

What forces maintain A-P equilibrium of the hip joints in bilateral stance?

Accepted Answer

A-P equilibrium of the pelvis requires no muscle activity in symmetrical bilateral stance.The gravitation line falls behind the hip joint,creating a hip extension or posterior pelvic tilt "moment" (torque).The extensor torque is offset by tension in the hip joint capsule and ligaments,with some possible contribution by the passive tone in the hip joint flexors.

Question 4

The capsular pattern of the hip is:

Accepted Answer

A)  Limitation of external rotation,flexion,and adduction. 
B)  Marked limitation of extension and moderate limitation of flexion,abduction,and external rotation. 
C)  Marked limitation of flexion,abduction,medial rotation,and moderate limitation of extension. 
D)  Moderate limitation of flexion,internal rotation,and external rotation.

Question 5

During ambulation,a patient complains of left hip pain when stepping forward with the right leg.You suspect that this is due to degenerative changes at the hip joint and wish to reduce the amount of compressive forces at the left hip joint during ambulation.When considering the mechanical forces acting on the left hip joint,which of the following would be most effective in reducing the hip joint compression force?

Accepted Answer

A)  Using a cane in the right hand with a moment arm of 15 inches 
B)  Using a cane in the right hand with a moment arm of 20 inches 
C)  Using a cane in the left hand with a moment arm of 5 inches 
D)  It is not possible to distinguish between these answers with the information given.

Question 6

Consider the motion of bringing the left knee to the chest.During normal arthrokinematics of the hip joint,the left femoral head glides (or spins in neutral)on the acetabulum during this motion:

Accepted Answer

A)  Anteriorly/inferiorly 
B)  Anteriorly/superiorly 
C)  Posteriorly/inferiorly 
D)  Posteriorly/superiorly

Question 7

How can the two-joint hip muscles affect this rhythm?

Accepted Answer

The answer of How can the two-joint hip muscles affect...

Question 8

What is the close-packed position of the hip joint?

Accepted Answer

The answer of What is the close-packed position of the...

Question 9

A person bends forward at the hips to tie his shoes.The acetabulum on the (R)side glides ________________on the head of the femur to allow this to happen.

Accepted Answer

A)  posteriorly and inferiorly 
B)  anteriorly and inferiorly 
C)  posteriorly and superiorly 
D)  anteriorly and superiorly

Question 10

The following two-joint muscle at the hip originates at the anterior inferior iliac spine (AIIS)and can contribute to both hip flexion and knee extension,dependent on joint position:

Accepted Answer

A)  Sartorius 
B)  Rectus femoris 
C)  Vastus lateralis 
D)  Psoas major

Question 11

The three reinforcing capsular ligaments at the hip will act together to limit motion in which plane?

Accepted Answer

A)  Sagittal 
B)  Transverse 
C)  Frontal

Question 12

Which statement is true regarding articular congruency of the hip joint?

Accepted Answer

A)  The hip joint is not considered to be a naturally congruent joint. 
B)  The acetabulum is larger than the femoral head and entirely covers the head. 
C)  A combination of hip flexion,abduction,and lateral rotation gives the hip joint its most congruent position. 
D)  A combination of extension and adduction gives the hip its most congruent position.

Question 13

________________is defined as an angle of torsion of the femoral neck-head on the femoral shaft that is greater than 15° to 20°.

Accepted Answer

A)  Retroversion 
B)  Anteversion 
C)  Coxa valga 
D)  Coxa vera

Question 14

Determine the muscle force needed to maintain an upright position for the following subject during single limb stance. Body weight = 240 lbs.
Line of gravity (LoG)to rotation point on femur = 4 in.
Femoral head to abductor muscle attachment = 2.5 in.

Accepted Answer

A)  384 lbs. 
B)  320 lbs. 
C)  256 lbs. 
D)  150 lbs.

Question 15

Which of the following statements is true concerning the neck-to-shaft angle (angle of inclination)of the femur?

Accepted Answer

A)  The normal angle in adults is approximately 100° to 115°. 
B)  A decrease in the normal angle is called coxa valga. 
C)  Coxa valga will decrease the lever arm of the hip abductor muscles. 
D)  It is the angle formed between the axis of the femoral neck and the transverse axis of the femoral condyles.

Question 16

The gluteus medius and gluteus minimus muscles act:

Accepted Answer

A)  To stabilize the pelvis during unilateral stance. 
B)  As the primary extensors of the hip. 
C)  To laterally rotate the hip in unilateral stance. 
D)  As accessory muscles to hip flexion.

Question 17

Why are fractures across the femoral neck common,especially among elderly women? How does the blood supply of the femoral head play a role in the critical nature of the injury?

Accepted Answer

The answer of Why are fractures across the femoral neck...

Question 18

The primary weight-bearing area of the acetabulum is the ________________portion.

Accepted Answer

A)  superior-medial 
B)  inferior 
C)  inferior-medial 
D)  Weight is evenly borne throughout the entire surface of the acetabulum.

Question 19

If an individual has a weak gluteus medius:

Accepted Answer

A)  The hip joint compression forces are greater during single limb stance,which can lead to joint degeneration. 
B)  He or she will rarely present with a Trendelenburg gait. 
C)  He or she will often shift the trunk over the hip to eliminate the force the gluteus medius needs to produce for single limb stance. 
D)  Using a cane on the ipsilateral side is a good way to address the weakness.

Question 20

A patient with femoral anteversion will present with which of the following apparent range of motion (ROM)adaptations at the hip?

Accepted Answer

A)  Increased lateral rotation and decreased medial rotation 
B)  Decreased lateral rotation and increased medial rotation 
C)  Symmetric lateral and medial rotation

Exam 10: The Hip Complex

Describe the ligaments of the hip joint.How does the capsule of the joint contribute to joint stability?

What is the role of the ligamentum teres at the hip joint?

What forces maintain A-P equilibrium of the hip joints in bilateral stance?

The capsular pattern of the hip is:

Consider the motion of bringing the left knee to the chest.During normal arthrokinematics of the hip joint,the left femoral head glides (or spins in neutral) on the acetabulum during this motion:

How can the two-joint hip muscles affect this rhythm?

What is the close-packed position of the hip joint?

A person bends forward at the hips to tie his shoes.The acetabulum on the (R) side glides ________________on the head of the femur to allow this to happen.

The following two-joint muscle at the hip originates at the anterior inferior iliac spine (AIIS) and can contribute to both hip flexion and knee extension,dependent on joint position: