Neumann: Kinesiology of the Musculoskeletal System, 3rd Edition

Chapter 12: Hip

Study Questions and Answers

1. What structures convert the greater sciatic notch to a foramen? List three
structures (nerves or muscles) that pass through this foramen.
The sacrotuberous and sacrospinous ligaments convert the greater sciatic notch to a
greater sciatic foramen. The piriformis muscle, sciatic nerve, and inferior gluteal
nerve exit through the greater sciatic foramen.

2. A patient has excessive anteversion of the femur and acetabulum. Which extreme
hip motion (in the horizontal plane) would most likely be associated with a
spontaneous anterior dislocation?
External rotation.

3. What characteristics define the close-packed position of the hip? How do these
characteristics differ from most other synovial joints of the body?
The close-packed position of the hip is defined by the position that creates the
greatest (stretch) tension in the capsular ligaments. (In the hip this position is
extension, slight internal rotation, and abduction.) In many other joints of the body,
the position that stretches most of the ligaments is also the position where the joint
is most congruent. This is not the case with the hip; the hip is most congruent in
flexion, external rotation, and abduction.

4. Explain why a patient with an inflamed capsule of the hip joint may be susceptible
to a hip flexion contracture.
A person with an inflamed hip capsule often feels most comfortable with the hip
partially flexed, a position that reduces intracapsular pressure. Over time, the capsule
and hip flexor muscles may experience adaptive shortening, leading to a hip flexion
contracture.

5. Describe how the ischiofemoral ligament becomes taut in full internal rotation and
extension of the hip. Include both femoral-on-pelvic and pelvic-on-femoral
perspectives in your description.
The ischiofemoral ligament arises from the pelvis near the posterior and inferior rim
of the acetabulum. The ligament attaches distally to the apex of the greater
trochanter. From a femoral-on-pelvic perspective, internal rotation and extension (of
the femur) move the apex of the greater trochanter away from the ligament’s pelvic
attachments. From a pelvic-on-femoral perspective, internal rotation and extension
of the hip move the posterior--inferior rim of the acetabulum farther away from the
ligament’s femoral attachments. (A skeletal model and Figure 12-15 may help
visualize these movements.) In both femoral-on-pelvic and pelvic-on-femoral
movements, the ischiofemoral ligament is stretched and becomes taut.

6. While standing, a person performs a full posterior pelvic tilt while keeping the
trunk essentially stationary. Describe how this movement could alter the tension in
the anterior longitudinal ligament and the ligamentum flavum in the lumbar region.
The posterior pelvic tilt decreases the lumbar lordosis. The associated increased
lumbar flexion slackens the anterior longitudinal ligament and increases tension in
the ligamentum flavum.

7. Using a ruler and Figure 12-30 as a reference, which muscle appears to have the
greatest moment arm for hip abduction?
Gluteus medius.

8. Based on Figure 12-35, which muscle has (a) the least leverage and (b) the greatest
leverage for producing internal rotation torque?
The adductor brevis has the least leverage and the anterior fibers of the gluteus
medius the greatest leverage for internal rotation torque.

9. A patient sustained a severe fracture of the femoral head and the acetabulum,
with marked reduction in contact area between the articular surfaces of the joint. As
part of the reconstructive surgery, the surgeon decides to slightly increase the
internal moment arm of the hip abductor muscles. What is the likely rationale for this
procedure?
A hip with markedly reduced contact area is subjected to higher than normal hip
stress (pressure). Because the hip abductor muscles generate the largest of all
muscular-based compression forces on the hip, a surgeon may decide to increase the
leverage of this muscle group. In theory, increasing the internal moment arm of the
hip abductor muscles will reduce the compressive stress produced on the joint
during the single-limb support phase of walking. This protective measure may reduce
the likelihood of the hip developing degenerative arthritis.
10. Explain how a reduced center-edge angle of the acetabulum could favor a
dislocation of the hip.
The center-edge (CE) angle describes the extent to which the acetabulum covers the
top of the femoral head. As indicated by Figure 12-13A, a smaller CE angle indicates
less coverage of the femoral head, which increases the likelihood of a dislocation.

11. Contrast the arthrokinematics of (femoral-on-pelvic) hip flexion and extension

12. As indicated in Figure 12-12, during the swing phase of walking the hip
experiences (compression) forces of about 10–20% of body weight. What causes this
force?
During the swing phase of walking, the forces from the contracting hip flexor muscles
compress the head of the femur against the acetabulum.

13. Figure 12-22A shows a seated person performing a 30-degree anterior pelvic tilt.
What structure(s) is/are most likely responsible for determining the end range of this
motion?
End range of extension of the lumbar apophyseal joints
Gluteus maximus
Deep fibers within the inferior and posterior parts of the hip capsule
Adipose tissue located between the front of the thigh and pelvis

14. A person sustained an injury of the cauda equina resulting in reduced function of
spinal nerve roots L3 and below. What pattern of muscular tightness may develop
without adequate physical therapy intervention? (Consult Appendix IV, Part A, for
assistance in responding to this question.)
This injury would spare the spinal nerve roots associated with L1 and L2 of the lower
extremity. As noted in the chart in Appendix IV, Part A, many of the hip flexor and
adductor muscles would remain at least partially innervated, with paralysis of all
other muscles. This situation would increase the likelihood of developing a hip
flexion and adduction contracture.

15. Justify how bilateral tightness in the adductor longus and brevis could contribute
to excessive lumbar lordosis while standing.
Because the adductor longus and adductor brevis are also hip flexors, their bilateral
tightness may be expressed as an exaggerated anterior pelvic tilt, at least while
standing. An increased anterior pelvic tilt is associated with an increased lumbar
lordosis.

16. A standard way for persons to stretch their own rectus femoris is to
simultaneously flex the knee while extending the hip. When performing this stretch,
some persons with a tightened rectus femoris also hold their extended hip slightly
abducted. Why would this be?
In the anatomic positon, the rectus femoris has a slight overall moment arm to
abduct the hip. Holding the extended hip slightly abducted therefore slackens the
muscle slightly, thereby reducing some of the discomfort caused by the relatively
extensive stretch placed on the muscle by the flexed knee and extended hip.

17. Which muscle depicted in the dynamic bilateral hip adduction event of Figure 12-
33 is active eccentrically? Please justify your answer.
The left gluteus medius is active eccentrically. Assuming this muscle is indeed active,
the rotation of the left hip into (pelvic-on-femoral) adduction would elongate the
gluteus medius. Any muscle that is active while being pulled into a longer length is
experiencing eccentric activation.