10. Hip Flashcards
Hip Self Report Outcome Measures
Pain Scales
AIMS
WOMAC
LEAP
LEFS
LEAS
Harris Hip Function Scale
HOOS
Hip Performance Outcome Measures
6MWT
DGI
TUG
Timed LE Chair Rise Test
Wall Sit Test
Vertical Jump Test
LE Agility Test
Hop Tests
LQ Y-balance Test
What are the 6 hip ER muscles?
Glute Med
Piriformis
Superior Gemelli
Obturator Internus
Inferior Gemelli
Quad Fem
What are 5 functions of Sartorius
Hip Flex, Abduct, ER
Knee Flex, IR
Line of gravity is (anterior/posterior) to hip joint
Posterior
T/F Line of gravity aligns with the greater trochanter
True
Since the LoG falls posterior to the hip joint, there is an _______ moment
Extension
counteracted by Iliopsoas and iliofemoral ligament (y-ligament)
what do you see?
Lumbar Lordosis
Genu Recurvatum
Anterior Pelvic Tilt: what muscles are too short?
Erector Spinae
Iliopsoas
Anterior Pelvic Tilt: what muscles are too long?
Glutes
Abdominals
Normal Angle of Inclination @ hip
125 degrees
Is Coxa Valga structural or functional?
Structural
Do you have a (longer/shorter) limb with coxa valga?
longer
Do you have a (more/less) stability with coxa valga?
more stability from top to bottom
_______ shearing across femoral neck with Coxa Valga
Decreased
Coxa Valga: ______ likelihood of femoral dislocation
Increased
Coxa Valga:_______ abductor muscle toruqe
Decreased
(decreased moment arm & decreased leverage)
Coxa Valga: _____ likelihood of superior hip OA
increased
Coxa Vara leads to (shorter/longer) limb?
Shorter
T/F: Coxa vara has worsened congruence between femoral head and acetabulum
False
Improved congruence!
T/F: Coxa vara stress fractures along femoral neck.
True!
and SCFE happens
Normal Femoral torsion
10-20 degrees of anteversion
Another name for Increased femoral torsion
Anteversion
Another name for decreased femoral torsion
Retroversion
Angle of inclination is measured in _____ plane whereas femoral torsion is measured in _____ plane
Frontal
Transverse
Excessive femoral anteversion leads to
- increased hip IR ROM
- decreased hip ER ROM
- In-toeing (uncompensated)
- Tibial ER (compensated)
Femoral Retroversion leads to:
- Increased hip ER ROM
- decreased hip IR ROM
- Out-toeing (uncompensated)
- Tibial IR (compensated)
normal hip flexion ROM
120 degrees
normal hip extension ROM
20 degrees
normal hip ABD ROM
45 degrees
normal hip ADD ROM
20 degrees
normal hip IR ROM
45 degrees
normal hip ER ROM
45 degrees
normal SLR
70 degrees male
90 degrees female
normal hip flexion end feel
soft
normal hip ext, ABD, ADD, ER, IR end feel
firm
abnormal hip capsular end feel
IR > EXT > ABD
Note
hip: IR
shoulder: ER
____ hip flexion needed to rise from seated position
100 degrees
_____ hip (3) ROM needed to tie shoes
115 hip flexion
18 abduction
13 ER
____ hip (3) ROM needed to sit cross-legged
85 hip flexion
35 Abduction
45 ER
what is Lateral Femoral Cutaneous Neuralgia often mis-dx as?
Typical post-surgical pain/paresthesia
Iatrogenic LFCN injuries from ?
Anterior Total hip arthroplasties
LFCN Tests and Measures
Observation - scar incision
Tinel’s sign at inguinal ligament
Hip extension
Purely sensory - sensation testing
FABER/FADIR
Dermatomes of LFCN
L1, L2, L3
Common presentation of Hip Dysplasia
- babies in breech position (butt first)
- first born babies
- females > male
- certain swaddling positions
Sx of hip dysplasia
- groin pain
- possible limb
- feeling “unstable”
- possible LLD
Harris vs. HOOS population?
Harris: acute
HOOS: Athletes
Harris vs. HOOS ability/disability?
Harris: ability
HOOS: disability
Harris vs. HOOS other differences?
Harris: functional, objective measures, AD
HOOS: more Qs, QoL, psychological
what is “bony overgrowth causing dysfunctional approximation of the femoral neck and acetabulum”
femoral acetabular impingement (FAI)
Types of FAI
- CAM Impingement (young athletic males)
- Pincer impingement (females)
- Mixed (more common
FAI leads to
- Labral tears
- Osteoarthritis (CAM)
- C sign holding anterolateral hip
what type of FAI is this?
CAM impingement
what type of FAI is this?
Pincer impingement
Outcome measures of FAI
HOOS
LEFS, LEAP, LEAS
5STS
TUG
10 MWT
Gait
SLS
Tests and Measures FAI
PROM end feels
Other tests and measures FAI
FADIR
FABER
Thomas
Ober
Labral Tear Causes
- Rotational force through planted limb
- Repetitive microtrauma from FAI
- Repetitive microtrauma from abnormal muscle firing pattern
Labral Tear result in
- decreased hip stability
- loss of “cushion” from pulvinar
- Eventual OA
what is “inflammation and/or degeneration of glute med tendon at attachment site”
gluteal tendinopathy
gluteal tendinopathy is usually tx with
corticosteroids
education plus exercise is better than “wait and see” approach
Gluteal tendinopathy outcome measures
SL balance (trendelenburg)
SL squat
5STS
Squat
Hip OA Causes
- coxa valga (acetabulum)
- FAI
- hip dysplasia
- repetitive microtrauma & Wolff’s Law
- obesity
- female
- age
- macrotrauma forcing joint surface compression
hip OA results in
- posture with hip flexion
- decreased hip extension during gait
- may see compensatory lumbar extension
diff Dx for hip OA
Pain in hip with
- IR > 15
- pain associated with internal hip
- AM stiffness of < 60 min
- over 50 years of age
NOT
* IR < 15
* ESR < 45 mm/hr or hip flexion < 115 if ESR unavailable
5 variables for CPR of Hip OA
CPR = clinical prediction rule
- Squatting was an aggravating factor
- active hip flexion caused lateral hip pain
- Scour test with adduction caused lateral hip/groin pain
- active hip extension caused pain
- passive IR of <= 25 degrees
CPR for Hip OA
3/5 variables = + LHR of 5.2 = ____ % Hip OA probability
LHR = likelihood ratio
68
CPR for Hip OA
4/5 variables = + LHR of 24.3 = ____ % Hip OA probability
LHR = likelihood ratio
91
Femoral neck fx are common in (3 things)
- > 60 years
- women
- result of osteoporosis
is femoral neck fx intra or extracapsular
intracapsular
THA precautions: anterior/posterior
Anterior: Ext, Abd, ER
Posterior: Flex >90 degrees, Add, IR
THA Outcome measures
- Harris or HOOS
- LEFS
- TUG c AD
- 10 MWT
- Gait