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10. Hip Flashcards

1
Q

Hip Self Report Outcome Measures

A

Pain Scales
AIMS
WOMAC
LEAP
LEFS
LEAS
Harris Hip Function Scale
HOOS

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2
Q

LEAP

A

self-care, mobility, household activities, work, leisure activities, emotional health, sleep/rest, social activities, appearance, pain

DISABILITY scale

23 items

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3
Q

LEFS

A

work, Athletics/sporting

ABILITY scale

20 items

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4
Q

LEAS

A

work

ABILITY scale

8 items

LeaS = Short

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5
Q

Harris Hip Function Scale

A

-functional tasks (ADLS)
-acute
-pain
-ROM
- deformity
-putting on shoes
-AD

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6
Q

HOOS: hip disability and osteoarthritis outcome score

A

-everyday orthopedics
-symptom based questionnaire
-previous week symptoms
-more specific: different surfaces, all difference parting of sitting versus standing, QOL
-putting on shoes
-getting on/off toilet
-LONG

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7
Q

Hip Performance Outcome Measures

A

6MWT
DGI
TUG
Timed LE Chair Rise Test
Wall Sit Test
Vertical Jump Test
LE Agility Test
Hop Tests
LQ Y-balance Test

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8
Q

What are the 6 hip ER muscles?

A

Glute Med
Piriformis
Superior Gemelli
Obturator Internus
Inferior Gemelli
Quad Fem

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9
Q

What are 5 functions of Sartorius

A

Hip Flex, Abduct, ER
Knee Flex, IR

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10
Q

Line of gravity is (anterior/posterior) to hip joint

A

Posterior

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11
Q

T/F Line of gravity aligns with the greater trochanter

A

True

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12
Q

Since the LoG falls posterior to the hip joint, there is an _______ moment

A

Extension

counteracted by Iliopsoas and iliofemoral ligament (y-ligament)

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13
Q

What structures limit hip extension?

A

iliofemoral ligament and hip flexors

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14
Q

what structures limit hip flexion?

A

glute max and hamstrings

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15
Q

What structures limit hip abduction?

A

pubofemoral ligament and adductors

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16
Q

what structures limit hip adduction?

A

ischiofemoral ligament, glute med/min, TFL/IT band

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17
Q

what structures limit hip IR?

A

ischiofemoral ligament and hip external rotators

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18
Q

what structures limit hip ER?

A

hip internal rotators (TFL, gluteus medius/minimus) and Iliofemoral ligament (Anterior fibers)

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19
Q

what do you see?

A

Lumbar Lordosis
Genu Recurvatum

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20
Q

Anterior Pelvic Tilt: what muscles are too short?

A

Erector Spinae
Iliopsoas

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21
Q

Anterior Pelvic Tilt: what muscles are too long?

A

Glutes
Abdominals

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22
Q

how does an anterior pelvic tilt affect the arch of the foot?

A

if unilateral anterior pelvic tilt, one leg appears longers, so the arch flattens to even out leg length

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23
Q

Normal Angle of Inclination @ hip

A

125 degrees

angle between the femoral shaft and femoral head/neck

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24
Q

Is Coxa Valga structural or functional?

A

Structural

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25
Do you have a (longer/shorter) limb with coxa valga?
longer | coxa valga = > angle of inclination
26
Do you have a (more/less) stability with coxa valga?
more stability from top to bottom
27
_______ shearing across femoral neck with Coxa Valga
Decreased
28
Coxa Valga: ______ likelihood of femoral dislocation
Increased
29
Coxa Valga:_______ abductor muscle toruqe
Decreased (decreased moment arm & decreased leverage)
30
Coxa Valga: _____ likelihood of superior hip OA
increased | superior hip takes on WAY more force with coxa valga
31
Coxa Vara leads to (shorter/longer) limb?
Shorter | coxa vara = < angle of inclination
32
T/F: Coxa vara has worsened congruence between femoral head and acetabulum
False Improved congruence!
33
T/F: Coxa vara stress fractures along femoral neck.
True! and SCFE happens
34
Normal Femoral torsion
10-20 degrees of anteversion
35
Another name for Increased femoral torsion
Anteversion
36
Another name for decreased femoral torsion
Retroversion
37
Angle of inclination is measured in _____ plane whereas femoral torsion is measured in _____ plane
Frontal Transverse
38
Excessive femoral **anteversion** leads to
* increased hip IR ROM * decreased hip ER ROM * In-toeing (uncompensated) * Tibial ER (compensated)
39
Femoral **Retroversion** leads to:
* Increased hip ER ROM * decreased hip IR ROM * Out-toeing (uncompensated) * Tibial IR (compensated)
40
normal hip flexion ROM
120 degrees
41
normal hip extension ROM
20 degrees
42
normal hip ABD ROM
45 degrees
43
normal hip ADD ROM
20 degrees
44
normal hip IR ROM
45 degrees
45
normal hip ER ROM
45 degrees
46
normal SLR
70 degrees male 90 degrees female
47
normal hip flexion end feel
soft
48
normal hip ext, ABD, ADD, ER, IR end feel
firm
49
abnormal hip capsular end feel
IR > EXT > ABD Note hip: IR shoulder: ER
50
____ hip flexion needed to rise from seated position
100 degrees | posterior THA precautions: no flexion past 90
51
_____ hip (3) ROM needed to tie shoes
115 hip flexion 18 abduction 13 ER posterior precautions: no flexion past 90 anterior precautions: no ER or abduction
52
____ hip (3) ROM needed to sit cross-legged
85 hip flexion 35 Abduction 45 ER posterior precautions: no flexion past 90 anterior precautions: no ER or abduction
53
Lateral Femoral Cutaneous Nerve
L2, L3
54
what is Lateral Femoral Cutaneous Neuralgia often mis-dx as?
Typical post-surgical pain/paresthesia
55
Iatrogenic LFCN injuries from ?
Anterior Total hip arthroplasties
56
LFCN Tests and Measures
Observation - scar incision Tinel's sign at inguinal ligament Hip extension Purely sensory - sensation testing FABER/FADIR
57
Diff Dx of LFCN
dermatomes: L1, L2, L3
58
Common presentation of Hip Dysplasia
* babies in breech position (butt first) * first born babies * females > male * certain swaddling positions
59
Sx of hip dysplasia
* groin pain * possible limb * feeling "unstable" * possible LLD
60
Harris vs. HOOS population?
Harris: acute HOOS: Athletes
61
Harris vs. HOOS ability/disability?
H**a**rris: **a**bility HOOS: disability
62
Harris vs. HOOS other differences?
Harris: functional, objective measures, AD HOOS: more Qs, QoL, psychological
63
what is "bony overgrowth causing dysfunctional approximation of the femoral neck and acetabulum"
femoral acetabular impingement (FAI)
64
Types of FAI
* CAM Impingement (young athletic males) * Pincer impingement (females) * Mixed (more common
65
FAI leads to
* Labral tears * Osteoarthritis (CAM) * C sign holding anterolateral hip
66
what type of FAI is this?
CAM impingement | between femoral neck/femoral head
67
what type of FAI is this?
Pincer impingement | **p**incer = **p**elvis
68
Outcome measures of FAI
HOOS LEFS, LEAP, LEAS 5STS TUG 10 MWT Gait SLS
69
Tests and Measures FAI
PROM end feels: hard hip flexion/extension MMT: hip abd, ext, flex
70
Other tests and measures FAI
FADIR FABER Thomas Ober
71
Labral Tear Causes
* Rotational force through planted limb * Repetitive microtrauma from FAI * Repetitive microtrauma from abnormal muscle firing pattern
72
Labral Tear result in
* decreased hip stability * loss of "cushion" from pulvinar * Eventual OA
73
what is "inflammation and/or degeneration of **glute med** tendon at attachment site"
gluteal tendinopathy
74
gluteal tendinopathy is usually tx with
corticosteroids education plus exercise is better than "wait and see" approach
75
Gluteal tendinopathy outcome measures
SL balance (trendelenburg) SL squat 5STS Squat
76
Diff Dx for gluteal tendinopathy
trochanteric bursitis
77
what recreates gluteal tendinopathy pain?
AROM: hip adduction and extension
78
Tests/measures for gluteal tendinopathy
MMT: glute med/max flexibility: ober and Thomas
79
Outcome measures for gluteal tendinopathy
single leg balance single leg squat 5 STS squatting
80
Hip OA Causes
* coxa valga (superior acetabulum) * FAI * hip dysplasia * repetitive microtrauma & Wolff's Law * obesity * female * age * macrotrauma forcing joint surface compression
81
hip OA results in
* posture with hip flexion * decreased hip extension during gait * may see compensatory lumbar extension
82
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
83
5 variables for CPR of Hip OA | CPR = clinical prediction rule
1. **Squatting** was an aggravating factor 2. active hip **flexion** caused lateral hip pain 3. **Scour** test with **adduction** caused lateral hip/groin pain 4. active hip **extension** caused pain 5. passive **IR** of <= **25** degrees
84
CPR for Hip OA 3/5 variables = + LHR of 5.2 = ____ % Hip OA probability | LHR = likelihood ratio
68
85
CPR for Hip OA 4/5 variables = + LHR of 24.3 = ____ % Hip OA probability | LHR = likelihood ratio
91
86
Femoral neck fx are common in (3 things)
* >60 years * women * result of osteoporosis
87
is femoral neck fx intra or extracapsular
intracapsular
88
THA precautions: anterior/posterior
Anterior: Ext, Abd, ER Posterior: Flex >90 degrees, Add, IR
89
which position is safer for goni measuring hip rotation for THA patients
prone/supine *dislocations occur easily with sitting
90
THA Outcome measures
* Harris or HOOS * LEFS * TUG c AD * 10 MWT * Gait
91
would you assess single leg balance on a THA patient?
no due to limited WB
92
do you clear the spine for a THA patient
no need to
93
ober's test
Flex knee and hip to 90 degrees Move hip through motions of abduction, flexion, then extension to position the tensor fascia lata over the greater trochanter If the hip flexes or the pelvis tilts, this is noted as the end of the range of motion
94
Thomas test
lower the contralateral leg down, while feeling the contralateral anterior superior iliac spine, to assess for any movement of the pelvis and to feel for true length of hip flexors
95
Ely's Test
Bend the patient’s uninvolved knee first to assess maximum knee flexion range and rectus femoris length Next bend the patient’s involved leg If you see an anterior pelvic tilt and hip flexion once you reach end of the muscle’s length, it is a positive test
96
FABER Patrick test
Place the patient passively into a figure of four position by crossing the ankle of the testing limb over the non testing distal thigh region Stabilize the opposite anterior superior iliac crest Apply anterior to posterior pressure through the medial aspect of the flexed knee Ask the patient about the location and intensity of their pain

Lauren (90 decks)

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