DD Of Hip

Question 1

What is the degrees of Coxa Vara?

Answer 1

<125

Question 2

What is the degrees of coxa valga?

Answer 2

“L” for longer leg
>125

Question 3

For reference what is the normal degree of the femoral neck?

Answer 3

125

Question 4

What is the presentation of Coxa Valga?

Answer 4

-Longer leg on side of valga
-Genu forum common
-Malleoli, fibular heads and trochanters are level
-Iliac spines and crests are high
-Associated with increased anteversion

Question 5

What is the presentation of Coxa Vara?

Answer 5

-Small area of inclination between femoral neck and shaft of femur
-Shorte”R” leg on coxa vara side
-Genu Valium is common
-Malleoli, fibular heads and trochanters are level
-PSIS/ASIS and iliac crests are lower
-Associated with retro version

Question 6

What is anteversion?

Answer 6

-Torsion of the femoral neck that causes shaft of femur to IR
-Causes a decrease in ER and glutes cannot fire properly
-Lack of proper push-off in gait
-Results in Genu vagus and pes planes
-Short leg on side of version if unilateral

Question 7

What is retroversion?

Answer 7

-Decrease in torsion of femoral neck
-Causes a decrease in IR
-Long leg on side of version

Question 8

What is the special test to diagnose version at the femur?

Answer 8

Craig’s test

Question 9

What is the capsular pattern of the hip?

Answer 9

Flex>ABD>IR

Question 10

What is osteoporosis?

Answer 10

chronic progressive disease
-Low bone mass, impaired bone quality and decreased bone strength
Types
Primary: age related, negative calcium balance, progressive estrogen deficiency
Secondary: meds (corticosteroids), cigarette, smoking, sedentary, alcoholism

Question 11

What is the clinical manifestation of osteoporosis?

Answer 11

Loss of height
-Postural changes
-Thoracic kyphosis (back fractures)
-vertebral body- hyperkyphotic posture, lift heavy, increase intrathoracic pressure- cough/sneeze
-Affects hips, ribs, radius and femur

Question 12

What is the prevention for osteoporosis?

Answer 12

-Peak bone mass at 30, regular physical exercise, calcium, vitamin D

Question 13

How do you screen for osteoporosis?

Answer 13

-Bone mineral density testing
Z score: norm values same sex and age
T SCORES***

Question 14

What is a -1 or higher T score?

Answer 14

Normal

Question 15

What is a -1 to -2.5 T score?

Answer 15

Osteopenia

Question 16

What is < or = to -2.5?

Answer 16

Osteoporosis

Question 17

What is the PT intervention for osteoporosis?

Answer 17

Long term commitment to exercise
-Fall prevention, balance exercises
-Reduce anterior translation of cervicothoracic kyphosis
-Stabilize and increase bone mass (closed chain, eccentric, resistive>aerobic)

Question 18

What is osteomalacia?

Answer 18

Progressive, lack of mineralization of bone, soft bone, w/o loss of bone matrix

Question 19

What is the clinical manifestation of osteomalacia?

Answer 19

Deficiency in calcium, vitamin D and phosphate
Initially: general ache, fatigue, weight loss, proximal myopathy, sensory polyneuropathy
-increased thoracic kyphosis, heart shaped pelvis, proximal weakness
-Difficulty with transitional movements, rise from chair, climb stairs, bed mobility

Question 20

What is the treatment for osteomalacia?

Answer 20

Similar to management of osteoporosis
Nutritional: vitamin D and phosphate

Question 21

What is Paget’s disease?

Answer 21

Progressive adult skeletal system
-Increased bone resorption with unorganized new bone formation
-Normal bone marrow replaced by fibrous tissue- enlarged bone but weak

Question 22

What are the clinical manifestations of Paget Disease?

Answer 22

MSK: primarily affect axial skeleton, fractures, bone change in size, shape, alignment, pain periosteal irritation- deep, worse at night, fatigue, LH, stiff, thoracic kyphosis, bowing of femur and tibia, bone is soft
-Coxa Vara
-Waddled gait
Neuro: impingement- myelopathy or ischemia, nerve compression syndrome, mental confusion, sensorineural hearing loss

Question 23

What is the treatment for Pagets Disease?

Answer 23

Mental deterioration which decreases blood flow, fatigue, vertigo
-Screen alkaline phosphate
-exercise is important** avoid running, jumping, forward bending and twisting, orthotics