Dr. OD Hip Lecture Flashcards
t/f: the pelvis is a system of functionally interdependent joints
true
what forces go to the pelvis?
from the head, arms, trunk, and LEs
what is the labrum of the hip?
an extra rim of stability around the acetabulum
is the labrum innervated?
yes
is the labrum vascular?
no
what are the clinical implications of an innervated avascular structure?
it can be painful and will heal slow or not heal at all
if a fx is closer to the femoral head, is it more or less likely to be spared?
less likely to be spared
what is the difference be a full jt replacement and a hemi hip jt replacement?
a full replacement involved the femoral head and acetabular cup, a hemi-replacement is just the femoral head
what are the 3 Rs of an examination?
reproducible sign
region of origin
reactivity level
what is the reproducible sign?
the action that brings about the pain that the patient has been experiencing
what is another name for the reproducible sign?
comparable sign
what is the region of origin?
where the pain is specifically coming from (more helpful in the spine)
what is reactivity level?
the level of irritability and behavior of the condition
what is the relationship of P1/2 to R1/2 in a highly reactive pt?
P1 and P2 will be close or the same and come before R1
if a pt is highly reactive, what grade mobs would be recommended?
grade 1 and 2
what are 2 good qualities of a historical interview in the exam?
focuses and empathetic
what is meralgia paraesthetica?
entrapment of the femoral nerve, often in the inguinal region, that created burning/tingling in the thigh
what conditions can contribute to hip pain?
ankylosing spondylitis
OA
congenital dysplasia (DDH), SCFE, LCPD
osteoporosis
surgical and traumatic hx
celiac
Crohn’s disease
bone tumors
lumbar radiculopathy
what is ankylosing spondylitis?
an autoimmune disease causing inflammation in the spine
what is DDH?
development dysplasia of the hip
what is included in the HPI?
MOI
pain location and type
relationship to activity/time of day
snapping, catching, locking (intra vs extra articular)
radiating symptoms
what is a normal femoral head/shaft angle?
125 degrees
what is coxa vara?
decreased femoral angle
what is coxa valga?
increased femoral angle
with coxa Vara/valga, what may be seen?
in/out toeing
pro/sup
leg length discrepancies
genu valgus/varus
would a pt with coxa vara appear to have a longer or shorter leg ipsilaterally?
shorter leg
would a pt with coxa valga appear to have a longer or shorter leg ipsilaterally?
longer leg
if a pt has femoral anteversion, would you likely see in toeing or outtoeing to compensate?
in-toeing
if a pt has femoral retroversion, would you likely see in toeing or outtoeing to compensate?
out-toeing
what is the OPP of the hip?
30 degrees of flexion
what is the CPP of the hip?
max extension, IR, and abd
what is the end feel of hip flexion?
elastic/tissue approximation
what is the end feel of hip extension?
tissue stretch, elastic
what is the end feel of hip abduction?
tissue stretch, elastic
what is the end feel of hip adduction?
elastic/tissue approximation
what is the end feel of hip IR/ER?
tissue stretch, elastic
in the pyramid of mobility testing, what do we do first, PROM, AROM, or mobs?
AROM
in the pyramid of mobility testing, what do we do after AROM, PROM or mobs?
PROM
what is the last and sometimes not done step in the pyramid of mobility testing?
mobs
what is the most specific test for joint motion?
mobs
what are some compensatory patterns for coxa Vara?
ipsi PF and sup
contra DF and pro
contra genu recurvatum
contra hip and/or knee flexion
ipsi ant pelvic rotation and/or contra post pelvic rotation in standing
what are some compensatory patterns of coxa valga?
ipsi DF and pro
contra PF and sup
ipsi genu recurvatum
ipsi hip and/or knee flexion
ipsi post pelvic rotation and/or contra ant pelvic rotation in standing
what are some compensatory patterns of femoral anteversion?
ipsi external tibial torsion
ipsi sup
ipsi knee ext
what are some compensatory patterns of femoral retroversion?
ipsi internal tibial torsion
ipsi pro
ipsi knee flex
what is normal femoral anteversion?
15-25 degrees
what is the angle of femoral anteversion?
> 25 degrees anteverted
what is the angle of femoral retroversion?
<15 degrees anterversion
what would be an example of a bottom up problem causing a shorter leg?
overpronation
what would be an example of a top down problem causing a shorter leg?
coxa vara
what is inhibited in upper crossed syndrome?
deep cervical flexors
LT/SA
what is facilitated in upper crossed syndrome?
UT/LS
SCM/pecs
what is inhibited in lower crossed syndrome?
abdominals
glut med/min/max
what is facilitated in lower crossed syndrome?
thoraco-lumbar extensors
rectus femoris and illiospoas
what should be strengthened in crossed syndrome?
core (TA, multifidi, pelvic floor) and glutes
what should be stretched in crossed syndrome?
lumbar extensors and HS
what is the capsular pattern of the hip?
limited in flexion, abd, and IR is variable
flex=abd=IR variable
to facilitate hip flexion, the femur rolls ___and glides ____ _____
anterior, posterior/inferior
to facilitate hip extension, the femur rolls ____ and glides ____
posterior, anterior
to facilitate hip abduction, the femur rolls ____ and glides ____
lateral, medial
to facilitate hip adduction, the femur rolls ____ and glides ____
medial, lateral
to facilitate hip IR, the femur rolls ____ and glides ____
medial, lateral/posterior
to facilitate hip ER, the femur rolls ____ and glides ____
lateral, medal/anterior
what is the roll and glide for hip flexion in the OKC?
roll anterior
glide posterior and inferior
what is the roll and glide for hip extension in the OKC?
roll posterior
glide anterior
what is the roll and glide for hip abduction in the OKC?
roll lateral
glide medial
what is the roll and glide for hip adduction in the OKC?
roll medial
glide lateral
what is the roll and glide for hip IR in the OKC?
roll medial
glide lateral and posterior
what is the roll and glide for hip ER in the OKC?
roll lateral
glide medial and anterior
what is the roll and glide for hip flexion in the CKC?
roll anterior
glide anterior
what is the roll and glide for hip extension in the CKC?
roll posterior
glide posterior
what is the roll and glide for hip abduction in the CKC?
roll lateral
glide lateral
what is the roll and glide for hip adduction in the CKC?
roll medial
glide medial
what is the roll and glide for hip IR in the CKC?
roll medial
glide medial
what is the roll and glide for hip ER in the CKC?
roll lateral
glide lateral
what is normal open chain hip flexion?
120-125 degrees
what is normal open chain hip extension?
9-19 degrees
what is normal open chain hip abd?
39-46 degrees
what is normal open chain hip add?
15-31 degrees
what is normal open chain hip ER?
32-47 degrees
what is normal open chain hip IR?
32-47 degrees
what is the hip equivalent motion for ant/post rotation of the pelvis?
flex/ext
what is the hip equivalent motion for upslip/downslip?
add/abd
what is the hip equivalent motion for outflare/inflare?
ER/IR
what is the lumbopelvic rhythm?
lumbar spine
lumbo-pelvic spine
hip
with hip flexion, what is lumbopelvic contribution at the beginning, middle, and end of motion?
lumbar more in early motion (2:1 L/H ratio)
lumbar/hips contribute equally in middle phase (1:1 L/H ratio)
hips in late motion (1:2 L/H ratio)
with hip extension, what is the lumbopelvic contribution at the beginning, middle, and end of motion?
hips in early motion (1:2 L/H ratio)
lumbar/hips contribute equally in middle phase (1:1 L/H ratio)
lumbar in late motion (2:1 L/H ratio)
with the hips in neutral, is IR or ER stronger?
ER
with the hip in neutral, what do the glut max, most of med, and deep rotators do?
ER
with the hip in >90 degrees flexion, what do the glut med, and piriformis do?
IR
with the hip in >90 degrees flexion, is IR or ER stronger?
IR
what is the process for palpation?
palpate for position early in the exam
palpate for condition
palpate for reproduction late in the exam to avoid a flare up during MMTs, special tests, etc
begin at the least painful sport and work towards the pain
what are some functional tests?
squatting
stair negotiation (1, 2, at a time)
leg crossing
gait assessment
jogging/running assessment
jumping/hopping
one leg hop (time, distance, crossover)
step down test (powers)
what hip range is required for squatting?
flexion: 115 degrees
abduction: 20 degrees
IR: 20 degrees
what hip range is required for sitting?
flexion: 115 degrees
what hip range is required for ascending stairs?
flexion: 70 degrees
what hip range is required for descending stairs?
flexion: 40 degrees
what hip range is required for donning pants?
flexion: 90 degrees
what hip range is required for crossing legs?
flexion: 120 degrees
abduction: 20 degrees
ER: 20 degrees
why do pts prefer ascending stairs to descending stairs?
because they can bend forward up stairs to activate the glutes more for more power
