Exam 2 Flashcards
What System should be considered when doing a system review?
(hip)
Urogenitial
- The Kidneys can refer to the lateral hip
- We may need to perform Kidney percussion test
When screening the hip, what vascular conditions should we look out for?
Avascular Necrosis / Osteonecrosis
- They may complain of a dull ache or throbbing pain in the groin, lateral hip or buttock
- Pain with ambulation, abduction and IR/ER
Pediatric Disorders
What is Legg-Calve-Perthes Disease?
When the Femoral Head temporarily loses blood supply
- This is idiopathic
- More common in overweight adolescents
- Hx of recent growth spurt or trauma
Legg-Calve-Perthes Disease, what can be observed and what may we find objectively?
- Limp is observed
- Pain in Hip, Groin, Thigh or Knee that worsens with activity
- Limited flexion, abduction and IR
What is Slipped Capital Femoral Epiphysis?
- Anterior displacement of the Femoral Neck
- Male > Females; 2-13 years old
- Gradual onset of groin, medial thigh and knee pain
With Slipped Capital Femoral Epiphysis, what can be observed?
- Limited abduction and extension ROM
- Short limb, antalgic gait
What is Congenital Hip Dysplasia?
- Hips that are “unstable”, malformed, subluxated, or dislocated
- Infants, Female > Male
- Short limb
- Associated with torticollis
- Hip position flexed and abducted
- May be a breech birth
- Galeazzi, Ortolani and Barlow signs
What types of infections should be considered with Red Flag considerations?
(hip)
- Septic Arthritis
- Osteomyelitis, espeically those patients who’ve had an acute trauma or who are post-op
Which Cancers are local to the hip?
- Osteoid Osteoma
- Colon Cancer
Which Neurologic conditions should be considered with Hip red flags?
- Cauda Equina Syndrome
- Guillain-Barre Syndrome
- MS
- ALS
What are the Red Flags associated with Colon Cancer?
- Age > 50
- Bowel Disturbances (e.g., rectal bleeding or black stools)
- Unexplained weight loss
- Hx of colon cancer in the family
- P! unchanged by positions or movement
What are the Red Flags with Osteonecrosis/Avascular Necrosis of the Hip?
- Hx of long-term corticosteroid use
- Hx of avascular necrosis of the contralateral hip
- Trauma
What is referred pain?
- Pain that is perceived at a different location than in source
- When determining probable hypothesis, somatic and visceral referred pain must be considered
Where can the Hip refer pain to?
Pretty much anywhere in the LE
- Most commonly to the buttock
- Also the groin and thigh
- Less commonly to the lower leg, dorsum of foot, and plantar heel
What can refer pain to the Hip?
Lumbar
- Somatic referral, commonly refers pain to the hip
- Must be considered as a source of hip pain
What muscles are a source of LE Pain?
- Gluteal musculature can and do develop myofascial trigger points
- Glute Medius, Glute Minimus, TFL, Deep Hip Rotators: Down to LE
What may you hear during the Subjective Hx with these patients?
(Hip w/ mobility def.)
- Insidious onset of stiffness and global pain
- Typically pain and stiffness worsens over time
- Worse in morning and with prolonged positioning, eases with movement
- Reports limited ROM eventually resulting in activity limitations and participation restrictions
- Aggravating Factors: Endrange hip motions; IR and Flex tend to be most provocative
What Objective Finding may you find with these patients?
(Hip w/ mobility def.)
- Limited AROM and PROM; if mobility deficits are a result of a joint integrity deficit than a capsular pattern may be present
- Possibly impaired joint integrity/mobility
- Possibly limited muscle length
What is the Prognosis for Hip P! with Mobility Deficit?
- Dependent upon integrity of joint
- Mobility deficits typically improve with interventions targeting joint mobility and pain control, if needed
What interventions are typically done with Hip P! and Mobility Deficit pts?
- Mobility/ROM exercises
- Manual Therapy
- Functional Optimization
If a Patient is in the Acute stage of condition, what should we the PTs do?
- These pt may require symptom modulation approach depending upon severity and irritability; also may present with somatic referred pain
If a patient is in the Subacute stage of condition, how may a patient present?
- The patient may begin to present with indications of movement and coordination impairments as mobility increases and motor control is impaired due to prolonged lack of mobility
If a patient is in the Chronic stage of healing, what do we, the PTs, do in this stage?
- Continue to address endrange mobility deficits, continue to improve movement and coordination impairments, and work towards functional optimization
What are the Primary S/S of Symptomatic Hip OA?
- Joint pain, joint stiffness, and activity associated limitations/participation restrictions