Exam 2 - hip clinical considerations, knee osteology

Question 1

describe the greater trochanter syndrome

Answer 1

can be primary cause of lateral hip pain

common > 40 yrs

“rotator cuff syndrome of the hip”

tension stress and compression

Question 2

what would a pt report with greater trochanter syndrome

Answer 2

ache, tender near greater trochanter

P! with standing on 1 leg, climbing stairs, prolonged walking, high/sustained use of hip and

Question 3

what is the rx for greater trochanter syndrome

Answer 3

injection, anti-inflammation meds, cane, PT

Question 4

what would be practiced in PT for greater trochanter syndrome

Answer 4

isometric abd
limit add
biomechanical assessment of LE alignment

Question 5

describe trendelinburg sign

Answer 5

weak hip “galls” into pelvic-on-femoral adduction

can be masked by trunk side lean as the trunk lean reduces external torque

Question 6

what other conditions can hip abductor weakness lead to

Answer 6

postural instability
falls
patella-femoral pain
LBP
ankle pain
knee instability

Question 7

what is the etiology of hip abductor weakness

Answer 7

muscular dystrophy
guillian-barre
incomplete spinal cord injury
GTPS
hip arthritis/deg
poliomyelitis
LBP
disuse atrophy
surgery

Question 8

what nerve is damaged if pt demonstrates trendelinburg sign

Answer 8

superior gluteal nerve

Question 9

what muscles are weakened if the pt demonstrates trendelenburg sign

Answer 9

gluteus medius and minimus

Question 10

what locations can the pt report pain with osteoarthritis of the hip

how with the pt report the pain

Answer 10

groin, thigh, buttocks, knee

stabbing and short, dull ache, stiff hip
pain with getting out of bed or prolonged sitting
pain, swelling, tenderness of the hip
sound/feeling of “crunching”
inability to move the hip to perform routine activities

Question 11

what occurs in the hip joint with osteoarthritis

Answer 11

loss of joint space
deterioration of cartilage
thickened joint capsule
sclerosis of subchondral bone
osteophytes

Question 12

describe total hip athroplasty

Answer 12

consists of ceramic femoral head with a titanium stem and polyethylene socket

can be cement or biological fixation via bone growth into the implanted device

large torsional forces between implant/bone can create loosening

Question 13

what is hip resurfacing procedure

Answer 13

surgeon trims damage from the natural bone ball at the top of the thighbone
surgeon resurfaces it with a smooth metal covering
surgeon also lines natural bone socket of the hip with a metal lining or shell

Question 14

what is the function of the piriformis when the hip is extended

Answer 14

external rotation

Question 15

what is the function of the piriformis when the hip is flexed

Answer 15

internal rotation

Question 16

what are the 2 main causes of hip impingement

Answer 16

cam - deformity of the ball at the top of the femur

pincer - deformity of the socket

Question 17

describe the cam impingement of the hip

Answer 17

the abnormal shaped head jams the socket when the hip is bent

occurs during hip flx and IR activities

Question 18

describe the pincer impingement of the hip

Answer 18

front of the acetabulum sticks out too far and excess bone growth on the femoral neck cannot pass smoothly in the socket

Question 19

what is “bone on bone” notion most commonly known as

how does this occur

Answer 19

arthritis

loss of cartilage and labrum d/t abnormal femoral head/neck repetitively rubs on the cartilage and labrum

Question 20

t/f
tears of the labrum can also fold into the joint space which further restricts motion of the hip and causes additional pain

Answer 20

true

Question 21

what are the key symptoms of femoroacetabular impingement

Answer 21

pain in hip or groin and sensation of catching or sharpness during movement

consistent, dull ache

can be felt along the side of the thigh and buttocks

first notice pain in front of hip/groin after prolonged sitting or exercise

Question 22

what type of forces occur on the labrum during acetabular labrum injury

Answer 22

compressive, tensile, shearing

Question 23

how can acetabular labrum injury occur

Answer 23

hip dislocations
deep squat and strenuous pull/lift
MVA
rotational, repetitive near end ROM (dance, soccer, etc)

Question 24

what is the rx for acetabular labrum injury

Answer 24

injections
NSAIDs
core and hip strengthening
pt education of improved motion to modify impingement
surgery (repair, debridement, microfracture)

Question 25

what is developmental dysplasia of the hip (DH)

Answer 25

dislocated or poorly formed acetabulum

loss of normal input for development

Question 26

t/f
fx of the proximal femur/hip are commonclinical occurrences in the elderly and osteoporotic patients

Answer 26

true

Question 27

what is the etiology of hip fractures

Answer 27

accident (fall/MVA)

athletes (long-distance runners)

minor fall or twisting/pivoting suddenly with elderly or osteoporotic patients

Question 28

what are the risk factors of osteoporosis

Answer 28

female > males
increased age
endocrine disorders
intestinal disorders
nervous system disorders
hypoglycemia
long term use of prednisone
lack of physical activity
tobacco/alcohol use

Question 29

what are the complications for hip fracture surgery

Answer 29

reduced independence
shortend life
immobility
blood clots
bed sores
UTI
pneumonia
muscle mass decrease
death

Question 30

where does the psoas major insert

what is its function

Answer 30

lesser trochanter

ER and FLX hip

Question 31

what position is the femur in when the femoral neck is detached

Answer 31

femur is pulled into ER

Question 32

why are canes utilized on the contralateral side of the injured hip

Answer 32

the cane reduces the compressive forces of the opposite hand and reduces the activation of the ipsilateral hip abductors by 36%

Question 33

with compromised hip, it is ideal to (carry/not carry) any external loads

Answer 33

not carry

if so, light/backpack/ipsilateral or cane ad ipsilateral load

Question 34

stability of the knee primarily relies on what kind of structures

Answer 34

soft tissue constraints > bony

Question 35

> 180 degrees at the knee indicates…

Answer 35

genu varum or “bow-leg”

Question 36

< 170 degrees at the knee indicates..

Answer 36

genu valgum or “knocked knee”

Question 37

what degrees is considered normal in the frontal plane at the knee

Answer 37

17-175 degrees