Exam 2 - hip clinical considerations, knee osteology Flashcards
describe the greater trochanter syndrome
can be primary cause of lateral hip pain
common > 40 yrs
“rotator cuff syndrome of the hip”
tension stress and compression
what would a pt report with greater trochanter syndrome
ache, tender near greater trochanter
P! with standing on 1 leg, climbing stairs, prolonged walking, high/sustained use of hip and
what is the rx for greater trochanter syndrome
injection, anti-inflammation meds, cane, PT
what would be practiced in PT for greater trochanter syndrome
isometric abd
limit add
biomechanical assessment of LE alignment
describe trendelinburg sign
weak hip “galls” into pelvic-on-femoral adduction
can be masked by trunk side lean as the trunk lean reduces external torque
what other conditions can hip abductor weakness lead to
postural instability
falls
patella-femoral pain
LBP
ankle pain
knee instability
what is the etiology of hip abductor weakness
muscular dystrophy
guillian-barre
incomplete spinal cord injury
GTPS
hip arthritis/deg
poliomyelitis
LBP
disuse atrophy
surgery
what nerve is damaged if pt demonstrates trendelinburg sign
superior gluteal nerve
what muscles are weakened if the pt demonstrates trendelenburg sign
gluteus medius and minimus
what locations can the pt report pain with osteoarthritis of the hip
how with the pt report the pain
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
what occurs in the hip joint with osteoarthritis
loss of joint space
deterioration of cartilage
thickened joint capsule
sclerosis of subchondral bone
osteophytes
describe total hip athroplasty
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
what is hip resurfacing procedure
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
what is the function of the piriformis when the hip is extended
external rotation
what is the function of the piriformis when the hip is flexed
internal rotation
what are the 2 main causes of hip impingement
cam - deformity of the ball at the top of the femur
pincer - deformity of the socket
describe the cam impingement of the hip
the abnormal shaped head jams the socket when the hip is bent
occurs during hip flx and IR activities
describe the pincer impingement of the hip
front of the acetabulum sticks out too far and excess bone growth on the femoral neck cannot pass smoothly in the socket
what is “bone on bone” notion most commonly known as
how does this occur
arthritis
loss of cartilage and labrum d/t abnormal femoral head/neck repetitively rubs on the cartilage and labrum
t/f
tears of the labrum can also fold into the joint space which further restricts motion of the hip and causes additional pain
true
what are the key symptoms of femoroacetabular impingement
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
what type of forces occur on the labrum during acetabular labrum injury
compressive, tensile, shearing
how can acetabular labrum injury occur
hip dislocations
deep squat and strenuous pull/lift
MVA
rotational, repetitive near end ROM (dance, soccer, etc)
what is the rx for acetabular labrum injury
injections
NSAIDs
core and hip strengthening
pt education of improved motion to modify impingement
surgery (repair, debridement, microfracture)
what is developmental dysplasia of the hip (DH)
dislocated or poorly formed acetabulum
loss of normal input for development
t/f
fx of the proximal femur/hip are commonclinical occurrences in the elderly and osteoporotic patients
true
what is the etiology of hip fractures
accident (fall/MVA)
athletes (long-distance runners)
minor fall or twisting/pivoting suddenly with elderly or osteoporotic patients
what are the risk factors of osteoporosis
female > males
increased age
endocrine disorders
intestinal disorders
nervous system disorders
hypoglycemia
long term use of prednisone
lack of physical activity
tobacco/alcohol use
what are the complications for hip fracture surgery
reduced independence
shortend life
immobility
blood clots
bed sores
UTI
pneumonia
muscle mass decrease
death
where does the psoas major insert
what is its function
lesser trochanter
ER and FLX hip
what position is the femur in when the femoral neck is detached
femur is pulled into ER
why are canes utilized on the contralateral side of the injured hip
the cane reduces the compressive forces of the opposite hand and reduces the activation of the ipsilateral hip abductors by 36%
with compromised hip, it is ideal to (carry/not carry) any external loads
not carry
if so, light/backpack/ipsilateral or cane ad ipsilateral load
stability of the knee primarily relies on what kind of structures
soft tissue constraints > bony
> 180 degrees at the knee indicates…
genu varum or “bow-leg”
< 170 degrees at the knee indicates..
genu valgum or “knocked knee”
what degrees is considered normal in the frontal plane at the knee
17-175 degrees
