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MSK II > Exam 2 - Pelvis and hip 3 > Flashcards

Exam 2 - Pelvis and hip 3 Flashcards

1
Q

what is the etiology of hypermobility in the LE

A

traumatic: fx, lig treat, labral tear

atraumatic: extreme motions in sports, labral tear with FAI/IPI, systemic connective tissue disorder

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2
Q

describe what kinds of bone abnormalities can lead to hypermobility in the hip

A

shallow acetabulum
inferior acetabular insufficiency
excessive femoral version or torsion
excessive femoral neck angle

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3
Q

in the transverse plane, excessive anteversion causes toeing (in/out)

A

toeing in

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4
Q

in the transverse plane, excessive retroversion causes toeing (in/out)

A

toeing out

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5
Q

describe coxa valga

A

frontal plane

larger angle of inclination
leads to genu vara or bow legged position

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6
Q

descrive coxa vara

A

smaller angle of inclination
leads to genu valga or knocked kneed position

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7
Q

list the risk factors of hypermobility in the hip

A

genetics
injury
pt activities: running, dance, any activity that involves rotation, flexion, hyperextension

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8
Q

what are the symptoms of hip hypermobility

A

anterior groin or lateral hip pain
popping, locking, snapping present
feeling of instability especially when squatting

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9
Q

what would you expect to find in your scan with hip hypermobility

A

ROM: hip R > 30 at 90 flx
CM: possible inconsistent block
Special: (+) hip apprehension, abnormal femoral version/torsion

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10
Q

what is hip apprehension test

A

pt prone, move hip into ext with ER and ABD while applying anterior inferior force onf emur

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11
Q

what is the focus of PT for hip hypermobility

A

primary focus is on cartilage integrity and stabilisation

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12
Q

what is regional interdependence

A

theory that different body regions are biomechanically and neurophysiological interdependent and impairment in one region can contribute to impairment in another

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13
Q

what is the prominant innervation to the L4-S1 Z joints

A

L4 dorsal rami

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14
Q

what is the predominant and the most consistent innervation to L4-S1 discs

A

L1,2 dorsal root ganglia and L4 and L5 sinuvertebral nerves

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15
Q

what is the primary innervation of the iliolumbar ligaments

A

L1-4 spinal nerves

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16
Q

if any of the L4-SS1 joints are persistently hypermobile/unstable, what muscles groups are more likely to excessively recruiter d/t the predominance of L1-4 innervation and sensitization

A

hip flexors (L1,2)
hip adductors (L3)
knee extensors (L3,4)
ankle dorsiflexion (L4,5)

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17
Q

what muscles are hip flexors

A

iliopsoas (L1-4)
iliocapsularis (L2-4)
rectus femoris (L2-4)

18
Q

what does the iliopsoas attach to

A

iliocapsularis

19
Q

what does the iliocapsularis attach to

A

iliopsoas, anteromedial capsule, rectus femoris

20
Q

what does the rectus femoris attach to

A

capsule

21
Q

what does the capsule attach to

A

labrum

22
Q

what is the etiology of the L4-S1 regional interdependence

A

L4-S1 hypermobility/instability
most common segments

23
Q

describe the pathomechanics of L4-S1 regional interdependence

A

inhibition of hip extensors and abductor

24
Q

what is the effect of excessive recruitment of the hip flexors that attach to the capsule

A

excessive traction on antmed portion (3 or 9 o’clock position) of capsule and labrum

may lead to labral irritation without boney changes like with FAI

25
Q

what is the effect of the inhibition of hip extensors and abductors

A

imbalance limites optimal axis of motion and joint support

easily overworked d/t lowered recruitment so overuse/lower supply occurs

26
Q

why do the hip extensors and abductors become hypertonic with L4-S1 regional interdependence

explain how a pt would report this

A

d/t being overworked even without overuse

pt would report as tightness that stretching can relieve for a short time, but tightness always returns

27
Q

what muscle hypertrophies in those with LBP

what does this indicate

A

iliopsoas

indicates continued and excessive recruitment

28
Q

what is a consequence of excessive recruitment of iliopsoas d/t L4-S1 regional interdependence

A

increased anterior shear most often occurring with lumbar hypermobility/instability

29
Q

what is iliopsoas impingement

A

impingement without dysplasia or bony changes

30
Q

what is the etiology of iliopsoas impingement

A

not fully clear

conditions that lead to excessive hip flexor recruitment

lumbar hypermobility/instability with regional interdependence

31
Q

what are the symptoms of iliopsoas impingement

A

like FAI

possible lumbar hypermobility/instability symptoms if aggravated

32
Q

what ROM would you expect with iliopsoas impingement

A

like FAI with:
IR limitation @ 90 flexion, elasic end feel
hip maltracking @ 90 flx

33
Q

why is IR limited with iliopsoas impingement

A

inhibition and hypertonicity of extensors or primarily glute max which is also the main ER at 90 flx

34
Q

what is the cause of hip maltracking @ 90 flexion

A

inhibition and hypertonicity of piriformis that is an abductor at 90 flexion

35
Q

what would you expect to see with RST with iliopsoas impingement

A

possible hip ER inibiiton at 90 flezion d/t glute max inhibition

possible inhibition of extensors, quad dominant squatting pattern

possible inhibited abductors

36
Q

what would you expect to find in the neuro scan for iliopsoas impingement

A

possible hypersensitivity

37
Q

what would you find during your palpation exam for iliopsoas impingement

A

TTP over anterior hip region at 3 or 9 oclock position depending on hip

38
Q

what would you find in the throacolumbar scan and biomechanical exam with iliopsoas impingement

A

possible lumbar hypermobility/instability

39
Q

what is the PT rx for iliopsaoas impingement

A

culprit rx - lumbar hypermobility/instability
victim rx - like FAI rx

40
Q

what would be the MD rx for iliopsoas impingement

A

iliopsoas surgical partial release

does not treat the culprit

MSK II (5 decks)

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