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DPT 730/1: MSK > Exam 2- SI jt-hip functional tests > Flashcards

Exam 2- SI jt-hip functional tests Flashcards

1
Q

what is the SI jt designed for

A

stability and very little mobility

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2
Q

what is RSA imaging

A

3D imaging motion and position

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3
Q

what are the RF for SI jt dysfunction

A

laxity and hormonal changes
during pregnancy- LBP or pelvic trauma

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4
Q

what is the primary cause of SI jt dysfunction

A

peri partum
immature skeleton due to lack of bone irregularity and congruency
trauma
disease (AS)

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5
Q

what are the S&S of SI jt dysfunction

A

localized SI jt pain
gluteal and lateral hip pain
pubic symphysis pain
hypermobility S&S

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6
Q

what can be seen on a SCAN for SI jt dysfunction

A

TL A/PROM- inconsistent
RST- impaired local m and weak antigravity m
ST- SI provocation tests

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7
Q

how are special tests with SI jt dysfunction

A

motion and palpation are unreliable
ASLR (+) for impaired m

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8
Q

what are most often the best evidence for dx a SI dysfunction

A

cluster and ASLR

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9
Q

how do we treat SI jt dysfunction

A

POLICED
m energy technique for m guarding/pain
pelvic belt
JM
MET

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10
Q

what does JM do for SI jt dysfunction

A

likely positive soft tissue and m influence per manip

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11
Q

what is the primary MET focus of SI jt dysfunction

A

stabilization

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12
Q

what do we do for MET with SI jt dysfunction

A

local m and lumbar hypermobility MET
hip m and thoracolumbar fascia

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13
Q

how does ligaments act if m attached to them

what if m is impaired

A

dynamic

if m is impaired, the ligament does not work how it should

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14
Q

what to edu the patient on with an SI jt dysfunction

A

reduce fear
early mobilization
general anatomy, biomechanics
reassurance of good prognosis

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15
Q

when are injections involved with the SI jt

A

pt has ankylosing spondylitis

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16
Q

what MD Rx can be given for SI jt dysfunction for short term benefit

A

pain/anti inflammatory meds
prolotherapy

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17
Q

what is the prognosis of SI jt dysfunction with pregnancy

A

rapidly declines during first 3 months post partum

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18
Q

what are the RF for an FAI

A

genetics and gender
susceptible population and activities
abnormal hip/pelvis kinematics

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19
Q

if a pt has limited post tilt, what other motion can be limited with FAI

A

hip ER

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20
Q

what is the more often cause of FAI

A

abnormal hip mechanics
vigorous athlete loading

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21
Q

what is less often the cause of FAI

A

pediatric hip conditions
femoral neck fx

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22
Q

what is a cam FAI

A

less spherical femoral head
contacts anterosuperior acetabulum (12 oclock)
more common in males

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23
Q

what are the congenitial types of FAI

A

cam
pincer
mixed

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24
Q

what is a pincer FAI

A

deeper acetabulum or anterior osteophyte
neck contacts anterior and sometimes posterior labrum
middle aged athletic

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25
Q

what structures are involved with FAI

A

articular cartilage
labral

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26
Q

what pain be reported that we should consider to be a FAI

A

mechanical groin pain

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27
Q

what are the symptoms of FAI

A

gradual onset of hip pain in anterior/groin area
lateral hip possible

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28
Q

what can worsen symptoms with FAI

A

repetitive and or prolonged hip flexion

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29
Q

what can you observe with FAI

A

impaired LE control

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30
Q

what functional tests can indicate FAI

A

impaired balance and LE control
quad dominant squat

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31
Q

what does ROM show with FAI

A

pain and limited with FLX and IR/H ADD at 90 deg flx
hip maltracking
<85 deg arc of RT

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32
Q

what is the largest predictor of groin pain

A

<85 deg arc at 90 flx

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33
Q

true/false
the different types of FAI all present in different ways

A

false
they all present the same

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34
Q

what does the rest of the SCAN show for a FAI

A

RST- decrease activation in ant gravity hip m
CM- possible consistent
ST- compression +

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35
Q

what will show in the BE for FAI

A

AM- possible hypo if persistent
Sp Test- FIR, FADDIR, FABER, possible femoral torsion +
palpation- + over anterior hip

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36
Q

how do we treat FAI

A

POLICED
JM
load management- exercise/ergonomic
foot orthotic- realignment or m activation
Pt edu
MET

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37
Q

what Pt edu can we provide with FAI

A

limit hip flexion >90
verbal cues for LE control

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38
Q

what are we trying to emphasize with MET for a pt with FAI

A

cartilage integrity
m function- antigravity hip m
mobility
emphasize LE control

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39
Q

what is the prognosis of FAI

A

many play with labral tears - no sx
ARJC decrease prognosis

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40
Q

what is the MD Rx for FAI

A

ultrasound guided injections
sx- iliopsoas release or labral

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41
Q

what is the most common cause of hip pian

A

ARJC

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42
Q

what are RF of ARJC in the hip

A

> 50 yrs
previous joint injury
preceded FAI
increasing BMI
occupational activity

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43
Q

what can allow a pt to develop ARJC in the hip sooner

A

previous injury
FAI

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44
Q

what is a subsequent predictor of hip disease

A

LBP

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45
Q

what drives the pain for ARJC in the hip

A

subchondral bone (innervation) since articular cartilage is gone (no innervation)

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46
Q

what are symptoms of ARJC in the hip

A

AM stiffness < 30 min
less tolerant to WB activities and sitting
C sign of pain
nociplastic

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47
Q

why is standing and sitting more painful with ARJC in hip than FAI

A

ARJC- articular cartilage = compression forces
FAI- labrum = stabilizer

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48
Q

what might you observe with ARJC in hip

A

asymmetrical gait
trendelenburg gait, lateral pelvic tilt

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49
Q

how is a lateral shift named

A

named by the way which hip drops

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50
Q

what can we see in a scan for ARJC in hip

A

ROM- > 3 planes restricted
CM- consistent block
RST- pain and weakness in ABD
ST- compression +

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51
Q

what will accessory motion show with ARJC in hip

A

hypomobility

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52
Q

what sp test would be found with ARJC in the hip

A

impaired functional performance (6 min walk, up and go)
impaired balance

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53
Q

what can we do to treat ARJC in the hip

A

POLICED
modalities
JM
MET
AD
pt edu

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54
Q

what is our purpose in treatment for ARJC in the hip

A

cartilage integrity
impaired m activation
mobility

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55
Q

what is an easy way to choose the correct assistive device

A

what AD allows walking most effectively with least pain

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56
Q

what pt edu is needed for ARJC in hip

A

limit hip flexion >90
wt managment

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57
Q

what needs to be included for MET with ARJC in hip

A

include trunk and hip anti gravity m
balance

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58
Q

what parameters for MET with ARJC in hip

A

1-5 x/wk
for 6-12 wks

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59
Q

what can the MD do for ARJC in hip

A

injections
THA

60
Q

what is the pro/con of ant THA approach

A

no trauma anti gravity m
smaller view
more prominent vascular structures

61
Q

what is the pro/con for post THA approach

A

larger view
trauma to anti gravity m
more common

62
Q

what is the purpose of the pre op visits before a THA

A

AD
plan recovery and HEP
expectation management

63
Q

what complications can arise with THA

A

heterotrophic ossification
painful PROM/JM with abrupt end feels are contraindicated

64
Q

what is a hemiarthroplasty

A

replace the head without replacing the acetabulum

65
Q

what is the PT RX for THA

A

same as ARJC except not encouraging cartilage integrity

66
Q

what are the precautions for a traditional THA

A

avoid hip flx past 90
avoid add past neutral
avoid RT

67
Q

what is the prognosis for THA

A

6-8 months out is 80% normal function

68
Q

what can cause hypermobility in the hip

A

fx
labral tear
extreme motions
labral tear with FAI/IPI
connective tissue disorder

69
Q

what is femoral torsion

A

the RT of the femur between the condyles and head/neck

70
Q

what can excessive anteversion cause

A

toeing in

71
Q

what can excessive retroversion cause

A

toeing out

72
Q

what is femoral neck angle

A

angle between the neck and the shaft

73
Q

what can coxa vara lead to

A

smaller angle
genu valga or knock knee

74
Q

what can coxa valga lead to

A

larger angle
genu varam or bow leg

75
Q

what are the RF for hypermobility in the hip

A

genetics
injury
excessive RT, FLX, hyperext

76
Q

what are the symptoms of hypermobility in the hip

A

anterior groin or lateral hip
popping. locking, snapping
feeling instable

77
Q

what can be found in a SCAN for hypermobility in the hip

A

ROM- IR >30 at 90 deg FLX
CM- inconsistent
Sp test- pubofemoral lig, abnormal femoral torsion

78
Q

what is the primary focus of PT Rx with hypermobility in the hip

A

stabilization
cartilage integrity

79
Q

what innervates the L4-S1 z joints

A

L4 dorsal rami

80
Q

what innervates the L4-S1 discs

A

L1-2 dorsal root ganglia and L4-5 n

81
Q

what innervates the iliolumbar lig

A

L1-4 n

82
Q

If L4-S1 joints are instable, what m groups are more likely to over recruit due to the innervation and sensitization?

A

hip flexor
hip ADD
knee ext
ankle DF

83
Q

if the L1-4 innervated m are over recruited, what would be inhibited

A

the antagonist
hip ext
hip ABD
knee flx
ankle PF

84
Q

what primary m have a significant effect due to L4-S1 RI

A

iliopsoas
iliocapsularis
rectus femoris

85
Q

what is the cause of L4-S1 RI

A

L4-S1 hypermobility

86
Q

what are the mechanics of the excessively recruited hip m due to the L4-S1 RI

A

excessive traction on antmed portion of capsule/labrum
labral changes without bony changes

87
Q

what are the mechanics of the inhibited hip m due to the L4-S1 RI

A

imbalance limits optimal axis of motion and joint support
easily overworked due to lowered recruitment so overuse due to lower recruitment

88
Q

what happens to the hip EXT and ABD when they are recruited less due to L4-S1 RI

A

hypertonicity
protection at rest and tightness

89
Q

what can cause IPI

A

not fully clear
conditions that lead to excessive hip flexor recruitment
lumbar hypermobility with RI

90
Q

what is iliopsoas impingement

A

impingement without dysplasia or bony changes

91
Q

what can be seen in the SCAN for IPI

A

PROM- IR limitiation at 90 deg flx due t inhibited glute max
hip maltracking due to piriformis inhibited
RST- weak ER at 90 deg flx, EXT, ABD
neuro- hypersensitivity

92
Q

what should also be assessed if IPI is the dx

A

palpation at 3 or 9 position
TL scan and BE hypermobility

93
Q

what is the PT Rx for IPI

A

stabilization
cartilage integrity

94
Q

what can MD do for IPI

A

iliopsoas partial release

95
Q

why is gluteal tendinopathy more common in sedentary women

A

underloaded
weak ABD
constant ADD of hip

96
Q

what are the RF for GTPS

A

female
high BMI
excessive ADD
weak ABD
coxa vara
plyometric

97
Q

what structures are involved in GTPS

A

greater trochanteric bursa
glute med/min
TFL/ITB

98
Q

how are the m attached on the greater trochanter in the form of a clock

A

12- glute med
11- piriformis
10- GOGO
9- quadratus femoris

99
Q

what can cause GTPS

A

excessive loads - tension + compression
impaired LE control leading to excessive hip ADD
L4-S1 RI

100
Q

what are the symptoms of GTPS

A

gradual onset
increase lateral hip pain
increased walking, running, or load
prolong sitting or crossed legs
lying on involved side
lumbar hypermobility/instability

101
Q

why is ADD and IR in neutral limited for GTPS

A

piriformis and glute med/min are lengthening

102
Q

what can be found in the scan for GTPS

A

painful and trendelenburg gait
impaired LE control- pain/weakness with 30 sec single leg stance
ROM- limited ADD/IR, ER/H. ADD in 90 deg flex

103
Q

what is in the resisted testing for GTPS

A

weakness and pain with
ABD in ADD position
ER in neutral
IR and H. ABD in 90 flex

104
Q

what special tests would be positive with GTPS

A

ER and H ADD in 90 deg flex
possible obers

105
Q

what is the hallmark sign of GTPS

A

TTP over bursa

106
Q

what needs to be in pt edu for GTPS

A

soreness rule
load management
avoid provoking positions
pillow between knees

107
Q

what is the difference between -itis and -otis

A

itis is inflammation where as otis is structural change over an amount of time

108
Q

what is the PT Rx for GTPS

A

policed
modalities - minimal effect
pt edu
MET

109
Q

what is the primary purpose of MET with GTPS

A

tendon proliferation and stabilization

110
Q

what is the tendinosis prescription

A

3x10-15 eccentric, heavy load
1. isometric shortened
2. isotonic neutral to short
3. isotonic lengthened
4. WB
5. plyometric

111
Q

what can MD do for GTPS

A

corticosteriod injection

112
Q

what are the causes for hamstring tendinopathy

A

prior injury
RI L4-S1
weak glute max/med, ADD

113
Q

why can excessive quad recruitment cause hamstring tendinopathy

A

leads to an anterior tilt and lengthens the hamstrings adding tension and compression
quad = hamstring ratio

114
Q

what structures are involved with hamstring tendinopathy

A

hamstring proximal tendon
adductor magnus
ischial bursa

115
Q

what can cause hamstring tendinopathy

A

repetitive action
prolong stretch
sedentary
m imbalance
deceleration

116
Q

what are the symptoms of hamstring tendinopathy

A

posterior hip/buttock pain
less symptomatic after warm up
worsened with lengthening activities
stiffness after prolong positions

117
Q

what functional tests can show hamstring tendinopathy

A

pain with squat, lunge, running

118
Q

what can be found in a scan for hamstring tendinopathy

A

pain and limitation with hip flex and knee ext
weak and painful in hip ext and knee flexion
neuro possible dural

119
Q

what special test can show hamstring tendinopathy

A

bent knee stretch test
palpation

120
Q

what is the pt edu for hamstring tendinopathy

A

stand over sit

121
Q

who is more likely to have a hip fx

A

around 80 years of age

122
Q

what is the goal of hip fx treatment to improve quality of life

A

balance

123
Q

what are the RF for hip fx

A

gait dysfunction
prior fall
vertigo
meds (orthostatic hypotension)

124
Q

what are the structures most commonly involved

A

femoral neck

125
Q

why is the LE pulled up and ER with a hip fx

A

ER pull the leg up and out as protection from the fx

126
Q

what sp test can be done to assess a hip fx

A

patellofemoral pubic tap test

127
Q

how is a hip fx most commonly fixed

A

ORIF

128
Q

what is the primary Rx for a hip fx

A

consequences of immobilization

129
Q

what is in the SCAN for a fixed hip fx after clinical union

A

ROM: limitation in multiple direction with firm/elastic end feel, guarding/fear of movement
RST: weak in multiple directions
CM: consistent or inconsistent

130
Q

what are RF for frozen hip

A

thyroid disorder
diabetes
alcoholism
middle age
female

131
Q

why are low grade inflammation disorders of the body more likely to have frozen hip

A

persistent inflammation causes more fibrotic tissue

132
Q

what are the S&S for frozen hip

A

gradual and progress loss of motion and pain
no capsular pattern

133
Q

describe stage 1 of frozen hip

A

initial
gradual onset, achy pain, sharp with use, night pain, unable to lie on side
high irritablility
AROM sig <PROM
empty and painful end feel

134
Q

describe stage 2 of frozen hip

A

freezing
constant pain at night
high irritability
mod-severe limitations, AROM<PROM
empty and painful end feel

135
Q

describe stage 3 of frozen hip

A

frozen
stiffness> Pain, intermittent pain
mod irritability
mod-sev limitations, pain at end range, AROM=PROM
firm end feel

136
Q

describe stage 4 of frozen hip

A

thawing
minimal to no pain
low irritability
gradually ROM improvement
firm end feels

137
Q

what is our Rx for frozen hip

A

POLICED
Pt edu
modalities
JM
STM
MET

138
Q

what do we need to educate the pt on with frozen hip

A

the stages
promote pain free activity
matching stretching with symptoms

139
Q

why do we need to match stretching/JM with symptoms for frozen hip

A

can create more fibrotic tissue if we stretch or do JM too aggressivly

140
Q

what is our primary focus of MET for frozen hip

A

elasticity and mobility
particularly with inhibited m

141
Q

what is the ideal ROM for most ADL’s of the hip

A

120 flx
20 ABD
20 ER
10 hyper ext

142
Q

what is happening functionally during the heel strike/initial contact

A

30 deg hip flx
ER and ADD
post innominate RT

143
Q

what is happening functionally during foot flat/loading response to midstance

A

hip ext with ant innominate RT
IR and ADD as pelvis RT towards weight acceptance leg

144
Q

what is happening functionally during heel off/terminal stance to toe off/pre swing

A

hip ext, ABD, ER
potential energy occuring due to lengthening of active and passive structures for swing phase

145
Q

what are the potential energy’s of the acceleration when swinging the leg in gait cycle

A

passive- iliofemoral, ischiofemoral, pubofemoral, and capsule
active- iliopsoas and iliocapsularis
T10 RT to assist trunk motion

146
Q

what are common areas of excessive stress if the potential energy storehouse does not occur

A

decrease cartilage integrity by limited motion
hip flexor overuse with shorter strides
LBP due to lack of motion at T10 and/or hip hyperext

DPT 730/1: MSK (11 decks)

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