Exam 2- SI jt-hip functional tests Flashcards
what is the SI jt designed for
stability and very little mobility
what is RSA imaging
3D imaging motion and position
what are the RF for SI jt dysfunction
laxity and hormonal changes
during pregnancy- LBP or pelvic trauma
what is the primary cause of SI jt dysfunction
peri partum
immature skeleton due to lack of bone irregularity and congruency
trauma
disease (AS)
what are the S&S of SI jt dysfunction
localized SI jt pain
gluteal and lateral hip pain
pubic symphysis pain
hypermobility S&S
what can be seen on a SCAN for SI jt dysfunction
TL A/PROM- inconsistent
RST- impaired local m and weak antigravity m
ST- SI provocation tests
how are special tests with SI jt dysfunction
motion and palpation are unreliable
ASLR (+) for impaired m
what are most often the best evidence for dx a SI dysfunction
cluster and ASLR
how do we treat SI jt dysfunction
POLICED
m energy technique for m guarding/pain
pelvic belt
JM
MET
what does JM do for SI jt dysfunction
likely positive soft tissue and m influence per manip
what is the primary MET focus of SI jt dysfunction
stabilization
what do we do for MET with SI jt dysfunction
local m and lumbar hypermobility MET
hip m and thoracolumbar fascia
how does ligaments act if m attached to them
what if m is impaired
dynamic
if m is impaired, the ligament does not work how it should
what to edu the patient on with an SI jt dysfunction
reduce fear
early mobilization
general anatomy, biomechanics
reassurance of good prognosis
when are injections involved with the SI jt
pt has ankylosing spondylitis
what MD Rx can be given for SI jt dysfunction for short term benefit
pain/anti inflammatory meds
prolotherapy
what is the prognosis of SI jt dysfunction with pregnancy
rapidly declines during first 3 months post partum
what are the RF for an FAI
genetics and gender
susceptible population and activities
abnormal hip/pelvis kinematics
if a pt has limited post tilt, what other motion can be limited with FAI
hip ER
what is the more often cause of FAI
abnormal hip mechanics
vigorous athlete loading
what is less often the cause of FAI
pediatric hip conditions
femoral neck fx
what is a cam FAI
less spherical femoral head
contacts anterosuperior acetabulum (12 oclock)
more common in males
what are the congenitial types of FAI
cam
pincer
mixed
what is a pincer FAI
deeper acetabulum or anterior osteophyte
neck contacts anterior and sometimes posterior labrum
middle aged athletic
what structures are involved with FAI
articular cartilage
labral
what pain be reported that we should consider to be a FAI
mechanical groin pain
what are the symptoms of FAI
gradual onset of hip pain in anterior/groin area
lateral hip possible
what can worsen symptoms with FAI
repetitive and or prolonged hip flexion
what can you observe with FAI
impaired LE control
what functional tests can indicate FAI
impaired balance and LE control
quad dominant squat
what does ROM show with FAI
pain and limited with FLX and IR/H ADD at 90 deg flx
hip maltracking
<85 deg arc of RT
what is the largest predictor of groin pain
<85 deg arc at 90 flx
true/false
the different types of FAI all present in different ways
false
they all present the same
what does the rest of the SCAN show for a FAI
RST- decrease activation in ant gravity hip m
CM- possible consistent
ST- compression +
what will show in the BE for FAI
AM- possible hypo if persistent
Sp Test- FIR, FADDIR, FABER, possible femoral torsion +
palpation- + over anterior hip
how do we treat FAI
POLICED
JM
load management- exercise/ergonomic
foot orthotic- realignment or m activation
Pt edu
MET
what Pt edu can we provide with FAI
limit hip flexion >90
verbal cues for LE control
what are we trying to emphasize with MET for a pt with FAI
cartilage integrity
m function- antigravity hip m
mobility
emphasize LE control
what is the prognosis of FAI
many play with labral tears - no sx
ARJC decrease prognosis
what is the MD Rx for FAI
ultrasound guided injections
sx- iliopsoas release or labral
what is the most common cause of hip pian
ARJC
what are RF of ARJC in the hip
> 50 yrs
previous joint injury
preceded FAI
increasing BMI
occupational activity
what can allow a pt to develop ARJC in the hip sooner
previous injury
FAI
what is a subsequent predictor of hip disease
LBP
what drives the pain for ARJC in the hip
subchondral bone (innervation) since articular cartilage is gone (no innervation)
what are symptoms of ARJC in the hip
AM stiffness < 30 min
less tolerant to WB activities and sitting
C sign of pain
nociplastic
why is standing and sitting more painful with ARJC in hip than FAI
ARJC- articular cartilage = compression forces
FAI- labrum = stabilizer
what might you observe with ARJC in hip
asymmetrical gait
trendelenburg gait, lateral pelvic tilt
how is a lateral shift named
named by the way which hip drops
what can we see in a scan for ARJC in hip
ROM- > 3 planes restricted
CM- consistent block
RST- pain and weakness in ABD
ST- compression +
what will accessory motion show with ARJC in hip
hypomobility
what sp test would be found with ARJC in the hip
impaired functional performance (6 min walk, up and go)
impaired balance
what can we do to treat ARJC in the hip
POLICED
modalities
JM
MET
AD
pt edu
what is our purpose in treatment for ARJC in the hip
cartilage integrity
impaired m activation
mobility
what is an easy way to choose the correct assistive device
what AD allows walking most effectively with least pain
what pt edu is needed for ARJC in hip
limit hip flexion >90
wt managment
what needs to be included for MET with ARJC in hip
include trunk and hip anti gravity m
balance
what parameters for MET with ARJC in hip
1-5 x/wk
for 6-12 wks
what can the MD do for ARJC in hip
injections
THA
what is the pro/con of ant THA approach
no trauma anti gravity m
smaller view
more prominent vascular structures
what is the pro/con for post THA approach
larger view
trauma to anti gravity m
more common
what is the purpose of the pre op visits before a THA
AD
plan recovery and HEP
expectation management
what complications can arise with THA
heterotrophic ossification
painful PROM/JM with abrupt end feels are contraindicated
what is a hemiarthroplasty
replace the head without replacing the acetabulum
what is the PT RX for THA
same as ARJC except not encouraging cartilage integrity
what are the precautions for a traditional THA
avoid hip flx past 90
avoid add past neutral
avoid RT
what is the prognosis for THA
6-8 months out is 80% normal function
what can cause hypermobility in the hip
fx
labral tear
extreme motions
labral tear with FAI/IPI
connective tissue disorder
what is femoral torsion
the RT of the femur between the condyles and head/neck
what can excessive anteversion cause
toeing in
what can excessive retroversion cause
toeing out
what is femoral neck angle
angle between the neck and the shaft
what can coxa vara lead to
smaller angle
genu valga or knock knee
what can coxa valga lead to
larger angle
genu varam or bow leg
what are the RF for hypermobility in the hip
genetics
injury
excessive RT, FLX, hyperext
what are the symptoms of hypermobility in the hip
anterior groin or lateral hip
popping. locking, snapping
feeling instable
what can be found in a SCAN for hypermobility in the hip
ROM- IR >30 at 90 deg FLX
CM- inconsistent
Sp test- pubofemoral lig, abnormal femoral torsion
what is the primary focus of PT Rx with hypermobility in the hip
stabilization
cartilage integrity
what innervates the L4-S1 z joints
L4 dorsal rami
what innervates the L4-S1 discs
L1-2 dorsal root ganglia and L4-5 n
what innervates the iliolumbar lig
L1-4 n
If L4-S1 joints are instable, what m groups are more likely to over recruit due to the innervation and sensitization?
hip flexor
hip ADD
knee ext
ankle DF
if the L1-4 innervated m are over recruited, what would be inhibited
the antagonist
hip ext
hip ABD
knee flx
ankle PF
what primary m have a significant effect due to L4-S1 RI
iliopsoas
iliocapsularis
rectus femoris
what is the cause of L4-S1 RI
L4-S1 hypermobility
what are the mechanics of the excessively recruited hip m due to the L4-S1 RI
excessive traction on antmed portion of capsule/labrum
labral changes without bony changes
what are the mechanics of the inhibited hip m due to the L4-S1 RI
imbalance limits optimal axis of motion and joint support
easily overworked due to lowered recruitment so overuse due to lower recruitment
what happens to the hip EXT and ABD when they are recruited less due to L4-S1 RI
hypertonicity
protection at rest and tightness
what can cause IPI
not fully clear
conditions that lead to excessive hip flexor recruitment
lumbar hypermobility with RI
what is iliopsoas impingement
impingement without dysplasia or bony changes
what can be seen in the SCAN for IPI
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
what should also be assessed if IPI is the dx
palpation at 3 or 9 position
TL scan and BE hypermobility
what is the PT Rx for IPI
stabilization
cartilage integrity
what can MD do for IPI
iliopsoas partial release
why is gluteal tendinopathy more common in sedentary women
underloaded
weak ABD
constant ADD of hip
what are the RF for GTPS
female
high BMI
excessive ADD
weak ABD
coxa vara
plyometric
what structures are involved in GTPS
greater trochanteric bursa
glute med/min
TFL/ITB
how are the m attached on the greater trochanter in the form of a clock
12- glute med
11- piriformis
10- GOGO
9- quadratus femoris
what can cause GTPS
excessive loads - tension + compression
impaired LE control leading to excessive hip ADD
L4-S1 RI
what are the symptoms of GTPS
gradual onset
increase lateral hip pain
increased walking, running, or load
prolong sitting or crossed legs
lying on involved side
lumbar hypermobility/instability
why is ADD and IR in neutral limited for GTPS
piriformis and glute med/min are lengthening
what can be found in the scan for GTPS
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
what is in the resisted testing for GTPS
weakness and pain with
ABD in ADD position
ER in neutral
IR and H. ABD in 90 flex
what special tests would be positive with GTPS
ER and H ADD in 90 deg flex
possible obers
what is the hallmark sign of GTPS
TTP over bursa
what needs to be in pt edu for GTPS
soreness rule
load management
avoid provoking positions
pillow between knees
what is the difference between -itis and -otis
itis is inflammation where as otis is structural change over an amount of time
what is the PT Rx for GTPS
policed
modalities - minimal effect
pt edu
MET
what is the primary purpose of MET with GTPS
tendon proliferation and stabilization
what is the tendinosis prescription
3x10-15 eccentric, heavy load
1. isometric shortened
2. isotonic neutral to short
3. isotonic lengthened
4. WB
5. plyometric
what can MD do for GTPS
corticosteriod injection
what are the causes for hamstring tendinopathy
prior injury
RI L4-S1
weak glute max/med, ADD
why can excessive quad recruitment cause hamstring tendinopathy
leads to an anterior tilt and lengthens the hamstrings adding tension and compression
quad = hamstring ratio
what structures are involved with hamstring tendinopathy
hamstring proximal tendon
adductor magnus
ischial bursa
what can cause hamstring tendinopathy
repetitive action
prolong stretch
sedentary
m imbalance
deceleration
what are the symptoms of hamstring tendinopathy
posterior hip/buttock pain
less symptomatic after warm up
worsened with lengthening activities
stiffness after prolong positions
what functional tests can show hamstring tendinopathy
pain with squat, lunge, running
what can be found in a scan for hamstring tendinopathy
pain and limitation with hip flex and knee ext
weak and painful in hip ext and knee flexion
neuro possible dural
what special test can show hamstring tendinopathy
bent knee stretch test
palpation
what is the pt edu for hamstring tendinopathy
stand over sit
who is more likely to have a hip fx
around 80 years of age
what is the goal of hip fx treatment to improve quality of life
balance
what are the RF for hip fx
gait dysfunction
prior fall
vertigo
meds (orthostatic hypotension)
what are the structures most commonly involved
femoral neck
why is the LE pulled up and ER with a hip fx
ER pull the leg up and out as protection from the fx
what sp test can be done to assess a hip fx
patellofemoral pubic tap test
how is a hip fx most commonly fixed
ORIF
what is the primary Rx for a hip fx
consequences of immobilization
what is in the SCAN for a fixed hip fx after clinical union
ROM: limitation in multiple direction with firm/elastic end feel, guarding/fear of movement
RST: weak in multiple directions
CM: consistent or inconsistent
what are RF for frozen hip
thyroid disorder
diabetes
alcoholism
middle age
female
why are low grade inflammation disorders of the body more likely to have frozen hip
persistent inflammation causes more fibrotic tissue
what are the S&S for frozen hip
gradual and progress loss of motion and pain
no capsular pattern
describe stage 1 of frozen hip
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
describe stage 2 of frozen hip
freezing
constant pain at night
high irritability
mod-severe limitations, AROM<PROM
empty and painful end feel
describe stage 3 of frozen hip
frozen
stiffness> Pain, intermittent pain
mod irritability
mod-sev limitations, pain at end range, AROM=PROM
firm end feel
describe stage 4 of frozen hip
thawing
minimal to no pain
low irritability
gradually ROM improvement
firm end feels
what is our Rx for frozen hip
POLICED
Pt edu
modalities
JM
STM
MET
what do we need to educate the pt on with frozen hip
the stages
promote pain free activity
matching stretching with symptoms
why do we need to match stretching/JM with symptoms for frozen hip
can create more fibrotic tissue if we stretch or do JM too aggressivly
what is our primary focus of MET for frozen hip
elasticity and mobility
particularly with inhibited m
what is the ideal ROM for most ADL’s of the hip
120 flx
20 ABD
20 ER
10 hyper ext
what is happening functionally during the heel strike/initial contact
30 deg hip flx
ER and ADD
post innominate RT
what is happening functionally during foot flat/loading response to midstance
hip ext with ant innominate RT
IR and ADD as pelvis RT towards weight acceptance leg
what is happening functionally during heel off/terminal stance to toe off/pre swing
hip ext, ABD, ER
potential energy occuring due to lengthening of active and passive structures for swing phase
what are the potential energy’s of the acceleration when swinging the leg in gait cycle
passive- iliofemoral, ischiofemoral, pubofemoral, and capsule
active- iliopsoas and iliocapsularis
T10 RT to assist trunk motion
what are common areas of excessive stress if the potential energy storehouse does not occur
decrease cartilage integrity by limited motion
hip flexor overuse with shorter strides
LBP due to lack of motion at T10 and/or hip hyperext
