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PT 206 > Exam 3- Hip so far > Flashcards

Exam 3- Hip so far Flashcards

1
Q

What are common pathologies of the hip and pelvis?

A 
Fractures hip and pelvis
AVN
DJD with osteotomy
Total joint replacement
Legg-Calve-Perthes disease
Trochanteric bursitis
Strains
Contusions
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2
Q

What pathology is a non-inflammatory syndrome in which the femoral head becomes flattened at the weight bearing surface resulting in AVN to the femoral head?

A

Legg Calve Perthes

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3
Q

What age range is affects by Legg Calve Perthes?

A

2-12 yo

6 years old being the most common age

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4
Q

What are the long term complications of the flattened femoral head?

A

Incongruous joint surface and advance DJD

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5
Q

What is the primary focus in the management of Legg Calve Perthes disease?

A

maintain femoral head in acetabulum
Regain ROM
Reduce pain and dysfunction

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6
Q

What methods are used to reduce pain and dysfunction w/ Legg Calve Perthes?

A

NSAIDs
bed rest
Traction- takes load off hip and restores ABD

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7
Q

What device can be use to keep the femoral head in the acetabulum in Legg Calve Perthes disease?

A

Abduction orthosis

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8
Q

What is the purpose of an abduction orthosis and how long can it be worn?

A

To aid in healing and avoid unwanted stress on the affected hip
Can be worn up to 2 years

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9
Q

Fractures are most common in? Why?

A

Elderly women b/c of osteoporosis

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10
Q

Where can fractures of the hip be located?

A

Extracapsular or intratrochanteric
Femoral neck or subcapital areas (intracapsular)
Proximal femoral shaft or subtrochanteric areas

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11
Q

What are the 3 main clinical complications noted w/ subtrochanteric fractures?

A

Malunion, nonunion AVN, delayed union

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12
Q

What are two factors that affect healing of subtrochanteric hip fractures?

A

Made up of cortical bone and has a poor blood supply

Exposed to large biomechanical stresses that can loose fixation devices

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13
Q

What is the non surgical management of displaced fragments

A

Pt on bedrest for up to 1 week, ROM, protected weight bearing for 4 weeks
May not need PT beyond ambulation/gait training

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14
Q

Following a THR what is a predictor for postoperative success?

A

Pt’s preoperative physical and mental condition

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15
Q

What conditions increases the pt’s risk of complications following a THR?

A 
Cardiovascular or pulmonary disease
Obesity
Osteoporosis
Dementia
Poor upper body strength
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16
Q

Following THR what % of patients regain their preinjury level of independence?

A

20-35%

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17
Q

What % of pts. will required instituionalized care for 1 year?

A

15-40%

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18
Q

What % of pts. will require assistive devices w/ ambulation?

A

50-83%

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19
Q

How long is the maximum protection phase following a THR?

A

1-21 day

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20
Q

What methods are used to prevent DVT post THR?

A

quad sets, glute sets ankle pumps, anti-coagulants, and TED stockings

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21
Q

What motions should be avoided following a THR?

A

No rotation or diagonal motions of femur

No active SLRs * or hip bridges** for 6-8 weeks ** depending on location of fractured fragments

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22
Q

What is used to manage pain during the max protection phase of THR?

A

Modalities and pain meds

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23
Q

What activities are recommended following a THR in max protect phase?

A

Isometric exercises; Gentle protected ROM exercise and during ADLs; limited weight bearing during ambulation

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24
Q

Mod protection activities following a Fx?

A

Return to Function (3-6 weeks)
Add active ROM, increase weight bearing to FWB, closed chain functional exercises (partial squats and step ups)
Bike
Standing 4-position cable (or theraband or ankle weights)

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25
Q

Min protection activities following a Fx?

A

Return to activity (6-8 weeks)
Gait ambulation w/o device
More advanced Ther ex- TM to enhance gait and increase hip and quad strength

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26
Q

Motions to avoid following a THR?

A

Hip ADD- use abduction wedge
Hip IR- wedge to prevent
Hip flex greater than 90
Avoid combined hip flex, IR, and ADD for up to 4 months after surgery

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27
Q

Positions to avoid following a THR?

A 
Do not sit on low chairs
Do not cross your legs
Do not sleep on your side
Do not bend FW at your hip
Do not squat
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28
Q

What are interventions for hip dislocations?

A

Bedrest
Skeletal traction
Protected weight bearing for up to 12 weeks

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29
Q

Motions to avoid w/ hip dislocations?

A

motions that place head of femur in position of dislocation – extremes of ROM

30
Q

What are clinical predictors of OA in the hip?

A

Squatting aggravates symptoms
Active hip Flex causes lateral hip pain- Hip Ext causes pain
Passive IR less than 25 degrees
Scour test w/ ADD causes lateral hip or groin pain

31
Q

What 3 ligaments reinforce the hip joint capsule?

A

Iliofemoral, pubofemoral, ischiofemoral

32
Q

Which ligament is AKA the Y ligament of Bigelow?

A

Iliofemoral

33
Q

What is the most common arthritic disease of the hip joint?

A

Osteoarthritis (DJD)

34
Q

What are OA intervention goals?

A 
Pain relief
Minimize disability
Reduce risk of disease progression
Pt. education
Activity modification
Proper diet and weight control strategies
Proper footwear
How to use assistive devices
35
Q

What is OA (DJD)?

A

Hip pain associated with subcondral bone erosion, cracking of articular cartilage, and wearing away of bone surface

36
Q

Interventions to use w/ OA pts.

A

Gait, balance, and proprioceptive training
Manual therapy techniques
Progressive thera ex
Assistive device training- canes, crutches, and walkers

37
Q

What is the goal of manual therapy techniques?

A

Pain relief, improve hip mobility and function

38
Q

What occurs during a proximal femoral intertrochanteric osteotomny?

A

Surgical changing of femoral neck to shaft angle

39
Q

What is the goal of Tx for proximal femoral intertrochanteric osteotomny?

A

reduce pain and improve function

40
Q

Max protect post op management of DJD

A

Protected weight bearing for 8 – 12 weeks, restore ROM, improving strength (start with gentle active ROM and isometrics) Aquatic ex like underwater treadmill
Focus on whole person

41
Q

Mod protect post op management of DJD

A

Based on X-ray evidence of healing
More challenging, more intensive strengthening (open chain isotonics, gentle isodynamic) Take care with CKCs due to compressive loading on the operative tissues-loading without overloading!

42
Q

Min protect post op management of DJD

A

wellness activities like aerobic training and stretching; care with CKCs to be functional not overloading

43
Q

When is a hemiarthroplasty used?

A

For severe femoral head Fx or femoral head osteonecrosis

44
Q

What is the goal of a hemiarthroplasty?

A

reduce pain and improve function

45
Q

What structure must be intact to qualify for a hemiarthroplasty?

A

Acetabular surface

*rarely used for arthritis

46
Q

Cemented vs Non-cemented WB

A

Cemented - usually sets up in 4 -8 hours allowed WBAT
NON-cemented – relies on bony bridges to form – takes longer, patient is allowed TTWB, progressing to PWB 3 weeks post op

47
Q

THR post op precautions w/ posterior lateral or lateral approach?

A

avoid fl past 90, no abd and rotation

48
Q

THR post op precautions w/ anterior or anterior lateral approach?

A

No hip ext or hip ER

49
Q

Max protect of THR

A

pre functional : ther ex to non-affected limbs; DVT prophalaxis; wt bearing as ordered; hip precautions during ADLs and all exercise

50
Q

Mod protect of THR

A

return to function: continue all hip motion precautions and wt bearing restrictions as ordered; more challenging exercise to more closely follow ADLs; light resisted exercises; closed chain functional exercises

51
Q

Min protect of THR

A

Minimally protective - return to activity
surgeon may discontinue hip precautions in 3 - 4 months or as many as 6 months
Return to gait training without assistive devices; balance, coordination, and proprioception exercises; advanced closed chain ex

52
Q

What is hip resurfacing?

A

Re-shaping of acetabular and femoral head surfaces

A type of arthroplasty developed as a conservative alternative to THR – may be done with a younger patient population

53
Q

What are the advantages of hip resurfacing?

A

Less bone loss than a THR
Post op stability- can always do THR later if needed
WBAT from 1st post op day, may have only a 3 day stay versus 5 days for THR.

54
Q

Pathology to Pubic Symphysis

A 
Usually associated with tight muscles
Psoas
Adductor (magnus, longus)
OR weak muscles
Gluteals (maximus, minimus, medius)
OR bony erosion on symphysis pubis
Pt may have increased pain with kicking, striding, or pivioting
55
Q

What causes trochanteric bursitis?

A

excessive compression and IT band friction

56
Q

Tx for trochanteric bursitis

A

rest, ice, and anti-inflammatory meds
Modify or eliminate motions/activities that exacerbate pain
Stretch IT band, quads, hams, hip adductors, TFL; strengthen hip abductors

57
Q

Ischial bursitis

A

characterized by pain of the ischial tuberosity
can occur after prolonged periods of sitting
Mimics a hamstring strain
Managed the same as trochanteric bursitis

58
Q

Iliopectineal bursitis

A

local tenderness over the iliopsoas muscle and tendon or diffuse radiating pain into the anterior thigh

59
Q

Ischial bursitis is AKA?

A

Weaver’s bottom

60
Q

What population has a higher occurrence of ischial bursitis?

A

Cyclists and thinner people

61
Q

Tightness of what muscle can cause compression and frictional wear to the iliopectineal bursa?

A

Iliopsoas

Increased likelihood of occurrence when in conjuction w/ excessive hip ext

62
Q

Max protect of Bursitis, strains

A

Maximum protection: RICE avoid motions that stretch the strained muscle; crutches may help decrease pain with ambulation; position of comfort; painfree AROM; multi-angle, sub-max isometrics to assist with healing

63
Q

Mod protect of Bursitis, strains

A

depends of severity of strain and tendon versus muscle fibers: when to begin AROM and progress to stretching and gentle strengthening

64
Q

Min protect of Bursitis, strains

A

when healing permits strengthening and stretching

65
Q

Contusion Tx

A

Max protection: RICE, may need protected weight bearing or crutch to minimize muscle forces
Moderate protection: may add other modalities to decrease pain and swelling

66
Q

What is a common term for a contusion to the hip?

A

Hip pointer

67
Q

How does a hip pointer occur?

A

Direct contact to the iliac crest from an external force or fall
Sudden forceful contraction

68
Q

How are non severe fractures of the pelvis and acetabulum treated?

A

weight bearing restrictions

“crack in the ring” type of Fx

69
Q

How are avulsions of muscles attachments treated for pelvis and accetabulum?

A

ORIF

70
Q

How are unstable Fx of pelvis and acetabulum treated?

A

ORIF or external fixators

PT 206 (3 decks)

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