Exam 3: The Hip

Question 1

What are possible pathomechanics found in the hip region

Answer 1

decreased flexibility
asymmetrical leg length
hip muscle imbalances and their effects

Question 2

What are possible causes of asymmetrical leg lengths

Answer 2

unilateral short leg
coxa valga and coxa vara
anteversion and retroversion

Question 3

A person with a unilateral short leg will cause a pelvic ____ and sends the (thoracic/lumbar) spine into a side bend

Answer 3

tilt; lumbar

Question 4

If a person has an anterior pelvic tilt, what muscles could be tight?

Answer 4

hip flexors and low back extensors

Question 5

If a person has an anterior pelvic tilt, what muscles could be over stretched?

Answer 5

Abs and hamstrings

Question 6

If a person has a posterior pelvic tilt, what muscle could be tight

Answer 6

abs and hamstrings

Question 7

If a person has a posterior pelvic tilt, what muscles could be over stretched

Answer 7

hip flexors and low back extensors

Question 8

Which muscle groups of the hip are important to function during gait

Answer 8

flexors, extensors, and abductors

Question 9

Which muscle group is important to function during initial contact to limit hip extension

Answer 9

hip flexors

Question 10

Why do the hip flexors need to function during gait

Answer 10

They are needed for IC to limit hip extension

Question 11

Which muscle group is important to function during stance phase and initial contact to control the hip as we load

Answer 11

hip extensors

Question 12

Why do the hip extensors need to function during gait

Answer 12

They are needed for initial contact and stance phase to control the hip as we load

Question 13

Which muscle group is important to function during gait, especially during single limb stance to keep the pelvis neutral instead of dropping to one side

Answer 13

Hip abductors

Question 14

Why do the hip abductors need to function during gait

Answer 14

They are needed in single limb stance to keep the pelvis neutral instead of dropping to one side

Question 15

If a patient’s pelvis drops to onside during single limb stance instead of remaining in a neutral position (Trendelenburg’s) which muscle group is probably at fault

Answer 15

hip abductors

Question 16

Which 3 nerves of the hip are subject to injury or entrapment

Answer 16

sciatic nerve
femoral nerve
obturator nerve

Question 17

The sciatic nerve will be entrapped from the _____ muscle, causing pain to go down most of the leg

Answer 17

piriformis

Question 18

Which nerve runs through the piriformis, often getting entrapped by this muscle and causing pain to run through the leg

Answer 18

sciatic

Question 19

The femoral nerve runs (anterior/posterior) to the hip and is often injured from a femoral or pelvis fracture.

Answer 19

anterior

Question 20

How is the femoral nerve commonly injured? Remember that it runs anterior to the hip

Answer 20

A femur or pelvis fracture

Question 21

Which nerve runs anterior to the hip and can be injured if a femoral or pelvis fracture occurs

Answer 21

femoral

Question 22

How is the obturator nerve usually injured?

Answer 22

In females that are giving birth

Question 23

Which nerve is most likely to get injured in females that are giving birth

Answer 23

obturator nerve

Question 24

What are the common sources of referred paid in the hip and buttock region

Answer 24

nerve roots L1-L3, S1-S2

Lumbar intervertebral and SI joints

Question 25

What are some pathologies that could be related to joint hypomobility of the hip that do no need surgical management

Answer 25

osteoarthritis degenerative changes post immobilization

Question 26

What are some examples of degenerative changes in the hip that would cause joint hypomobility

Answer 26

aseptic necrosis slipped epiphysis dislocations congenital deformities

Question 27

What is aseptic necrosis

Answer 27

bone death of the femoral head

Question 28

When would a patient have a slipped epiphysis

Answer 28

adolescents and young males during times of accelerated growth

Question 29

What is slipped epiphysis

Answer 29

the femoral head slips in and out of place at the growth plate

Question 30

What are some common impairments of body structure and function at the hip relating to hypomobility (Hint: There's 6 possible reasons)

Answer 30

``` pain in groin and anterior thigh to knee stiffness after rest limited motion with a firm end feel antalgic gait limited hip extension impaired balance and postural control ```

Question 31

Which common impairment of body structure and function relates to true hip joint pain

Answer 31

pain in groin and anterior thigh to knee

Question 32

Which common impairment of body structure and function relates to patients with arthritis

Answer 32

stiffness after rest

Question 33

what is antalgic gait

Answer 33

painful gait

Question 34

Common activity/functional limitations and participation restrictions in patients with joint hypomobility include pain with WB activities, cleaning, shopping - especially at the end of the day. Would this be considered during the early or progressive stage of degeneration

Answer 34

early

Question 35

Common activity/functional limitations and participation restrictions in patients with joint hypomobility include difficulty rising from a chair, climbing stairs, squatting, bathing, and dressing. Would this be considered during the early or progressive stage of degeneration

Answer 35

progressive

Question 36

What are common activity/functional limitations and participation restrictions of a patient with hip joint hypomobility in the early stage of degeneration

Answer 36

pain with WB activities, cleaning, shopping - especially at the end of the day.

Question 37

What are common activity/functional limitations and participation restrictions of a patient with hip joint hypomobility in the progressive stage of degeneration

Answer 37

difficulty rising from a chair, climbing stairs, squatting, bathing, and dressing.

Question 38

During the protection phase, what are three goals that a clinician would have for their patient in treating joint hypomobility in the hip

Answer 38

decrease pain at rest decrease pain during weight bearing activities decrease effects of stiffness and maintain available motion

Question 39

During the protection phase, how would a clinician decrease hip pain at rest

Answer 39

low grade joint mobilizations

Question 40

During the protection phase, how would a clinician decrease pain during weight bearing activities

Answer 40

use assisted devices | adapt seating surfaces

Question 41

During the protection phase, how would a clinician decrease effects of stiffness and maintain available motion

Answer 41

ROM exercise | aquatic therapy and non impact activities

Question 42

During the controlled motion and return to function phases, how would a patient improve joint tracking and pain free motion

Answer 42

increase IR, flexion, extension and increase extension during WB activities

Question 43

During the controlled motion and return to function phases, how would a patient improve muscle performance in supporting muscles

Answer 43

neuromuscular facilitation with muscle setting, and strengthening exercises progressing to functional activities and balance then low impact exercise program

Question 44

What are examples of painful hip syndromes and overuse syndromes that do not require operative management

Answer 44

tendonitis/muscle strain trochanteric bursitis psoas bursitis ischiogluteal bursitis

Question 45

____ bursitis occurs with excessive flexion and can be paired with a popping or clicking sound

Answer 45

psoas

Question 46

psoas bursitis occurs with excessive (flexion/extension)

Answer 46

flexion

Question 47

What is another name for ischiogluteal bursitis

Answer 47

tailor's or weaver's bottom

Question 48

Tailor's or weaver's bottom is another name for ______ ____

Answer 48

ischogluteal bursitis

Question 49

What are some common body structure and function impairments and activity limitations and participation restrictions related to painful hip syndromes and overuse syndromes

Answer 49

pain gait deviations imbalance in muscle flexibility and strength decreased muscular endurance

Question 50

How would a clinician manage painful hip syndromes and overuse syndromes in the protection phase

Answer 50

By controlling inflammation and promoting healing as well as developing support in related areas

Question 51

Which phase of managing painful hip syndromes and overuse syndromes would a clinician develop balance in length and strength of muscles, develop stability of closed chain function, and develop muscle and cardiopulmonary endurance

Answer 51

controlled motion

Question 52

How would a clinician manage painful hip syndromes and overuse syndromes in the return to function phase

Answer 52

progress strength and functional control | return to full function

Question 53

Which phase of managing painful hip syndromes and overuse syndromes would a clinician have a patient perform accelerating and decelerating sprints to practice quick starts and slowing down

Answer 53

return to function

Question 54

What are a patient's limitations after a total hip replacement performed from a posterolateral approach

Answer 54

Patient cannot exceed hip flexion greater than 90 | patient cannot exceed adduction and IR greater than neutral

Question 55

What is the number one initial goal for the clinician when treating a post-op patient

Answer 55

protect healing of soft tissues surrounding surgical procedure

Question 56

A patient will fall under a (hypermobility/hypomobility) classification for slow progression of exercise within the restraints of WB and motion precautions after operation

Answer 56

hypomobility