Final Exam questions! Flashcards
What extra-articular structures can be a source of symptoms around the hip?
- Gluteus Medius
- Gluteus Minimus
- Adductor longus
What must be “ruled out” for patients with hip area symptoms?
Lumbar spine and SIJ
What are the clinical sets for HIP OA?
- Provocation of symptoms (increased pain)
a. Hip pain
b. Age > 50 y/o
c. Hip > or equal 15 degrees
d. Pain with hip IR
e. Hip morning stiffness < or equal 60 min - Decreased mobility (Loss of ROM)
a. Hip pain
b. Age > 50 y/o
c. Hip IR < 15 degrees
d. Hip FLEX < or equal to 115 degrees
What is Legg-Calve-Perthes disease?
Idiopathic avascular necrosis of the femoral head in children
What are the broad clinical trajectories of pain for patients with Hip OA?
- Mild pain throughout
- Moderate pain with increased in pain
- Moderate pain with decreased in pain
- Severe pain throughout
What are the performance based measures of physical function for hip OA? (Name the recommended measures first)
- Sit to stand with 30 second chair stand test
- 4x10m fast paced walk test (walking short distances)
- Stair negotiation
- TUG (ambulatory transitions)
- 6MWT (aerobic capacity/ walking long distances)
Interventions for patients with Hip OA?
- Exercise and manual therapy
a. Manual therapy effective for pain and self-reported function
b. Exercise effective for physical performance - Aquatic therapy
Define “cam type” FAI
Changes in the sphericity of the femoral head and loss of normal narrowing at femoral head-neck junction
Define “pincer type” FAI
Global over-coverage of the femoral head (coxa profunda or deep acetabulum), local over-coverage of the femoral head (anterosuperior overcoverage at roof of acetabulum) or changes in the orientation of acetabulum (retroversion of acetabulum)
What is FAI syndrome?
Preferred term to describe patients who have triad of symptoms, clinical signs, and imaging findings needed to diagnose this disorder
What is the most common location of symptoms for FAI?
Groin area
a. But can also see symptoms in LATERAL hip, ANTERIOR thigh, buttocks, knee, and low back
What tests can commonly provoke symptoms for patients with FAI?
- Anterior Impingement tests (FADIR)
- Passive OP into IR in 90 degrees of flexion
- IR in prone
- FABER test
- Sinchfield test (resisted hip flexion)
- Modified Thomas test
- Log roll rest (passive supine rotation test)
What interventions will you utilize for patients with FAI?
Inferior and lateral glides of the hip (combined with physiological flexion or IR in 90 degrees of flexion) AND strengthening exercises of the hip
What characterizes lateral hip pain/ greater trochanteric pain syndrome?
Pain and tenderness in lateral hip/ greater trochanter region
What tests are used to differentiate lateral hip pain?
- Resisted ABD - assess for lag sign
- Sustained single leg stance for 30s (low load)
a. Single leg hop (high load) - Resisted external de-rotation test
- FABER test
- TTP (anterior, lateral, and/or posterosuperior) of the greater trochanter
What functional movements are unlikely to be seen from patients with lateral hip pain/ greater trochanteric syndrome?
Unlikely to have limitations with:
- Hip flexion and IR
- Hip Ext
- FABER position (no lack ROM) *
*However, FABER pain can indicate lateral hip pain.
What interventions utilized for patients with lateral hip pain?
Piriformis stretching and gluteal/thigh strengthening
What muscle injury could be contributing to pain for patients with groin pain not related to hip OA or FAI?
- ADductor mm.
- Iliopsoas mm.
- Rectus femorios m.
+ or - lower abdominal mm. and pubic symphysis problems
What clinical tests are utilized for extra-articular problems of the hip?
- ADductor Squeeze test
- Single ADductor test
- Bilateral ADductor test
- Resisted ADD in greater ABD
- ADD squeeze (0 degrees of hip flexion)
- Passive ADD stretch
- ADD palpation
Which muscle undergoes the greatest amount of stretch-related mechanical load during terminal swing?
long head tendon of Biceps Femoris m.
If patient reports sudden onset of posterior thigh symptoms related to rapid hip flexion/ knee extension (ie. dancing or kicking) will more likely have injury to what tendon?
Proximal free tendon of the Semimembranosus mm.
What are common provocation tests for hamstring injuries?
- Puranen-Orvara Test - standing HS stretch
- Bent-knee stretch test involving max hip Flex followed by knee Ext - tests contractile loading
- Modified bent-knee stretch test involving faster speed of knee extension
- Supplement these tests with isometric testing of knee flexion in PRONE
- Slump testing for nerve sensitivity - it is warranted for HS injuries
Besides the clinical sets, what other comparable findings can help clinically diagnose HIP OA?
Hip IR ROM > or equal 15 degrees compared to non-involved hip or hip IR < 24 degrees (sitting)
What are interventions for hamstring injuries?
- Eccentric loading in lengthened positions (ie single-leg deadlifts)
- Trunk exercises
- Agility drills
What are interventions for proximal hamstring tendinopathy?
- Isometric contractions in lower angles of hip FLEXION for analgesic effect and avoidance of compression
- Load in shortened position
- Nerve gliding exercise in slump position
What are the primary risk factors for Development of Dysplasia of the Hip (DDH)?
- Female
- Breech presentation
- Family history of DDH
What intervention is utilized for patients with Legg-Calve-Perthes Disease?
Maintain good ROM and obtain/maintain good containment of the femoral head in the acetabulum to allow the femoral head to remodel into a spherical shape
What is a SCFE?
Slipped Capital Femoral Epiphysis
- Posterior and inferior slippage of the proximal femoral epiphysis on the metaphysis (femoral neck)
What are the risk factors for SCFE?
- Obesity
- Endocrine disorders
- Renal Failure
- Previous radiation therapy (childhood cancers)
Define Tibio-femoral OA.
Characterized by focal areas of loss of articular cartilage, hypertrophy of bone, and thickening of the joint capsule
What are the clinical diagnosis criteria for tibio-femoral OA?
- Knee pain on most days of month
- Crepitus
- Morning stiffness < 30 min
- > 50 y/o
- Bony enlargement of knee on examination
- Bony tenderness of knee on examination
- No palpable warmth
Where do symptoms commonly occur on patients with tibio-femoral OA?
Common in medial compartment of the knee (but both medial and lateral may be involved).
Increased frequency of medial compartment may be related to normal knee alignment, in which 60% of WB force go through this part)
True or False? Changes in knee alignment increases risk of developing tibio-femoral OA.
FALSE. It does not increase risk of developing tibio-femoral OA.
However once OA is present, changes in knee aligment may be related to progression
Pts with isolated patello-femoral OA more likely to have what symptoms?
- Coarse crepitus
2. Pain with patellar compression
Pts with combined tibio-femoral OA more likely to have what symptoms?
- Impairments with knee EXT strength
- Greater impairments in Knee Flex ROM
- Greater difficulty descending stairs
Which knee misalignment is more common in pts with patello-femoral OA?
Valgus misalignment
What are some knee OA interventions?
- Emphasize restoring knee extension with EXT + PA mobs
- Encourage to lose weight
- Exercise and manual therapy are effective in improving pain and self-reported function
a. Exercise should address hip strengthening (quads), and hip musculature along with aerobic and functional training (balance/ proprioception) - Lateral wedge insoles w/ subtalar strapping for medial compartment tibio-femoral OA
- Patellar taping
What factors amplifies the forces to the ACL?
Knee Flexion + IR + Valgus + Increased Quad activation + reduced activation of the Hamstrings
What physical exam findings would you utilize to diagnose for ACL injury?
- (+) Lachman’s test = increased laxity
- (+) Pivot shift Test = Anterolateral sublux (Lateral tibia subluxes ANT) ; detects rotatory instability
- (+) Anterior Drawer Test = increased laxity
- Loss of EROM knee EXT
What is the terrible triad?
Injury to the ACL along with injury to MCL and medial menisci
What are the ACL conservative treatment interventions?
- Reduce quad dominance pattern
2. Restore knee EXT
What would increase your suspicion of a Grade I MCL injury?
- Trauma by external force to lateral leg OR rotational trauma AND
- Pain with valgus stress testing in 30 degrees flexion
What would increase your suspicion of a Grade II MCL injury?
- Trauma by external force to lateral leg OR rotational trauma AND
- Pain with valgus stress testing in 30 degrees flexion AND
- Laxity with valgus stress testing in 30 degrees flexion
Why do ligament testing of varus/ valgus in 20- 30 degrees of flexion?
To take out the anterior cruciate ligaments of the knee during testing.
How are MCL injuries treated conservatively?
- Restore ROM
- Strengthening
- Progressive return to functional activities
How is a grade III MCL treated?
Treated with a brace for ~6 weeks to prevent valgus stress