Hip Flashcards
Coxa Vara
Angle is ~90 degrees–normal 125
places excessive stress through femoral epiphysis, shortens leg
Coxa Valga
> 125
places excessive stress through femoral head, increases leg length
Femoral Anteversion
Neck/Shaft angle in transverse plane
Normal is 12-15*
Greater than 15* is anterverted
Causes: in-toeing, excessive hip IR
X-ray and/or Craigs
Femoral Retroversion
<15 degrees of anteversion=retroverted
Causes: out-toeing, excessive hip ER
X-ray and/or Craigs
Legg-Calve Perthes Disease
Avascular necrosis of proximal femoral epiphysis
90% unilateral
S&S: pain hip, thigh, or knee
limping, loss of ABD, ext, and ER, thigh atrophy
Slipped Capital Femoral Epiphysis (SCFE)
epiphysis gradually or suddenly slips downward and backward in relationship to the femoral neck
SCFE commonalities
Most common in boys 10-16; girls 12-14 Boys> girls 1.5:1 African Americans > Caucasians (L) hip > (R) When onset < 10 years old endocrine disorder likely
SCFE Risk factors
Obesity Coxa Vara mediacations thyroid problems (hypo) radiation treatment chemotherapy bone problems related to kidney disease
SCFE S&S
painful limp groin or knee pain comfort by holding hip in slight flexion cannot actively IR hip difficulty standing in single limb support Passive flexion hip=moves into ER
Femoral Acetabular Impingement
femur and acetabulum repeatedly come into abdormal contact in certain positions. Leads to bony issues-spurring and damage to labrum and cartilage surface over time.
3 types of FAI
1) Cam
2) Pincer
3) Mixed
Precursor to FAI
Acetabular retroversion Previous Hz of: femoral neck fx SCFE Legg-Calve Perhes Disease
FAI profile
B/W ages 25-60
Many FAIs occur in athletes, especially if sport demands hip to work an end ROM
FAI presentation
Dull, aching pain= C-sign
(+) FADIR
Limited hip IR ROM at 90* flexion in supine
will lead to labrum tear then to OA
Five causes of hip labral tear
- Trauma-sublux/dislocation
- FAI-hypomobility
- capsular laxity/hip hypermobile
- Congential
- Degeneration
Diagnosis of Hip Labral Tear
Groin pain=C-sign
Limited painful IR and ABD
(+) FADIR, FABER, Hip Scour
MRI
Labral tear treatment
Rehab first (10-12wks)—>surgery
4 goals of rehab for labral tear
- optimize hip alignment
- work on stabilizing a hypermobile hip
- work on jt mobes and soft tissue stretch on hypomobile hip
- limit activities
Labral surgery
piece of labrum is removed or repaired—whichever allows for preservation of more healthy tissue: closer to edges is best
Hip Pointer
Contusion to iliac crest
S&S: local pain, swelling, ecchymosis, pain with trunk and hip motion, laughing coughing breathing
Inactive 2-3 days–>MHP, US, TENS, gradual return to ROM exercises….3 weeks recovery
Strains-Hamstring, Adductors, Quads
from excessive forcible contraction or stretch
S&S: pain with active contrax, resistance and passive stretch. Weakness ecchymosis, sweeling
Adductors=common when activity requires quick position change or quicl propulsion and acceleration.
Avulsion Fx-hamstring
can rule out from palpating ischial tuberosity
Avulsion fracture would hate sitting, MMT would be very weak
Hip Sprains
Uncommon due to stability
S&S: acute pain inability to circumduct thigh
Rx: grade 2,3 crutch walking as needed gradual PRE progression when pain free
Accessory motion tests
AP glide-flexion/IR
PA glide-extension/ER
Inferior glide-ABD
Lateral dislocation-pull away no specific direction
Posterior Hip Dislocation
Most common posteriorly
MOI: landing on a flexed knee while hip is flexed, adducted, and IR (FADIR)
Anterior hip dislocation
Forced hip flexion, ABD, and ER (FABER)
S&S of Post. dislocation
Severe hip and thigh pain referred pain in knee hip positioned in flexion, adduction, IR not able to walk possible neurovascular complaints
Medical tests
X-ray: bone
CT Scan: soft tissue damage
MRI: post surgery out 2-3 months to screen AVN
Hip dislocation complications
AVN
Acetabular labral tear
Hip OA (most common)
Avulsion Fx and Apophysitis
Apophysitis-inflammation of the apophysis from overuse—>can lead to avulsion fx
S&S: loss of strength, loss of hip motion, point tender
Hip stress fx
seen mostly in distance runners in femoral neck and pubic ramus
S&S: groin pain, aching in thigh with activity hard to stand on 1 leg
X-ray will be normal for 6-10 wks, use Bone scan
Tx: rest, minimize weight bearing 2-5 months rehab
Femoral fracture
Direct trauma or indirect
S&S: sudden severe pain, loss of fxn, direct and indirect tenderness
Complication AVN
Trochanteric Bursitis
inflammation of bursa or glut med from overuse, muscle imbalance, LLD, SLE, RA
S&S: lateral hip pain may refer distally, point tender
Tests: asymmetrical leg length, weak glut med, tight TFL
Rx: RICE acutely
Iliopectineal bursitis
excessive compression during hip flexion
S&S: deep anterior hip pain, pain with deep palpation, pain with resisted hip flexion
Snapping Hip Syndrome Anterior
iliopectinal bursitis and/or labral tears
Snapping Hip Syndrome Lateral
Proximal ITB friction with or without pain associated iwth it—greater troch suspected if its with pain
THR precautions post-op
Avoid:
Flexion > 90
Hip Add
Hip Ext with IR
Most common surgical complications=infection or DVT
Sports Hernia
imbalance in muscle strength hip adductors and RA and Obliques at insertion pubic ramus
S&S: groin and testicular pain, pain with running and cutting
can R/O with inguinal palpation
Dynamic tests for Sports Hernia
Resisted oblique MMT
Resisted Adductor tests
Kicking with flexion/adduction
MRI
