Hip Flashcards
Hip issue related to age: 0-2
develipmental dysplasia
septic arthritis
Hip issue related to age: 2-12
Acute transient synovitis
legg-calve-perthes
Hip issue related to age: 8-17
Slipped capital femoral epiphysis
Hip issue related to age: 5-30
Osteoid Osteoma (femoral neck)
Hip issue related to age: 40-50
Idiopathic Avascular Necrosis
Hip issue related to age: >35
RA
Hip issue related to age: >40
Degenerative Joint Disease
Hip issue related to age: >50
Hip fracture
Normal anteversion
8-15deg
Anteverted hip
torsion >15deg (toe in, excessive IR ROM)
Retroverted Hip
Torsion <8deg (toe out, excessive ER and limited IR ROM)
Transient Synovitis Symptoms
2-10yo
limp, refusal to walk
Fever <101
Decreased IR ROM
Legg-Calve-Perthes
9-12yo male Unilateral Necrosis of femoral neck Self limiting Pain at night
SCFE
most common hip disorder in adolescents
9-17yo male, obese, african american
Growth plate not fused yet
Gradual symptoms
How to rule out intra-articular pathology
FABER test
Obturator Nerve Entrapment
Activity/exercise induced
Medial thigh pain with exercise, improves with rest
Adductor weakness WITHOUT pain
EMG diagnostic
Labral tear vs OA
Labrum = pain at groin, peritrochanteric, ant thigh, ischial OA = ant thigh or ischial
Osteonecrosis of Femoral Head (ONFH) risk factors
prior trauma
long term alcohol use
long term corticosteroid use
connective tissue disease (lupus)
Hip OA CPG: diagnosis criteria
A level Mod ant/lat hip pain with WB Morning stiffness <1hr Hip IR <24deg Hip IR and flex 15 less vs opposite side Increased pain with passive IR
Hip OA CPG: Outcome measures - pain
A level WOMAC - pain BPI PPT VAS
Hip OA CPG: outcome measures - activity limitation and participation restriction
A level WOMAC physical function HOOS LEFS HHS
Hip OA CPG: Exam - Activity limitation/physical performance measures
A level 6min walk test 30 sec chair stand Stair measure TUG Self paced walk Timed single leg stance 4 square step test Step test
Hip OA CPG: Exam - Activity limitation/physical performance measures for balance
A level
Berg balance scale
4 square step test
timed single leg stance test
Hip OA CPG: Exam - Physical Impairment measures
A level
FABER test
PROM: IR, ER, flex, ext, abd, add
MMT: IR, ER, flex, ext, abd, add
Hip OA CPG: Interventions - Pt ed
B level Pt ed + exercise and/or manual Activity modification Exercise for weight reduction Unloading joint
Hip OA CPG: Interventions - Functional, gait, and balance training
C level
Impairment based training
Individualized program
AD training
Hip OA CPG: Interventions - Manual therapy
A level
1-3x/wk for 6-12wks
Hip OA CPG: Interventions - flexibility, strength, endurance
A level
Individualized programs
Hip OA CPG: Interventions - Modalities
B level
US (1MHz; 1w/cm2 for 5 min)
Hip OA CPG: Interventions - Bracing
F level, don’t use it
Hip OA CPG: Interventions - weight loss
C level
Collaborate with other providers
Nonarthritic Hip CPG: Risk factors
F level
- presence of osseous abnormalities
- local or global ligamentous laxity
- connective tissue disorders
- nature of pts activity and participation
Nonarthritic Hip CPG: Diagnosis/classification - nonarthritic hip joint pain
C level - clinical findings of:
- anterior groin or lateral hip pain, or generalized hip jt pain reproduced with FADIR or FABER
- consistent imaging findings
Nonarthritic Hip CPG: Exam: Outcome measures
A level
- HOS
- HAGOS
- iHot-33
Nonarthritic Hip CPG: Exam: physical impairment measures
B level
- measures of hip pain
- hip ROM
- hip strength
- movement coordination
Nonarthritic Hip CPG: Intervention: pt ed and counseling
F level: modify aggravating factors
Nonarthritic Hip CPG: Intervention: manual therapy
F level: jt mobs and STM when indicated
Nonarthritic Hip CPG: Intervention: Therex and Therac
F level: can use therex and therac to address jt mobility, muscle flexibility, muscle strength, muscle power deficits, deconditioning, metabolic disorders
Nonarthritic Hip CPG: Intervention: NMR
F level: use NMR to diminish movement coordination impairments
Cam impingement
asphericity of femoral head, often related to SCFE
Pincer impingement
acetabular abnormalities:
-excessive acetabular coverage anteriorly
Combo Cam/Pincer impingement
likely most common presentation
Acetabular labral tear mechanism
acute trauma (forceful rotation with hip in hyperextended position) or insidious onset
Nonarthritic Hip CPG: Exam: balance
Berg balance scale
4-square step test
timed single leg stance test
