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MSK 2 > Hip > Flashcards

Hip Flashcards

1
Q

purpose of patella-pubic percussion test?

A

rule out fracture in femur and pelvis

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2
Q

purpose of fulcrum test

A

rule out stress fracture of femur

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3
Q

purpose of resisted external derotation test. What should be done if negative test?

A

rule out or confirm glut tendinopathy

- if negative supine test, test again in prone

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4
Q

purpose of Flexion-Adduction-IR (FADDIR) test

A

rule out intra-articular hip pathology

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5
Q

purpose of Thomas test

A

rule out intra-articular hip pathology (+ if clicking/popping/anterior groin pain)
- also looks at rectus femoris flexibility and ITB tightness

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6
Q

What is pelvic cross syndrome? What muscles are shortened (tight) and lengthened (weak)?

A
  • excessive lumbar lordosis
  • tight iliopsoas and erector spinae
  • weak abdominals and glut max
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7
Q

What muscles are shortened (tight) and lengthened (weak) w/ flat back?

A
  • shortened hamstrings

- lengthened hip flexors

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8
Q

What is the purpose of the hip scower test?

A

confirm intra-articular hip pathology

- compress into ER and IR

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9
Q

What is the purpose of FABER test (Patrick’s Test)

A

confirm intra-articular hip pathology

- figure 4 stretch

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10
Q

symptoms and physical exam findings of hip fracture

A

Symptoms
- severe groin pain

Physical Findings

  • shortening of LE
  • painful/limited A/PROM in all directions
  • painful/weakness MMT
    • Fulcrum and pubic percussion tests
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11
Q

Symptoms and Physical Findings of AVN of femoral head

A

Symptoms
- deep groin, buttock, knee pain

Physical Exam

  • limited/painful A/PROM (especially IR)
  • painful/weakness MMT
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12
Q

Patients who are ___________, are more likely to develop osteoarthropathy over time.

A

hypermobile

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13
Q

Symptoms and physical exam findings of hip osteoarthropathy

A

Symtpoms

  • dull buttock, groin, thigh, knee pain
  • C-sign (hands on hip - “it hurts here”)
  • hip stiffness (especially after inactivity)
  • mobility limitations
  • stair ambulation limitations

Physical Findings

  • limited hip A/PROM, painful at endrange (greatest IR, flexion, abduction)
  • joint hypomobility
  • +/- weakness/pain w/ MMT
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14
Q

excessive hip _______ is difficult with hip osteoarthropathy. This causes difficulty with what daily task?

A
  • excessive hip flexion
  • difficulty donning/doffing pants and shoes
  • difficulty with stairs
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15
Q

Cam vs Pincer deformity

A

Cam - increased size of femoral head

Pincer - increased protrusion of acetabular rim

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16
Q

Symptoms and Physical exam of femoral acetabular impingement (FAI)

A

Symptoms

  • sharp, deep anterior groin pain
  • pain w/ deep squat, cutting, lateral movements, painful ER

Physical Exam

  • Cam deformity - hip flexion/adduction/IR ROM painful
  • +FABER and FADDIR tests
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17
Q

What motions are limited with Cam deformity?

A

hip flexion, adduction, IR ROM painful/limited

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18
Q

loose bodies symptoms and physical exam

A

Symptoms

  • anterior groin pain
  • catching, locking, clicking, giving way of LE
  • sudden pain w/ weight bearing

Physical Exam

  • inconsistent ROM deficits
  • springy end feel w/ PROM
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19
Q

During what motions is most pain felt w/ anterior snapping hip?

A
  • when hip extended to flexed position

- movement from FABER to extension, adduction, IR

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20
Q

What aggravates external snapping hip?

A
  • running on slanted surfaces

- directional change on planted LE - tends to hurt as pt practices for longer duration

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21
Q

What is a common MOI for hamstring strain?

A

sprinting w/ trunk flexion and fast running

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22
Q

What is a common MOI for adductor muscle strain?

A

directional change while running

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23
Q

What is a common MOI for iliopsoas muscle strain?

A

forced hip extension during active hip flexion

- getting tackled from behind while running

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24
Q

__________ strains have worse prognosis and longer recovery time

A

rectus femoris - crosses 2 joints

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25
Q

Greater trochanteric pain syndrome symptoms

A
  • pain greater at night
  • pain w/ standing > 15 min
  • radiating symptoms
  • pain in FABER position - donning/doffing socks
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26
Q

Greater trochanteric pain syndrome physical exam

A
  • excessive hip abduction vs adduction during gait
  • tender lateral hip
  • ITB tightness
  • +FABER and Resisted External Derotation test
  • pain/limitations w/ hip adduction ROM
  • pain/weakness w/ hip abduction and ER AROM
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27
Q

How will someone w/ Greater trochanteric pain syndrome compensate during walking?

A

vaulting to shift center of mass over leg to decrease tension

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28
Q

potential areas of compression for sciatic nerve

A
  • piriformis
  • ischial tub
  • long head of biceps femoris
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29
Q

potential areas of compression for obturator nerve

A

overlying fascia

30
Q

Motor and sensory distribution for sciatic nerve

A

Motor

  • hamstrings
  • fibular and tibial distributions

Sensory
- lower leg tibial and fibular distributions

31
Q

Motor and sensory distribution for obturator nerve

A

Motor
- adductors/IR

Sensory
- medial thigh and knee joint

32
Q

What does diminished achillies and hamstring DTR mean?

A

sciatic nerve entrapment

33
Q

What additional things can lead to obturator nerve entrapment?

A
  • hx of pelvis fracture
  • THA
  • pelvic operation
  • prolonged labor
34
Q

potential areas of compression for femoral nerve

A

inguinal canal

35
Q

potential areas of compression for lateral femoral cutaneous nerve

A

inguinal canal

36
Q

motor and sensory distribution for femoral nerve

A

Motor
- knee extensors

Sensory
- anterior thigh/lower leg

37
Q

Sensory distributions for lateral femoral cutaneous nerve

A

anterio-lateral thigh

38
Q

other clinical indicators of femoral nerve entrapment

A

diminished patellar reflex

- aggravated w/ hip extension

39
Q

Who is more common for avulsion fractures of hip and in what decade?

A

males in 2nd decade

40
Q

What is normal anteversion at hip? At what degree is it excessive and what is the patient at risk of doing?

A

normal - 10-15 degrees

excessive - > 40 degrees - risk for anterior dislocation

41
Q

Piriformis does what muscle action when hip is extended? When hip is flexed?

A

extended - ER

flexed - abductor

42
Q

action of TFL

A

IR of hip

acts on knee during hip extension

43
Q

pes anserine attachments

A

sartorius, gracilis, semitendonosis

44
Q

What action do hamstrings do during flexed knee?

A

IR and ER of tibia

45
Q

What hip adductor helps w/ hip flexion? What helps w/ hip extension?

A

adductor longs - helps w/ hip flexion

adductor magnus - helps w/ hip extension

46
Q

glute min action

A

ABD and IR of hip

47
Q

open and closed packed position of hip

A

open - ~ 30 flexion, 30 abduction, and slight ER

closed - full extension w/ abduction and IR

48
Q

Phase 1 to Improve mobility of hip

A
  • activation/coordination exercises
  • mobility exercises
  • inhibitory exercises (reciprocal inhibition - strengthen hip extensors to losen hip flexors)
  • STM ad joint mobs
49
Q

Phase 2 to improve mobility of the hip

A
  • progression to strength/endurance training - strength in newly improved ROM
50
Q

Phase 3 to improve mobility of hip

A
  • increase challenge of exercises

- sport specific activities

51
Q

What muscles are typically weak with hip osteoarthropathy?

A
  • hip ER
  • extensors
  • abductors
52
Q

What interventions are good for osteoarthropathy?

A
  • patient education (B)
  • flexibility, strengthening, and endurance exercises (A)
  • manual therapy (A)
53
Q

What type of exercises are good for ankylosing spondylitis?

A

extension based exercises

54
Q

Phase 1 to improve hip stability

A
  • exercise - physiologic effects
  • activation/coordination exercises
  • joint mobs
55
Q

Phase 2 to improve hip stability

A
  • progression to strength/endurance training of stabilizers
56
Q

Phase 3 to improve hip stability

A
  • increase challenge of exercise
57
Q

What activity should be avoided during phase 1 of labral tear operative recovery?

A

single leg raise

  • focus on isometric and closed chain exercises
  • open chain hip flexion, extension, AB/ADDuction
58
Q

What muscles are typically involved with greater trochanteric pain syndrome? What motion is ill-advised?

A

hip abductors and ER

  • ITB stretching (hip adduction) is ill-advised
59
Q

What type of exercises can help rehab a hamstring strain in athletes?

A
  • eccentric (B)
  • progressive agility and trunk stabilization (B)
  • Nordic hamstring exercises (A)
60
Q

High score on the LEFS means what?

A

high score = more function

- highest score is 80/80

61
Q

high score on WOMAC means what? What type of patients is this outcome measure used on?

A

higher score = more functional impairment, pain, and stiffness

hip/knee OA

62
Q

posterior hip precautions

A
  • no flexion > 90 degrees
  • no adduction past neutral
  • no IR past neutral
63
Q

lateral hip precautions

A
  • depends on MD

- avoid abduction

64
Q

anterior hip precautions

A
  • no hyperextension

- no ER past neutral

65
Q

transtrochanteric precautions

A
  • no AROM hip abduction

- weight-bearing restrictions (TDWB or PWB)

66
Q

Wells Criteria for DVT scoring

A
  • =0 - low probability
  • 1-2 - intermediate probility
  • /=3 - high probability
67
Q

Advantages and disadvantages of posterior hip replacement

A

Advantages
- hip abductors are not disrupted

Disadvantages

  • higher risk for dislocation
  • post-op precautions limiting ADLs
68
Q

Advantages and disadvantages of lateral hip replacement

A

Advantages
- decreased risk for dislocation

Disadvantages

  • prolonged hip abductor weakness
  • greater risk for heterotrophic ossicans
69
Q

Advantages and disadvantages of anterior and anteriolateral hip replacement

A

Advantages

  • ADLs less affected
  • decreased risk for dislocation

Disadvantages
- prolonged hip abduction weakness IF anterior glut med released for access

70
Q

Advantages and disadvantages of transtrochanteric hip replacement

A

Advantages
- preserves attachment of hip abductors

Disadvantages

  • WB limitations until bony union
  • Risk for non-union
  • prolonged hip abduction weakness

MSK 2 (8 decks)

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