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CATA 437 > Hip > Flashcards

Hip Flashcards

1
Q

Most common hip conditions in young and middle aged active adults are-

A

FAI, acetabular dysplasia and/or hip instability, and labral/chondral or ligamentous teres tears

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2
Q

what is a common and overlooked cause of hip pain

A

myofascial pain syndrome
Trigger points and complex motor and sensory abnormalities producing local and referred pain

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3
Q

extra articular hip pathologies

A

snapping hip
muscle injuries
stress fraction
IT band restriction
tendinopathies of rectus abdominus
osteitis pubis

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4
Q

what could be creating the snapping in the hip

A

External -> IT over greater trochanter
Internal -> iliopsoas over pelvic rim
Intra-articular -> symptom of other pathologies
Muscle injuries

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5
Q

intra articular hip injuries

A

Femoral acetabular impingement
Acetabular labral tear
Chondral injuries
Synovitis
Intra articular pathologies usually radiate to anterior and medial hip due to structures being innervated by femoral and obturator nerve (Frank et al, 2010)

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6
Q

what could a posterior hip pain could indicate

A

Proximal hamstring tendinopathies and obturator internus/gemelli, sacral stress fracture, piriformis syndrome, ischiofemoral impingement, sacral neuropathies

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7
Q

posterior hip pain referer from

A

lumbar and SIJ

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8
Q

which type of injury could be under recognized with posterior hip pain

A

femoroacetabular joint disease

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9
Q

what could lateral hip pain could indicate

A

Tendinosis of glute medius and minimus, thickening of IT band, trochanteric bursitis

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10
Q

labral tear may refer wear

A

lateral hip pain

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11
Q

what sould be rule out with anterior hip pain

A

OA primary consideration with older individuals with restrictions in hip flexion and internal rotation during examination

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12
Q

OA is associated with which hip restricted ROM

A

hip flexion and internal rotation

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13
Q

anterior hip pain is often associated with what with younger and older individual

A

younger: Labral tear
older: OA

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14
Q

which hip pathologie could be associated with anterior hip pain

A

FAI, iliopsoas impingement, internal snapping hip, stress fractures, capsular laxity

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15
Q

physical examination of hip pain contribue to how many % in determining differential diagnosis of hip

A

30%

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16
Q

history question of hip shown to be instrumental in determining how many % of differential diagnosis of the hip

A

56-90%

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17
Q

a patient aged 3-11yrs with hip pain could have which pathologies

A

legg-calves-perthes disease

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18
Q

a patient aged 12-15yrs with hip pain could have which pathologies

A

slipped femoral epiphysis

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19
Q

Hip is so close to reproductive areas and GI tract, therefore patients with _ symptoms should be screened _

A

systemic, infection and cancer

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20
Q

what are some alarming symptom when someone is presenting with hip pain

A

Alarming symptoms include fever, malaise, night sweats, weight loss, history of drug abuse, past or present diagnosis of cancer, or being immunocompromised

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21
Q

if I have pain in back, buttock, hip, thigh, leg and foot which region is affected

A

lumbar pathology pain

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22
Q

if I have pain in buttock. thigh, groin, back, knee which region the pain come from

A

SIJ pathology pain regions

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23
Q

if I have pain in groin buttock, thigh and knee which region could create the pain

A

hip pain pathology region

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24
Q

if you have lumbar pathology pain where do you might feel the pain

A

Back
Buttock
Hip
Thigh
Leg
Foot

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25
Q

if you have SIJ pathology pain where do you might feel the pain

A

buttock, thigh, groin, back, knee

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26
Q

if you have hip pathology pain where do you might feel the pain

A

groin, buttock, thigh, knee

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27
Q

if you have trigger point that refer to posterolateral and anterolateral hip which muscle are affected

A

Glute group (maximus, medius, minimus), piriformis, TFL and QL muscles

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28
Q

if you have trigger point that refer to tigh and anteromedial hip which muscle are affected

A

illiopsoas and proximal adductor

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29
Q

Hip Subjective Screening

A
  • clicking, catching type of pain
  • AM stiffness
  • pain on loading the hip after rest, squat or stair
  • history of W sitting or hip dysplasia
  • hip injury activity
  • sleep position
  • footwear
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30
Q

if an athlete have
Dull or sharp groin pain

½ of pt have pain radiate to the lateral hip, anterior thigh and buttock

Usually insidious but could be after traumatic even

½ of patients have catching, or painful clicking with activity

A

hip labral tear

31
Q

a patient with hip labra tear can present with which finding

A

Dull or sharp groin pain

½ of pt have pain radiate to the lateral hip, anterior thigh and buttock

Usually insidious but could be after traumatic even

½ of patients have catching, or painful clicking with activity

32
Q

if a patient have iliopsoas bursitis what are some finding

A

Anterior hip pain when extending the hip from a flexed position

Can be associated with intermittent catching, snapping, or popping of the hip

33
Q

if a patient have
Anterior hip pain when extending the hip from a flexed position

Can be associated with intermittent catching, snapping, or popping of the hip

A

iliopsoas bursitis

34
Q

if a patient have stress Fx what are the finding

A

Trauma or repetitive weight bearing

Usually worse with activity

Pain in extreme ROM, active SLR, log roll test or hopping

35
Q

a patient that had
Trauma or repetitive weight bearing

Usually worse with activity

Pain in extreme ROM, active SLR, log roll test or hopping

A

stress fx

36
Q

if an athlete is young and physically active, have Insidious onset pain

Worse with sitting, rising from a seat, getting in or out of car, leaning forward

Location in groin primarily

A

FAI

37
Q

if someone have FAI what could be the finding

A

Insidious onset

Worse with sitting, rising from a seat, getting in or out of car, leaning forward

Location in groin primarily

38
Q

if someone have OA what could be the S/S

A

Limited motion

Gradual onset

Constant, deep, aching and stiffness

Worse with prolonged standing and weight bearing

Decrease ROM
Extreme ROM often cause pain

39
Q

if you are old and have Limited motion

Gradual onset

Constant, deep, aching and stiffness

Worse with prolonged standing and weight bearing

Decrease ROM
Extreme ROM often cause pain

A

OA

40
Q

what could indicate that an injury originated from the hip and not the spine

A

Presence of a limp, groin pain and decrease in internal rotation significantly predicted an injury originating from the hip and not spine (Reiman, 2014)

41
Q

hoe munch ROM is required for gait on level surface, ascending/descending stairs, sitting in a chair, putting on socks

A
  • 30-44 degrees of hip flexion
  • 45-66 degrees of hip flexion
    ~112 degrees of hip flexion
  • 120 degrees of hip flexion, 20 abd, 20 ER
42
Q

if someone have pain when putting sock which ROM could be limited

A

120º of hip flexion, 20º abd + ER

43
Q

which test help to rule out facet joint pathology almost conclusively

A

seated extension and rotation test

44
Q

can SLR help rule out discogenic/radiculopathy (SN 90-92)

A

only to a small degree

45
Q

Athletes with joint changes may have complaints with a combination of

A

flexion, adduction and internal rotation

46
Q

Pain in the deep groin area with flexion ,adduction + IR could indicate what and which movement could mimic those movement

A

intra articular pathology
Sitting into low chair, up stairs with involved leg, squatting etc. will mimic these movements

47
Q

someone supine with external rotation with lateral of foot on table could indicate what

A

ant capsule laxity or hip retroversion

48
Q

piriformes help with hip flexion past

A

60 degree internal rotation and abduction

49
Q

Clinical Prediction Rule for Hip OA

A
  1. Limited active hip flexion with lateral hip pain
  2. Active hip extension causes pain
  3. Limited passive hip medial rotation (25deg or less)
  4. Squatting limited and painful
  5. Scour test with adduction causes lateral hip or groin pain
50
Q

explain the patellar pubic percussion test

A

athlete supine with bilat leg relax. stethoscope is place on pubic tubercle on ipsilateral side of lower extremity being assed. tuning fork over patella

+ve if diminish percussion on one side

51
Q

explain the stress fracture fulcrum test

A

athlete sitting on edge of table with bilateral feet off, clinician place one forearm under athlete’s thigh and applies downward pressure to proximal knee

52
Q

FABER is testing what and how is it positive

A

Testing for: intraarticular hip joint pathology, SI joint, iliopsoas spasm

If the patient experiences posterior hip pain, the SI joint may be responsible. If groin pain occurs without loss of motion, the problem is most likely native to the hip (88% sensitivity in the athletic population for intra-articular pathology)

53
Q

purpose of stinchfield test (resisted hip flexion test)

A

Designed to help distinguish between intra and extra articular hip pathologies

54
Q

what is the log roll test and what does it test

A

patient supine, examiner passively rotates the femur medially and laterally to compare
Looks at hip mobility
Stresses capsule and femoral head in acetabulum
Positive: restriction or painful, click can indicate labral tear, and excessive lateral rotation may indicate a lax iliofemoral ligament

55
Q

good test to rule out extra articular hip pathology

A

faber, hip scours, stinchfield

56
Q

good test to rule in intra articular hip pathology

A

thomas test, patient clicking or locking in history

57
Q

A recent systematic review and meta-analysis by Reiman et al. deemed 4 clinical tests to be both valid and reliable for the diagnosis of gluteal tendinopathy:

A

Trendelenburg sign
Resisted hip abduction
Resisted hip internal rotation
Hip external de-rotation tests

58
Q

what is resisted hip de-rotation test

A

For gluteal tendinopathies

Hip flexed to 90 degrees and externally rotated
Pt to bring leg back to neutral against resistance

Positive: spontaneous reproduction of patients pain

59
Q

Inequality in leg length is commonly associated with compensatory gait abnormalities and may lead to

A

degenerative arthritis in the lower extremity and L/S

60
Q

which tissue is contracted with leg length discrepancies

A

hip and knee muscle contracture

61
Q

T/F Average of two tape measurements appears to have acceptable validity and reliability when used as a screening tool for leg length discrepancy

A

T

62
Q

how do you measure true leg length direct method

A

Set patients pelvis square- bridge up and down
Set legs 15-20cm apart and parallel to each other
Make sure the legs are comparable in amount of abduction/adduction they are in in relation to the pelvis

Measure leg length with tape measure from distal portion of ASIS to medial malleolus (or lateral)
Be aware of muscle wasting or hypertrophy

Slight difference between 1-1.5cm is considered normal
But can still cause symptoms

63
Q

how measure functionnal leg length

A

umbilicus to medial malleolus

64
Q

coxa vara angle and coxa valga angle

A

coxa vare decrease angle of femoral shaft and neck <105

coxa valga increased angle between femoral shaft and neck >135

65
Q

what is an ante version and retroversion

A

Angle made by the femoral neck and femoral condyles
Degree of forward projection of the femoral neck from the coronal plane of the shaft

66
Q
A
67
Q

normal angle of anterversion and retroversion

A

8-15

68
Q

anteversion or retroversion increase what

A

ant: risk for dislocation
retro: increased stability

69
Q

excessive antervesion is associated with

A

Toeing in
Subtalar pronation
Lateral patellar subluxation
Medial tibial and femoral torsion

70
Q

excessive retroversion is associated with

A

Excessive retroversion
Toeing out
Subtalar supination
Lateral tibial and femoral torsion

71
Q

coxa valga is associated with

A

Pronated subtalar joint
Medial rotation of leg
Short ipsilateral leg
Anterior pelvic rotation

72
Q

coxa vara is associated with

A

Supinated subtalar joint
Lateral rotation of leg
Long ipsilateral leg
Posterior pelvic tilt

73
Q

Increased anteversion leads to

A

squinting patellae and toeing in
More common females

CATA 437 (12 decks)

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