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CATA 437 > Hip > Flashcards

Hip Flashcards

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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
if you have SIJ pathology pain where do you might feel the pain
buttock, thigh, groin, back, knee
26
if you have hip pathology pain where do you might feel the pain
groin, buttock, thigh, knee
27
if you have trigger point that refer to posterolateral and anterolateral hip which muscle are affected
Glute group (maximus, medius, minimus), piriformis, TFL and QL muscles
28
if you have trigger point that refer to tigh and anteromedial hip which muscle are affected
illiopsoas and proximal adductor
29
Hip Subjective Screening
- 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
30
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
hip labral tear
31
a patient with hip labra tear can present with which finding
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
if a patient have iliopsoas bursitis what are some finding
Anterior hip pain when extending the hip from a flexed position Can be associated with intermittent catching, snapping, or popping of the hip
33
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
iliopsoas bursitis
34
if a patient have stress Fx what are the finding
Trauma or repetitive weight bearing Usually worse with activity Pain in extreme ROM, active SLR, log roll test or hopping
35
a patient that had Trauma or repetitive weight bearing Usually worse with activity Pain in extreme ROM, active SLR, log roll test or hopping
stress fx
36
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
FAI
37
if someone have FAI what could be the finding
Insidious onset Worse with sitting, rising from a seat, getting in or out of car, leaning forward Location in groin primarily
38
if someone have OA what could be the S/S
Limited motion Gradual onset Constant, deep, aching and stiffness Worse with prolonged standing and weight bearing Decrease ROM Extreme ROM often cause pain
39
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
OA
40
what could indicate that an injury originated from the hip and not the spine
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
hoe munch ROM is required for gait on level surface, ascending/descending stairs, sitting in a chair, putting on socks
- 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
if someone have pain when putting sock which ROM could be limited
120º of hip flexion, 20º abd + ER
43
which test help to rule out facet joint pathology almost conclusively
seated extension and rotation test
44
can SLR help rule out discogenic/radiculopathy (SN 90-92)
only to a small degree
45
Athletes with joint changes may have complaints with a combination of
flexion, adduction and internal rotation
46
Pain in the deep groin area with flexion ,adduction + IR could indicate what and which movement could mimic those movement
intra articular pathology Sitting into low chair, up stairs with involved leg, squatting etc. will mimic these movements
47
someone supine with external rotation with lateral of foot on table could indicate what
ant capsule laxity or hip retroversion
48
piriformes help with hip flexion past
60 degree internal rotation and abduction
49
Clinical Prediction Rule for Hip OA
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
explain the patellar pubic percussion test
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
explain the stress fracture fulcrum test
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
FABER is testing what and how is it positive
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
purpose of stinchfield test (resisted hip flexion test)
Designed to help distinguish between intra and extra articular hip pathologies
54
what is the log roll test and what does it test
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
good test to rule out extra articular hip pathology
faber, hip scours, stinchfield
56
good test to rule in intra articular hip pathology
thomas test, patient clicking or locking in history
57
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:
Trendelenburg sign Resisted hip abduction Resisted hip internal rotation Hip external de-rotation tests
58
what is resisted hip de-rotation test
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
Inequality in leg length is commonly associated with compensatory gait abnormalities and may lead to
degenerative arthritis in the lower extremity and L/S
60
which tissue is contracted with leg length discrepancies
hip and knee muscle contracture
61
T/F Average of two tape measurements appears to have acceptable validity and reliability when used as a screening tool for leg length discrepancy
T
62
how do you measure true leg length direct method
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
how measure functionnal leg length
umbilicus to medial malleolus
64
coxa vara angle and coxa valga angle
coxa vare decrease angle of femoral shaft and neck <105 coxa valga increased angle between femoral shaft and neck >135
65
what is an ante version and retroversion
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
67
normal angle of anterversion and retroversion
8-15
68
anteversion or retroversion increase what
ant: risk for dislocation retro: increased stability
69
excessive antervesion is associated with
Toeing in Subtalar pronation Lateral patellar subluxation Medial tibial and femoral torsion
70
excessive retroversion is associated with
Excessive retroversion Toeing out Subtalar supination Lateral tibial and femoral torsion
71
coxa valga is associated with
Pronated subtalar joint Medial rotation of leg Short ipsilateral leg Anterior pelvic rotation
72
coxa vara is associated with
Supinated subtalar joint Lateral rotation of leg Long ipsilateral leg Posterior pelvic tilt
73
Increased anteversion leads to
squinting patellae and toeing in More common females

CATA 437 (12 decks)

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