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OCS study > Hip > Flashcards

Hip Flashcards

1
Q

Does intra-articular hip pain a localized or global set of symptoms

A

Intra-articular hip pain really goes into just the hip

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2
Q

What is the normal range for femoral torsion
How do you measure it

A

Normal 8-15°
Under 8° toes out Increased ER- retroversion
Over 15° toes in -Increased IR Anterversion

Craigs test: prone, measure angle between tibial shaft and table when the greater trochanter is most lateral

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3
Q

Describe character traits of someone with developmental dysplasial

A

Mostly girls, White, unilatera

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4
Q

Signs and symptoms of developmental dysplasia

A

limited or asymmetrical abduction asymmetrical thigh false positive Galezzi, telescope, or ortolani signs

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5
Q

Developmental dysplasia treatments

A

Below 9 months:Abduction diaper Pavlik harness
Past 9 months: abduction orthosis or surgery

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6
Q

Open packed position of the hip

A

FABER
One of the only joints where openpacked position is optimal articular contact, not the closed packed position.
Flexion and external rotation tend to uncoil the ligaments and make them slack

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7
Q

How do you distinguish Synovitis from septic arthritis

A

Septic arthritis:
Will present with fever, malaise and decreased appetite. Young: two years old, Hip held an open pack position to due to pain
Tx: Aspiration, IV and antibiotics.

Synovitis
inflammation of synovial lining
Not medical emergency like septic arthritis. Usually has upper respiratory infection. Can lead to AVN. Decreased hip IR due to pain, fever LESS than 101
Tx: managed with partial weight-bearing now and imaging needed due to soft tissue origin

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8
Q

Describe leg calves Perthes disease

A

Very young boys, AVN of femoral head, self limiting, unilateral
pain at night, decreased hip abduction and external rotation, most comfortable position an open pack position and present with hip flexion contracture. Psoatic limp is worst in the day, Obligatory adduction

Treatment: promote optimal compressive forces and Osteokinematic compressive F for spherical head to develop, usually have THA at early age

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9
Q

Describe SCFE

A

Occurs in skeletally immature patients boys 10 to 16 years old
- Growth plate defect
- 50% or bilateral
- Gradual onset with medial side hip pain
Decreased extension and hip IR and increased hip flexion angle
- Images: A-P frog leg
- 3 Grades: greater than 50% slippage = grade 2
- treatment: ORIF
SAME DAY OR ER REFERRAL
in very active or fat boys

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10
Q

What are non-musculoskeletal origins of hip pain

A

Appendicitis: Mcburey point 3.8-5.1 cm (1.5-2 inches) from the navel to the RIGHT ASIS,
Hernia
Kidney/Uterur referral

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11
Q

Hip OA cluster
What is the most specific OA finding

A

*Moderate anterior or lateral hip pain with weight bearing activities
*Morning stiffness >60 minutes
Decreased IR and Flexion by >15° difference from CL side, or <25 IR ROM
*Painful IR
* > 50 years

Decreased IR is most Sp, but any ROM loss could be due to OA

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12
Q

Intra-ariticlar hip pain sign

A

FABER

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13
Q

Hip Labral tear cluster

A

Hip locking
Catching, clicking pain
Instability, instances of giving way
Anterior hip pain

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14
Q

Diagnosis of Labral tear anterior vs posterior. Which is more common?

A

Rule out labral tears using FABER, if (-) than tear isnt there. FABER is a intra-articular sign. Clicking is a good way to rule in, moderate association

Resisted SLR tests the posterior labrum. Test position is in ER and ABD

Femoral impingement test: will test the anterior and superior labrum, position of IR and ADD for test.

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15
Q

Hip labral tear MOI

A

Extension and ER

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16
Q

Surgery for hip displasia

A

PAO to correct loss of coverage
H.D is a combo of pincer and CAM deformity

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17
Q

Illiopsoas bursitis

A

Pain with direct palpation and MMT resisted hip flexion
May have snapping
Due to over use
pain over anterior hip

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18
Q

Femoral neck stress fracture

A

Can be tension (worse) or compression fracture (Compression at femoral neck)
Consider bone health and frail females
May not see fracture for 3-4 weeks but MRI is gold standard

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19
Q

Osteitis pubis

A

Can occur after lower abdominal Sx like bladder or prostate surgery
Overuse related to muscular imbalance in pelvic instability. Ab muscles and posterior vertebral muscles work together to stabilize pelvis.
- tests: compression test Faber decreased hip range of motion SI joint dysfunction pubic symphysis gap test adductor muscle testing unilateral and bilateral
- Pain with kicking?

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20
Q

How do you rule in Nerve entrapment.

A

If no pain and just weakness, rule in nerve entrapment.

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21
Q

How can you tell Obturator N. entrapment from lateral femoral cuteanous nerve and Inguinal nerve entrapment

A

-Obturator N: medial thigh pain with exercise and adductor weakness
-Inguinal N: Groin and scrotal pain, overdoing it, Ab mus hypertrophy, preg. Hip hyper extension will bring on symptoms
-Lateral femoral cuteanous nerve: Sensory only over lateral/anterior thigh. Also known as merlagia parethestica

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22
Q

How do you rule down SIJ pain with hip concerns

A

SIJ pain will not present in anterior hip
Pain will be in groin, thigh and butt and mostly PSIS

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23
Q

How can you rule up kidney involement with hip pain?

A

Costovertebral thumb test by thumping first over ribs to vibrate kidneys
unrelieved by position

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24
Q

Signs and symptoms in piriformis syndrome

A

Pain in glutes
Aggravated with sitting
Tenderness over greater sciatic notch
Increased pain with piriformis tension: Add+IR with palpation of greater sciatic notch
Active piriformis test: Side lying, resistance in FABER

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25
Q

What does the sciatic nerve branch into

A

L4-S3
Branches off to the tibial nerve and common peroneal nerve.
-Common peroneal nerve goes to short head biceps and and splits into the superficial (innervates lateral leg muscles) and deep peroneal nerve to innervate anterior leg muscles

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26
Q

what is the sciatic nerve innervation and what the relationship to the pirifomris

A

L4-S3, Sciaitc N runs through the piriformis and superior gluteal nerve innervates the piriformis

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27
Q

What does the sciatic nerve innervate?
.

A

hamstring muscles, adductor magnus, and glutes (via inferior gluteal N

Can be tested with the SLR test

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28
Q

What is Maralgia paresthetica

A

Sensory loss of lateral femoral cutaneous nerve L1 - L3
Burning, aching, numbness, buzzing lightning over lateral anterior thigh.
Must rule out lower back pain
Relief with sitting may occur due to decreased pressure on inguinal nerve
Tests: Pelvic compression test to decrease pain, Femoral N neuro dynamic testing

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29
Q

How can you distinguish: Bursitis, Glutemedius and minimus tendinopathy, tendon tear, and IT band, snapping hip syndrome

A

-Bursitis will feel boggy to palpation
- Tendinopathy will react to activity and will have muscle based signs such as weakness, trendelenburg and + ER derotation test
-Tear will have a related MOI and dramatic weakness
- IT band syndrome/ snapping hip will have + Obers test, TFL hypertrophy, snapping will distinguish it from IT band pathology
-Internal snapping hip is also known as coxa sultans and affects the femoral head and the illiofemoral ligament

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30
Q

What is Coxa Sultans

A
  • Internal snapping hip is a syndrome
  • Caused by the snapping of the iliopsoas tendon over the underlying hip capsule and femoral head.
  • Popping with repetitive active hip flexion and extension
  • doen’t have to snap to make the diagnosis
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31
Q

What is elys test

A

Patient lays prone and you flex one knee. Also called Thomas test.

Positive for rectus femoris tightness if the hip of the leg that is flexed pops up off the table

32
Q

What is the FAI progression

A

FAI can be associated with labral tears.
Impingement and related tears can lead to joint arthritis

Labral tears are due to bony issue or abnormality and can lead to FAI or developmental dysplasia

32
Q

What are types of hip impingement

A

CAM - “Fat neck” aspherical femoral head with bony prominence at antero-lateral head and neck junction
impinges on rim. Lleads to superior OA. Seen in young athletic males
FADIR causes pain and is better test than FABER.

PINCER- over coverage of head by acetabulum, which pinches neck.
Can lead to posterior-inferior or central OA. Middle aged females
Ext and ER cause pain

33
Q

What is the imaging gold standard for FAI

A

MRA because MRI can miss bony cysts

34
Q

What are characteristics of FAI

A

Anterior hip pain, they will point to hip C-sign
Coxa valga, > 135*
Clicking
ER and Ext MOI
“ACE”

35
Q

What are intra articular tests

A

Fitzgerald
FABER
Scour
Resisited SLR
Distraction
Impingement tests

36
Q

What are recommneded compoents to at least inclide in hip OA exam

A

ROM in all planes
Faber, Scour test
NPRS

37
Q

What is the MCID for the WOMAC, what should it be used for?

A

12-22% is MCID. Shoulder be used with hip OA

38
Q

What are risk factors for OA

A

low socioecomnic status
devepopmental dx
decreased ROM
Increased bone mass or BMI
subchondral cycts

39
Q

Which tests can detect hip impingment

A

Hyper-mobiltiy is different than micro-instability
Log roll
FABER: < 3 inches between the lateral knee joint line and table with the leg in the FABER position is suggestive of increased laxity of the hip joint
- Anterior instability test: AB-HEER, prone instability, and HEER
- Beighton scale >5/9

40
Q

What are A level interventions for hip OA

A

Manual therapy, flexibility, strength and endurance

41
Q

What are B level interventions for hip OA

A

Patient education with exercise or MT
US: 1 MHZ/1 watt 5 mins

42
Q

What is drehmans sign

A

Decreased IR and ER. Obligatory ER and ABD during passive hip flexion ROM in SCFE and LCPD.

43
Q

Stress Fx

A

Suspect females with female athlete triad or REDS: Poor nutrition loss. Decreased bone density
Endurance athletes
Consider history: previous stress fx, load and rest

44
Q

Describe AVN

A

Can happen in 30-50s
Mimics OA
Refer/ suspect of no improvement in 6 weeks
Corticosteriod use x 3 months mg/day is a risk fx

45
Q

What is the difference between apophysitis and in avulsion for ASIS

A

Both:Can range from 12 to 25 years old and have pain with active flexion
- Sartorious attaches to ASIS
Avulsion: will include fracture from insertion site, MOI is traumatic. Imaging with xray to confirm, ORIF
Apophysitis: overuse, treat with rest load management and Progressive strengthening

46
Q

FAI is an umbrella term for which deformities and concerns

A

Femoral acetabular impingement syndrome deformities include CAM and pincer deformity’s.
Labral tears are you continuum of FAI syndrome progression

46
Q

What are signs and symptoms femoral acetabular impingement syndrome

A

Younger population, C sign, aggravating factor of FADIR
Clicking is associated with labral tears

47
Q

Which impairments are associated with femoral acetabular impingement syndrome

A

Hip weakness, anterior pelvic tilt, shortened hip flexors, weak core

48
Q

What would you expect to find in a patient with hip microinstability

A

Hyper-mobility controbutign the micro instability, pain, apprehension, possible connective tissue disorder with at least four out of five score on Bighton score for mobility

49
Q

A patient with underlying hip micro instability would have familiar symptoms with which motions?

A

External rotation + extension is a feeling of apprehension.
Will present with ER and shortened hip flexors

Cluster: or Abduction Hyperextension External Rotation Test (AB-HEER performed in SL), prone instability, HEER tests (pretty much the thomas test)

50
Q

Which test of the apprehension test for hip micro instability has the best sensitivity and specificity
AB - HEER

A

AB-HEER

51
Q

Hip OA treatment Do’s and Dont’s and maybes

A

DO: MT with exericse to progress and maintain ROM with EDU and Ultra Sound
MAYBE: WBing, gait, balance, weight loss
DONT: bracing

52
Q

How do you treatment interventions differ from FAIS and labral tears

A

FAIS: treated with activity modification flexibility and joint mobilization address pain and tightness
Labrum: address weakness and control impairments via strength endurance and control

53
Q

Which locations are predisposed to snapping hip syndrome of the hip

A

Lateral hip: also known as greater trochanteric pain syndrome
Anterior hip also known as Coxa sultans. Illopsoas tendon snaps over anterior capsule.

Locations of snapping: Iliopsoas over the femoral head,
proximal lesser trochanter,
iliopectineal eminence
Gluteus maximus over the greater trochanter

54
Q

Distinguish athletic pubalgia from Ostitus pubis
Athletic pubalgia

A

weakness/injury of the posterior inguinal wall distal to the abdominal attachment at pubis
Cluster: deep groin pain increased with activity, pubic ramus tenderness 2 to 3 cm lateral pubic tubercle, pain with resisted crunch and hip abduction

Osteitis Pubis:
chronic, 30-40s, serere burning and ache

55
Q

How to distinguish hamstring grades 1 2 and 3

A

Grade 1 : Majority of fibers are intact, less than 15° deficit active knee extension test

Grade 2: Partial fiber disruption, limited walking ability, 1 to 2 day activity limitation 16 to 25 AKE test, larger area, Echymosis may be present

Grade 3: complete tear, deformity present, extreme inability to walk 26 to 35° deficit in AKE test

56
Q

Largest risk factor for hamstring injury

A

previous HS injury

57
Q

when to consider avulsion for hamstring injury

A

Presence of Echymosis, unable to weight bear, palpable deformity

58
Q

Predicting factors of hamstring injury extent

A

Greater percentage of hamstring tenderness, older age, proximal location

59
Q

Hamstring injury prevention

A

Nordic hamstring exercise in superior exercise warm-up, strengthening, RTS movement

60
Q

How to distinguish ishiofemoral impingement from hamstring injury

A

distinguish impingement from hamstring using active and passive range of motion of knee flexed and extended. Hamstring MMT shouldn’t recreate symptoms in impingement.

61
Q

What are differential diagnosis for greater trochanteric pain syndrome and how to distinguish

A

Bursitis, external snapping hip, Glute minimus/medius tendon apathy or can be distinguished from one another with palpation.
GTPS will have aggravating factors of pain with active adduction, hip weakness, pain with direct pressure such as laying on the side prolonged activities of walking

62
Q

What is the underlying cause of GTPS

A

Tissue compression over GT due to overuse, leads that TFL hypertrophy and/or weak ABductors ,tissue compression and poor frontal plane control (Trendelenburg). This leads to impairments such as TFL hypertrophy and pain cycle.

63
Q

Patient profile GTPS and differential diagnosis

A

Females in 40s to 50s and athletes. Rule out hip OA.
Related to muscular impairments
excess IR and ADD may cause TFL adn IT issues
aggravation with laying on side and prolonged activities

64
Q

How to distinguish gluteal tendinopathy versus gluteal tendon tear

A

Gluteal tendinopathy will present in middle/older woman with weak abductors and external rotators. Trendelenberg sign will be present pain, single leg stance with less than 30 seconds positive the rotation test

Glute tear: Will present with more severe weakness with the potential for severe pain and Echymosis if a cute. To be treated with irritability level based interventions

65
Q

What is return to sport criteria for hip flexion and abduction injuries

A

Adductots strength greater than 80% of hip abductors

66
Q

What are the short term, intermediate and long-term goals for hip hamstring injury rehab progressions

A

Acute: symmetrical ROM, normalized gait, no pain with submaximal isometrics

Subacute: symmetrical hamstring strength, adequate control, eccentric exercises OK, symptom free jogging

Late RTS goals: strong and pain-free all ROM, no apprehension with H - test, plyos high velocity and perturbation training

67
Q

What is the pain monitoring model for hamstring injury rehab progressions

A

<4/10 pain during tx for optimal strength gains

68
Q

Characteristics of femoral nerve neuropathy versus saphrenous nerve neuropathy

A

Femoral nerve neuropathy: quad weakness, entrapment is at the hip flexor if hip flexor weakness is present. hip flexion is spared if the entrapment is under the inguinal ligament. Decreases patella DTR and sensation in thigh and saphrenous pattern (medial knee, lower leg, medial foot, first MTP)

Saphenous nerve neuropathy sensation only in saphenous nerve pattern

69
Q

Distinguish obturator nerve neuropathy from lateral femoral cutaneus nerve neuropathy

A

Obturator nerve neuropathy
will affect adductors and sensation at the medial thigh. Entrapment at adductors. Expect aggravation with hip extension and adductor stretch

LFCN
No weakness sensation loss ONLY over lateral thigh
Aggravated with tight belts/clothing.
+ tinel test at ASIS or just medial to it.
Also known as meralgia persthetica

70
Q

What are aggravating factors for OA

A

Weight-bearing, not necessarily sitting, suspect greater trochanteric syndrome

71
Q

What are aggravating factors for FAI

A

Hip flexion

72
Q

What are aggravating factors for GT syndrome

A

Adduction, direct pane over area, pressure

73
Q

What are aggravating factors for glute tear

A

Extreme weakness with MMT and single leg stance. Distinguishes from tendinopathy

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