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517 Ortho > Hip > Flashcards

Hip Flashcards

1
Q

degrees of freedom of hip joint

A

3, 6 osteokinematic directions

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2
Q

capsular pattern

A

joint specific pattern of restriction of passive movement

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3
Q

hip capsular pattern

A

flexion>IR>abduction limitations

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4
Q

open packed capsular restriction

A

flexion and ER

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5
Q

How does hip joint congruency differ from other joints?

A

Very congruent, meaning less accessory movement so mobilizations are less effective
increased stability with mobility

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6
Q

femoral head vascularity

A

ligamentum teres - 1/3
circumflex
superior/inferior gluteal arteries

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7
Q

4 major ligaments of the hip

A

iliofemoral: anterior, Y
pubofemoral: anterior
ischiofemoral: posterior
ligamentum teres: blood supply and stabilize at 90 flexion

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8
Q

stabilizer muscles of the hip

A

psoas, hip rotaters

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9
Q

hip clock orientations

A

felt around greater trochanter
12: glut med
1-2: glut min
3: glut max
4-5: vastus lateralis
6-7: quadratus femoris
8-10: conjoint tendon
10-11: piriformis

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10
Q

flexors of the hip

A

iliacus
TFL
sartorius
rectus femoris
adductor longus
pectineus

assist: gracilis, adductor brevis, glut min anterior fibers

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11
Q

extensors of the hip

A

glut max
hamstrings
adductor magnus posterior fibers

assist: glut med

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12
Q

abductors of the hip

A

glut med
TFL
superior glut max
glut min

assist: sartorius, rectus femoris, piriformis

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13
Q

adductors of the hip

A

adductor group
pectineus
gracilis

Assist:
obturator externus

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14
Q

internal rotaters of the hip

A

no pure internal rotaters
TFL
glut min
glut med
adductor longus/brevis
semimebranosus/tendinosis

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15
Q

external rotaters of the hip

A

obturator internus/externus
gemellus sup/inf
quadratus femoris
piriformis
glut max
posterior glut med
biceps femoris

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16
Q

functional mobility at hip

A

shoe tying: 120 flexion
sitting: 112 flexion
squatting: 115 flexion/ 20 abduction/20 IR
up stairs: 67 flexion
down stairs: 36 flexion
put on pants: 90 flexion

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17
Q

normal angle between head of femur and neck

A

125 degrees

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18
Q

How does the angle at the femoral neck change the hip?

A

increased angle: coxa valga
decreased angle: coxa vara

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19
Q

coxa valga

A

creates increased stress across joint surfaces
shortens hip abduction moment arm to be disadvantageous
increased LE length
creates varus at knee, stress to medial side
more likely to get FAI

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20
Q

coxa vara

A

more horizontal femoral neck
increased downward shear force
decreased angle of pull for hip abduction
creates valgus at knee, stresses lateral side
more prone to fx due to increased torsional/shear force

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21
Q

femoral anteversion

A

neck is oriented anterior, smaller angle of head and neck in transverse plane
results in hip IR and in toeing

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22
Q

femoral retroversion

A

increased angle of femoral neck and head in transverse plane
results in hip ER and out toeing

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23
Q

avascular necrosis of femoral head

A

dead bone/bone marrow into subchondral plate cause by lack of blood flow to femoral head

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24
Q

PT treatment of avascular necrosis

A

the aftermath, we can catch condition but primary treatment is surgery

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25
Q

subjective findings of avascuar necrosis

A

groin pain radiating to lat hip, knee, buttock
deep throbbing
intermittent gradual onset
antalgic shift

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26
Q

risk factors for avascular necrosis

A

corticosteroid high cumulative dose
alc use
systemic lupus
sickel cell
trauma
cancer

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27
Q

objective findings of avascular necrosis

A

painful ROM esp IR OP
pain w SLR
antalgic gait

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28
Q

complications of avascular necrosis

A

incomplete Fx
superimposed degenerative arthritis

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29
Q

Legg Calve Perthes Disease

A

osteonecrosis of femoral head in kids 4-10
malformed bone due to less blood supply
unilateral
4x more in boys
disorder of epiphyseal cartilage

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30
Q

subjective findings of Legg Calve Perthes DIsease

A

vague groin ache radiating medial thigh to inner knee
muscle spasm

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31
Q

objective findings of Legg Calve Perthes DIsease

A

limp/leg drag
thigh muscle atrophy
child small for age
positive trendelenberg
out toeing involved side
decreased abduction/IR
hip flexion contracture

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32
Q

Legg Calve Perthes DIsease treatment

A

monitoring by physician if mild/mod
severe: operative

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33
Q

slipped capital femoral epiphysis

A

displacement of femoral head from epiphysis/growth plate during growth spurt
anterior displacement of femoral neck
common in adolescents

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34
Q

subjective findings of slipped capital femoral epiphysis

A

pain worse w activity
groin/med thigh pain with some knee or lower thigh pain first
dull/aching
leg weakness
no Hx of trauma necessary

35
Q

objective findings of slipped capital femoral epiphysis

A

walk w difficulty and limp, ER involved foot
decreased hip ROM in IR, adb, flexion
IR loss is greater in flexion
ER with passive hip flexion
involved extremity 1-3 cm shorter

36
Q

risk factors for slipped capital femoral epiphysis

A

obesity
male
sports involvement

37
Q

slipped capital femoral epiphysis interventions

A

relieve symptoms
contain femoral head
restore ROM
surgical fixation if necessary

38
Q

femoral neck stress Fx

A

result of accelerated bone remodeling as response to repeated stress
neck is weak point due to angle and lack of trabeculae in area

39
Q

who gets femoral neck stress Fxs?

A

military recruits/athletes/runners
older persons: superior neck/tension Fx
younger persons: inferior femoral head/compression fracture

40
Q

femoral neck stress Fx subjective findings

A

sudden hip pain associated w change in training
deep thigh pain
pain in WB and end range motion
radiate into knee
night pain

41
Q

femoral neck stress Fx objective findings

A

negative physical exam
empty end feel or pain at end range IR/ER
pain w resisted hip ER
+ resisted SLR
+ ausculatory patellar/pubic percussion test
+ fulcrum test
diagnose w MRI, not xray

42
Q

ausculatory patellar/pubic percussion test

A

place stethoscope over pubic symphysis
tap patella and note sound
repeat on both sides
+ is diminished percussion on side of pain

43
Q

femoral head stress Fx intervention

A

surgical for tension Fx
compression: bed rest to NWB until WBAT once pain free
progress weight bearing

44
Q

hamstring strain

A

1 or more hamstring muscles
partial, often in eccentric phase w tension while lengthening

45
Q

hamstring strain subjective findings

A

distinct MOI
running or deceleration
pop at injury
posterior thigh pain
worse w knee flexion

46
Q

hamstring strain objective findings

A

tenderness with passive stretching
tender to palpation
pain w resisted knee flexion
isolate muscle w IR/ER

47
Q

hamstring strain intervention duration

A

grade 1: continue activity as tolerated, pain as guide
grade 2: 5days-3weeks
grade 3: 3-12 weeks

48
Q

sample hamstring strain interventions

A

prone curls
supine stretch
machine loaded curls in prone/seated
SL bridge
good mornings
lunges
SL squats
nordic curls (eccentric)
ball hamstring curls and hamstring bridges
barbell deadlift
SL deadlift
dumbbell swing

49
Q

Adductor tendinopathy

MOI, involved muscle

A

mostly comonly adductor longus
common adductor pathology proximally
caused by repetitive loading with twisting/running
muscular imbalance of stabilizing muscles of hip

50
Q

subjective findings of Adductor tendinopathy

A

twinge/stab pain in groin
edema/ecchymosis
aggravated by running, directional changes, kicking, SL exercise, lunges

51
Q

Adductor tendinopathy objective findings

A

pain w passive abduction or resisted adduction
bias different adductors at different levels of hip flexion
0: gracilis
45: add longus/brevis
90 + abduction: pectineus

52
Q

Adductor tendinopathy interventions

A

acute: RICE or POLICE (protect, optimal loading, ice, compression, elevation)
Sub acute: isometrics
gentle stretching
graded resistance
gradual return to full activity
good prognosis

53
Q

Adductor tendinopathy sample exercises

A

supine stretch
hamstring stretch
sidelying lift
SLR
resisted hip flexion
side plank
resisted hip abd/add

54
Q

hip OA subjective findings

A

insidious onset
buttock/groin/thigh/knee
dull or sharp
worse w activity lastin several hours after
antalgic gait
hard to climb stairs/put on socks

55
Q

hip OA objective findings

A

restricted IR/abd/flexion
pain at end range
pain to resisted hip flexion/adduction
+Scour
+FABER

56
Q

hip OA interventions

A

relief symptoms
minimize disability
reduce progression
education
modalities for pain relief
weight management
add AD if needed
manual mobilization
passive stretch
strengthen stabilizers

57
Q

Snapping hip

A

snapping/pop sensation occuring with moving tendons around the hip over bony proiminences

58
Q

causes of snapping hip

A

internal: iliopsoas snap over femoral head, lesser trochanter, tenosynovitis
external: ITB/glut max snap over greater trochanter
intra articular: synovial chondromatosis, Fx fragments, labral tears, loose body

59
Q

snapping hip subjective findings

A

snap/pop greater trochanter area with ambulation
snap caused by subluxed iliopsoas tendon in groin/hip while flexed
may be pain if bursa inflamed

60
Q

snapping hip objective findings

A

IT band subluxing on standing/rotation
palpable snapping while extending from flexed
Obers
Thomas

61
Q

snapping hip intervention

A

improve muscle length
improve strength imbalances
often conservative treatment

62
Q

trochanteric bursitis

A

common cause of lateral hip pain second to OA
GTPS: greater trochanteric pain syndrome

63
Q

trochanteric bursitis subjective findings

A

lateral thigh, groin, gluteal pain
worse lying on involved side
radiate distally
pain worse in sit to stand or recumbent
better after a few steps, worse after walking 30 min
STM will make bursa worse but muscle better to differentiate

64
Q

trochanteric bursitis objective bursitis

A

reproduce pain w palpation or stretching of ITB
resisted abd/ext/ER painful
tight hip adductors
Obers
modified obers

65
Q

trochanteric bursitis intervention

A

stretch soft tissue lateral thigh
flexibility of ER/quad/hip flexors
strengthen hip abductors/muscular balance w adductors
orthotic if needed
responds well to conservative

66
Q

hip labral tears

MOI

A

from trauma, FAI, capsular laxity/hypermobility, dysplasia, or degeneration
often undiagnosed

67
Q

hip labral tears subjective findings

A

anterior hip/groin pain
click/pop/locl/give way

68
Q

hip labral tears objective findings

A

+ anterior hip impingement test
similar to FAI presentation
aggravation w activity
painful faber/faddir

69
Q

hip labral tears intervention

A

conservative management for a few months
limit pivoting
strengthen
assess foot motion
surgical: arthroscopic debridement of tear

70
Q

FAI treatment

A

restore mobility/function
decrease pain
avoid surgery
avoid progression to OA and labral tear

71
Q

prevalence of FAI

A

20-40 y/o
athletes 15% of cases
repetitive end range hyperextension/flexion w abduction
slip/twist injury

72
Q

types of impingement

A

CAM: aspherical femoral head impinging rim of labrum; provoked by FADDIR; superior OA; young males
PIncer: acetabulum over covers femoral head impinging neck of femur; middle aged females; provoke by hip ext/ER

73
Q

CAM/pincer prevalance

A

86% have both

74
Q

CAM/pincer ROM limitations

A

IR/ER, flexion, add progressively more limited

75
Q

FAI symptoms

A

C sign
dull ache
worse w prolonged sitting
sharp catch w pain in activity
faddir increases symptoms
limp
struggle with ADLs

76
Q

non surgical FAI treatment

A

activity changes: avoid provoking activities
NSAIDs
PT: improve hip ROM and strengthen supporting muscles

77
Q

surgical treatment FAI

A

arthroscopic clean out of damaged labrum/cartilage
trim bony rim and femoral head

78
Q

surgical vs conservative FAI treatment

A

surgical has better statistical difference between pre and post outcomes than physical therapy

79
Q

FAI post op protocol phase 1

A

1: 4-6 weeks protect, restore ROM, control pain/inflam, NM control
progress to 2 when FWB, 75% ROM, NM control patterns, minimal pain

80
Q

FAI post op protocol phase 2

A

2: CKC exercise, balance, stretching, STM
progress to 3 when pain free gait FWB, full ROM, 60% hip flexion strength

81
Q

FAI post op protocol phase 3

A

3: restore muscular endurance and strength, NM control/balance/proprioception
6-8 weeks post op
introduce single leg strengthening, closed chai

82
Q

FAI post op protocol phase 4

A

4: sports specific, 8-16 weeks post op
to return to sport need 85% hip flexion str, full pain free ROM, perform drills at speed, complete sport related testing
plyometrics, mechanics, jogging

83
Q

Common hip problems by age

A

newborn: congenital dislocation
2-8: avascular necrosis, legg calve perthes, synovitis
10-14: SCFE
14-25: stress Fx
20-40: labral tear
40+: OA

517 Ortho (8 decks)

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