Hip Flashcards
Coxa Vara
- Angle is approximately 90 degrees (<125)
- Excessive stress through femoral epiphysis, (short leg)
Coxa Valga
- Angle > 125 degrees
- Excessive stress on femoral head (long leg)
Femoral Anteversion
- Greater than 15 degrees anteverted
- Causes in-toeing/excessive hip IR
- xray/craig’s test
Femoral Retroversion
- Less than 12 degrees ante version
- Causes out-toeing/excessive hip ER
- Xray/Craig’s test
Legg-Calve-Perthes Disease
“Coxa Plana”
- Avascular necrosis of the femoral epiphysis with onset between 4-8 years
- Death of tissues at femoral head
- S&S: Pain in hip, thihg, or knee; limping; loss of abduction, ext and ER; thigh atrophy
Slipped Capital Femoral Epiphysis (SCFE)
- Epiphysis gradually or suddenly slips downward and backward in relationship to the femoral neck
- Most common in boys 10-16
- Risk Factors: obesity, coxa vara, medications, hypothyroid, radiation tx, bone problems
- S&S: Pain in groin, limp, knee; flexion comfort; loss of AROM IR hip; SLS difficulty; passive flexion hip will ER
Femoral Acetabular Impingement
-Bone spurring from overuse can cause damage to the labrum as well as the cartilage
-FAI can be resolved with the bone spurs being burred or remodeled
Types:
-Cam = on femoral head
-Pincer = on acetabulum
-Mixed
Precursors to FAI
Ages: 25-60
- Retroversion
- Hx of femoral neck fx
- Hx of SCFE
- Hx of L-C-P disease
FAI Presentation
- C Sign dull, aching pain
- Positve FADIR
- Limited hip IR ROM with hip 90 degrees flexion in supine
- Leads to labral tear, which leads to Osteoarthritis
5 Causes of Labral Tear
- Trauma
- FAI
- Capsular laxity/hypermobility
- Dysplasia
- Degeneration
DX of Labral Tears
- Groin Pain: C sign
- Painful/limited IR and Abduction
- +FADIR’s
- +FABERs
- +Hip Scour
- +MRI
TX of Labral Tears
10-12 week rehab tried before surgery
- Optimize hip alignment
- Stabilize hypermobile hip
- Joint mobes and stretching on hypo mobile hip
- Limit activities for healing
Hip Pointer
- Contusion to iliac crest
- S&S: Local pain, swelling, ecchymosis, pain with trunk and hip motion, laughing, coughing, breathing
Hamstring Strain Tx
- Acute rehab: onset of injury - 3 days (0-3 reduce swelling)
- Subacute rehab:day 4-7
- Chronic Rehab: around day 7
Hip Dislocations
Etiology: MVA most common; in sports occur with force through long axis of femur when knee is flexed
Types:
-Anterior = MOI: forced hip flexion, abduction, and ER
-Posterior = MOI: landing on a flexed knee while the hip is flexed, adducted and IR
Posterior Hip Dislocation
S&S:
- severe hip and thigh pain
- Referred pain in knee
- Hip positioned in flexion, adduction, and IR
- Inability to walk
- Possible neurovascular complaints
Hip Dislocations: Management
- Stabilize and transport to ER
- Need closed reduction within 24 hours
- Post reduction, limb is held in traction 1-2 weeks
- 5-7 days post reduction, open chain AROM exercise is initiated
- Screen for AVN, acetabular tear and future hip OA(50% of all pts)
Apophysitis
-Inflammation of the apophysis from overuse: often seen in long distance running= can lead to avulsion fx
S&S: loss of strength, loss of hip motion, point tender
Hip Stress Fractures
-Seen mostly in distance runners with femoral neck and pubic ramus(abs and adductor pain) (women>men)
S&S: groin pain, aching in thigh with activity, hard for SLS
Tx: rest, min weight bearing 2-5 monte, rehab
Femoral Fracture
MOI: direct trauma or indirect, such as landing on a leg in an extended and rotated position
S&S: sudden severe pain, loss of function, direct and indirect tenderness
-Could lead to AVN
Tx: fixation intramedullary rod
Trochanteric Bursitis
MOI: inflammation of the bursa or gluteus medius from overuse, muscle imbalance, LLD, SLE(lupus) and RA
S&S: lateral hip pain that may refer distally, point tender
Tests: Asymmetrical leg length, weak glute med, tight TFL
Rx: RICE acutely, find cause and fix
Iliopectineal Bursitis
MOI: Excessive compression during hip flexion(long distance runners)
S&S: deep anterior hip pain, pain w/ deep palpation(pectineus), pain with resisted hip flexion
-Negative FADIR’s
Snapping Hip Syndrome
Anterior: SLR = iliopectineal bursitis or Labral tears
-palpate pectineal area for bursitis, FABERs/FADIRs for labral tears
Lateral: Proximal ITB friction w/ or w/out pain
-With pain = greater troch bursitis
Hip Osteoarthritis
S&S:
-deep joint aching
-Sore in morning; better throughout day; worse at night
-could refer to knee
Tests: Scour test, radiograph
Management:
-Stretch tight muscles, light cardio, joint moves to decompress, open chain exercises
Total Hip Replacement
Avoid: -Flexion greater than 90 -Hip adduction -Hip extension with IR Complications: -INFECTION -DVT= blood clot -DVT in calf leads to embolus
Sports Hernia
-Tear in muscular tendons of hip adductors, RA, and Obliques at pubic ramus = could lead to surgery because of low healing rate of tendons S&S: inguinal pain with palpation Tests: resisted oblique MMT -Resisted adductor test -Kicking w/ flexion/adduction -MRI
Self-Locked (CPP) of SI joints
- Full posterior innominate rotation; lifting in a squat
- Sacral Nutation during active flexion and extension of the spine
Pelvic girdle in Open pack position
- Spine neutral
- supine, standing, sitting upright, and during gait cycle
Form Closure
-The ability to transfer loads through the PG, while keeping the joint surfaces stable
Includes:
1. Ligaments
2. Bony and joint integrity
Force Closure
-Optimal muscle function provides the PG with dynamic stability
Local muscle Force Closure
- Pelvic floor muscles
- Diaphragm
- TA
- Lumbo-sacral multifidi
Global muscle Force closure
- Opposite Lats and flute max
- Abdominal Obliques and adductors
- Gluteus medius in weight bearing
Posterior Oblique Sling
-Left lats and right glute max
Anterior Oblique Sling
-External Oblique and opposite adductors
The Lateral Sling
-Stance leg glute med and adductors and opposite side quadratus Lumborum
Deep Posterior Sling
- Biceps femoris coupled with the erector spine through the sacrotuberous ligament
- Contraction of the biceps femoris pulls the sacrotuberous taut, assisting in stabilization of the sacroiliac joint
Emotional-Awareness
- Chronic pelvic pain may be tied to chronic stress and negative lift experiences
- May result in hypertonic muscle firing
- Over-activationt of pelvic muscles = overly compressed joint surfaces = pain
Hyper-Abduction of hip
-Separation force of the pubic Symphysis
Hyper-flexion of hip
- Posterior ilial rotation
- Stressed sacrotuberous and ilio-lumbar ligaments
Hyper-Extension of hip
- Anterior ilial rotation
- Stressed Short and long SI ligaments
Hyper ER of hip
-Possible damage to anterior SI ligament and Pubic symphysis separation
Caused by:
- Weak lateral sling
- Hormonal= relaxin
- Systemic hypermobility
- Restricted hip motion may compensate at SI joint by becoming hypermobile
- Beighton scale (Ehlers danlos syndrome-extreme weak collagen)
Active SLR sign
SI joint hyper mobility
-0.9 SPIN and SNOUT
Hypomobile SI joint
- March and flare test
- Local ligament tenderness
- Referred pain in butt/thigh
- pain provocation (squish test)
- ASIS or PSIS asymmetry
- Bilateral hip ROM Asymmetry
- Negative hyper mobility tests (ASLR and posterior ilial translation, stork standing)
Hypermobile Pubic Symphysis
- MOI= childbirth or forced Hip abduction or ER
- systemic hypermobility: beighton over grade 5
- Hormonal influences
- Poor tolerance to sitting, standing, walking
- pain over pubic tubercles
- pain/spasm of adductors or RA
- ASIS gapping test
- FABER test
Hypermobile SI joint
- Hx of systemic hyper mobility
- Hormonal
- SIJ pain or referred to butt/thigh
- Difficult holding trendelenberg
- squish test, ASIS gapping and or FABER’s
- ASLR
- Posterior ilial translation test
- BIlateral hip ROM asymmetry
Prolotherapy
- The intraligamentous or intratendinous injection at a fibro-osseous junction (SI or PS) of a solution that induces a temporary inflammatory reaction
- This causes an influx of fibroblasts that synthesize collagen at the injection site leading to the formation of new ligament and tendon tissue
Candidates of Prolotherapy
- Patients with disabling joint pain and instability that has lasted greater than 6 months
- Significant joint instability
