Hip Flashcards
What is the Angle of Inclincation of the Femur?
- Angle between the femoral neck and shaft
- 150 deg in Infants - 125 in Adults - 120 in elderly
What is the Angle of Torsion of the Femur?
- Angle between the axix of Femoral Condyle and the Femoral Neck
- 12-15 degrees in Adults
What are the Three Primary Ligaments of the HIp?
- Iliofemoral Ligament (Y ligament of Bigalow)
- Pubofemoral Ligament
- Ischiofemoral Ligament
What is common MOI of Groin Pulls?
- Sports that require quick acceleration or direction changes
- Commonly the Adductor Longus
- Grade 1 and 2 most common
What is best treatment for Groin Pulls?
- Active Strengthening of the Adductors
- Should be 80% of the strength of the ABductors to avoid reinjury
Describe Iliopectineal Bursitis
- Bursitis of Bursa deep to iliopsoas tendon
- Common with Osteo and Rheumatoid Arthritis
- Painful Passive Hip Flexion and Adduction, and Passive Hip Extension
Describe Ischial Tubersity Bursitiis
- Occurs in people with sedentary occupations
- Sometimes after a direct fall on the ischial tuberosity
- Palpation over Ischial Tuberosity and Hamstring Stretching is painful
What is the Sign of the Buttock?
- No increase in Hip Flexion Angle during SLR when the knee is bent and further hip flexion is attempted
- Indicates pathology of the buttock
Describe Clinical Signs of a Hip Pointer
- Disabling Pain
- Athlete flexed toward the side of injury to avoid stretching it
How is Myositis Ossificans Treated?
- Early on, RICE
- Once pain and swelling decrease, gentle ROM
- Avoid aggressive stretching for 4 months
What is Snapping Hip Syndrome?
- Also Known as Coxa Saltans
- Occurs commonly in female athletes
- Complaint of clicking greater than pain
- Treated with stretching of involved tissues
What is Osteitis Pubis?
- Chronic inflammation of the Pubic Symphysis
- Caused by repetitive stress of the muscels that attach to Pubic Symphysis
- X rays show widening of the symphysis and can appear “moth eaten” in chronic cases
How are Acetabular Labral Tears Identified and Treated?
- Fitzgeralds Labral Test, Impingment Test
- Treated with Reduced Weight Bearing and Crutches x 4 weeks, if no change, may require surgery
What are common special tests for Piriformis Syndrome?
- Frieberg Test
- Pace Test
- FAIR Test
- Beattie Test
- Lee Test
What is Meralgia Parasthetica and How is it Treated?
- Nerve entrapment of Lateral Femoral Cutaneous Nerve
- Tight fitting garments or heavy tool belt usually the cause
- Treated with Rest and Removal of Causative Factor
What is Hamstring Syndrome?
- Entrapment of the Sciatic Nerve by Adhesions in the Hamstrings
- Caused by Repetitive Hamstring Strain
How does Superior Gluteal Nerve Become Entrapped?
- As it passes through Greater Sciatic Notch and Piriformis
- Pain in Gluteal Area and Tenderness to Palpation just lateral to Greater Sciatic Notch
What is a Malgaigne Fracture?
- Double Vertical Fractur of the Pelvis
- Usually Superior and Inferior Pubic Ramus and ipsilateral SIJ dysfunction
- Makes Pelvis Unstable
What are the Total Hip Precautions?
- Hip Flex > 90
- Internal Rotation
- Adduction past midline
What are the outcome differences between Anterolateral and Posterior Approach for THA?
- Anterolateral has less risk of Dislocation but requires more time to full weight bearing because of Glut Med Integrity
- Posterior approach at higher risk for dislocation but faster recovery times
What are some Contraindications for Posterior Approach THA?
- Dementia, Mental Retardation, etc.
- Times when patient unable to follow precautions well
What is Developmental Dysplasia of the Hip?
- Developmental Abnormality resulting in possible Subluxation and Dislocation of the hips in infants
- Tested with Barlow, Ortolani, and Galeazzi Special Tests
- Treated with Pavlik Harness or Surgical Reduction if needed
What is Legg Calve Perthes?
- Idiopathic avascular necrosis of the proximal femoral epiphysis in children
- Most Common between the ages of 4 and 8
- Children over Age 6 has worse prognosis than <6
- When Lateral Pillar of the femur has decreased height or there is a loss or ROM, worse prognosis as well
What is Treatment for Legg Calve Perthes?
- observation alone, activity restriction, partial weight bearing, traction, and physical therapy
- Maintain ROM
- Surgical Procedures include osteotomy and are typically performed on children with poor prognosis for conservative treatment
What is Typical Presentation of Legg Calve Perthes?
- Painless Limp
- Groin, Hip, Thigh Pain
- Loss of Internal Rotation and Abduction
What is Slipped Capital Femoral Epiphysis?
- Disorder of the proximal femoral physis that leads to slippage of the epiphysis relative to the femoral neck
- Occurs most often in obese males
- Usually treated with Percutaneous Pinning
What is the typical presentation of Slipped Capital Femoral Epiphysis?
- Groin, Thigh, and Knee Pain
- Externally Rotated Hip in Gait
- Loss of Internal Rotation, Abduction and Flexion
What is Proximal Femoral Focal Deficiency?
- Congenital Defect of the proximal femur
- Results in possible Absent Hip, Absent Femur, or shortened Femur
- Severe Shortening of one or both legs, percentage of shortening remains constant with growth
- Can be treated with observation (in bilateral cases) or with surgical lengthening or ampuation depending on severity
Describe Genu Varum Progression in Children
- Genu varum (bowed legs) is normal in children less than 2 years
- Genu varum migrates to a neutral at ~ 14 months
- Peak genu valgum (knocked knees) at ~ 3 years of age
- Genu valgum then migrates back to normal physiologic valgus at ~ 4 years of age
What are Infantile and Adolescent Blounts Disease?
- Progressive pathologic genu varum centered at the tibia
- Infantile < 3
- Adolescent > 10
- Treated with bracing with KAFO in children < 3 and Osteotomy Children > 3
What Degree of Hip Flexion do you test the adductors in to differentiate specific muscle (groin) strain?
- 0 Deg - Gracilis
- 45 Deg - Adductor Longus and Brevis
- 90 Deg- Pectineus
