HIP Flashcards
MSK: hip
traumatic hip arhritis
trauma can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
- Subtrochanteric Fx
- Young or middle aged
- If ORIF fails (non-union), then it is repeated with bone grafting
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Acetabular fracture MOI
trauma
femoral head is driven into pelvis
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Complaints of morning stiffness, stiffness after sitting, and hip pain with weight-bearing are suggestive of joint involvement, such as
- OA
- RA
- avascular necrosis
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Advantages of THR anterior approach surgery
- reduced risk of dislocation since no damage to to short external rotators muscles.
- Barelly any precautions:
- soft tissue precautions
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Meralgia paresthetica:
- Is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury, compression, or disease of the lateral femoral cutaneous nerve.
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Which THR approach is technically easier, takes less OR time, less blood loss, less impact on abductor function?
Posterior Approach
- “This is the classic approach that many older surgeons refuse to give up” (Dr. M).
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The piriformis is an___________of the hip at less than 60 degrees of hip flexion. At 90 degrees of hip flexion, the piriformis reverses its muscle action, becoming an ___________ of the hip
- external rotator
- internal rotator and abductor
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Disadvantages of THR lateral approach approach surgery
abductor weakness
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OUTPATIENT HIGH PRIORITY CHECKLIST for THR
- Hip IR/extension ROM
- Neuromuscular control of gluteal muscles
- Lumbopelvic control
- Balance and proprioception
- Gait training
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HIP ARTHRITIS:
- Capsular pattern limitation (IR, FLX)
- Groin or anterior thigh pain
- Nontraumatic or traumatic.
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Acetabular fracture will require what type of examination?
Neurological examination (sciatic nerve)
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MOI of femoral shaft Fx:
trauma
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Mobilization to increase IR
- supine
- flx & add, posterior glide
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THR, greatest factors associated with adverse outcomes:
- Advanced age (>70)
- Medical co-morbidities: CHF, CRF, DM
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Which THR approach has the highest rate of hip dislocations?
posterior approach
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Walking on heels test which dermatome?
L4, dorsiflexion
dermatome: medial leg, medial foot
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displacement of femoral neck fracture will disrupt the blood supply and cause and may cause:
avascular necrosis
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During a resisted testing (prone), a manual isometric resistance given for hip extension.
What muscle istested if the test is performed with the knee in flexion?
What muscle istested if the test is performed with the knee in extension?
- Hip extension, knee flexion: glut maximus
- Hip extension, knee extension: hamstrings
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A post menopausal woman with osteoporosis steps out of the shower, then falls. What type of Fx is most likely to occur in this situation?
Fx of the femoral neck
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Special test Straight Leg Raise results:
- (+) bet 50-70 deg = discs
- >70 deg = hamstring muscle lenght
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Traction to increase hip extension:
- prone:
- indirect: ext limit + ADD/ER
-
direct mob:
- with knee flx ((towel under ISIS), PA mobs
- FABER
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Legg–Calvé–Perthes disease (LCPD) AKA
Ischemic necrosis of the femoral head
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which THR has the lowes rate for dislocation?
anterior approach
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Precaution after surgery is not becasue surgeans are concerned about the prothesis not being able to handle the compressive forces. Surgean are concern about…
the soft tissue disection had no had a chance to heal
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Normal gait speed:
- Normal 1.2 - 1.4m/s
- < 1.0m/s require rehab
- < 0.6m/s increase fall risk
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predictors that increase the likelihood of OA:
- Self-reported squatting as an aggravating factor
- Active hip flexion causing lateral hip pain
- Scour test with adduction causing lateral hip or groin pain
- Active hip extension causing pain
- Passive IR ≤ 25°
- 4/5 present +LR 24.5
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Treatment of avulsion fractures:
- 4-6 wk pain control
- rest
- gradual return to activity
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Causes of dislocation with posterior approach:
- Bending forward while putting on shoes
- Twisting the trunk sit/standing with feet planted
- Rising from a low toilet with hip in ADD/IR position
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how does the leg presents in a femoral neck fracture?
shorter and externally rotated
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Advantages of THR lateral approach approach surgery
- good exposure of acetabulum
- reduced risk of dislocation (no damage to short ER)
- reduced injury to sciatic nerve
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disanvantages of THR posterior approach:
- Dettachment of ER muscles:
- Fascia lata is incised, fibers glut max are split
- Detachment of short ER, incise posterior capsule
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Treatment of femoral shaft Fx in adults:
- Intramedullary rod for open Fx
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Which myotome tests active resistance of knee extension?
L3-L4 (L3 in board exams)
L2 ant mid thigh, L3 distal ant-medial thigh
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True or false: intertrochanteric fx prognosis is better than femoral neck fx
true
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Objective examination order:
- Structural Inspection
- Screening exam
- Movement analysis
- AROM
- PROM
- Resistive test (mmt)
- Muscle lenght if needed
- Special tests
- Palpation
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Ischemic necrosis of the femoral head (AKA Legg–Calvé–Perthes disease) occurs mostly in children of what age?
Children between 3-10 yr
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types of disorders with limitations:
(classification)
-
Capsular pattern limitations
- Ex. hip arthritis
-
Noncapsular pattern limitations:
- Ex. Sliped capital femoral epiphysis
- Ischemic necrosis of the femoral head
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Does a pt that walks at 0.8 m/s require rehab?
yes
less than 1m/s require rehab
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“Rotator cuff” of the hip:
- Glut medius/ max
- Sup/inf gemelus
- Obturator intternus
- Quadratus femoris
- Must function: decelerate the femur in close kinetic chain motion
- Proximal stability
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Sharp pain:
labral tears, articular loose bodies, accompanied by a click, giving way, and a feeling of catching or locking
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types of disorders without limitations:
(classification)
-
Buttock pain:
- emerging from lumbo-scral/SIJ, hamstring syndrome, piriformis syndrome, hamstring tendinopathy, throcanteric bursitis
-
Groin pain:
- Tendinopathy, osteitis pubis, femoroacetabular impigement.
-
Snapping hip:’
- intra/extra articular
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What is Atelectasis?
is the collapse or closure of a lung resulting in reduced or absent gas exchange
(a complication of THR)
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Complications and acute care of THR:
- DVT or PE
- Pulmonary/cardiac issues:
- OH, anemia, pneumonia
- Acute care: screening and prevention
- Vitals, auscultations of lungs
- LE aligment (dislocation)
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Hip arthritis, passive movement testing reveals capsular limitation with______ being the greatest
Internal rotation
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What does the CRAIG TEST measure?
the angle of anterversion / retroversion /
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Posterior dislocation treatment and complications:
- Tx: closed reduction within 6 hours
- Complications:
- avascular necrosis over time
- Sciatic nerve injury
- Post-traumatic arthritis
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Periarticular pain that is not reproduced by passive motion and direct joint palpation suggests an alternate etiology such as
bursitis, tendinitis, or periostitis
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Posterior hip dislocation presentation:
short leg, adduction, and internal rotation
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Most common indication for THR:
osteoarthritis
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Which myotome test is useful to diagnose disc herniation problems?
great toe extension L5
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After a hip replacement, what is the OUTPATIENT HIGH PRIORITY CHECKLIST?
- Restablish hip IR/extension
- Neuromuscular control of gluteal muscles
- Lumbopelvis control
- Balance and proprioception
- Gait training
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which THR surgical approach have less impact on abductor function?
posterior approach
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What are the weight bearing precautions on cemented implants (THR)?
Functional weight bearing immediately
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Walking on toes tests wich myotome?
S1
dermatome Lateral side of foot
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Femoral head blood supply:
- profunda
- circumflex femoral
- small supply from artery of ligamentum teres
- displacement of femoral neck fracture will disrupt the blood supply and cause an intracapsular hematoma (avascular necrosis)
(Femoral neck fracture?)
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What is the normal angle of anteversion?
15 deg
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Intertrochanteric Fx treatment:
ORIF to avoid complications
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Resistance to 1st toe extension test which myotome?
L5
dermatome: lateral leg
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Treatment of femoral shaft Fx in children:
- Conservatively
- External fixation for open Fx
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most hip replacement last how long?
- > 90% THR last 10 years, many last 20 years
- 97% hip resurfacing lasts 8 years
- Rate of revision 3x higher younger males
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Burning pain:
- nerve entrapment may be accompanied by paresthesias, numbness, and/or weakness, or sympathetic changes:
- (femoral, lateral femoral cutaneous, ilioinguinal, genitofemoral, obturator
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Treatment and complications of acetabular fractures:
- Tx: ORIF if displaced
- Complication: post traumatic DJD (osteoarthritis)
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The patient’s age may help in the diagnosis. OA of the hip is diagnosed most often in patients over ______, although it can occur earlier.
60 years of age
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Disadvantages of THR anterior approach approach surgery
abductor dysfunction secondary glut med tenotomy*
(the surgical cutting of a tendon)
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OA affects _____% of adults 65yo or older
33.6%
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What dictates post-operative walking ability in primary and revision THR?
Pre-operative function
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Active hip flexion with resistance test which myotome?
L1-L2
- L1 inguinal region
- L2 anterior mid thigh
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Which muscles decelerate the femur in close kinetic chain motion:
- Glut medius/ max
- Sup/inf gemelus
- Obturator intternus
- Quadratus femoris
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What are the weight bearing precautions on non cemented implants (THR)?
Weight bearing precautions 8 -12 weeks
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predictors for succesful PT response in patients with hip OA:
- Unilateral hip pain
- Less that 58 y/o
- Pain is greater than 6/10
- 40 m walk test is less than 25 sec
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Posterior hip dislocation MOI
- high-energy impact at position of adduction/flexion
- MVA
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Slipped Capital Femoral Epiphysis occurs mostly in children what age?
teenagers, boys (13-15), girls (11-15)
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Femoral neck Fx MOI?
caused by or result in fall
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Traction to increase hip flexion (supine):
- Supine with belt
- Indirect: 30 deg flx, abd, ER
- Direct: AB/ER or AB/IR
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Most common site for avulsion fractures:
- ASIS (sartorious, TFL)
- AIIS (rectus femoris)
- Inferior pubic ramus (adductors)
- Ischial tuberosity (hamstrings)
- Lesser trochanter (iliopsoas)
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In what population do avulsion fractures occur more often?
- In the younger population, ligaments and tendons are stronger than bone.
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Aching pain:
bursitis, tendinopathy, arthritis
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Intertrochanteric Fx occurs more often in
Women over 60
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Treatment and complications of femoral neck fractures:
- Closed reduction: may be considered in some patients who are non-ambulators, have minimal pain, and who are at high risk for surgical intervention
- ORIF: displaced fractures in young or physiologically young patients indicated for most pts <65 years of age
-
Complications: avascular necrosis, non-union,
DJD (osteoarthritis), death in elderly.
MSK: hip
Mobilization to increase AB:
- supine, abd + ER
- inferior medial glide
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wich group of muscles decelerate the femur in close kinetic chain motion during ambulation
“Rotator cuff of the hip”:
- Glut medius/ max
- Sup/inf gemelus
- Obturator intternus
- Quadratus femoris
