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OCS > Hip > Flashcards

Hip Flashcards

1
Q

Acetabulum orientation

A

ventromedially to dorsolaterally in teh transverse plane and carniolaterally to caudomedially in teh frontal plane

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2
Q

Collodiaphyseal angle

A

starts at 150* from the femoral diaphysis at birth and decreases to 120-130 by adulthood due to WB

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3
Q

CD angle <120

A

coxa vara - can result in potential shearing stresses that damage the epiphyseal plate of femoral head

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4
Q

Excessive CD angle

A

-coxa valga - can lead to altered muscle activity and intraarticular forces in the CFJ as well as altered cartilage response

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5
Q

CFJ

A

Coxafemoral joint

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6
Q

Center edge angle

A

-is the angle between the acetabulum and the femoral head in teh frontal plane

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7
Q

Center edge angle

A

30*

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8
Q

Center edge angle <30*

A

means dysplastic changes in teh joint

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9
Q

Anterior rotation of femoral neck changing over a lifetime

A

goes from 40* to 9* from the line between the distal femoral epicondyles

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10
Q

Anteversion

A
  • excessive naterior rotation
  • hip IR is increased and hip ER is decreased in order to maintain the 90-100 total rotational ROM in transverse plane
  • compression forces on teh cartilage and may expose person to tendinopathies
  • best fixed by positional adaptation before pubsecence vs. surgical
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11
Q

Retrotorsion (retroversion)

A
  • decreased torsion angle
  • decreased hip IR and increased hip ER
  • could produce early degenerative changes in anterior superior acetabular labrum due to close proximity and impact of femoral neck
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12
Q

Cartilage and the humeral head

A

2/3 covered in hyaline cartilage

-center lacks cartilage to allow insertion of teres ligament and neurovascular supply

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13
Q

Gothic arch

A

-cartilage of acetabulum forms this - where cartilage is least developed in the far superior region of the dome and discontinuous in teh floor and anterior inferior region

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14
Q

Pulvinar acetabuli

A

-layer of fat found on the floor of the acetbulum that migrates out with change sin pressure

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15
Q

Where is cartilage most developed in the acetabulum?

A

In the anterior and posterior superior surface of the gothic artch because that is where femoral head has greatest contact and loading during gait

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16
Q

Who experiences greater stress on cartilage - men or women?

A

Women - and any dysfunction in muscles around the joint could lead to increases in force imposed on joint and early degeneration

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17
Q

Labrum

A
  • serves to enlarge articular surfaces
  • acts as an attachment for joint capsule
  • assists in maintaining fluid pressurization
  • provides proprioceptive sensory info regarding hip position and movement
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18
Q

Loss of labrum

A

-can produce a reduction in articular seal, fluid pressurization, load support, and joint lubrication

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19
Q

Vascularization of the labrum

A
  • similar to the meniscus
  • outer margins are well vascularized and inner sanctum is less vasculrized
  • superior is also less vascularized leading to this are being more susceptible to tears
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20
Q

Capsule - 3 different fiber systemes

A

1) longitudinal - along the length of capsule from proximal to distal creating a tensile strength
2) transverse - circular fashion around capsule at the neck creating Zona Orbicularis - region where capsule narrows
3) Arcuate fibers - loops at the proximal insertion at the labrum reinforcing the insertion

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21
Q

Ligamentum teres

A
  • arises from transverse acetabular ligament
  • attached to periosteum
  • aids the capsule in maintaining the reduction of the femoral head whiel acting as a conduit for the neurovascular supply
  • recognized as a significant potential source of pain and mechanical symptoms
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22
Q

Iliofemoral ligament

A

1) Pars inferioris - constrains hip extension

2) pars superioris - constrains hip ext, adduction, ER

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23
Q

Pubofemoral ligament

A

-constrains hip extension, abduction, ER

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24
Q

Ischiofemoral ligament

A

-works with the arcuate ligament to provide hip stability during quiet standing - taut in the upright position

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25
Q

Inguinal canal

A
  • formed by numoerous tissues and is highly variable
  • ilioinguinal nerve is located in the canal
  • can be a site for nerve entrapment and hernia
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26
Q

Capsular pattern

A
  • arthritic patients
  • IR limits are greatest compared to other limitations
  • specific definition of capsular pattern is not consistent in the literature
  • variable combination of limits in flexion, ext, abduction
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27
Q

Hip arthritis

A
  • can be nontraumatic or traumatic
  • c/o groin and anterior thigh pain during functional activities (sitting, walking, ascending stairs)
  • passive movement limitations
28
Q

Predictor variables for arthritis

A
  • looking for 3/5
    1) self reported squatting as agg. factor
    2) active hip flexion causing lateral hip pain
    3) scour test with adduction causing lateral hip or groin pain
    4) active hip extension causing pain
    5) passive internal rotation = 25*
29
Q

Treating hip OA

A

-joint specific low velocity mobs in a traction direction

30
Q

Other diseases with capsular pattern

A
  • RA
  • gout
  • reiter syndrome
  • psoriasis
  • ankylosing spondylitis
  • onset of legg-calve-perthes
31
Q

Coxarthrosis

A
  • common hip joint disorder that may or may not cause pain
  • diagnosis = radiographs
  • can develop synovitis as result of overuse or from an accident
  • can be primary or secondary
32
Q

Primary coxarthrosis

A
  • genetically coded and typically occurs w/ advancement in age
  • patients >40
  • can be (B) or unilateral
  • more often seen in females (and is usually more severe in females)
33
Q

Secondary coxarthrosis

A
  • articular erosions that emerge as result of other underlying condition (joint instability, dysplasia, previous intraarticular fracture, long standing loose body, disease)
  • patients >25
34
Q

Treatment for cosarthrosis

A
  • manual therapy has been shown to be effective

- surgery for intractable pain or severe functional limitation

35
Q

Best approach for THA

A

-controversial

36
Q

Pre-operative PT for THA

A
  • shown to decrease post-acute care services

- preop abductor strength and knee extension strength are reliable predictors of ambulation ability following THA

37
Q

Anterolateral THA

A

-return to earlier side sleeping, driving, and riding in automobiles, and work activities sooner than those with precautions

38
Q

Transient synovitis

A
  • viral, autoimmune, or microtraumatic
  • more common in males under age 6
  • rare in adults
  • hx usually includes preceding illness and patient presents with antalgic gait
  • slight capsular pattern
39
Q

Slipped capital femoral epihpysis (SCFE)

A
  • non-capsular pattern
  • femoral head epiphysis slides off femoral neck
  • variable limitations in hip IR and flexion
  • traditionally affected males more than females (2:1), but recent netherlands study found no gender difference
  • affects in pubescent years (13 to 15 for males, 11 to 15 for females)
  • 30% chance of (B) involvement
  • overweight and underdeveloped
40
Q

S/S of SCFE

A
  • muscle guarding
  • limited IR, increased ER,
  • Drehmann’s sign
  • Trendelenburg test = +
  • greater risk for developing necrosis of teh femoral head
41
Q

Drehmann’s sign

A

-obligatory abduction and ER during passive flexion

42
Q

Treatment of SCFE

A

-surgical percutaneous pinning in situ followed by PWB and ambulation w/ AD for 4-6 weeks

43
Q

Ischemic necrosis of femoral head

A
  • presents with variable hip motion limitations
  • can occur in children or young adults
  • associated with LCPD and SCFE in children, but etiology is less clear in adults
  • may produce a drehmann sign
44
Q

diagnosing necrosis via x-ray

A

-requires lauenstein position (frog leg)

45
Q

Stages of LCPD

A

1) 25% of femoral head is involved
2) 50% of femoral head produces subchondral fracture in shape of half moon along with intact anterior pillar of femoral head
3) 75% involved producing progressive femoral head collapse
4) involvement of entire head adn plate - aggressive femoral head disintegration

46
Q

Treatment for LCPD

A
  • stage specific
  • best managed by specialist
  • conservative management = joint surface containment and remodeling through bed rest w/ traction into hip abduction, serial casting, functional orthoses (not recommended for patients > 6 yrs old who have >50% head involvement)
47
Q

Avascular necrosis and non-surgical treatments

A

-new research suggests that several minimally nonsurgical treatment options may be promising in adults with early stages of necrosis

48
Q

Osteochondritis dissecans

A
  • can occur w/ or w/o loose body
  • begins with inflammation of cartilage and subchondral bone
  • can be result of micro or macrotrauma
  • some loose bodies can be managed conservatively while others require surgery
49
Q

Primary bone tumors

A 
-usually malignant
In order of decreasing frequency:
-chondrosarcoma
-ewing sarcoma
-osteosarcoma
-fibrosacroma
-langerhans cell histiocytosis
50
Q

Snapping hip (coxa saltans)

A
  • can be intra or extra-articular
  • intra=snapping of iliopsoas tendon over iliopectineal eminence
  • extra = thickening of iliotibial tract at greater trochanter, iliopsoas at pectin pubis, glute max fibrosis, proximal hamstring at ischial tub
  • motion limitations with walking esp when hip moves into flexion, IR, ER
51
Q

Stress related avulsion

A
  • can occur with macro and/or microtrauma
  • presents with an initial severe pain followed by reudced pain and increased weakness
  • recorded in adductors, sartorius, iliopsoas, biceps femoris, rectus femoris
52
Q

Diagnosing avulsion

A

-mri or diagnostic ultrasound

53
Q

Treatment of avulsion

A

-best treated with conservative care - 4 to 6 weeks of rest with gradual resumption of activities

54
Q

friction massage

A
  • found to stimulate fibroblast proliferation and promote tissue healing through increased fibroblast recruitment
  • can produce temporary analgesia through application of a noxious stimuli - requires about 2 minutes to reach a painfree threshold for hours to days o frelief
55
Q

Causes of buttock pain

A
  • lumbar issues
  • sij
  • periarticular structures
  • tension
  • compressive irritation
  • adhesion of lumbosacral root or dorsal root ganglion
56
Q

Piriformis syndrome

A
  • can produce buttock pain secondary to nerve compression and irritation
  • can begin with blunt trauma to buttock region or overuse activities
57
Q

S/S of piriformis syndrome

A
  • increased pain in buttock with walking activities, sitting may decrease pain
  • pain can refer into posterior thigh to knee when more severe
  • FAIR test position = approximates the nerve closer to the ischial spine in a more aggressive fashion = greater risk for injury
58
Q

Trochanteric bursitis

A
  • diagnosed by positioning hip in full flexion, adduction, and er/IR for reproduction of pain
  • will not cause pain during slr or slump test
  • confirm diagnosis with palpation and differentiating tenderness associated with glute med tendinopathy
59
Q

management of bursitis

A
  • injections
  • habit changes
  • changes in sitting behaviors
60
Q

Pudendal nerve entrapment

A
  • sharp, burning buttock pain
  • pudendal nerve = S2-4
  • nerve can get entrapped between the sacrotuberal and sacrospinous ligaments, in the pudendal canal
  • may be accompanied by burning in perineal area that worsens with sitting and improves with standing
  • symptoms could be related to childbirth
  • may be irritated by bicycling
61
Q

Treatment of pudendal nerve entrapment

A

-can be treated by nonop management including relaxation of pelvic floor muscles and implementing strategies to minimize compression

62
Q

(B) resisted adduction to diagnose groin pain

A

-valid, sensitive, and specific to diagnose sports-related groin pain that is frequently accompanied by bone marrow edema

63
Q

Most common cause of groin pain

A

-increased tendon load during directional change type of sports associated with stress shielding in teh insertion of the tendon

64
Q

Conditions w/ painful resistive hip adduction

A
  • acute adductor tendinopathy
  • chronic adductor tendinopathy
  • rectus abdominis
  • obturator nerve
  • osteitis pubis
  • ossifying myositis
  • symphysitis
  • SIJ affliction
65
Q

conditions with painless resisted hip adduction

A
  • urological
  • gynecological
  • vascular
  • lymphatic
  • herniation
  • hip joint labrum
  • stress fracture
  • psoas tendinopathy
  • psoas bursitis
  • nerve entrapment
  • incompetent abdominal wall
  • lumbar spine affliction
  • t/s affliction
66
Q

Sportsmans hernia (hockey hernia, athletic pubalgia)

A

weaknenng or tearing of transversalis fascia, conjoined tendon, or internal oblique fibers creating an inside out hernia

OCS (13 decks)

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