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PTA Ortho > Hip > Flashcards

Hip Flashcards

1
Q

Hip Joint ROM needs for functional activities

A

120 flexion
20 abduction
external rotation

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2
Q

What 3 joints support the hip

A

Iliofemoral
Pubofemoral
Ischiofemoral

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3
Q

What do the 3 ligaments collectively limit

A

hip extension

–tightly coiled around capsule in extension to give hip stability

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4
Q

Anterior hip Joints

A

Iliofemoral-Y ligament, strongest ligament
**limits IR and EXT

Pubofemoral-limits abduction

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5
Q

Posterior hip joint

A

Ischiofemoral- limits IR and Adduction

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6
Q

Acetabulum

A

made up of fusion of:
Ilium
Ischium
Pubic Bones

concave

deepened by ring of fibrocartilage labrum

  • -hyaline cartilage decreases the forces of friction
  • -Thicker on lateral aspects b/c forces more on lateral side
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7
Q

Open Pack of hip

A

30 flex
30 abd
slight ER-10-15 degrees

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8
Q

close pack of hip

A

full ext
slight abd
slight IR

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9
Q

Arthrokinematic motion of FEMUR on ACETABULUM

A 
Flex: posterior
Ext: Anterior
Abduction: inferior
Adduction: superior
IR: posterior
ER: anterior
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10
Q

Normal end feels of hip

A

flexion: soft
Ext: abduction, adduction, ER, IR- firm

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11
Q

Angle of inclincation

A

angle between axis of femoral neck and shaft of femur

NORMAL: 125 degrees

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12
Q

Coxa Valga

A

greater than 135 degree angle and results in long leg on that side and genu varum

  • -longer leg on coxa valga
  • -leg will bow out–>varum @ knee
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13
Q

Coxa Vara

A

less than 120 degrees angle and results in short leg on that side and genu valgum

  • -shorter leg on coxa vara side
  • -valgum at knee
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14
Q

angle of torsion

A

–angle formed by transverse axis through the formal condyles and axis of neck of the femur

–normal 10-15 degrees

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15
Q

Anteversion

A

Increased angle of torsion
femoral shaft is rotated medially

RESULTS IN:
genu valgum
pes planus

**internally rotated and foot pronated

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16
Q

Retroversion

A

Decreased angle of torsion
femoral shaft rotated laterally

RESULTS IN:
long leg
genu varum

**externally rotated and femoral head rotates more in line w/ condyles

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17
Q

Hip flexor muscles

A

psoas major
iliacus
rectus femoris

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18
Q

Hip extension muscles

A

gluteus maxiums-attaches to ITband

hamstrings

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19
Q

hip abductors

A

gluteus medius
gluteus minimus
TFL/IT band

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20
Q

Hip adductors

A

pectinus
gracilis
adductor magnus, brevis, longus

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21
Q

External rotators

A

piriformis
quadratus femoris
obturator externus, internus
gemellus superior, inferior

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22
Q

internal rotators

A

gluteus minimus, medius

Tensor Fascia Latae

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23
Q

Active insufficciency

A

hamstrings in prone knee flexion

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24
Q

Passive insufficiency

A

Hamstrings in supine with straight leg raise

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25
Q

Anterior Pevlic Tilt

A

ASIS moves downwardly and anteriorly

Hip Flexors (iliopsoas and Sartorius) pull down anteriorly

Erector Spinae pull up posteriorly

POSITION: increased hip flexion and lumbar spine extension

OBSERVE: hip flexors, back extensors, abdominals and hip extensors
-excessive femoral IR

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26
Q

Compensations for Anterior Pelvic Tilt

A

Femur IR
genu valgum
lateral tibial torsion
pes planus

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27
Q

Posterior Pelvic Tilt

A

ASIS moves upwardly and posteriorly
Rectus Abdominus pulls up anteriorly
Gluteus Maximus and hamstrings pull down posteriorly

POSITION:
-increased hip extension and trunk flexion

OBSERVE:

  • hip flexors, back extensors, stability form Y ligaments
  • people rest on Y ligaments
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28
Q

Compensastions for Posterior Pelvic Tilt

A 
hip extension
Femur ER 
genu recurvatum
genu varum
pes valgus
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29
Q

Lateral Pelvic Movement

A

pelvic drop of less than 5 degrees on swing leg side

gluteus medius on stance side ccontracts to hold up pelvis on swing leg side

IF glute med weak= Trendelenburg Gait

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30
Q

Pelvic Rotation movement

A

keeps body’s center of gravity within its base of support

forward motion of pelvis
femur opposite side is rotated internally

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31
Q

Common sources of pelvic/hip pain

A 
sciatic nerve-passes under piriformis
SI joint
lumbar and lumbar/sacral joint
bursae 
OA-groin pain
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32
Q

Acetabular Labral Tear or Femero Acetabular Impingement

A

groint pain
usually people younger than 40 y.o
athletes-soccer and gymnastics

33
Q

Faber’s Test

A

figure 4 test
identifies arthritis of hip, SI joint involvement, iliopsoas problem

Patient supine w/ knee flexed

What to do:

  • Therapist Flexes, Abducts, ER hip and rests lateral malleolus on opposite knee above patella
  • Therapist applies downward force
  • will feel pain in general hip
  • SI=back pain
  • iliopsoas= more groin pain
34
Q

Thomas Test

A

Identifies hip flexor tightness

What to do:

  • patient supine with non-test limb in full hip and knee flexion held by patient
  • limb to be tested is off of exercise surface

Normal:
*thigh level with exercise surface
knee flexion of 80 degrees or greater

35
Q

1 Joint Muscle tight- Thomas Test

A

hip in flexion
knee can flex to 80 degrees

**Psoas and iliacus

36
Q

2 Joint muscle tight: Thomas test

A

thigh level with exercise surface- 0 degrees of hip flex
knee flexion less than 80 degrees

**Sartorius, TFL, rectus femoris

37
Q

1 & 2 Joint tightness -Thomas Test

A

hip in flexion

knee in flexion less than 80 degrees

38
Q

Ober Test

A

Identifies tightness in ITB or TFL

Patient sidelying w/ test limb up
Passively abducts and extends limb and allow limb to lower

If limb does not drop to 10 degrees below horizontal the IT/TFL is tight

Ober test: knee flexed to 90 degrees
Modified Ober: knee straight

39
Q

True Leg Length Discrepancy Test

A

identifies leg length asymmetry

Patient supine
measure from ASIS to Medial Malleolus

If knee projects anteriorly: femur is longer
If knee projects superiorly: tibia is longer

40
Q

Legg-Calve_Perthes Disease

A
  • affects children between 2-12 y/o
  • noninflammatory, self-limiting syndrome
  • femoral head becomes flattened at WB surfaces= disruption of blood supply
  • abductor orthosis

TREATMENT GUIDELINES
-must keep hip abducted during ROM and strengthening exercises

41
Q

Slipped Capital Femoral Epiphysis

A

The neck of the femur slips upwardly and anteriorly at epiphysis

ETIOLOGY

  • epiphyseal plate is at risk of displacement before it fuses in adolescent years
  • can be idiopathic or due to trauma
  • occurs btw. 10-15 y/o
  • occurs in males more than female: 2 to 1
42
Q

Clinical Signs of slipped capital femoral epiphysis

A

present with mild to moderate pain at hip and sometimes knee

Dx on x-ray

surgical fixation

43
Q

Total HIP-THA/THR Indications

A

decreased functional ability to ambulate or perform ADLs/Functional Roles

hip instability

avascular necrosis

previous hip surgery failure

44
Q

Cemented THR

A 
prosthesis is cemented to existing bone
usually older patient
usually immediate WBAT 
Disadvantage 
-has higher incidence of loosening
45
Q

Non-cemented THR

A

prosthesis allows for bony in-growth
usually for younger pts.
usually more stable and lasts longer
TTWB or PWB for 6 weeks up to 3 months

46
Q

THR anterolateral approach

A 
older approach
glute med is cut
other muscles disturbed:
glute min
TFL
Iliopsoas
rectus femoris
47
Q

Hip Precautions for anteriorlat approach

A

no hip flexion > 90
no hip extension
no adduction past neutral
no ER past neutral

48
Q

ADL reminders for Anteriorlat approach

A

no prone lying
no bending forward in sitting position-putting on socks
no tailor sitting
no pivoting on involved leg

49
Q

THR anterior approach

A

TFL is divided longitudinally
1/2 of glute med is released
Vastus Lateralis is divided longitudinally

HIP PRECAUTIONS

  • check w/ MD
  • Sometimes hip extension and ER limitations
  • sometimes no hip precautions
50
Q

Posteriorlateral Approach THR

A
  • most common
  • glute max is divided in line with muscle fiber alignment
  • glute med and vastus lateralis not cut-> strong ability to abduct
  • Highest percentage of post-surgical dislocations
51
Q

Hip Precautions for posteriorlateral THR

A

no hip flexion > 90
no IR past neutral
No adduction past neutral

ADL reminders:
no sitting on low chairs
no bending of waist > 80
no crossing legs
no pivoting on involved side
no laying on involved side for 8-12 weeks
52
Q

Minamaly invasive surgical THR

A

can be lateral, posterior or anterior
smaller incision: 1 or 2
check with MD protocol
evidence base practice
-presently no evidence to support quicker recover times with minimally invasive THR
0all approaches achieve similar outcomes at 6 months and 1 year post-op

53
Q

Treatment considerations for all THR

A 
ensure no hip dislocation
bed mobility with precautions
prevent DVT
early rehab management:
-open chain exercise
-transfer training
-initiate ambulation w. appropriate AD
-initiate ambulation with typical environmental home barriers
54
Q

Hip hemiarthroplasty surgical procedure

A

surgical procedure where only priximal femur is replaced

follow MD protocol

55
Q

hip resurfacing surgical procedure

A

similar to THA but removes less bone

cap placed within femur with matching Cup placed within acetabulum

56
Q

Precautions for Hip resurfacing

A

prone lying alllowed to decrease contractures
active hip abduction allowed
strengthening exercises for hip abduction and extension begun early in rehab
keep hip in neutral IR/ER for first 6 weeks

57
Q

Hip fractures

A

70% occur in people older than 70
90% occur from falls

Most common fracture: intertrochanteric Fracture
*proximal femur fracture

58
Q

complications from hip fractures

A 
compromised blood supply to the head of the femur
fracture is displaced
delayed healing or non-healing fracture
avascular necrosis of head of femur
often results in THA
59
Q

ORIF following hip fracture: rehab management

A 
similar to THA program
usually no hip precautions
follow MD WB precautions
-DVT
-non-union/ failed surgical intervention
60
Q

Tendonitis/ Muscle Strain

A

can be one specific event or occur secondary to overuse

CLinical findings:

  • localized pain at muscle belly, insertion or origin
  • pain reproduce with an active contraction or stretching of the involved muscle
  • most common in hamstrings, adductor longus, iliopsoas or rectus femoris

Initial rehab: Acute/protection Phase

  • RICE
  • protect muscle during healing process
61
Q

Hip Pointer

A

direct trauma to subcutaneous tissues of iliac crest

Acute/Protection Phase:
-RICE

62
Q

Bursitis

A

Inflammation of Bursa
aggravated when muscle over bursa is stretched or contracts

CLINICAL SIGNS:

  • pain in area of inflammation
  • pain with muscle stretching or resisted testing
  • gait deviations
  • decreased muscle endurance
63
Q

Greater Trochanteric Bursitis

A

inflammation of bursa located between glute med/ IT band and greated trochanter

often due to compression and friction from tight ITBAND

usually there is a pelvic asymmetry
–check lumbar and SI joints

Clinical SIGNS:

  • pain over lateral hip, lateral thigh to knee
  • pain aggravated by stair climbing
  • pain may awaken patient at night
64
Q

Psoas Bursitis

A

inflammation of bursa that is below Iliopsoas near anterior capsule of hip

often due to activities that require excessive/reptative hip flexion=running,swimming

CLINICAL SIGNS:

  • pain in groin area, can go to patella
  • pain with resisted hip flexion
65
Q

Ischiogluteal Bursitis

A

-inflammation of bursa located near ischial tuberosity
often due to sitting on hard surface and/or excessive -hamstring contraction-running, jumping
-slow to heal, difficult to treat

CLINICAL SIGNS:

  • pain at Ischial Tuberosity
  • pain with palpation of ischial tuberosity
  • pain increases with walking, climbing stair
  • may present with sciatica
66
Q

Maximum Protection Phase

A 
limit aggravating activities 
alter lifestyle 
STM, joint mob for pain relief-improve motion
control WB forces
posture
well joint mechanics
progressive ROM
flexibility
stationary biking, pool
multi-plane isometrics
supplemental modalities for inflammation control
67
Q

Controlled motion phase

A

CRITERIA:

  • decreased pain
  • improve pain-free ROM
  • ability to full WB
return to full WB w/ minimizing gait devviations
gain maximal ROM
increase strength-function patter
muscle flexiblity and strength balance
balance strategies
begin to return to funcitonal acitivites
68
Q

Return to Function Phase

A

CRITERIA:

  • max ROM and strength
  • Appropriate balance strategies
  • no gait deviations

gain max strength
max functional acitivities
plyometrics
sports related activities if appropriate

69
Q

Hip Flexor tightness

A

stresses back-increase lumbar extension as thigh extends into gait

stresses knee-if during gait hip cant move into full extension
the femur cant move as far posteriorly and lock the knee as it should

70
Q

TFL tightness

A

IF IT band is not long enough
to slide easily over hip which may result in trochanteric bursitis

slide easily over knee which may result in lateral knee pain

may pull the patella laterally which may result in patellafemoral impairment

pelvic may anteriorly tilt which rotates femur internally stressing medial knee too

71
Q

Hip Abdcutor, ER and/or extensor tightness

A

increase femoral IR and adduction w/ knee valgum increasing

results in:

  • piriformis syndrome-over use from ER of femur compresses sciatic nerve
  • patellofemoral impairment
  • anterior cruciate strain-valgus increases anterior shear of tibia
72
Q

Total Hip phase 1

A

post op
0-3 days after

gaosl:

  • bed mobility
  • minimal assistance
  • maintain precautions
  • ambulation
  • regain 80 degrees of PROM and AROM of hip flexion
73
Q

Criteria to move to phase 2

A

hip flexion 0-90 degrees
hip abduction 0-30 degrees
independt transfers and abmulation w/ AD

74
Q

Phase 2 rehab

A

day 3- 6 weeks
motion phase

goals:

  • strenghten entire hip
  • begin proprioceptive training
  • continue gait and endurance

Week 1-4:
- AROM hip abduction, quad, hamstring, glute isometris

Week 4-6:
-continue/progress above exercises with resistance

75
Q

Criteria to move to phase 3

A

AROM of hip motion 0-110
good quad control
independently ambulate 800 ft. w/o AD or gait deviations

76
Q

Phase 3

A

7-12 weeks

adequate strength of all LE muscles
return to functional activities

77
Q

Criteria to move to phase 4

A

4+/5 of all LE muscle

minimal to no pain or swelling

78
Q

Phase 4 rehab

A

return to appropriate sports/rereational activities

increase endurance and strength

79
Q

Criteria for DC

A

AROM
4+/5 strength
normal age-appropriate balance and proprioception
independent in HEP

PTA Ortho (5 decks)

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