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3rd semester Therex > Hip > Flashcards

Hip Flashcards

1
Q

phase where emphasis is placed on:

  • protection of the injury
  • management of pain and inflammation
  • gentle protected ROM/stretching exercises
  • light strengthening exercise as appropriate

often acute injury/immediate and early post-surgery

A

maximal protection phase

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2
Q

phase where emphasis is on progression of activity within pt tolerance and healing to include:

  • continue to progress ROM and stretching in larger ranges
  • increased strengthening, advancing and/or adding OKC exercise as appropriate

sub-acute conditions or middle post-op stages

A

moderate protection phase

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3
Q

phase where emphasis is on:

  • advance OKC to CKC strengthening
  • emphasis on functional activity
  • progress activity as tolerated with goals of returning to PLF (normal ROM, str, return to sports, etc)

chronic conditions, normal healing, later post-op stages

A

minimal protection phase

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4
Q

progression of phases is dictated by: (3)

A
  • tissue healing
  • successful achievement of goals within each phase
  • pt tolerance
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5
Q

restore hip/pelvis function goals (8)

A
  • postural alignment and dynamic stability of lumbopelvic region
  • awareness of pelvic positioning
  • activation of core and pelvic stabilizing mm
  • strengthening of the hip and trunk mm
  • working on overall alignment of LE kinematic chain
  • hip jt mobility and soft tissue extensibility
  • coordinated neuromuscular control between core and LE mm to ensure safe ADLs, IADLS, work, etc
  • function of associated body systems (ie. cardiovascular endurance)
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6
Q

fracture type:

  • fracture occurring between the greater and lesser trochanter
  • more common in pts with OA
A

intertrochanteric

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7
Q

fracture type:

  • occurs at femoral neck
  • disrupts blood supply to hip joint with 65-85% developing avascular necrosis

common in pts with osteoporosis

A

femoral neck fx

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8
Q

fracture type:

  • fx below greater and lesser trochanters, usually along the proximal 1/3 of the shaft of the femur

malunion, delayed union or non-union of bone is common

loosening of fixation devices also common d/t increased force load through femur

A

subtrochanteric

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9
Q

5 complications of hip fx

A
  • poor healing/union of bone
  • avascular necrosis
  • blood clots/PE 40-90%
  • infection, pneumonia d/t poor mobility
  • death
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10
Q

Hip fx maximum protection phase rehab (5)

day 1 - 21

A
  • ankle pumps, breathing ex. for DVT prevention
  • pain and swelling control
  • gentle protected assisted ROM (supine, seated)
  • sub-maximal isometrics
  • protected weight bearing
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11
Q

hip fx precautions:

A
  • no combined/diagonal motions
  • no SLRs
  • no bridging
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12
Q

Hip fx moderate protection phase rehab (~3-6 weeks) (4)

A
  • progress from supine/seated to standing exercise
  • isometric to streight plane OKC –> con/ecc based on pain tol. (quads, glutes, abd, hams)
  • progress to CKC once pain free FWB achieved
  • progress hip ROM and strengthening as tol.
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13
Q

hip fx minimum protection phase (6-8 weeks) (3)

A
  • continue to advance exercise OKC to CKC
  • promote normal gat
  • functional activities
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14
Q

pelvic fx stable rehab:

A

bed rest of days to 1 week followed by AROM exercises and isometric strengthening exercises

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15
Q

pelvic fx unstable rehab:

A

require ORIF follwoed by AROM exercises and isometric strengthening exercises

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16
Q

pelvic fx WB status:

A

NWB to PWB for ~2 months (unstable)

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17
Q

indications for THA

A
  • severe arthritis
  • severe pain
  • severe decrease in ability to ambulate
  • decrease in ADLs functional mobility and activity tolerance
  • complex hip fx
  • hip osteonecrosis
  • deformity or instability
  • congenital hip issues
18
Q

cemented THA:

A

an acrylic cement is used to fixate the two components

pros: early WB
cons: more likely to loosen in younger/active pts

19
Q

uncemented THA:

A

porous-coated components are used so that bone growth can occur

pros: less likely to loosen
cons: NWB 6-8 weeks, slow rehab progression

20
Q

THA posteriolateral precautions:

A
  • no adduction
  • no ir
  • no hip flexion >90
21
Q

THA anterior precautions:

A
  • no extension
  • no ER
  • no adduction
22
Q

DO NOT have pt put pillow _______ to sleep or rest with to avoid contractures

A

under the leg

23
Q

THA maximal protection phase:

A

follow WB precautinos

perform supine LE exercises within hip precautions: ankle pumps, heel slides, supine hip abduction, quad sets, glute sets

transfer and gait training

24
Q

THA moderate protection phase

A

6-8 weeks post op (uncemented) several weeks post op cemented

transition from walker to standard cane

add resistance to supine and progress hip exercises

begin CKC pending WB status

25
Q

THA minimum protection phase

A

3ish months post op (cemented)

balance, coordination, proprio activities

CKC –> more advanced

normal gait w/o assistive device

26
Q

procedure where cap placed over head of femur

generally for individuals under age of 60

not appropriate for frail pts at risk for femoral neck fx

A

hip resurfacing arthroplasty

27
Q

when the femoral head slides beyond its normal articular surface with the acetabulum

can occur as a result of hip fx, post-op THA, trauma, instability

A

hip dislocation

28
Q

predisposition to hip dislocation b/c a person has a shallow acetabulum

A

congenital hip dysplasia

29
Q

anterior hip dislocation precautions

A
  • no ER
  • no extension
  • no adduction
30
Q

posterior hip dislocation precautions

A
  • no IR
  • no flexion
  • no adduction
31
Q

_____ often occur in active adults between ages 20 and 40 y/o

can be caused by”

  • repetitive hip flexion and cutting, twisting, and pivoting positions
  • sports injuries or trauma
  • hip dislocations or other congenital hip problems
  • degeneration
  • altered alignment
A

labral tears/repairs

32
Q

SandS of _____:

  • pain in anterior hip/groin region
  • feeling of hip instability and giving out
  • snapping within jt
  • (+) FADIR test
  • aggravated with standing, sitting, or walking
A

labral tears

33
Q

inflammation of the trochanteric bursa from excessive compression and repeated friction as the IT band snaps over the trochanter (bursa)

A

greater trochanteric bursitis

34
Q

Tx for greater trochanteric bursitis (6)

A
  • PRICE
  • IT band and ABD mm stretching
  • stretch Hams, quads and hip adductors as needed
  • strengthen weak mm that cross hip jt
  • joint mobs
  • cortisone injections
35
Q

pain in the groin or anterior thigh and possibly into the patellar region. Aggravated with excessive hip flexion activities

A

psoas bursitis

36
Q

pain around the ischial tuberosities, especially when sitting. Sciatica may also accompany this

A

ischiogluteal bursitis

37
Q

most common acute mm injury that affects the hip

A

mm strain

38
Q

grade I mm strain

A
  • stretch of the mm

- < 25% fibers torn

39
Q

grade II mm strain

A
  • mm is torn with 25-50% mm fibers damaged
40
Q

grade III mm strain

A
  • mm is torn with > 50% mm fibers damaged

- rupture of the mm

41
Q

how to treat mm strain initially:

A
  • rest
  • ice/ decrease inflammation modalities
  • compression
  • temporary use of crutches if necessary
  • positioning

Do Not place mm in stretch position

42
Q

how to treat mm strain post 3ish wks

A
  • progress ROM exercises and gentle pain-free stretching to help reorganize the scar tissue that has formed
  • cross-fiber massage followed by multiple angle submaximal isometrics in pain-free positions
  • progress to stretching for mm in affected area post 3-6 wks

3rd semester Therex (8 decks)

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