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Ortho 1- second half > Hip > Flashcards

Hip Flashcards

1
Q

primary roles of the hip

A

1: support weight of head, arms, trunk during upright postures and dynamic weight bearing activities
2: provides a pathway for transmission of forces between the lower extremities and pelvis

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2
Q

2 angular relationships

A

1: angle of inclination of femoral head
1: angle of torsion

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3
Q

normal angle of inclination

A

125-135 degrees

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4
Q

angle of inclination

A

the angle formed by the meeting of the axis of the shaft of the femur with the long axis of the femoral neck and head

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5
Q

coxa valga

A

> 135 degrees

clinically abducts

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6
Q

coxa vara

A

<120 degrees

clinically adducts to get femoral head back in position in the acetabulum

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7
Q

angle of torsion

A

projection of the long axis of the femoral head and the transverse axis of femoral condyles

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8
Q

normal angle of torsion

A

10-15 degrees
35 degrees at birth

  • think about alignment of knee axis during gait
  • think about compensations at the subtalar joint
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9
Q

excessive anteversion

A

> 15 degrees

clinically toes in

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10
Q

excessive retroversion

A

cannot change bony alignment but can change activation of muscle groups and ROM to help

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11
Q

ligaments of the hip

A

iliofemoral ligament
ischiofemoral ligament
pubofemoral ligament

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12
Q

hip flexors

A 
iliopsoas
tensor fascia lata
rectus femoris
sartorius
adductor magnus, longus, brevis
pectineus
gracilis
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13
Q

hip extensors

A

gluteus maximus
hamstrings
posterior fibers of gluteus medius
piriformis

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14
Q

hip abductors

A 
*typically the most impacted 
glut med
TFL
superior glut max
glut min
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15
Q

hip adductors

A 
adductor magnus, longus, brevis
quadratus femoris
pectineus
obturators
gracilis
medial hamstrings
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16
Q

hip medial rotators

A 
TFL
glut min
anterior fibers of glut med
adductor magnus, longus
semimembranosus/tendinosis
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17
Q

hip lateral rotators

A 
piriformis
obturator interior/exterior
gemelli
quadratus femoris
glut max
posterior fibers of glut med
biceps femoris
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18
Q

nerve supply to the hip

A 
lumbar plexus (L1-L4)
sacral plexus (L4-S3)
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19
Q

blood supply for head of femur

A

artery of ligamentum trees

medium and lateral circumflex arteries

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20
Q

ROM

A
  • varies with age, sex
  • flexion 120-135 degrees with knee flexed 90
  • extension: 0-15 degrees
  • abduction 0-30 degrees
  • rotation generally 45 deg in each direction (more LR with males, more MR with females
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21
Q

lateral pelvic tilt

A

the hip on the high iliac crest side is in relative ADDUCTION while the hip on the low iliac crest side is in relative ABDUCTION

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22
Q

rotation of pelvis and hip

A

rotation of the pelvis in a clockwise direction results in left hip ER and right hip IR

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23
Q

single limb stance components of gait

A

normal: adduction torque on the standing hip counterbalanced by sufficient abduction torque

compensation by lateral trunk flexion

Trendelenberg: contralateral iliac crest tends to drop bc of glut med insufficiency

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24
Q

leg length discrepancy (LLD)

A

=unilateral difference in the total length of one leg compared with another

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25
Q

anatomic LLD

A

=actual osseous length difference between the hemipelvis, femur, tibia

measured from umbilicus (fixed point)
anything greater than 3/8 of an inch would require modification of the shoe

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26
Q

functional LLD

A

position of osseous structures as they relate to each other and to the environment during WBing function

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27
Q

hip exam and eval

A
  • history
  • lumbar spine clearing
  • other clearing tests (visceral involvement
  • balance
  • joint mobility and integrity
  • muscle performance
  • pain and inflammation
  • posture and movement
  • range of motion and muscle length
  • work, community, and leisure integration or reintegration
  • special tests
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28
Q

hip questions

A 
sudden injury? gradual? pathology?
"developing hip"? coxa valga/varus?
something gradual w/ age? degeneration?
trauma?
over correction?
visceral pain?
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29
Q

standing force on the hip

A

=0.3 times body weight

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30
Q

unilateral standing force on the hip

A

=2.4-2.6 times BW

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31
Q

walking- force on the hip

A

=1.3-5.8 times BW

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32
Q

walking up stairs- force on the hip

A

=3 times BW

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33
Q

running- force on the hip

A

=4.5+ times BW

34
Q

balance tests

A

often included in hip examinations due to high incidence of falls resulting in hip injury:

  • Berg balance scale (not good for high performers)
  • Mini BESTest of dynamic balance
  • Dynamic gait index (similar to Berg but don’t hit ceiling as quickly)
  • Balance self-perception test
  • History of balance problems
  • type of assistive device used for ambulation
35
Q

gait evaluation

A

an important component of examination of a person with a hip dysfunction

  • analysis of gait should include observation of the hip along all three planes of movement during each critical phase of gait
  • *the relationships between the hip and the rest of the kinetic chain

-video analysis can assist in this complex examination procedure

36
Q

joint mobility and integrity

A

quantity of motion, end feel and presence/location of pain should be noted during the following tests:

  • lateral/medial translation
  • distraction
  • compression
  • anteroposterior/posteroanterior glides
37
Q

muscle performance

A
  • MMT of hip musculature
  • specialized tests looking at positional strength to determine length-associated changes
  • selective tissue tension tests to diagnose noncontractile versus contractile lesions
  • resisted tests to determine severity of the tissue lesion- weak and painful?
  • resisted tests can also screen neurologic cause of muscle performance impairment
38
Q

pain and inflammation

A
  • examination is done in conjunction with other tests to determine source (if possible) and cause of pain
  • source diagnosis often requires additional tests that are beyond the scope of physical therapy
39
Q

posture and movement

A
  • specific lumbopelvic and lower quadrant alignment should be examined about all three planes
  • hypothesis can be developed regarding the contribution of faulty alignments at the ankle, foot, knee, and lumbopelvic regions to the alignment of the hip
  • hypothesis can be generated regarding muscle lengths related to posture alignment
  • initial screening for LLD can be performed
40
Q

range of motion and muscle length

A
  • Quick tests: placing foot on standard step, forward bending, squatting, sitting with leg crossed
  • stand to sit; willingness to move, ROM, strength

-AROM/PROM in open kinetic chain

Muscle length tests:

  • medial/lateral hamstrings
  • individual hip flexor lengths
  • hip adductors/abductors
  • hip rotators
41
Q

work, community and leisure, integration or reintegration

A
  • functional ability can be measured directly through observation of functional tasks
  • self-report measures can also be used

-Harris hip function scale is another self report measure that is specific to degenerative joint conditions

42
Q

functional tests of the hip

A
  • squatting
  • reciprocal stairs (how do they ambulate stairs? 1 at a time? every other?)
  • ankle to opposite knee in sitting
  • stairs 2 at a time
  • running: straight plane, decelerating
  • one legged hop
  • jumping
43
Q

impaired muscle performance

A

RESULT OF:

  • neurologic pathology
  • muscle strain
  • altered length-tension relationships
  • general weakness from disuse
  • pain and inflammation
44
Q

neurologic pathology

A

-neuromusculoskeletal or neuromuscular in origin

Neuromusculoskeletal- pathology at nerve root or peripheral nerve

-treat origin of pathology to positively affect muscle force/torque production

45
Q

muscle strain

A
  • hamstring strains/overuse are common
  • underused synergists

Overstretch

  • ex: glut med on high iliac crest side
  • strengthen glut med in short range
  • taping in short range
  • correct posture habits and movement patterns that maintain muscle in lengthened state
46
Q

treatment of muscle strain focuses on..

A

CAUSE of strain

47
Q

treatment of underused synergist in hamstring strain

A

improving motor control and muscle performance of underused synergists (ex: glut max and hip lateral rotators- prime moves that tend to get underused)
-correct biomechanical factors contributing to underused synergists

PRONE HIP EXTENSIONS
walk stance progression
Step up and overs

48
Q

glut med strength progression

A

purpose: to strengthen the hip muscles that keep your hip and pelvis in good alignment when you walk

1: prone hip abduction
2: w/ TB

49
Q

hypermobility

A
  • often associated with impairment in the developing hip
  • with increasing use of arthroscopy, diagnosis of acetabular labral tears is more common
  • labral tears are a possible precursor to OA
  • treatment for developing hip consists of positioning, bracing or surgery
  • treatment for adult hypermobile hip consists of specific therapeutic exercise, posture education, movement training
  • children- bracing`
  • adults- dynamic stabilizers
50
Q

primary objective of treatment

A
  • promote joint stability
  • prevent continuous stress to overstretched or torn tissues
  • posture and movement pattern training
  • strengthen lengthened muscles in short range
  • improve muscle performance of deep musculature to enhance core stability
51
Q

anteversion

A
  • whenever excessive medial rotation ROM is measured, screen for ante version (trochanteric prominence angle test)
  • focus on strengthening deep hip LRs
  • educate regarding postural habits and movement patterns

strengthen abductors
prone –> sidelying

52
Q

functional approach to treating medial hip rotation tendencies

A

“standing knees over toes”
isn’t a limit of motion but often don’t have motor control to keep it there- need to be re-educated

  • wt distributed evenly
  • pelvis level
  • knees aligned with feet; if bent should be over midline of your feet
  • shoulder width apart and slightly outward
  • arch slightly elevated with big toe down

walking knee over toes:

  • don’t let knee lock back as weight comes over your foot. knee slightly bent when heel contacts floor and should slightly straighten as BW moves over
  • at heel strike think of squeezing butt to prevent your knee from turning in as your BW moves over your foot
  • think of using you foot muscles to prevent your arch from dropping too low as your BW moves over
  • keep inner core activated to prevent pelvis from tilting forward
53
Q

hypomobility: established capsular pattern

A

50-55 degrees of limitation of femoral abduction
0 degrees of femoral MR from neutral
90 deg of limitation of femoral flexion
10-30 deg of limitation of femoral extension
femoral LR and adduction are fully maintained

limitation of MR: thinking capsular shortening or OA
but if hip flexion is no more than 90, thinking capsular
either way mobilizing the joint based on patient response model!!

54
Q

hypomobility

A

-look at relationships to other regions in the kinetic chain to treat hip hypo mobility

Examples:

  • lumbar spine relative flexibility during forward bending with associated stiff hips in the direction of flexion)
  • knee flexion relative flexibility during standing knee bends with associated stiff hips in direction of flexion

-hip extension stiffness is often associated with anterior pelvic tilt and lumbar extension relative flexibility

  • specific muscle length tests are necessary to prescribe accurate exercises to address muscle length impairments
  • train proper movement patterns to utilize specific exercise (late stance phase of gait)
55
Q

hypomobility- improving ROM

A

slide 53

56
Q

balance

A
  • falls are the leading cause of morbidity and mortality in persons older than 65
  • Tai Chi has been shown to be valuable in promoting posture stability and balance control in the well elderly
  • force-platform biofeedback is another mode used to improve balance
  • clinical trials have not demonstrated a reduction in falls among older persons using force-platform biofeedback systems

risk of falls adjusts how much care and direction (living situations, surgeries)

57
Q

pain

A

differential diagnosis of etiology and cause of pain

  • pain can be referred to the groin, laterally or posteriorly radiate down the anterior and medial thigh or to the knee
  • tx must focus on alleviating impairments related to the underlying cause of symptoms

do they belong here??

58
Q

guidelines for pain relief

A
  • activity modification
  • physical agents or electrotherpeutic modalities
  • manual therapy
  • therapeutic exercise
  • assistive devices
  • weight loss
  • biomechanical support (orthotics)
59
Q

posture and movement impairment

A
  • optimize kinetics and kinematics at the hip and other joints in the kinetic chain
  • ALL patients should be educated on details of posture and movement that contribute to the cause of symptoms
  • hip alignment- influenced by other joint angles (knee and pelvis), hypo/hyper mobilities, length-tension relationships, muscle performance, etc

check posture w/o telling pt., try different positions to see if it alleviates any pain

  • changes in posture and movement require basic skills in mobility, muscle performance, and motor control
  • these skills must be at functional levels to intervene at the level of posture and movement
  • initially, the goal is to improve all associated impairments to functional levels
  • gradual transition to functional activities with emphasis on optimal posture and movement
60
Q

leg length discrepancy (LLD)

A

3 categories:

  • mild (0-30 mm)
  • moderate (30-60 mm)
  • severe (>60 mm)

treatment ranges from shoe inserts, posture training, and movement training to various surgical techniques

61
Q

functional LLD

A

ex: femoral and tibial medial rotation

  • lengthened or weak post glut med and deep hip lateral rotators
  • lengthened or weak foot supinators
  • postural foot pronation or supination
62
Q

therapeutic exercise interventions for osteoarthritis

A

ROM and mobility:

1: passive stretch
2: active stretch
3: active exercises

63
Q

osteoarthritis-muscle performance

A
  • functional exercises should be included whenever possible
  • use of adjuncts may be necessary to reduce joint reaction forces
  • always include core activation
  • step up activities stimulate hip extensor recruitment, facilitate hip flexion mobility
  • alter step height and resistance (adding weight) to ensure proper technique
64
Q

OA- balance

A

after establishing muscle balance in single limb stance, progress to balance activities

65
Q

OA posture and movement

A

educate pts on positioning, core training, and Ads during functional activities

66
Q

OA adjunctive interventions

A

NWBing activities (aquatics, etc) are recommended

67
Q

ITB related diagnoses

A
  • ITB fascitis (inflammation from overuse)
  • trochanteric bursitis (bursa becomes inflamed)
  • ITB friction syndrome (pain localized to lateral femoral condyle)
  • patellofemoral dysfunction
  • TFL strain (overuse of short or stretched TFL/ITB)
  • faulty movement patterns
68
Q

synergistic relationships associated with ITB/TFL overuse

A
  • anteromedial TFL dominates in hip flexion force couple= underuse of iliopsoas
  • posterolateral TFL dominates in hip abductor and IR force couple = underuse of glut med, upper fibers of glut max and min

overuse of ITB may contribute to underuse of quads

69
Q

signs of nerve entrapment syndrome (piriformis syndrome)

A
  • hip flexion with IR
  • lordosis and ant pelvic tilt
  • high iliac crest on involved side
  • ER and ABD reduces symptoms
70
Q

key tests for nerve entrapment syndrome

A
  • standing alignment
  • tissue tension tests
  • ROM
  • palpation
  • positional strength
  • functional tests
  • lumbar clearing exam
71
Q

strengthening piriformis in shortened range

A

prone, knees flexed to 90. pt positions hip in abduction and ER. pushes heels together with submax contraction

72
Q

hip is designed for:

A

stability and transmission of kinetic forces

73
Q

angles of inclination and torsion are:

A

critical for ideal functioning

74
Q

hip osteokinematic ROM is closely linked to:

A

lumbopelvic region

75
Q

thorough hip exam is necessary to understand:

A

anatomic/physiologic impairments in hip and related regions

*impairments in muscle performance, gait, balance, posture and movement, ROM and mobility commonly occur together

76
Q

primary focus of treating OA is:

A

to improve joint loading

77
Q

restoring mobility and force are often prerequisites to:

A

restoring endurance and improving posture

78
Q

stretched piriformis syndrome can mimic:

A

lumbar radiculopathy

79
Q

disuse and deconditioning

A

results from injury, pathology, acquired movement patterns contributing to disuse and deconditioning of specific synergists

consider acquired postures and movement habits

optimize length-associated relationships and restore motor control and force/torgue contributions from underused synergists

80
Q

cam lesion

A

lesion of femoral neck
in some developing hips there isn’t a concave neck
decreases excursion of hip movements and causes acetabulum impingement possibly causing a future labral tear

81
Q

pincer lesion

A

extra lip of labrum

Ortho 1- second half (5 decks)

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