Hip and Pelvis Orthopedic Pathology

Question 1

3 types of hip fractures

Answer 1

• femoral neck or sub capital
• extra capsular or trochanteric
• proximal femoral shaft or subtrochanteric area

Question 2

Signs & symptoms of a DVT

Answer 2

• swelling
• erythema
• pain
• Homan’s sign
• point tenderness in calf

Question 3

Clinical complications for hip fractures

Answer 3

• malunion: heals in an improper shape
• delayed union: takes excessive amount of time to heal
• non-union: doesn’t heal at all or a false joint
• avascular necrosis (AVN)

Question 4

Avascular necrosis

Answer 4

• hip is most common joint
• men ages 30-60
• trauma
• long term steroid use
• RA/Lupus
• alcoholism

Question 5

Symptoms of avascular necrosis

Answer 5

• antalgic gait
• pain in the groin down to medial knee
• throbbing deep hip pain
• restricted hip IR, flexion, & abduction

Question 6

Treatment goals of hip OA

Answer 6

• relieve symptoms
• minimize disability
• education
• modification of activities
• maintain ROM
• consider footwear & use of AD

Question 7

Interventions for hip OA

Answer 7

• gait and balance training
• manual therapies
• systematically progressed therapeutic strengthening, flexibility, & endurance
• use of AD can improve function associated with weight bearing activities

Question 8

Anterior THA approach

Answer 8

• fewer dislocations
• less time in hospital
• relatively muscle sparing
• femur less exposed (difficult to place hardware)

Question 9

Posterior THA approach

Answer 9

• most common approach
• good femur visibility
• deep ER muscles get cut
• no abduction muscles cut

Question 10

Lateral/direct lateral THA approach

Answer 10

• better distal access
• risk neuromuscular compromise
• dislocation risk lower than posterior approach
• frontal plane gait problems are possible

Question 11

Greater trochanteric bursitis

Answer 11

• common in active patients
• bursa irritated from excessive compression/friction

Question 12

Treatment for greater throchanteric bursitis

Answer 12

• relieve pain & inflammation
• eliminate activités that make it worse
• focus on functional exercise
• stretching of glutes/TFL

Question 13

Ishcial bursitis (Weaver’s bottom)

Answer 13

• pain over the ischial tuberosity
• caused by direct pressure from prolonged sitting
• can mimic a hamstring strain
• affects thinner people & cyclists

Question 14

Interventions for ischial bursitis

Answer 14

• rest, ice, NSAIDs
• injection with corticosteroids

Question 15

Muscle strains

Answer 15

• hamstrings
• iliopsoas
• adductors
• rectus femoris

Question 16

Injury management of the acute phase for muscle strains

Answer 16

• 1-7 days
• avoid motions that cause pain
• sleeping with pillows under both knees to support the injured limb
• PRICEMEM (protect, rest, ice, compress, elevate, manual therapy, early motion, medication)
• painless PROM and AAROM

Question 17

Injury management of subacute phase for muscle strains

Answer 17

• 1-3 weeks
• begin AROM & initiate strengthening
• aquatic therapy to decrease WBing loads
• pain free submit isometrics
• pain free concentric AROM
• UE strengthening
• CV trying

Question 18

Injury management of repair phase for muscle strains

Answer 18

• 3-8 weeks
• isometric contractions at 100% w/o pain
• no pain on full ROM
• minimal to no pain with palpation
• eccentric exercise only when concentric weight equals non-involved side

Question 19

Injury management of functional phase for muscle strains

Answer 19

• normal gait pattern without pain
• begin fast walking
• once ambulating 30 min at fast speed w/o pain, jogging can begin
• once jogging 30 min sprinting can begin
• then adapt to sport/function

Question 20

2 types of hamstring strains

Answer 20

• High speed running/biceps femoris: associated with recurrence
• Extensive lengthening/proximal semimembranous: associated with prolonged return to sport

Question 21

Risk factors for rein jury of hamstring strain

Answer 21

• hamstring weakness & fatigue
• imbalance in hamstring eccentric & quads concentric strength
• decreased quads flexibility
• reduced hip flexor flexibility
• strength & coordination deficit

Question 22

The L-protocol

Answer 22

• for hamstring lengthening
• the extender: twice every day 3 sets of 12 reps
• the diver: every other day 3 sets of 6 reps
• the glider: every 3rd day 3 sets of 4 reps

Question 23

Treatment of stable pelvis/acetabulum fractures

Answer 23

• rest with hip extended and ER to avoid stress on heel bones
• once bone is healed progressive flexibility & strengthening

Question 24

Treatment of unstable pelvic fractures

Answer 24

• external fixator, ORIF, or extended bed rest
• rehab depends on type/severity of fracture
• WBing could be deferred for 8 weeks
• can exercise UE but limited LE

Question 25

Pelvi ring fracture stable versus unstable

Answer 25

• Stable: pain rangement & WBAT
• Unstable: external fixation until medically stable for surgery, internal fixation, timeline for mobilization depends

Question 26

Internal fixation of a pelvic ring fracture

Answer 26

• 0-6 wks: toe touch WBing
• 6 wks: partial WBing
• 3 months: full WBing w/o AD
• Exercise: don’t pull on pubic symphysis, no isometric ADD or full Ange ABD, no SLR, attempt core stability & glute strengthening within tolerance

Question 27

Acetabular fracture stable versus unstable

Answer 27

• Stable: protected WBing for 6-8 wks & partial WBing at discretion of physician
• Unstable: PWB encouraged for 8-10 wks, LE strengthening, as bone healing progresses so can rehab