Hip Eval & Treat Flashcards
1
Q
Hip Joint (OP/CP)
A
-synovial joint
-Designed for stability and less mobility
-Convex head of femur and concave acetabulum
-Femoral head faces Medially, anteriorly, superiorly
Resting Position: Flx 30, Abd 30, Slight ER
Closed Packed: Full ext, IR, ABD
Capsular Pattern: Flx, Abd, IR (sometimes IR first)
2
Q
Hip Dysplasia
A
-undercoverage of femoral head by acetabulum
-instability
3
Q
Femoro-Acetabular Impingement
A
-FAI
-excessive bony development or overcoverage by acetabulum
-too much contact
4
Q
Acetabulum
A
-faces anteriorly, laterally, inferiorly
-concave
-2/5 ilium and ischium, 1/5 pubis
-labrum provides neg pressure and suction (fibrocartilage)
-Acetabular fossa: shock absorption and proprioception
5
Q
Angle of Inclination
A
-frontal plane of femoral neck
Normal:
-Adults: 125-139
-Infants: 150
-Elderly: 120
Coxa Valga: >139, longer limb, neck straight
Coxa Vara: <125, shorter limb, neck bent
6
Q
Angle of Torsion
A
-horizontal plane of femoral neck in relation to condyles
Normal:
-Adults: 10-15 Anterior
-Infants: 30
Excessive Anteversion: >15 deg
-toe in and IR of hip to compensate
Relative Restroversion: <10 deg of anteverison
-toe out and ER of hip to compensate
Absolute Reroversion: <0 deg
-toe out and ER
7
Q
Joint Capsule
A
Anterior/Superior:
-thick and dense
-more disposed to shortening and becoming a restriction
Posterior/Inferior:
-thin and loose
-dislocation risk
8
Q
Posterior Oblique System
A
-lats, contra glue max, L fascia
-helps with SLS
9
Q
Anterior Oblique System
A
-EO/IO, contra hip add and abdominal fascia
-helps wih SLS
10
Q
Lateral Muscle System
A
-Glute med/min and contra hip add
11
Q
Pectineus action
A
- Adducts hip.
- Slightly flex hip.
- Internal rotation of hip.
12
Q
Sartorius action
A
- Flex hip.
- Abduct hip.
- Externally rotate hip.
- Flex knee
- Internally rotate leg with flexed hip.
13
Q
Gluteus maximus action
A
- Extend hip joint.
- ER of hip.
- Flex hip.
- AB hip (Sup fibers)
- ADD hip (Inf fibers)
14
Q
Gluteus, medius action
A
- Abduct hip.
- Internally rotate hip.
- Support, contralateral leg
15
Q
Gluteus, minimus action
A
- Abduct hip
- Internally rotate hip (ant fibers)
- ER hip (post fibers)
- Support, contralateral leg
commonly weak
16
Q
Tensor fasciae latae action
A
- Internally rotate hip.
- Abduct hip.
- Flexes hip
- Support, contralateral leg
commonly short and stiff
17
Q
Piriformis action
A
- Externally rotate, extended hip.
- Abduct hip while flexed.
- Stabilize hip.
- IR when >90 flexed
18
Q
Adductor Longus Action
A
- Adducts hip
- Flexes Hip
most commonly strained
19
Q
Adductor Brevis Action
A
- Adducts hip
- Flexes hip
20
Q
Adductor Magnus Action
A
- Adducts hip
Adductor Part:
1. Flex hip (anterior)
Hamstring Part:
1. Extend hip (posterior)
21
Q
Gracilis Action
A
- Adducts hip
- Flexes knee
- Internally rotate hip when flexed
22
Q
Rectus Femoris Action
A
- Extend knee
- Stabilized Knee and hip
- Help iliopsoas flex hip
- APT
23
Q
Semitendinosus Action
A
- Extend hip
- Flex knee
- Internal rotation when hip is flexed
- Extend trunk at hip when hip and knee are flexed
24
Q
Semimembranosus Action
A
- Extend hip
- Flex knee
- Internal rotation when hip is flexed
- Extend trunk at hip when hip and knee are flexed
25
Biceps Femoris Action
1. Flexes and ER knee
2. External rotation of hip
3. Extends hip
26
Iliopsoas major action
1. Iliacus: Flex the hip (all the way to end range)
2. Psoas: lumbar side bending, vertical stabilizer
3. Externally rotate the hip.
4. Flex the trunk toward the thigh
5. Tilted pelvis anteriorly
6. Stabilize the hip joint.
27
Iliopsoas Bursa
-largest and most constant bursa around hip
-near lesser trochanter
-cushions tension from anterior structures
28
Trochanteric Bursa
-greater troch and glue min
29
Ischiogluteal Bursa
-located btwn ischium and glute max
-on isch tub
30
Femoral Triangle
-VAN (m-l)
Superior Border: inguinal lig
Medial Border: adductor longus
Lateral Border: Sartorius
31
Neurology of Hip
-L1-L2 and L3
-supply joint capsule and joint
32
Flow of arterial supply
-Abdominal Aorta
-Common iliac
-External iliac-----------Internal iliac (to PF)
-(@inguinal lig) Femoral A.--Deep Femoral (circumflex)
-(@hiatus) Popliteal A.
-(@soleal line) Pos. Tib A. ------ Fibular A.
-Ant. Tib A.
-Dorsalis Pedis
33
Lateral Femoral Circumflex A.
-comes from femoral
-anterior femoral neck and capsule
34
Medial Femoral Circumflex A.
-comes from femoral
-supplies posterior hip joint, synovium, and femoral head (lig teres)
35
Normal ROM Hip
Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30
36
Hip Flexion ROM
-120 (soft)
-supine, knee flexed
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
37
Hip Abduction and Adduction ROM
-45 ab, 30 add (firm)
-supine, knee extended
-stabilize pelvis
Stationary: Opposite ASIS
Axis: ASIS
Movement: Midline of femur
38
Hip Extension ROM
-10-15 (firm)
-prone, knee extended
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
39
Hip IR/ER ROM
-45 (firm)
-sitting or prone, knee flexed
-stabilize pelvis
Stationary: Perpendicular to ground or table
Axis: Patella
Movement: Midline of tibia
40
Arthrokinematics of Hip
Flexion: sup spin, post glide
Extension: inf spin, ant glide
Abd: inf glide, med glide
Add: sup glide, lat glide
IR: posterior glide
ER: anterior glide
41
Hip Pathologies by Age
Newborn: congenital dislocation
2-8yrs: Legg Perthes
Children: Hemophilia
10-14yrs: SCFE, osteochondritis dissecans
14-25yrs: stress fx, synovitis, FAI, trauma, bursitis
45-60yrs: OA, synovitis
Females 50+: glute med tear
65+: stress fx, OA, replacement surgery
42
Congenital Hip Dislocation
Age: birth
-Females>Males
Observation: short limb, hip flexed and abducted
-upward and lateral displacement
ROM: limited abd
43
Legg-Calve-Perthes
Age: 2-8yrs
-avascular necrosis
S/s: gradual onset, ache in hip
Observation: short limb, higher g troch, quad atrophy, adductor spasm
ROM: limited abd and ext
Intervention: ROM and positioning
44
Slipped Femoral Capital Epiphysis
Age: 10-17 yrs males, 8-15yrs female
-ice cream falling off cone
S/s: gradual onset, vague pain
Observation: short limb, usually obese, quad atrophy
ROM: limited IR, abd, flex
Gait: antalgic acutely, Trendelenburg chronically
45
Avascular Necrosis
Age: 30-50yrs
-sharp pain or intermittent with motion
ROM: decreased
Intervention: Protected WB
46
Degenerative Joint Disease
Age: >40yrs
S/s: insidious onset, pain with WB
Observation: often obese, joint crepitus, muscle atrophy
ROM: capsular pattern
Radiographic: increased bone density, bone spurs, degenerative cartilage
Interventions: manual, exercise
47
Altman's Clinical Criteria (Hip)
-do you have hip OA?
1. Hip pain
2. IR <15deg
3. Pain with IR
4. Morning stiffness up to 60min
5. Age >50yrs
48
Sutlive CPR
-what are the odds you have hip OA
3/5 present= 68%
4/5 present= 91%
1. Self-reported squatting is aggravating
2. SCOUR test w/ ADD causes groin or lat hip pain
3. Active hip flx causes lat pain
4. Active hip ext causes hip pain
5. Passive hip IR less than or equal to 25deg
49
Hip OA Clinical Guidelines
1. Asses for impairments in the mobility of hip
2. Consider Age as Risk Factors
3. Diagnosis and classification using CPR
4. Differential Diagnosis
5. Exam: Outcome Measures
6. Exam: Activity and Participation Limitations
7. Intervenions: Education
8. Interventions: Functional, gait, balance
9. Interventions: Manual Therapy
10. Interventions: Flexibility, strength, endurance
50
Differential Diagnosis w/ Hip OA
-SCOUR/FABER/Fitzgerald's/FADIR for labral tears
-SIJ provocation
-Femoral nerve stretch for radiculopathy
51
Hip Replacement Patient
Acute:
-prevent DVT
-precautions (posterior MC)
-home equipment
Outpatient:
-progressive strengthening
-mobilization (ext MC)
-Balance and gait
52
Muscle Strains
-rule out neural irritability
-hamstrings, rec fem, adductor long MC
53
Myositis Ossificans
-heterotopic ossification
-bone-like tissue in places it shouldn't be
54
Osteitis Pubis/ Symphysiolysis
-inflammation of pubic tubercles
-during surgery or pregnancy
55
ITB Syndrome
-gradual onset; overuse
-Ober's test
S/s:
-lat hip, thigh, knee pain
-snapping IT band over greater troch
Tx:
-activity modification
-stretching
-footwear
56
Trochanteric Bursitis
-pain over greater troch w/ resisted abd
57
Meralgia Paresthesia
-brittany spears
-gradual onset, obese, pregnancy
S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous
58
Gluteus Med Tendinopathy/Tear
-post menopausal, >50yrs
-Aggravating factors: stair climbing and sleeping on side
-muscle wasting
Diffx:
-troch bursitis
-hip OA
Testing Cluster:
-FABER
-external de-rotation tests
-palpation
-SLS
59
Femoroacetabular Impingement
-FAI
Cam Impingement:
-related to femoral head and neck morphology
-early contact
-damages labrum
Pincer Impingement:
-acetabular abnormalities
Pain locaions:
-Anterior-medial: flx/IR positioning
-Posterior: flx/abd/ER positioning
(ischtub pain)
60
Femoral Neck Fracture
-not on Xray
-unable to passively rotate hip
61
Hip Subjective Hx
-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx
62
Examination Order of Hip
1. Hx
2. Observation
3. Gait/Squat/SLS
4. Scan/Not
5. Hip ROM > Back ROM > Knee ROM
6. MMT
7. Flexibility
8. Joint Play
9. Palpation
10. Special Tests
63
Hip Joint (OP/CP)
-synovial joint
-Designed for stability and less mobility
-Convex head of femur and concave acetabulum
-Femoral head faces Medially, anteriorly, superiorly
Resting Position: Flx 30, Abd 30, Slight ER
Closed Packed: Full ext, IR, ABD
Capsular Pattern: Flx, Abd, IR (sometimes IR first)
64
Normal ROM Hip
Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30
65
Arthrokinematics of Hip
Flexion: sup spin, post glide
Extension: inf spin, ant glide
Abd: inf glide, med glide
Add: sup glide, lat glide
IR: posterior glide
ER: anterior glide
66
Legg-Calve-Perthes
Age: 2-8yrs
-avascular necrosis
S/s: gradual onset, ache in hip
Observation: short limb, higher g troch, quad atrophy, adductor spasm
ROM: limited abd and ext
Intervention: ROM and positioning
67
Slipped Femoral Capital Epiphysis
Age: 10-17 yrs males, 8-15yrs female
-ice cream falling off cone
S/s: gradual onset, vague pain
Observation: short limb, usually obese, quad atrophy
ROM: limited IR, abd, flex
Gait: antalgic acutely, Trendelenburg chronically
68
Altman's Clinical Criteria (Hip)
-do you have hip OA?
1. Hip pain
2. IR <15deg
3. Pain with IR
4. Morning stiffness up to 60min
5. Age >50yrs
69
Sutlive CPR
-what are the odds you have hip OA
3/5 present= 68%
4/5 present= 91%
1. Self-reported squatting is aggravating
2. SCOUR test w/ ADD causes groin or lat hip pain
3. Active hip flx causes lat pain
4. Active hip ext causes hip pain
5. Passive hip IR less than or equal to 25deg
70
Osteitis Pubis/ Symphysiolysis
-inflammation of pubic tubercles
-during surgery or pregnancy
71
ITB Syndrome
-gradual onset; overuse
-Ober's test
S/s:
-lat hip, thigh, knee pain
-snapping IT band over greater troch
Tx:
-activity modification
-stretching
-footwear
72
Trochanteric Bursitis
-pain over greater troch w/ resisted abd
73
Meralgia Paresthesia
-brittany spears
-gradual onset, obese, pregnancy
S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous
74
Gluteus Med Tendinopathy/Tear
-post menopausal, >50yrs
-Aggravating factors: stair climbing and sleeping on side
-muscle wasting
Diffx:
-troch bursitis
-hip OA
Testing Cluster:
-FABER
-external de-rotation tests
-palpation
-SLS
75
Femoroacetabular Impingement
-FAI
Cam Impingement:
-related to femoral head and neck morphology
-early contact
-damages labrum
Pincer Impingement:
-acetabular abnormalities
Pain locaions:
-Anterior-medial: flx/IR positioning
-Posterior: flx/abd/ER positioning
(ischtub pain)
76
Femoral Neck Fracture
-not on Xray
-unable to passively rotate hip
77
Subjective Hx
-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx
78
Examination Order of Hip
1. Hx
2. Observation
3. Gait/Squat/SLS
4. Scan/Not
5. Hip ROM > Back ROM > Knee ROM
6. MMT
7. Flexibility
8. Joint Play
9. Palpation
10. Special Tests
