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MSK > Hip Eval & Treat > Flashcards

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)

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2
Q

Hip Dysplasia

A

-undercoverage of femoral head by acetabulum
-instability

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3
Q

Femoro-Acetabular Impingement

A

-FAI
-excessive bony development or overcoverage by acetabulum
-too much contact

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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

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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

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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

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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

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8
Q

Posterior Oblique System

A

-lats, contra glue max, L fascia
-helps with SLS

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9
Q

Anterior Oblique System

A

-EO/IO, contra hip add and abdominal fascia
-helps wih SLS

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10
Q

Lateral Muscle System

A

-Glute med/min and contra hip add

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11
Q

Pectineus action

A
  1. Adducts hip.
  2. Slightly flex hip.
  3. Internal rotation of hip.
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12
Q

Sartorius action

A
  1. Flex hip.
  2. Abduct hip.
  3. Externally rotate hip.
  4. Flex knee
  5. Internally rotate leg with flexed hip.
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13
Q

Gluteus maximus action

A
  1. Extend hip joint.
  2. ER of hip.
  3. Flex hip.
  4. AB hip (Sup fibers)
  5. ADD hip (Inf fibers)
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14
Q

Gluteus, medius action

A
  1. Abduct hip.
  2. Internally rotate hip.
  3. Support, contralateral leg
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15
Q

Gluteus, minimus action

A
  1. Abduct hip
  2. Internally rotate hip (ant fibers)
  3. ER hip (post fibers)
  4. Support, contralateral leg

commonly weak

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16
Q

Tensor fasciae latae action

A
  1. Internally rotate hip.
  2. Abduct hip.
  3. Flexes hip
  4. Support, contralateral leg

commonly short and stiff

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17
Q

Piriformis action

A
  1. Externally rotate, extended hip.
  2. Abduct hip while flexed.
  3. Stabilize hip.
  4. IR when >90 flexed
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18
Q

Adductor Longus Action

A
  1. Adducts hip
  2. Flexes Hip

most commonly strained

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19
Q

Adductor Brevis Action

A
  1. Adducts hip
  2. Flexes hip
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20
Q

Adductor Magnus Action

A
  1. Adducts hip

Adductor Part:
1. Flex hip (anterior)

Hamstring Part:
1. Extend hip (posterior)

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21
Q

Gracilis Action

A
  1. Adducts hip
  2. Flexes knee
  3. Internally rotate hip when flexed
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22
Q

Rectus Femoris Action

A
  1. Extend knee
  2. Stabilized Knee and hip
  3. Help iliopsoas flex hip
  4. APT
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23
Q

Semitendinosus Action

A
  1. Extend hip
  2. Flex knee
  3. Internal rotation when hip is flexed
  4. Extend trunk at hip when hip and knee are flexed
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24
Q

Semimembranosus Action

A
  1. Extend hip
  2. Flex knee
  3. Internal rotation when hip is flexed
  4. Extend trunk at hip when hip and knee are flexed
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25
Q

Biceps Femoris Action

A
  1. Flexes and ER knee
  2. External rotation of hip
  3. Extends hip
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26
Q

Iliopsoas major action

A
  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.
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27
Q

Iliopsoas Bursa

A

-largest and most constant bursa around hip
-near lesser trochanter
-cushions tension from anterior structures

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28
Q

Trochanteric Bursa

A

-greater troch and glue min

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29
Q

Ischiogluteal Bursa

A

-located btwn ischium and glute max
-on isch tub

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30
Q

Femoral Triangle

A

-VAN (m-l)

Superior Border: inguinal lig
Medial Border: adductor longus
Lateral Border: Sartorius

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31
Q

Neurology of Hip

A

-L1-L2 and L3
-supply joint capsule and joint

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32
Q

Flow of arterial supply

A

-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
Q

Lateral Femoral Circumflex A.

A

-comes from femoral
-anterior femoral neck and capsule

34
Q

Medial Femoral Circumflex A.

A

-comes from femoral
-supplies posterior hip joint, synovium, and femoral head (lig teres)

35
Q

Normal ROM Hip

A

Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30

36
Q

Hip Flexion ROM

A

-120 (soft)
-supine, knee flexed
-stabilize pelvis

Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle

37
Q

Hip Abduction and Adduction ROM

A

-45 ab, 30 add (firm)
-supine, knee extended
-stabilize pelvis

Stationary: Opposite ASIS
Axis: ASIS
Movement: Midline of femur

38
Q

Hip Extension ROM

A

-10-15 (firm)
-prone, knee extended
-stabilize pelvis

Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle

39
Q

Hip IR/ER ROM

A

-45 (firm)
-sitting or prone, knee flexed
-stabilize pelvis

Stationary: Perpendicular to ground or table
Axis: Patella
Movement: Midline of tibia

40
Q

Arthrokinematics of Hip

A

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
Q

Hip Pathologies by Age

A

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
Q

Congenital Hip Dislocation

A

Age: birth
-Females>Males

Observation: short limb, hip flexed and abducted
-upward and lateral displacement

ROM: limited abd

43
Q

Legg-Calve-Perthes

A

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
Q

Slipped Femoral Capital Epiphysis

A

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
Q

Avascular Necrosis

A

Age: 30-50yrs
-sharp pain or intermittent with motion

ROM: decreased

Intervention: Protected WB

46
Q

Degenerative Joint Disease

A

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
Q

Altman’s Clinical Criteria (Hip)

A

-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
Q

Sutlive CPR

A

-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
Q

Hip OA Clinical Guidelines

A
  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
Q

Differential Diagnosis w/ Hip OA

A

-SCOUR/FABER/Fitzgerald’s/FADIR for labral tears
-SIJ provocation
-Femoral nerve stretch for radiculopathy

51
Q

Hip Replacement Patient

A

Acute:
-prevent DVT
-precautions (posterior MC)
-home equipment

Outpatient:
-progressive strengthening
-mobilization (ext MC)
-Balance and gait

52
Q

Muscle Strains

A

-rule out neural irritability
-hamstrings, rec fem, adductor long MC

53
Q

Myositis Ossificans

A

-heterotopic ossification
-bone-like tissue in places it shouldn’t be

54
Q

Osteitis Pubis/ Symphysiolysis

A

-inflammation of pubic tubercles
-during surgery or pregnancy

55
Q

ITB Syndrome

A

-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
Q

Trochanteric Bursitis

A

-pain over greater troch w/ resisted abd

57
Q

Meralgia Paresthesia

A

-brittany spears
-gradual onset, obese, pregnancy

S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous

58
Q

Gluteus Med Tendinopathy/Tear

A

-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
Q

Femoroacetabular Impingement

A

-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
Q

Femoral Neck Fracture

A

-not on Xray
-unable to passively rotate hip

61
Q

Hip Subjective Hx

A

-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx

62
Q

Examination Order of Hip

A
  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
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)

64
Q

Normal ROM Hip

A

Flx: 110-120
Ext: 10-15(20)
IR: 30-40
ER: 40-60
Abd: 30-50
Add: 25-30

65
Q

Arthrokinematics of Hip

A

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
Q

Legg-Calve-Perthes

A

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
Q

Slipped Femoral Capital Epiphysis

A

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
Q

Altman’s Clinical Criteria (Hip)

A

-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
Q

Sutlive CPR

A

-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
Q

Osteitis Pubis/ Symphysiolysis

A

-inflammation of pubic tubercles
-during surgery or pregnancy

71
Q

ITB Syndrome

A

-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
Q

Trochanteric Bursitis

A

-pain over greater troch w/ resisted abd

73
Q

Meralgia Paresthesia

A

-brittany spears
-gradual onset, obese, pregnancy

S/s:
-pain and paresthesia of ant lat thigh
-lateral femoral cutaneous

74
Q

Gluteus Med Tendinopathy/Tear

A

-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
Q

Femoroacetabular Impingement

A

-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
Q

Femoral Neck Fracture

A

-not on Xray
-unable to passively rotate hip

77
Q

Subjective Hx

A

-H/o LBP
-Hip problems as a child
-Clicking/popping/catching (w/ or w/o pain)
-OA
-Surgical Hx

78
Q

Examination Order of Hip

A
  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

MSK (34 decks)

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