Hip exam/alignment Flashcards
1
Q
Hip exam: history, interview and systems review consider what?
A
- Non-musculoskeletal: medical - visceral, systemic origin such as genitourinary can refer to hip
- medical/mechanical: cancer, osteoporosis, fracture (either of them can produce fx)
2
Q
L/S pathology radicular NR pain/symptoms
A
- upper L/S L1, L2, L3, Nrs = groin and anterior thigh
- Lower L/S L4, L5, S1 NRs = posterior hip buttock, leg, calf and foot
- L/S is better or worse with ROM, sitting
3
Q
Hip OA and DJD as a reason for hip pain
A
- reason for hip pain
- age related wear and tear
- obesity = 1ºfactor
4
Q
Ra as a reason for hip pain
A
- autoimmune
- inflammatory disease
- joint erosion
5
Q
Trauma or injury as a reason for hip pain
A
- labral tear, muscle strain/tear
- tendonopathy
- bursitis
- impingement syndrome
- hip fracture (type, repair, WB status)
6
Q
Femoral neck fracture
A
- possible Avascular necrosis of femoral head
- circumflex arteries (1ºsource= medial circumflex artery) suppled blood to joint capsule and femoral head
- femoral neck fx and injury to joint capsules can disrupt blood supply leading to avascular necrosis of FH needed THR
7
Q
Childhood hip conditions
A
- congenital disease: hip dysplasia (malformation/alignment) – With or without dislocation abnormal Femoral head/acetabulum
- legs-calf perches disease
- slipped capital epiphysis
8
Q
Legg calve perthes
A
- osteochondrosis of femoral head
- inflammation of bone/cartilage interface with abnormal revascularization at femoral head
- results in a misshaped femoral head from dysfunctional bone lay down
- avascular necrosis
9
Q
Legg calve perthes incidence
A
- age 3-10 M>F
10
Q
Legg calve perthes signs and symptoms
A
- abnormal small flat femoral head and flattened epiphysis
- pain in hip/groin
- antalgic gait
- decreased ROM
- (+) postive adduction test = pain
11
Q
Legg calve perthes treatment
A
- NWB Wtih crutches
- abduction splint prevent subluxation and put joint in better alignment
- FH in acetabulum reshapes and heals
12
Q
Slipped capital epiphysis
general description and incidence
A
- adolescent coxa vara
- Age 10-16
M>F - obesity is factor
- development issue with going from coxa valga to coxa vara
13
Q
Slipped capital epiphysis: what happens
A
- epiphysis is subjected to greater vertical shear force
- FH displaced down/backward
- neck is displaced up and forward
- can lead to avascular necrosis - seen on X-ray
14
Q
Slipped capital epiphysis: signs and symptoms
A
- pain in hip groin
- antalgic gait
- (+) trendelenberg test and gait
15
Q
Slipped capital epiphysis: treatment
A
- if stable
- NWB with crutches
- if unstable in-situ pinning
- WB restrictions for–6 weeks
- healing up to 6-18 months until epiphysis closes
- percutaneously CRIF
16
Q
Hip exam history: mechanical pathology
A
- MOI: trauma vs gradual onset, overuse, dx of OA/RA
- pain: type, intensity, where,
- worsens with WB, ROM
- symptoms pain, weakness, hypomibile, hyper mobile (not as frequent - stable joint)
- gait abnormalities
17
Q
Diagnostic tests and results
A
- X-ray
- bone scans
- Dex-scan
- MRI
- NCV/EMG
- blood tests - Rh factor (RA)
18
Q
Observation structure vs functional findings
A
- structural: true leg length, ante version/retroversion, femoral torsion/tibial torsion. Q-angle, pes caves rigid foot scoliosis
- Functional: muscle imbalances of hip/knee/foot, SIJ/pelvis, spine
19
Q
What to observe with function at the hip
A
- ROM
- deviations/compenstation
- pain during LQS squat, functional movement, gait
20
Q
Angle of inclination - structure/alignment
A
- normal; 125º
- smaller <125º
- larger > 125º
21
Q
Coxa vara
A
- smaller <125 from femoral head/acetabulum to shaft
- increase shear force on femoral neck
- decreased length of abductors
- decreased force production of abductors
22
Q
Coxa valga
A
- angle between the head of the femur and shaft is >125
- less shear force across femoral neck
- increase length of abductors = better force production
23
Q
Normal anteversion
A
- 15º
- femoral neck is rotated 15ºin relation to femoral condyles
24
Q
Excessive anteversion
A
- > 15º
- can result in
- medial femoral torsion (structural change OR
- toeing-in compensation
25
Retroversion angle
- <15º
- can result in
1. lateral femoral torsion (structure change) OR
2. Toeing-out compensation so that femoral head gets seated properly
26
Craig's test for ante version
- palpate greater trochanter parallel to table
- normal angle 8-15
- measure with Goni - patella SA= straight up and MA = 2nd toe?
27
Femoral medial torsion
- patellas point inward
- squinting patella and bowlegs when feet are pointing forward
- femoral condyles go medially
- ER hip so that patellas face forward but feet are now out
28
Congential hip dislocation testing: telescoping sign
- push posterior long axis of femur
- lift femur up
- (+) is excessive movement (hip comes out)
29
Congential hip dislocation testing: ortbanti's sings and Barlows sign
- Ortolanti's sign: abduct and ER hip will relocate (reducing click)
- Barlow's sign: perform IR and adduction of hip and the hip dislocated posterior (then do ortolani)
30
Congential hip dislocation: limited abduction (harts sign) Cleland
- passvely abduct both hips
- (+) test = see asymmetrical abduction
- may clunk as abducting reduces hip
31
How is the hip joint a stable joint
- acetabulum = deeper socket
- expansive capsule is 1º support: runs acetabulum to base of femoral neck, thinner posterior/inferior capsule = dislocated posterior)
- extrinsic ligaments add support; iliofemoral, pubofemorla, ischiofemoral
32
Normal end feels at the hip
- normal capsular with some give/creep
- flexion- soft tissue approximation
33
abnormal end feels at the hip
- limited capsular pattern (stiff without creep)
- marked limitation IR, abduction
- moderate limitation: flexion/extension
- less limitation ER, adduction
34
During AROM/PROM of the hip patient may experience
- femoroacetabular impingement: pain end ROM
- labral tear = pain or clicking
35
Femoralacetabular impingements
- Cam impingement: large FH, small acetabulum
- pincer type impingement: large overhanging acetabulum
- Combination of CAM and pincer impingement
- **these may result in degeneration or labrum/articular cartilage and cause DJD
36
Hip arthrokinematics
- open chain: convex FH on concave acetabulum (spin)
- anterior glide of FH: ER/Ext
- Posterior glide Femoral head: Flex/IR
- Medial glide of FH ABD
- lateral glide Add
- inferior glide hip flexion beyond 70
- Closed chain: roll and slide in the same direction as pelvic motion
37
open pack vs closed pack positions for the hip joint
- loose pack: 30º flexion, 30º abduction, Slight ER
- closed pack: full extension, IR, abduction
38
Joint assessment if hypomobile turn into treatment
- long axis distraction
- inferior glide - hip flexion beyond 70
- lateral distraction; Rx with strap
- capsule length: stretch flexion/extension, adduction/abduction, IR/ER
- FABER (Patrick's) test
39
Strength assessment of the hip
- RI of myotomes/NR scan
- RI of hip musculature = strength status/pain or painless
- MMT as indicated of different muscles
40
Piriformis compression of Sciatic N (flail leg)
- spared: ilipsoas, sartorius, quads, adductors
- motor loss: hamstrings, adductor Magnus, popliteus, gastrocnemius, planteris, soleus, tibialis posterior, FDL, FHL
- Sensory: lateral lower leg
41
- how does a sciatic injury occur
- compression, piriformi syndrome: overuse, fall on piriformis/injection
42
Femoral n. injury
- sensory: femoral anterior thigh, saphenous medial leg
- lateral femoral cutaneous n injury - lateral thigh
- motor: quads, iliposas, sartorius,
43
femoral n injury vs lateral femoral cutaneous n injury
| causes
- femoral nerve injury: femoral head fx, anterior hip dislocation, THR anterior approach
- LFCN: inguinal ligament trauma, THA- anterior approach
44
Lateral femoral cutaneous
- neuralgia paresthetica
- sensory only to lateral thigh to knee
- compression under inguinal ligament
- trauma, obesity
- anterior approach THA
45
Ilioingunial Nerve compression
- compression by: TrA and IO hypertrophy in presence of L/S instability
- sensory: groin, pain mimics hip OA
46
- Obturator nerve compression
- compressed between pubic bones and obturator muscles or fracture of pelvis
- sensory: medial thigh
- motor: adductor weakness
