hip fx, adhesive capsulitis, functional tests - exam 2 Flashcards
are hip fractures caused mostly by traumatic or non traumatic incidents?
traumatic
< 5% are non-traumatic
what is the most frequent fx seen in the ER? avg age for these people?
hip fx
80
what are risk factors for hip fx?
prior fall
gait dysfunction
vertigo
medications influencing BP, dizziness, etc
what structures are involved in hip fx?
bone - most commonly of femoral neck
ligaments - most likely ligament damage just from the bone fx
hip fx S&S:
observation?
special tests?
typical fx s&s
LE possibly shortened and in an extremely rotated position
(+) patellofemoral pubic tap test
where is the most common site for a hip fx?
femoral neck
what are we primarily treating a patient for post hip fx? explain
consequences of immobilization of other tissues
they’re showing up to PT ~4-8 weeks post fx after clinical union
what do you expect to find in a pt who had a hip fx? (clinical union formed already)
repair/remodeling phase
firm or elastic end feels
muscle atrophy
limited in multiple directions
what are risk factors of adhesive capsulitis aka frozen hip?
systemic low grade inflammation
– thyroid disorder
– diabetes
– alcoholism
middle aged
females
what is the primary cause of adhesive capsulitis? secondary?
unknown
concomitant pathology
what is the pathogenesis of adhesive capsulitis?
synovial inflammation turns to capsular fibrosis
what structures are involved in adhesive capsulitis?
hip capsule
ligaments
what are S&S of adhesive capsulitis?
gradual and progress loss of motion and P!
no consensus on capsular pattern of restriction
Frozen shoulder stage I: initial
symptoms?
irritability?
ROM?
end feel?
gradual onset, achy at rest, sharp with use, night P!, unable to lie on involved side
high
limited but no deficit under anesthesia
empty and painful
Frozen shoulder stage II: freezing
symptoms?
irritability?
ROM?
end feel?
– constant p!, particularly at night
– high
– moderate limitation. similar under anesthesia
– empty and painful
Frozen shoulder stage III: frozen
symptoms?
irritability?
ROM?
end feel?
– stiffness > P!
– moderate
– severe limitations with pain at end range. similar under anesthesia
– capsular
Frozen shoulder stage IV: thawing
symptoms?
irritability?
ROM?
end feel?
minimal P!
low
gradually improves
capsular
Rx for adhesive capsulitis
passively move them
go away from P!
at most grade I and II JM
POLICED
pt education on 4 phases
3 sets 10 reps light resistance
what are functional ROM for:
- stairs?
- sit –> stand and squatting?
- gait?
~70 deg flexion
~ 115 deg flexion
10 deg hyperext
how many degrees is ideal for most ADLs?
flexion?
abd?
ER?
hyperext?
120 flex
20 abd
20 ER
10 hyperext
in R heel strike period:
R hip is maximally flexed to _____ deg with ______ and _____
R innominate rotates _____
30 deg
ADD & ER
posterior
in R foot flat to mid stance:
R hip ext begins with R innominate _____ rot
R hip ____ and _____ as pelvis begins to rotate _____ on _____ femur
anterior
IR and aDd (relative movements)
R on R
in R heel off to toe off:
R hip _____, ______, ______ (actions)
maximal potential energy occurs in lengthened R hip ________/______ and hip _______
ext, aBd, IR
capsule/ligaments
flexors
in R heel off to toe-off:
R ______ lengthening further assists with R _____, ______, & L ______ IF T10 rotation WNL
psoas
R SB, ext and L rot
in R acceleration to mid-swing:
release of lengthened _____ & _______
psoas creates hip ______
capsule, ligaments
flexion
non contractile tissue is a storehouse of potential energy. give example and one area of excessive stress if the storehouse of potential energy does not occur
hip capsule and ligaments lengthen with hyperext
hip joint - decreased cartilage integrity by limited motion
contractile tissue is a storehouse of potential energy. give example and one area of excessive stress if the storehouse of potential energy does not occur
hip flexors lengthen, particularly psoas and iliocapsularis
hip flexor overuse with shorter strides due to increased active hip flexion and demonstrated with iliocapsularis
what does the T10 rot allow the psoas to do?
to assist with trunk motion and early and mid swing of LE
what area could have excessive stress if T10 rot does not occur?
lower lumbar spine under more stress with lack of T10 rot and/or hip hyperext
what are you looking for in a functional test when testing your patient for return to sport or pre sport screening?
quantity and quality
limb symmetry
agility tests
Star Excursion Balance Test (SEBT) is looking for? what does it predict?
looking for asymmetry or P!
predicts LE basketball injury in basketball
what is the single limb squat test looking for?
asymmetry or P!
what is the functional movement screen (FMS) used to predict?
non contact injury
what 2 areas of injury are the hop tests commonly used for?
knee and ankle
who are agility tests best used for?
athletic population because of sport specific testing
if your patient is ready to return to practice what are some progression guidelines you should give them? (can make sport specific for pt)
predictable and non contact
unpredictable and non contact
predictable and contact
unpredictable and contact
what muscle is highly active as a stabilizer for ER esp through extension and with abduction in a flexed position?
piriformis
