hip fx, adhesive capsulitis, functional tests - exam 2

Question 1

are hip fractures caused mostly by traumatic or non traumatic incidents?

Answer 1

traumatic
< 5% are non-traumatic

Question 2

what is the most frequent fx seen in the ER? avg age for these people?

Answer 2

hip fx
80

Question 3

what are risk factors for hip fx?

Answer 3

prior fall
gait dysfunction
vertigo
medications influencing BP, dizziness, etc

Question 4

what structures are involved in hip fx?

Answer 4

bone - most commonly of femoral neck
ligaments - most likely ligament damage just from the bone fx

Question 5

hip fx S&S:
observation?
special tests?

Answer 5

typical fx s&s
LE possibly shortened and in an extremely rotated position
(+) patellofemoral pubic tap test

Question 6

where is the most common site for a hip fx?

Answer 6

femoral neck

Question 7

what are we primarily treating a patient for post hip fx? explain

Answer 7

consequences of immobilization of other tissues
they’re showing up to PT ~4-8 weeks post fx after clinical union

Question 8

what do you expect to find in a pt who had a hip fx? (clinical union formed already)

Answer 8

repair/remodeling phase
firm or elastic end feels
muscle atrophy
limited in multiple directions

Question 9

what are risk factors of adhesive capsulitis aka frozen hip?

Answer 9

systemic low grade inflammation
– thyroid disorder
– diabetes
– alcoholism
middle aged
females

Question 10

what is the primary cause of adhesive capsulitis? secondary?

Answer 10

unknown
concomitant pathology

Question 11

what is the pathogenesis of adhesive capsulitis?

Answer 11

synovial inflammation turns to capsular fibrosis

Question 12

what structures are involved in adhesive capsulitis?

Answer 12

hip capsule
ligaments

Question 13

what are S&S of adhesive capsulitis?

Answer 13

gradual and progress loss of motion and P!
no consensus on capsular pattern of restriction

Question 14

Frozen shoulder stage I: initial
symptoms?
irritability?
ROM?
end feel?

Answer 14

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

Question 15

Frozen shoulder stage II: freezing
symptoms?
irritability?
ROM?
end feel?

Answer 15

– constant p!, particularly at night
– high
– moderate limitation. similar under anesthesia
– empty and painful

Question 16

Frozen shoulder stage III: frozen
symptoms?
irritability?
ROM?
end feel?

Answer 16

– stiffness > P!
– moderate
– severe limitations with pain at end range. similar under anesthesia
– capsular

Question 17

Frozen shoulder stage IV: thawing
symptoms?
irritability?
ROM?
end feel?

Answer 17

minimal P!
low
gradually improves
capsular

Question 18

Rx for adhesive capsulitis

Answer 18

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

Question 19

what are functional ROM for:
- stairs?
- sit –> stand and squatting?
- gait?

Answer 19

~70 deg flexion
~ 115 deg flexion
10 deg hyperext

Question 20

how many degrees is ideal for most ADLs?
flexion?
abd?
ER?
hyperext?

Answer 20

120 flex
20 abd
20 ER
10 hyperext

Question 21

in R heel strike period:
R hip is maximally flexed to _____ deg with ______ and _____
R innominate rotates _____

Answer 21

30 deg
ADD & ER
posterior

Question 22

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

Answer 22

anterior
IR and aDd (relative movements)
R on R

Question 23

in R heel off to toe off:
R hip _____, ______, ______ (actions)
maximal potential energy occurs in lengthened R hip ________/______ and hip _______

Answer 23

ext, aBd, IR
capsule/ligaments
flexors

Question 24

in R heel off to toe-off:
R ______ lengthening further assists with R _____, ______, & L ______ IF T10 rotation WNL

Answer 24

psoas
R SB, ext and L rot

Question 25

in R acceleration to mid-swing:
release of lengthened _____ & _______
psoas creates hip ______

Answer 25

capsule, ligaments
flexion

Question 26

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

Answer 26

hip capsule and ligaments lengthen with hyperext

hip joint - decreased cartilage integrity by limited motion

Question 27

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

Answer 27

hip flexors lengthen, particularly psoas and iliocapsularis

hip flexor overuse with shorter strides due to increased active hip flexion and demonstrated with iliocapsularis

Question 28

what does the T10 rot allow the psoas to do?

Answer 28

to assist with trunk motion and early and mid swing of LE

Question 29

what area could have excessive stress if T10 rot does not occur?

Answer 29

lower lumbar spine under more stress with lack of T10 rot and/or hip hyperext

Question 30

what are you looking for in a functional test when testing your patient for return to sport or pre sport screening?

Answer 30

quantity and quality
limb symmetry
agility tests

Question 31

Star Excursion Balance Test (SEBT) is looking for? what does it predict?

Answer 31

looking for asymmetry or P!
predicts LE basketball injury in basketball

Question 32

what is the single limb squat test looking for?

Answer 32

asymmetry or P!

Question 33

what is the functional movement screen (FMS) used to predict?

Answer 33

non contact injury

Question 34

what 2 areas of injury are the hop tests commonly used for?

Answer 34

knee and ankle

Question 35

who are agility tests best used for?

Answer 35

athletic population because of sport specific testing

Question 36

if your patient is ready to return to practice what are some progression guidelines you should give them? (can make sport specific for pt)

Answer 36

predictable and non contact
unpredictable and non contact
predictable and contact
unpredictable and contact

Question 37

what muscle is highly active as a stabilizer for ER esp through extension and with abduction in a flexed position?

Answer 37

piriformis