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Theory :lower extremity > Hip, groin and thigh > Flashcards

Hip, groin and thigh Flashcards

0
Q

For increased anterior pelvic tilt, what muscles are lengthened and which are shortened?

A

lengthened:Abs, piriformis, gluteus medius (stretched weakness)
Shortened: iliopsoas, gluteus maximus, TFL

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1
Q

What are some problems at the hip that can occur?

A
  • decreased flexibility
  • joint hypomobility
  • muscle strength imbalance
  • nerve injury
  • referred pain
  • weight-bearing forces and movement transmitted to spine
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2
Q

What can restriction in the TFL cause besides anterior pelvic tilt?

A

greater trochanteric bursitis and ITB syndrome associacted with knee and patellofemoral pain

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3
Q

If you have increased anterior pelvic tilt, what observations might you see and what other movement might be resitricted?

A 
Movement restricted: external rotation 
Observations: 
-forward head posture
-increased thoracic kyphosis
-IR of the femur
-Genu Valgum
-Pes Planus
-Hallux Valgus
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4
Q

Which muscles are stretched and which are shortened with an increased posterior pelvic tilt?

A

Stretched: iliopsoas, gluteus max, back extensors (stretched weakness may be present)
shortened:rectus femoris, hamstrings, abs, gluteus medius

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5
Q

With an increased posterior pelvic tilt, what can happen with decreased lumbar lordosis?

A

you have decreased shock attenuation, possible increase risk of injury

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6
Q

what observation might you see with increased posterior pelvic tilt?

A
  • hip extension
  • IR or the femur
  • genu recurvatum
  • genu varum
  • pes planus
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7
Q

Describe swayback posture?

A
  • entire pelvis shifted anteriorly
  • hip extension
  • increased lumbar lordosis and thoracic kyphosis
  • forward head
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8
Q

What muscles are shortened and which are lengthened with swayback?

A

Shortened: upper abs, lower lumbar extensors, glute max, and hamstrings
lengthened: lower abs, thoracic extrensors, iliopsoas and recuts femoris

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9
Q

What observations might you see with swayback?

A
  • frontal plane asymmetry
  • pelvic drop
  • may shift weight to one side
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10
Q

Observations of military posture?

A
  • decreased in curves of spine

- depressed scapula

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11
Q

what muscle dysfunctions can you have that is associated with military posture?

A
  • anterior cervical
  • thoracic erector spinae
  • scapular retractors
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12
Q

With military posture what observations might you see?

A
  • protracted or retracted jaw (TMJ problems?)
  • thoracic outlet syndrome
  • decreased shock attenuation
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13
Q

What can joint pain and hypomobility be due to?

A
  • degenerative changes (OA and RA)
  • aseptic necrosis
  • slipped capital femoral epiphysis (SCFE)
  • congenital deformities
  • dislocations or fractures
  • post-immobilization after fracture or surgery
  • swelling after surgery
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14
Q

describe aseptic necrosis

A 
it's the same as avascular necrosis
-death of the bone
-blood supply to bone is disrupted
can be caused from:
--trauma
--chemottherapy
--perthes disease
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15
Q

what is perthes disease?

A
  • occurs in kids 4-10 years old
  • etiology unknown
  • can be because blood supply is disrupted
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16
Q

What congenital deformities can occur at the hip?

A
  • congenital hip dysplasia
  • femoral retroversion (grasshopper patella, tibial ER)
  • femoral anteversion (squinting patella, tibial IR)
  • coxa vara or coxa valga
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17
Q

What can muscle imbalances cause in the hip?

A
  • dominance of one muscle over another
  • strength deficits
  • length deficits
  • altered proprioception and neuromuscular control
  • postural impairments
  • TFL dominates glute med
  • ITB syndrome
  • PFPS syndrome
  • iliopsoas is weak
  • the other hip flexors dominate ( rectus femoris, TFL, Sartorius)
  • hamstrings are strong, glute max disuse
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18
Q

When the TFL dominates the glute med what does that mean?

A
  • glute medius is weak
  • increased tension on ITB- pull on ITB
  • valgus collapse at the knee-can cause patellar femoral pain because of hip muscle weakness- can cause ACL injury
  • dynamic increase in Q-angle
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19
Q

When your hamstrings are too strong what can happen?

A

loss of flexibility of glut max results in loss of hip flexion ROM

  • compensate with excessive lumbar spine flexion
  • increased tension on ITB (associated knee pain or greater throchanteric bursitis possible
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20
Q

When you have overuse of hamstrings what can happen?

A
  • cramping
  • decreased flexibility
  • imbalances with quads ( altered pull on the tibia may result in PFPS)
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22
Q

What does PFPS stand for?

A

patellar femoral pain syndrome

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23
Q

What nerve injuries can happen at the hip?

A
  • sciatic nerve
  • obturator nerve
  • femoral nerve
  • radiculopathy (treat source?)
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24
Q

How can you injure the sciatic nerve?

A

entrapment as nerve passes under (sometimes through) piriformis

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25
Q

How can your injure the obturator nerve?

A

rare, but may be damaged during labor due to uterine pressure

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26
Q

How can you injure the femoral nerve?

A
  • fracture
  • reduction of dislocation
  • during labor and delivery
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27
Q

What can cause a muscle strain, pull or tear?

A
  • stretched muscle is forced to contract suddenly
  • fall or direct blow
  • overstretching
  • overuse
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28
Q

What muscles are mostly injured by strain, pull or tear in the hip? and why are they most commonly injured?

A
  • hamstrings, quads, adductors

- because they are big, strong muscles groups

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29
Q

Which muscles between hamstrings, quads and adductors are most commonly injured and why?

A

hamstrings and quads because they cross the hip and knee and they are used in high speed activities

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30
Q

What can predispose (risk) for muscle strains?

A

increases if prior injury to the area

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31
Q

What is the severity of muscle strains?

A

stress/strain curve

  • mild (strain or pull)
  • moderate (tearing of some fibers)
  • severe (tear)
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32
Q

What are the signs and symptoms of a muscle strain?

A
  • pain
  • redness
  • warmth
  • swelling
  • loss of strength (depends on severity)
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33
Q

Describe Grade 1 for a muscle strain?

A

minimal loss of strength

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34
Q

Describe Grade 2 for a muscle strain?

A

strength is compromised

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35
Q

Describe Grade 3 for a muscle strain?

A

rupture of the muscle

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36
Q

Describe what is going on if a muscle strain is strong and painful?

A

suggests minor problem with muscle, tendon or attachment

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37
Q

Describe what is going on if a muscle strain is strong and painless?

A

Nothing wrong with the contractile structures

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38
Q

Describe what is going on if a muscle strain is weak and painful?

A
  • suggest partial tear
  • pain causing non-compliance with the test (patients do not like pain)
  • painful inhibition due to fracture or tumor (rare)
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39
Q

Describe what is going on if a muscle strain is weak and painless?

A
  • complete rupture of muscle/tendon

- impaired nerve function q

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40
Q

What do you do for rehab during the acute phase of an injury?

A
  • price
  • isometrics
  • OKC exercises
  • upper body and core strengthening
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41
Q

What is the clinical milestone for the acute phase of remodeling?

A

Concentric adduction against gravity

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42
Q

What do you do for rehab during the subacute phase of an injury?

A
  • initiate concentric adduction exercises

- initiate CKC exercises

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43
Q

What is the clinical milestone for the subacute phase of remodeling?

A

injured side approximately 75-80% strength of the uninjured side

44
Q

What do you do for rehab during the return to sport phase of an injury?

A
  • sport specific activities
  • plyometrics
  • advanced strengthening
45
Q

What is the clinical milestone for the return to sport phase of remodeling?

A

strength 90-100% of uninvolved side

46
Q

What is the risk for injury for the adductors?

A
  • adductor muscle strength
  • ratio or ABD/ADD strength
  • flexibility
47
Q

Which adductor is most commonly injured?

A

adductor longus

48
Q

What sports are adductor muscle injuries common in?

A

hockey and soccer

49
Q

How do you prevent muscle injuries?

A

By strengthening and flexibility

50
Q

What does the adductor muscles do in CKC?

A

stabilizes the lower extremity and trunk

51
Q

How are the hamstrings injured?

A

rapid acceleration or deceleration with an eccentric load (any sport with sprinting)

52
Q

What are the risk factors for hamstring muscle injury?

A
  • strength deficit
  • flexibility
  • endurance
  • poor core stability
  • poor lumbar posture
53
Q

What is the make up for the hamstrings?

A

primarily fast twitch

respond to powerful movements

54
Q

is a hamstring muscle injury common or not?

A

it is very common and it has a high reoccurrence rate (22-34%)

55
Q

Which quad is most commonly injured?

A

rectus femoris

56
Q

Where is the most common location, in the hip, for an avulsion fracture?

A
  • ischial apophysis
  • ASIS
  • AIIS
57
Q

how do you treat an avulsion fracture?

A
  • rest initially

- pain free progression of ROM and strengthening

58
Q

What is the MOI for an avulsion fracture?

A

-sudden, forceful, eccentric or unbalanced contraction of the musculotendinous unit at the apophysis

59
Q

What is an apophysis?

A

a bony projection of the epiphysis and does not play a role in longitudinal growth of the bone

60
Q

In which population is avulsion fractures common in?

A
  • adolescents

- in adults the same MOI would result in a torn ligament or tendon

61
Q

Describe a Hip pointer?

A
  • trauma at the iliac crest

- can be contact (sports) or non contact (fall)

62
Q

Describe grade 1 for hip pointer?

A

pain and tenderness, but gait and posture are not abnormal

63
Q

Describe grade 2 for hip pointer?

A

painful, tender, swelling, gait deviations

64
Q

Describe grade 3 for hip pointer?

A

severe pain, swelling, bruising, and limited ROM and gait deviations

65
Q

How do you rehab a hip pointer in all phases?

A
  • acute: protection
  • subacute: restore full ROM and flexibility
  • return to sport: progress strengthening pain free
66
Q

if a bruise is not treated correctly what can occur?

A

it can turn into a myositis ossifican

67
Q

Describe grade 1 for hip contusion?

A

mild discomfort on palpation

68
Q

Describe grade 2 for hip contusion?

A

attempting to continue activity will cause injury to become progressively disabling

69
Q

Describe grade 3 for hip contusion?

A

muscle herniates through the fascia

70
Q

How do you rehab a muscle contusion?

A
  • PRICE
  • initiation of AROM
  • initiation of pain free strengthening and return to function
  • stretching occurs late phase of rehab (why?)
71
Q

Describe a myositis ossifican?

A
  • ectopic bone production occurs after an injury to the periosteum of the bone
  • can occur without injury to the bone if the contusion is severe enough
  • can be removed surgically but you should wait 1 year if you do
72
Q

Describe anterior hip dislocation

A
  • extension, ER, and ABD

- force the femur out of the front of the acetabulum

73
Q

Describe posterior hip dislocation

A
  • flexion, IR, and ADD

- force the femur head out of the back of the acetabulum

74
Q

how can you dislocate the hip by trauma (most common)?

A

motor vehicle accidents, after total hip replacement surgery

75
Q

Is a hip dislocation a medical emergency? why?

A

FUCK YES!

-nerves and vascular shit like arteries are in the way

76
Q

how can you tear the labrum in the hip?

A

twisting movement during weight bearing

77
Q

labral tear is a predisposition for what?

A

hip osteoarthritis

78
Q

what is the acute signs and symptoms for labral tear?

A
  • pain in the groin or front of the hip
  • pinching sensation
  • giving way of the leg
79
Q

which type of labral tear do you operate on?

A

large tears because they cause instability

80
Q

How do you manage the joints without surgery?

A
  • stronger the muscles are that support the joint
  • better weight distribution across that joint
  • better control of the body
  • reduce weight will recuse forces across the joint
81
Q

Describe the posterior lateral approach for total hip arthroplasty?

A
  • muscles/structures cut: ITB, glut max, short ER
  • glut med intact
  • highest incidence of post op instability
82
Q

why is hip in neutral for hip arthroscopy?

A
  • flexion brings sciatic nerve too close to the joint

- extension brings femoral nerve too close to the joint

83
Q

What is the rehab for 4-8 weeks post op?

A
  • NWB for 4-8 weeks
  • but can only do OKC exercises
  • stationary bike my be ok also
84
Q

What is the rehab for acute phase after surgery?

A
  • restore ROM

- pain free exercises->isometric (LE and core exercises)

85
Q

What is the rehab for repair and remodeling phase after surgery?

A
  • restore strength and ROM
  • pain free progression (don’t forget balance)
  • return to ADL or sport activities
86
Q

describe a bursitis and how it can occur

A
  • inflammation due to excessive fiction or shear forces
  • overuse, altered mechanics
  • post traumatic: direct blow or contusion resulting in inflammation
87
Q

Where is the most common bursitis?

A

greater throchanteric bursitis

88
Q

how do you treat a bursitis?

A
  • restore flexibility and strength balance

- may need to assess walking or running mechanics

89
Q

Describe intraarticular snapping hip

A
  • loose bodies
  • labral tears
  • osterocartilaginous exostosis
  • synovial chondromatosis
  • subluxation
90
Q

Describe extraarticular snapping hip

A
  • ITB snapping over the greater trochanter

- iliopsoas snapping over the pelvic brim

91
Q

how do you treat a snapping hip?

A
  • restore balanced ROM, flexibility and strength

- dynamic assessment (walking or running gait)

92
Q

What can pathologically cause hypomobility?

A
  • osterarthirits
  • Rheumatoid arthritis
  • necrosis
  • congenital deformities
93
Q

What can naturally cause hypomobility?

A
  • aging
  • trauma
  • repetitive stresses
  • obesity
  • disease
94
Q

What are some degenerative changes that can occur in the hip?

A
  • loss of motion
  • loss of strength
  • cartilage breakdown
  • capsular fibrosis
  • osteophytes
95
Q

What are the three different type of hip surgeries?

A
  • total hip athroplasty (precautions depend of surgical approach
  • hip hemi arthroplasty
  • hip resurfacing
96
Q

What are the precautions for posterior lateral approach for total hip arthroplasty?

A

no flexion beyond 90, ADD, IR in combination

97
Q

Describe the anterior approach for total hip arthroplasty?

A
  • muscles/structures cut: rectus femurs can attach on the joint capsule
  • less blood loss
  • less pain
  • shorter hospital stay
  • faster functional recovery in the short term
98
Q

What are the precautions for anterior approach for total hip arthroplasty?

A

TRICK QUESTION!!! there are none!

99
Q

What are weight bearing considerations for post op rehab?

A
  • may be partial weight bearing or ORIF (open reduction internal fixation)
  • depends on the surgeon
100
Q

What can you do in acute phase for post op rehab?

A
  • get them functional so they can go home

- home care PT

101
Q

What can your do in repair and remodeling phases for post op rehab?

A
  • restore ROM and strength

- restore functional abilities

102
Q

What hip surgeries all need an open reduction internal fixation (ORIF)

A
  • femoral neck fracture

- femoral shaft fracture

103
Q

In what population is hip surgeries most common in?

A
  • elderly
  • 75-85 years old
  • age related loss of strength balance, and gait deficits
  • osteoperosis
  • did the trauma cause the fracture or did the fracture cause the fall?
104
Q

is it common or rare for a person is PROM after hip injury

A
  • rare that a person is PROM after a lower extremity injury or surgery
  • may be NWB or have use limitation instead
105
Q

How do you know if the patient is doing the exercise correctly?

A
  • stabilization appropriate
  • position of patient is appropriate
  • resistance occurring in proper plane of motion (change the resistance?)

Theory :lower extremity (3 decks)

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