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DPT 616 : MSK > Hip Lecture > Flashcards

Hip Lecture Flashcards

1
Q

what are some potential causes of hip pain?

A

articular cartilage

childhood disorders (dysplasia, LCP, epiphysis)

inflammation (bursitis, tendonitis, synovitis)

infection

labral tears

neoplasm

neurologic (entrapment)

overuse (sprain, strain, hernia)

referred (disc, piriformis, SI, genitourinary)

systemic (RA, Chron’s, lupus, cancer)

trauma (fx, DL, avulsion, MO)

vascular (necrosis)

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2
Q

what are some anterior hip/groin pathologies?

A

labral tears 2nd FAI

labral tears 2nd hypermobility

DJD/arthritis

femoral stress fx

SCFE

avascular necrosis

adductor strain

athletic pubalgia/sports hernia

avulsion fx of ASIS

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3
Q

what are some posterior hip pathologies?

A

referred pain from L spine, SI jt dysfxn

sciatic nerve entrapment

pudendal nerve entrapment

HS strain

ischiofemoral impingement

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4
Q

what are some lateral hip pathologies?

A

external snapping hip

ITBS

glut med/min pathology

greater trochanter bursitis

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5
Q

what are the 3 general MOI for pain and/or disability?

A

overuse situation

chronic degeneration

acute trauma

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6
Q

what things are a part of a pt’s PMH?

A

cardiac

surgery

meds

cancer

asthma

diabetes

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7
Q

what are the components of the examination?

A

sensation

DTRs

AROM

PROM

accessory motion

MMTs

palpation

clinical tests

functional tasks

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8
Q

what are radiographs used for?

A

fx

dislocations

arthritis

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9
Q

what are MRIs used for?

A

best choice for injuries to acetabular labrum and articular cartilage

femoroacetabular impingment

avascular necrosis of femoral head

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10
Q

what are CTs used for?

A

to distinguish fx in the acetabulum

localizing position of fx fragments

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11
Q

what are musculoskeletal USs used for?

A

primary choice to detect DDH in neonatal hips

guide aspiration procedure

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12
Q

what are current s/s of hip pathology?

A

tasks that are challenging

snapping, catching, locking

magnitude of pain

location of pain (C-sign)

referral patterns

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13
Q

t/f: leg length discrepancies always have a great impact on the treatment and pathology

A

false

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14
Q

what is the clinical presentation of pediatric hip pathology?

A

assymetry of the thighs or gluteal folds

limitation of hip abd

unequal femoral length

abnormal gait pattern

(+) Ortolani test

(+) Barlow test

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15
Q

what are abnormal gait patterns that may be seen in pediatric hip pathologies?

A

toe walking

in-toeing gait

out-toeing gait

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16
Q

t/f: the success of the Pavlik harness decreased in pts older than 4 months

A

true

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17
Q

what does a Pavlik harness do?

A

holds the hip at 90-100 degrees of flexion

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18
Q

what are some long term effects of DDH?

A

gait dysfxn

hip pain

DJD of hip

early onset THA

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19
Q

what is avascular necrosis (Legg-Calve-Perthes Disease)?

A

damage to vascular supply that may occur at birth

trauma resulting in ischemia

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20
Q

what % of avascular necrosis progresses to lead to collapse of the femoral head?

A

70-80%

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21
Q

what population is avascular necrosis most common in?

A

boys aged 3-13 yo (average 5-7 yo)

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22
Q

what are the s/s of avascular necrosis (Legg-Calve-Perthes disease)?

A

pain in the groin, buttock, proximal thigh

pain exacerbated by weight bearing

decreased ROM

antalgic gait

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23
Q

what are some interventions for avascular necrosis (Legg-Calve-Perthes disease)?

A

emphasis on containment of the femoral head and avoiding collapse

Scottish Rite brace to hold the femur in abd w/the ability to flex

surgical intervention (hip resurfacing vs THA)

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24
Q

what is slipped capital femoral epiphysis (SCFE)?

A

the femoral head slips down and back off the femoral neck

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25
Q

what is the initial symptom of 45% of pts with a SCFE?

A

knee or lower thigh pain

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26
Q

t/f: fx screening of a SCFE can manifest as a compression or tension rxn

A

true

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27
Q

if a pt with a SCFE has a compression rxn, what should be done?

A

reduce WB

therapy

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28
Q

if a pt with a SCFE has a tension rxn, what should be done?

A

NWB often progresses to displacement and needs ORIF

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29
Q

what is the stress fx intervention for SCFE?

A

nutrition

metabolic panal

aquatics

aerobic conditioning

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30
Q

what is the purpose of the patella-pubic percussion test?

A

to assess for osseous pathology

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31
Q

what is the position for the patella-pubic percussion test?

A

supine w/the stethoscope on the pubic symphysis

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32
Q

what is the technique of the patella-pubic percussion test?

A

percuss or vibrate tuning fork on the patella and compare BL to hear for difference in sound

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33
Q

what would be a positive result of the patella-pubic percussion test?

A

decreased sound transmission when compared BL

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34
Q

what are the stats for the patella-pubic percussion test?

A

sensitivity=excellent

specificity=high-excellent

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35
Q

t/f: you should always ask WHERE the pain is when doing special tests

A

true

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36
Q

what is the purpose of the sign of the buttocks?

A

to assess for hip pathology, neoplasm, or abscess

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37
Q

what is the position for the sign of the buttocks?

A

supine

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38
Q

what is the technique for the sign of the buttocks?

A

performs passive SLR, note the angle of hip flexion that symptoms occur in

flex the hip and knee and compare the angle of hip flexion that symptoms occur at w/the SLR angle

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39
Q

what is a (+) test for the sign of the buttocks?

A

hip flexion angle isn’t greater than the SLR angle

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40
Q

what are the stats on the sign of the buttock?

A

no data

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41
Q

what is the purpose of the fulcrum test?

A

to assess for femoral shaft stress fxs

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42
Q

what is the position for the fulcrum test?

A

sitting, knees flexed, feet off the floor

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43
Q

what is the technique for the fulcrum test?

A

weave your arm under the involved femur to serve as a fulcrum

apply a posterior force to the distal femur

44
Q

what is a (+) fulcrum test?

A

sharp pain with force

45
Q

what are the stats on the fulcrum test?

A

sensitivity=excellent

specificity=high

46
Q

t/f: we can always tell if the fall or the fx occurred first

A

false

47
Q

t/f: the WB status of a pt depends on the type of fixation they have

A

true

48
Q

what are some reasons for THA?

A

fx

trauma

dysplasia

JRA and RA

osteonecrosis

malignancy

49
Q

what factors can make a person a poor candidate for THA?

A

systemic co-morbidities

gender

vascular supply

pre-op LEF score

walking speed and TUG

age

weight

dementia

50
Q

with posterior approach THA, what muscles are involved?

A

violates the piriformis and short ER

preserves the glut med and min

51
Q

what are the concerns with posterior approach THA?

A

problem w/hip flexion causing DL

52
Q

what muscles are involved in posterio-lateral THA?

A

splits the glut med

53
Q

what are the concerns with the posterio-lateral approach THA?

A

lurching gait

54
Q

what muscles are involved in the lateral approach THA?

A

splits glut med and ITB

55
Q

what are the concerns with the lateral approach THA?

A

lurching gait

56
Q

what muscles are involved in the anterio-lateral approach THA?

A

detaches 1/3 glut med

57
Q

what are the concerns with the anterio-lateral approach THA?

A

takes longer and increased risk of HO

58
Q

what muscles are involved in the anterior approach THA?

A

splits the ITB and sartorius

59
Q

what are the concerns with the anterior approach THA?

A

takes longer and higher femur fx rate

60
Q

what are the precautions with the posterior approach THA?

A

no flexion >90 degrees (trunk on LE and LE on trunk)

no adduction past midline

clients shouldn’t sit in lower chairs for at least 6-8 weeks bc loads of 8x body weight can be produced at the hip jt when rising to stand

61
Q

t/f: there is a reduced DL rate after hip arthroplasty for femoral neck fxs when changing from posteriolateral to anteriolateral approach

A

true

62
Q

what are the risks of THA?

A

DL

HO

infection

leg length discrepancies

DVT

63
Q

what are the 2 general categories of hip impingements?

A

femoroacetabular (FAI) - anterior

ischiofemoral (IFI) - posterior

64
Q

is an FAI anterior or posterior impingement?

A

anterior

65
Q

is an IFI anterior or posterior impingement?

A

posterior

66
Q

does anterior or posterior hip impingement cause asynchronous patterns of movement w/end range ER?

A

posterior impingement

67
Q

painful palpation of the external rotators may point to what syndrome?

A

deep glut syndrome (sciatic/piriformis)

68
Q

painful palpation of the ischial tuberosity may point it what syndrome?

A

ischial tunnel syndrome

69
Q

what are the s/s of posterior hip impingement?

A

peripheral nerve entrapment syndrome of the sciatic nerve

reproduction w/resisted ER

reproduction w/FAdIR

palpable MTrPs and/or hypertonic bands

radiating neurologic symptoms w/any of the above maneuvers

dull ache in buttocks that may radiate

tenderness to the deep palpation (92%)

pain with sitting (76%) and walking but decreased when in supine

pain with resisted hip extension and passive IR/add

70
Q

what is the active piriformis test?

A

in SL on the involved LE up in a clamshell position, palpate the piriformis and resist ER and abd

71
Q

what is a (+) active piriformis test?

A

reproduction of pain

72
Q

what is the seated piriformis stretch test?

A

seated with the knee extended, palpate about 1 cm lateral to the ischium and passively lower the leg into hip add and IR

73
Q

what is a (+) seated piriformis stretch test?

A

pain with passive motion

74
Q

what are the clustered metrics for the active piriformis and passive seated stretch tests?

A

sensitivity=91%
specificity=80%

75
Q

what is ischial tunnel syndrome?

A

thickening of the HS tendon

posterior thigh pain aggravated by running

76
Q

what are the clinical tests for ischial tunnel syndrome?

A

active 30/90 and long stride

77
Q

what is the active 30/90 test?

A

in sitting flex the hip to 30 degrees then 90 degrees and palpate the conjoint tendon lateral or the ischial tuberosity and resist knee flexion for 5 seconds

78
Q

what are the clustered metrics for the active 30/90 and long stride tests?

A

sensitivity=96%

specificity=73%

(+)LR=3.61

(-)LR=0.05

79
Q

what is ischiofemoral impingement?

A

narrowing of the space bw the ischial tuberosity and lesser trochanter

abnormalities of the quad fem ranging from deformity and edema to tears and atrophy

hip pain radiating to the med thigh

80
Q

IFI is most associated with what?

A

trauma or surgery

81
Q

what is the IFI test?

A

with the pt in SL, passively extend the hip in neutral and/or add

w/complaints of pain lateral to the ischium, repeat w/hip in abd

82
Q

what is a (+) IFI test?

A

pain w/extension when the hip in in add that is relieved when the hip is in extension with abd

83
Q

what are the stats for the IFI test?

A

sensitivity=82% (56-95%)

specificity=85% (54-97%)

84
Q

t/f: FAI (anterior) has a relationship to neonatal hip deviations

A

true

85
Q

what is FAI caused by?

A

abnormal contact bw the femur and the acetabulum

86
Q

what population tends to be more affected by FAI?

A

younger ppl who push the extremes of hip ROM esp with pivoting IR (10x risk)

gymnastics, hockey, soccer, breast stroke

87
Q

what is a cam lesion (FAI)?

A

osseous abnormality (bone bump) at the femoral head-neck junction

abnormality of the femur

impact damages articular cartilage

88
Q

what is a pincer lesion (FAI)?

A

abnormality of the boney acetabulum leading to over coverage of the femoral head

damage to the labrum

89
Q

what is a mixed FAI lesion?

A

cam and pincer (femur and acetabulum bone bump)

90
Q

what is the FAI presentation?

A

when asked where the hip hurts, client will cup their hip just above the greater trochanter (c-sign)

groin pain w/FAdIR test

sharp pain/clicking and giving away

pain w/stair climbing and prolonged sitting

difficulty with max squat or making cuts

91
Q

what is the c-sign?

A

when asked where the hip hurts, the client with cup their hip just above the greater trochanter

92
Q

what is the FAdIR test technique?

A

passive hip flexion, add, and IR

93
Q

what is a (+) FAdIR test?

A

reproduction of pain

94
Q

what are the stats for the FAdIR test?

A

sensitivity=excellent

FAdIR + FAbER sensitivity=excellent

FAdIR + FAbER + resisted SLR +Thomas test specificity=excellent

95
Q

what is the impingement test positon?

A

supine 90/90

96
Q

what is the impingement test technique?

A

passive IR, some clinicians recommend adding some axial compression and overpressure to IR

97
Q

what is a (+) impingement test?

A

pain into the groin

98
Q

what are the stats of the impingement test?

A

sensitivity=poor-excellent

specificity=poor-high

w/axial compression and IR overpressure sensitivity=high, specificity=poor

99
Q

what is the maximal squat test used for?

A

detecting a cam lesion (FAI)

100
Q

what is the maximal squat test technique?

A

perform a deep squat

101
Q

what is a (+) maximal squat test?

A

pain limiting ability to complete the squat

102
Q

what are the stats for the maximal squat test?

A

sensitivity=high

specificity=poor

103
Q

what is an intervention that is typically not helpful for FAI?

A

injections

104
Q

what are some acute interventions for FAI?

A

3-5 days of cold application

activity modification about 6 weeks

NSAIDs

105
Q

when inflammation decreased in FAI (about >5 days), what are some interventions?

A

stationary bike w/seat elevated

stretch prn (piri, illiospoas, quads, ITB)

strengthening prn (glut med, ER, and core musculature

functional balance exercises begin w/1 leg activities and progress to sport specific exercises

106
Q

if conservative therapy for FAI is unsuccessful, what may be done?

A

surgical ex

correction of the abnormal shape of the femur (cam), acetabulum (pincer), or both mixed)

107
Q

what are some interventions for immediate post-op debridement?

A

cryotherapy

gentle ROM in mid-range

post op bracing

NWB-PWB w/crutches about 2-4 weeks

DPT 616 : MSK (15 decks)

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