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THEREX 2 > Hip Lecture > Flashcards

Hip Lecture Flashcards

1
Q

How can you increase a patients proprioception during a treatment?

A

Eyes closed

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2
Q

What do you need for dynamic stability

A

Proprioception and kinesthesia

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3
Q

Squat has the most force:

Open chain leg extension has the most force:

A

squat: in deepest position

Open chain: at the end range of ext

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4
Q

The acetabulum is oriented:

the femur is oriented:

A

anterior, lateral, inferior

anterior, medially, superiorly

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5
Q

What is the normal angle of inclination?

A

125

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6
Q

What is considered coxa vara?

Coxa valga?

A

Under 110

Over 140

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7
Q

What is the most congruent position for the hip

A

Flex, Abd, lateral rotation

Open packed position

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8
Q

What muscle limits abduction?

What muscle limits adduction?

A

Gracilis

TFL and ITB

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9
Q

What is normal hip Flexion?

Ext?

Abducton?

Adduction?

A

120 or 90 depending on knee position

10-30

45-50

20-30

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10
Q

How much ROM do you need for gait?

Flexion:

Ext:

Ab/ad/er/ir

A

30

10

5/5/5/5

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11
Q

in close chain, anterior pelvic tilt causes hip __________

posterior pelvic tilt produces hip ___________

A

flexion

ext

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12
Q

If you hike one side of your pelvis, what motion happens at the hip on that same side

what happens at the opposite side?

A

adduction

abduction

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13
Q

rotating backwards on your stance leg produces what rotation of the hip?

rotating forward?

A

lateral rotation

medial rotation

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14
Q

Forward bending sequence:

A
  1. Head and upper trunk initiates flexion
  2. pelvis shifts posterior
  3. Trunk continues to bend forward controlled by extensors
  4. pelvis rotates and tilts anteriorly
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15
Q

In BL stance, the line of gravity creates an __________ moment counterbalanced by _________

A

extensor moment

iliopsoas

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16
Q

What is the best way to target the glute med MMT?

A

Hip Abd, ER, Extension w/ knee straight

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17
Q

What is the primary Hip Abduction compensator?

A

TFL

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18
Q

What are the 2ndary Hip ER muscles?

A
  1. Post glute med & min
  2. Sartorius
  3. Biceps fem long head
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19
Q

What are the primary Hip IR muscles?

A

Trick Question!

there are none!

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20
Q

What are the 2ndary Hip IR Muscles?

A
  • Ant glute med
  • Ant glute min
  • TFL
  • ADductors
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21
Q

In Ober’s Test, if it is a (+) test what does that mean?

A

Tight IT Band

Tight in Internal Rotation (the bony structures aren’t allowing IR)

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22
Q

If I create compression around the Greater Trocahnter area, and there is pain, what structure may be the primary pain generator?

A

Bursa

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23
Q

If I have the patient contract or resist and that causes pain, what may be the primary pain generator?

A

Tendon

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24
Q

If I have the patient stretch and that causes pain, what may the primary pain generator?

A

Peritendon (covering of a tendon)

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25
Q

For the Iliopsoas should we test in sitting flexion or supine?

A

Supine

he said with sitting flexion, they tend to compensate and lean back and the hip is already flexed

26
Q

Testing Hamstrings, if I knee flex and IR, I am testing ______

if I knee flex and ER, I am testing _____

A

Semimem & Semiten

Biceps Fem

27
Q

What is the most lateral attachment on the Isch Tub?

A

Semimembranosus

28
Q

[review hip tendon palpation - the clock]

A
29
Q

When measuring LLD, what landmarks should we use most of the line? (acc. to Palumbos)

A

Greater Trochanter –> Lat Mall

(instead of ASIS because if there is an upslip or SIJ issue, measuring from the GT won’t account for that) be careful of the exception

30
Q

[note: add x-ray pics]

A

ok

31
Q

Do we want the primary movers to be stronger than our stabilizer muscles?

A

NO = that is a problem!

32
Q

What is a PAIL?

A

Isometric contraction of the muscle in a lengthened position

33
Q

What is a RAIL?

A

Isometric contraction of the tissue in a shortened position

34
Q

What are the benefits of PAILS/RAILS?

A
  • bypass the stretch reflex
  • creates cortical mapping
  • increase neural drive to the tissue
  • cause a cellular adaptation in the tissue
  • increase blood flow to both tissue
35
Q

What does PAIL stand for?

RAIL

A

Progressive/Regressive Angular Isometric Loading

36
Q

When we ask the patient to abduct their hip in sidelying, what are we likely to see?

A

Abduction with hip flexion

iliopsoas is dominant even in abduction & TFL kicks in

37
Q

When testing glute max MMT, what position do we have their hip in?

A

30 degrees abduction to make it a prime mover

38
Q

When testing the PGM, what position do we place the hip?

A
  • hip Extension
  • ER
  • ABDuction
39
Q

When testing Glute Min, what position do we place the hip?

A
  • Abduction
  • Extension

no ER

40
Q

When we want the deep rotators to activate, what position do we put the hip in?

A
  • Abduction
  • ER

no extension

41
Q

When does hip IR occur?

A
  • when extending towards 0 degrees from a flexed position
  • flexed 60-100 degrees
42
Q

Hip Pain with Mobility Deficits CPG

  • Pain of ______ onset, first with WB
  • moderate ____ or ____ hip pain during WB
  • morning stiffness < ____ in duration
  • hip IR ROM < ___ degrees
  • IR and hip flexion ___ less than nonpainful side
  • increased hip pain with ____ hip IR
A

Hip Pain with Mobility Deficits CPG

  • Pain of insidious onset, first with WB
  • moderate anterior or lateral hip pain during WB
  • morning stiffness < 1 hour in duration
  • hip IR ROM < 24 degrees
  • IR and hip flexion 15 degrees less than nonpainful side
  • increased hip pain with passive hip IR
43
Q

Sutlive Hip OA CPR

  • self-reported ____ causes symptoms
  • active hip ____ causes lateral hip pain
  • Scour test with ____ causes lateral hip or groin pain
  • Active hip __ causes pain
  • Passive IR is <= ____ degrees
A

Sutlive Hip OA CPR

  • self-reported squatting causes symptoms
  • active hip flexion causes lateral hip pain
  • Scour test with adduction causes lateral hip or groin pain
  • Active hip extension causes pain
  • Passive IR is <= 25 degrees
44
Q

Non-Arthritic Hip Joint Pain CPG: FAI

  • structural variations may result in abnormal contact between femoral head-neck junction and ______ rim
  • associated with ____ and ____ damage
  • combination of pincer/cam is most common
  • ____ can also cause FAI
  • FAI can lead to development of ______
A

Non-Arthritic Hip Joint Pain CPG: FAI

  • structural variations may result in abnormal contact between femoral head-neck junction and acetabular rim
  • associated with labral and chondral damage
  • combination of pincer/cam is most common
  • SCFE can also cause FAI
  • FAI can lead to development of secondary hip OA
45
Q

CAM FAI is on the _____

Pincer FAI is on the_____

A

CAM: femoral head/neck

Pincer: acetabulum

46
Q

Which impingement is more common in younger males?

A

CAM

47
Q

Which impingement is more common in middle-aged, active women?

A

Pincer impingement

48
Q

What are the functions of the labrum?

A
  • deepens the socket
  • decreases forces
  • negative intra-articular pressure creating a seal
  • may play a role in proprioception
  • potential source of pain
49
Q

T/F: we see increased incidence of acetabular labral tears with increased age.

A

True

50
Q

Age we see Legg-Calve-Perthes (LCPD) in?

It is a deformity of ____ ___

A

Children 4-8 years old

Deformity of the femoral head

51
Q

Usually LCPD presents as ______, then as it progresses there may be pain in_____

A

Painless limp

Pain in the hip/groin/thigh/knee

typically male & family history

52
Q

Examination of LCPD includes:

A
  • decrease hip IR and ABD
  • Trendelenburg
  • TTP
  • affected leg may be short (in severe cases)
  • anterior thigh atrophy
53
Q

LCPD is an example of when we want to use what 2 landmarks to measure LLD?

A
  • ASIS to lat mall to account for the femoral head deformity
54
Q

We usually see SCFE in what age?

displacement of ______

A

10-15 overweight kids

displacement of femoral neck

55
Q

Examination of SCFE includes:

A
  • decreased hip IR, ABDuction, flexion
  • LE goes into ER with passive hip flexion
  • hip TTP
56
Q

THA posterior precautions

A
  • no hip flex > 90 degrees
  • no hip IR
  • no adduction beyond neutral
  • no combined
57
Q

THA anterior precautions

A
  • no hip ext/ER beyond neutral
  • no bridging, prone lying, no combined
  • when supine, keep hip flexed >=30 degrees
  • pillow under pt’s knees and raise head of bed
58
Q

THA lateral precautions

A
  • hip ABD restrictions
59
Q

Hip Labral Tear

Things to avoid post-op 1st month

  • Active Hip ____
  • ER > ___
  • ROM outside of ____ - ____
  • Walking with ___ lbs of pressure through surgical limb
  • TTWB
  • Hip Ext > ___
  • Hip ABD > ___
A

Hip Labral Tear

Things to avoid post-op 1st month

  • Active Hip Flex
  • ER > 20
  • ROM outside of 0 - 90
  • Walking with 20 lbs of pressure through surgical limb
  • TTWB
  • Hip Ext > 0
  • Hip ABD > 20
60
Q

Hip Microfracture Precautions

  • Control WB forces for ___ weeks
  • Protect against excessive forces onto hip joint
  • Promote ____ ____ healing
  • Limit aggressive functional activities until advices by physician
A

Hip Microfracture Precautions

  • Control WB forces for 8-10 weeks
  • Protect against excessive forces onto hip joint
  • Promote articular cartilage healing
  • Limit aggressive functional activities until advices by physician
61
Q

Hip Microfracture WB Progression

Weeks 0-4:
Week 4-6:
Week 7-8:
Week 8-10:

A

Hip Microfracture WB Progression

Weeks 0-4: TTWB with 2 crutches
Week 4-6: 25% BW w/ 2 crutches
Week 7-8: 50-75% BW w/ 2 crutches (goal is full by end of week 8)
Week 8-10: weaning off the crutches

THEREX 2 (12 decks)

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