Hip Lecture Flashcards
How can you increase a patients proprioception during a treatment?
Eyes closed
What do you need for dynamic stability
Proprioception and kinesthesia
Squat has the most force:
Open chain leg extension has the most force:
squat: in deepest position
Open chain: at the end range of ext
The acetabulum is oriented:
the femur is oriented:
anterior, lateral, inferior
anterior, medially, superiorly
What is the normal angle of inclination?
125
What is considered coxa vara?
Coxa valga?
Under 110
Over 140
What is the most congruent position for the hip
Flex, Abd, lateral rotation
Open packed position
What muscle limits abduction?
What muscle limits adduction?
Gracilis
TFL and ITB
What is normal hip Flexion?
Ext?
Abducton?
Adduction?
120 or 90 depending on knee position
10-30
45-50
20-30
How much ROM do you need for gait?
Flexion:
Ext:
Ab/ad/er/ir
30
10
5/5/5/5
in close chain, anterior pelvic tilt causes hip __________
posterior pelvic tilt produces hip ___________
flexion
ext
If you hike one side of your pelvis, what motion happens at the hip on that same side
what happens at the opposite side?
adduction
abduction
rotating backwards on your stance leg produces what rotation of the hip?
rotating forward?
lateral rotation
medial rotation
Forward bending sequence:
- Head and upper trunk initiates flexion
- pelvis shifts posterior
- Trunk continues to bend forward controlled by extensors
- pelvis rotates and tilts anteriorly
In BL stance, the line of gravity creates an __________ moment counterbalanced by _________
extensor moment
iliopsoas
What is the best way to target the glute med MMT?
Hip Abd, ER, Extension w/ knee straight
What is the primary Hip Abduction compensator?
TFL
What are the 2ndary Hip ER muscles?
- Post glute med & min
- Sartorius
- Biceps fem long head
What are the primary Hip IR muscles?
Trick Question!
there are none!
What are the 2ndary Hip IR Muscles?
- Ant glute med
- Ant glute min
- TFL
- ADductors
In Ober’s Test, if it is a (+) test what does that mean?
Tight IT Band
Tight in Internal Rotation (the bony structures aren’t allowing IR)
If I create compression around the Greater Trocahnter area, and there is pain, what structure may be the primary pain generator?
Bursa
If I have the patient contract or resist and that causes pain, what may be the primary pain generator?
Tendon
If I have the patient stretch and that causes pain, what may the primary pain generator?
Peritendon (covering of a tendon)
For the Iliopsoas should we test in sitting flexion or supine?
Supine
he said with sitting flexion, they tend to compensate and lean back and the hip is already flexed
Testing Hamstrings, if I knee flex and IR, I am testing ______
if I knee flex and ER, I am testing _____
Semimem & Semiten
Biceps Fem
What is the most lateral attachment on the Isch Tub?
Semimembranosus
[review hip tendon palpation - the clock]
When measuring LLD, what landmarks should we use most of the line? (acc. to Palumbos)
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
[note: add x-ray pics]
ok
Do we want the primary movers to be stronger than our stabilizer muscles?
NO = that is a problem!
What is a PAIL?
Isometric contraction of the muscle in a lengthened position
What is a RAIL?
Isometric contraction of the tissue in a shortened position
What are the benefits of PAILS/RAILS?
- 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
What does PAIL stand for?
RAIL
Progressive/Regressive Angular Isometric Loading
When we ask the patient to abduct their hip in sidelying, what are we likely to see?
Abduction with hip flexion
iliopsoas is dominant even in abduction & TFL kicks in
When testing glute max MMT, what position do we have their hip in?
30 degrees abduction to make it a prime mover
When testing the PGM, what position do we place the hip?
- hip Extension
- ER
- ABDuction
When testing Glute Min, what position do we place the hip?
- Abduction
- Extension
no ER
When we want the deep rotators to activate, what position do we put the hip in?
- Abduction
- ER
no extension
When does hip IR occur?
- when extending towards 0 degrees from a flexed position
- flexed 60-100 degrees
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
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
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
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
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 ______
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
CAM FAI is on the _____
Pincer FAI is on the_____
CAM: femoral head/neck
Pincer: acetabulum
Which impingement is more common in younger males?
CAM
Which impingement is more common in middle-aged, active women?
Pincer impingement
What are the functions of the labrum?
- deepens the socket
- decreases forces
- negative intra-articular pressure creating a seal
- may play a role in proprioception
- potential source of pain
T/F: we see increased incidence of acetabular labral tears with increased age.
True
Age we see Legg-Calve-Perthes (LCPD) in?
It is a deformity of ____ ___
Children 4-8 years old
Deformity of the femoral head
Usually LCPD presents as ______, then as it progresses there may be pain in_____
Painless limp
Pain in the hip/groin/thigh/knee
typically male & family history
Examination of LCPD includes:
- decrease hip IR and ABD
- Trendelenburg
- TTP
- affected leg may be short (in severe cases)
- anterior thigh atrophy
LCPD is an example of when we want to use what 2 landmarks to measure LLD?
- ASIS to lat mall to account for the femoral head deformity
We usually see SCFE in what age?
displacement of ______
10-15 overweight kids
displacement of femoral neck
Examination of SCFE includes:
- decreased hip IR, ABDuction, flexion
- LE goes into ER with passive hip flexion
- hip TTP
THA posterior precautions
- no hip flex > 90 degrees
- no hip IR
- no adduction beyond neutral
- no combined
THA anterior precautions
- 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
THA lateral precautions
- hip ABD restrictions
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 > ___
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
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
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
Hip Microfracture WB Progression
Weeks 0-4:
Week 4-6:
Week 7-8:
Week 8-10:
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
