hip lecture Flashcards
1
Q
coxa valga
A
- angle of the femoral head larger then 140
- leads to knee varus
- decrease the moment of the movement arm into ABD
- increase stress along the joint surface
2
Q
coxa vera
A
- angle of the femoral head less then 106
- lead to knee valgus
- more likely to fx
- increase downward shear forces of the femoral head
- increase moment of the movement arm into ABD
3
Q
anteversion
A
anterior orientation of the femoral head leading to in toeing
4
Q
retroversion
A
posterior orientation of the femoral head leading to out toeing
5
Q
MOI of avascular necrosis of the femoral head
A
variable areas of dead trabecular done due to decreased blood flow
6
Q
Subjective of avascular necrosis of the femoral head
A
- pain in the groin
- “throbbing and deep”
- intermittent and gradual onset
7
Q
Objective of avascular necrosis of the femoral head
A
- lateral lean in gait
- painful ROM with IR
- pain with SLR
8
Q
tx and px for avascular necrosis of the femoral head
A
- restore ROM
- more success in early stage (will need surgical intervention in later stage)
9
Q
MOI for legg-clave-perthes disease
A
idiopathic osteonecrosis of the femoral head due to being developed with a lack of blood flow. More common in boys
10
Q
subjective for legg-clave-perthes disease
A
- kids 4-10 years old
- vague ache in the groin that radiates medially
- muscle spasm
- usually unilateral
11
Q
objective for legg-clave-perthes disease
A
- limp and dragging of the leg
- atrophy of the thigh
- positive transelenburg
- out-toeing
- decrease in abd and IR
- might have an hip flexion contracture
12
Q
px and tx for legg-clave-perthes disease
A
conservative: try to manage and remodel tissue to restore ROM
13
Q
MOI for Slipped Capital Femoral Epiphysis (SCFE)
A
displacement of the femoral head through the physis that occurs during an adolescent growth spirt
14
Q
subjective for slipped capital femoral epiphysis (SCFE)
A
- increased pain with activity
- Hx of groin and medial thigh pain
- no Hx of trauma
- mild weakness in leg
15
Q
what is the objective for slipped capital femoral epiphysis (SCFE)
A
- limped gait (out toeing)
- decreased ROM with IR, ABD, and flexion
- passive flexion will often be accompanied by ER
- decreased IR in flexion
- involved limb is shorter
16
Q
what is the tx and px of slipped capital femoral epiphysis (SCFE)
A
- symptom relief
- restore ROM
- surgical fixation
17
Q
stress fx of the femoral neck MOI
A
- accelerated bone remodeling in response to repeated stress
- usually military recruits and athletes
- older people: superior fx (tension fx)
- younger people: inferior fx (compression fx)
18
Q
subjective of a stress fx to the femoral neck
A
- onset of sudden hip pain
- pain in deep thigh
- increased with wt bearing
- night pain
19
Q
objective of stress fx to the femoral neck
A
- usually negative physcial exam
- maybe empty end feel in PROM
- resisted SLR
- Auscultatory pateller pubic percussion
- fulcrum test
20
Q
tx and px of stress fx to the femoral neck
A
- treated surgically
- once pain free begin to wt bear
21
Q
hamstring strain MOI
A
strain or rupture of one or more of the hamstring muscles. usually tears during eccentric loading
22
Q
hamstring strain Subjective
A
- immediate pain
- might hear a pop
- posterior thigh pain worsened with knee flexion
23
Q
hamstring strain objective
A
- tenderness with PROM knee extension and hip flexion
- tender with palpation
- weakness/pain with knee flexion and hip extension
- pain with knee flexion and IR= semis
- pain with knee flexion and ER = bicep fem.
24
Q
px with specific grades and hamstring tears
A
grade 1: continue as tolerated
grade 2: 5-21 days
grade 3: 3-12 weeks
RTS: demonstrate good eccentric control of HS
25
MOI of hip Adductor tendinopathy
- repeatitive loading with twisting
- muscular imbalance
- add long most commonly affected
26
Subjective of hip adductor tendinopathy
- twisting or stabbing pain in the groin area with quick start and stops
- edema or ecchymosis
-symptoms aggrivated with running, directional changes, kicking, single leg exercises, cutting and lunging
27
Objective of hip adductor tendinopathy
- pain with palpation
- pain with PROM abd
- pain with AROM or MMT Add
0 degrees= gracillis
45 degrees = add long
90 degrees = pectineus
28
px and tx for hip adductor tendinopathy
depends on the phase of recovery
RICE, Isos, stretching, concentric, eccentric, PNF
29
MOI of OA of the hip
repeatitive weardown of the cartilage
30
subjective for OA of the hip
- insidious
- dull and achy
- groin, thigh, butt, or knee
- increased with activity
- increased when climbing stairs or putting socks on
31
objective for OA of the hip
- antalgic gait
- restrictions in all planes
- early OA restrictions in IR and ABD or Flex
- pain at end range
- painful resisted hip flexion and add
- + scours
- + FABER
32
px and tx for OA of the hip
- avoid end range
- swimming or cycling
- decrease body weight
- manual resistance techniques for mobilization
- passive stretches
- strengthening for hip and trunk stabilizers
33
MOI of snapping hip
- popping or snapping as the tendons around the hip move over boney promidences
- Internal: Iliopsoas tenosynovitis
- external: ITB or glute max over the great tro
- intra-articular: synovial chondromatosis, lose bodies, fracture fragments, and labral tears
34
snapping hip subjective
- snapping or popping with ambulation over the greater tro
- snapping caused by sublux of the iliopsoas tendon usually is felt in the groin as the hip extends from a flexed position (raising from a chair)
- might be assoiciated with trochanteric bursa
35
snapping hip objective
- ITB felt when asking the pt to stand and rotate the hip
- Iliopsoas can be palpated when asking the pt to extend the hip from a flexed position
- positive obers and thomas
36
tx for snapping hip
improve muscle length and correct muscle strength imbalances
37
MOI of trochanteric bursitis
- inflammation of the bursa near the great tro
- 2nd most common cause of lateral knee pain
38
subjective of trochanteric bursitis
- females 40-60
- pain with lying on involved side
- pain worse with STS
- increase in pain when standing then decrease in pain with inital steps
- increase with walking over 30 mins
39
objective of trochanteric bursitis
- pain with palpation or ITB stretching
- pain with resisted Abd, EX or ER
- tightness of ADD
- positive obers and modifies obers
40
tx and px of trochanteric bursitis
- stretching lateral thigh muscles
- flexibility of the ER, quads, and hip flexors
- strengthening of the hip abductors
- establish muscular imbalances especually between ABD and ADD
41
MOI of hip labral tears
- trauma
- FAI
- capsular laxity
- hypermobility, dysplasia
- often go un dx
42
subjective of hip labral tears
- anterior hip or groin pain
- often mechanical symptoms of clicking, locking, and giving way
43
objective of hip labral tears
- positive anterior hip impingement test
44
tx and px of hip labral tears
conservative PT for 10-12 weeks
- limit pivoting motions that increase the force along the joint
- strengthen inhibited muscles
- assess foot motion
45
what is FAI
contact between the femoral head and the acetabulum can be a CAM or a Pincer
46
CAM FAI
boney promidence on neck and head junction impinges the the rim of the labrum ; provocated with FADDIR
- can lead to superior OA
47
Pincer FAI
over coverage of the femoral head by the acetabulum; acetabulum impinges the neck of the femur which is provocated with hip ex and ER
- can lead to posterior inferior or central OA
48
what is the subjective of FAI
- 20 to 40 y.o.
- ideopathic or repeatitive end range hyperextension or flexion with abd
- C sign
- dull and aching
- pain with sitting
49
what is the objective of FAI
- decrease end range ROM
- positive anterior or posterior impingement test
- pain with FADDIR in CAM
- pain with EX and ER in pincer
- may have a limp
50
things to avoid with FAI
- end range flexion, adduction and IR
- running on a treadmill or narrow trail
- upright cycling (recumbant cycling)
- sitting with hip flexed and a neutral spine for long periods of time
51
FAI post op rehab phase 1
- 0-4 weeks post op
- protect restored tissue, restore ROM, control pain and inflammation, restore neuromuscular control
- WBAT
52
when can a leg press be initiated into rehab post op FAI
week 6
53
FAI post op rehab phase 2 - intermediate
- 4-6 weeks
- progress to pain free gait full weight bearing, full ROM, hip flexion strength 60% all other hip 70%
- precausions: avoiding forceful or ballistic stretching, no use of treadmill, preventing hip and joint contraction
- closed chain, core, and balance (SLS)
54
FAI post op rehab phase 3- Advanced
- 6-8 weeks
- hip flexion strength at 70% all others at 80 or more
- TRX closed chain and ballistic movemets and bosu balancing
55
FAI post op phase 4: sport specific
- 8-16 weeks
- hip flexor strength at 85%
- sport specific plyo and multidirectional agility drills
- progressive jogging at week 12
