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Ortho UE > hip lecture > Flashcards

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
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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
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3
Q

anteversion

A

anterior orientation of the femoral head leading to in toeing

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4
Q

retroversion

A

posterior orientation of the femoral head leading to out toeing

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5
Q

MOI of avascular necrosis of the femoral head

A

variable areas of dead trabecular done due to decreased blood flow

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6
Q

Subjective of avascular necrosis of the femoral head

A
  • pain in the groin
  • “throbbing and deep”
  • intermittent and gradual onset
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7
Q

Objective of avascular necrosis of the femoral head

A
  • lateral lean in gait
  • painful ROM with IR
  • pain with SLR
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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)
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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

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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
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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
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12
Q

px and tx for legg-clave-perthes disease

A

conservative: try to manage and remodel tissue to restore ROM

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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

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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
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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
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16
Q

what is the tx and px of slipped capital femoral epiphysis (SCFE)

A
  • symptom relief
  • restore ROM
  • surgical fixation
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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)
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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
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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
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20
Q

tx and px of stress fx to the femoral neck

A
  • treated surgically
  • once pain free begin to wt bear
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21
Q

hamstring strain MOI

A

strain or rupture of one or more of the hamstring muscles. usually tears during eccentric loading

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22
Q

hamstring strain Subjective

A
  • immediate pain
  • might hear a pop
  • posterior thigh pain worsened with knee flexion
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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
Q

MOI of hip Adductor tendinopathy

A
  • repeatitive loading with twisting
  • muscular imbalance
  • add long most commonly affected
26
Q

Subjective of hip adductor tendinopathy

A
  • 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
Q

Objective of hip adductor tendinopathy

A
  • pain with palpation
  • pain with PROM abd
  • pain with AROM or MMT Add
    0 degrees= gracillis
    45 degrees = add long
    90 degrees = pectineus
28
Q

px and tx for hip adductor tendinopathy

A

depends on the phase of recovery
RICE, Isos, stretching, concentric, eccentric, PNF

29
Q

MOI of OA of the hip

A

repeatitive weardown of the cartilage

30
Q

subjective for OA of the hip

A
  • insidious
  • dull and achy
  • groin, thigh, butt, or knee
  • increased with activity
  • increased when climbing stairs or putting socks on
31
Q

objective for OA of the hip

A
  • 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
Q

px and tx for OA of the hip

A
  • avoid end range
  • swimming or cycling
  • decrease body weight
  • manual resistance techniques for mobilization
  • passive stretches
  • strengthening for hip and trunk stabilizers
33
Q

MOI of snapping hip

A
  • 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
Q

snapping hip subjective

A
  • 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
Q

snapping hip objective

A
  • 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
Q

tx for snapping hip

A

improve muscle length and correct muscle strength imbalances

37
Q

MOI of trochanteric bursitis

A
  • inflammation of the bursa near the great tro
  • 2nd most common cause of lateral knee pain
38
Q

subjective of trochanteric bursitis

A
  • 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
Q

objective of trochanteric bursitis

A
  • pain with palpation or ITB stretching
  • pain with resisted Abd, EX or ER
  • tightness of ADD
  • positive obers and modifies obers
40
Q

tx and px of trochanteric bursitis

A
  • 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
Q

MOI of hip labral tears

A
  • trauma
  • FAI
  • capsular laxity
  • hypermobility, dysplasia
  • often go un dx
42
Q

subjective of hip labral tears

A
  • anterior hip or groin pain
  • often mechanical symptoms of clicking, locking, and giving way
43
Q

objective of hip labral tears

A
  • positive anterior hip impingement test
44
Q

tx and px of hip labral tears

A

conservative PT for 10-12 weeks
- limit pivoting motions that increase the force along the joint
- strengthen inhibited muscles
- assess foot motion

45
Q

what is FAI

A

contact between the femoral head and the acetabulum can be a CAM or a Pincer

46
Q

CAM FAI

A

boney promidence on neck and head junction impinges the the rim of the labrum ; provocated with FADDIR
- can lead to superior OA

47
Q

Pincer FAI

A

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
Q

what is the subjective of FAI

A
  • 20 to 40 y.o.
  • ideopathic or repeatitive end range hyperextension or flexion with abd
  • C sign
  • dull and aching
  • pain with sitting
49
Q

what is the objective of FAI

A
  • 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
Q

things to avoid with FAI

A
  • 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
Q

FAI post op rehab phase 1

A
  • 0-4 weeks post op
  • protect restored tissue, restore ROM, control pain and inflammation, restore neuromuscular control
  • WBAT
52
Q

when can a leg press be initiated into rehab post op FAI

A

week 6

53
Q

FAI post op rehab phase 2 - intermediate

A
  • 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
Q

FAI post op rehab phase 3- Advanced

A
  • 6-8 weeks
  • hip flexion strength at 70% all others at 80 or more
  • TRX closed chain and ballistic movemets and bosu balancing
55
Q

FAI post op phase 4: sport specific

A
  • 8-16 weeks
  • hip flexor strength at 85%
  • sport specific plyo and multidirectional agility drills
  • progressive jogging at week 12

Ortho UE (4 decks)

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