Hip P! with Mobility Deficits Flashcards
What may you hear during the Subjective Hx with these patients?
- Insidious onset of stiffness and global pain
- Typically pain and stiffness worsens over time
- Worse in morning and with prolonged positioning, eases with movement
- Reports limited ROM eventually resulting in activity limitations and participation restrictions
- Aggravating Factors: Endrange hip motions; IR and Flex tend to be most provocative
What Objective Finding may you find with these patients?
- Limited AROM and PROM; if mobility deficits are a result of a joint integrity deficit than a capsular pattern may be present
- Possibly impaired joint integrity/mobility
- Possibly limited muscle length
What is the Prognosis for Hip P! with Mobility Deficit?
- Dependent upon integrity of joint
- Mobility deficits typically improve with interventions targeting joint mobility and pain control, if needed
What interventions are typically done with Hip P! and Mobility Deficit pts?
- Mobility/ROM exercises
- Manual Therapy
- Functional Optimization
If a Patient is in the Acute stage of condition, what should we the PTs do?
- These pt may require symptom modulation approach depending upon severity and irritability; also may present with somatic referred pain
If a patient is in the Subacute stage of condition, how may a patient present?
- The patient may begin to present with indications of movement and coordination impairments as mobility increases and motor control is impaired due to prolonged lack of mobility
If a patient is in the Chronic stage of healing, what do we, the PTs, do in this stage?
- Continue to address endrange mobility deficits, continue to
improve movement and coordination impairments, and work towards functional optimization
What are the Primary S/S of Symptomatic Hip OA?
- Joint pain, joint stiffness, and activity associated limitations/participation restrictions
What are some risk factors for Hip OA?
- Family Hx
- Obesity
- Hypermobility of the joint
With Symptomatic Hip OA, what are the 4 diagnostic critera (CPG)?
- Moderate anterior or lateral hip pain with weight-bearing activities
- Morning stiffness lasting less than 1 hour in duration
- Hip IR < 24 degrees or Hip IR and Flexion 15 degrees less than the asymptomatic hip
- Increased Pain with passive Hip IR
-P! may be felt in the butt, groin, thigh or knee. Can be a dull to sharp and stabbing pain
What is the Sutlive et al. Diagnosis Criteria for those with Hip OA? (5)
- Self-reported squatting as an aggravating factor
- Scour test with adduction causing groin or lateral pain
- Active hip flexion causing lateral pain
- Active hip extension causing hip pain
- Passive hip internal rotation less than or equal to 25°
What Outcome Measures should be completed with patients with Symptomatic Hip OA?
- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
- Hip Disability and Osteoarthritis Outcome Score (HOOS),
- Harris Hip Score (HHS)
- Lower Extremity Functional Scale (LEFS
Patients with Symptomatic Hip OA, what other test and measures should be done during the Examination?
- Balance performance and activities that predict risk of falls should be measured
(Berg, Timed Single Leg Stance Test) - Use FABER (Patrick’s) Test, Assess hip PROM, Assess hip muscle strength
How can you differentially diagnose between Hip OA and RA?
Sx that include prolonged morning stiffness (>1 hour) should raise suspicion of inflammatory arthritis such as RA
What intervention should be done to those patients with Symptomatic Hip OA?
- Manual therapy: thrust and non-thrust, and soft-tissue mobilization. As hip motion improves add exercise.
- Individualized flexibility, strengthening, and endurance exercises to address identified impairments of body function
- Bracing should not be used as an initial intervention
- Clinicians should collaborate with physicians and dieticians to support weight reduction in individuals with hip OA who are overweight or obese
