hip pathologies Flashcards
1
Q
what is OA?
A
degenrative condition affecting joints
damage to joint surface
irregular loss of ac
2
Q
Why does a joint w/ OA become hypo-mobile over time?
A
thickening of the subchondral bone
3
Q
what happen to the muscles around a joint affected by OA?
A
muscles are hypertonic due to aims to provide more stability
4
Q
what happens to the ligament and capsule as they try to stabilize joint w/ OA
A
stress that leads to irritation/thickening and scar tissue leading to joint hypomobility
5
Q
what happens to bones as a result oif the increase tension on the ligaments and capsule due to OA
A
increase tension leads to stress on bone and it will try to heal itself; as such osteophytes will form and lead to deformity
6
Q
what are the most common risk factors associated w/ OA
A
- females
- age
- stress/abnormal loadingh
- overuse
- previous injury to the joint
- obesity
- joint misalignment
- underloading
7
Q
how does OA compare to RA
A
OA tends to be assymetrical
8
Q
characteristics of OA
A
pt > 50 asymmetrical pain am stiffness < 30 min swellinh loss ROM weak surrounding ms
9
Q
how to assess for hip OA?
A
- presence of pain in the hip and
IR hip < 15 degrees and ESR less or equal to 45 degree mm/H OR hip IR greater or equal to 15 degreres and am stiffness less than 60 min and over 50 yo
10
Q
where is the pain site for hip OA
A
Groin deep Buttocks Anterior thigh Knee (referred) Pain site will be asymmetrical
11
Q
what is the MOI for hip OA
A
insidious onset
progressive disease
12
Q
what is the pain pattern for hip OA
A
initially c/o pain
over time c/o stiffness and decreased ROM
13
Q
w/ hip OA what is generally the first mvmt to be limited?
A
flexion
14
Q
what muscles may be atrophied w/ hip OA?
A
glute med and max
15
Q
what functional tests can be performed to assess for hip
A
unilateral WB trendelenberg proprioception pain w/ squatting gait assessment
16
Q
what are the stages of OA?
A
- ms reaction, mvmt reaction
- contracture
- bone ankylosing, osteophytes
17
Q
what happens to ROM in the first stage of OA?
A
reduced IR especially w/ hip extended, decreased flexion, add, decreased FABER
decreased extensioon, abd, ir in CPP
18
Q
how is the hip EF w/ OA in the first stage?
A
hypertonicity
19
Q
how is EF in 2nd stage of hip OA?
A
early Capsular
loss of IR > flexion, abd > extension
20
Q
how is the EF in the 3rd stage of hip OA?
A
bone to bone
21
Q
what is often a cause for back pain in pts?
A
hip problems
22
Q
how is risom in pts w/ hip OA?
A
weakness or inhibition w/o pain often due to glute weakness
23
Q
how is palpation in pt w/ hip OA?>
A
pain around ms joint
ms may have increased tone and tension
24
Q
what are some hip OA questionnaires that can be used?
A
WOMAC
LEFS
HHS
25
what conservative Rx can be used for OA
- pt education on lifestyle modifications
- pain management and self management
- weight control
26
What can be used to treat for pain of oa?
ice
tens
ifc
27
how can hypertonicity be reduced in oa?
```
static distraction
traction
compression
massage
STT
dry needling
```
28
how to improve flexibility w/ hip OA?
HEP
| massage
29
how to improve ROM w/ hip OA?
AROM/PROM
| passive acessory glides of the hip
30
how can traction be helpful to joints w/ oa?
improves cartilage nutrition and lubrification
31
how to improve str?
w/ reduced pain go from NWB to WB
32
what is the GLAD program?
clinical guidelines for Rx of the hip and knee OA in order to proved high quality care
33
what is the purpose of GLAD?
```
Reduce pain
Reduce med intakes
Improve physical function and physical activity
Improve QoL
Reduce number of patients on sick leave
```
34
what data from GLAD was obtained from danemark?
-pain improved (not clincially sign ificant)
important physical function and act at 3 months
-decreased use of painkillers
less pts on sickleave after 1 year
better response in knee > hip OA
35
what data from GLAD was obtained from canada`
```
improved pain (cvlinically significant difference)
improved function and QoL
no change in med intake
decrease BMI
```
36
myofascial imbalances are caused by what?
stiff muscles and weak muscles
37
what are common muscles to be stiff in the hip that may lead to myofascial imbalances?
```
iliopsoas
erector spinae
TFL
adductors
rectus femoris
hamstrings
External rotators
```
38
what are common muscles to be weak in the hip that may lead to myofascial imbalances?
glute max
glute med/min
quads
abductors
39
what ms is most commonly affected by adductor ms strain?
adductor longus
40
what are risk factors associated to add ms strain?
previous groin injury
higher level of play
decrease add STR of the hip
lower level of sports specific training
41
what is the pain site of adductor ms strain?
groin pain
anterior hip pain
pain at mT junction
42
what is the MOI of add ms strain?
sudden onset
| ms contraction when ms is stretched often associated w/ sudden changes in direction or rapid accelertation/decceleration
43
what is the pain pattern associated w/ add ms strain?
PROM: pain w/ passive abd at EOR
| AROM/risom: pain w/ add and add and flexion
44
what may be observed w/ add ms strain?
bruising and discoloration, slightly lower that region of strain due to effect of gravity on bleeding
45
how to treat add ms strain in the inflammatory phase?
police to reduce pain and inflammation
| discontinue activtiy and sport
46
how to treat add ms strain in the proliferative phase?
```
rehab on progressive STR (add, flexion of the hip, abd and core work)
use holmich protocol
proprioception
STT
avoid stretching
```
47
what is holmich’s protocol?
use of a criteria based protocol rather than a time based protocol
48
what exercises are suggested to pt in initial stages of hip add strain?
isometric ankle w/ ball or isometric add squeeze w/ crook lying
49
as you progress from the initial stage what exercises are suggested to pt w/ hip add strain?
```
side lying hip add
hip add lateral slide
hip add w/ elastic band or pulley
copenhagen add exercise
sport specific exercises
```
50
how to monitor exercise progression for hip add ms strain in rehab?
pain level before and after; dont want it to increase b yh more than 2/10
PROM hip abd immediately post exercise
51
how long should rehab last for hip add strain?
8-12 weeks minimum but continue specific exercises for at least 1 year
52
why is it important to treat add ms strain properly?
avoid longstanding groin pain
| avoid risk of re-injury
53
what may cause pain in ITBFS
overuse where fat pads and connective tissue of the lateral femoral condyle gets compressed B/W ITB and lateral femoral condyle
54
what are the pathomechanics if ITBFS?
involves multiple segments causing for ms imbalances and compressive loads on the ITB at the level of femoral condyle
55
biomech dysfunction at the knee caused by ITBFS?
--dynmic knee valgus due to weakness of ionhibition of glute med
56
biomech dysfunction at the hip/pelvis caused by ITBFS?
contralateral pelvic drop due to weakness of glute med
57
where is the pain site for ITBFS?
lateral knee more than GT pain
58
how is pain described in ITBFS?
Sharp/burning pain
59
what is the pain pattern associated w/ ITBFS?
Often associated to repeated mvmts s/a running/cycling
| initially irritted w/ knee flexion/extension ~20-30 degrees
60
what funcitonal tests can be performed to assess ITBFS
Trendelenberg
unilateral WB
unilat squat will notice valghus
61
how is rom in ITBFS
Full but the first 20-30 degrees of knee flexion/extension may be painful
62
how is RISOM in ITBFS?
Weakness of glute med and max is possible and also of knee flexors and extensors
63
what tests can be used to assess decreased flexibility of ITB/TFL
ober’s test
| modified thomas test
64
how to treat for itbfs?
pain relief
treat biomech dyusfunction
actibvate and strengthen weak ms
decrease ms tension of ITB
65
what is GTPS an synonym of?
lateral hip pain
66
what is the MOI of GTPS
excessive loading
67
what may cause excessive compressive loads leading to GTPS?
- glute tendon or ITB compressed at GT
- excess static postures
- sitting w/ knees crossed
- excess dynamic postures w/ excess lateral hip tilt
- dynamic knee valgus
- friction or direct impact and activities w/ high eccentric load
68
what is the pain site for GTPS?
Lateral hip joint
| GT area down the lateral thigh
69
what is the pain pattern of GTPS?
Pain when lying on affected side at nigh
pain on SL WB task
pain when leaning or touching affected area
70
is ROM limited in GTPS?
generally not but may have pain w/ active ABD and passive add and w/ risom
71
what functional tests can be performed for GTPS
30 s sustained SLS
72
what special tests can be performed for GTPS
FABER
| resisted external derotation test
73
how can we treat for GTPS?
Rx generally consistent w/ insertional tendinopathy
74
how to treat for pain relief of GTPS if in reactive on degnerative?
Load reduction by removing provocative load, modify sleeping postures
provide isometric exercises taht target glutes more than TFl
75
how to treat for pain relief of GTPS if in tendon disrepair and degeneration
4 stage program
optimization of mvmt patterns
stretch into hip add
76
what is piriformis syndrome
controversial syndrome for buttocks pain
77
what is the MOI for piriformis syndrome
insidious onset
78
what is the pain pattern for piriformis pain syndrome?
mvmt associated w/ stretching of piriformis (flexion, add, er)
muscle hypertonic
79
how is ROM in piriformis syndrome
decreased ROM and pain w/ hip IR w/ hip felxion below 70
decreased rom and pain w/ hip er above hip flexion ~70
decreased rom and pain w/ combined flexion, add and er
80
how to treat for piriformis syndrome`
ms stretch in flexion/add/er
DTF/STT
myofasial release
STR exercises for buttock
