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ORTHO 560 > hip pathologies > Flashcards

hip pathologies Flashcards

1
Q

what is OA?

A

degenrative condition affecting joints
damage to joint surface
irregular loss of ac

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2
Q

Why does a joint w/ OA become hypo-mobile over time?

A

thickening of the subchondral bone

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3
Q

what happen to the muscles around a joint affected by OA?

A

muscles are hypertonic due to aims to provide more stability

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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

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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

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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
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7
Q

how does OA compare to RA

A

OA tends to be assymetrical

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8
Q

characteristics of OA

A 
pt > 50
asymmetrical pain
am stiffness < 30 min
swellinh
loss ROM
weak surrounding ms
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9
Q

how to assess for hip OA?

A
  1. 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
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10
Q

where is the pain site for hip OA

A 
Groin deep
Buttocks
Anterior thigh
Knee (referred)
Pain site will be asymmetrical
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11
Q

what is the MOI for hip OA

A

insidious onset

progressive disease

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12
Q

what is the pain pattern for hip OA

A

initially c/o pain

over time c/o stiffness and decreased ROM

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13
Q

w/ hip OA what is generally the first mvmt to be limited?

A

flexion

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14
Q

what muscles may be atrophied w/ hip OA?

A

glute med and max

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15
Q

what functional tests can be performed to assess for hip

A 
unilateral WB
trendelenberg 
proprioception
pain w/ squatting
gait assessment
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16
Q

what are the stages of OA?

A
  1. ms reaction, mvmt reaction
  2. contracture
  3. bone ankylosing, osteophytes
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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

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18
Q

how is the hip EF w/ OA in the first stage?

A

hypertonicity

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19
Q

how is EF in 2nd stage of hip OA?

A

early Capsular

loss of IR > flexion, abd > extension

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20
Q

how is the EF in the 3rd stage of hip OA?

A

bone to bone

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21
Q

what is often a cause for back pain in pts?

A

hip problems

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22
Q

how is risom in pts w/ hip OA?

A

weakness or inhibition w/o pain often due to glute weakness

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23
Q

how is palpation in pt w/ hip OA?>

A

pain around ms joint

ms may have increased tone and tension

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24
Q

what are some hip OA questionnaires that can be used?

A

WOMAC
LEFS
HHS

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25
Q

what conservative Rx can be used for OA

A
  • pt education on lifestyle modifications
  • pain management and self management
  • weight control
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26
Q

What can be used to treat for pain of oa?

A

ice
tens
ifc

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27
Q

how can hypertonicity be reduced in oa?

A 
static distraction
traction
compression
massage 
STT
dry needling
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28
Q

how to improve flexibility w/ hip OA?

A

HEP

massage

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29
Q

how to improve ROM w/ hip OA?

A

AROM/PROM

passive acessory glides of the hip

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30
Q

how can traction be helpful to joints w/ oa?

A

improves cartilage nutrition and lubrification

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31
Q

how to improve str?

A

w/ reduced pain go from NWB to WB

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32
Q

what is the GLAD program?

A

clinical guidelines for Rx of the hip and knee OA in order to proved high quality care

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33
Q

what is the purpose of GLAD?

A 
Reduce pain
Reduce med intakes
Improve physical function and physical activity
Improve QoL
Reduce number of patients on sick leave
34
Q

what data from GLAD was obtained from danemark?

A

-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
Q

what data from GLAD was obtained from canada`

A 
improved pain (cvlinically significant difference)
improved function and QoL
no change in med intake
decrease BMI
36
Q

myofascial imbalances are caused by what?

A

stiff muscles and weak muscles

37
Q

what are common muscles to be stiff in the hip that may lead to myofascial imbalances?

A 
iliopsoas
erector spinae
TFL
adductors
rectus femoris
hamstrings
External rotators
38
Q

what are common muscles to be weak in the hip that may lead to myofascial imbalances?

A

glute max
glute med/min
quads
abductors

39
Q

what ms is most commonly affected by adductor ms strain?

A

adductor longus

40
Q

what are risk factors associated to add ms strain?

A

previous groin injury
higher level of play
decrease add STR of the hip
lower level of sports specific training

41
Q

what is the pain site of adductor ms strain?

A

groin pain
anterior hip pain
pain at mT junction

42
Q

what is the MOI of add ms strain?

A

sudden onset

ms contraction when ms is stretched often associated w/ sudden changes in direction or rapid accelertation/decceleration

43
Q

what is the pain pattern associated w/ add ms strain?

A

PROM: pain w/ passive abd at EOR

AROM/risom: pain w/ add and add and flexion

44
Q

what may be observed w/ add ms strain?

A

bruising and discoloration, slightly lower that region of strain due to effect of gravity on bleeding

45
Q

how to treat add ms strain in the inflammatory phase?

A

police to reduce pain and inflammation

discontinue activtiy and sport

46
Q

how to treat add ms strain in the proliferative phase?

A 
rehab on progressive STR (add, flexion of the hip, abd and core work)
use holmich protocol
proprioception
STT
avoid stretching
47
Q

what is holmich’s protocol?

A

use of a criteria based protocol rather than a time based protocol

48
Q

what exercises are suggested to pt in initial stages of hip add strain?

A

isometric ankle w/ ball or isometric add squeeze w/ crook lying

49
Q

as you progress from the initial stage what exercises are suggested to pt w/ hip add strain?

A 
side lying hip add
hip add lateral slide
hip add w/ elastic band or pulley
copenhagen add exercise
sport specific exercises
50
Q

how to monitor exercise progression for hip add ms strain in rehab?

A

pain level before and after; dont want it to increase b yh more than 2/10
PROM hip abd immediately post exercise

51
Q

how long should rehab last for hip add strain?

A

8-12 weeks minimum but continue specific exercises for at least 1 year

52
Q

why is it important to treat add ms strain properly?

A

avoid longstanding groin pain

avoid risk of re-injury

53
Q

what may cause pain in ITBFS

A

overuse where fat pads and connective tissue of the lateral femoral condyle gets compressed B/W ITB and lateral femoral condyle

54
Q

what are the pathomechanics if ITBFS?

A

involves multiple segments causing for ms imbalances and compressive loads on the ITB at the level of femoral condyle

55
Q

biomech dysfunction at the knee caused by ITBFS?

A

–dynmic knee valgus due to weakness of ionhibition of glute med

56
Q

biomech dysfunction at the hip/pelvis caused by ITBFS?

A

contralateral pelvic drop due to weakness of glute med

57
Q

where is the pain site for ITBFS?

A

lateral knee more than GT pain

58
Q

how is pain described in ITBFS?

A

Sharp/burning pain

59
Q

what is the pain pattern associated w/ ITBFS?

A

Often associated to repeated mvmts s/a running/cycling

initially irritted w/ knee flexion/extension ~20-30 degrees

60
Q

what funcitonal tests can be performed to assess ITBFS

A

Trendelenberg
unilateral WB
unilat squat will notice valghus

61
Q

how is rom in ITBFS

A

Full but the first 20-30 degrees of knee flexion/extension may be painful

62
Q

how is RISOM in ITBFS?

A

Weakness of glute med and max is possible and also of knee flexors and extensors

63
Q

what tests can be used to assess decreased flexibility of ITB/TFL

A

ober’s test

modified thomas test

64
Q

how to treat for itbfs?

A

pain relief
treat biomech dyusfunction
actibvate and strengthen weak ms
decrease ms tension of ITB

65
Q

what is GTPS an synonym of?

A

lateral hip pain

66
Q

what is the MOI of GTPS

A

excessive loading

67
Q

what may cause excessive compressive loads leading to GTPS?

A
  • 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
Q

what is the pain site for GTPS?

A

Lateral hip joint

GT area down the lateral thigh

69
Q

what is the pain pattern of GTPS?

A

Pain when lying on affected side at nigh
pain on SL WB task
pain when leaning or touching affected area

70
Q

is ROM limited in GTPS?

A

generally not but may have pain w/ active ABD and passive add and w/ risom

71
Q

what functional tests can be performed for GTPS

A

30 s sustained SLS

72
Q

what special tests can be performed for GTPS

A

FABER

resisted external derotation test

73
Q

how can we treat for GTPS?

A

Rx generally consistent w/ insertional tendinopathy

74
Q

how to treat for pain relief of GTPS if in reactive on degnerative?

A

Load reduction by removing provocative load, modify sleeping postures
provide isometric exercises taht target glutes more than TFl

75
Q

how to treat for pain relief of GTPS if in tendon disrepair and degeneration

A

4 stage program
optimization of mvmt patterns
stretch into hip add

76
Q

what is piriformis syndrome

A

controversial syndrome for buttocks pain

77
Q

what is the MOI for piriformis syndrome

A

insidious onset

78
Q

what is the pain pattern for piriformis pain syndrome?

A

mvmt associated w/ stretching of piriformis (flexion, add, er)
muscle hypertonic

79
Q

how is ROM in piriformis syndrome

A

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
Q

how to treat for piriformis syndrome`

A

ms stretch in flexion/add/er
DTF/STT
myofasial release
STR exercises for buttock

ORTHO 560 (7 decks)

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