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Clinical Interventions > hip pathology > Flashcards

hip pathology Flashcards

1
Q

What is the orientation of the acetabulum?

A

anterior
lateral
inferior

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2
Q

What is the orientation of the femoral head?

A

posterior
medial
superior

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3
Q

What is the normal angle of inclination?

A

125 degrees

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4
Q

definition: Pathologically larger angle of inclination

-Unilateral
- Relatively longer leg
- genu varum

A

Coxa valga

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5
Q

definition: Pathologically smaller angle of inclination

  • Unilaterally
  • Relatively shorter leg
  • Genu valgum
  • Leading to pronation
A

coxa vara

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6
Q

definition: Angle formed by transverse axis of the femoral condyles and the axis of the neck of the femur

A

torsion

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7
Q

definition: decrease in the femoral neck angle of the femur on the tibia

A

retroversion

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8
Q

definition: increase in the femoral neck angle of the femur on the tibia

A

anteversion

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9
Q

What is the normal femoral neck anteversion?

A

15 degrees

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10
Q

definition: ASIS move anteriorly and inferiorly

  • Results in hip flexion and lumbar spine extension (hyperextension)
  • Hip flexors and back extensors
A

Anterior pelvic tilt

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11
Q

definition: PSIS move posteriorly and inferiorly

  • Results in hip extension and lumbar spine flexion
  • Hip extensors and trunk flexors
A

posterior pelvic tilt

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12
Q

Where does the sciatic nerve leave the pelvis?

A

through the lower edge of the greater sciatic notch

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13
Q

The sciatic nerve passes deep to the ___ muscle and/or through it.

A

piriformis

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14
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

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15
Q

What does entrapment of the sciatic nerve cause?

A
  • Sensory changes along the lateral and posterior portion of the leg and dorsal and plantar aspect of foot
  • Progressive weakness in hamstrings, part of adductor magnus, and all muscles of leg and foot
  • SIJ pain
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16
Q

What are the nerve roots of the obturator nerve?

A

L2-L4

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17
Q

Entrapment of the obturator nerve leads to what?

A
  • Sensory changes along the medial aspect of thigh
  • Weakness primarily in adductor muscles
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18
Q

What population is hip OA most common in?

A

Females > 60 y/o

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19
Q

What is the patient presentation of early DJD?

A
  • Pain in groin or along L3 dermatome along anterior thigh and knee
  • Stiffness in AM; better with movement
  • Pain on WB during gait or @ end of day after activity
  • Antalgic gait (pt may limp)
  • decreased joint space on an x-ray
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20
Q

What AD can be used to decrease compressive forces to the hip with hip OA?

A

cane

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21
Q

What are the s/s of end-stage OA?

A

unrelenting pain

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22
Q

What special tests can help Dx hip OA?

A

scour
grind
FABER

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23
Q

definition: Usually due to an excessively tight ITB or possibly leg length discrepancy

A

IT band friction syndrome

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24
Q

What is the typical patient presentation for IT band friction syndrome?

A
  • discomfort proximally (region of greater trochanter) or distally (lateral aspect of knee, possibly L5 dermatome)
  • Tightness easy to palpate
  • aggs: Walking or running excessively on hills, stairs, or uneven terrain
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25
Q

What are special tests used for Dx IT band friction syndrome?

A

Ober/modified ober
Nobel’s compression

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26
Q

What are the intra-articular causes of snapping hip syndrome?

A

Loose body
Synovitis
Subluxation
Cartilage defect
Labral tears

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27
Q

What are the extra-articular causes of snapping hip syndrome?

A
  • Thickening of post border of ITB
  • Iliopsoas tendon over the iliopectineal eminence
  • Iliofemoral ligaments over the iliopectineal eminence
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28
Q

What is the Iliopsoas involvement in snapping hip syndrome?

A
  • snapping with ABD and ER
  • groin and/or anterior hip pain
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29
Q

What does legg-calve perthes disease begin as?

A

avascular necrosis of the secondary epiphysis of the femoral head

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30
Q

What is the common age range for Legg-calve Perthes disease?

A

2-12 y/o (commonly age 6)

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31
Q

Legg calve perthes disease commonly affects (boys/girls) more.

A

boys

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32
Q

(true/false) Legg calve perthe disease normally heals

A

true

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33
Q

If legg calve perthes disease does not heal, what would the typical presentation be?

A

Antalgic gait with soreness in hip, thigh or knee

ROM may be limited esp IR and ABD

Involved limb may be 1-2cm shorter

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34
Q

What is the most common hip disorder during the adolescent years, usually 10-17 y/o for boys and 8-15 y/o for girls?

A

SCaFE

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35
Q

SCaFE commonly affects (boys/girls) more.

A

boys

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36
Q

Treatment of SCaFE includes Bracing in ___ and ___ for 12-14 weeks

A

ABD and IR

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37
Q

What are the causes of piriformis syndrome?

A

Localized trauma
Overuse (most common)
Fibrous adhesions
Anatomic abnormalities

38
Q

What is the typical patient presentation of piriformis syndrome?

A

Buttock, groin, hip, and disc type sx

Worse with prolonged sitting or sitting on hard chairs

May have pain with resisted hip ER, passive hip flexion and IR (FAIR Test)

Localized tenderness to deep palpation of muscle belly (#1 common s/s)

39
Q

definition: Usually, traumatic contusion of iliac crest possibly due to contact sport, and external oblique muscle strain at attachment to crest

A

hip pointer

40
Q

What is the typical patient presentation of hip pointers?

A

Pain usually localized at the region of the iliac crest with possible ecchymosis and swelling

41
Q

(ipsilateral/contralateral) SB with hip pointers may cause discomfort

A

contralateral SB

42
Q

What treatment is commonly used in elderly to due fall or osteoporosis?

A

ORIF

43
Q

What are indications for ORIF surgery?

A

Intertrochanteric fx (extracapsular)
Subtrochanteric fx
Fx of proximal femur

44
Q

Those who get an ORIF should start moving when?

A

ASAP (day of or day after WBAT)

45
Q

(true/false) There are usually hip precautions after ORIF

A

false

46
Q

definition: acetabulum OR femoral head replaced

A

Hemiplasty

47
Q

What are main complications of a THA?

A

Loosening of prosthetic components (rare)

Cement breaks down, limited life span, 15-20 years vs. porous coated: younger population

48
Q

definition:
Head of femur removed and replaced with intramedullary metal femoral stem prosthesis

Acetabulum replaced with high-density polyethylene cup

A

THA

49
Q

How should a patient after a THA have their hip positioned following surgery?

A

slight FLX/ABD and neutral rotation

50
Q

What is the main precaution with THA?

A

dislocation/subluxation

51
Q

Avoid excessive ___ and ___ beyond midline after a THA.

A

FLX and ADD

52
Q

What is the thomas test used for?

A

assessing for hip flexor tightness/contracture

53
Q

What does lateral distraction of the hip help restore?

A

all motions (along with LAD)

54
Q

What do anterior glides to the hip help restore?

A

EXT

55
Q

What do posterior glides to the hip help restore?

A

FLX

56
Q

What muscle groups of the hip are at risk for muscle strains? Why?

A

Hamstrings and quadriceps because they cross the hip AND knee joints

57
Q

What is the typical patient presentation of a muscle strain?

A
  • pain over the injured muscle (the most common symptom of a hip strain)
  • increased pain level with muscular contraction
  • swelling and discoloration (depending on the severity of the strain)
  • loss of strength in the muscle.
58
Q

What muscles are in the hip ADD group?

A

pectineus, adductor longus, adductor brevis, adductor magnus, gracilis, and obturator externus.

59
Q

definition: pain on palpation of the adductor tendons or the insertion on the pubic bone, or both, and groin pain during adduction against resistance

A

Adductor muscle strain/injury

60
Q

Groin strains and muscle strains in general are graded as a ______-degree strain if there is pain but minimal loss of strength and minimal restriction of motion.

A

first-degree

61
Q

A ____-degree strain is defined as tissue damage that compromises the strength of the muscle, but not including complete loss of strength and function.

A

second-degree

62
Q

A ____-degree strain denotes complete disruption of the muscle tendon unit. It includes complete loss of function of the muscle

A

third-degree

63
Q

What sports are adductor muscle strains most commonly seen in?

A

hockey and soccer

64
Q

What ADD muscle is most commonly injured?

A

ADD longus

65
Q

What causes the most hamstring injuries?

A

Eccentric loading

66
Q

Most hamstring strains are ___ and ___ degree.

A

1st and 2nd

67
Q

What type of muscle strain occur in a wide variety of athletics requiring rapid acceleration and deceleration (sprinting)?

A

Hamstring

68
Q

What quadriceps muscle is most commonly injured?

A

rectus femoris

69
Q

Patients with a grade ____ quadriceps tear often were sprinting and felt a sudden sharp stabbing pain

A

grade 3

70
Q

What is the MOI of avulsion Fx?

A

Result of a sudden, forceful, eccentric or unbalanced contraction of a musculotendinous unit at its attachment at an apophysis

71
Q

What percent of children’s Fx do avulsion FX account for?

A

15%

72
Q

Ischial apophysis avulsion injury is commonly seen in what population?

A

hurdlers, sprinters, cheerleaders, and dancers

73
Q

Anterior inferior iliac spine avulsion is common in ____ sports (rectus femoris)

A

kicking

74
Q

Anterior superior iliac spine avulsion is commonly seen in what population?

A

Sprinters and hurdlers (sartorius)

75
Q

What is the typical patient presentation of avulsion Fx?

A
  • Traumatic event with a sudden onset of pain
  • tenderness over the IT and pain with straight leg raise
  • pain with sitting
  • antalgic gait
76
Q

What is the grading scale of hip pointer injuries?

A

1 -normal gait and posture, complaints of pain, tenderness, swelling

2 -more painful, swelling, gait dysfunction, limited ROM , flexed posture to injured side

3 -severe pain, increased swelling, ecchymosis, limited ROM, slow/short stride length

77
Q

What is the typical MOI for quadriceps contusion?

A

Direct blow to anterior thigh compression muscle against the femur bone

78
Q

What is the grading scale for quadriceps contusions?

A
  1. normal gait cycle, no swelling, mild pain
  2. normal gait cycle but abnormal gait, add compensation/hip hiking, moderate swelling, pain, limited ROM
  3. Herniated muscle through the fascia, severe bleeding, disability, severe weakness
79
Q

What is the position of vulnerability for hip dislocation?

A

hip joint is flexed, internally rotated and adducted

80
Q

Is an anterior or posterior hip dislocation more common?

A

posterior

81
Q

What is the typical patient presentation for hip dislocation?

A
  • severe pain in the hip region
  • unable to walk or move the LE
  • limb will appear shortened, flexed, adducted, and internally rotated
82
Q

What are the causes of hip labral tears?

A

twisting movement during WB

83
Q

What is the typical patient presentation of hip labral tears?

A
  • Immediate onset of pain at the front of the hip
  • Mechanical catching and giving way
  • Occurs when hip is changing positions
84
Q

Are intra-articular or extra-articular causes responsible for most cases of snapping hip syndrome?

A

extra-articular

85
Q

definition: ITB snapping over the greater trochanter during hip flexion and extension.

A

snapping hip syndrome

86
Q

What is the patient presentation for a femoral neck stress Fx?

A
  • Pain in groin and thigh that worsens with activity
  • Antalgic gait
87
Q

What are surgical posterior dislocation precautions?

A

No hip flexion greater than 90 degrees, no hip internal rotation or adduction beyond neutral. None of the above motions combined.

88
Q

What are surgical anterior dislocation precautions?

A

No hip extension or hip external rotation beyond neutral.

No bridging, no prone lying and none of the above motions combined.

When the patient is supine, keep the hip flexed to approximately 30 degrees by placing a pillow under the patients knee or raising the head of the bed.

Patients may perform a step through gait pattern but should avoid end range hip extension.

89
Q

What are the global hip dislocation precautions after surgery?

A

no hip flexion greater than 90 degrees, no hip adduction beyond neutral, no hip internal or external rotation

  • no laying flat, no prone laying
  • no bridging.
90
Q

What are the phases of hip rehabilitation after THA?

A

Immediate post surgical phase (0-3 days)

Motion phase (1-6 weeks)

Intermediate phase (7-12 weeks)

Advanced strengthening and higher-level function phase (12-16 weeks)

91
Q

(true/false) hip dislocation is rare

A

true

92
Q

(true/false) Adult hips and child hips have a much different injury pattern

A

true

Clinical Interventions (25 decks)

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