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Clinical Medicine > Hip Pathology & Rehabilitation > Flashcards

Hip Pathology & Rehabilitation Flashcards

1
Q

What is the MOI for Hip OA?

A

Aging process or trauma

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2
Q

What is the patient population for those with Hip OA?

A

Common in >60 y/o
Women> Men

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3
Q

What is the patient presentation of Early DJD?

A

Pain (deep aching) in lateral hip, groin or along L3 dermatome (along anterior thigh & knee)

  • Stiffness in AM (better w/ movement)
  • Pain on WB during gait or at end of day after activity
  • Pain w/ sitting on low chair, crossing legs & putting on sock/ shoes
  • Antalgic Gait
  • ADLs become difficult
  • Commonly accompanied by limitation in back extension
    • finding confirmed w/ plain radiographs
  • Bilateral stance (less than ½ BW on each hip)
  • Unilateral Stance (3x BW due to muscular contraction, pain w/ stair climbing > walking on flat surface
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4
Q

In early DJD of the hip can positive finding be found on radiographs?

A

Yes

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5
Q

In addition to DJD why is osteonecrosis possible?

A

Excessive steroid use
Alcohol abuse
Excessive radiation
Trauma

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6
Q

What is the main symptom during end stage DJD?

A

Unrelenting pain

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7
Q

What is commonly needed because of hip OA?

A

Total Hip Repair

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8
Q

What are some specific things found on a radiogram that are consistent with hip OA?

A

Asymmetrical Joint Space Narrowing
Osteophytes
Subchondral Cysts
Subchondral Sclerosis

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9
Q

What is the clinical criteria for hip OA?

A

Hip internal rotation <15°
Morning Stiffness for < 60 min
Hip Flexion <115°
Pain w/ IR of hip
Age > 50 year

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10
Q

What are some special test used to diagnosis hip OA?

A

Dec flex/ IR ROM
Trandelenberg Sign
Scour
FABER

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11
Q

What are some treatment option to decrease effects of stiffness from Hip OA?

A

Stress importance of daily movement
ROM exercise (Stationary bike)

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12
Q

What are some treatment option to decrease effects of pain from Hip OA?

A

Decrease mechanical strain by using AD
Grade I or II osciliations
Stretching to correct muscle - length imbalances

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13
Q

What are some treatment options to increase ROM / strength in patients with hip OA?

A
  • Joint mobs (grade III or IV)
  • PNF stretching techniques to tight muscles (hip flexors/hip ABD)
  • Self stretching
  • Increase strength in supporting muscles (Hip ABD, Hip ext, quads)
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14
Q

What are some treatment options to increase endurance in patients with Hip OA?

A
  • Stationary bike
  • Swimming
  • Treadmill (has handles)
  • Walking around community
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15
Q

What are the 3 ways to evaluate the pelvis & hip with radiographs?

A

Antero-posterior pelvis
Antero- posterior hip
Lateral frog leg hip

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16
Q

What are some benefit to the AP Hip projection?

A

Enhanced detail
Improved profile greater tuberosity

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17
Q

What is the benefit of the lateral frog leg projection?

A

Allows profile of lesser tuberosity

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18
Q

What is a radiographic grade I ?

A

Doubtful narrowing of joint space & possible osteophyte formation

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19
Q

What is a radiographic grade 2?

A

Definite osteophytes, definite narrowing of joint space

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20
Q

What is a radiographic grade 3?

A

Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis & possible deformity of bone contour

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21
Q

What is a radiographic grade 4?

A

Large osteophytes, marked narrowing of joint space

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22
Q

Grade 2 or greater for radiographic grade is a strong predictor of?

A

Hip OA progression

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23
Q

Grade 3 or 4 radiographic grade indicates?

A

4-5x higher odds ration that patient would have a THA

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24
Q

What radiographic grade will respond the best to treatment?

A

Grade 1

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25
Q

What is the symptoms of labral tear?

A
  • Pain experience in groin & hip
  • Locking or clicking of hip joint
  • Stiffness of hip
  • Limited ROM of hip
  • Sudden appearance of sxm after an incident is noticeable
  • Gradual development of sxm w/ progressive degeneration
26
Q

What is the Asymptomatic incidence of labral tears?

A

40-54% (increase w/ age)

27
Q

What is the symptomatic incidence of labral tears?

A

70%
Median age (38 yr for males & 40 years for females)
Male patients had a higher incidence of acute injury than females

28
Q

What are the risk factors of labral tears?

A

Trauma
Increased ROM
Anatomic abnormalities

29
Q

What are some special test for Labral Tears?

A

FABER
Scour
Anterior Labral Tear Test (FADDIR)

30
Q

How are labral tears diagnosed?

A

MRIO arthrogram

31
Q

What is Femoral Acetabular Impingement?

A
  • Decreased joint clearance b/w femur & acetabulum
32
Q

What does Femoral Acetabular Impingement cause?

A

Abnormal contact b/w femur & acetabulum ,particular when hip flexion is combined w/ adduction & IR

33
Q

What other pathologies can Femoral Acetabular Impingement cause?

A

Labral tears
Brin about progressive degeneration process leading to OA

34
Q

What is a CAM?

A

Bony overgrowth of femoral neck

35
Q

What is a PINCER?

A

Bony overgrowth of acetabulum

36
Q

What are the main goals for Labral tear/FAI?

A

Relieve sxm
Maintain function

37
Q

What are the management strategies for Labral tears/FAI?

A
  • Control inflammation/pain, joint mobs, ROM, maintain muscle length & strength
  • Limiting activities in frontal & sagittal plane
  • Lumbopelvic strengthening & stabilization
  • Surgery if needed
38
Q

What is the population for Greater trochanteric bursitis?

A

Women > Men
Middle aged women most commonly affected

39
Q

What is the etiology of greater trochanteric bursitis?

A

Repetitive microtrauma
Blunt trauma
Idiopathic
Active or sedentary patients

40
Q

What is the typical patient presentation of those with Greater Trochanteric Bursitis?

A

Pain usually in region of greater trochanter & possible along lateral aspect of thigh
- Usually worse w/ WB, sitting w/ crossed legs or w/ direct pressure
- End of day pain is worst
- Difficulty sleeping on painful side

41
Q

What are some contributing factors to greater trochanteric bursitis?

A
  • Leg length discrepancy
  • History of lateral hip surgery
  • Sports participation that involves running or contact
  • Running on crowned roads (leg closest to curb most susceptible)
42
Q

What is the clinical diagnosis for greater trochanteric bursitis?

A

Imagine usually not needed but radiographs may be done to r/o other disorders

43
Q

What diagnosis need ruled out when suspecting greater trovhanteric bursitis?

A

Hip OA as contributing factor
Lumbar pathology

44
Q

With greater trochanteric bursitis will you normally see swelling & ecchymosis?

A

No, unless direct trauma

45
Q

What are special test for greater trochanteric bursitis?

A
  • ER ROM more painful than IR
  • ADD more painful than ABD (Ober Test)
  • Pain & weakness w/ hip ABD (Trandelenberg)
  • FABER
  • Palpation
46
Q

What is the treatment options for greater trochanteric bursitis w/ a + Ober Test?

A

TFL/ITB stretching

47
Q

What can be done for greater trochanteric bursitis to aid in inflammation?

A

Ice, E-stim, ionto, anti- inflammatory, relative rest

48
Q

What are some additional treatment for greater trochanteric bursitis?

A
  • Hip flexors stretching
  • Hip Strengthening emphasizing gluteus medius
  • Check muscle imbalance or possible Biomechanical causes
  • Lumbar impariments
  • Pt Education
49
Q

What can be done if there is a lack of response to PT in a patient with greater trochanteric bursitis?

A

Cortisone injection & rarely surgery

50
Q

What hip muscles are commonly sprained?

A

Adductor longus
Glutesu medius
Proximal hamstring
Psoas

51
Q

When is pain experienced with hip muscle strength?

A

After sudden onset w/ incident

52
Q

When are radiographs needed with hip muscle strain?

A

To rule out avulsion fx if pain is noted w/ palpation at bony insertion site

53
Q

What is the clinical picture of a hip muscle strain?

A
  • Antalgic / altered gait
  • Ecchymosis in site of injury
  • Local tenderness to palpation at site of injury
  • Pain w/ resisted movements of affected muscles
  • Pain w/ passive movements opposite of muscle action
54
Q

What treatments are done acute hip muscle strain?

A
  • Modalities to promote healing & decrease pain & inflammation
  • Massage, sub maximal isometric exercises, passive ROM exercises & lumbopelvic stabilizing exercises
55
Q

What treatments are done for subacute injuries?

A
  • Concentric exercises (including functional closed- chain & WB exercises, lumbopelvic stabilization activities, general flexibility exercises & progressive balance & stability exercises)
56
Q

What are treatment are done for chronic/ remodeling phase?

A

Eccentric exercises & sport specific training

57
Q

What is the common population for Slipped Capital Femoral Epiphysis?

A

Common hip disorder during adolescent years
Usually 10-17 y/o boys & 8-15 y/o for girls

58
Q

What is the incidence rate & risk factor for Slipped Capital Femoral Epiphysis?

A

Boys 2x vs girls
Increased BMI

59
Q

What is the clinical picture for slipped capital femoral epiphysis?

A
  • Progressive worsening sx (min vague pain early)
  • Antalgic gait & limitation in hip ROM/ strength (non capsular pattern for ROM loss)
60
Q

What is the treatment option for slipped capital femoral epiphysis?

A

Surgery

61
Q

What is post-op treatment after surgery for slipped capital femoral epiphysis?

A

ROM, strengthening, maximize function

Clinical Medicine (12 decks)

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