Hip Study Guide Flashcards
Femoral
L2-L3
Quads
Sciatic
L5-S3
biceps fem
Tibial
L4-S1
semis, popliteus
Obturator
L3-L4
adductors, pectineus, gracilis
Superior gluteal
L4-S1
iliacus, TFL, glut med/min
Inferior gluteal
L5-S1
glut max
Piriformis
S2 nerve/nerve root
Psoas major/minor
femoral and L1
L1-L4 nerve roots
Gemellus
Superior (L5-S2)
Inferior (L4-S1)
Obturator muscles
Internus (L5-S2)
Externus (L3-L4, obturator nerve)
Teres Ligament
intrinsic stabilizer
resists hip FABER
Iliofemoral ligament
resists ext, ER
Ischiofemoral ligament
resists abd w/ hip flex/IR
Pubfemoral ligament
resists hyperabd and ER
Hip OA Clusters
1 - hip pain, IR < 15 , flex < 115
2 - painful IR, age > 50, AM stiff > 60 min
Hip OA CPR
IR < 25 squatting aggravates flex ROM = lat hip pain SCOUR or groin pain pain with ext
Labral Repair
1-2 weeks painfree ROM
limit flex 4 weeks
WBAT
no running 12 weeks
Debridement
1-2 weeks painfree ROM
limit flex 4 weeks
progress as tol (no time dependent restrictions)
Osteoplasty
1-2 weeks painfree ROM
limit flex 4 weeks
initially 20 lb PWB, WBAT @ 4-6 weeks
progress as tol @ 6 weeks
Capsular Modification
1-2 weeks painfree ROM
WBAT
limit ER and ext 4 weeks
no running 12 weeks
Microfracture
1-2 weeks painfree ROM
limit flex 4 weeks
initially 20 lbs PWB, WBAT @ 4-6 weeks
no running 12-16 weeks
Angle of Inclination
angle between neck of femur and shaft
normal 125, > 140 coxa valga, < 120 coxa vara
Angle of Torsion
ankle of fem neck and transverse axis of fem condyles
12-15 normal
anteversion - inc angle, toe in
retroversion - dec, toe out
Thomas Test
tight hip flexors
FABER
SIJ, ant hip pain
Renne’s Test
TFL pain
Nobel’s Test
TFL dysfxn
Ely’s Test
tight rec fem
Log roll
intra-articular pathology
FADIR
hip impingement, FAI
Dial Test
ant lax
Pace’s and Freiberg’s Sign
piriformis syndrome
Craig’s Test
hip anteversion
Percussion Test
LE fx
C-sign
pain around hip into groin
Quad Contusion (CET)
C - direct blow to upper thigh
E - pain, loss of function initially, bruising
T - RICE, ROM
avoid heat, massage, and US to prevent myositis ossificans
Heterotrophic Ossification (Myositis Ossificans) (CEIT)
C - severe blow or repetitive blows; follows a hematoma (acute inflammation following hemorrhage that may become calcified)
E - pain, muscle weakness, tissue tension
I - X-rays 2-6 weeks after injury
T - conservative, surgery after 1 year
Femoral Fx (CEIT)
C - significant trauma
E - difficulty standing/walking, pain, hip may ER/slight abd (makes it short)
I - X-ray
T - immediately immob, open or closed reduced, rehab is low (4 mo)
fx across epip have highest incidence of AVN
Femoral Stress Fx (CEIT)
C - most often in endurance athletes, overuse
E - several weeks of gradually increasing pain, pain in groin/ant thigh - may refer to knee, difficulty WBing w/ time
I - A/P X-ray may or may not show, bone scan
T - rest usually 2-5 mo, conservative tx
Quad Strain (CET)
C - sudden, forceful contraction of hip/knee into flex, usually with hip ext
E - acute pain, restricted ROM, antalgic gait
T - RICE, conservative tx, avoid overstretching
HS Strain (CET)
C - change in direction/speed, during terminal swing
E - hemorrhage, bruise, pain, antalgic gait
T - RICE, conservative tx, avoid overstretching
Adductor Strain (CET)
C - running, jumping, twisting esp w/ hip ER
E - may not notice pain until end of activity, pain, weakness, antalgic gait
T - RICE, conservative tx, avoid overstretching
Hip Dislocation (CET)
C - traumatic force along femur usually with knee bent, mostly post
E - thigh - FADIR, palpation - tender, possible swelling, may feel femur post to acet
T - immediate medical attention for reduction, immob, use of AD
can lead to AVN
SCFE (CEIT)
C - adolescent boys most common, tall and thin or obese
E - groin pain, limited FABIR, walk w/ limp (sometimes see ER of foot or appearance of short limb)
I - frog leg view, Kline’s line
T - NWBing, corrective surgery if unsuccessful
LCP Disease (CEIT)
C - AVN of fem head, 4-10 yo, boys common
E - groin pain, referral to knee, limping, comes on gradually w/o MOI
I - A/P, frog leg; MRI best
T - rest and/or immob; avoid WBing
Snapping Hip (CET)
C - excessive repetitive movement, ITB snapping over greater troch or iliopsoas over iliopectineal eminence
E - iliopsoas “clunk heard across room”; ITB “seen across room”; feeling of instability
T - anti-inflammatories, address mobility restrictions, hip stability exercises
Labral Tear (CET)
C - forced hip ER while in ext, repetitive motions, degeneration
E - pain, clicking, clunking, locking
T - conservative, > 4 wks - possible debridement or repair
Hip Pointer (CET)
C - iliac crest contusion, blow to iliac crest
E - pain, bruise, difficulty rotating trunk
T - RICE, referred to X-ray, protection of area
Pelvic Stress Fx/Osteitis Pubis (OP) (CEIT)
C - history of overuse, repetitive stress causes if chronic inflammation
E - insidious onset, pain at pub symp, feels better NWBing
I - A/P or frog, bone scan
T - rest, anti-inflammatories, gradual return to exercises
Athletic Publagia (CET)
C - repetitive stress from kicking, twisting, cutting; shear forces from forceful hip abd/hypertext
E - dull/widespread pain in groin, pain inc w/ resisted hip flex, IR and abdominal contraction, radiates to inner thigh
T - conservative tx, cortisone injection, surgery
Hip Replacement
Precautions
ant - avoid ER/ext, no prone lying
post/lat - no flex > 90, IR, add past midline
WBing - usually WBAT w/ AD, sometimes given knee immob
